Screening lipid panel dx for Medicare pt


La Crosse Wisconsin Chapter
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A Medicare patient presents for annual preventative exam. The provider ordered diagnostic and screening labs. The patient had a screening lipid ordered. The patient has risk factors of hypertension and obesity, but no diagnosis of cardiovascular disease. In reviewing Medicare LCD for this service, is it appropriate to append diagnosis Z13.6 screening for cardiovascular disorders to the lipid lab ordered? Thank you for your help!

HPI annual exam
_______ is a 67 year old female who presents to clinic for her annual preventative exam. She has spent the past few months in St. Louis. While there, she was seen by a dermatologist. Otherwise, no changes to her health. She denies problems today. She admits she has been quite sedentary while away, making several quilts. She has not been eating very "healthy" either. She does take a multivitamin and biotin supplement. She has no family history of osteoporosis, but has never had a DXA scan. She says that a few months ago she sprained her MCL and was told by a doctor in Marshfield that she has the knees of a woman in her 20's. She does have low back pain and intermittent numbness/tingling of the right leg. Her last colonoscopy was done in Saint Louis 2 years ago and she was found to have polyps, told to return in 5 years. Last mammogram was a couple years ago and she cannot recall when her last PAP was, although, she has never had an abnormal.

Preventative health care (Z00.00) Colonoscopy done in 2014 or 2015. Patient to have those results transferred here. Needs to work on weight loss. Stopped smoking years ago. Labs ordered. ---glucose high. Will do A1c if patient willing. Mammogram today negative. Consider: ---DXA Immunizations; ---Pneumo 13. Had Pneumo 23 in 2013. ---Zoster --- does not appear patient has ever had the tdap, but not due for Td until 2021. (will offer above vaccines via telephone as WIR was not available at appointment time). Lipid Panel to be performed and Vitamin D, 25-Hydroxy to be performed. Essential hypertension with goal blood pressure less than 140/90 (I10) BMP unremarkable. Continue current medications. BMP to be performed. Obesity, unspecified obesity severity, unspecified obesity type (E66.9) TSH to be performed. Postmenopausal (Z78.0) Last PAP done today because has not had one in many years. If normal, patient no longer needs PAP. Impaired fasting blood sugar (R73.01) Moderate COPD (chronic obstructive pulmonary disease) (J44.9) Controlled with prn albuterol inhaler. Patient to see pulmonology soon for further treatment options. Encounter for lipid screening for cardiovascular disease (Z13.220)
As long as that is why it was ordered, its an appropriate covered diagnosis for lipid panel. Please note the limitation on the service as referenced in the NCD 190.23

§ 410.17 Cardiovascular disease screening tests.

(a) Definition. For purposes of this subpart, the following definition apply:

Cardiovascular screening blood test means:

(1) A lipid panel consisting of a total cholesterol, HDL cholesterol, and triglyceride. The test is performed after a 12-hour fasting period.

(2) Other blood tests, previously recommended by the U.S. Preventive Services Task Force (USPSTF), as determined by the Secretary through a national coverage determination process.

(3) Other non-invasive tests, for indications that have a blood test recommended by the USPSTF, as determined by the Secretary through a national coverage determination process.

(b) General conditions of coverage. Medicare Part B covers cardiovascular disease screening tests when ordered by the physician who is treating the beneficiary (see § 410.32(a)) for the purpose of early detection of cardiovascular disease in individuals without apparent signs or symptoms of cardiovascular disease.

(c) Limitation on coverage of cardiovascular screening tests. Payment may be made for cardiovascular screening tests performed for an asymptomatic individual only if the individual has not had the screening tests paid for by Medicare during the preceding 59 months following the month in which the last cardiovascular screening tests were performed.
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