Pathology/Lab Coding Alert

Question: If a patient is receiving treatment for hyperlipidemia, how should we code the condition and the regular lipid testing? Are there frequency restrictions for testing? Connecticut Subscriber Answer: The diagnosis codes for hyperlipidemia are 272.2 (Mixed hyperlipidemia) and 272.4 (Other and unspecified hyperlipidemia). The former involves elevated blood lipoproteins due to an inherited metabolic disorder. Without more definitive information, you should report unspecified hyperlipidemia as 272.4. Medicare's national coverage determination (NCD) for lipid testing applies to both of these diagnosis codes. The NCD defines coverage rules for patients being treated for hyperlipidemia using the following tests:
80061 Lipid panel
82465 Cholesterol, serum or whole blood, total
83715 Lipoprotein, blood; electrophoretic separation and quantitation
83716 Lipoprotein, blood; high resolution fractionation and quantitation of lipoprotein cholesterols (e.g., electrophoresis, nuclear magnetic resonance, ultracentrifugation)
83718 Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
83721 Lipoprotein, direct measurement; LDL cholesterol
84478 Triglycerides. For patients on anti-lipid dietary or drug-management therapy, Medicare's NCD states that "it may be reasonable to perform the lipid panel annually while measurement of the serum total cholesterol or a measured LDL should suffice for interim visits if the patient does not have hypertriglyceridemia."

For monitoring hyperlipidemia therapy, the NCD goes on to state that any one component of the panel or a measured LDL may be reasonable and necessary up to six times the first year. Changes in therapy or marked lipid elevation may indicate medical necessity for more frequent total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride testing. "The LDL cholesterol or total cholesterol may be measured three times yearly after treatment goals have been achieved," according to the NCD. Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors'Anatomic Pathology Services in Jonesboro, Ark.; and Laurie Castillo, MA, CPC, CPC-H, CCS-P, past member of the National Advisory Board of the American Academy of Professional Coders and vice president of ambulatory services for Health Revenue Assurance Associates in Chapel Hill, N.C.