frequency and coverage of lab work - Kidney Disease

Kidney Disease

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frequency and coverage of lab work

lexycat profile image

My 65 y.o. husband was diagnosed with CKD 6 months ago with a calculated GFR of 53. We immediately changed his diet to very low sodium, potassium and phospherous, and limited protein. In January (3 Mos. later) his PCP ordered lab work (blood and urine). There was very little change. Here it is 3 more months later, and we want to know if the change in diet is helping. Should he ask his PCP to order lab work again? He is now (recently) on Medicare with a Part G supplemental insurance. Will Medicare cover lab work again? We called medicare, but we are not confident that the information is correct because the representative didn't seem sure and didn't ask for any specifics.

Or should we just wait until November when he is scheduled to see his nephrologist? Any advice would be appreciated.

16 Replies

You didn't mention which Medicare your husband has. If it's original Medicare they will pay for more lab tests if a doctor orders them and uses the correct codes. I couldn't say if you have an Advantage plan. Usually they aren't so advantageous. You also didn't say what the lab results were... are they high? Who told you about the diet advice? Is he only seeing a neph once a year? Can you get in to see him again so he can explain what is going on?

lexycat profile image
lexycat in reply to jodaer

Thank you for your reply. He has original Medicare. His calculated GFR was 53, His sodium, potassium and phosphorous were within range. His neph only wants to see him once per year, but recommended the dietary changes. We just want to check his labs more frequently for our own peace of mind.

jodaer profile image
jodaer in reply to lexycat

I would ask his primary to request the labs and if he isn't inclined then ask the neph. There is a lot to be said about peace of mind.

lexycat profile image
lexycat in reply to jodaer

Thank you!!

lowraind profile image
lowraind in reply to jodaer

agree

orangecity41 profile image
orangecity41NKF Ambassador

I too am on original Medicare and have part E. I am CKD 3b and on prescribed diet.. My Doctor has me on a 3 months schedule for the CBC and CMP tests. Medicare has always paid. Here is a link to eGFR calculation and age relation. kidney.org/atoz/content/gfr

lexycat profile image
lexycat in reply to orangecity41

Thank you for your reply, the information and the link!

Marvin8 profile image
Marvin8 in reply to orangecity41

CBC test or did you mean CMP test?

lexycat profile image
lexycat in reply to Marvin8

I think CMP.

orangecity41 profile image
orangecity41NKF Ambassador in reply to Marvin8

You are correct. I should have said CMP. I corrected it. Thanks

Congratulations !! You have the Best Medicare , Part G.... since Part F is discontinued.

Yes, medicare pays for all lab work, every 3 months. You have to ask your primary doctor. Find a friendly one, who cares for patients and talks to you openly. Explains or answers your questions. If not delivered happy, change doctor.

You should have PPO, so you can change B or you go to another Nephro, without a referral.

Does your husband have diabetes ? Is he taking BP medicine ??

Be positive. He is in early stage. We have many members with eGFR of 30 or 20.

Follow doctors advise.

Good Luck.

lexycat profile image
lexycat in reply to Fatbuddy

Thank you for your reply. He does not have high BP or diabetes. We want to keep his CKD stable so that it never becomes late stage. We want to be proactive, but not over reactive. That is a difficult line for us to walk. We appreciate the advice.

FYI...you can always get a test thru requestatest.com Their tests are fairly cheap for the common ones. The less common ones like cystatin-c are a lot more expensive.

lexycat profile image
lexycat in reply to Marvin8

thank you for your reply

When my eGFR was in the 50s my Dr. only ordered blood once a year.

Now that my eGFR is 28 I see the Neph and have blood work every 3 months.

Medicare will pay for blood work as often as the Dr. deems it's necessary.

Usually every 3 - 6 months at that stage.

Keep up the diet and add exercise too.

Best wishes.

lexycat profile image
lexycat in reply to Sophiebun11

thank you for your reply

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