G2 Compliance Corner: Our laboratory continues to be unclear on what the rules are for performing and billing complete blood counts (CBCs) when the physician orders “CBC.” Can you help?

Medicare considers an order for a CBC to mean an order for the test described by Current Procedural Code (CPT) 85027, which does not include a differential. If a physician wants a differential, the order must include a specific request for it like “CBC with differential.” In that case the laboratory would perform and bill the test described by CPT code 85025. Another question that often arises concerning these tests relates to manual differentials (85007). Basically, you should only bill this test if the physician specifically orders it. The order might look like this, “CBC and manual differential.” Performing a manual differential as a result of an instrument flag or a laboratory policy is not a billable test. Medicare considers this a quality control measure necessary to complete an order for a CBC with differential.

This month we are introducing a new feature in
G2 Compliance Advisor in which we answer compliance-related questions from our readers. Do you have a question? Please send to Christopher Young at cpyoung@cox.net.

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