What code would I report if the physician has ordered only a CBC with no mention of a differential?


Understand that 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. Understand that 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.

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.


CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.