Check for Full Lipid Panels before Choosing 80061

Posted on 11 Jan, 2016 |comments_icon 0|By Chris Boucher
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You must have evidence of three tests to choose full panel code.

If encounter notes indicate that your provider performs a “lipid panel test,” be sure you don’t just mark down 80061 and go on about your day.

Reason: In order to code correctly, you’ll need to know how many tests the provider performed. A full lipid panel consists of three tests:

  • Cholesterol, serum or whole blood (82465, Cholesterol, serum or whole blood, total)
  • Lipoprotein (83718, Lipoprotein, direct measurement; high density cholesterol [HDL cholesterol])
  • Triglycerides (84478, Triglycerides) 

Before you code: Check the notes, or ask the provider, to be sure she performed all three of these tests. If the provider performed all three of the above blood tests on the same patient during the same encounter, code the encounter with 80061 (Lipid panel).

For Medicare payers, and some private payers that follow Medicare’s lead, append modifier QW (CLIA-waived test) to 80061 to show that your practice has CLIA certification. If you are unsure of a payer’s stance on the QW modifier, call and check with a representative before coding CLIA-waived tests.

For a list of CLIA-waived tests, see www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/waivetbl.pdf.

Report 1-2 Tests Separately

Reporting lipid panels is easy enough when the provider performs all three of the aforementioned tests. When she only orders one or two of the tests, however, coding gets more interesting. Though it’s a rare occurrence, the entire lipid panel is not necessary in certain specific situations.

Let’s say you are coding a claim that says “lipid panel performed” in the notes. You ask the provider if she performed a full lipid panel, and she says she only performed cholesterol and lipoprotein panels.

In this scenario, you would:

  • report 82465 (Cholesterol, serum or whole blood, total) for the cholesterol panel with modifier QW appended, if necessary, and
  • report 83718 (Lipoprotein, direct measurement; high density cholesterol [HDL cholesterol]) for the lipoprotein panel with modifier QW appended, if necessary.

Author

Chris Boucher


Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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