Millions of people have diabetes and don’t know it. Left undiagnosed, diabetes can lead to severe complications such as heart disease, stroke, blindness, kidney failure, leg and foot amputations, pregnancy complications, and death related to pneumonia and flu. Diabetes is the leading cause of blindness among adults, and the leading cause of end-stage renal disease.
The good news is that scientific evidence now shows that early detection and treatment of diabetes with diet, physical activity, and new medicines can prevent or delay many of the illnesses and complications associated with diabetes. Section 613 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expanded preventive services covered by Medicare to include preventive screening for beneficiaries at risk for diabetes or those diagnosed with pre-diabetes. This benefit will help to improve the quality of life for Medicare beneficiaries by preventing more severe conditions that can occur without proper treatment from undiagnosed or untreated diabetes.
Diabetes (diabetes mellitus) is defined as a condition of abnormal glucose metabolism using the following criteria:
*A fasting blood glucose greater than or equal to 126 mg/dL on two different occasions.
*A 2-hour post-glucose challenge greater than or equal to 200 mg/dL on two different occasions. *A random glucose test over 200 mg/dL for a person with symptoms of uncontrolled diabetes `
CPT Codes for Diabetes Screening Tests
82947 – Glucose; quantitative, blood (except reagent strip)
82950 – Glucose; post glucose dose (includes glucose)
82951 – Glucose; tolerance test (GTT), three specimens (includes glucose)
Medicare providers must report the screening (“V”) diagnosis code V77.1 (Special Screening for Diabetes Mellitus). Effective April 1, 2005, when a Medicare provider submits a claim for diabetes screening where the beneficiary meets the definition of pre-diabetes, they should report the appropriate diagnosis code with modifier TS. The appropriate CPT code(s) are also required on the claim