Vitamin D Screening Icd 10

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ICD10 code for Vitamin D deficiency E20.0 Idiopathic hypoparathyroidismE20.8 Other hypoparathyroidismE20.9 Hypoparathyroidism, unspecifiedE21.0 -E21.3 Hyperparathyroidism and other disorders of parathyroid gland (code range)E55.0 Rickets, activeE55.9 Vitamin D deficiency, unspecifiedE83.3-83.9 Disorders of phosphorus metabolism (code range)E83.51 HypocalcemiaE83.52 HypercalcemiaM81.0 Age-related osteoporosis without current pathological fractureM81.

6 Localized osteoporosisM81.8 Other osteoporosis without current pathological fractureM83.0-M83.9 Adult osteomalacia (code range)M85.9 Disorder of bone density and structure, unspecifiedN18.3-N18.5 Chronic kidney disease, Stage III to End stage renal disease (code range)N25.81 Secondary hyperparathyroidism of renal originD51 Vitamin B12 deficiency anemiaExcludes1: vitamin B12 deficiency (E53.8)D51.

0 Vitamin B12 deficiency anemia due to intrinsic factor deficiencyAddison anemiaBiermer anemiaPernicious (congenital) anemiaCongenital intrinsic factor deficiencyD51.1 Vitamin B12 deficiency anemia due to selective vitamin B12malabsorption with proteinuriaImerslund (-Gr?sbeck) syndromeMegaloblastic hereditary anemiaD51.2 Transcobalamin II deficiencyD51.3 Other dietary vitamin B12 deficiency anemia Vegan anemiaD51.

8 Other vitamin B12 deficiency anemiasD51.9 Vitamin B12 deficiency anemia, unspecified Vitamin d deficiency Indications:Measurement of vitamin D levels is indicated for patients with:• chronic kidney disease stage III or greater;• osteoporosis;• osteomalacia;• osteopenia;• hypocalcemia;• hypercalcemia;• hypoparathyroidism;• hyperparathyroidism;• hypervitaminosis D;• rickets; and• vitamin D deficiency to monitor the efficacy of replacement therapy.

Vitamin D is a hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. An excess of vitamin D may lead to hypercalcemia. Vitamin D deficiency may lead to a variety of disorders. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for these services.Vitamin D is called a "vitamin" because of its exogenous source, predominately from oily fish in the form of vitamin D2 and vitamin D3.

It is really a hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol, which then acts throughout the body. In the skin, 7-dehydrocholesterol is converted to vitamin D3 in response to sunlight, a process that is inhibited by sunscreen with a skin protection factor (SPF) of 8 or greater. Once in the blood, vitamin D2 and D3 from diet or skin bind with vitamin D binding protein and are carried to the liver where they are hydroxylated to yield calcidiol.

Calcidiol then is converted in the kidney to calcitriol by the action of 1a-hydroxylase (CYP27B1). The CYP27B1 in the kidney is regulated by nearly every hormone involved in calcium homeostasis, and its activity is stimulated by PTH, estrogen, calcitonin, prolactin, growth hormone, low calcium levels, and low phosphorus levels. Its activity is inhibited by calcitriol, thus providing the feedback loop that regulates calcitriol synthesis.

An excess of vitamin D is unusual, but may lead to hypercalcemia. Vitamin D deficiency may lead to a variety of disorders, the most infamous of which is rickets. Evaluating patients’ vitamin D levels is accomplished by measuring the level of 25-hydroxyvitamin D. Measurement of other metabolites is generally not medically necessary.Vitamin D has been described as an immunomodulator targeting various immune cells, including monocytes, macrophages, T-lymphocytes, and B-lymphocytes.

5 Studies have suggested that vitamin D plays an important role in maintenance of the immune system. Vitamin D may have a central role in infectious and autoimmune diseases, in particular tuberculosis and type 1 diabetes.Vitamin D influences the immune response to tuberculosis, and vitamin D deficiency has been associated with increased tuberculosis risk in different populations.6 A meta-analysis explored the association between low serum vitamin D and risk of active tuberculosis in humans.

7  After review of studies published between 1980 and 2006, low serum vitamin D levels are associated with higher risk of active tuberculosis.Low levels of vitamin D have been associated with a higher risk of cardiovascular disease and myocardial infarction.9, 10 A study of over 18,000 men, free from cardiovascular disease ages 40 to 75 years, was conducted with 10 years follow-up.11 Men with 25(OH)D levels less than 16 ng/mL were at 2.

42 times higher risk of developing infarction than those with levels >29 ng/mL. Similarly, Wang et al. (2008) reported on 1739 participants without prior cardiovascular disease and those with 25(OH)D levels less than 10 ng/mL had cardiovascular hazard ratio of 1.80 comparing with the ones with higher concentrations.12  Likewise, there have been reports of clinical and epidemiological studies that suggest there may be an association between hypertension and vitamin D status as well as calcium metabolismIn 2010, the Mayo Foundation published a review for clinicians “Vitamin D Deficiency in Adults: When to Test and How to Treat”.

The review point on the clinical risk factors for vitamin D severe deficiency such as** Inadequate oral intake of vitamin D** Malnutrition** Limited sun exposure** Malabsorption including** Short bowel syndrome** Pancreatitis** Inflammatory Bowel Disease** Amyloidosis** Celiac Sprue** Malabsorptive bariatric surgery procedures** Some antiepileptic medications** Severe liver disease or failure** Aging** Renal insufficiency, glomerular filtration rate <60 p="">** Nephrotic syndrome POLICY STATEMENT:I.

Based upon our criteria and assessment of the peer-reviewed literature, screening for Vitamin D deficiency in individuals considered high risk for vitamin D deficiency (See Policy Guideline I) is considered medically appropriate.II. Based upon our criteria and assessment of the peer-reviewed literature, routine screening for Vitamin D deficiency in healthy adults or children is considered not medically necessary.

III. Based upon our criteria and assessment of the peer-reviewed literature, screening for Vitamin D deficiency for nonskeletal diseases (e.g., cardiovascular disease, cancer, and autoimmune disease) is considered not medically necessary.POLICY GUIDELINES:I. Individuals that are high risk for vitamin D deficiency include, but are not limited to:A. Osteomalacia;B. Osteoporosis;C. Chronic kidney disease;D.

Hepatic failure;E. Malabsorption syndromes (e.g., cystic fibrosis, inflammatory bowel disease, Crohn’s disease, bariatric surgery, radiation enteritis);F. HyperparathyroidismG. Medications (e.g., antiseizure, glucocorticoids, AIDS medications, antifungals, cholestyramine);H. African-American and Hispanic children and adultsI. Pregnant and lactating women;J. Older adults (age greater than 65 years) with history of falls or nontraumatic fractures;K.

Obese children and adults (BMI greater than 30 kg/m2 );L. Granuloma-forming disorders (e.g., sarcoidosis, tuberculosis, histoplamosis, coccidiomycosis, berylliosis);M. Some lymphomas.II. Serum concentration of 25 hydroxyvitamin D (25OHD) is the optimal clinical indicator of vitamin D metabolism due to the rapid conversion of vitamin D to 25 OHD with only a small fraction converted to 1,25 hydroxyvitamin D (1, 25 OHD).

III. The Federal Employee Health Benefit Program (FEHBP/FEP) requires that procedures, devices or laboratory tests approved by the U.S. Food and Drug Administration (FDA) may not be considered investigational and thus these procedures, devices or laboratory tests may be assessed only on the basis of their medical necessity.DESCRIPTION:A major source of vitamin D for most humans comes from exposure of the skin to sunlight typically between 1000 hours and 1500 hours in the spring, summer, and fall.

Vitamin D produced in the skin may last at least twice as long in the blood compared with ingested vitamin D. A variety of factors reduce the skin’s production of vitamin D3, including increased skin pigmentation, aging, and the topical application of a sunscreen. An alteration in the zenith angle of the sun caused by a change in latitude, season of the year, or time of day dramatically influences the skin’s production of  vitamin D3.

Few foods naturally contain vitamin D2 or vitamin D3 however some foods have been fortified with Vitamin D.Vitamin D deficiency results in abnormalities in calcium, phosphorus, and bone metabolism. Specifically, vitamin D deficiency causes a decrease in the efficiency of intestinal calcium and phosphorus absorption of dietary calcium and phosphorus, resulting in an increase in parathyroid hormone (PTH) levels.

Secondary hyperparathyroidism maintains serum calcium in the normal range at the expense of mobilizing calcium from the skeleton and increasing phosphorus wasting in the kidneys. As a result there may be bone weakness and a generalized decrease in bone mineral density (BMD), resulting in osteopenia and osteoporosis. Vitamin D deficiency may also cause muscle weakness making standing and walking difficult for affected children.

In the elderly, more frequent falls may occur, which increases their risk of fracture.</60><60 p=""></60> D50 Iron deficiency anaemiaD500 Iron deficiency anaemia secondary to blood loss (chronic)D501 Sideropenic dysphagiaD508 Other iron deficiency anaemiasD509 Iron deficiency anaemia, unspecifiedD51 Vitamin B12 deficiency anaemiaD510 Vitamin B12 deficiency anaemia due to intrinsic factor deficiencyD511 Vitamin B12 deficiency anaemia due to selective vitamin B12 malabsorption with proteinuriaD512 Transcobalamin II deficiency<60 p=""></60>D513 Other dietary vitamin B12 deficiency anaemia<60 p="">RATIONALE:The Endocrine Society Task Force for Evaluation, Treatment and Prevention of Vitamin D deficiency (2011) recommended screening for vitamin D deficiency in individuals at risk for deficiency.

The Task Force did not recommend population screening for vitamin D deficiency in individuals who are not at risk (high quality evidence).High risk for vitamin D deficiency include those individuals with osteoporosis, chronic kidney failure, malabsoprtion syndromes, hyperparathyroidism, African-American and Hispanic children and adults, pregnant or lactating women, older adults with history of falls or non-traumatic fractures, obese children or adults (BMI greater than 30 kg/m2 ), granuloma-forming disorders, and some lymphomas.

The Agency for Healthcare Research and Quality report on Vitamin D and Calcium: a systematic review of health outcomes (2009) found that no qualified systematic reviews have evaluated the association between vitamin D intake or serum 25(OH)D concentrations and incidence of cardiovascular disease, body weight in adults, total cancer incidence and mortality, immune function-related outcomes, and pregnancy.

There is fair evidence between low serum 25 (OH)D levels and rickets. However no threshold level has been determined when rickets will not occur. The association between low serum 25 (OH)D levels and the risk of falls, fractures or performance measures among postmenopausal women or elderly men is inconsistent. There is fair evidence to support an association between serum 25(OH)D and BMD or changes in BMD at the femoral neck in postmenopausal women and elderly men.

However more recent studies show no significant effects of vitamin D supplementation on BMD in children or adults.The Institute of Medicine (IOM) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium assessed the health outcomes associated with vitamin D and calcium (2010). The Committee found that the evidence supported a role for these nutrients in bone health but not in other health conditions.

In addition, the Committee assigned an upper level to both vitamin D and calcium intake noting that beyond these levels the risk of harm increases. Too much calcium has been associated with kidney stone formation while very high levels of vitamin D are known to cause kidney and tissue damage.The Institute for Clinical Systems Improvement (ICSI) Health Care Guidelines; Preventative Services for Adults recommendation states there is insufficient evidence to assess the balance of benefits and harms of counseling adults to get an adequate intake of vitamin D and calcium in order to prevent either cancer or bone fractures (Weak Recommendation).

The evidence for effectiveness states that adequate calcium intake from food sources and supplements promote bone health; however, the evidence is insufficient to recommend counseling for noninstitutionalized, community-dwelling, asymptomatic adults without previous history of fractures or cancer. However, vitamin D supplementation does appear to be effective in preventing injury from falls in community-dwelling adults aged 65 years and over who are at increased risk for falls.

The U.S. Preventative Task Force (USPSTF) guidelines for Vitamin D and Calcium Supplementation to Prevent Fractures (2013) concluded that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men (Grade I statement).In addition the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium for the primary prevention of fractures in non-institutionalized postmenopausal women (Grade I statement).

The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the primary prevention of fractures in non-institutionalized postmenopausal women. (Grade: D Recommendation).The U.S. Preventative Task Force (USPSTF) guidelines for Screening for Vitamin D deficiency in adults: U.S. Preventive Services Task Force Recommendation Statement (2015) found no studies that evaluated the direct benefit of screening for vitamin D deficiency in adults.

The Task Force found adequate evidence that the harms of treatment of vitamin D deficiency are small to none. No studies reported on the harms of treatment of vitamin D deficiency or identified a significant increase in total adverse events, hypercalcemia, kidney stones, or gastrointestinal symptoms.The Task Force found adequate evidence that treatment of asymptomatic vitamin D deficiency has no benefit on cancer, type 2 diabetes mellitus, risk for death in community-dwelling adults, and risk for fractures in persons not selected on the basis of being at high risk for fractures.

The Task Force found inadequate evidence on the benefit of treatment of asymptomatic vitamin D deficiency on other outcomes, including psychosocial and physical functioning. Although the evidence is adequate for a few limited outcomes, the overall evidence on the early treatment of asymptomatic, screendetected  vitamin D deficiency in adults to improve overall health outcomes is inadequate.The USPSTF concluded that the evidence on screening for vitamin D deficiency in community-dwelling, nonpregnant, asymptomatic adults aged 18 years or older to improve health outcomes is insufficient and that the balance of benefits and harms of screening and early intervention cannot be determined.

ICD9: 252.00-252.1 Disorders of the parathyroid gland (code range)268.0 Rickets, active268.2 Osteomalacia, unspecified268.9 Unspecified vitamin D deficiency275.3 Disorders of phosphorus metabolism275.41 Hypocalcemia275.42 Hypercalcemia585.3-585.6 Chronic kidney disease, Stage III to End stage renal disease (code range)588.81 Secondary hyperparathyroidism (of renal origin)733.00 Osteoporosis, unspecified733.

01 Senile osteoporosis733.02 Idiopathic osteoporosis733.03 Disuse osteoporosis733.09 Other, osteoporosis733.90 Disorder of bone and cartilage, unspecified</60>

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Procedure  Code: 82306Group 1 Codes:82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED82652 VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMEDLCD Description:Vitamin D is a hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. An excess of vitamin D may lead to hypercalcemia. Vitamin D deficiency may lead to a variety of disorders.

This LCD identifies the indications and limitations of Medicare coverage and reimbursement for these servicesICD10 DESCRIPTIONE55.9 Vitamin D deficiency, unspecifiedE20.0 Idiopathic hypoparathyroidismE20.8 Other hypoparathyroidismHypoparathyroidism, unspecified E20.9E21.0 Primary hyperparathyroidismSecondary hyperparathyroidism, not elsewhere classified E21.1E21.2 Other hyperparathyroidismHyperparathyroidism, unspecified E21.

3Rickets, active E55.0Vitamin D deficiency, unspecified Medicare generally considers vitamin assay panels (more than one vitamin assay) a screening procedure and therefore, non-covered. Similarly, assays for micronutrient testing for nutritional deficiencies that include multiple tests for vitamins, minerals, antioxidants and various metabolic functions are never necessary. Medicare reimburses for covered clinical laboratory studies that are reasonable and necessary for the diagnosis or treatment of an illness.

Many vitamin deficiency problems can be determined from a comprehensive history and physical examination. Any diagnostic evaluation should be targeted at the specific vitamin deficiency suspected and not a general screen. Most vitamin deficiencies are nutritional in origin and may be corrected with supplemented vitamins. Most vitamin deficiencies are suggested by specific clinical findings. The presence of those specific clinical findings may prompt laboratory testing for evidence of a deficiency of that specific vitamin.

Certain other clinical states may also lead to vitamin deficiencies (malabsorption syndromes, etc). Limitations: For Medicare beneficiaries, screening tests are governed by statute (Social Security Act 1861(nn)). Vitamin or micronutrient testing may not be used for routine screening.Once a beneficiary has been shown to be vitamin deficient, further testing is medically necessary only to ensure adequate replacement has been accomplished.

Thereafter, annual testing may be appropriate depending upon the indication and other mitigating factors. Assays of selenium (84255), functional intracellular analysis (84999) or total antioxidant function (84999) are non-covered services. Assays of vitamin testing, not otherwise classified (84591), are not covered since all clinically relevant vitamins have specific assays. The following are pertinent laboratory tests for which frequency limitations will be specified [note this should be all the CPT codes in the list below, except for those that are non-covered]: Vitamins and metabolic function assays: 25-OH Vitamin D-3, Carnitine, Vitamin B-12, Folic Acid (Serum), Homocystine, Vitamin B-6, Vitamin B-2, Vitamin B-1, Vitamin E, Fibrinogen, High-Sensitivity C-Reactive Protein and Lipoprotein-associated phospholipase A2 (Lp-PLA2); Vitamin A; Vitamin K; and Ascorbic acid.

. Additional inclusion of Vitamin D (with limited coverage not otherwise specified). Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.

To be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is: Safe and effective. Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).

Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is: Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member. Furnished in a setting appropriate to the patient’s medical needs and condition. Ordered and furnished by qualified personnel.

One that meets, but does not exceed, the patient’s medical need. At least as beneficial as an existing and available medically appropriate alternative. Bill Type Codes Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

12X, 13X, 14X, 18X, 21X, 22X, 23X, 71X, 72X, 75X, 77X, 83X, 85X Revenue Codes Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual Publication 100-04, Claims Processing Manual, for further guidance.

030XCPT/HCPCS Codes Note:Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web. 82180© Assay of ascorbic acid82306© Vitamin D, 25-hydroxyNote: Code 82306 includes fractions, if performed.82379© Carnitine82607© Cyanocobalamin, (Vitamin B-12)82652© Vitamin D 1, 25-dihydroxyNote: Code 82652 includes fractions, if performed.

82746© Folic Acid83090© Homocysteine83698© Assay lipoprotein pla284207© Pyridoxal phosphate (Vitamin B-6)84252© Riboflavin (Vitamin B-2)84425© Thiamin (Vitamin B-1)84446© Tocopherol84590© Assay of Vitamin A84591© Assay of NOS vitamin84597© Assay of Vitamin K85385© Fibrinogen, antigen86141© C-reactive protein, hs86352© Cell function assay w/stim86353© Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis Billing and Coding Guidelines ALL these codes are required CLIA certification and QW Modifier Vitamin D Assays (CPT code 82306) LCD Description:Vitamin D is a hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol.

An excess of vitamin D may lead to hypercalcemia. Vitamin D deficiency may lead to a variety of disorders. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for these services. ICD-10 Description ICD-10 ICD-9 Age-Related Osteoporosis without Current Pathological Fracture M81.0 733.00Age-Related Osteoporosis without Current Pathological Fracture M81.0 733.

01Hypercalcemia E83.52 275.42Hypocalcemia E83.51 275.41Other Osteoporosis without Current Pathological Fracture M81.8 733.02Other Osteoporosis without Current Pathological Fracture M81.8 733.09Vitamin D Deficiency, Unspecified E55.9 268.9** Z00 Encounter for general examination without complaint, suspected or reported diagnosis** Z00.0 Encounter for general adult medical examination** Z00.00 Encounter for general adult medical examination without abnormal findings** Z00.

1 Encounter for newborn, infant and child health examinations** Z00.11 Newborn health examination** Z00.110 Health examination for newborn under eight days old** Z00.111 Health examination for newborn 8 to 28 days old** Z00.12 Encounter for routine child health examination** Z00.129 Encounter for routine child health examination without abnormal findings** Z00.8 Encounter for other general examination CPT code 84591 and 82306 are not paid when billing together.

ICD-9-CM Codes That Support Medical Necessity The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary. Medicare is establishing the following limited coverage for CPT codes 82306 and 82652: Covered for: 252.

00–252.02 Disorders of parathyroid gland Other hyperparathyroidism Hypoparathyroidism Rickets, active Osteomalacia, unspecified Unspecified vitamin D deficiency Disorders of phosphorus metabolism 275.41–275.42 Disorders of calcium metabolism 585.3–585.6 Chronic kidney disease (CKD) Secondary hyperparathyroidism (of renal origin) 733.00–733.03 Osteoporosis Other osteoporosis Disorder of bone and cartilage, unspecified Medicare is establishing the following limited coverage for CPT code 82379: Covered for: 277.

81–277.84 Carnitine deficiency Anemia in chronic kidney disease Hypotension of hemodialysis Medicare is establishing the following limited coverage for CPT codes 82607, 82746 and 83090: Covered for: Whipple’s Disease Nutritional marasmus Other severe protein calorie malnutrition Malnutrition of moderate degree Arrested development following protein-calorie malnutrition 263.

8-263.9 Other protein-calorie malnutrition Other B complex deficiencies Disturbances of sulphur bearing amino-acid metabolism 281.0-281.3 Pernicious anemia Unspecified deficiency anemia Thrombocytopenia, unspecified Senile dementia, uncomplicated 303.91-303.92 Other and unspecified alcohol dependence Alzheimer’s Disease Other and unspecified extrapyramidal diseases and abnormal movement disorders Idiopathic progressive polyneuropathy Peripheral neuropathy, unspecified Glossodynia Achlorhydria 555.

0–555.2 Regional enteritis Regional enteritis, unspecified site 579.0–579.4 Intestinal Malabsorption 579.8–579.9 Intestinal Malabsorption Memory loss Other general symptoms *Note: Use to identify altered mental status Paresthesia Sensory loss Personal history of nutrition deficiency Renal dialysis status Intestinal bypass or anastomosis status Encounter for antineoplastic chemotherapy Long-term (current) use of other medications Medicare is establishing the following limited coverage for CPT code 84207: Covered for: Vitamin B-6 deficiency Sideroblastic anemia Other and unspecified extrapyramidal diseases and abnormal movement disorders Peripheral neuropathy, unspecified Medicare is establishing the following limited coverage for CPT code 85385: Covered for: Congenital deficiency of other clotting factors 286.

6-286.7 Coagulation defects 287.30–287.33 Primary Thrombocytopenia Posttransfusion purpura Other secondary thrombocytopenia Secondary thrombocytopenia Abnormal Coagulation profile Medicare is establishing the following limited coverage for CPT codes 86352 and 86353: Covered for: 279.10-279.13 Deficiency of cell-medicated immunity 996.81-996.87 Complications of transplanted organ Organ or tissue replaced by transplant, kidney Organ or tissue replaced by transplant, heart Organ or tissue replaced by transplant, lung Organ or tissue replaced by transplant, liver Organ or tissue replaced by transplant, bone marrow Organ or tissue replaced by transplant, pancreas Organ or tissue replaced by transplant, intestine Medicare is establishing the following limited coverage for CPT code 86141, and 83698: Covered for: Coronary atherosclerosis of native coronary artery Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.

Diagnoses That Support Medical Necessity Note: Limited coverage is not being established, at this time, for the remaining CPT codes (82180, 84252, 84425 and 84446, 84590 and 84597). See the “Utilization Guidelines” section for frequency limitations. Documentation Requirements Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.

Utilization Guidelines Medicare will not cover more than one test per year, per beneficiary except as noted below. Certain tests may exceed the stated frequencies, when accompanied by a diagnosis fitting the exception description for exceeding the once per annum maximum. Carnitine (82379) may be tested up to three times per year to account for baseline assay followed by evaluations at six-month increments (adapted from “Levocarnitine” NCD).

Vitamin B-12 (82607) and folate (82746) can be tested up to four times per year for malabsorption syndromes (579.9) or deficiency disorders (266.2, 281.1 and 281.2). Vitamin B-12 (82607) can only be tested more frequently than four times per year for postsurgical malabsorption (579.3). 25-OH Vitamin D-3 (82306) may be tested up to four times per year for Vitamin D deficiencies (268.0–268.9). Fibrinogen, antigen (85385) may be tested up to four times per year for low platelet diagnoses (287.

30–287.33, 287.41, 287.49, 287.5). Medicare will not cover more than two high-sensitivity C-reactive protein (86141) tests per year per beneficiary. This allows for baseline testing and six-month follow-up tests for statin therapeutic management. The same frequency edit (two tests per year per beneficiary) will be applied to Lipoprotein-associated phospholipase A2 (Lp-PLA2) used in the management of patients with coronary artery disease.

Cell function assay with stimulation (86352) and Lymphocyte transformation assays (86353) will not be subjectedto any frequency edits. Notice: This LCD imposes utilization guideline limitations. Despite Medicare’s allowing up to these maximums, each patient’s condition and response to treatment must medically warrant the number of services reported for payment. Medicare requires the medical necessity for each service reported to be clearly demonstrated in the patient’s medical record.

Medicare expects that patients will not routinely require the maximum allowable number of services.

Wilma Lawrence

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