Complete Blood Count – CERT Denials
June 28, 2016MAC J5 for Iowa, Kansas, Missouri, and Nebraska
MAC J8 for Indiana and Michigan
Recent claim reviews performed by the Comprehensive Error Rate Testing (CERT) contractor have noted significant error findings for complete blood count (CBC) services billed under CPT code 85025. In these cases, the service was down coded to CPT 85027 because the progress note and the physician order indicated only “CBC” with no mention of an automated differential. Without a valid order, the medical necessity of the code billed is not supported, and the Medicare payment must be adjusted to reflect the ordered test.
Source: https://www.wpsgha.com