Pathology/Lab Coding Alert

Question: Physicians often order a fasting glucose (CPT 82947 ), followed two hours later by a glucose challenge test (82950). Although our physicians have told us that this testing sequence follows the American Diabetes Association guidelines for diagnosing diabetes, we're not getting paid when we bill both tests together for Medicare screening using diagnosis code V77.1 (Special screening for diabetes mellitus). Why?

Michigan Subscriber

Answer: Medicare's diabetes screening guidelines only allow one lab test to screen patients with certain risk factors but no symptoms of the disease. You can  get paid for either a fasting glucose (82947, Glucose; quantitative, blood [except reagent strip]), a glucose challenge test (82950, Glucose; post glucose dose [includes glucose]) or a glucose tolerance test (82951, Glucose; tolerance test [GTT], three specimens [includes glucose]).

For diagnostic testing that a physician orders based on signs and symptoms of diabetes such as excessive thirst (783.5, Polydipsia) or frequent urination (788.41, Urinary frequency), Medicare covers testing in accordance with the ADA guidelines.

- Reader Questions and You Be the Coder were prepared with the assistance of Laurie Castillo, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.