Recently, our lab hired a new lab supervisor. She pointed out that we shouldn't be reporting both an automated differential and a manual diff. Our oncology center needs the ANC right away and bases treatment on that number. Then, after the manual diff is complete, the ANC could potentially change. How does your lab deal with diff's? Do you report out one or the other, not both? If so, how do you give them an ANC?

 

We report the total white cell count and 'NA' the rest. Our oncology have never had an issue with this.

We perform a manual diff on any flagged differential and NP the auto only if it's significantly different. Our oncology department has to wait on these until we can report out the correct ANC.If the manual differential matches the auto we just have a comment that the scanned results correlate with the auto but they still have to wait until we scan the slide.

In most cases here, we only report out the absolute counts from the analyzer.  If that diff looks bad, we blank it and report out a manual.  In some cases, we do both a manual and automatic (leukemias, nRBCs present etc.).  (However, note that you cannot bill for BOTH a manual and automatic diff on CBCs per CMMS in the US)..

 

Scott

When a manual diff is indicated that is all that is reported.  Automated diff disappears when manual diff in indicated.

As above - we only release valid results to Clinicians - so any significantly abnormal (or flagged) WBC Diff is not released until manual review performed.

If on manual review abnormal cells seen and previously WBC Diff released (No flags & within Technical limits), then we would amend report and ONLY report the manual WBC DIff.

Hi,

Is it permitted to bill for both the full CBC/auto diff (CPT code 85025) and the manual diff (CPT code 85007)?  Thanks,

Rachel

Rachel - NO - you cannot bill for both.

lol we had a pediatrician that always ordered a manual diff.  Most of the other techs would send the CBC which included the auto diff and the manual diff as well. The instrument allowed one to run a sample and not report the auto diff but only the manual.  I sent one out to her office one day and she called the lab shortly there after wanting to know where her diff was.  I calmly pointed it out to her that the difff was there and it was the manual diff per her order.  She was confused but didn't argue the point.  Oh and you are correct in that you cannot charge for both diffs..

Speaking of ANC, are metas and myelocyte included in the ANC calculation or just neutrophils and bands?