Medicare Compliance & Reimbursement

But Medicare wants a V code, not a G code, when reporting a screening.

Physicians now have a new tool in the battle to keep patients heart-healthy.

The Medicare Modernization Act (MMA) provided coverage for cardiovascular screening blood tests that will help detect cardiovascular disease and its associated abnormalities.
 
"The new benefit permits Medicare beneficiaries who have not been previously diagnosed with cardiovascular disease to receive a screening for the disease's risk factors - including individuals who have no prior history of heart problems," explains Annette Grady, a senior health care consultant with Eide Bailly in Bismarck, ND.

That means simple behavioral or lifestyle choices - such as a poor diet and lack of exercise - would qualify a patient for the CV disease screen. But there are a few rules physicians must abide by in order to collect reimbursement from Medicare, warns Diane Jepsky, a coding expert in Seattle.

Physicians cannot bill just any combination of diagnosis and procedure codes for CV disease screens, notes Christopher Young, president of Laboratory Management Support Services in Phoenix, AZ.

The MMA calls for V diagnosis codes when billing for the screening rather than the G codes you're used to, Young says. Physicians have three choices:

V81.0 - Special screening for ischemic heart disease

V81.1 - Special screening for hypertension

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

These V codes must be linked to one of these screening specific procedure codes:

80061 - Lipid panel

82465 - Cholesterol, serum or whole,blood total

83718 - Lipoprotein, direct measurement, high-density cholesterol

84478 - Triglycerides

Don't Forget Lipid Panel Exception

When ordered together, 82465, 83718 and 84478 comprise a CV disease screening panel that should be grouped and coded as 80061 (Lipid panel).

The new screening benefit is a "proactive stance that will allow patients to receive better care and stay healthier," Jepsky asserts. It's also a move that will save Medicare money down the road, she adds.

Remember: The screening benefit must be ordered by a physician and cannot occur more frequently than once every five years (that's 59 months after the last covered
screening tests), Jepsky says.