LIPID PANEL CHOLESTEROL LIPOPROTEIN, ELECTROPHORETIC SEPARATION LIPOPROTEIN, DIRECT MEASUREMENT (HDL) LDL DIRECT TRIGLYCERIDES

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1 Test Code Test Name CPT CHOL Cholesterol, Serum HDL HDL, (High Density Lipoprotein) TRIG Triglycerides, Serum FTRIG Triglycerides (Fluid) LIPID Lipid Panel LDL LDL (Low Density Lipoprotein) Direct Measurement LIPE Lipoprotein Electrophoresis **** Lipoprotein High Resolution Fractionation And Quantitation **** Quantitation of Lipoprotein particle numbers and lipoprotein particles subclasses MEDICARE LIMITATIONS AND GUIDELINES: When monitoring long-term anti-lipid dietary or pharmacologic therapy and when following patients with borderline high total or LDL cholesterol levels, it is reasonable to perform the lipid panel annually. A lipid panel (CPT code 80061) at a yearly interval will usually be adequate while measurement of the serum total cholesterol (CPT code 82465) or a measured LDL (CPT code 83721) should suffice for interim visits if the patient does not have hypertriglyceridemia (for example, ICD-9-CM code 272.1, Pure hyperglyceridemia). Any one component of the panel or a measured LDL may be medically necessary up to six times the first year for monitoring dietary or pharmacologic therapy. More frequent total cholesterol HDLcholesterol, LDL cholesterol and triglyceride testing may be indicated for marked elevations or for changes to anti-lipid therapy due to inadequate initial patient response to dietary or pharmacologic therapy. The LDL cholesterol or total cholesterol may be measured three times yearly after treatment goals have been achieved. If no dietary or pharmacological therapy is advised, monitoring is not necessary. When evaluating non-specific chronic abnormalities of the liver (for example, elevations of transaminase, alkaline phosphates, abnormal imaging studies, etc.), a lipid panel would generally not be indicated more than twice per year.

2 Narrative Description ICD9 Light for dates with signs of fetal malnutrition Abnormal alkaline phosphatase Abnormal imaging study Abnormal transaminase Acute myocardial infarction Acute renal failure with lesion of tubular necrosis Alcoholism Amyloidosis Aneurysm, heart (wall) Angina pectoris Aortic aneurysms Arterial embolism & thrombosis Arteriosclerosis Arteriosclerotic cardiovascular disease Benign essential hypertension (Any form of atherosclerotic disease, or any disease leading to the formation of atherosclerotic disease) Biliary atresia Chest pain, other Chest pain, unspecified Chronic ischemic heart disease, unspecified Chronic kidney disease, Stage IV (severe) Chronic kidney disease, Stage V Chronic kidney disease, unspecified Chronic vascular insufficiency of intestine Complication of transplanted organ, kidney Corneal arcus, juvenile Coronary atherosclerosis of coronary artery of transplanted heart

3 Coronary atherosclerosis, of bypass graft (artery)(vein) of transplanted heart Coronary athrsci-artery bypass graft Coronary athrsci-unspec graft Coronary occlusion without myocardial infarction Coronary vessel aneurysm Crystalline deposits in vitreous Cushing s syndrome Degenerative and vascular disorder of ear, unspecified Diabetes mellitus Disorders of the thyroid gland with hormonal dysfunction Disturbances of amino-acid transport End stage renal disease Essential hypertension 401.0, Familial Mediterranean fever Galactosemia Heart disease NOS Heart failure Heart Failure (Combined systolic and diastolic) Heart Failure (Diastolic) Heart Failure (Systolic) Hepatomegaly Hyperchylomicronemia Hyperchylomicronemia Hypertensive heart and chronic kidney disease Hypertensive heart disease Hypertensive chronic kidneyl disease Iliac artery aneurysm Impotence of organic origin, penis disorder

4 Intracerebral hemorrhage 431 Kwashiorkor 260 Late effects of cerebrovascular disease ( ), 438.6, 438.7, , , Lipidoses Lipodystrophy Lipoprotein deficiencies Liver disorder antepartum Liver disorders in pregnancy Long Term (current) use of antiplatelet/antithrombotic V58.63 Long Term (current) use of non-steroidal anti-inflammatories V58.64 Long term (current) use of other medications V58.69 Malnutrition of mild degree Malnutrition of moderate degree Mixed hyperlipidemia (tuberous xanthoma) Morbid obesity Moyamoya disease Nephrogenic diabetes insipidus Nephrotic syndrome Nutritional marasmus 261 Obesity Occlusion & stenosis of precerebral arteries Occlusion of cerebral arteries Old myocardial infarction 412 Organ replacement by transplant, liver V42.7 Other & unspecified postsurgical nonabsorption Other abnormal blood chemistry Other acute and subacute ischemic heart disease

5 Other acute and subacute ischemic heart disease Other amyloidosis Other and ill-defined cerebrovascular disease Other and unspecified angina pectoris Other and unspecified hyperlipidemia (unspecified xanthoma) Other aneurysm of heart Other background retinopathy and retinal vascular change Other chronic liver disease without mention of alcohol Other disorders of lipoid metabolism Other generalized ischemic cerebrovascular disease Other protein-calorie malnutrition Other psoriasis Other severe, protein-calorie malnutrition 262 Other specified disorders of liver Other specified disorders resulting from impaired renal function Other specified forms of chronic ischemic heart disease Other specified intestinal malabsorption Overweight Pancreatic disease Precordial pain Psoriatic arthropathy Pure hypercholesterolemia Renal artery aneurysm Renal osteodystrophy Retinal exudates and deposits Retinal vascular occlusion Secondary hyperparathyroidism (of renal origin) Secondary hypertension

6 Special screening for cardiovascular diseases V81.0 V81.2 Thyroid disfunction in pregnancy and the puerperium Toxic effect of unspecified gas or vapor Transient cerebral ischemia Transient ischemic deafness Transplanted organ, kidney V42.0 Unspecified chronic liver disease without mention of alcohol Unspecified disorder resulting from impaired renal function Unspecified disorders of lipoid metabolism Unspecified disorders of liver Unspecified protein-calorie malnutrition Upper extremity aneurysm Xanthelasma

7 LIPOPROTEIN ELECTROPHORETIC SEPARATION ICD Codes Numerical Order V42.0 V42.7 V58.63 V58.64 V58.69 V81.0 V81.1 V81.2

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