Corporate Compliance

Cardiovascular disease screening coverage

Compliance Monitor, January 27, 2005

Q: I have heard CMS is planning to cover cardiovascular disease screening beginning in 2005. Is that true? 

A: Yes. CMS started covering cardiovascular disease screening starting on January 1. In a program transmittal dated December 17, 2004, (CFR 410.17 and PM Transmittal 408), CMS provided details of this new benefit. 

Here is a summary of the new benefit. Medicare beneficiaries are allowed one cardiovascular disease screening every five years. The allowable blood tests under this new benefit include the following CPT codes:

80061, Lipid Panel 
82465, Total Cholesterol 
83718, HDL Cholesterol 
84478, Triglycerides

Remember, CPT codes 82465, 83718, and 84478 are included in the lipid panel and should not be billed individually in addition to the panel test. Bill only the individual tests if a panel will not be performed. Medicare is requiring facilities that bill for these screenings to submit one of the following V codes on the order for payment to be considered:

V81.0--Special screening for ischemic heart disease

V81.1--Special screening for hypertension

V81.2--Screening for other and unspecified cardiovascular conditions

Facilities and physicians should be aware that this is for screening only. If the patient presents with signs and symptoms, it would not be considered a screening exam. For more information, please review the CMS transmittal, which is available at http://www.cms.hhs.gov/manuals/pm_trans/R408CP.pdf.

This question was answered by Julie Downey, CPC, CPC-H, ambulatory coding coordinator-HIM, University of Colorado Hospital, Denver.

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