Pathology/Lab Coding Alert

Question: Our pathologist reviewed a peripheral blood smear as a reflex test from an abnormal CBC, but Medicare denied payment. The pathologist routinely reports 85060 for peripheral smears that are part of a bone marrow case and gets paid. What's the difference? Arizona Subscriber Answer: The coverage key isn't the reason for the test (bone marrow case versus hematology abnormality); it's place of service (POS). Medicare will pay for 85060 (Blood smear, peripheral, interpretation by physician with written report) only for hospital inpatients (POS 21). Your pathologist might be equally likely to get requests to review an abnormal peripheral blood smear as a reflex from a complete blood count (CBC) for a hospital inpatient or outpatient. Although bone marrow cases can be from an outpatient, you're more likely to see them in an inpatient setting, which may be why you haven't had problems billing 85060 to Medicare in these instances. You [...]