ABC, 123, I mean A1C?

14 Aug
How many of us look at our lab results and know what all the letters and numbers mean?  It can be overwhelming to know what all of the different tests are for and why we need them. One test we hear a lot about as consumers is A1C.   A1C also goes by several other names such as hemoglobin A1C, HbA1c, glycated hemoglobin, or glycohemoglobin test.1 

So what is A1C?
A1C is a blood test that is used to manage diabetes, in particular Type II diabetes as well as prediabetes.  The A1C test measures the average blood sugar or blood glucose levels over the last 2-3 months.

How are the results reported?
If you are looking at your lab test results, you will see a percentage recorded for your A1C level. The higher the percentage, the higher your levels of blood sugar or glucose.   Below 5.7% is considered a normal test result, between 5.7% and 6.4% indicates a likelihood of developing diabetes and anyone with 6.5% would most likely be diagnosed with diabetes.
 
How is the test billed?
The A1C test is billed using Current Procedural Terminology Code 83036, Hemoglobin; glycosylated (A1C).  Since the test is looking at the average levels over the last 2-3 months, it would not be common to see this test billed daily, weekly or even monthly.  
 
What to look for?
Keep in mind that every patient has a different medical history which should be reviewed in context of any analysis.  It is always recommended to check your internal policies and procedures first. However, some areas of concern could be:
  • Look for providers billing this upwards of 6 or more times per year
  • Look for diagnoses that don’t correspond to diabetes related symptoms
  • Look for excessive units per date of service
  • Review medical records to determine if tests are repeated after normal results
If you have any questions or comments, please contact SIU@hcfraudshield.com.

REFERENCES
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