Recent audits by the Comprehensive Error Rate Testing (CERT) contractor, as well as by WPS Medicare have identified some issues relating to how CBC’s (complete blood counts) are being ordered by AMS clients. CMS and WPS have changed the traditional definition of CBC. The new definitions are as follows:

If a physician orders a “CBC,” then only a CBC without differential should be performed and billed.

If a physician orders a “CBC with differential,” then only a CBC with differential should be performed and billed.

What this means is that the test ordering physician, whether using a script pad order or any of the AMS test ordering methods, forms, electronic, etc, must select and mark the correct options, either CBC with diff, or CBC without diff. If using script pad ordering it must be written as “CBC with Diff”, the term “CBC” will no longer generate a differential. The AMS forms provide the correct choices.

Please be aware that as May 1, 2010, any request for “CBC” will not generate a differential.

Below are the new and revised codes for laboratory and pathology services. As of January 1, 2010, Medicare will not allow a grace period to accommodate coding revisions. The rule requires use of the medical code set that is valid at the time the service is provided. These codes were obtained from the Current Procedural Terminology CPT 2010 book published by the American Medical Association. Questions concerning your utilization of the CPT codes should be addressed with your local carrier/payer, as coding may vary from one carrier to another.