Current Procedural Terminology (CPT) codes provide the standardized language used by healthcare providers and payers to describe medical services and procedures for billing purposes. The Complete Blood Count (CBC) with Differential is a common laboratory test that provides a broad look at a patient’s health status. This analysis identifies the precise CPT code for the CBC with Differential procedure and clarifies its use for accurate medical documentation and claims processing.
Understanding the Complete Blood Count with Differential
The Complete Blood Count (CBC) is a fundamental screening test that gives healthcare providers a snapshot of the cellular components circulating in a patient’s blood. The test measures key parameters, including the number of Red Blood Cells (RBCs), White Blood Cells (WBCs), and Platelets. It also provides measurements for Hemoglobin and Hematocrit, which assess the blood’s oxygen-carrying capacity.
The “Differential” component analyzes the five major types of white blood cells (leukocytes): Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Basophils. These cells are counted and classified. The relative percentages of these cell types change predictably in response to various health conditions, such as bacterial infections, viral illnesses, or allergic reactions. Analyzing this distribution offers a powerful tool for diagnosing and monitoring diseases.
The Standard CPT Code for Automated Analysis
The vast majority of Complete Blood Counts with Differential are performed using automated hematology analyzers. This standard, comprehensive analysis is reported using CPT Code 85025. This single code covers the entire process, including the measurement of all basic CBC components and the automated breakdown of the white blood cell population.
The full descriptor for CPT 85025 is “Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count.” This designation signifies that the instrument not only determines the total count of cells but also uses technology like flow cytometry to classify white blood cells into their respective categories. The automated differential is the default method due to its speed, precision, and cost-effectiveness for routine screening.
CPT Code 85027 is used for a Complete Blood Count without a differential. Code 85027 includes the measurement of Red Blood Cells, White Blood Cells, Platelets, Hemoglobin, and Hematocrit. However, it does not include the detailed breakdown of the five white blood cell types. If a physician orders only a basic CBC without the differential breakdown, 85027 is the appropriate code for billing.
CPT 85025 is the code most commonly associated with a standard physician order for a CBC with Differential because the differential component provides significantly more diagnostic information regarding immune response and infection. The code reflects the comprehensive nature of the test. Correctly selecting between 85025 and 85027 depends entirely on whether the differential count was performed by the automated analyzer.
Coding for Manual Differentials and Specific Component Counts
While automated analysis is the norm, certain circumstances require a laboratory technician to manually examine a prepared blood smear under a microscope. This detailed review is triggered when the automated instrument flags the sample due to abnormal cell morphology, immature cells, or extremely low white blood cell counts. The code used to report this microscopic examination and manual differential is 85007.
CPT 85007 is considered medically necessary when the automated analyzer cannot produce a reliable differential or identifies abnormalities needing visual confirmation. In these situations, the lab often bills the basic CBC without differential (CPT 85027) along with the manual differential (CPT 85007). This combination reflects that the initial automated analysis was incomplete or flagged, requiring the specialized, time-intensive manual review.
Tests for individual blood components are coded separately if the entire CBC panel is not performed. For instance, if a physician orders only a manual count of a specific cell type, such as a platelet count, CPT Code 85032 would be used. This code is designated for a manual cell count for any single component (e.g., erythrocytes, leukocytes, or platelets) when performed in isolation. These specific codes ensure that billing precisely matches the scope of the laboratory work performed.