Lab Code Meet and Greet: Save Denials Now by Getting to Know 83036 and 82985

You need special documentation to report 83036 more than four times a year
If you haven't extended a hand already, it's important to get acquainted with two prominent glucose test codes today.

CMS data indicate that 83036 (Hemoglobin; glycated) is the sixth-most-reported code by endocrinologists. And 82985 (Glycated protein) is the 33rd-most-reported code. You need to know frequency limits, appropriate diagnoses and bundling possibilities to call these codes your friends.

Purpose: Endocrinologists order 83036, commonly called a hemoglobin A1C test, "to assess long-term glucose control in diabetic patients," says Joan Logue, BS, MT-ASCP, principal with Health Systems Concepts Inc. in Longwood, Fla. The test assesses glycemic control over an eight- to 12-week period.

The glycated protein test (82985) provides more short-term results, assessing glycemic control over a one- to two-week period, Logue says. Physicians often use this test monthly to monitor glycated protein in pregnant diabetic women, she adds.

Another name: If your physician documents a fructosamine test, look no further than 82985 when coding. Before CPT officially termed this test "glycated protein," the code descriptor read "fructosamine," so the two tests are one and the same, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Frequency limits: You may report 83036 no more often than once every three months for controlled diabetics, CMS dictates. More frequent testing may meet medical necessity requirements if the physician changes a patient's medications or if the test result indicates that the patient's diabetes is uncontrolled, Logue says. For 82985, "testing frequency should be no more than monthly," she adds.

Watch for bundles: You may encounter a situation in which there is medical necessity to order both 83036 and 82985 on the same day. However, a National Correct Coding Initiative edit bundles these two codes if you bill them on the same day, Logue says. If both tests are truly medically necessary, use modifier -59 (Distinct procedural service) to unbundle the codes and recoup payment for both, Logue says.

However, you should be very careful not to inappropriately unbundle. If you are unsure about reporting both codes, call your Medicare carrier and ask what it considers justified medical necessity for both tests on the same day.

The CMS Web site lists the most current National Coverage Decision (NCD) for both 83036 and 82985. Check out this resource to identify documentation guidelines for medical necessity of these tests and acceptable diagnoses.

The NCD lists the current (October 2004) ICD-9 codes that Medicare will cover. You should note that the list now includes one new code, V58.67 (Long-term [current] use of insulin), Logue says.

- Published on 2004-10-19