Pathology/Lab Coding Alert

Question: The ordering physician requested a CBC without platelets but with a differential, and we perform an automated panel. Should I code this as 85025 or 85027 plus 85004?

Georgia Subscriber

Answer: You should not report this scenario as 85025 (Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count) because the test the physician request doesn’t include platelets.

Nor should you report 85027 (… complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)) plus 85004 (… automated differential WBC count), again because you don’t evaluate platelets.

Do this: For lab test panels that list the component tests, such as the CBC codes do, the lab must test for each component in order to use the panel code. When the lab performs just part of a panel, you should individually code each component test. In this case, that means reporting the following codes:

• 85014 (Blood count; hematocrit (Hct))
• 85018 (... hemoglobin (Hgb))
• 85041 (... red blood cell (RBC), automated)
• 85048 (... leukocyte (WBC), automated)
• 85004 for the automated differential WBC.

Payer: If the patient is a Medicare beneficiary, the answer is different. In that case you should report G0306 (Complete CBC, automated (HgB, HCT, RBC, WBC, without platelet count) and automated WBC differential count).