Internal Medicine Coding Alert
Look for Diabetes Screening Coverage Next Year
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Question: I've heard that Medicare will start covering diabetes screening tests soon, but exactly what tests will that entail? Answer: CMS decided to start covering diabetes screening tests in 2005, which is sure to come as welcome news to many IM practices.
Oklahoma Subscriber
Medicare will cover diabetes screening tests using CPT codes 82947 (Glucose; quantitative, blood [except reagent strip]) and 82951 (Glucose; tolerance test [GTT], three specimens [includes glucose]). To show the service is a screening test, include code V77.1 (Special screening for diabetes mellitus) in the diagnosis section of the claim.
But because Medicare already covers random serum or plasma glucose tests for patients with symptoms of uncontrolled diabetes, these tests aren't included under the new screening tests designation. And Medicare may start covering other diabetes screening tests via the National Coverage Decision process, according to the 2005 proposed Physician Fee Schedule, published in the Federal Register Aug. 5.
CMS defines a patient as "at risk" for diabetes - and therefore eligible for screening tests - if he has hypertension, dyslipidemia, obesity, a previous indication of an impaired glucose after fasting or an impaired glucose tolerance, or two risk factors such as being overweight or having a family history of diabetes. If a physician diagnoses a patient with prediabetes, meaning a worrying record of fasting glucose or postglucose challenge results, the patient will be eligible for two screening tests per year. Medicare will cover one screening per year for other at-risk patients.
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