Primary Care Coding Alert

Complications need special attention Diabetes refers to diabetes mellitus or, less often, to diabetes insipidus, and both conditions are characterized by excessive urination (polyuria). When physicians use -diabetes- alone, they-re referring to diabetes mellitus. The two main types of diabetes mellitus (insulin-requiring type I diabetes and adult-onset type II diabetes) are distinct and different diseases. Know the CPT Codes for Diabetes Screening Medicare pays physicians for most diabetes screenings. If your physician wants to screen a Medicare patient for diabetes, you should report one of the following lab codes:

- 82947 -- Glucose; quantitative, blood (except reagent strip). Assign this code when the provider draws the patient's blood to check for glucose after the patient has fasted for 12 hours.

- 82950 -- - post glucose dose (includes glucose). Report this code when the provider checks the patient's glucose following the patient's ingestion of a dose of glucose.

- 82951 -- - tolerance test (GTT), three specimens (includes glucose). This code is appropriate when the provider draws blood for a fasting glucose determination, and then following that the patient ingests a glucose solution before having another blood draw at half-hour and one-hour intervals.

Diagnosis: When you report any of the above three codes, you should list V77.1 (Special screening for diabetes mellitus) as your primary diagnosis code.

Must-have modifier: The three Medicare-approved diabetes-screening tests carry a -waived status.- That means if your office has obtained the Clinical Laboratory Improvement Amendments (CLIA) certification, your physician can perform the tests in the office. Be sure to append modifier QW (CLIA waived test) to the codes.

And if your physician performs a screening test on a patient with -prediabetes,- Medicare requires that you attach modifier TS (Follow-up service). For example, if your provider performs the glucose tolerance test on a prediabetes patient, you would report 82951-QW-TS.
 
Coverage guidelines: You may bill one test every six months for patients with prediabetes. But you should report only one test every 12 months for patients whom the physician has not diagnosed with prediabetes, or whom a physician has never tested.

Also, before reporting a screening code, make sure the patient has at least one of these diabetes risk factors: hypertension, dyslipidemia, obesity (with a body mass index greater than or equal to 30 kg/m2), and/or previous identification of elevated impaired fasting glucose or glucose intolerance.

If you-re not reporting the right fourth and fifth digits on 250.xx, you may be undermining patient complexity and thereby billing for lower-level services than your physician provides.

Patients with diabetes often have one or multiple complications that require the physician's extra attention and consideration, and these added complications can have a significant effect on the E/M level you bill. Use these six steps for definitive diabetes diagnosis coding to ensure that your [...]