Health Information Management

Q&A: Coding for CBC with and without differential

JustCoding News: Outpatient, July 11, 2012

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QUESTION: Our laboratory medical director sent out a notification to our medical staff, patient care departments, and order entry personnel that a physician order that read “CBC” or “CBC with differential” would be completed as a CBC with automated or manual differential and coded using CPT® code 85025 (blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC, and platelet count] and automated differential WBC count). Should we code 85025 when the order just reads CBC and when we do a manual differential with the CBC?

ANSWER: You must code the service that you actually performed. Therefore, if a CBC with automated differential was performed, code 85025 would be appropriate.
 
Code an automated CBC without a differential WBC count with CPT code 85027 (Complete [CBC] automated [Hgb, Hct, RBC, WBC and platelet count]).
 
A blood differential measures the numbers, as a percentage, of white blood cells (leukocytes). If this is done manually, you should report it separately with code 85032 (blood count; manual cell count [erythrocyte, leukocyte, or platelet] each) or 85009 (blood count; manual differential WBC count, buffy coat).
 
However, if (and when) you get audited, you may have a problem with the lab performing a test not specifically ordered by the physician.
 
Editor’s note: Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, Fla., answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, Wis. Email her at ssafian@embarqmail.com.
 
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
 
Need expert coding advice? Submit your question to Senior Managing Editor Michelle Leppert, CPC-A, at mleppert@hcpro.com, and we’ll do our best to get an answer for you.



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