A patient had a thromboembolic event and was placed on a newer oral anticoagulant (eg, dabigatran, rivaroxaban). The physician wishes to evaluate the patient for venous thrombophilia risk factors. The new oral anticoagulants interfere with these assays and may cause false positive results. Therefore, an in vitro neutralization method is used to eliminate interference to obtain accurate thrombophilia assessments so that the patient does not need to discontinue treatment. Is it appropriate to report code 85525 , Heparin neutralization, for assays that eliminate interference from other anticoagulants, as this is the only CPT code to report neutralization, even though the code specifically lists heparin in the code descriptor? ...

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Note:  The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.

Article Overview

This premium coding article addresses a laboratory coding question involving thrombophilia assessment after thromboembolic events in patients taking newer oral anticoagulants. It explains the general coding issue around interference-neutralization testing, the relevant CPT code set, and why an unlisted procedure code may be considered when a specific code is not available. The article is useful for laboratory coders, pathology practices, and billing staff who need to understand how this type of assay is categorized for claims documentation.

Why This Topic Matters

Accurate reporting of specialized laboratory procedures affects claim acceptance, documentation requirements, and compliance when testing is performed under nonroutine conditions. The article helps readers understand the coding scope for assay neutralization services and when additional supporting documentation may be needed.

Codes Discussed

• CPT: 85525
• CPT: 85999

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