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Test Code Billings Clinic: 3219 Complete Blood Count (CBC) With Automated Differential-No Platelets (Medicare/Branch), Blood

Performing Laboratory

Billings Clinic Laboratory: WE Lab, Heights Lab, Oncology Lab

Useful For

  • Screening tool to confirm a hematologic disorder
  • Establish or rule out a diagnosis
  • Detect an unsuspected hematologic disorder
  • Monitor effects of radiation or chemotherapy

These counts are used as clinical guides in the diagnosis and/or monitoring of many diseases

Methodology

Electronic resistance detection enhanced by Hydro Dynamic Focusing, flow cytometry method (using a semiconductor laser), cummulative pulse height detection, and SLS (sodium lauryl sulfate) hemoglobin method, read photometrically

Specimen Requirements

  • Specimen must arrive within 24 hours of draw (ambient) or within 48 hours of draw (refrigerated).
  • Draw blood in a lavender-top (EDTA) tube(s), and send 4 mL of unprocessed EDTA whole blood refrigerated. 
  • Do not centrifuge.
  • Forward unprocessed whole blood promptly.

Reject Due To

  • Clotted specimens
  • Specimens containing small clots, fibrin strands or platelet clumps
  • Gross hemolysis
  • Samples drawn above an IV line
  • Samples kept at room temperature > 24 hours after collection

**Lipemia, icterus and cold agglutinins may affect the test results.

 

Reference Values

Reference values are included with patient’s report.

Day(s) Test Set Up

Daily

Test Classification and CPT Coding

G0307 - Complete CBC, automated (HgB, HCT, RBC, WBC; without platelet count)

85007 - Blood count; blood smear, microscopic examination with manual differential WBC count (if appropriate)
85008 - Blood count; blood smear, microscopic examination without manual differential WBC count (if appropriate)
 

LCD or NCD test. ICD-9 code is required for this test. When appropriate, obtain a properly executed ABN and submit the ABN with test order(s). See “Medical Necessity and Advanced Beneficiary Notice (ABN) Policy and Form” under "Resources" for a copy of a form and additional information.

LOINC Code Information

 

Result ID Reporting Name LOINC Code
HGB Hemoglobin 718-7
HCT Hematocrit 4544-3
RBC Erythrocytes 789-8
MCV MCV 787-2
RDW RBC Distrib Width 788-0
WBC Leukocytes 6690-2
Neut,Abs Neutrophils 751-8
Lymph, Abs Lymphocytes 731-0
Mono, Abs Monocytes 742-7
Eos, Abs Eosinophils 711-2
Baso, Abs Basophils 704-7

 

Profile/Testing Information

Reflex Rules:

1. Reflex smear review testing (85008**) at a charge of $0.00 occurs when:
    A. WBC for inpatient is <2,400 or >20,000 or WBC for referring clinic is <3,200 or >15,000

    B. RDW >20
    C. Hemoglobin <6 g/dL

    D. Hematocrit <18%
    E. MCV <75 or >105
    F. Instrument indicates possible blasts, variant lymphs, immature cells, dimorphic RBC population, or RBC agglutination

2. Reflex manual WBC differential testing (85007**) may occur when:
    A. WBC for ED or SDC is <3,200 or> 18,000

    B. Blasts present or

    C. Promyelocytes, myelocytes, and metamyelocytes total >5% or

    D. Bands >15% or
    E. Variant lymphs >15% or
    F. Nucleated red blood cells >5%

3. In the event that a peripheral blood smear interpreted by a physician with a written report (85060) is indicated, Billings Clinic Laboratory will call the ordering physician/nonphysician provider (NPP) and request a specific order for this test.

 

Note: In the event that the automated results can not be reported and further testing is required to fulfill the ordering physician/NPP’s order, only the procedure ordered will be billed. Such examples are not true reflex testing.

This test may automatically reflex to other tests. An additional fee may be added. The ordering physician/NPP must indicate if the reflex test is NOT DESIRED. Indicate on order if no reflex test is desired.

 

**If a reflex manual differential occurs, the claim submitted will be changed to codes 85027 and 85007 to reflect the actual testing that was performed. 85025 will not be billed. If 85007 is performed and billed, 85008 will not be charged.

 

When the automated results can not be reported, the test is not a true “reflex” situation. Thus when further testing must be completed in order to issue a report, CMS considers such further testing to be part of the required procedure required to fulfill the physician/NPP’s order. In such cases, only the testing ordered is billed.

 

It is inappropriate to report a confirmatory test separate from the ordered CBC test. For example, if a patient with leukemia has a low platelet count, and a manual platelet count is performed (85032), it is not appropriate to bill the 85032 in addition to the CBC ordered.

 

General Information:

This test is to be ordered when the physician/NPP requests a CBC with an automated differential. By ordering this test, the physician/NPP understands the order includes reflex testing unless otherwise indicated. This test does not include a platelet count.