Revenue Cycle Insider

Question: Can you bill lab codes 85025 and 85027 at the same time? Can they be separate tests if they have separate diagnoses attached to them? If you can bill them  together, do they need a 59 modifier? Or is the 85027 service always included in 85025?

Also, If the provider's notes do not specifically state “differential WBC,” then would we only use 85027 even if they have separate diagnoses?

AAPC Forum Participant

 Answer: You cannot bill the two tests together, either with or without modifier 59 (Distinct procedural service). Here’s why.

The difference between the two tests lies in the automated white blood cell (WBC) count that is integral to 85025 (Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differ­ential WBC count) but is not a component part of 85027 (… complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)). So, if the order does not specify a differential WBC count, you’ll choose 85027.

But note this exception: If the order does not include a differential WBC count, and the lab performs the 85027 test that reveals an abnormal WBC finding, such as an out-of-range WBC count, the lab will typically go on to perform a manual rather than an automated differential WBC count. That’s because a manual differential WBC count is a more labor-intensive and accurate way of assessing cell count and composition than an automated differential WBC count. If this happens, your coding will change, and you’ll use 85007 (Blood count; blood smear, microscopic examination with manual differential WBC count) along with the 85027 per HYPERLINK "https://www.cms.gov/files/document/10-chapter10-ncci-medicare-policy-manual-2026-final.pdf".the Medicare National Correct Coding Initiative (NCCI) Policy Manual, Chapter X.H.2.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC