Payment for CPT 85025
Data analysis and claim review findings by the Comprehensive Error Rate Testing (CERT) contractor has identified an increase in the number of errors related to incorrect billing of CPT 85025 and 85027. Providers are billing CPT 85025 when the documentation clearly supports billing of CPT 85027. CMS regulations state only services ordered by the physician should be performed and billed to Medicare.
CPT 85025 Complete Blood Count, with differential WBC, automated Consists of measuring a blood specimen for levels of hemoglobin (Hgb), hematocrit (Hct) , red blood cells (RBC), white blood cells (WBC), and platelets. Also, a differential white blood cell (WBC) count measures the percentages of different types of white blood cells.
CPT 85027 Complete Blood Count, automated Consists of measuring a blood specimen for levels of hemoglobin (Hgb), hematocrit (Hct) , red blood cells (RBC), white blood cells (WBC), and platelets.
If the coder is unsure of the intention of the physician he or she should query the physician. Always verify with physician prior to assigning the code if there is conflicting or incomplete information.
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