Internal Medicine Coding Alert

Published on Wed Jan 07, 2009 PDF

Question: A 65-year-old established Medicare patient is scheduled to report next week for a total cholesterol screening. His medical record indicates that he received a lipid panel earlier in the decade from a different physician. Will Medicare cover the total cholesterol screening, or is this a violation of frequency rules?

Minnesota Subscriber

Answer: Coverage depends on how long ago the patient received the lipid panel (80061, Lipid panel). In order to meet Medicare's guidelines, the panel must have occurred at least five years ago; otherwise, the carrier won't cover the total cholesterol screening (82465, Cholesterol, serum or whole blood, total).

Best bet: Check how long ago the patient received the lipid panel. If it's less than five years, let him know that Medicare won't pay for his scheduled screening before he reports. In addition to 80061, the patient is ineligible for the cholesterol screening if he's had either of the following in the past five years:

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

• 84478 -- Triglycerides.