Confused between different Complete Blood Count (CBC) codes? Use CPT code 85027 for a test without an automated differential! CBC is the standard for assessing and diagnosing a wide range of medical conditions, including anemia and infections. CBC is, in fact, so common that healthcare providers perform over 500 million of these tests annually in the U.S.
So, coding shouldn’t be a problem, right? Unfortunately, practices still struggle with coding this test despite performing it routinely. The root cause is, as usual, coding confusion. To clarify this, we will break down a popular hematology code, CPT code 85027.
CPT Code 85027 – Description
So, what is the actual description of CPT code 85027? It refers to a common blood test, a complete blood count (CBC) without automated differential. In simple terms, it means that the test does not use a machine to count different types of white blood cells. So, what does it actually cover?
A standard CBC helps healthcare providers assess a patient’s overall health by analyzing the following components in their blood:
- Red blood cells (RBCs)
- White blood cells (WBCs)
- Platelets (thrombocytes)
- Hemoglobin
Typically, lab analysts measure hemoglobin via:
- Spectrophotometry (a method for analyzing a chemical substance’s interaction with light), and
- Hematocrit (a test for determining the number of RBCs in your blood).
In short, lab analysts perform this test using an automated analyzer. They use CPT code 85027 when the differential WBC count is not required.
Scenarios Where CPT Code 85027 is Applicable
Want to reduce coding mistakes to avoid payment delays for a CBC? Learn how to use CPT code 85027 appropriately by understanding the following scenarios:
Investigating Unexplained Symptoms
Did you know that medically unexplained symptoms (MUS) are quite common across all specialties? Around 45% of all general practice consultations and 20% of primary care visits are due to these symptoms. So, what do healthcare providers usually do? They often conduct blood tests to investigate MUS.
So, for our first example, suppose a young adult (aged 21) visits a primary care clinic with unexplained symptoms. He reports persistent fever and fatigue. Suspecting a viral infection, the healthcare provider orders a CBC without an automated differential.
The patient then goes to the lab for the test, where a technician draws his blood and uses a machine to measure RBCs, WBCs, platelets, and hemoglobin. The technician then uses CPT code 85027 to report this test.
Monitoring an Ongoing Health Condition (Chronic Kidney Disease)
Many people with advanced chronic kidney disease (CKD), stage 3 to 5, also have anemia. According to NHANES data (from 1999-2000 to 2017-2018), around 25% of Americans with stage 3 to 5 CKD suffered from this problem.
For the second scenario, assume a lab technician performing a CBC to monitor a chronic kidney disease. Let’s get into the details! Assume a 66-year-old man with stage 3 chronic kidney disease arrives at a hospital for his routine checkup. The physician evaluates his condition and notes his new symptoms: extreme fatigue, weakness, and shortness of breath.
Noticing the severity of the patient’s condition, the physician orders a standard complete blood count test. A lab technician performs the test without an automated differential and then bills for it using CPT code 85027.
Monitoring the Effectiveness of a Treatment (Chemotherapy)
Around 25% of cancer patients in the U.S. undergo chemotherapy via different methods. To check the effectiveness of this treatment, healthcare providers conduct many tests, including a complete blood count (CBC).
Finally, consider a 66-year-old woman with stage 2 breast cancer. After completing 2 cycles of chemotherapy, the oncologist orders a CBC without an automated differential to monitor the treatment’s impact on the patient’s blood cells.
A lab technician collects her blood sample and performs the test using an analyzer. He then uses CPT code 85027 to document the test.
Applicable Modifiers for CPT Code 85027
So, which modifiers can help you communicate additional information about a CBC? You can use the following with CPT code 85027:
Modifier 59
Was the complete blood count unrelated to other tests you performed on the same patient within the same day? For example, if you performed a CBC with automated differential and then performed another test without WBC differential for a different reason, use modifier 59 with CPT code 85027. This modifier will help you receive a separate payment for this test.
Modifier 90
Did you perform the test on reference? For example, a healthcare provider referred this test to an outside lab due to a lack of proper equipment. In this case, the laboratory can apply modifier 90 to CPT code 85027.
Modifier 91
Did you repeat a CBC without automated differential on the same day due to medical necessity? For example, you performed the test again to monitor a patient’s condition or response to a medication. In this case, append modifier 91 to CPT code 85027.
CPT Code 85027 – Billing & Reimbursement Guidelines
So, how can you obtain quick approvals for CPT code 85027? It is quite easy! Follow these reimbursement and billing guidelines:
Use 85027 for a CBC without Automated Differential
Our first advice? Don’t confuse CPT code 85027 with differential codes. This hematology code covers a standard complete blood count. In simple words, it does not include the analysis of different types of white blood cells in a patient’s blood. Hence, use it appropriately to avoid denials.
Report Additional Details with Appropriate Modifiers
Modifiers can also help you receive timely payment for CPT code 85027. Attach appropriate modifiers with this code to convey whether you repeated the test or performed it on someone’s reference. Avoid using the QW modifier with this code, as a CBC is not a CLIA-waived test due to its moderate complexity.
Document Important Details to Justify the Medical Necessity
You must also justify why you performed a CBC test without an automated differential. Therefore, document the following details in the patient’s record:
- Patient’s condition and symptoms with appropriate ICD-10 codes
- Test report and findings
Summary
A simple blood test, like complete blood count, can create billing confusion if you are unaware of its coding requirements. CPT code 85027 is a commonly used hematology code, covering a standard CBC without automated differential.
We have covered all the essentials of this code, so you don’t confuse it with another similar option, CPT code 85025. If you have read this blog, you should understand the accurate application of this code. To clear your confusion, we have highlighted three real-life scenarios, along with applicable modifiers and billing requirements.
However, if you want to maximize your reimbursements, you can outsource coding to an expert. Consider partnering with a company that understands the nuances of all codes, including CPT code 85027. In short, choose a reliable name that offers pathology billing services.
