Primary Care Coding Alert

Coding lab tests can be a challenge when lab panels dont include all of the tests that were done. Look at each lab panel carefully to see what is on it, warns Debora Sullivan, CPC, CMA, office manager for Paul E. Gerard, MD, in Elizabethtown, Ky. If the panel doesnt include every test you perform, code each test separately.

A few examples highlight the proper coding for certain lab tests:

A 56-year-old male patient on Lipitor, a cholesterol lowering drug, comes in to have his progress monitored six weeks after he started the regimen. He also is experiencing some palpitations. In addition to coding for an office visit, 99212 (office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history, a problem-focused examination and straightforward decision-making) or higher level, if necessary, code 80061 (lipid panel which must include the following: cholesterol, serum, total; lipoprotein, direct measurement, high density cholesterol; and triglycerides).

Cathy Hill, CPC, data processing manager for Landmark Medical Center, a two-physician family practice in Kansas City, Mo., says that the FP should also code 84450 (transferase; aspartate amino) to test liver function since the Lipitor may adversely affect the liver, as well as 272.2 (disorders of lipoid metabolism; mixed hyperlipidemia) which explain that the lipids are high. Finally, Hill says you should code V58.69 (long-term [current] drug use; long-term [current] use of other medications; high-risk medications) to document the ongoing use of the medication. Many times, coders forget to use the V code, Hill says.

A 70-year-old male patient is suffering from cardiac arrhythmia and takes Coumadin to thin his blood. He visits his FP for an evaluation of how quickly his blood is clotting. Hill says you would code 85610 (prothrombin time), a finger-stick procedure for determining how fast the blood is clotting. Along with that, code V58.61 (long-term [current] drug use; long-term [current] use of anticoagulants) to indicate the use of coumadin. The
V-code indicates to the insurance company that the FP will have to monitor the patients blood on a regular basis, Hill says.

Hill says she would code 99211 (office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, five minutes are spent performing or supervising these services) along with the lab and V-codes in the above two examples because the nurse can conduct the lab tests. In Hills office, the FP signs off on the tests, and the nurse documents them.

Doug Henley, MD, who practices with Heritage Family Physicians, a five-physician practice in Fayetteville, N.C., is concerned that certain ICD-9 codes will not properly indicate the medical necessity of certain lab tests and thus, the tests will not be reimbursed.

Verify with your carriers as to which ICD-9 codes indicate the medical necessity of a lab panel so it will be covered by Medicare, Henley says. If you dont think the lab work will be covered by Medicare, have the patient sign an advance beneficiary noticeespecially if the diagnostic code is not indicating medical necessity.

Dont Overlook Changes to Pathology/Laboratory Codes Several of the pathology and laboratory codes were replaced with the issuance of CPT 2000. There has been some confusion as a result of practices submitting the old codes that no longer exist. Code 80059 (hepatitis panel) has been replaced by 80074 (acute hepatitis panel), which includes hepatitis A antibody, IgM antibody; hepatitis B core antibody, IgM antibody; hepatitis B surface antigen; and hepatitis C antibody but has eliminated hepatitis B surface antibody. Code 80058 has been replaced by 80076 (hepatic function panel), which includes albumin; bilirubin, total; bilirubin, direct; phosphatase, alkaline; transferase, alanine amino; and transferase, aspartate amino and has added protein, total. Code 80049 has been replaced by 80048 (basic metabolic panel) that must include calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium and urea nitrogen. Calcium was added to the new code. Code 80054 is now 80053 (comprehensive metabolic panel), which includes albumin; bilirubin, total; calcium; carbon dioxide; chloride; creatinine; glucose; phosphatase, alkaline; potassium, protein; total, sodium; transferase, alanine amino; transferase, aspartate amino; and urea nitrogen. This code now includes transferase, alanine amino. Be sure to differentiate between the basic metabolic panel (80048) and the comprehensive metabolic panel (80053), the latter including albumin; bilirubin, total; phosphatase, alkaline; protein, total; transferase, alanine amino; and transferase, aspartate amino in addition to the basic panels tests for calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium and urea nitrogen.