85025

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count) and automated differential WBC count

A Complete Blood Count (CBC) with automated differential is a common laboratory test that provides information about the different cells in the blood: red blood cells (RBCs), white blood cells (WBCs), and platelets. The test measures hemoglobin (Hgb), hematocrit (Hct), RBC count, WBC count, and platelet count. The automated differential further breaks down the WBC count into its five major types (neutrophils, lymphocytes, monocytes, eosinophils, and basophils) to identify their relative proportions.

Clinical Indications

  • Diagnosis and monitoring of anemia, polycythemia, and other red blood cell disorders
  • Diagnosis and monitoring of infections, inflammatory conditions, and allergic reactions
  • Screening for and diagnosis of leukemia, lymphoma, and other bone marrow disorders
  • Assessment of bleeding and clotting disorders, including thrombocytopenia and thrombocytosis
  • Monitoring effects of certain medications (e.g., chemotherapy, antibiotics known to cause hematologic side effects)
  • Pre-operative assessment to evaluate overall health and identify potential risks
  • General health screening as part of a routine medical examination

Procedure Steps

  1. A healthcare professional draws a venous blood sample, typically from a vein in the arm, using aseptic technique.
  2. The blood sample is collected into a tube containing an anticoagulant (e.g., EDTA) to prevent clotting.
  3. The sample is sent to the laboratory for analysis.
  4. An automated hematology analyzer processes the blood sample, performing cell counts and measurements of Hgb and Hct.
  5. The analyzer uses light scatter or impedance technology to count and differentiate the various blood cell types.
  6. Results are reviewed by laboratory personnel, and any abnormal or critical values may trigger manual microscopic review or further testing.
  7. The final report is generated and sent to the ordering clinician.

Coding Guidelines

  • CPT code 85025 includes the complete blood count (Hgb, Hct, RBC, WBC, and platelet count) and an automated differential WBC count. Do not bill 85027 (CBC without differential) or 85004 (automated differential WBC count) separately if 85025 is performed.
  • Medical necessity must be documented for ordering a CBC with differential. Routine screening may be covered under certain preventive care guidelines (e.g., Z00.00 for routine examination).
  • Frequency of testing should align with clinical guidelines and patient condition. Excessive or unnecessary testing may lead to denials.
  • If a manual differential (85007) is performed in addition to an automated differential (85025) because the automated results are abnormal or require further investigation, both may be reported. The medical record must clearly justify the medical necessity for the manual review.
  • For monitoring purposes, appropriate ICD-10 codes reflecting the condition being monitored should be used.
  • Ensure that the diagnosis code provided accurately reflects the reason for the test.

Associated ICD-10 Codes