Wiki A1C Help.....

[StacyGalloway]

Per Medicare a payable DX for the A1C is v58.69. Does this have to be paired with something else in order for them to pay? They deny V58.69 alone and there is nothing in the edits to indicate it needs any other code. Any thoughts.......

 

[racauditor]

A1C response

Hi Stacy,

Need more info but I hope this helps. Hgb A1C assesses the glycemic index (blood sugar levels) of a patient over a 4-8 wk period. Did the patient have an abnormal glucose level (hyperglycemia) or an abnormal glucose tolerance test, is the patient a diabetic? (If so, is the patient on insulin long term?). Does the patient have gestational diabetes, on glucocorticoid therapy, i.e. steroids), other endocrine disorder, pancreatitis, etc? Review the record to see if the patient have any of these diagnosis or other. You may have to more specific, i.e. long term use of insulin-V58.67 (if applicable) or any of the other codes I listed above. Hope this helps, or ask you physician what was the reason for the test, and make sure the diagnosis was documented in the record or on an order when the Hgb A1C was drawn. Note there are also other diagnosis that applicable for that test, I listed a few examples for you.

 

[StacyGalloway]

This was a case of an A1C ordered for a patient with out the patient having any "real" reason to have the lab drawn. The patient is on several other medications, but nothing for diabetes. I am sure we will end up writing it off.