Cardiology Coding Alert

ABN protects you if patient forgets last screening date Medicare patients who report to your cardiologist for cardiovascular screenings are probably expecting the carrier to pay for the test. But the beneficiary or your office will be left footing the bill unless you correctly choose from four screening codes, use an approved V81.x code, and observe strict frequency guidelines. In 2005, Medicare started covering cardiovascular screening blood tests (at proscribed intervals). Check out this information on cardiovascular screening test types and how to code for each of them.
Use Lipid Panel Code When Dr Performs 3 Screens Patients who are at risk for certain types of heart disease -- such as coronary artery disease or peripheral arterial disease -- often require cardiovascular screenings, says Mary Franklin, coding/billing specialist at Virginia Medical Alliance in Springfield. Four types of screenings are available to physicians, says Sean M. Weiss, CPC, CPC-P, CMPE, CCA-P, CCP-P, senior partner at The CMC Group LLC in Atlanta. The test the cardiologist performs (or orders) will depend on the patient: Total cholesterol. This test measures the patient's total cholesterol. Code these screenings with 82465 (Cholesterol, serum or whole blood, total). Cholesterol test for high-density lipoproteins. This test checks the patient's level of "good" cholesterol. Code these screenings with 83718 (Lipoprotein, direct measurement; high-density cholesterol [HDL cholesterol]). Triglycerides. This test checks the patient's triglyceride levels. Code these screenings with 84478 (Triglycerides). Lipid panel. Although your cardiologist might perform one of the above screens individually, he could also perform all three of the tests as a panel in the same session, Weiss says. When the cardiologist performs total cholesterol, cholesterol test for high-density lipoproteins and triglycerides in the same encounter, report 80061 (Lipid panel) for the service. Note: You should also include a cholesterol test for low-density lipoproteins (LDL) in lipid panels.
Verify CLIA Cert Before Testing Suppose your cardiologist is part of a multi-specialty practice. Practices without a waived status Clinical Laboratory Improvement Amendments (CLIA) certification can forget about reporting the above cardiovascular screening codes. "If a provider's office does not have a CLIA certification or other lab certification, they are not able to provide the cardiovascular screening service or bill for it," Weiss says. Only practices with CLIA-waived status should perform cardiovascular screening tests. If you code for a CLIA-waived practice, remember to attach modifier QW (CLIA-waived test) to cardiovascular test codes to indicate that you are billing for a waived test. Example: A patient reports to a CLIA-waived multi-specialty practice. The physician conducts a total cholesterol test. You should report 82465-QW for the service.
Including V Code Is a Necessity No matter which test the cardiologist runs on the patient, Medicare requires you to include one of these [...]