Endocrinology Coding Alert
You Be The Coder: Hyperlipidemia Requires Definitive Dx Codes
Question: Our endocrinologist often treats diabetic patients and others for hyperlipidemia. How should we code the condition and the regular lipid testing? Are there frequency restrictions for testing? Also, what code should we use for regular cholesterol checks?
Tennessee Subscriber
Answer: Hyperlipidemia is something that endocrinologists treat every day, so it's important to know how to code this condition. The diagnosis codes for hyperlipidemia are 272.2 (Mixed hyperlipidemia) and 272.4 (Other and unspecified hyperlipidemia). The former involves elevated blood lipoproteins due to an inherited metabolic disorder. Without more definitive information, you should report unspecified hyperlipidemia as 272.4.
But don't settle for this code too quickly. You should code the diagnosis and treatment of hyperlipidemia to the highest level of specificity. Be sure to read all documentation and, if you have to, ask the physician for the detailed information necessary to choose the proper code. The patient might actually have hypertriglyceridemia (272.1) or hyper-cholesterolemia (272.0).
Coverage: Medicare's national coverage determination (NCD) for lipid testing applies to both hyperlipidemia diagnosis codes (272.2 and 272.4). The NCD defines coverage rules for patients being treated for hyperlipidemia using the following tests: 80061, 82465, 83715, 83716, 83718, 83721, and 84478.
Frequency limits: For patients on anti-lipid dietary or drug-management therapy, Medicare's NCD states that "it may be reasonable to perform the lipid panel annually ... while measurement of the serum total cholesterol or a measured LDL should suffice for interim visits if the patient does not have hypertriglyceridemia."
For monitoring hyperlipidemia therapy, the NCD goes on to state that any one component of the panel or a measured LDL may be reasonable and necessary up to six times the first year. Changes in therapy or marked lipid elevation may indicate medical necessity for more frequent total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride testing. "The LDL cholesterol or total cholesterol may be measured three times yearly after treatment goals have been achieved," according to the NCD.
Regular cholesterol checks: As for coding regular cholesterol checks, you should bill for the blood draw with 36415 (Collection of venous blood by venipuncture). If your office analyzes the lab results, you should report the cholesterol test, such as 83718 (Lipoprotein, direct measurement; high density cholesterol [HDL cholesterol]), 83719 (... VLDL cholesterol) or 83721 (... LDL cholesterol).
Do not bill for an office visit also unless the staff performs additional medically necessary services. For instance, if the nurse reviews the patient's medications, you may also report a nurse visit with 99211 (Office visit for an established patient). If she finds a problem and requests that the doctor check the patient and review her treatment, you may bill for the appropriate-level physician office visit (99212-99215).
- Published on 2004-03-12
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