85097
Bone Marrow Interpretation, Smear Only
CPT code 85097 describes the professional interpretation of bone marrow smears, with or without a differential count. This procedure is a fundamental component of hematopathologic evaluation, where a physician—typically a pathologist or hematologist—examines the cellular morphology of bone marrow aspirate material that has been spread onto glass slides and stained. The interpretation involves a comprehensive assessment of the marrow's cellularity, the myeloid-to-erythroid (M:E) ratio, and the maturation sequences of the various hematopoietic cell lines, including erythroid, myeloid, and megakaryocytic lineages. The physician evaluates the presence of any abnormal or malignant cell populations, such as leukemic blasts, plasma cell dyscrasias, or metastatic non-hematologic tumor cells. Unlike a bone marrow biopsy (which evaluates tissue architecture and is reported under 88305), the smear interpretation focuses on individual cell morphology and the relative proportions of cell types. The physician's work includes correlating these marrow findings with the patient's clinical history, peripheral blood counts, and peripheral smear findings. A formal, signed written report detailing the diagnostic findings and clinical impressions is a requirement for this code. This service covers the intellectual work of diagnosis and does not include the technical preparation of the slides or the physical act of obtaining the marrow aspirate specimen.
Clinical Indications
- Unexplained cytopenias including anemia, leukopenia, or thrombocytopenia
- Suspected acute or chronic leukemia
- Evaluation of myelodysplastic syndromes (MDS)
- Investigation of plasma cell dyscrasias or multiple myeloma
- Staging of lymphomas or other solid tumors for marrow involvement
- Evaluation of suspected myeloproliferative neoplasms
- Monitoring response to chemotherapy or bone marrow transplantation
- Investigation of storage diseases (e.g., Gaucher's disease)
- Evaluation of iron stores or sideroblastic changes
Procedure Steps
- Receive bone marrow aspirate smears prepared from the patient's aspiration procedure.
- Perform a low-power microscopic screening to evaluate overall specimen adequacy and cellularity.
- Evaluate the number and morphology of megakaryocytes at intermediate magnification.
- Perform a high-power (oil immersion) examination of hematopoietic cells to assess maturation and morphology.
- Conduct a differential count of at least 200 to 500 nucleated cells if clinically indicated to determine cell ratios.
- Identify and characterize any abnormal cell populations, including blasts, lymphoma cells, or metastatic deposits.
- Examine iron-stained slides (if performed) to assess iron stores and search for ring sideroblasts.
- Integrate findings with peripheral blood data and clinical context.
- Synthesize observations into a formal diagnostic report with a final interpretation.
Coding Guidelines
- 85097 represents the professional component of the smear interpretation and is distinct from the surgical pathology interpretation of a bone marrow biopsy (88305).
- If the same physician performs both the aspiration and the interpretation, report the aspiration procedure (e.g., 38220 or 38221) separately from 85097.
- 85097 includes the differential count; do not report 85060 or other differential count codes for the same marrow specimen.
- Use modifier 26 (Professional Component) when the interpretation is performed in a hospital or facility setting where the equipment and technical staff are provided by the facility.
- If multiple aspirate specimens from different anatomical sites are interpreted, documentation must support the clinical necessity for multiple interpretations.
- Do not report 85097 if the physician is only reviewing the report of another pathologist; there must be an independent review of the slides.