Hematology is the medical specialty that deals with the study of blood, blood diseases, and blood forming organs. Hematology and Oncology are sometimes grouped together because many hematologists go on to study Oncology. Hematology coding requires thorough knowledge regarding the ICD-9 and ICD-10 diagnostic codes as well as the CPT procedural codes. The coder will have to apply the correct diagnostic code to the physician’s diagnosis and also report the various procedures using the correct CPT codes. Codes relevant to hematology and oncology may also include laboratory, medicine, evaluation and management, surgery and radiology codes.
A Hematologist Might Assess
- Blood Test
- Laboratory Tests
- Blood Film Results
- Direct Coomb’s Test
- Endoscopy Results
- Genetic Testing
- Bone Scan
- Lymph Node Biopsy
- Bone Biopsy
- Enzyme Assays
Hematology Diagnostic Codes
The hematology diagnostic codes are used to distinguish the diseases of the blood and blood forming organs and range from 280 – 289. The ICD-9 codes from 280 – 285 are anemia codes. D50 -D64 are the ICD-10 codes for anemia, which will soon have to be used for the current ICD-9 codes. Coagulation defects, purpura and other hemorrhagic conditions are identified by the ICD-9 codes 286 -287 and the ICD-10 codes D65 – D69. Other diseases of blood and blood forming organs are listed under 288 – 289 ICD-9 and D70 – D77 ICD-10 codes. ICD-10, being more comprehensive has a separate code set for disorders involving the immune mechanism and these range from D80 – D89.
Hematology Procedural Codes
CPT codes for hematology range from 85002 – 85999 and come under the Pathology and Laboratory subsection. These are the codes that are used to signify the various tests and procedures that a hematologist might ask for or perform respectively.
Most often Billed Hematology CPT Codes
- 85004: Blood count; automated differential WBC count
- 85013: Blood count; spun microhematocrit
- 85014: Blood count; hematocrit (Hct)
- 85018: Blood count; hemoglobin (Hgb)
- 85041: Blood count; red blood cell (RBC), automated
- 85048: Blood count; leukocyte (WBC), automated
- 85049: Blood count; platelet, automated
- 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
- 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)
- G0306 Complete CBC, automated (HgB, Hct, RBC, WBC, without platelet count) and automated WBC differential count
- G0307 Complete CBC, automated (HgB, Hct, RBC, WBC; without platelet count)
When coding for hematology, the components are to be bundled to the appropriate panel when all components of a panel are present. If fewer components are present, they can be ordered as a panel, but billing has to be for individual components, for instance, H&H (Hemoglobin and Hematocrit).
Some Points to Note
- All hematology tests that are reported should be medically necessary and must be done on the basis of a documented physician’s or non-physician practitioner (NPP)’s order.
- When all the tests in the panel are ordered and carried out, the individual components have to be bundled to the panel level. It is important not to “unbundle” or use two or more CPT billing codes instead of one inclusive code. Tests not medically necessary and tests not asked for should not be billed. If these errors occur, Medicaid, Medicare and other payers might deny the submitted claims.
- Hematology procedures that are repeated, even when there is overlapping components of panels, can be reported with the modifier 91 if the tests are medically necessary. This modifier should however, be reported only when it becomes necessary to repeat a lab test on the same day for obtaining subsequent test results.
- The important thing here is Modifier 91 cannot be reported when the lab tests are conducted once again to confirm the results obtained initially, in the event of testing problems with equipment or specimens or some other reason.
- Another instance when this modifier cannot be used is when a series of test results such as evocative/suppression testing, or glucose tolerance tests are reported by other code(s).
- When a payer doesn’t accept modifier 91, and when specific billing guidance has not been provided for repeated laboratory tests, they cannot be billed.