Friday, January 20, 2017

CPT CODE 82306, 82652 - Vitamin D Hydroxy

Procedure Codes and Description

Group 1 Paragraph: Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural (CPT) codes.

Group 1 Codes:
82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82652 VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED

Coverage Indications, Limitations, and/or Medical Necessity

Vitamin D is called a "vitamin" because of its exogenous source, predominately from oily fish in the form of vitamin D 2 and vitamin D 3. It is more accurate to consider fat-soluble Vitamin D as a steroid hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. Clinical disorders related to vitamin D may arise because of altered availability of the parent vitamin D, altered conversion of vitamin D to its predominant metabolites, altered organ responsiveness to dihydroxylated metabolites and disturbances in the interactions of the vitamin D metabolites with PTH and calcitonin. Normal levels of Vitamin D range from 20 – 50 ng/dl. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for the lab assay.

Indications:

Measurement of 25-OH Vitamin D, CPT 82306, level is indicated for patients with:

chronic kidney disease stage III or greater

cirrhosis

hypocalcemia

hypercalcemia

hypercalciuria

hypervitaminosis D

parathyroid disorders

malabsorption states

obstructive jaundice

osteomalacia

osteoporosis if
i. T score on DEXA scan <-2 .5="" nbsp="" or="" p="">ii. History of fragility fractures or
iii. FRAX > 3% 10-year probability of hip fracture or 20% 10-year probability of other major osteoporotic fracture or
iv. FRAX > 3% (any fracture) with T-score <-1 .5="" or="" p="">v. Initiating bisphosphanate therapy (Vit D level should be determined and managed as necessary before bisphosphonate is initiated)

osteosclerosis/petrosis

rickets

vitamin D deficiency on replacement therapy related to a condition listed above; to monitor the efficacy of treatment.

Measurement of 1, 25-OH Vitamin D, CPT 82652, level is indicated for patients with:

unexplained hypercalcemia (suspected granulomatous disease or lymphoma)

unexplained hypercalciuria (suspected granulomatous disease or lymphoma)

suspected genetic childhood rickets

suspected tumor-induced osteomalacia

nephrolithiasis or hypercalciuria
<-2 .5="" nbsp="" or="" p=""><-1 .5="" or="" p="">
<-2 .5="" nbsp="" or="" p=""><-1 .5="" or="" p="">
Limitations:

Testing may not be used for routine or other screening.

Both assays of vitamin D need not be performed for each of the above conditions. Often, one type is more appropriate for a certain disease state than another. The most common type of vitamin D deficiency is 25-OH vitamin D. A much smaller percentage of 1,25 dihydroxy vitamin D deficiency exists; mostly, in those with renal disease. Documentation must justify the test(s) chosen for a particular disease entity. Various component sources of 25-OH vitamin D, such as stored D or diet-derived D, should not be billed separately.

Once a beneficiary has been shown to be vitamin D deficient, further testing may be medically necessary only to ensure adequate replacement has been accomplished. If Vitamin D level is between 20 and 50 ng/dl and patient is clinically stable, repeat testing is often unnecessary; if performed, documentation most clearly indicate the necessity of the test. If level <20 dl="" ng="" or=""> 60 ng/dl, a subsequent level(s) may be reimbursed until the level is within the normal range.


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.
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
014x Hospital - Laboratory Services Provided to Non-patients
018x Hospital - Swing Beds
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
085x Critical Access Hospital

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.

0300 Laboratory - General Classification
0301 Laboratory - Chemistry
0309 Laboratory - Other Laboratory





ICD-10 Codes that Support Medical Necessity


ICD-10 CODE DESCRIPTION

E20.0 Idiopathic hypoparathyroidism
E20.8 Other hypoparathyroidism
E20.9 Hypoparathyroidism, unspecified
E21.0 Primary hyperparathyroidism
E21.1 Secondary hyperparathyroidism, not elsewhere classified
E21.2 Other hyperparathyroidism
E21.3 Hyperparathyroidism, unspecified
E41 Nutritional marasmus
E43 Unspecified severe protein-calorie malnutrition
E55.0 Rickets, active
E55.9* Vitamin D deficiency, unspecified
E67.3 Hypervitaminosis D
E83.30 Disorder of phosphorus metabolism, unspecified
E83.31 Familial hypophosphatemia
E83.32 Hereditary vitamin D-dependent rickets (type 1) (type 2)
E83.39 Other disorders of phosphorus metabolism
E83.50* Unspecified disorder of calcium metabolism
E83.51 Hypocalcemia
E83.52 Hypercalcemia
E89.2 Postprocedural hypoparathyroidism
E89.820 Postprocedural hematoma of an endocrine system organ or structure following an endocrine system procedure
E89.821 Postprocedural hematoma of an endocrine system organ or structure following other procedure
E89.822 Postprocedural seroma of an endocrine system organ or structure following an endocrine system procedure
E89.823 Postprocedural seroma of an endocrine system organ or structure following other procedure
K74.1 Hepatic sclerosis
K74.2 Hepatic fibrosis with hepatic sclerosis
K76.9 Liver disease, unspecified
K90.0 Celiac disease
K90.1 Tropical sprue
K90.2 Blind loop syndrome, not elsewhere classified
K90.3 Pancreatic steatorrhea
K90.41 Non-celiac gluten sensitivity
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.89 Other intestinal malabsorption
K90.9 Intestinal malabsorption, unspecified
K91.2 Postsurgical malabsorption, not elsewhere classified
M81.0 Age-related osteoporosis without current pathological fracture
M81.8 Other osteoporosis without current pathological fracture
M83.0 Puerperal osteomalacia
M83.1 Senile osteomalacia
M83.2 Adult osteomalacia due to malabsorption
M83.3 Adult osteomalacia due to malnutrition
M83.4 Aluminum bone disease
M83.5 Other drug-induced osteomalacia in adults
M83.8 Other adult osteomalacia
M83.9 Adult osteomalacia, unspecified
M85.80 Other specified disorders of bone density and structure, unspecified site
M85.88 Other specified disorders of bone density and structure, other site
N18.3 Chronic kidney disease, stage 3 (moderate)
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N25.81 Secondary hyperparathyroidism of renal origin
Q78.2 Osteopetrosis

E83.50* Use only for HYPERCALCIURIA

E55.0 Rickets, active
E55.9 Vitamin D deficiency, unspecified
E83.50* Unspecified disorder of calcium metabolism
E83.52* Hypercalcemia
M83.0 Puerperal osteomalacia
M83.1 Senile osteomalacia
M83.2 Adult osteomalacia due to malabsorption
M83.3 Adult osteomalacia due to malnutrition
M83.4 Aluminum bone disease
M83.5 Other drug-induced osteomalacia in adults
M83.8 Other adult osteomalacia
M83.9 Adult osteomalacia, unspecified
N20.0 Calculus of kidney
N20.1 Calculus of ureter
N20.2 Calculus of kidney with calculus of ureter
N20.9 Urinary calculus, unspecified
N22 Calculus of urinary tract in diseases classified elsewhere
Group 2 Medical Necessity ICD-10 Codes Asterisk Explanation: M83.9* Use only for tumor-induced osteomalacia
E83.50* Use only for unexplained hypercalciuria
E83.52* Use only for unexplained hypercalcemia
Showing 1 to 17 of 17 entries in Group 2
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Medical Policy Vitamin D Screening and Testing

Currently, the best accepted measure for assessing vitamin D status is total serum 25(OH)D, expressed in ng/mL or nmol/L. The Institute of Medicine lists the following vitamin D value cutoffs:

• Deficiency—serum 25-hydroxyvitamin D values ≤12 ng/mL (30 nmol/L)

• Insufficiency—serum 25-hydroxyvitamin D values of 12-19 ng/mL (30-49 nmol/L)

• Sufficiency—serum 25-hydroxyvitamin D values of 20-50 ng/mL (50-125 nmol/L)

While these values are widely accepted, there is limited evidence as to what concentration of 25(OH)D is optimal for health



Policy and Coverage Criteria:

Harvard Pilgrim Health Care(HPHC) considers screening for Vitamin D deficiency (or excess) medically necessary for:


• Members under age 18; and
• Symptomatic or “high risk” members aged 18 to 65 years. Members are considered “high risk” due to certain medical conditions, including:
• Biliary Cirrhosis
• Biliary Tract Disorders
• Blind Loop Syndrome
• Calcium Metabolism Disorders (e.g., hyper/hypocalcemia)
• Celiac Disease
• Chronic Kidney Disease
• Crohn’s Disease
• Cystic Fibrosis
• Dermatomyositis
• Hyperparathyroidism or Hypoparathyroidism
• Hypervitaminosis of Vitamin D
• Individuals receiving hyperalimentation
• Intestinal Malabsorption
• Liver Cirrhosis
• Long term use of medications known to lower vitamin D levels (e.g., anticonvulsants, glucocorticoids)
• Lupus Erythematosus (any form)
• Lymphoma
• Malnutrition
• Myalgia
• Myopathy related to endocrine diseases
• Myositis
• Obesity
• Osteogenesis imperfecta
• Osteomalacia
• Osteopetrosis
• Osteoporosis
• Phosphorus metabolism disorders
• Post-Bariatric Surgery
• Premature osteopenia
• Pancreatic steatorrhea
• Primary or miliary tuberculosis
• Psoriasis
• Rheumatoid Arthritis
• Regional enteritis
• Renal, ureteral or urinary calculus (includes nephrolithiasis)
• Rickets
• Sarcoidosis
• Ulcerative Colitis
• Vitamin D deficiency

 NOTE: Once testing demonstrates the member is vitamin D 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.

Screening for Vitamin D deficiency (i.e., testing to determine if someone without signs or symptoms is vitamin D deficient) is not medically necessary in healthy adults as there is limited clinical evidence to support routine screening in this population.

• Harvard Pilgrim does not cover Vitamin D screening and testing in asymptomatic adults aged 18 to 65 years without conditions listed above.

Exclusions:

Harvard Pilgrim Health Care considers vitamin D screening and testing as not medically necessary for all other indications. In addition, HPHC does not cover:

• Screening and testing in asymptomatic adults under 65 without conditions listed above


Coding:

Codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive. Deleted codes and codes which are not effective at the time the service is rendered may not be eligible.

CPT® Codes Description

82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed

82652 Dihydroxyvitamin D, 1, 25 dihydroxy, includes fraction(s), if performed



Billing Guidelines:

<-2 .5="" nbsp="" or="" p=""><-1 .5="" or="" p="">
Member’s medical records must document that services are medically necessary for the care provided. Harvard Pilgrim Health Care maintains the right to audit the services provided to our members, regardless of the participation status of the provider. All documentation must be available to HPHC upon request. Failure to produce the requested information may result in denial or retraction of payment.

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