CERT Updates May 2010
Cahaba GBA recently updated the Comprehensive Error Rate Testing (CERT) Program Common Errors page. The errors are sorted by Type of Bill and there are two common errors listed for 13X TOB.
One error is the billing of CPT code 85025, CBC with a differential White Blood Count, when the documentation indicated the physician only ordered a CBC (as described by CPT code 85027).
The other error is the billing of CPT code 81000, Urinalysis with Microscopy, when the documentation indicated the physician ordered Urinalysis without Microscopy which should be billed with CPT code 81002. The update does not indicate how an order that states simply “urinalysis” would be interpreted, but if CERT follows the same thought process as they did for CBC orders, a urinalysis order would need to specify “with microscopy” to justify the billing of CPT code 81000.
Although this error was not for 13X TOB, hospitals should be aware that CPT code 82272 is for the billing of Occult Blood Feces, 1-3 tests. Even if the physician’s order is for occult blood x 2 and 2 tests are performed, only one unit of this code should be billed. The definition of CPT 82272 includes up to 3 results; reporting multiples with a 91 modifier for the performance of 2 or 3 tests is considered unbundling.
More information about CERT and the complete Summary of Common Errors are available on the Cahaba GBA website at https://www.cahabagba.com/part_a/education_and_outreach/cert/index.htm.