CPT 85025 coverage edits

sdschuett

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Hi,

Wondering if anyone out there can advise on the medical coverage for CPT 85025. We have been recently receiving edits regarding needed medical coverage for the lab 85025. Per the NCD there is a list of codes that are NOT medically supported. Is there a list out there somewhere we're overlooking for covered dx? Considering how many times this lab is ordered and all of the sudden we are seeing these Medicare edits when we didn't in the past, it's a little confusing. My co-worker and I were reviewing an account where the patient had HTN, DM, and long term use of anticoagulants/other drugs and would have thought those dx would have covered the lab, but that's not the case. Are we out of luck on getting this covered if there is no ABN on file?

Thanks!!

SS
 

CodingKing

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Those should be covered dx for blood counts per the NCD. Have you contacted your MAC about any of these? There is only a list of non-covered DX (i don't know which list would be longer)
 

sdschuett

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Hi CodingKing,

Thanks so much for your response! No, we have not contacted our MAC. Figured I'd put some feelers out quick to other coders to see if we were missing something. Thanks again for the help, it's appreciated!

Thanks,

SS
 
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