Pathology/Lab Coding Alert

You can't report 85027 and 85004 for CBC and differential

CPT 2004 cleaned up two panel codes that had appeared in CPT Codes 2003 with outdated hematology code references. But what seems like a simple clarification could reopen the confusion many coders have about reporting complete blood count (CBC) code 85027 with automated differential code 85004.

Panels Delete Hemogram Reference

"CPT 2004 deleted references in the general health and obstetric panels to nonexistent hemogram codes," says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm in Chattanooga, Tenn. The portion deleted from 2003 codes read, "Hemogram, automated, and manual differential WBC count (CBC) (85022) OR Hemogram and platelet count, automated and automated complete differential WBC count (CBC) (85025)." The corrected codes are:

80050 - General health panel

This panel must include the following: Comprehensive metabolic panel (80053); Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004)

OR

Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009); Thyroid stimulating hormone (TSH) (84443)

80055 - Obstetric panel

This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004)

OR

Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009); Hepatitis B surface antigen (HBsAg) (87340); Antibody, rubella (86762); Syphilis test, qualitative (e.g., VDRL, RPR, ART) (86592); Antibody screen, RBC, each serum technique (86850); Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901).

The correction updates 85025's definition and eliminates the reference to deleted code 85022, which previously reported an automated hemogram and manual differential WBC.

NCCI Says 'No' to 85027 and 85004

"The fact that the corrected panel codes state that you can report a complete CBC and automated differential WBC as 85027 and 85004 might confuse you," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. Since CPT implemented the new hematology codes in January 2003, the National Correct Coding Initiative (NCCI) edits have paired 85027 and 85004. Because NCCI lists the edit pair with a modifier indicator of "0," Medicare won't pay for these codes when they are reported together under any circumstances.
 
"In other words, if the lab performs a CBC and automated differential WBC, you should report 85025 for the service," Dettwyler says. If the lab performs a CBC with manual differential, you may report 85027 with the appropriate code as the revised panel codes suggest - 85007 (Blood count; blood smear, microscopic examination with manual differential WBC count) or, rarely, 85009 (... manual differential WBC count, buffy coat).
 
Medicare has been strict about the CBC and automated differential. Even if the lab performs an 85025 and reflexes to a separate differential, you can't report the additional service. "Medicare's stance is that you have to perform the second differential to accomplish what the doctor ordered - it's part of the 85025 service," Dettwyler says.