Medicare Compliance & Reimbursement
Labs Should Ramp Up Diabetes Screening Tests
Billing at least once per year for all patients now allowed. Patients who display any of these symptoms qualify for a bi-annual diabetes screen no fewer than six months from their first test.
The Medicare Modernization Act (MMA) rang in the New Year with far-reaching reimbursement changes that open the door for annual diabetes screens for patients - and bi-annual ones for those who qualify.
"Before this, Medicare patients were refused screening [for diabetes] except for certain procedures," explains Margaret Ann Hyder, lab manager for Clinical Laboratory Services in Lincolnton, NC.
Good news: The screening benefit, effective Jan. 1, allows for one test per year for patients not previously diagnosed with diabetes. That means a diabetes screen can become part of patients' annual physicals, Hyder asserts.
The rules are especially helpful for those at risk for developing diabetes, points out Maggie Mac, a health care consultant with Pershing, Yoakley & Associates in Clearwater, FL. Medicare says it will consider patients to be "at risk" if they present with at least one of the following symptoms:
Medicare will also consider patients at-risk when they have two or more of the following symptoms:
Labs must use a CPT code plus the diagnosis code V77.1 (Special screening for diabetes mellitus) to report a diabetes screening test. To report six-month screens, use the V77.1 diagnosis code, the correct CPT code and the HCPCS modifier -TS (Follow up service), stresses Anne Pontius, president of Laboratory Compliance Consultants in Raleigh, NC. Without the mod, Medicare doesn't know that this claim fell into the at-risk column.
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Labs Should Ramp Up Diabetes Screening Tests
Billing at least once per year for all patients now allowed.
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