Cardiology Coding Alert

Don't try to report this code with lipid panel.

If your practice performs its own lab tests, make sure you keep in compliance by implementing a new edit pair included in Correct Coding Initiative (CCI) version 16.3, which went into effect Oct. 1 for physicians.

Choose One Code for Single Lipid Specimen

CCI 16.3 adds three edit pairs your lab may need to know. You'll find that, effective Oct. 1, 83704 (Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses [e.g., by nuclear magnetic resonance spectroscopy]) is a column 1 code bundled with the following three codes in column 2 on the non-mutually exclusive edit list:

• 80061 -- Lipid panel
• 82465 -- Cholesterol, serum or whole blood, total
• 84478 -- Triglycerides.

What that means for you: If your lab performs a lipid panel, total cholesterol, or triglycerides test on a blood specimen, you can't additionally report 83704 for the same specimen. "The edit pairs make sense for a single specimen, because codes 80061, 82465, and 84478 describe tests that quantify certain lipoproteins," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

But what if the lab reports an abnormal result for a lipid panel, total cholesterol, or triglycerides test, and the physician orders a follow-up quantification using 83704? "The lab would perform a follow up test for quantitation of lipoprotein particle number and subclass using a different blood specimen, probably on a different day, so the edit pairs shouldn't be a problem," Dettwyler says.

Caution: Because the nuclear magnetic resonance (NMR) spectroscopy might include quantification of triglycerides and other lipid fractions, some payers might have frequency limitations for 83704 with other lipid tests.

Use modifier: On the outside chance that the lab acquires a separate specimen to perform 83704 on the same day as 80061, 82465, or 84478, you can override the edit pair with modifier 59 (Distinct procedural service).