Complete Blood Count with Differential CPT Code 85025

Error code 31 services incorrectly coded have been increasing in relation to CPT code 85025 - Complete blood count with differential (CBC w/Diff). Review of the CERT data shows that the CERT contractor has been recoding CPT 85025 to show the appropriate service rendered as CPT 85027 - Automated complete blood count (CBC), or a CBC without differential.

The CERT reviewers are finding that the physician has ordered only a "CBC" (with no mention of a differential) or CPT 85027 in many of these cases. The records are indicate either the lab performed CBC with differential in error or the billing departments are billing for a CBC with differential or CPT 85025 in error. Please make sure that you are not assuming that the CBC is with a differential and that you are billing for the appropriate service ordered and rendered.

There are some cases where the actual test that was performed was CBC with differential and CPT 85025 was appropriately billed, but more often than not the records are supporting a CBC without differential being performed which should be coded as CPT 85027.

National Government Services encourages you to review the medical records and the physician order/requisition before performing and coding the service. Please double check to make sure that what is being performed and billed matches the order.

Reviewed 11/14/2024