When can you bill for a manual differential or a pathologist’s review of an abnormal smear?
When the laboratory typically performs and bills for a CBC with an automated differential (85025), the performance of a manual differential to confirm or rule out flagged findings of the analyzer is a quality check to determine the accuracy of the automated result. This quality check does not represent a billable procedure. The laboratory may bill based on the treating physician’s order. Does this mean your pathologist cannot review your slides? No. The pathologists’ review of abnormal smears is part of their supervision of the clinical hematology department. The department’s written protocol for review of the abnormal differential will determine the differentials that are billable by the pathologist. Be sure to adhere to the limitations CMS set on the pathologist’s billing of 85060. The code is not billable by the hospital to the intermediary or A/B MAC; there is no technical component.
This question was answered in our Coding Essentials for Laboratories. For more hot topics relating to laboratory services, please visit our store or call us at 1.800.252.1578, ext. 2.