Pathology/Lab Coding Alert

Question: I noticed that Medicare will no longer pay for CPT 85060 for outpatients. How should we bill for physician interpretation of a blood smear for outpatients?


Illinois Subscriber

Answer: Beginning Jan. 1, CMS discontinues payment for 85060 (Blood smear, peripheral, interpretation by physician with written report) under the outpatient prospective payment system (OPPS). CMS halted OPPS payment for 85060 because the agency considers the interpretation of an abnormal blood smear to be a routine part of any other hematology lab service that the physician orders.

For example, if the physician requests a manual differential and white blood count for a hospital outpatient, Medicare pays for the service through the Clinical Laboratory Fee Schedule (CLFS) using 85007 (Blood count; blood smear, microscopic examination with manual differential WBC count). CMS claims that hospitals would get double payment for facility resources if Medicare paid separately for 85007 under CLFS and 85060 under OPPS.