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CPC STUDY COURSE · 2026 EDITION

A complete lipid panel with a calculated result

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-08 · Professional outpatient claim; Original Medicare unless stated otherwise

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Clinical order

Fictional patient Nina Cole, age 57, has provider-documented hyperlipidemia without a specified subtype. Her treating physician orders a lipid panel to assess the response to treatment. The authenticated encounter note links the order to that condition. This is disease monitoring, not screening. No other diagnosis is supplied as the reason for this laboratory order.

Laboratory work

The independent laboratory receives the order and an acceptable specimen. It performs all components required by the current licensed lipid-panel definition. The completed report identifies total cholesterol, HDL cholesterol and triglyceride measurements. The laboratory also calculates an LDL result from the measured values; it does not perform a direct LDL assay.

Quality check

A laboratory instrument prompts one analytical rerun to confirm the initial triglyceride result before the single final report is released. There is no new clinical order, new specimen or request to track a changing patient condition. The rerun is part of the laboratory’s quality process, not a second medically necessary clinical measurement.

Finished record

The final laboratory report is sent to the treating physician. No new provider diagnosis is added to this packet, and the laboratory does not select a more specific lipid disorder from the numbers. Assume that the laboratory meets applicable certification requirements for the tests. The worksheet concerns this laboratory claim, not a physician office visit or collection service.

Charge review

The draft charge list contains the panel, each component separately, a direct LDL assay and a repeat-test modifier on the analytical rerun. Review each item against the work actually performed. Find the current licensed panel entry and its component definition. Identify the documented diagnosis and distinguish a clinical repeat from verification of one reportable result.

Your coding worksheet

  1. Identify the reason for this encounter and the supported diagnoses.
  2. List the services actually completed and the applicable code sets.
  3. Use your books to select final codes, units and any supported modifiers.
  4. Sequence the diagnoses and explain the relevant instruction.
  5. Review included work and any separate coverage question. Explain why the strongest alternative does not fit.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Write your answer

Use only this fictional record. Your entries stay on this page and disappear when you leave or reload. Do not enter real patient information.

Compare with the worked explanation
  1. The documented condition is hyperlipidemia without a specified subtype. Verify E78.5 through the Index and Tabular List. Do not infer mixed or familial disease from the test values or change this monitoring encounter into screening.
  2. All required panel components were performed. NCCI X C directs use of the panel rather than separately reporting its included components for the same testing. Confirm the full component list in the licensed book.
  3. The LDL value was calculated. NCCI X G.1 does not permit reporting a direct LDL measurement for a calculated value; the report must distinguish the method.
  4. The analytical rerun confirms a single final result. It does not meet the cited medically necessary repeat-testing rule. A repeat-test modifier does not make quality verification into a second clinical service.
  5. The authenticated treating record supplies the order and medical reason. Preserve the link between that order, the performed tests and the signed report; the existence of a valid code is not a separate coverage guarantee.
  6. Submit the service supported by this laboratory’s work. A different professional encounter or separately ordered test would require its own documentation; neither can be created from this charge list.

Reference sections: NCCI X C,G.1; E78.5; ICD IV diagnostic services

Practice the linked chart questions

Review the lesson

Sources

  1. CMS — Medicare NCCI 2026 Chapter X: Pathology and Laboratory. 2026. Accessed 2026-09-10.
  2. CMS — Lab Test Order Requirements. Page modified November 25, 2025. Accessed 2026-09-10.
  3. CDC NCHS — ICD-10-CM April1,2026 Index and Tabular XML. April1–September30,2026. Accessed 2026-09-12.
  4. CDC/NCHS and CMS — ICD-10-CM April 1 2026 Guidelines. FY2026 April. Accessed 2026-09-10.

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