Pathology/Lab Coding Alert

Establish 'no platelet' reporting alternatives, too.

When your lab runs an ordered 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count), it's not uncommon to obtain differential parameters that require an additional manual diff.

But that doesn't mean you should add 85007 (Blood count; blood smear, microscopic examination with manual differential WBC count) to your billing.

Let our experts show you how to solve this and other sticky CBC coding dilemmas with the following guidance.

Distinguish With/Without Differential

CPT® provides more than 85025 for CBC coding -- you might also choose 85027 (... complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count]) when your lab performs a CBC without an automated differential.

What if the physician orders a CBC with manual differential? That's when you should report 85027 plus 85007.

Beware reflex: Sometimes, the physician orders a CBC with automated diff (85025), which the lab performs, and then the lab reflexes to an additional manual diff based on the initial results. "The situation brings up the question: Should you bill 85007 in addition to 85025, or should you change the coding to 85027 plus 85007?" notes Victoria Cooper, CPC, medical billing clerk for Molecular Pathology Laboratory Network, Inc. in Maryville, Tenn.

"You should not add a manual diff charge (85007) to a CBC plus automated diff (85025)," advises William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

CMS instruction: Medicare's National Correct Coding Initiative (CCI) Policy Manual states, "A provider may not report an automated hemogram with automated differential WBC count (CPT® code 85025) with a manual differential WBC count (CPT® code 85007) because this combination of codes results in duplicate payment for the differential WBC count." CCI bundles 85025 and 85007 with a modifier indicator of "0," meaning that you cannot override the edit pair under any circumstances.

What about changing the coding from 85025 to 85027 plus 85007 when the lab reflexes to a manual diff? You shouldn't

do that either, according to Dettwyler. "You can't change the coding from what the physician ordered to something different based on lab protocols," he says.

Do this: For the reflex scenario, "report the service as 85025," Dettwyler says. "Medicare's stance is that if you have to perform the second differential to accomplish what the doctor ordered, then it's part of the original 85025 service."

AMA differs: According to CPT® Assistant Jan. 2004, "... some laboratories commonly must perform manual and buffy coat leukocyte differentials depending on the results of the other CBC parameters." In those cases, the lab should report 85027 plus "the appropriate additional evaluation necessary ... (i.e., 85007, 85009 [... manual differential WBC count, buffy coat])...."

"The AMA wrote that instruction when the codes were new, and I believe CMS may not approve that use of the codes," Dettwyler says.

Handle Platelet Absence

CPT® defines CBC as hemoglobin (Hgb), hematocrit (Hct), red blood cells (RBC), white blood cells (WBC), and platelet count. "The definition matches the tests that almost all automated lab systems perform," Dettwyler says.

Occasionally, physicians may order some components rather than the entire CBC, and that presents another coding dilemma.

Code what's done: If the physician orders specific blood counts rather than a CBC, bill each test individually by selecting the appropriate code(s) from the following list:

• 85014 -- Blood count; hematocrit (Hct)
• 85018 -- ... hemoglobin (Hgb)
• 85032 -- ... manual cell count (erythrocyte, leukocyte, or platelet) each
• 85041 -- ... red blood cell (RBC), automated
• 85048 -- ... leukocyte (WBC), automated
• 85049 -- ... platelet, automated.

Platelet Medicare exception: If the physician orders all components except platelets, you'll need to turn to a "G" code for Medicare payers:

• G0306 -- Complete CBC, automated (Hgb, Hct, RBC, WBC, without platelet count) and automated WBC differential count
• G0307 -- Complete CBC, automated (Hgb, Hct, RBC, WBC, without platelet count).

Just like 85027 and 85025, you'll distinguish between G0306 and G0307 based on whether the physician orders an automated WBC differential count.

Include Smear Exam

When labs perform an 85025 or 85027 CBC test, certain criteria established by the lab may "flag" the test for a blood smear exam to verify CBC results. Does that mean you can code 85008 (... blood smear, microscopic examination without manual differential WBC count) or 85007 to capture the lab's work for the blood smear exam?

CCI says no: The CCI Policy Manual states, "The laboratory should not report CPT® code 85007 or CPT® code 85008 for the examination of a blood smear to complete the ordered automated hemogram test (CPT® codes 85025 or 85027)."