Pathology/Lab Coding Alert

Question: We received a paternal blood specimen for blood typing as part of the neonatal care for a pregnant mother who is Rh negative. What are the correct diagnosis and procedure codes?

Montana Subscriber

Answer: The correct diagnosis code is Z01.83 (Encounter for blood typing).

The procedure code will depend on what test(s) your lab performs. Presumably the lab will identify at least the Rh blood group type, but possibly other blood groups as well. Your lab might commonly perform one of the following serologic blood typing tests in this case:

• 86901 (Blood typing, serologic; Rh (D))
• 86906 (Blood typing, serologic; Rh phenotyping, complete)
• 86910 (Blood typing, for paternity testing, per individual; ABO, Rh and MN)

Tests that use gene analysis for blood typing also exist, and the following proprietary tests could be used for Rh blood group typing:

• 0198U (Red cell antigen (RH blood group) genotyping (RHD and RHCE), gene analysis Sanger/chain termination/conventional sequencing, RHD (Rh blood group D antigen) exons 1-10 and RHCE (Rh blood group CcEe antigens) exon 5)
• 0222U (Red cell antigen (RH blood group) genotyping (RHD and RHCE), gene analysis, next-generation sequencing, RH proximal promoter, exons 1-10, portions of introns 2-3)

Context: Human red blood cells often have certain types of surface antigens, and the presence or absence of those antigens are the basis of blood groups or “types.” The Rh blood type system includes the antigen, RhD, which has particular clinical significance for blood transfusions and in pregnancy. A person without that antigen (Rh negative) will develop antibodies to the antigen in Rh positive blood, causing destruction of red blood cells. More extensive Rh antigen testing will include the Rh blood group CcEe antigens.

Pregnancy: If the fetus is Rh positive, but the mother is Rh negative, the mother may form antibodies to fetal blood cells that have entered the maternal bloodstream. The antibodies can then cross the placenta and cause conditions such as fetal hydrops, fetal death, or hemolytic disease of the newborn, which is anemia and jaundice in the newborn.