Pathology/Lab Coding Alert

For patients on anti-lipid dietary or drug-management therapy, Medicare's NCD states that "it may be reasonable to perform the lipid panel annually while measurement of the serum total cholesterol or a measured LDL should suffice for interim visits if the patient does not have hypertriglyceridemia."

For monitoring hyperlipidemia therapy, the NCD goes on to state that any one component of the panel or a measured LDL may be reasonable and necessary up to six times the first year. Changes in therapy or marked lipid elevation may indicate medical necessity for more frequent total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride testing. "The LDL cholesterol or total cholesterol may be measured three times yearly after treatment goals have been achieved," according to the NCD.

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors'Anatomic Pathology Services in Jonesboro, Ark.; and Laurie Castillo, MA, CPC, CPC-H, CCS-P, past member of the National Advisory Board of the American Academy of Professional Coders and vice president of ambulatory services for Health Revenue Assurance Associates in Chapel Hill, N.C.