Wiki 85025 and 85007

[ljohns31]

We are having a discussion with our lab about billing both 85025 and 85007. NCCI edits say they are not to be billed together. Medicare is paying both, Kansas Medicaid is not. I think this is a coding/billing issue and if the lab does both, billing should not care. Any thoughts out there on this or how are some of you doing this.

Thanks,
Lynne Johnson, CPC

 

[AFELDKAMP]

85027/85007

Hi Lynne, Correct coding for this is that when a manual diff is done (85007) change the CBC with auto diff (85025) to (85027) CBC -without auto diff.

 

[ljohns31]

Thanks for the fast response. Sometimes Lab coding is confusing--shouldn't be but we are a small facility and just get in a routine. Thanks again

lynne

 

[Asti Winters]

CBC billing

I know that this post is quite old, but I am now experiencing a complicated issue that should not be so complicated. Our clinic sends our labs to a reference lab to be processed and we then bill the patient (the lab bills the clinic). We currently have a lab interface where the results are automatically dropped into our practice managemnet system. So here is the dillema: The provider orders a CBC w/ auto diff (85025), but the lab says that they need to places to drop the results, 1 for the CBC and 1 for the auto diff. The provider has only provided one space by ordering the 85025. We know have started ordering a 85025 and a 85027, then removing the 85027 before sending the claim to insurance so that the patient is not "double charged" for the CBC. I would like to know if any others have experienced this issue and how they have tackled it. Also, is it considered unbundling if we bill for 85004 (auto diff only) and 85027 (CBC only)?

Your help is greatly needed and appreciated!
Thanks in advance. Asti