Pathology/Lab Coding Alert

Question: If a physician orders a CBC with automated differential but the test results reflex to a manual differential, can we report both services even though it means reporting the differential twice?

Oregon Subscriber

Answer: No, you should not report 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC, and platelet count] with automated differential WBC count) in addition to 85007 (Blood count; blood smear, microscopic examination with manual differential WBC count).

The Correct Coding Initiative (CCI) lists these two codes with a modifier indicator of "0," meaning that you cannot override the edit pair under any circumstances. The CCI Policy Manual explains the edit pair in this way:

"The laboratory should NOT report CPT code 85007 - for the examination of a blood smear to complete the ordered automated hemogram test (CPT code 85025)."

In other words, Medicare's stance is that if you have to perform the second differential to accomplish what the doctor ordered, you should consider the extra work as part of the requested 85025 service.

Bottom line: When billing CBCs, you should code based on what the physician orders, not based on what the lab has to perform to arrive at the results. If you have an order for a CBC with auto diff, you should report 85025 even though the lab policy reflexes to a manual diff as well.

Only if the physician orders a CBC with manual diff should you report them separately -- 85027 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC, and platelet count]) plus 85007.