High Sensitivity C-Reactive Protein (hsCRP) Testing ...
High Sensitivity C-Reactive Protein (hsCRP) Testing - Supplemental Instructions Article
The information in this article contains coding or other guidelines that complement the Local Coverage Determination (LCD) for High Sensitivity C-Reactive Protein (hsCRP) Testing. This LCD can be accessed on our contractor web site. It can also be found on the Medicare Coverage Database.
Coding Guidelines:
Currently, CRP (CPT code 86140) is covered as a diagnostic test for the detection and evaluation of infection, tissue injury and inflammatory disease, not involving atherosclerosis of the arteries. It is not to be used in place of CPT code 86141, which is the correct CPT code for hsCRP addressed in this LCD.
If a denial for screening is desired so that the denied claim may be submitted to the beneficiary's secondary insurance, ICD-9-CM code V82.9 (Persons without reported diagnosis encountered during examination and investigation of individuals and populations; special screening for other conditions; unspecified condition) or V70.0-V70.9 (Persons without reported diagnosis encountered during examination and investigation of individuals and populations; general medical examination) should be used.
Use V58.69 [Long term (current) use of other medications] when obtaining hsCRP testing to monitor lipid lowering or other therapy related to cardiovascular disease. The hsCRP test for monitoring lipid or other therapy is not considered medically necessary and will be denied.
If a denial for screening or "observation" is desired so that the denied claim may be submitted to the beneficiary's secondary insurance, one of the following ICD-9-CM codes may be used: V71.7 (Observation for suspected cardiovascular disease); V81.0 (Special screening for ischemic heart disease); V81.2 (Special screening for other and unspecified cardiovascular conditions); or V82.9 (Persons without reported diagnosis encountered during examination and investigation of individuals and populations; special screening for other conditions; unspecified condition).
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