Pathology/Lab Coding Alert

Don't report G0306-G0307 and 88361 with component tests If you want to code 2004's new blood count and morphometric tumor analysis codes with confidence, you'll need to know how to maneuver edit pairs in the latest National Correct Coding Initiative edits (version 10.0).
 
NCCI 10.0 took effect Jan. 1. You can access the edits at http://www.cms.hhs.gov/physicians/cciedits/default.asp. Watch Out for CBC G Code Bundles CMS added two new G codes in 2004 for complete blood counts (CBC) without platelets, and as a result, NCCI 10.0 introduced 25 new edit pairs involving codes G0306 (Complete [CBC], automated [Hgb, Hct, RBC, WBC, without platelet count] and automated differential WBC count) and G0307 (Complete [CBC], automated [Hgb, Hct, RBC, WBC, without platelet count]).
 
"You'll have to know about these edit pairs and how to override them if you want to get paid when your lab legitimately performs a CBC followed by a separate blood count for the same patient on the same day," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. See "Remember Blood Count Bundles With This Clip-and-Save Chart" in this issue for a complete list of the edit pairs.

"NCCI 10.0 bundles the CPT codes for each component test with G0306 and G0307," Dettwyler says. Although you should not unbundle and separately report a component test from G0306 or G0307, you may have to override the edit pair and separately report a component code if the lab repeats a component test later in the day. For example, if the lab performs a CBC and differential without platelets and later the same day performs a medically necessary hemoglobin for a Medicare patient, you should report 85018 with modifier -91 (Repeat clinical diagnostic laboratory test) in addition to G0306.
 
You can override most G0306 or G0307 component-test bundles, including hematocrit (85013, 85014), hemoglobin (85018), red blood cells (85041) and white blood cells (85048), because NCCI 10.0 lists them with modifier indicator "1." But you cannot separately report a differential white blood count (WBC) with G0306 using any modifier because NCCI pairs G0306 with codes 85004, 85007, 85008 and 85009 using a modifier indicator of "0."
 
"NCCI 10.0 also bundles G0306 and G0307 with other CBC codes, and lists a 0 modifier prohibiting overriding these edits," Dettwyler says. That means you can't report G0306 and G0307 together, or either G code with 85025 or 85027, even if the lab performed the tests at separate encounters on the same day. 
 
You also shouldn't report either G0306 or G0307 with an automated platelet (85049), according to NCCI 10.0. [...]