How often can lipid testing be done? What about measuring the direct LDL?
Previously, there were local medical review policies for lipid testing, but these were retired in deference to the implementation of a national coverage determination by CMS that can be viewed at the following link: http://cms.gov/mcd/viewncd.asp?ncd_id=40-12&ncd_version=7&show=all The above addresses indications for performing and frequency of testing. Deviating from these guidelines would need to be supported by clinical indication(s) as documented in the medical record. Providers have inquired about separately billing for a direct LDL beyond the calculated LDL included in a lipid profile (as the latter can be an inaccurate value if the triglycerides are high). If the patient’s treatment will be impacted by these results (i.e. by additional dietary or pharmacological therapy) then it is acceptable to separately bill a direct LDL with modifier 59 in addition to the lipid panel. There is no set guideline for a triglyceride level that should be followed with a direct LDL measurement. Te
