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Mary Posted Tue 08th of January, 2013 16:27:24 PM

One of our physicians had ordered an A1C to be done on a patient and the admission clerk asked his office for more information. The clerk was informed by the physician that the screening code (V77.1) would suffice because this was what he was told while attending conferences and reading journals that a screening A1C is now the "way" to test for a person suspected of having diabetes. However, he is adamant that he only needs to give a screening dx. Our advice to admissions was to abide by the dx and get an ABN signed at the time if there is an absence of any symptoms. Has anyone else encountered this?

SuperCoder Answered Wed 09th of January, 2013 19:14:19 PM

From Coding Alert :

Make Sure You Get Paid for Pre-Diabetes Screening

You've been performing glucose tests to screen at-risk Medicare patients for diabetes since the first of the year. Some patients - but not all - will soon be due for their first re-screening. How do you tell Medicare which patients qualify for the greater screening frequency? That's something we didn't know - until Medicare's recent direction for modifier use.

Payment Hinges on Correct Codes

You must use a CPT code plus the diagnosis code V77.1 (Special screening for diabetes mellitus) to report your diabetes screening tests. Depending on which test your lab performs, you should report one of three codes:

82947 - Glucose; quantitative, blood (except reagent strip)

82950 - ... post glucose dose (includes glucose)

82951 - ... tolerance test (GTT), three specimens (includes glucose).
Note: Medicare will cover only one of these tests for diabetes screening.

Tip: You have to alert Medicare to pre-diabetes if you want to get paid for more frequent testing. Read "Medicare Screens All Patients With Diabetes Risk" to find out who qualifies. To report your six-month screens, use the V77.1 diagnosis code, the correct CPT code, and HCPCS modifier -TS (Follow-up service), says Anne Pontius, MBA, CMPE, MT(ASCP), president of Laboratory Compliance Consultants in Raleigh, NC. Without the modifier, Medicare doesn't know that a specific claim falls into the pre-diabetes category.

Don't Confuse Screening With Diagnostic Tests

Medicare's new diabetes screening rules don't cancel out everything you were doing before, says Maggie Mac, a healthcare consultant with Pershing, Yoakley & Associates in Clearwater, Fla. "You can do bigger and better testing after the first screen if the symptoms warrant it," she says. Additional testing would no longer be considered screens, which would mean switching to a different diagnosis code.

Example: Following initial examination and screening glucose-tolerance test (82951) for a 60-year-old patient, the ordering physician diagnoses uncontrolled type II diabetes (250.02, Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled).

After initiating treatment, the physician follows the patient with periodic glycated protein tests (82985, Glycated protein) to monitor short-term glycemic control, and occasional hemoglobin A1C tests (83036, Hemoglobin; glycated) to assess long-term glucose control.

Based on the diagnosis, these follow-up tests are not screening tests, and you should not report them with the original V77.1 code. Rather, you should report these as diagnostic tests using the assigned 250.02 diagnosis code.

Medicare's National Coverage Determination for glycated hemoglobin/glycated protein describes coverage rules and frequency restrictions for these tests.

Warning: Don't report V77.1 for a diabetes screen if a patient shows symptoms of uncontrolled diabetes - code the symptoms instead, such as excessive thirst (783.5, Polydipsia) or frequent urination (788.41, Urinary frequency). Medicare's NCD for blood glucose testing already covers these conditions for diagnostic diabetes testing.

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