Cardiology Coding Alert

Question: Is it appropriate to report a direct LDL beyond the calculated LDL included in a lipid profile?

Idaho subscriber

Answer: If the cardiologist believes that medical necessity supports a direct LDL measurement (83721, Lipoprotein, direct measurement; LDL cholesterol), you can bill it with modifier 59 (Distinct procedural service) in addition to the lipid panel (80061, Lipid panel).

For example: A patient has a familial dyslipidemia resulting in severe hypertriglyceridemia and raises concerns that a high triglyceride level affects the assay. Your cardiologist performs a direct LDL in addition to the lipid panel because the patient's results may impact her treatment, such as changes to her dietary or pharmacological therapies.

Keep in mind: Both the lipid panel (80061) and LDL test (83721) share the same list of covered ICD-9 diagnoses, but this does not mean that you can always report these services together. Some carriers restrict combining 80061 and 83721. These policies indicate that unless documented triglyceride readings exceed 400, you should calculate LDL by using the three tests results' already included in the lipid panel:

• 82465 -- Cholesterol, serum or whole blood, total

• 83718 -- Lipoprotein, direct measurement; high-density cholesterol (HDL cholesterol)

• 84478 -- Triglycerides.