Pathology/Lab Coding Alert

Question: The lab performed three glucose tests on the same date and billed 82947 x 3. Medicare denied the claim. We didn’t exceed an Medically Unlikely Edits (MUE) limit or bill with any other test that could be subject to an NCCI edit, so what could the problem be?

Texas Subscriber

Answer: Instead of listing units on a single claim line, Medicare and other payers typically expect you to use modifier 91 (Repeat clinical diagnostic laboratory test) for the second and subsequent repeat tests on the same date.

That means you should report 82947 (Glucose; quantitative, blood (except reagent strip)), plus 82947-91 on each of two additional claim lines.

Caution: Make sure you’re not reporting three individual glucose test codes if what the lab is doing is actually a glucose tolerance test (GTT). Although GTT involves three separate glucose tests, you should report the entire procedure as 82951 (… tolerance test (GTT), 3 specimens (includes glucose)).