Cardiology Coding Alert

Question: Is it appropriate to report a direct LDL beyond the calculated LDL included in a lipid profile?

Idaho subscriber

Answer: If the cardiologist believes that medical reasonability supports a direct LDLmeasurement (83721, Lipoprotein, direct measurement; LDL cholesterol), you can bill it with modifier -59 (Distinct procedural service) in addition to the lipid panel (80061, Lipid panel).

For example: A patient has a familial dyslipidemia resulting in severe hypertriglyceridemia and raises concerns that a high triglyceride level affects the assay. Your cardiologist performs a direct LDL in addition to the lipid panel because the patient's results may impact her treatment, such as changes to her dietary or pharmacological therapies.

A CMS National Coverage Determination (Number 40-12, dated July 17, 2003) states that Medicare normally covers lipid testing once per year. But Part B carrier Cigna in Tennessee, North Carolina and Idaho says in its "frequently asked questions" list that testing can occur more often if "supported by clinical indication(s)." Because no set guideline exists for testing triglyceride levels, medical necessity, rather than institutional protocol level, determines whether the patient would benefit from a separate LDL.

Keep in mind: Both the lipid panel (80061) and LDL test (83721) share the same list of covered ICD-9 diagnoses, but this does not mean that you can always report these services together. Some carriers, like Blue Cross Blue Shield of Arkansas, restrict the use of 80061 and 83721 together and say that unless documented triglyceride readings exceed 400, you should calculate LDL by using the results from the three tests already included in the lipid panel: