Laboratory Question for the Week of July 3, 2023


What is the correct code if a physician has ordered a CBC exclusively with no mention of a differential?


Billing for a CBC with or without a differential has historically been the focus of OIG audits and is again being identified as an issue in post-payment reviews. If the physician has ordered only a CBC with no mention of a differential, the correct code is 85027. Even if a lab has a policy in place to always perform an automated differential with a CBC regardless of what is included in the request/order, the laboratory may bill only for what is ordered in the patient’s medical record. Again, validate the clarity of the chargemaster descriptions and ensure all code options are available for accurate charge capture.

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