Cardiology Coding Alert

Understanding the asymptomatic/screening link is key for proper reporting.

If you don’t know that five years equal “at least 59 months,” then the time to brush up on your cardiovascular screening blood test rules has arrived. Getting up to speed is as easy as 1-2-3 with these frequency, lab code, and V code essentials.

1. Which Patients Are Eligible?

All asymptomatic Medicare beneficiaries are eligible for the cardiovascular screening blood tests -- as long as they have not had the test in the last five years, which is as often as Medicare will cover the screening. To be exact, you must make sure that at least 59 months have passed since the last covered cardiovascular screening blood test,according to “The Guide to Medicare Preventive Services” at www.cms.hhs.gov/mlnproducts/downloads/psguid.pdf,starting on page 11.

No symptoms: As mentioned above, the beneficiary must be asymptomatic for you to report the lipid panel as a screening test. This means that the beneficiary must have “no apparent signs or symptoms of cardiovascular disease,” according to the Guide. When a patient has symptoms, the test becomes diagnostic rather than a screening.

Revenue tip: Inform patients about the availability of screening tests based on age and family history. Also, use advance beneficiary notices (ABNs) to make patients aware of what they could be paying out of pocket should their insurer not allow for the services. (The patient may have forgotten that he had a screening three years ago, for example.) Education is the key to making sure you’re bringing in every legitimate dollar, says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CCC, CEMC, CMC, healthcare coding consultant and CEO/President of Terry Fletcher Consulting Inc. in Laguna Beach, Calif.

2. Which Tests Are Covered?

Three clinical laboratory tests comprise the cardiovascular blood screening:

82465 -- Cholesterol, serum or whole blood, total

83718 -- Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)

84478 -- Triglycerides test.

Combo: Although the physician may order the tests individually, CMS recommends ordering the full lipid panel (80061, Lipid panel), notes Ashleigh A. Raubenolt, CPC, CPC-H,CPC-P, CPMA, CEMC, CHCA, director of Chart Watch Auditing and Review, and Credentialing and Physician Contracting, at S.A. Medical of Virginia Inc. in Fredericksburg. If your practice performs the full panel, report 80061 rather than reporting the codes for the individual tests (82465, 83718, 84478).

From a clinical standpoint, ordering the full panel makes sense, says Raubenolt. For instance, if a cholesterol test came back abnormal, the physician would need to know whether the HDL and, potentially, the low density lipoprotein (LDL) measurements were high or low to treat the patient, Raubenolt continues.

Frequency alert: The five-year frequency limit for each test applies regardless of whether the physician ordered the tests individually or in a panel. For example, if Doctor A orders only one test, and then less than five years later, Doctor B orders the full panel, Medicare will not reimburse Doctor B for the test already provided within the last five years, Raubenolt says.

Lab lesson: The codes are lab codes, which means you should report them for the lab service. If your practice doesn’t perform the lab test, you cannot report the lab codes. Instead, your best option may be to use the appropriate E/M codes (99201-99215), assuming the documentation supports billing an office visit.

If you do report the lab codes, they are for waived-status tests. As long as your practice has a “waived status” ClinicalLaboratory Improvement Amendments (CLIA) certification, you can perform the tests in the office. Just remember to attach modifier QW (CLIA waived test) to the codes.

3. Which ICD-9 Codes Do I Report?

To correctly report the lipid panel screening, you must include a diagnosis code. The codes most commonly associated with the lipid panel screen are V81.0-V81.2 (Special screening for cardiovascular, respiratory, and genitourinary diseases):

V81.0 -- Special screening for ischemic heart disease

V81.1 -- Special screening for hypertension

V81.2 -- Special screening for other and unspecified cardiovascular conditions.

You may select more than one V code, says Raubenolt, but always indicate the primary reason the patient is receiving this service. For instance: “The patient has a family history of ischemic heart disease but is currently asymptomatic. No other family history is noted.” In this case, you would report only V81.0, the special screening for ischemic heart disease. If the patient has multiple family history conditions, such as heart disease and hypertension, then you may select both relevant ICD-9 codes (V81.0 and V81.1).

If you find no reason for the screening indicated in the chart, ask the physician why she ordered the screening, recommends Raubenolt. “Even though a patient may be asymptomatic, there has to be a reason to prompt the physician to order the screening,” she says. And knowing that reason “will direct coders to the appropriate code selection,” she adds.

Alternate diagnoses: Codes V81.0-V81.2 are the diagnoses that come up as “payable” without questions. But many payers also may reimburse for 278.01 (Morbid obesity), 250.x (Diabetes mellitus), 997.91 (Hypertension), and even V15.82 (History of tobacco use) if the patient is  more than 50 years old, shares Fletcher. Always check with the individual payer for guidance on covered diagnoses.