Pathology/Lab Coding Alert

Question: A physician ordered cardiovascular lipid panel screening. How should I code the work?

Oregon Subscriber

Answer: Your coding will depend on exactly what the physician ordered and what the lab performed. Physicians may order any or all of the following tests to screen for cardiovascular disease:

• 82465 — Cholesterol, serum or whole blood, total
• 83718 — Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
• 84478 — Triglycerides.

Alert: These three tests comprise the lipid panel, so if the lab performs all three tests, you should report 80061 (Lipid panel) instead of the individual test codes.

Beware calculated value: Although physicians may need to know low density lipoprotein (LDL), and CPT^® provides a code for the test (83721, Lipoprotein, direct measurement; LDL cholesterol) you’ll notice that it’s not a covered test for screening. That’s because the lab typically calculates LDL from the other lipid fractions measured in a lipid panel, so you shouldn’t separately charge for a calculated value.

Waived test: If you’re a waived-status lab under the Clinical Laboratory Improvement Amendments (CLIA), you’ll need to report the lipid tests 82465, 83718, 84478, or 80061 with modifier QW (CLIA waived test).