Basics of CBC CPT code 85025 & 85027
These tests may be ordered as a complete automated blood count (CBC). The specimen is whole blood. Method is automated cell counter. These codes include the measurement of erythrocytes (red blood cells or RBC), leukocytes (white blood cells or WBC), hemoglobin, hematocrit (volume of packed red blood cells or VPRC), platelet or thrombocyte count, and indices (mean corpuscular hemoglobin or MCH, mean corpuscular hemoglobin concentration or MCHC, mean corpuscular volume or MCV, and red cell distribution width or RDW).
CPT Code 85025 includes an automated differential of the white blood cells or “diff” in which the following leukocytes are differentiated: neutrophils or granulocytes, lymphocytes, monocytes, eosinophils, and basophils. Use CPT code 85027 if the complete CBC, or automated blood count, is done without the differential WBC count.
85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)
The symptoms of hematological disorders are often nonspecific, and are commonly encountered in patients who may or may not prove to have a disorder of the blood or bone marrow. Furthermore, many medical conditions that are not primarily due to abnormalities of blood or bone marrow may have hematological manifestations that result from the disease or its treatment. As a result, the CBC is one of the most commonly indicated laboratory tests.
If a complete blood count (CBC) with or without an automated differential is ordered (CPT code range 85025-85027), it is not appropriate to additionally report a code that captures a manual examination of a blood smear (CPT code range 85007-85008) for additional verification.
The National Correct Coding Initiative Policy Manual for Medicare Services, states:
If a treating physician orders an automated complete blood count with automated differential WBC count (CPT code 85025) or without automated differential WBC count (CPT code 85027), the laboratory sometimes examines a blood smear in order to complete the ordered test based on laboratory selected criteria flagging the results for additional verification.
The laboratory should NOT report CPT code 85007 (microscopic blood smear examination with manual WBC differential count) or CPT code 85008 (microscopic blood smear examination without manual WBC differential count) for the examination of a blood smear to complete the ordered automated hemogram test (CPT codes 85025 or 85027)…… If a treating physician orders an automated hemogram (CPT code 85027) and a manual differential WBC count (CPT code 85007), both codes may be reported.
85007 Blood count; blood smear, microscopic examination with manual differential WBC count
85008 Blood count; blood smear, microscopic examination without manual differential WBC count
The collection of the specimen by venipuncture (e.g., 36415) is not considered an integral part of the laboratory procedure performed. If both the collection of the specimen(s) by venipuncture and the laboratory procedure(s) are performed, then it would be appropriate to report a code for the collection of the specimen(s) in addition to the appropriate code(s) from the 80000 series for the laboratory procedure(s) performed.
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare & Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited at the CLIA certificate level.
The Current Procedural Terminology (CPT) codes for the following new tests must have the modifier QW to be recognized as a waived test.
- 83516QW, October 2, 2017, Quidel Corporation, InflammaDry
- 87809QW, October 3, 2017, Quidel, AdenoPlus Test {Tear Fluid}
- 82274QW, G0328QW, October 13, 2017, Enterix Inc. InSure One – One Day Fecal
Immunochemical Test - 85025QW, November 6, 2017, Sysmex XW-100
Read also: Coding guide for Evacuation of Hematoma for different techniques
LAb fees for CPT code 85025
| Modifier | Payment Rate | Pricing Indicator |
|---|---|---|
| N/A | $7.77 | National |
| QW | $7.77 | National |
Lab fees for CPT code 85027
| Modifier | Payment Rate | Pricing Indicator |
|---|---|---|
| N/A | $6.47 | National |
Additional Code Information for CPT code 85025 & 85027
NCCI edits for CPT code 85025 and 85027
Major Code/Column 1 Minor Code/Column 2 Effective Date Deletion Date Modifier/Policy Indicator 85025 85004 1/1/2003 * 0-Not allowed 85025 85007 1/1/1999 * 0-Not allowed 85025 85008 7/1/2003 * 0-Not allowed 85025 85009 1/1/2003 * 0-Not allowed 85025 85013 1/1/1996 * 1-Allowed 85025 85014 1/1/1996 * 1-Allowed 85025 85018 1/1/1996 * 1-Allowed 85025 85023 1/1/1996 3/31/2003 1-Allowed 85025 85024 1/1/1996 3/31/2003 1-Allowed 85025 85027 1/1/2003 * 1-Allowed 85025 85032 1/1/2003 * 0-Not allowed 85025 85041 1/1/1996 * 1-Allowed 85025 85048 1/1/1996 * 1-Allowed 85025 85049 1/1/2003 * 1-Allowed 85025 85585 7/1/1999 3/31/2003 0-Not allowed 85025 85590 7/1/1999 3/31/2003 0-Not allowed 85025 85595 1/1/1996 3/31/2003 1-Allowed 85025 88738 1/1/2010 * 1-Allowed 85025 96523 4/1/2019 * 0-Not allowed 85025 G0306 1/1/2004 * 0-Not allowed 85025 G0307 1/1/2004 * 0-Not allowed 85027 85004 1/1/2003 * 0-Not allowed 85027 85008 7/1/2003 * 0-Not allowed 85027 85013 1/1/1996 * 1-Allowed 85027 85014 1/1/1996 * 1-Allowed 85027 85018 1/1/1996 * 1-Allowed 85027 85023 1/1/1996 3/31/2003 1-Allowed 85027 85024 1/1/1996 3/31/2003 1-Allowed 85027 85025 1/1/1996 12/31/2002 1-Allowed 85027 85032 1/1/2003 * 0-Not allowed 85027 85041 1/1/1996 * 1-Allowed 85027 85048 1/1/1996 * 1-Allowed 85027 85049 1/1/2003 * 1-Allowed 85027 85585 7/1/1999 3/31/2003 0-Not allowed 85027 85590 1/1/1996 3/31/2003 0-Not allowed 85027 85595 1/1/1996 3/31/2003 1-Allowed 85027 88738 1/1/2010 * 1-Allowed 85027 96523 4/1/2019 * 0-Not allowed 85027 G0307 1/1/2004 * 0-Not allowed
Top ICD 10 diagnosis supporting CPT code 85004, 85007, 85008, 85013 , 85014, 85018, 85025, 85027, 85032, 85048, 85049
D50.9 Iron deficiency anemia, unspecified
D64.9 Anemia, unspecified
E03.9 Hypothyroidism, unspecified
E11.65 Type 2 diabetes mellitus with hyperglycemia
E11.9 Type 2 diabetes mellitus without complications
E53.8 Deficiency of other specified B group vitamins
E55.9 Vitamin D deficiency, unspecified
E78.00 Pure hypercholesterolemia, unspecified
E78.2 Mixed hyperlipidemia
E78.5 Hyperlipidemia, unspecified
I10 Essential (primary) hypertension
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
K21.9 Gastro-esophageal reflux disease without esophagitis
N18.3 Chronic kidney disease, stage 3 (moderate)
N39.0 Urinary tract infection, site not specified
R53.83 Other fatigue
R73.01 Impaired fasting glucose
R73.09 Other abnormal glucose
R79.89 Other specified abnormal findings of blood chemistry
Z79.899 Other long term (current) drug therapy