** When codes 85025, 8443 are done on the same encounter, you must report each code individually. ** Medicare does not cover CPT code 80050. Do not report individually claim will be denied for inappropriate coding. ** When codes 85025, 8443 are all done on the same encounter, report using the the general health panel code 80050. General Health Panel – 80050 (component codes included in panel are 85025, 84443, 80053) For example, test codes 8504 should not be billed along with code 85025 which represents the bundled testing serviceĪ submission that includes a Comprehensive Metabolic Panel, CPT code 80053, a Thyroid Stimulating Hormone, CPT code 84443 and one of the following CBC or combination of CBC Component Codes, either CPT codes 85025 or 85027 + 85004 or 85027 + 85007 or 85025 + 85009 by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a General Health Panel, CPT code 80050. National Correct Coding Initiative (NCCI) edits have been established to promote correct coding and prevent inappropriate payments. New code G0328QW is priced at the same rate as code 86318. New code G0328 is priced at the same rate as code 86318. New code G0307 is priced at the same rate as code 85027. New code G0306 is priced at the same rate as code 85025. New code 89235 is priced at the same rate as deleted code 89365. New code 89225 is priced at the same rate as deleted code 89355. New code 87660 is priced at the same rate as code 87470. New code 87329 is priced at the same rate as code 87328. New code 87269 is priced at the same rate as code 87272. New code 85055 is priced at the same rate as code 86361. New code 84157 is priced at the same rate as code 84155. New code 84156 is priced at the same rate as code 84155. Mapping Information for New and Revised Codes The national limitation amount field on the data file is zero-filled. Similar to prior years, the 2004 pricing amounts for certain organ or disease panel codes and evocative/suppression test codes were derived by summing the lower of the fee schedule amount or the NLA for each individual test code included in the panel code. Billing modifiers can assist in reporting additional medically necessary CBC component test(s) or bundling testing service for the same patient on the same date of service, such as modifier -91 Repeat clinical laboratory test. hemoglobin (Hgb) or hematocrit (Hct) ) should be ordered and performed. G0306 Complete (CBC), automated (Hgb, Hct, RBC, WBC, without platelet count) and automated differential WBC count G0307 Complete (CBC), automated (Hgb, Hct, RBC, WBC, without platelet count) If additional CBC component test(s) are medically necessary, only the medically necessary components (e.g. For example, test codes 8504 should not be billed along with code 85025 which represents the bundled testing service.įurther information on the NCCI edits is available at Based on comments, codes G0306 and G0307 have been established to permit continued billing of common bundled CBC testing services without a platelet count. the ordering physician for additional documentation).ĬPT codes representing the bundled testing services include:Ĩ5025 Complete CBC, automated (Hgb, Hct, RBC, WBC, and platelet count) and automated WBC differential 85027 Complete CBC, automated (Hgb, Hct, RBC, WBC, and platelet count) National Correct Coding Initiative (NCCI) edits have been established to promote correct coding and prevent inappropriate payments. The provider may need to contact a third party to obtain the appropriate documentation (i.e. The report also showed the physician’s order was missing to support medical necessity. Providers are advised to make sure they are completing the tests ordered by the physician and only bill for those exact tests that were ordered. The report shows that the physician’s order is for CBC, not CBC with differential as billed. However, recent Comprehensive Error Rate Testing (CERT) analysis revealed an increase in errors due to incorrect coding for CPT 8507. Laboratory test results that show automated CBC as well as the differential WBC support the use of CPT 85025 (provided the physician ordered them). This hematology testing is commonly ordered by physicians to diagnose and treat a wide array of physical disorders. Also, a differential white blood cell (WBC) count measures the percentages of different types of white blood cells. Billing Complete Blood Counts (CBC) CPT code 8507Ĩ5025 – Blood count complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count – average fee amoount – $10 – $20Ī complete blood count consists of measuring a blood specimen for levels of hemoglobin, hematocrit, red blood cells, white blood cells, and platelets.
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