CPT Code 80061 | Lipid Panel Test

The CPT code for Lipid Panel is CPT 80061. This panel test is performed to screen lipid-protein in the bloodstream of the patient’s body. The test samples are retrieved by Venipuncture. If a significant level of lipid-protein found in the bloodstream leads to a higher risk of cardiovascular disease and stroke.

CPT 80061 is also used to screen out lipid-protein if a patient has Pancreatitis, Liver disease, or CKD (chronic kidney disease) that contributes to raising the level of lipid-protein.

CPT 80061 | Short Description & Explanation

The CPT code 80061 panel consists of three components (HDL, Triglycerides, Total Cholesterol) and other factors measurement. It would aid in identifying the risks of heart-related diseases.

Description: Lipid panel. This panel must include the following:Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high-density cholesterol (HDL cholesterol) (83718) Triglycerides (84478).

There are tests included in the Lipid Panel CPT code; including:

• Triglycerides (CPT 84478)
• Cholesterol, Serum total (CPT 82465)
• Lipoprotein, direct measurement high-density cholesterol (HDL cholesterol) (CPT 84478)

There is no other panel that exists in CPT 80061. Individual tests will be reported if any of the three tests are not included. 

CPT 80061 can be billed with other Panels or organs-related diseases if it comprises the same set of tests according to CPT coding guidelines.

The 80061 CPT code is approved under CLIA (Clinical Laboratory Improvement Amendments) waived test. Therefore, Modifier QW is applicable.

Symtoms & Risks

There is the following list of symptoms or risks when a physician orders the 80061 Panel Test:

• Nausea, Vomiting, and Epigastric pain
• Sweating
• Headache
• Toothache, Jaw pain
• Chest tightness, Body Aches, and Fullness
• Often Left Arm Pain
• Hypertension
• Indigestion and Heartburn etc.
• Organ related Diseases (CKD, Liver Diseases, Dysfunction of pancreas, Diabetes)
• Family history of heart disease

Reimbursement

The reimbursement of the 80061 CPT code for panel test is as follows according to CMS payment Schedules:

1. CPT 80061 without QW modifier ($ 13.39)
2. CPT 80061 with QW modifier ($ 13.39)

Only 1 CPT 80061 can be reported on the same day, and 3 units are only applicable if medical documentation supports the service as medically necessary. RVUS is not applicable for CPT code 80061.

Panel CPT 80061 code is only used for coding purposes and does not influence clinical parameters. It reports only 1 code (CPT 80061) instead of all 14 components with different CPT codes.

Modifiers 

Modifier 90 is appropriate to attach with the CPT code for Lipid Panel when service is performed by other than reporting or treating physician. The test would be processed by an outside laboratory. While modifier 59 will be used when CPT code 80061 is not allowed to be billed together in conjunction with other procedures.

When CPT 80061 service is Performed more than once or repeated, Modifier 91 will be appended with the 80061 CPT code.

Example: Patients presented to the hospital with Hyperlipidemia and the physician ordered the laboratory test to rule out the diagnosis. Results revealed abnormal laboratory findings and the Provider treated the diagnosis with medications. Physicians reordered the lab test to check that vitals are better or worse.

Modifier QW is appropriate to append with CPT 80061 as Its CLIA approved waived test.

Billing Guidelines

CPT code 80061 services should be medically necessary and appropriate and not be bundled with other panel codes. This service should be met and regulated under CLIA (1988) for patient screening, testing, or treatment purposes.

The Lipid Panel CPT code 80061 is only used for coding purposes and would not affect any clinical condition. It contains 3 components and is appropriate to the bill when all the components are met and performed on the same date of service (DOS) on the same patient by the Same Physician or another qualified another healthcare professional.

CPT 80061 can be bellied in two ways:

• 1^st way is to bill as a panel code
• 2^nd way is to bill all the components as individual CPT Codes

All three components of CPT 80061 do not have any panels. 

Modifier AY is applicable with CPT code 80061 for Medicare Part B services. CPT 80061 is associated with Organ or Disease oriented panels. When lab and pathology tests are not related to end-stage renal diseases (ESRD) or treatment of ESRD. Modifier AY will be appended to this type of service the Physician provides.

If the test specimens are retrieved by Venipuncture (like CPT code 36415) in combination with CPT code 80061. It is appropriate to bill both services separately. 

There is the following list of Place of service (POS) codes that applies to CPT 80061:

Facility POS are 23, 34, 51, 52, 21, 19, 26, 55, 61, and 57, while the rest are considered non-facility POS like 22, 11, etc.

Lipid Panel CPT Coding Examples

Below are billing examples of cases when it is appropriate to bill the 80061 CPT code for Lipid Panel.

Example 1

A 34-year-old male with PMH of thyroidectomy (on Synthroid) is here for CP and lightheadedness/HA this afternoon.

The fire alarm went off, and Pt felt chest pain while going downstairs and was lightheaded. Pt states chest pain feels like a tightness that has lasted for at least an hour and is still present in the ER. The patient also endorses nausea and lightheadedness. Denies room spinning sensation.

Denies SOB, vomiting, fever/chills, fainting, and blood in the stool. Pt has not taken any pain medication at home. Pt denies having had this pain before. PE reveals AOx3. No focal neurological deficits like facial droop or pronator drift.

The finger to the nose is negging. Her gait is steady, and she ambulates independently. Heart exam reveals no m/g/r. CP is not reproducible w/ palpation. Lungs are CTAB. The physician ordered a Lipid profile test, CMP, EKG, and cardiac monitoring.

Billing:

Patient: 34-year-old male

Diagnoses:

• ICD 10 R07.2: Precordial pain (chest pain)
• ICD 10 R42: Dizziness and giddiness (lightheadedness)
• ICD 10 G44.1: Vascular headache, not elsewhere classified (headache)
• ICD 10 R11.0: Nausea

History:

• ICD 10 Z90.09: Acquired absence of other specified organs (thyroidectomy)
• ICD 10 T38.3X5A: Adverse effect of thyroid hormones, initial encounter (on Synthroid)

Lab procedures:

• CPT 80061: Lipid Panel
• CPT 80053: Comprehensive Metabolic Panel (CMP)
• CPT 93000: Electrocardiogram (EKG)
• CPT 94760: Noninvasive ear or pulse oximetry for oxygen saturation (if cardiac monitoring was performed using pulse oximetry)

Example 2 

77 y/o F, pmh of COPD on nebulizers at home, CABG, aortic valve replacement- 2 valve replacement (bio MVR/AVR 2/2 endocarditis 2015 at Islamabad, L kidney transplant (previously HD with L AFV), HTN, HLD, chronic arthritis, Left hip replacement- 10/19, and asthma, presents with nausea and vomiting black emesis. Started four days ago. Cannot tolerate solids or liquids PO. Weakness.

Denies CP, SOB, hematuria, dysuria, and blood in the stool. The physician ordered multiple diagnostic tests like Lipid Panel, CMP, CBC, EKG, and Cardiac Trop. Vitals reveal HTN, 186/73, tachycardic at 100. PE reveals generalized abdominal pain to palpation. Heart and lungs unremarkable.

Billing:

Patient: 77 y/o F

Diagnoses:

• ICD 10 R11.0: Nausea
• ICD 10 R11.14: Vomiting of blood (black emesis)
• ICD 10 R53.1: Weakness
• ICD 10 I10: Essential (primary) hypertension
• ICD 10 R00.0: Tachycardia, unspecified

History:

• ICD 10 J44.9: Chronic obstructive pulmonary disease, unspecified (COPD)
• Z95.1: Presence of aortocoronary bypass graft (CABG)
• Z95.2: Presence of prosthetic heart valve (aortic valve replacement)
• N18.6: End stage renal disease (ESRD) (kidney transplant)
• I12.9: Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease (HTN)
• E78.5: Hyperlipidemia, unspecified (HLD)
• M19.90: Unspecified osteoarthritis, unspecified site (chronic arthritis)
• Z96.649: Presence of unspecified artificial hip joint (left hip replacement)
• J45.909: Unspecified asthma, uncomplicated

Lab procedures:

• CPT 80061: Lipid Panel
• CPT 80053: Comprehensive Metabolic Panel (CMP)
• CPT 85025: Complete Blood Count (CBC) with differential, automated
• CPT 93000: Electrocardiogram (EKG)
• CPT 83018: Cardiac Troponin (Trop) assay

Example 3

The patient is a 39-year-old male with a significant PMH of cholecystectomy, depression, cannabis dependence, and cyclic vomiting who presents to the emergency department for vomiting five times from 4 AM until now after smoking one blunt. Pt denies bloody emesis and blood in the stool.

Pt endorses generalized abdominal discomfort at rest and during palpation. Denies fever, SOB, CP, and bloody stool. Denies other drug or alcohol use. Physicians plan to order multiple Laboratory and pathology tests Like MRI, CT, Lipid profile, CMP, CBC.

Billing:

Patient: 39-year-old male

Diagnoses:

• R11.2: Vomiting, unspecified
• R10.84: Generalized abdominal pain

History:

• Z98.89: Other specified postprocedural states (cholecystectomy)
• F32.9: Major depressive disorder, single episode, unspecified (depression)
• F12.20: Cannabis dependence, uncomplicated
• R11.14: Vomiting of blood (cyclic vomiting)

Labs procedures:

• CPT 80061: Lipid Panel
• CPT 80053: Comprehensive Metabolic Panel (CMP)
• CPT 85025: Complete Blood Count (CBC) with differential, automated

Imaging procedures:

• CPT 70551: Magnetic Resonance Imaging (MRI) of the brain, without contrast
• CPT 74176: Computed Tomography (CT) of the abdomen and pelvis, without contrast

Example 4

A 44-year-old female with a PMH of HTN (not on meds for the past month) presents with stroke-like symptoms.

The patient states that she noticed difficulty writing while working as a security guard, described as being unable to properly grip the pen and feeling like she had to “shake out” her arm.

She also developed difficulties with speech around that time, with her coworkers and family members noticing that she was “speaking as if she were drunk”. Symptoms have been constant but waxing and waning in intensity since onset.

The patient denies new focal weakness or numbness, though she notes that she has right some right leg weakness at baseline. Denies previously experiencing similar symptoms. The physician ordered to obtain CT head, Pathology, and lab test CBC, CMP, and Lipid Panel.

Anticipate admission for further monitoring, possible neurology evaluation, and a brain MRI.

Billing:

Patient: 44-year-old female

Diagnoses:

• ICD 10 R47.01: Aphasia (difficulty with speech)
• ICD 10 R26.2: Difficulty in walking, not elsewhere classified (unable to grip pen properly, right leg weakness)
• ICD 10 I10: Essential (primary) hypertension (HTN)

Labs:

• CPT 85025: Complete Blood Count (CBC) with differential, automated
• CPT 80053: Comprehensive Metabolic Panel (CMP)
• CPT 80061: Lipid Panel

Imaging:

CPT 70450: Computed Tomography (CT) of the head, without contrast

Anticipated:

• Admission for further monitoring
• Possible neurology evaluation
• CPT 70551: Magnetic Resonance Imaging (MRI) of the brain, without contrast (if ordered during admission)

Example 5

The patient is a 27-year-old female with no medical history and complaints of nausea, vomiting, and diarrhea since last night. 

States this evening, she is feeling weak and dehydrated.  She has vomited multiple times today and has been intolerant of solids or liquids.  LMP not known she is on OCPs.  The patient is not Covid vaccinated. Symptoms are consistent with a viral illness, possibly Covid. The patient who is tachycardic up to 120s will give IV fluids, Zofran, and Pepcid. Labs panels were ordered, such as CBC, CMP, and Lipid.

Billing:

Patient: 27-year-old female

Diagnoses:

• ICD 10 R11.0: Nausea
• ICD 10 R11.10: Vomiting, unspecified
• ICD 10 A09: Infectious gastroenteritis and colitis, unspecified (diarrhea)
• ICD 10 R53.1: Weakness
• ICD 10 E86.0: Dehydration
• ICD 10 R00.0: Tachycardia, unspecified

History:

• ICD 10 Z79.890: Long term (current) use of oral anticoagulants and antiplatelets (OCPs)
• ICD 10 Z23: Encounter for immunization (patient not vaccinated for COVID-19)

Interventions:

• CPT 96360: Intravenous infusion, hydration (IV fluids)
• CPT 96372: Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular (Zofran, Pepcid)

Labs:

• CPT 85025: Complete Blood Count (CBC) with differential, automated
• CPT 80053: Comprehensive Metabolic Panel (CMP)
• CPT 80061: Lipid Panel

Example 6

A 39-year-old male with h/o asthma (never admitted or intubated for this; triggers are weather changes and fumes, and he notes they are painting in his building right now, which has made things worse), sarcoidosis on chronic prednisone, chronic leukopenia.

He is coming in with 2 days of sob and chest pain. States it feels similar to his sarcoidosis exacerbation. He states that he takes 10 mg daily prednisone but bumps it up to 20 mg as he was told to take an extra dose whenever he feels his sarcoidosis flaring up. 

He uses albuterol for his asthma, and he used it today, but it did not help. Physician plan to order a Lipid profile, MRI, and CT.

Patient: 39-year-old male

Diagnoses:

• ICD 10 J45.909: Unspecified asthma, uncomplicated (history of asthma)
• ICD 10 D86.9: Sarcoidosis, unspecified
• ICD 10 D72.819: Leukocytosis, unspecified (chronic leukopenia)
• ICD 10 R06.02: Shortness of breath
• ICD 10 R07.9: Chest pain, unspecified

History:

ICD 10 Z79.899: Other long term (current) drug therapy (chronic prednisone)

Lab:

CPT 80061: Lipid Panel

Imaging:

• CPT 70551: Magnetic Resonance Imaging (MRI) of the brain, without contrast
• CPT 71250: Computed Tomography (CT) of the thorax, without contrast