The previous CCI edits opened the door for reporting a medically necessary complete
blood count (CBC) with subsequent transcutaneous hemoglobin later in the day. However CCI 16.2 slams that door shut.
Think twice prior to coding two hemoglobins
According to CCI 16.2, although your lab might get a request for two medically necessary hemoglobin tests by different methods in a single day, you will not be able to bill for both. CCI has bundled 88738 with 85025 and 85027 since January 1. CCI 16.0 listed a 0" modifier indicator, meaning you couldnt override the edit pair under any circumstances. The previous CCI codes changed the modifier indicator to 1.
But now the latest CCI codes that went into effect on July 1, reinstate the 0 modifier indicator so that you cant override the edit pairs; but the change is retroactive to January 1. This means you might see payment adjustments for any claims filed during the second quarter of this year with both a CBC and transcutaneous hemoglobin test.
Remember that CCI does not bundle the hemoglobin chemistry codes like 83020 with the 85025. As such the lab could bill a stick hemoglobin, but not a transcutaneous hemoglobin, in addition to the CBC.
For more on CCI 16.2, sign up for a one-stop medical coding website. When you sign up for one, you will have access to reimbursement tools like CCI edit alerts that will help you get the latest updates as far as CCI codes are concerned. So sign up for one today and stay up to date on all the CCI code changes.