Wiki Medically necessary code for cpt-80061

[bcorlene@yahoo.com]

I'm looking for a medically necessary ICD10 code to bill for lipid panel 80061. most insurances will only cover if it's medically necessary and my providers use code for all well visits.

 

[erjones147]

We have that problem here, as well. We use a lot of locum FNP's who think that patient-requested annual labs or "just in case" screening labs are perfectly fine to order

If the patient has no known problems with lipid metabolism or obesity and they are only in for a well check, then why are we ordering lipid panels?

If your providers are anything like mine, then you just will not get a satisfactory reply

I know we are not allowed to question provider judgment, but on the other hand, they don't have to deal with the no pays

 

[ca_cpc]

In my experience: It depends on the insurance - a number of them do cover screening lipid panels as part of a well visit. Even Medicare will generally cover a cholesterol screening (including the 80061) every five years with code Z13.6 if there isn't a known condition for it. A lot of private insurances will cover yearly with Z00.00, Z13.220, or Z13.6 - naturally they can't be consistent with their preferences, so you should double-check with the carrier. And of course, frequency and coverage can depend on the patient's plan, as well. I may be mistaken, but I believe lipid panels are actually one of the more commonly-covered screening labs. It just (unfortunately!) requires a little research with carriers and plans.