# Well Woman Exam with Lipid Panel coding



## fredcpc (Dec 20, 2010)

We had a 61 year old woman for annual physical exam. She had various problems including a history of hyperlipidemia, so the doctor ordered a fasting Lipid Panel check. The doctor did not list symptoms for the lipid test, just the final dx note that stated Hx of Hyperlipidema. My understanding is that a lipid test is included in a Well Woman exam, so for this situation I would not list any dx codes relating to the Hyperlipidemia. ANy thoughts?


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## btadlock1 (Dec 20, 2010)

Some insurers will cover 80061 and 83721 with a routine diagnosis, but a lot won't. You can submit them under the well check code and see what happens, but if it denies, you may have to resubmit them with hyperliidemia as the Dx. The physician is checking the lipids because of the history of hyperlipidemia, so it's fair to say that they believe that the patient may have hyperlipidemia at the present time. You should clarify that with the doctor, though, and may need to have them append the medical record if it's not clear. The rationale for ordering labs doesn't have to be explicitly stated, as long as it's easily inferred.

On a side note, if your doctor ordered a full panel and the LDL, the LDL (83721) will deny as inclusive to the 80061, and will require a 59 modifier to process on its own. This is because you can get a pretty accurate calculaton of the patient's LDL based off of the results on the 80061. There are a few exceptions to this situation which make it medically necessary to run both tests; most notably, when the triglyceride level is over 400. Just a little fun fact, in case you didn't know!


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## fredcpc (Dec 20, 2010)

*Well woman and Lipid panel*

I am a remote coder and can not check with doctor. It would be nice though. All I have is Well woman exam, 99396 with a V72.31. They also did a Blood occult, 82270 with V76.51 (I am coding this cpt). A few other significant problems (Fibromyalgia, Depression, and Dermatitis), including as the doctor put it Hx of Hyperlipidemia. All I know is that it is a "fasting lipid panel" was ordered that was related to Hx of Hyperlipidemia. My feeling is to code 1) 99396, 99213-25 (link to the problems), and then 3)82270. Would you code it this way? And would you code the lipid panel?  

Personally, I think the labs usually code and bill for the lipid panels and not the offices.


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## btadlock1 (Dec 20, 2010)

Depends on whether the lab is in-house or not - some of our clinics bill labs, and some don't, so whether or not you code the lipid panel is up to you. I wouldn't suggest billing an additional 99213/25, though, unless you're prepared to assign a definitive, current problem diagnosis. Having a history of a condition alone, won't cut it to prove you went above and beyond a well-check. Any relevant history that could feasibly have an affect on the patient's health becomes part of the "relevant risk factors" element of preventive exams. It only becomes signficant enough to warrant a separate E/M code when there are indications that it is currently problematic, therefore requiring specific evaluation and medical decision making elements.


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## fredcpc (Dec 20, 2010)

*Well woman and Lipid panel*

Connected with the 99213-25, I have Fibromyalgia of which the doctor is monitoring the meds; then, I Dermatitis of which the doctor is giving a new Rx for Prednisolone; then Depression of which the doc is also monitoring the meds. Pretty strong 99213. 

On the Lipid panel, I don't feel comfortable about listing Hyperlipidemia, the only thing that is in the hx and ex is a family member with HYperlipidemia. I could code the lipid panel with a screening V77.99. What do you think? Better safe than sorry. But what is the CPt for Fasting LIpid panel? Here are what the notes say, "Needs fasting lipid panel check. Will notify her of results." Any thoughts here?   

You have to be a mind reader for some of this stuff.


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## btadlock1 (Dec 20, 2010)

I think he's referring to the 80061 - patients are typically told to fast for it for optimal results, although it's not supposed to have much of an impact (or so I've read - failure to fast is not a legitimate reason to perform the LDL separately from the complete panel - but I'll shut up about those now...) What that does tell me, is that the lipid panel was not done on that date of service, unless the patient just_ happened _to fast before going in that day. 

If you are to code it and verify which date of service it happened on, you could code it with V70.0 or V72.31, and it would be allowed (provided the patient has coverage for this lab under their routine benefits) , but V77.91 (Screening for lipoid disorder, NEC) is technically the correct code IF there are no apparent signs/symptoms of a current lipoid disorder documented.


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## preserene (Dec 20, 2010)

Lipid profile has to be taken during fasting to avoid eroneous results (findings of the lipid components; so also many of the biochemical tests/profiles) 
So you don't have to give "  "  for the fasting aspect of the lipid profile. Just take as it is.
You have to support with ICD-9 for performing the test. If patient had personal history of hypercholererimia(lipidemia)report with Vcode; and so also Family H/o hyperlipidemia is equally important to report( with Vcode), because lipidemia has familial tendency and runs in some/all members of the family.


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## fredcpc (Dec 20, 2010)

*Well woman and Lipid panel*

I think you are right about the Lipid panel, so no CPT on this one. But the Dx for Hx of Hyperlipid is V12.2. Perhaps I should code that although it feels weird.


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## btadlock1 (Dec 20, 2010)

If you've got room for it on either of your E/M's, it wouldn't hurt to add it. It's relevant somehow. If you don't have room, I wouldn't worry about it.


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## fredcpc (Dec 20, 2010)

*Well woman and Lipid panel*

Brandi -- this the same encounter as the WW and lipid panel. So, so I may just go with the 692.1 and maybe the hx of hyperlipidemia - V12.2. I may include the V12.2 because the doc is going send the pt to the lab to get a Fasting Lipid Panel. It feels good even though I have about 6 dx codess.


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## btadlock1 (Dec 20, 2010)

You should add it if you feel that it's important, but it's just a side note, so don't bump more significant diagnoses in favor of it. There's only room for 4 codes on the HCFA 1500, so it'll probably never make it on the claim, anyways.


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## fredcpc (Dec 20, 2010)

*Well woman and Lipid panel*

Thank you for all the help. Great to be able to discuss this with another coder. Do you discuss coding on FB?


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## btadlock1 (Dec 20, 2010)

Not specifically - I'm in a couple of groups, but I don't visit the pages much - it's mostly people complaining about the job market when I do. That, and FB is blocked when I'm at work, which is where my codebooks usually are.


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## fredcpc (Dec 20, 2010)

*Well woman and Lipid panel*

Ok, thanks again.


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