Pathology Associates Of Lexington, P.A.

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August 2009 Memo concerning e-GFR

TO: Lexington Medical Center Medical Staff
FROM Ervin B. Shaw, Chief, Section of Pathology & Laboratory Medicine
SUBJECT: Insurance Coverage and “Calculated GFR” (e-GFR)
DATE: August 14, 2009

In order to avoid renal complications in certain types of contrasted radiographic imaging studies, there has been a more-or-less national recommendation that the calculated GFR be determined (as a screen to detect a nephropathy) prior to any such dye injection. Our Radiology Department for the Lexington County Health Services District has required this for some time. Certain studies require it beginning at age 60 and others beginning at age 70. The Radiology schedulers are in the best position to know the various age cutoffs at the time your staff calls to schedule an imaging study.

CPT-4 code: Offices ordering the lab test: just ask for “GFR” (and this will get CPT-4 code 82565 [or, if you’re performing as a waived test in the office = 82565 QW]).

ICD-9 code: Since the test is being performed in the absence of known renal disease, then this is a screening test for occult (not-previously-diagnosed) renal insufficiency. The recommended ICD-9 “clinical diagnosis” code is the one for “nephropathy screening”, V81.5.

As of August of 2009, the PSA coding expert available to our practice has not been able to find record of any filed “letters of national or local limitation” for the serum creatinine test which is required (along with age and gender) for our lab to calculate the e-GFR. So, insurance should not reject the claim.

EBS/sbg