Pathology/Lab Coding Alert
Use a Modifier for a Repeat Test
Question: A physician ordered two glucose tests in one day based on a patient's diagnosis of "hypo-glycemia." How should the lab report this? Answer: Because the physician does not provide a more specific diagnosis than "hypoglycemia," you should report the nonspecific ICD-9 code 251.2 (Hypoglycemia, unspecified). Medicare has a National Coverage Determination (NCD) for glucose testing that lists which ICD-9 codes indicate medical necessity. Note that the glucose NCD does not list 775.0 and 775.6 as covered diagnoses.
Nevada Subscriber
If the physician provides more specific information, you should select one of the more specific hypoglycemia codes such as:
The correct CPT code for the lab glucose test is 82947 (Glucose; quantitative, blood [except reagent strip]).
Because your lab performs the test twice in one day, you'll need to append modifier 91 (Repeat clinical diagnostic laboratory test) to indicate that you performed two separate tests, and that you are not double-billing.
Pathology/Lab Coding Alert
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