Advanced Search

Practice Management Alert

Reader Questions:

Modifiers Are Key to Preventing Diabetes Screening Denials

Published on Fri Mar 18, 2005

Question: I know that Medicare now covers most diabetes screening tests, but I'm confused about how to report these services. Can you explain which codes, modifiers and limitations apply?


Idaho Subscriber


Answer: As of Jan. 1, 2005, Medicare began paying physicians for most diabetes screenings. If your physician wants to screen a Medicare patient for diabetes, you should report one of the following lab codes:
 

  • 82947 - Glucose; quantitative, blood (except reagent strip). Assign this code when the provider draws the patient's blood to check for glucose after the patient has fasted for 12 hours.
     
  • 82950 - ... post glucose dose (includes glucose). Report this code when the provider checks the patient's glucose following the patient's ingestion of a dose of glucose.
     
  • 82951 - ... tolerance test (GTT), three specimens (includes glucose). This code is appropriate when the provider draws blood for a fasting glucose determination, and then following that the patient ingests a glucose solution before having another blood draw at half-hour and one-hour intervals.

    Diagnosis: When you report any of the above three codes, you should list V77.1 (Special screening for diabetes mellitus) as your primary diagnosis code.

    Must-have modifier: The three Medicare-approved diabetes-screening tests carry a "waived status." That means if your office has obtained the Clinical Laboratory Improvement Amendments (CLIA) certification, your physician can perform the tests in the office. Be sure to append modifier -QW (CLIA waived test) to the codes.

    And if your physician performs a screening test on a patient with "prediabetes," Medicare requires that you attach modifier -TS (Follow-up service). For example, if your provider performed the glucose tolerance test on a prediabetes patient, you would report 82951-QW-TS.

    Coverage guidelines: You may bill one test every six months for patients with "prediabetes." But you should report only one test every 12 months for patients whom the physician has not diagnosed with prediabetes, or whom a physician has never tested.

    Also, before reporting a screening code, make sure the patient has at least one of these diabetes risk factors: hypertension, dyslipidemia, obesity (with a body mass index greater than or equal to 30 kg/m2), and/or previous identification of elevated impaired fasting glucose or glucose intolerance.

    • Other Articles in this issue of

    Practice Management Alert

    View All