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Pathology/Lab Coding Alert

Reader Question:

80061 Frequency Can Clog Claims

Published on Wed Jun 08, 2011

Question: The lab received a total cholesterol order for a 65-year-old established Medicare patient. His medical record indicates that he had a lipid panel screening earlier in the decade from a different physician. Will Medicare cover the total cholesterol screening?Minnesota SubscriberAnswer: Coverage depends on how long ago the patient received the lipid panel (80061, Lipid panel). In order to meet Medicare's guidelines, the panel must have occurred at least five years ago; otherwise, the carrier won't cover the total cholesterol test (82465, Cholesterol, serum or whole blood, total).Do this: Check how long ago the patient had the lipid panel. If it's less than five years, let him know that Medicare won't pay for the test. In addition to 80061, the patient is ineligible for any of the following tests if he's had the lipid panel within the past five years:8246583718 -- Lipoprotein, direct measurement; high-density cholesterol (HDL cholesterol)84478 -- Triglycerides.
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