Pathology/Lab Coding Alert

Question: Are there any conditions that warrant performing a lipid panel and separate LDL assay on the same day?


Mississippi Subscriber

Answer: Although the lab typically calculates LDL from the other lipid fractions measured in a lipid panel, some clinical conditions might prompt a physician to order both tests.

For instance, a patient with familial dyslipidemia may have severe hypertriglyceridemia, raising concerns that the calculated LDL is inaccurate.

The physician might order a direct LDL (83721, Lipoprotein, direct measurement; LDL cholesterol) in addition to the lipid panel (80061, Lipid panel) because the results of both tests are medically necessary and may impact treatment.

In the lipid testing National Coverage Determination, CMS indicates that "direct measurement of LDL cholesterol (83721) and lipid panel (80061) may be reasonable and necessary if the triglyceride level is too high to permit calculation of the LDL cholesterol."

Because a National Correct Coding Initiative edit lists 80061 and 83721 together, you'll have to use modifier 59 (Distinct procedural service) to override the edit. Only use the modifier if you can document medical necessity for reporting both services together, such as a triglyceride level above 400 mg/dl. Never report 83721 for a calculated LDL.