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Matistic010@gmail.com

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I was wondering if I can get some assistance in identifying units billed for cpt codes: 83921,82726 (organic acid and long fatty chains). My team at my employer
we are having a difficult time matching up the units billed with documentation. If anyone can assist I would appreciate it.
 
Hi
Here is info on CPT lab 82726

What is the Significance of the Free Fatty Acids Blood Test Result?​

The significance of the Free Fatty Acids Blood Test result is explained.
  • A high value (greater than 25 mg/dL in adults) for the test may indicate:
    • Pheochromocytoma
    • Hyperthyroidism
    • Von Gierke disease
    • Huntington chorea
    • Acute myocardial infarction (heart attack)
    • Reye syndrome
    • Refsum disease
    • Zellweger syndrome
    • Neonatal adrenoleukodystrophy
    • Beta-lipoproteinemia
  • A low value (less than 8 mg/dL in adults) for the test may indicate:
    • Cystic fibrosis
    • Malabsorption
    • Zinc deficiency
    • Certain factors may interfere with the results of the Free Fatty Acids Blood Test. These include exercise, anxiety, other meds pt. taking and long-term fasting
The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario.
When coding you can link dx of K85-K86, R19, B25 and K50 to it per our editing system of lab codes.

​

Well hope this helps a bit......Lady T
 
Last edited:
Hi Again Matistico,:)
Here is data on lab CPT 83921 Organic Acid in our editing system. We link up to dx codes of E55, CKHD- N18, E83, D61, and dx C90. But of course it depends on provider s documentation and medical necessity of what illness searching for.
  • Inborn Errors of Metabolism. Inborn errors of metabolism are genetic disorders that disrupt biochemical pathways in the body (1). These disorders are rare, but their effects can be devastating (4).
  • B-Vitamin Deficiencies. Organic acid testing can also be used to detect deficiency (or insufficiency) of certain B vitamins. For example, elevated levels of the organic acid methylmalonic acid (MMA) in the urine are a well-validated indicator of vitamin B12 deficiency (17).
  • Gut Dysbiosis. Organic acids are produced by bacteria in the gut as they metabolize various components of the foods we eat. A portion of these acids is absorbed and excreted into the urine, providing insight into diet and gut health.
  • Impaired Fatty Acid Metabolism. If the body is struggling to burn fat for fuel
  • Well hope this is helpful!:)
  • Lady T
 
TThivierge said:
Hi Again Matistico,:)
Here is data on lab CPT 83921 Organic Acid in our editing system. We link up to dx codes of E55, CKHD- N18, E83, D61, and dx C90. But of course it depends on provider s documentation and medical necessity of what illness searching for.
  • Inborn Errors of Metabolism. Inborn errors of metabolism are genetic disorders that disrupt biochemical pathways in the body (1). These disorders are rare, but their effects can be devastating (4).
  • B-Vitamin Deficiencies. Organic acid testing can also be used to detect deficiency (or insufficiency) of certain B vitamins. For example, elevated levels of the organic acid methylmalonic acid (MMA) in the urine are a well-validated indicator of vitamin B12 deficiency (17).
  • Gut Dysbiosis. Organic acids are produced by bacteria in the gut as they metabolize various components of the foods we eat. A portion of these acids is absorbed and excreted into the urine, providing insight into diet and gut health.
  • Impaired Fatty Acid Metabolism. If the body is struggling to burn fat for fuel
  • Well hope this is helpful!:)
  • Lady T
Click to expand...
Hi Lady T,
Thank you so much for your response. I am still a little bit confused. We are typically seeing providers billing 17 units of 83921 and 4 units of 82726 as well as a lab code. We are trying to identify on the lab records when sent the units they are billing. Please see example lab attached . Thanks so much!
 

Attachments

  • Metabolomix+Sample-Report.pdf
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Last edited:
Hi Mastico
Are these lab test all done on same day for OP visit or during a week or few days while during the patient's inpatient status ? I hope the provider is documenting reason on such lab test from some of dx codes gave above. When code lab in EMR setting sometimes pt. is there for like 10 hours, then 2 sets of blood or urine lab taken differ time during 10 hour period. And 2nd set of lab put on a modifier 91. Or we will have 2 differ docs order same set of labs at differ times on same day. Each lab order has the attending doc s name on ordering those labs. This maybe happening at your facility. You should use modifier 91 on 2nd CPT code of 83921. The lab order may tell the lab tech to do so many specimens . CPT 83921 organic acid is single quantitively. So if doctor or provider order 6 specimens for the day code it CPT 83921 one time then CPT 83921 x 5 modifier 91. Ensure put definitive dx.code on it not just Z code . Id do the same with CPT 83921.. If on differ days then link the proper cpt lab code. If all on same day code one by itself and other x 6 time or 8 times or whatever and add modifier 91. Well hope this helps you out. But also you need to view lab results , order date, pt name, dte collected and provider who ordered it. This will help answer some questions
Lady T
 
Hello! I need clarification on billing a full echocardiogram 93306. We have had some controversy on when is appropriate to bill. Base on the billing guidelines it says all 4 valves must be access bilateral with color doppler and spectrum. In some cases not all measurements are done but it states due to minimal images can we still bill a full echo? Thank you
 
TThivierge said:
Hi Mastico
Are these lab test all done on same day for OP visit or during a week or few days while during the patient's inpatient status ? I hope the provider is documenting reason on such lab test from some of dx codes gave above. When code lab in EMR setting sometimes pt. is there for like 10 hours, then 2 sets of blood or urine lab taken differ time during 10 hour period. And 2nd set of lab put on a modifier 91. Or we will have 2 differ docs order same set of labs at differ times on same day. Each lab order has the attending doc s name on ordering those labs. This maybe happening at your facility. You should use modifier 91 on 2nd CPT code of 83921. The lab order may tell the lab tech to do so many specimens . CPT 83921 organic acid is single quantitively. So if doctor or provider order 6 specimens for the day code it CPT 83921 one time then CPT 83921 x 5 modifier 91. Ensure put definitive dx.code on it not just Z code . Id do the same with CPT 83921.. If on differ days then link the proper cpt lab code. If all on same day code one by itself and other x 6 time or 8 times or whatever and add modifier 91. Well hope this helps you out. But also you need to view lab results , order date, pt name, dte collected and provider who ordered it. This will help answer some questions
Lady T
Click to expand...

TThivierge said:
thank you for your insight. We are looking how to identify the number of units for the codes when looking at the medical records. For example, which section in the medical records (example would be the attached pdf) are the units located? In able for our team to determine that the providers are billing the correct units, we need to know where to look for the units billed.
Click to expand...
 
Matistic010@gmail.com said:
Hi Lady T,
Thank you so much for your response. I am still a little bit confused. We are typically seeing providers billing 17 units of 83921 and 4 units of 82726 as well as a lab code. We are trying to identify on the lab records when sent the units they are billing. Please see example lab attached . Thanks so much!
Click to expand...
This is not my area of expertise but, the description of 83921 is (83921 – Organic acid, single, quantitative). So if it's single that means it would be counted once for each organic acid. However, when searching the MUEs it shows 2:
Effective: 1-Jan-23
The MUE for 83921 is 2
The MAI is 3

So, for example, the code would be used for (METHYLMALONIC ACID (MMA), SERUM). You would have to know which organic acids are identified and tested in the report.

I am guessing there are a lot of policy guidelines and limitations on this according to which payer is being billed. Also, not sure if there might be a lab panel code that would encompass all of the tests being done on your example report which would roll up into one (possibly). 82726 is for very long chain fatty acids, so you would have to know which those were in the report. Maybe Adipic Acid Suberic Acid?

Do you have the ability to consult with the providers about this to have them help you and explain what is being tested, etc? In that sample report if you look under "Amino Acids (mg/day)" pg. 2, there are 17 listed but I have no clue if that actually corresponds or not to the code. Again, I don't deal with this type of coding much. If you look at pg. 8 under "Organic Acids" there are a bunch. I think you need provider input or more of an expert in this type coding :)
 
amyjph said:
This is not my area of expertise but, the description of 83921 is (83921 – Organic acid, single, quantitative). So if it's single that means it would be counted once for each organic acid. However, when searching the MUEs it shows 2:
Effective: 1-Jan-23
The MUE for 83921 is 2
The MAI is 3

So, for example, the code would be used for (METHYLMALONIC ACID (MMA), SERUM). You would have to know which organic acids are identified and tested in the report.

I am guessing there are a lot of policy guidelines and limitations on this according to which payer is being billed. Also, not sure if there might be a lab panel code that would encompass all of the tests being done on your example report which would roll up into one (possibly). 82726 is for very long chain fatty acids, so you would have to know which those were in the report. Maybe Adipic Acid Suberic Acid?

Do you have the ability to consult with the providers about this to have them help you and explain what is being tested, etc? In that sample report if you look under "Amino Acids (mg/day)" pg. 2, there are 17 listed but I have no clue if that actually corresponds or not to the code. Again, I don't deal with this type of coding much. If you look at pg. 8 under "Organic Acids" there are a bunch. I think you need provider input or more of an expert in this type coding :)
Click to expand...
Thank you so much for your response! Yes, everything you have said above is exactly what we have been trying to figure out. It seems as though the provider is as you indicated billing the 17 units and now I understand that these will be falling under whatever diagnosis they are trying to obtain. I agree with reaching out to the provider. Thank you again for your insight.
 
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