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Question: If our lab performs both a total bilirubin and a direct bilirubin test, can we report both tests?

Michigan Subscriber

Answer: You may report both 82247 (Bilirubin; total) and 82248 (… direct) if the lab performs both total and direct bilirubin tests.

Here’s why: The two tests measure two different types of bilirubin in the patient’s blood: indirect, or unconjugated, bilirubin, which is bilirubin circulating in the patient’s blood before it enters the liver; and direct, or conjugated, bilirubin, which is bilirubin after the patient’s liver has processed it. High levels of direct, or conjugated, bilirubin may indicate a blockage in the patient’s bile duct, liver disease, or a liver infection, such as viral hepatitis. High levels of indirect, or unconjugated, bilirubin may indicate conditions such as hemolytic anemia, hepatitis, cirrhosis, and other liver conditions.

A direct bilirubin test obviously detects levels of direct, or conjugated, bilirubin. But a total bilirubin test takes the bilirubin and calculates the fraction of the bilirubin that is not direct; this total helps provides the level of the patient’s indirect bilirubin.

Consequently, as the two tests indicated different bilirubin type levels, they have different diagnostic significance and can be billed together. This is reflected in the National Correct Coding Initiative (NCCI) edits for the tests, as neither test is listed as a column 2, or component code, when the other test is listed as a column 1 code.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC