Primary Care Coding Alert

Question: Which CPT code(s) should I use for a patient who requires regular cholesterol checks?

Massachusetts Subscriber

Answer: The patient may require frequent cholesterol tests due to hyperlipidemia (excess fat or lipids in the blood) and may routinely present to your office for a blood draw. In this case, you should bill for the blood draw with 36415* (Collection of venous blood by venipuncture).

If your office analyzes the lab results, you should report the cholesterol test, such as 83718 (Lipoprotein, direct measurement; high density cholesterol[HDL cholesterol]), 83719 ( VLDL cholesterol) or 83721 ( LDL cholesterol).

Do not also bill for an office visit unless the staff performs additional medically necessary services. For instance, if the nurse reviews the patient's medications, you may also report a nurse visit with 99211 (Office visit for an established patient). If she or he finds a problem and requests that the doctor check the patient and review her treatment, you may bill for the appropriate-level physician office visit (99212-99215).

Answers to You Be the Coder and Reader Questions provided by Jaime Darling, CPC, certified coder for Graybill Medical Group in Escondido, Calif.; and Lynn Handy, LPN, CPC, BSBM, director of professional development center, consulting, auditing and educational services for RevCare Inc. in Cypress, Calif., professional medical coding curriculum coding instructor for the American Academy of Professional Coders.