Neurology & Pain Management Coding Alert

Question: Our physician sometimes performs a MILD procedure at the hospital and sends the patients to a lab. Their work-up includes tests covered by codes 85025, 85610, and 85730. The lab needs a diagnosis supporting the tests that Medicare will accept -- but a "pre-procedure" diagnosis doesn't work. What do you recommend? Mississippi Subscriber Answer: Your first step is to determine whether the patients have any medical conditions that warrant the labs (such as V58.61, Long-term [current] use of anticoagulants). If not and the tests are for screening or pre-op purposes, insurers probably won't cover the tests. You mentioned the following codes for the tests: 85025 -- Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85610 -- Prothrombin time 85730 -- Thromboplastin time, partial (PTT); plasma or whole blood. Payers generally consider testing prior to any medical intervention associated with a risk of bleeding and [...]