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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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7 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.

  4. Smitha says:

    can we perform cpt 85027 in POS-22?

  5. Kimber says:

    What if a 85025 and 85027 are charged? Can they be charged together? Why isn’t anyone answering these questions? Argh.

  6. Miranda says:

    When billing from a pathology lab – 85025 and 85027 using mod 26 – are these acceptable to be billed together? I am not seeing any rules saying otherwise. Also we are placing modifier 26 on these and are not getting paid. Thank you

  7. kimber says:

    We frequently see two lab orders from two different physicians brought in at the same time by patients – one physician will have ordered a CBC and the other order from another physician will have ordered a CBC with diff. Both the 85027 and the 85025 are being charged for the lab and the two tests are run less than 5 minutes apart. An edit comes up stating add a -59 modifier. Do we add the -59 modifier to the less comprehensive code (CBC 85027) or should we have the 85027 removed from the charges as the more comprehensive code that was run suffices both physicians’ ordered and they were run one right after the other? PLEASE someone who knows, answer this question, it’s becoming an issue of debate where I work. Thank you.