Pathology/Lab Coding Alert

Question: Which code should I use to report a hemogram that includes RBC, WBC, hemoglobin and hematocrit? Ohio Subscriber Answer: Report a hemogram with 85021-85031, depending on the lab methods you use. The term refers to the following components: white blood cells (WBC), red blood cells (RBC), hemoglobin (Hgb), hematocrit (Hct) and indices (calculated or measured values).

Select the proper code based on whether the tests are manual or automated, whether some values are measured or calculated, and whether other components are reported (such as platelets or complete blood count, CBC). Depending on these parameters, the test you describe would probably be reported as 85021 (Blood count; hemogram, automated [RBC, WBC, Hgb, Hct and indices only]) because you did not mention differential WBC or platelets. Although a hemogram does not include platelets, it may be performed with the platelets if that is part of the instrument's capabilities. Platelets are included in 85023-85027. Some Medicare carriers will downcode these four codes to 85022 or 85021 for payment if a diagnosis code required for platelets is not present.