Pathology/Lab Coding Alert

Question: On review of peripheral smear slides from a CBC, the cytotechnologist noted immature cells and sent the slides to our pathologist for interpretation. The pathologist reviewed the peripheral smear and returned a written report on his findings. What is the correct CPT code for the pathologist's service?

California Subscriber

Answer: The answer depends on the payer and the patient status -- whether inpatient, outpatient, or nonhospital patient.

The correct code for the service is as 85060 (Blood smear, peripheral, interpretation by physician with written report). However, Medicare will pay for 85060 for a hospital inpatient only when billed in addition to an underlying lab test such as CBC.That means you can't bill 85060 for a peripheral blood smear interpretation for an outpatient or a patient from a physician's office in addition to a blood count.

Here's why: Medicare says that it has paid for the peripheral blood smear interpretation by paying for the lab test on the clinical lab fee schedule (such as CBC, 85027, Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC, and platelet count]). Billing Medicare, secondary payers, or the patient would be double-billing.