Pathology/Lab Coding Alert

Want to Improve Iron-Test Pay? Dont Forget Medical Necessity


- Published on Tue, Jul 01, 2003


Your labs serum iron revenues could be anemic if insurers dont know that the patients diagnosis warrants the procedure. When it comes to getting paid for iron tests, the ICD9 Codes is just as important as the CPT code.


Whether suspecting too much or too little serum iron, the physician must tell the lab what signs, symptoms or conditions prompted an iron-test request. Medicare has made that task easier by issuing a National Coverage Determination (NCD) for serum iron studies that sets consistent standards for reporting these codes. You can access the NCD on the Internet at http://www.cms.gov/ncd/labindexlist.asp.


Labs can facilitate correct diagnosis coding by educating physicians about serum iron medical-necessity requirements and designing requisition forms to capture that information. "Labs must know that medical-necessity criteria and some frequency limitations apply to several iron studies, including ferritin (82728), iron (83540) and either iron binding capacity (83550) or transferrin (84466) so they can secure a signed advance beneficiary notice (ABN) when a payable diagnosis is absent," says Joyce Ludwick, clinical laboratory compliance consultant with Park City Solutions Laboratory Services Group in Ann Arbor, Mich.


Understand Coverage Indications


"Diagnosing anemia, iron deficiency or iron overload conditions relies on tests for iron, ferritin, and either transferrin or iron binding capacity," says Stan Werner, MT (ASCP), administrative director of Peterson Clinical Laboratory in Manhattan, Kan. You need to understand the purpose of each test to correctly report the services. See the inset for a list of serum iron CPT codes and to learn what each test measures.

Physicians must justify use of these serum iron tests by reporting signs and symptoms that indicate medical necessity, according to the NCD. For instance, the following presenting conditions may indicate iron deficiency and support medical necessity for serum iron studies such as ferritin (82728) and transferrin (84466):


Certain abnormal blood tests, for example 790.01 (Precipitous drop in hematocrit)


Acute or chronic gastrointestinal blood loss, such as 531.xx-534.xx (Gastrointestinal ulcers)


Menorrhagia, for instance 627.0 (Premenopausal menorrhagia)


Malabsorption, such as 579.x (Intestinal malabsorption)


Status post-gastrectomy, for example V15.2 (Personal history of surgery to other major organs presenting hazards to health)


Malnutrition, for instance 263.x (Other and unspecified protein-calorie malnutrition)


Malignancies, including many ICD-9 codes from the neoplasms section.


For suspected iron overload conditions, the following illustrate some conditions and ICD-9 codes that may indicate medical necessity for serum iron studies such as iron (83540) and iron binding capacity (83550), according to the NCD:


Liver disease, for example 571.4x (Chronic hepatitis)


Diabetes, for instance 250.xx (Diabetes mellitus)


Arthropathy, [...]

Pathology/Lab Coding Alert
Issue - Jul, 2003
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