Diabetes and Cholesterol Screening ICD-10-CM codes

Z13.1 (encounter for screening for diabetes mellitus) is the diagnosis for a fasting glucose (82947), glucose tolerance test (82951), or hemoglobin A1c (83036) ordered in a patient with no diagnosis of diabetes and no symptoms. Medicare pays diabetes screening once every 12 months under Z13.1, or twice a year when the patient has documented prediabetes (R73.03) or impaired fasting glucose (R73.01). Once diabetes is diagnosed, the same tests become monitoring and must be coded to E11.x or E10.x; billing Z13.1 on an A1c for a known diabetic is a screening-versus-diagnostic denial.

Lipid screening in a patient without hyperlipidemia is Z13.220 (encounter for screening for lipoid disorders), billed with the lipid panel 80061 or its components. Medicare's cardiovascular screening blood test benefit is the exception: CMS requires Z13.6 (screening for cardiovascular disorders) rather than Z13.220 on 80061, 82465, 83718, and 84478, payable once every five years. Use Z13.220 for commercial payers and Z13.6 for Medicare, and use neither once the patient has a diagnosis; E78.5 or E78.00 with the Z79 statin code is the correct diagnosis for a lipid panel that monitors treatment.

Family history codes are secondary and explain why the screen is ordered earlier or more often: Z83.3 for family history of diabetes, Z83.42 for familial hypercholesterolemia, Z83.430 for elevated lipoprotein(a), Z83.438 for other lipid disorders, and Z82.49 for family history of ischemic heart disease. Z86.32 (personal history of gestational diabetes) supports ongoing diabetes screening after pregnancy.

Z13.228 covers other metabolic screening and Z13.29 other endocrine screening such as a TSH ordered without symptoms. Screening codes may be first-listed when the lab draw is the reason for the encounter or added as secondary codes when the screen is ordered during a visit for something else. If the screen comes back abnormal, add the abnormal finding as a secondary code (R73.03, R73.01, or R79.89 for other abnormal blood chemistry); the screening code stays.