How To Use CPT Code 85027

CPT 85027 is a code for a complete blood count (CBC) test, which includes the analysis of red and white blood cells, hemoglobin, hematocrit, and platelet count. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 85027.

1. What is CPT 85027?

CPT 85027 is a code used to represent a complete blood count (CBC) test. This test is performed to analyze the number of red and white blood cells, hemoglobin, hematocrit, and platelet count in a blood sample. It is a common diagnostic tool used by clinicians to detect various medical conditions, such as anemia, infection, leukemia, and other diseases, as well as to monitor a patient’s blood count during treatment.

2. 85027 CPT code description

The official description of CPT code 85027 is: “Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)”.

3. Procedure

  1. The collecting provider collects a blood sample from the patient’s arm using a needle and a tube containing an anticoagulant to prevent clotting.
  2. The blood sample is sent to the lab for analysis.
  3. The lab analyst performs an automated cell count using a flow cell, photometer, laser sensors, and electronics to enumerate the different cell types and measure the hemoglobin and hematocrit levels.
  4. The results of the CBC test are reported, including the counts of red and white blood cells, hemoglobin, hematocrit, and platelet count.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 85027 services are those who require a complete blood count test for the diagnosis or monitoring of various medical conditions, such as anemia, infection, leukemia, and other diseases. The test may also be ordered as part of a routine health checkup or as a follow-up to previous test results. The decision to order a CBC test is at the discretion of the ordering clinician based on the patient’s medical history, symptoms, and other relevant factors.

5. When to use CPT code 85027

It is appropriate to bill the 85027 CPT code when a complete blood count test is performed using an automated method to analyze the red and white blood cells, hemoglobin, hematocrit, and platelet count in a blood sample. This code should be used for billing purposes when the test is ordered by a clinician for the diagnosis or monitoring of various medical conditions, as part of a routine health checkup, or as a follow-up to previous test results.

6. Documentation requirements

To support a claim for CPT 85027, the following information should be documented:

  • The patient’s demographic information, including name, date of birth, and insurance information.
  • The ordering clinician’s name and contact information.
  • The date and time of the blood sample collection.
  • The reason for ordering the CBC test, such as the diagnosis or monitoring of a specific medical condition, routine health checkup, or follow-up to previous test results.
  • The results of the CBC test, including the counts of red and white blood cells, hemoglobin, hematocrit, and platelet count.
  • Any additional notes or observations made by the lab analyst during the analysis of the blood sample.

7. Billing guidelines

When billing for CPT code 85027, it is important to follow the guidelines and rules set forth by the payer. Some payers may pay separately for the collection of the blood sample using a code such as 36415, Collection of venous blood by venipuncture. Additionally, it is crucial to ensure that the documentation requirements are met to support the claim for CPT 85027. Work with ordering clinicians to be sure they understand the difference between CBC and CBC with differential, as the latter is represented by CPT code 85025.

8. Historical information

CPT 85027 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2003, from its previous descriptor, “Blood count; hemogram and platelet count, automated”.

9. Similar codes to CPT 85027

Five similar codes to CPT 85027 and how they differentiate are:

  1. CPT 85025: This code represents a complete blood count with an automated differential white blood cell count, providing more detailed information about the types of white blood cells present in the sample.
  2. CPT 85004: This code is for an automated differential white blood cell count only, without the complete blood count.
  3. CPT 85007: This code is for a manual blood smear examination with a manual differential white blood cell count.
  4. CPT 85008: This code is for a manual blood smear examination without a differential white blood cell count.
  5. CPT 85014: This code is for a hematocrit test only, without the complete blood count or differential white blood cell count.

10. Examples

Here are 10 detailed examples of CPT code 85027 procedures:

  1. A patient presents with symptoms of fatigue and shortness of breath. The clinician orders a CBC test to check for anemia. CPT 85027 is billed for the automated CBC test.
  2. A patient with a history of leukemia is undergoing treatment and requires regular CBC tests to monitor their blood count. CPT 85027 is billed for the automated CBC test.
  3. A patient presents with symptoms of a possible infection, such as fever and chills. The clinician orders a CBC test to help diagnose the cause of the symptoms. CPT 85027 is billed for the automated CBC test.
  4. A patient is scheduled for a routine health checkup, and the clinician orders a CBC test as part of the examination. CPT 85027 is billed for the automated CBC test.
  5. A patient presents with unexplained bruising and bleeding. The clinician orders a CBC test to check for a possible platelet disorder. CPT 85027 is billed for the automated CBC test.
  6. A patient with a history of anemia requires a follow-up CBC test to monitor their hemoglobin and hematocrit levels. CPT 85027 is billed for the automated CBC test.
  7. A patient presents with symptoms of an autoimmune disorder, such as joint pain and inflammation. The clinician orders a CBC test to help diagnose the condition. CPT 85027 is billed for the automated CBC test.
  8. A patient is undergoing chemotherapy and requires regular CBC tests to monitor their blood count and overall health. CPT 85027 is billed for the automated CBC test.
  9. A patient presents with symptoms of a possible blood disorder, such as an enlarged spleen or persistent infections. The clinician orders a CBC test to help diagnose the condition. CPT 85027 is billed for the automated CBC test.
  10. A patient with a history of kidney disease requires a CBC test to monitor their red blood cell count and overall health. CPT 85027 is billed for the automated CBC test.

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