decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
National_Coverage_Determinations_Manual / BLOOD_COUNTS
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Article Overview
This Medicare coverage article explains when blood count testing is generally considered reasonable and necessary, and when it is not covered as screening or as part of limited requests. It is intended for coders, billing staff, and clinicians who need to understand the general coverage framework for blood counts, related laboratory components, and documentation considerations under the National Coverage Determinations Manual.
Why This Topic Matters
Blood count testing is one of the most frequently ordered laboratory services, so understanding the coverage context helps support compliant ordering, documentation, and claim submission. The article is relevant when evaluating medical necessity for hematology-related testing across a range of clinical settings.
Article Sections
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Overview
Introduces blood count testing and describes its role in evaluating and monitoring a wide range of blood and bone marrow-related conditions.
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Indications
Outlines the general clinical circumstances in which blood count testing may be considered appropriate. The section organizes the material by broad hematologic domains and related conditions.
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Limitations
Summarizes situations in which blood count testing is not covered or may be subject to additional documentation and review. It also addresses circumstances where repeat testing may be considered in relation to changing clinical status.
What You Will Learn
- How Medicare frames coverage for blood count testing
- The broad clinical categories associated with appropriate use of blood counts
- Which situations are treated as screening or otherwise not covered
- What documentation considerations are mentioned for certain claims
- How repeat testing is discussed in relation to medical necessity
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Clinicians ordering laboratory tests
- Health information management professionals
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