Pathology/Lab Coding Alert

You can report complete blood count (CBC) without platelets using one code again. CMS introduced two new HCPCS Level II codes for 2004: G0306 for CBC without platelets with differential, and G0307 for CBC without platelets without differential. Medicare accepted these codes beginning Jan. 1.

Medicare Assigns CBC HCPCS Level II Codes

"New codes G0306 and G0307 allow you to report a combination of blood tests to Medicare using a single code," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, president of Professional Coding and Compliance Consulting in Manassas, Va. "CPT provided similar codes (85021 and 85022) prior to 2003, but current CPT codes require you to report a combination of CBC tests without platelets using multiple individual codes for the component tests."
 Medicare's two new codes for CBC without platelets are as follows:
 

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

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

Medicare established codes G0306 and G0307 to "permit continued billing of common bundled CBC testing services without a platelet count." As with any code, Medicare will only pay for the service if each component test is medically necessary.

Continue Billing CPT Codes for Other Payers

CPT doesn't have an individual code for CBC without platelets. In fact, CPT only lists two blood count codes that represent a combination of tests, and both of the codes include platelets: 85025 (... complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) and 85027 (... complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count]).
 
"Because payers other than Medicare generally won't accept HCPCS Level II codes, you'll still use a
combination of CPT codes to report CBC without platelets, with or without a differential," Castillo says. (See box, "CPT Lists Hemogram Component Codes" for a list of blood component CPT codes and their definitions.) Coding will vary depending on whether the tests are manual or automatic, but possible combinations include the following for CBC without platelets or differential:
 

Hemoglobin (85018), hematocrit (85014), automated RBC (85041) and automated WBC (85048)
 

Hemoglobin (85018), hematocrit (85014), manual RBC (85032) and manual WBC (85032).
 If the lab also performs a differential WBC, additionally report 85004 for an automated differential, or 85007 or 85009 for a manual differential.

Beware of NCCI Edits

Medicare's National Correct Coding Initiative (NCCI) bundles many blood count codes, indicating that you should not report the codes together for the same patient on the same day. "None of the edit pairs will keep you from reporting the code combinations for a CBC without platelets," Castillo says.
 
If you perform any additional tests, however, you may have to use modifiers to override the edit pairs, according to CMS. For example, if the lab performs a complete CBC with differential (85025) and later the same day performs a medically necessary hemoglobin, you should report 85018 with modifier -91 (Repeat clinical diagnostic laboratory test).

Medicare Codes Pay Less

"Medicare will pay your lab less for G0306 and G0307 than it would for a comparable group of CPT codes used to report a CBC without platelets," says Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, director of coding and analysis for National Health Systems Inc., a coding consultation company in Camp Hill, Pa. Based on the 2004 Clinical Laboratory Fee Schedule national limits, G0307 pays $9.28. But the sum of individual CPT codes for the same service (85018, 85014, 85041 and 85048) pays $14.76. Similarly, G0306 pays $11.14 compared to $24.04 for the sum of comparable CPT codes 85018, 85014, 85041, 85048 and 85004.
 
Because clinical situations indicating automated CBC without platelets are uncommon, these G code payment rates should not have a huge impact on labs, Wolfgang says. "Currently, use new codes G0306 and G0307 for Medicare and CPT codes for other payers, but watch for instructions from other payers who may pick up on these new codes for their own billing purposes," he says.