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Official Description

Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 86078 pertains to blood bank physician services specifically focused on the investigation of transfusion reactions. This code is utilized when a physician conducts a thorough analysis of donated blood that is intended for transfusion into a patient. The primary objective of this investigation is to ensure the safety and compatibility of the blood being transfused. The physician assesses various factors, including the matching of blood types and the identification of any unusual antibodies present either in the patient's bloodstream or within the donated blood itself. Following this analysis, the physician is required to compile their findings into a comprehensive written report. This report serves as a critical document that outlines the results of the investigation, particularly in cases where there is a suspicion of transmissible diseases that may have been contracted through the transfusion. It is important to note that this code is specifically applicable when the physician is involved in investigating unusual occurrences after the blood has been infused, distinguishing it from other related codes that may apply to different scenarios in blood transfusion practices.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The CPT® Code 86078 is indicated for use in specific scenarios related to blood transfusions. The following conditions warrant the investigation of transfusion reactions:

  • Transfusion Reaction The patient exhibits symptoms or signs that suggest a reaction to the transfused blood, necessitating an investigation to determine the cause.
  • Suspicion of Transmissible Disease There is a concern that the patient may have contracted a transmissible disease through the transfusion, prompting a thorough analysis of the blood.
  • Unusual Antibodies The presence of unusual antibodies in the patient's blood or in the donated blood raises questions about compatibility and safety, requiring further investigation.

2. Procedure

The procedure associated with CPT® Code 86078 involves several critical steps to ensure the safety of blood transfusions. Each step is essential for a comprehensive investigation:

  • Step 1: Initial Assessment The physician begins by reviewing the patient's medical history and any reported symptoms following the blood transfusion. This initial assessment helps to identify potential transfusion reactions and guides the subsequent investigation.
  • Step 2: Blood Type Matching The physician evaluates the blood type of both the patient and the donated blood to confirm compatibility. This step is crucial in preventing hemolytic reactions that can occur if incompatible blood types are transfused.
  • Step 3: Antibody Screening The physician conducts tests to identify any unusual antibodies present in the patient's blood or the donated blood. This screening is vital for detecting potential issues that could lead to adverse reactions during or after the transfusion.
  • Step 4: Investigation of Symptoms If the patient exhibits symptoms of a transfusion reaction, the physician investigates these symptoms in detail, correlating them with the findings from the blood tests. This investigation may involve additional laboratory tests or consultations with specialists.
  • Step 5: Documentation and Reporting After completing the investigation, the physician compiles all findings into a written report. This report details the analysis conducted, the results obtained, and any recommendations for further action or monitoring of the patient.

3. Post-Procedure

Following the investigation associated with CPT® Code 86078, the physician may recommend specific post-procedure care based on the findings. This may include monitoring the patient for any delayed transfusion reactions, providing supportive care as needed, and ensuring that the patient is informed about any potential risks identified during the investigation. Additionally, the written report generated by the physician serves as a critical document for future reference, guiding any necessary follow-up actions or interventions to ensure the patient's safety and well-being.

Short Descr PHYS BLOOD BANK SERV REACTJ
Medium Descr BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT
Long Descr Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report
Status Code Active Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator STV-Packaged Codes
Type of Service (TOS) 5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS) T1G - Lab tests - other (Medicare fee schedule)
MUE 1
CCS Clinical Classification 227 - Other diagnostic procedures (interview, evaluation, consultation)
GC This service has been performed in part by a resident under the direction of a teaching physician
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
91 Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.
CR Catastrophe/disaster related
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XP Separate practitioner, a service that is distinct because it was performed by a different practitioner
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2013-01-01 Changed Short Descriptor changed.
Pre-1990 Added Code added.
Code
Description
Code
Description
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