Pathology/Lab Coding Alert

Question: Can we report a direct LDL test in addition to the calculated LDL that is part of the lipid panel?

Iowa Subscriber

Answer: If the physician orders a separate LDL test in addition to the lipid panel based on clinical conditions that indicate medical necessity, you can report both codes:

- 80061 " Lipid panel

- 83721 " Lipoprotein, direct measurement; LDL cholesterol.

Example: A patient has a familial dyslipidemia resulting in severe hypertriglyceridemia (272.1). The high triglyceride level may adversely affect the assay and invalidate a calculated LDL value. The physician orders a separate direct LDL measurement because the patient's results may impact her treatment, such as changes to her dietary or pharmacological therapies.

Bill both the lipid panel and the LDL test, but append modifier 59 (Distinct procedural service) to 83721 to override the Correct Coding Initiative (CCI) edit pair that prohibits billing the two codes together.

The lipid panel (80061) and direct LDL test (83721) share the same list of covered ICD-9 diagnoses in the laboratory National Coverage Determination (NCD), but this does not mean that you can always report these services together. The NCD indicates that unless documented triglyceride readings exceed 400, you should calculate LDL by using the three tests results- already included in the lipid panel:

- 82465 " Cholesterol, serum or whole blood, total

- 83718 " Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)

- 84478 " Triglycerides.

Never report 83721 for a calculated LDL value.