Pathology/Lab Coding Alert

Question: Our point-of-service lab often uses a desk-top analyzer to perform alanine aminotransferase, total cholesterol, HDL cholesterol and triglyceride tests from a whole blood sample. How should we report the tests?

Virginia Subscriber

Answer: Physicians commonly order the group of tests you describe to monitor patients taking statin medication to control serum cholesterol levels. The total cholesterol, HDL cholesterol and triglyceride tests comprise the lipid panel. Physicians use the alanine aminotransferase test (ALT, formerly serum glutamic pyruvic transaminase [SGPT]) to monitor for liver damage -- a possible side effect of statin therapy.

Because CPT provides a panel code for the lipid tests, you should report 80061 (Lipid panel) rather than the individual component test codes (82465, Cholesterol, serum or whole blood, total; 83718, Lipoprotein, direct measurement; high-density cholesterol [HDL cholesterol]; and 84478, Triglycerides). If you don't perform all three tests, list the components separately instead of using the panel code.

In addition to the panel, you should report the ALT as 84460 (Transferase; alanine amino [ALT] [SGPT]) when you conduct that test.

You mentioned that you are performing point-of-care testing. If you are a lab with a certificate of waiver under the Clinical Laboratory Improvement Amendments (CLIA), the latest CMS update for CLIA-waived tests has good news for you. CMS approved the previously mentioned codes for CLIA-waived labs when you perform them on the Cholestech LDX analyzer.

Don't miss: If you are a CLIA-waived lab, you should report each of the codes with modifier QW (CLIA waived test) to show that you can rightfully perform and bill for the test.