Medical Coding

Category - Laboratory and Pathology

A pediatric patient with hyperpyrexia, headache and nausea presented to the office for a sick visit. Upon examination, the pediatrician determined that the patient needed a Complete Blood Count (CBC) to check for the presence and the amount of bacteria in the blood. The first CBC came back with a highly elevated number of white blood cells indicating infection. The pediatrician then ordered a Dexamethasone antibiotic injection in the office and waited three hours and then repeated CBC to recheck the patient’s white blood cell count. The repeat CBC showed a decrease in the number of white blood cells indicating that the antibiotic injection was effective. The pediatrician then released the patient. What is the correct code for the CBC only?
  1. 85025, 85025 -91
  2. 85025 -22
  3. 85025
  4. 85025 (X2)
Explanation
Answer: A - The correct code for the CBC only is with 85025 (Blood Count; Complete, Automated, and Automated Differential WBC Count). This code needs to be indicated twice, as the test was performed twice and the modifier -91 needs to be appended to the second code to indicate that it was a repeat laboratory test. This code and modifier indicate that the same test was repeated in the office, as medically necessary and is not a mistake. Both tests are reimbursable.
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