Wiki Hyperlipidemia

[Judy Lemonds]

My providers are coding hyperlipidemia E78.49 for CPT code 82550 and BCBS denies it stating inconsistent with procedure. What is everyone else using with this code?

 

[heartyoga]

Creatine Kinase

Creatine Kinase is Test for myocardial infarction and skeletal muscle damage. Elevated results may be due to: Myocarditis, Mycardial Infarction (heart attack), Muscular Dystrophy, Muscle Trauma or excessive exercise. (copied from Quest Diagnostics website).

Hyperlipidemia may not be in the list of allowed diagnosis per insurance policy.

 

[thomas7331]

I agree, hyperlipidemia alone is not a nornal indication for this test - you may wish to have a discussion with your providers about this to see what their rationale is for ordering this. It is more likely that hyperlipidemia is the patient's risk factor for heart disease and they are doing the test as a screening for other heart problems, in which case a screening ICD-10 code would be more appropriate. However, it may not be covered as a screening/preventive service either, but you would need to check with your local insurance plan to confirm whether or not the patients have this benefit.

Incidentally, hyperlipidemia with no other qualifiers should be coded as E78.5 (hyperlipidemia, unspecified). E78.49 is for 'other hyperlipidemia', which would be for a specified type of hyperlipidemia that does not have another assigned code.