Oncology & Hematology Coding Alert

Numerous changes to the Hematology section of the 2003 CPTcode descriptors are designed to focus more on organization than substance. Nonetheless, several hematology alterations will have a measurable impact on oncology practices that perform their own blood-count tests. For example, to report any automated differential in 2003, use 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count). While manual differentials retain most of the same code numbers, 85024 has disappeared. This means that there is no longer a difference between a partial and a complete differential, said Charles Root, PhD, an officer with MCF Compliance in Barrington, Ill., during a recent AACC reimbursement teleconference. Rich CBCs Can Tempt the Unwary The CBC code changes also dangle what Root calls "the old greed factor" before the unwary. Since there is no longer a code for a CBC without platelets, you have to use the component parameter codes. If you do that, you would submit five codes and be reimbursed $23.44. This is a considerable bump over the $10.86 that you'd get for a CBC with platelets (85025). "Obviously, this will strike people as a little strange that we can get two and a half times as much money for doing less," Root said. Root doesn't recommend the "extreme" solutions of coding 85025 even if you haven't done a platelet count, or running everything without platelets merely to increase your reimbursement. Instead, "Be very careful anytime you unbundle 85025. Make sure the patient record justifies it." Root also recommends keeping an eagle eye out for CMS guidance in 2003. Leukocyte Differentials At the annual CPT Symposium in November 2002, Mark Synovec, MD, member of the CPTAdvisory Committee and chairman of the department of pathology at Stormont-Vail Regional Health Center in Topeka, Kan., addressed questions about automated leukocyte differentials from hospital laboratories that service many oncology patients.

Synovec said CPT 2003 recognizes that some labs must perform manual and buffy-coat leukocyte differentials. "For this reason, 85027 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count]) has been updated to include all the components of the CBC except the leukocyte differential, and should be used for this service by these laboratories."

Labs may then code any additional evaluations necessary to complete the CBC, Synovec said. Additional tests may include: 85004 Blood count; automated differential WBC count, with or without 85008 ( blood smear, microscopic examination without manual differential WBC count)

85007 ... blood smear, microscopic examination with manual differential WBC count

85009 manual differential WBC count, buffy coat. "In the past, we always did a smear with an automated count," says Alice Ettinger, RN, MSN, CPNP, program coordinator with the [...]