Pathology/Lab Coding Alert

Question: Our lab performs a test that measures HDL cholesterol subfraction (HDL2 and HDL3), LDL subclasses, total HDL cholesterol, total LDL cholesterol, total VLDL cholesterol, total cholesterol, and triglycerides (indirect measurement). We use vertical density-gradient ultracentrifugation and enzyme test for triglycerides. How should we report   the service? 


Texas Subscriber

Answer: For cholesterol fractionation including subclasses, report 83701 (Lipoprotein, blood; high-resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed [e.g., electrophoresis, ultracentrifugation]). This single code includes the total LDL, HDL, VLDL and cholesterol as well as the HDL subfraction and LDL subclasses.

Because the code is inclusive, you should not separately report the direct measure of the lipoprotein fractions using codes such as 83718 (Lipoprotein, direct measurement; high density cholesterol [HDL cholesterol]), 83719 (- VLDL cholesterol), or 83721 (- LDL cholesterol).

Caution: In fact, the National Correct Coding Initiative (NCCI) bundles 83718, 83719 and 83721 with 83701 under the -most extensive procedure- policy. NCCI lists the code pairs with a modifier indicator of -0,- meaning that you cannot override the bundled tests under any circumstances.

Opportunity: The enzymatic triglyceride assay is not a part of 83701. You should report 84478 (Triglycerides) in addition to 83701 for the testing you describe.