How To Use CPT Code 83036

CPT 83036 describes the measurement of glycosylated hemoglobin (A1C) levels in the blood. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 83036?

CPT 83036 is used to measure the amount of sugar (glucose) attached to the hemoglobin in red blood cells over a period of approximately three months. This test, also known as the A1C test, provides physicians with valuable information about a patient’s blood sugar levels over time. A normal A1C level for a healthy individual is below 7%.

2. Official Description

The official description of CPT code 83036 is: ‘Hemoglobin; glycosylated (A1C).’ This code is used to measure the amount of sugar attached to the red blood cells and display the result as a percentage.

3. Procedure

1. A blood sample is collected from the patient by a physician or lab technician.
2. The blood sample is then analyzed using one of several procedures, such as high-performance liquid chromatography (HPLC), immunoassay, or boronate affinity chromatography.
3. The procedure determines the amount of sugar attached to the red blood cells and provides the result as a percentage value.

4. Qualifying circumstances

CPT 83036 is used for the measurement of glycosylated hemoglobin levels in patients. It is typically performed for individuals with diabetes or other conditions that require monitoring of blood sugar levels over time. The test is suitable for patients of all ages and can be performed by any qualified healthcare professional.

5. When to use CPT code 83036

CPT code 83036 should be used when measuring the glycosylated hemoglobin levels in a patient’s blood. It is appropriate for individuals with diabetes or other conditions that require monitoring of blood sugar levels over time. This code should be used for each instance of the A1C test performed.

6. Documentation requirements

To support a claim for CPT code 83036, the healthcare professional must document the following information:

• Patient’s diagnosis or reason for performing the A1C test
• Date of the test
• Method used to analyze the blood sample
• Result of the test, displayed as a percentage
• Signature of the healthcare professional performing or interpreting the test

7. Billing guidelines

When billing for CPT code 83036, ensure that the test is performed to measure the glycosylated hemoglobin levels in the patient’s blood. It is important to follow the specific guidelines provided by the payer to ensure accurate and timely reimbursement. CPT code 83036 should not be reported with other codes unless there are specific circumstances that warrant additional codes.

8. Historical information

CPT code 83036 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A physician orders an A1C test for a patient with diabetes to monitor their long-term blood sugar control.
2. A nurse collects a blood sample from a pregnant woman to measure her A1C levels as part of gestational diabetes screening.
3. A healthcare professional performs an A1C test on a patient with a suspected hemoglobin variant to assess their blood sugar levels accurately.
4. A primary care physician orders an A1C test for an individual with prediabetes to monitor their progress and guide treatment decisions.
5. A pediatrician performs an A1C test on a child with a family history of diabetes to assess their risk and provide early intervention if necessary.
6. A healthcare professional conducts an A1C test on an elderly patient with multiple comorbidities to monitor their overall blood sugar control.
7. A diabetes educator performs an A1C test on a newly diagnosed diabetic patient to establish a baseline for future monitoring.
8. A laboratory technician analyzes a blood sample using HPLC to measure the A1C levels of a patient with uncontrolled diabetes.
9. A nurse practitioner orders an A1C test for a patient with a history of gestational diabetes to assess their long-term risk of developing type 2 diabetes.
10. A physician performs an A1C test on a patient with diabetes to evaluate the effectiveness of their current treatment plan.