Pathology/Lab Coding Alert

You need to rethink your understanding of blood counts to keep up with this year's code changes.

"With multiple deletions, additions and revisions to hematology and coagulation codes (85002-85999), CPT 2003 changes the basic structure of the section," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, a laboratory coding and compliance consulting firm in Longwood, Fla.

"Despite numerous changes, labs may not see a big difference in their coding because the most common blood count codes still describe the same procedures, even if the wording has changed," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. "Other changes are a welcome reorganization, such as moving all the blood counts to one family of codes."

Blood Counts Redefined

CPT Codes 2003 redefines complete blood count (CBC) it now includes platelet count but not differential count and no longer uses the term "hemogram" to describe any hematology tests. Only two codes remain of what used to be seven different automated or manual hemogram codes (85021-85031) that listed varying combinations of red blood cells (RBC), white blood cells (WBC), hemoglobin (Hgb), hematocrit (Hct), differential WBC count, and platelet count. For the two remaining codes, only the number stays the same the definitions use the CBC rather than hemogram terminology as follows:

"Despite the new definitions, you'd use codes 85025 and 85027 much as you used to because they still represent the same lab tests," Dettwyler says. One difference is that now you would use code 85025 with either a complete or partial differential WBC because CPT 2003 deletes 85024 for partial differential.

Don't Pair Manual/Automated, Component/Comprehensive

To report an automated differential WBC without a CBC, use new code 85004 (Blood count; automated differential WBC count). Report blood smears with or without manual differential WBC using the following CPT 2003 modified codes:

"The updated wording for these two codes doesn't change the nature of the tests. You should continue to use them the same as you have under past CPT versions," Dettwyler says.

With slightly revised wording, the same codes for components of CBC remain in CPT 2003:

A new code in CPT 2003 describes a final CBC component test, automated platelet count. The old code for this service (85595, Platelet; automated count) has been deleted, effectively moving the service into the blood count section rather than at the end of the hematology section. The new code is:

"Based on general coding principles, you should not separately report the individual tests if there is a single code that includes all the components," Dettwyler says. Report a CBC as 85027, not as a list of these component tests (85014, 85018, 85041, 85048 and 85049). Also, a new note in CPT 2003 directs that coders should "not report code 85041 in conjunction with 85025 or 85027." You should expect the same coding restrictions with the other component codes, Dettwyler says.

CPT 2003 added a new code for manual cell counts and modified the two codes for manual or automated reticulocyte as follows:

"Don't report together codes for a manual and automated test for the same blood component, such as 85032 for manual and 85048 for automated leukocyte," Dettwyler says.

Know Other Hematology Changes

To coordinate with blood count code changes, CPT 2003 deletes three additional platelet codes and provides direction to the revisions:

Report with revised code 85008.

Report with new code 85032.

Report with new code 85049.

CPT 2003 revisions also update notes following 85613 and 85810 to refer to the new RBC and WBC codes.

You can now code more specifically for fibrin degradation product tests because CPT 2003 modifies one code and adds another to describe the different procedures. The modified code now specifies qualitative or semiquan-titative (85378, Fibrin degradation products, D-dimer; qualitative or semiquantitative), and the new code denotes an ultrasensitive test method (85380, ... ultrasensitive [e.g., for evaluation for venous thromboembolism], qualitative or semiquantitative).