Laboratory Question for the Week of January 16, 2017

Laboratory Compliance Question of the Week

Question:

If a treating physician orders an automated hemogram (CPT code 85027) and a manual differential WBC count (CPT code 85007), can both codes be reported for Medicare patients?

Answer:

Yes, both codes may be reported, but, according to the NCCI Manual for Medicare Services, a provider may not report an automated hemogram with automated differential WBC count (CPT code 85025) with a manual differential WBC count (CPT code 85007) because this combination of codes results in duplicate payment for the differential WBC count. Medicare does not pay twice for the same laboratory test result even if performed by two different methods unless the two methods are medically reasonable and necessary.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.