CPT® 85025 or 85027? That is the Question

National Government Services (NGS) says Error Code (EC) 31 Services incorrectly coded denials have been increasing in relation to CPT® 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count.

“Review of the CERT data shows that the CERT contractor has been re-coding CPT 85025 to show the appropriate service rendered,” NGS writes in its November 2009 Medicare Monthly Review (MMR). So how should billing staff code this service?

NGS says, generally, CPT® 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) is more appropriate.

Correct coding: If the physician has ordered only a CBC (with no mention of a differential), the correct code is 85027.

To prevent EC 31 denials, providers should review the medical records and the physician order/requisition before performing and coding the service to make sure what is being done and billed matches the order.


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3 Responses to “CPT® 85025 or 85027? That is the Question”

  1. Michelle Haggard says:

    We perform our CBC’s on a Horiba Micros 60 which gives us a three part differential and we code 85025 for this. Per manufacturers recommendation when a patient result flags we perform a manual differential. Do we code this 85025/85007 or 85027/85007? The provider is always getting an automated CBC with a three part diff.

  2. Julie says:

    What is the add on procedure code for 90669?

  3. Elaine Averett says:

    In reading the above and charging a 85027 can you also bill a 85007 with that if a manual
    diff is done.

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