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Lipid Profile/Cholesterol Testing
July, 2009
According to National Government Services (NGS) providers have been
inappropriately billing a Lipid Panel (CPT code 80061) and a Lipoprotein (CPT
code 83721) test for the same patient on the same date of service.
According to the Local Coverage Determination (LCD) for Lipid
Profile/Cholesterol Testing, it is not medically necessary to perform these
tests on the same day unless the triglyceride level exceeds 400 mg/dl. It is
inappropriate to bill CPT code 80061 and 83721 (with modifier -59) to get the
claim paid unless the lipoprotein test is medically necessary (determined by
the triglyceride level).
This notice was recently published on the NGS website.
For additional information, please contact Charlene Nutter with The Quality
Management Consulting Group, Ltd. (QMCG) at 614.227.4852 /
cnutter@qmcg.com.
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