How To Code CPT 85025 & CPT 85027 (2023)
Data analysis and claim review findings by the Comprehensive Error Rate Testing (CERT) contractor have identified increased errors related to incorrect billing of CPT 85025 and CPT 85027.
Providers are billing CPT 85025 when the documentation clearly supports the billing of CPT 85027. CMS regulations state only services ordered by the physician should be performed and billed to Medicare.
CPT 85025 | Description & Explanation
CPT code 85025 is a full blood count (CBC). This blood test gives detailed data about different types of cells in a patient’s blood. It is often performed by a physician or nurse. A pathologist or a technician often conducts the CBC test and provides the results to
the physician. The blood, which is drawn from the patient’s vein via a syringe, is stored in a test tube combined with an anticoagulant (EDTA or citrate). This prevents clotting while being transported to the lab. These days, the cell counting process is
often automated by using an ‘automated analyzer”. The automatic cell counter calculates the number of individual cells in the blood; then the results are
printed out for the physician to review.
Description: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count.
Also, a differential white blood cell (WBC) count measures the percentages of different types of white blood cells.
CPT 85027 | Description & Explanation
The laboratory analyst completes a blood count on the thrombocytes,
which are the platelets and white and red blood cells. The analyst also
determines the hemoglobin, normally by spectrophotometry, as well as the
hematocrit (or packed red cell volume) 3% considering a full blood
count (CBC).
Description: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count).
If the coder is unsure of the physician’s intention, he or she should query the physician. Always verify with the physician before assigning the code if there is conflicting or incomplete information.
