Pathology/Lab Coding Alert

Question: A physician ordered seven glucose blood tests over a three hour time period, including a "glucose challenge." Should the lab bill this as 82947x7?

Utah Subscriber

Answer: The "glucose challenge" means that the patient consumes a dose of glucose and the lab subsequently measures blood glucose levels. The challenge follows a baseline glucose measure taken before glucose consumption.

Because the sequence of seven blood tests involves a glucose challenge, you know that the series is a glucose tolerance test (GTT), not just a series of repeat glucose tests. That means you should not report multiple units of the glucose test code: 82947 (Glucose; quantitative, blood [except reagent strip]).

Do this: Instead, you should report the service as 82951 (Glucose; tolerance test [GTT], three specimens [includes glucose]) for the first three tests. For each additional test, you should report one unit of 82952 (Glucose; tolerance test, each additional beyond three specimens).

Code the case: The correct coding for your example would be 82951, 82952 x 4. If your payer does not accept units but instead requires modifiers, you might code 82951 with four line items of 82952-91 (Repeat clinical diagnostic laboratory test). Some payers may require you to use modifier 59 (Distinct procedural service), and you should follow their direction for billing.

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.