Pathology/Lab Coding Alert

Other payers may cover the service.

Pathologists typically receive a peripheral blood smear for evaluation with bone marrow cases that include a bone marrow biopsy and aspiration. But that doesn't mean you can always code the service.

Know Medicare Limitation

For Medicare or other patients whose insurers follow Medicare rules, you can't bill CPT 85060 (Blood smear, peripheral, interpretation by physician with written report) unless the service is for a hospital inpatient (place of service 21).

Here's why: Medicare's logic for not paying 85060 for hospital outpatients or non-patients is that "payment for the underlying clinical laboratory test is made to the hospital, generally through the PPS [prospective payment system] rate."

In other words, Medicare holds that it has paid for the peripheral blood smear interpretation by paying for the lab test on the clinical lab fee schedule (such as CBC). Billing Medicare, secondary payers, or the patient would be double billing.

Check other payers: Not all payers follow this rule, so you can check 85060 coverage rules with your primary payers to see if the Medicare restriction applies.

Regardless of payer, you shouldn't bill 85060 if another physician has already interpreted the smear, or if the pathology report simply prints the cell counts without a written pathologist interpretation.