Pathology/Lab Coding Alert

Question: A physician ordered a weekly hemoglobin A1C test to monitor a patient for diabetes, but we’re getting denials. How should I code the test to get paid? 

Georgia Subscriber

Answer: Most payers cover hemoglobin A1C testing for diabetes patients only once every three or four months. Your denials could be due to the fact that you don’t meet the payer frequency criteria.

Also called glycated hemoglobin, the hemoglobin A1C test provides a measure of blood sugar control over a longer period of time, such as three months. Physicians typically order the test once every three to six months, depending on the patient’s compliance and ability to control blood sugar.

You should report the test using one of the following codes, depending on the type of device or test (not on the testing site):

• 83036 — Hemoglobin; glycosylated (A1C)

• 83037 — Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use.

Do this: Check with your payer for frequency limits on hemoglobin A1C testing, and talk to the physician about the coverage restrictions that you find.