Are 80061 and 83721 separately reportable?
According to the National Correct Coding Initiative Manual for Medicare Services, there may be limited circumstances when the column-two code is separately reportable with the column-one code. On page I-33 of chapter I—General Correct Coding Policies, the Centers for Medicare & Medicaid Services give this example, which may be useful for laboratories:
…the NCCI has an edit with column one CPT® code of 80061 (lipid profile) and column two CPT code of 83721 (LDL cholesterol by direct measurement). If the triglyceride level is less than 400 mg/dl, the LDL is a calculated value utilizing the results from the lipid profile for the calculation, and CPT code 83721 is not separately reportable.
However, if the triglyceride level is greater than 400 mg/dl, the LDL may be measured directly and may be separately reportable with CPT code 83721 utilizing an NCCI-associated modifier to bypass the edit.
In Chapter X—Pathology/Laboratory Services—of the NCCI manual, section G—Chemistry, it says the following about the above codes:
1. CPT code 83721 (lipoprotein, direct measurement; direct measurement, LDL cholesterol) describes direct measurement of LDL cholesterol. It shall not be used to report a calculated LDL cholesterol. Direct measurement of LDL cholesterol in addition to total cholesterol (CPT code 82465) or lipid panel (CPT code 80061) may be reasonable and necessary if the triglyceride level is too high (greater than or equal to 400 mg/dl) to permit calculation of the LDL cholesterol. In such situations, CPT code 83721 should be reported with modifier 59.
The NCCI manual can be found at https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html under Downloads.
CPT® is a registered trademark of the American Medical Association.
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