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Coding Consult: Answers to your questions about. . .


Cholesterol checks; a new member of the practice; types I and II diabetes.


Coding Consult

Answers to your questions about . . .

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Choose article section...Cholesterol checks A new member of the practice Types I and II diabetes

Cholesterol checks

Q: Which CPT code(s) should I use for a patient who requires regular cholesterol checks?

A: Bill for the blood draw with 36415* (collection of venous blood by venipuncture). If your office analyzes the lab results, report the cholesterol test, such as 83718 (lipoprotein, direct measurement; HDL cholesterol), 83719 (. . . VLDL cholesterol), or 83721 (. . . LDL cholesterol). You can't also bill for an office visit unless the staff performs additional medically necessary services.

For instance, if the nurse reviews the patient's medications, you may also report a nurse visit with 99211 (office visit for an established patient). If a problem is found, and the nurse requests that you check the patient and review the treatment, you may bill for the appropriate-level physician office visit (99212 to 99215).

A new member of the practice

Q: We have a new doctor who doesn't have her Medicare or other provider numbers yet. Medicare says we can let her see patients because her Medicare number is retroactive to the date of license, but that we should hold the bills until we have her provider number. We all want her to start seeing patients. One doctor in the practice says maybe we can bill under the medical director's number if he peeks in and signs the chart when the new doctor sees patients. What should we do?

A: Follow Medicare guidelines and hold her claims. The new physician can't submit claims for reimbursement from Medicare or other payers until she has received approval by way of issuance of a number by Medicare or notification of being credentialed by other payers. According to the Centers for Medicare & Medicaid Services, a physician can't provide a service and have another group partner report the service simply because she doesn't yet have a provider number. Doing so would be considered fraud.

Incident-to rules don't apply in this situation. The established physician can't submit a claim under his Medicare number for services provided by the new physician even if the medical director briefly sees the patient or signs the medical record.

Ask your other third-party payers for their policies on how a new physician becomes credentialed and when she can start providing care for patients who have coverage through them.

Types I and II diabetes

Q: When I'm choosing the "type" of diabetes for coding purposes, how old does the patient have to be to be considered an adult instead of a juvenile? Does age even matter?

A: It's time to bury the myth that age is a factor when determining if a patient has adult- or juvenile-onset diabetes.

Insulin-dependent, juvenile-onset, type I diabetes is an autoimmune disease that is typically diagnosed before age 20—thus the term "juvenile." But that doesn't mean that patients over 20 can't be diagnosed with type I diabetes.

Noninsulin-dependent, type II diabetes is often referred to as "adult-onset" because patients used to take longer to show symptoms. But many youths are being diagnosed with type II diabetes, which can often be controlled with nutrition management, exercise, and oral medication.


This information provided by The Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact The Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit www.codinginstitute.com.


Coding Consult: Answers to your questions about. . .. Medical Economics Aug. 22, 2003;80:15.

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