Examine Testing for Complete Blood Counts without Platelets
Get a comprehensive understanding of the CBC test and the correct CPT®, ICD-10, and HCPCS Level II codes to use.
If you have ever wondered what the components of a complete blood count (CBC) test are, you’re in luck. Here’s an explanation, with examples of the components in use.
What Makes Up a CBC
The CBC is a mainstay of clinical diagnostics and laboratory medicine. The test is so versatile that it’s the only clinical laboratory test with a National Coverage Determination (NCD) that lists the excluded diagnoses, rather than those covered. The components of the standard CBC are:
- Red blood cell (RBC) count
- White blood cell (WBC) count
- Hemoglobin (Hgb)
- Hematocrit (Hct)
- Mean corpuscular volume (MCV)
- Mean corpuscular hemoglobin concentration (MCHC)
- RBC distribution width (RDW)
Some of these components are separately orderable (RBC, WBC, Hgb, and Hct). Per the Centers for Medicare & Medicaid Services (CMS) guidelines, when three or more components of a CBC are ordered, you may bill for the panel. The logic behind this is: when three components have been reached, the individual components have a higher total reimbursement than the panel. HCPCS Level II codes G0306 Complete CBC, automated (HgB, HCT, RBC, WBC, without platelet count) and automated WBC differential count and G0307 Complete (CBC), automated (HgB, HCT, RBC, WBC; without platelet count) were established to represent CBC panels without platelet counts.
RBC Count (85041 – Automated, 85032 – Manual)
RBCs are produced in the bone marrow and typically live for approximately 120 days. Their main function is to carry oxygen throughout the body.
Some illnesses and ICD-10 codes related to RBCs are:
Iron deficiency anemia – D50.9 Iron deficiency anemia, unspecified: Iron deficiency anemia occurs when the body does not have enough iron. Iron is the component in Hgb, which carries the oxygen inside the RBC. Symptoms of iron deficiency anemia are consistent with anemia (R53.83 Other fatigue) and iron deficiency (brittle nails, L60.3 Nail dystrophy), swelling or soreness of the tongue (K14.8 Other diseases of tongue), cracks in the sides of the mouth (K13.0 Diseases of lips), splenomegaly (R16.1 Splenomegaly, not elsewhere classified), and frequent infections.
Sickle-cell disease – D57.1 Sickle-cell disease without crisis: Sickle-cell disease is a genetic anomaly of the Hbg. Hbg, the protein inside the RBC responsible for carrying oxygen, contorts into a sickle shape hindering the body’s ability to effectively oxygenate organ systems. Early symptoms of sickle-cell disease include dactylitis (D57.00 Hb-SS disease with crisis, unspecified), fatigue from anemia (R53.83 Other fatigue), and jaundice (R17 Unspecified jaundice).
Fanconi anemia – D61.09 Other constitutional aplastic anemia: Fanconi anemia is an inherited disorder that effects the ability of bone marrow to produce enough new blood cells or malfunctioning cells. As a result, patients experience anemia (D64.9 Anemia, unspecified), bone marrow failure (D75.89 Other specified diseases of blood and blood-forming organs), birth defects, and developmental or eating problems.
WBC Count (85048 – Automated, 85032 – Manual)
WBCs are made in the bone marrow and consist of different cell types. All types are nucleated and work to combat infections of various kinds. High WBC counts can be seen in:
1. Various types of infections;
2. As a reaction to certain drugs; or
3. Caused by certain bone marrow diseases.
These cell types are quantified in the differential (manual – 85007 Blood count; blood smear, microscopic examination with manual differential WBC count or automated – 85004 Blood count; automated differential WBC count). Some illnesses associated with abnormal WBC counts include:
An increase in the number of WBCs is known as leukocytosis and is typically in response to the following conditions: infection, immunosuppression, corticosteroids (T38.0xx Poisoning by, adverse effect of and underdosing of glucocorticoids and synthetic analogues), bone marrow or immune disorders, acute or chronic lymphocytic leukemia (C91.xx Lymphoid leukemia), allergic reaction, rheumatoid arthritis (M05.9x Rheumatoid arthritis with rheumatoid factor, unspecified).
A low WBC count is typically caused by viral infections that disrupt the bone marrow (human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)), certain congenital disorders (Kostmann’s syndrome – D70.0 Congenital agranulocytosis), cancer (leukemia), autoimmune disorders, certain medications, and D86 Sarcoidosis).
Hgb is a complex protein found in RBCs that contains an iron molecule. The main function of Hgb is to carry oxygen from the lungs throughout the body for the exchange of oxygen and carbon dioxide. The iron molecule in the Hgb helps maintain the normal RBC shape.
Some illnesses associated with low Hgb levels include: aplastic anemia (D61.3 Idiopathic aplastic anemia), certain cancers, anti-retroviral drugs for HIV infection, cirrhosis (K74.5 Biliary cirrhosis, unspecified), Hodgkin’s lymphoma (C81.xx Hodgkin lymphoma), iron deficiency anemia (D50.9).
Conditions that may cause increased Hgb levels include: COPD (J44.9 Chronic obstructive pulmonary disease, unspecified), emphysema (J43 Emphysema), heart failure (I50 Heart failure), IBS (K58.x Irritable bowel syndrome), blood cancer (D45 Polycythemia vera), and smoking (T65.221 Toxic effect of tobacco cigarettes, accidental (unintentional)).
Hct represents the ratio of RBC volume to total blood volume, expressed as a percentage. For example, a Hct of 50 percent means that there are 50 mL of RBCs in 100 mL of blood.
Low Hct levels may require intravenous iron, transfusions, or medications to stimulate the production of red cells by the bone marrow. High Hct levels may be due to diseases, such as polycythemia rubra vera (D45).
MCV is the average RBC volume. It can either be directly measured or calculated from the Hct and RBC: MCV=Hct/RBC.
An increased MCV is seen in macrocytic anemias while decreased MCVs are seen in microcytic anemias. The main causes of macrocytic anemia include folate deficiency (D52 Folate deficiency anemia), B12 deficiency (D51 Vitamin B12 deficiency anemia), hypothyroidism (E03.x Other hypothyroidism), and myelodysplastic syndrome (D46.9 Myelodysplastic syndrome, unspecified). Common conditions associated with microcytic anemia include iron deficiency anemia (D50.9), anemia of chronic disease (D63.8 Anemia in other chronic diseases classified elsewhere), inherited blood disorders (D56 Thalassemia), and sideroblastic anemia (D64.x Other anemias).
MCHC is the measure of Hbg in RBCs and is calculated by dividing the Hgb by the Hct: MCHC=Hbg/Hct.
Symptoms associated with low MCHC levels include fatigue (R53.xx Malaise and fatigue), shortness of breath (R06.02 Shortness of breath), pale skin (R23.1 Pallor), dizziness (R42 Dizziness and giddiness), and weakness (R53.1 Weakness). High levels of MCHC are associated with macrocytic anemia, as previously described.
RDW is a measure of variation in RBC volume. Increased RDW values have been associated with early iron (D50.9), vitamin B12 (D51) or folate (D52) deficiency, dimorphic anemia (D53.1 Other megaloblastic anemias, not elsewhere classified), and sickle-cell disease (D57.x Sickle-cell disorders).
Frank Mesaros, DBA, MPA, MT(ASCP), CPC, CPCO, is CEO of Trusent Solutions, LLC, a management consulting firm specializing in the clinical laboratory industry. Trusent provides revenue stream integrity services to regional laboratories, hospital based laboratories, and physician office based laboratories. He is a member of the Harrisburg, Pa., local chapter.