Primary Care Coding Alert
Do You Know Medicare's New CBC Codes?
Question: An office staff member draws a Medicare patient's blood and performs a complete blood count (CBC). Should I submit G0001 or a CPT lab code? Also, if I report a lab code, should I use a modifier? Texas Subscriber Answer: Because your personnel performed the laboratory test in the office, you should report the test in addition to the blood draw (G0001, Routine venipuncture for collection of specimen[s]). When you bill a CBC for a Medicare patient, you may need to submit a HCPCS Level II laboratory code, if the CBC doesn't include a platelet count. This year, Medicare added G0306 and G0307, which correspond to CPT lab codes 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) and 85027 (... complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count]). The corresponding CPT codes include a platelet count, so check with your carrier before you submit these new codes. Because the Clinical Laboratory Improvement Amendments (CLIA) classify a CBC as a moderate-complexity test, you shouldn't append modifier -QW (CLIA waived test) to the lab code. Modifier -QW only applies to CLIA-waived laboratory tests. Your office must maintain a moderate- or high-complexity certificate to perform CBCs. When you submit the claim, make sure to enter your practice's CLIA certification number on line 23 of the CMS-1500 form. -- Information for You Be the Coder and Reader Questions provided by Quinten A. Buechner, MS, MDiv, CPC, CHCO, president of ProActive Consultants LLC in Cumberland, Wis.; and Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.
If the CBC without a platelet count doesn't include an automated white blood count (WBC) differential count, report G0307 (Complete CBC, automated [HgB, Hct, RBC, WBC; without platelet count]). If it does, assign G0306 (Complete CBC, automated [HgB, Hct, RBC, WBC, without platelet count] and automated WBC differential count).
Primary Care Coding Alert
- 1 Tool You Need Before Coding a Skin Lesion Excision
" CPT, ICD-9 force you to withhold suspicious-lesion claims Don't be tempted to bill claims [...] - Inconclusive Path Report?:
Uncertain,Unspecified Diagnosis Codes May Help You
Even though uncertain and unspecified diagnoses don't apply to suspicious lesions, you should link 238.x [...] - You Be the Coder:
Test Your New Patient Component Savvy
Question: A 22-year-old female who is new to our practice presents with irregular menses. Our [...] - NCCI 10.2 Adds New Bundles of Joy to Maternity Care Codes
The National Correct Coding Initiative, version 10.2, goes into effect on July 1, and while [...] - Get the NCCI 10.2 Rundown Here
Integrate these new FP bundles July 1 Forget fumbling through pages of edits on the [...] - Pediatric Coding Corner:
3 Documentation Tips Improve Your Precath-E/M Pay
Separate chart notes and diagnoses justify office visit reimbursement You can overturn denials for an [...] - ICD-9 2005 Preview:
New V Code Makes Billing Chickenpox Exposure a Snap
Our clip-and-post chart reveals upcoming family practice diagnostic changes Does your practice face denials when [...] - Reader Question:
Go Beyond CPT for Dystrophic Nail Trimming Code
Question: A family physician's documentation reads, "Trimmed dystrophic nails." He doesn't mention any debridement. Should [...] - Reader Question:
Combine Same-Day E/Ms Into 1
Question: A family physician treats in our office a patient who has difficulty breathing. Because [...] - Reader Question:
FP's Opinion Counts When Coding ECG's I&R
Question: What should my family physician document to claim electrocardiogram (ECG) interpretation and report (I&R)? [...] - Reader Question:
Time-Based Billing Is Key to Counseling Coding
Question: During the annual physical of a 19-year-old established patient, the family physician diagnoses him [...] - Reader Question:
Do You Know Medicare's New CBC Codes?
Question: An office staff member draws a Medicare patient's blood and performs a complete blood [...] - 4 Steps Reduce Denials for Teaching Physician Services
Techniques can clarify confusing Medicare guidelines When a physician works as a "teaching physician" (TP) [...] - You Be the Expert:
TP Rules and Med Students
Question: I've heard about the new teaching physician (TP) guidelines and was wondering whom they [...] - Reader Question:
Know the Meaning of 'Immediately Available'
Question: If the doctor has to leave the room for a few minutes during a [...]
