Vitamin D Testing Recommendations and Coding Information

Produced when the body is exposed to sunlight, Vitamin D is necessary to absorb calcium and phosphorus needed to maintain bone strength. As every cell in the body had Vitamin D receptors, it plays a key role in important functions such as cell growth modulation, neuromuscular and immune function and inflammation reduction. Evaluation of vitamin D levels is done by measuring the level of 25-hydroxyvitamin D. Medical coding services for Vitamin D deficiency involve coding to the highest level of specificity to report medically necessary screening for Vitamin D deficiency. Medical News Today reports that a 2011 study found that, in general, more than 40 percent of the U.S. population was vitamin D deficient.

Today, the sunshine vitamin is in the news with a new study finding that vitamin D-3 is twice as effective at raising vitamin D levels in the body as vitamin D-2. Researchers say that this may change guidelines. Daily vitamin D dietary recommendations for adults have changed over the years. The Institute of Medicine’s recommended dietary allowance, or RDA, for vitamin D is 600 international units (IU) per day for young adults and 800 IU per day for adults older than 70. However, 1,000 to 2,000 IU per day of vitamin D from a supplement is generally considered safe and adequate. Screening for Vitamin D deficiency is recommended for people with osteoporosis or certain other health conditions. An excess of vitamin D is uncommon, but can lead to hypercalcemia.

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Indications for Measurement of Vitamin D Levels

The Centers for Medicaid and Medicare Services (CMS) and commercial payers do not pay for Vitamin D testing for routine screening. According to CMS, measurement of Vitamin D levels is indicated for patients with the following conditions:

• Chronic kidney disease stage III or greater
• Osteoporosis
• Osteomalacia
• Osteopenia
• Hypocalcemia
• Hypercalcemia
• Hypercalciura
• Hypoparathyroidism
• Hyperparathyroidism
• Malabsorption states
• Cirrhosis
• Hypervitaminosis D
• Obstructive jaundice
• Osteosclerosis/petrosis
• Rickets
• Low exposure to sunlight
• Vitamin D deficiency to monitor the efficacy of replacement therapy

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Vitamin D Assay Testing – Coding Information for 2017

CPT codes

82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed 82652 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed

ICD 10 Codes

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E20.0 Idiopathic hypoparathyroidism E20.8 Other hypoparathyroidism E20.9 Hypoparathyroidism, unspecified E21.0 – E21.3 Primary hyperparathyroidism – 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 E83.31 Familial hypophosphatemia E83.32 Hereditary vitamin D-dependent rickets (type 1) (type 2) E83.39 Other disorders of phosphorus metabolism E83.51 Hypocalcemia E83.52 Hypercalcemia E89.2 Postprocedural hypoparathyroidism 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 M81.6 Localized osteoporosis [Lequesne] M81.8 Other osteoporosis without current pathological fracture M83.0 – M83.5 Puerperal osteomalacia – Other drug-induced osteomalacia in adults M83.8 Other adult osteomalacia M85.80 Other specified disorders of bone density and structure, unspecified site M85.811 Other specified disorders of bone density and structure, right shoulder M85.812 Other specified disorders of bone density and structure, left shoulder M85.821 Other specified disorders of bone density and structure, right upper arm M85.822 Other specified disorders of bone density and structure, left upper arm M85.831 Other specified disorders of bone density and structure, right forearm M85.832 Other specified disorders of bone density and structure, left forearm M85.841 Other specified disorders of bone density and structure, right hand M85.842 Other specified disorders of bone density and structure, left hand M85.851 Other specified disorders of bone density and structure, right thigh M85.852 Other specified disorders of bone density and structure, left thigh M85.861 Other specified disorders of bone density and structure, right lower leg M85.862 Other specified disorders of bone density and structure, left lower leg M85.871 Other specified disorders of bone density and structure, right ankle and foot M85.872 Other specified disorders of bone density and structure, left ankle and foot M85.88 Other specified disorders of bone density and structure, other site M85.89 Other specified disorders of bone density and structure, multiple sites M89.9 Disorder of bone, unspecified M94.9 Disorder of cartilage, unspecified N18.3 – N18.6 Chronic kidney disease, stage 3 (moderate) – End stage renal disease N25.81 Secondary hyperparathyroidism of renal origin Q78.2 Osteopetrosis

Guidelines for Utilization of Vitamin D Testing Services

According to CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice. Reimbursement will be provided for only one 25 OH Vitamin D level in any 24 hour period:

• Only one 25 OH vitamin D level will be reimbursed in any 24 hour period. Storage and supplement components will not be reimbursed separately.
• Only one 1, 25-OH vitamin D level will be reimbursed in a 24 hour period if medically necessary.
• Assays of vitamin D levels for conditions other than ICD-10 codes E55.0, E55.9, E64.3, M83.0 – M83.5, and M83.8 – M83.9 are limited to once a year.
• Assays of the appropriate vitamin D levels for ICD-10 codes E55.0, E55.9, E64.3, M83.0 – M83.5, and M83.8 – M83.9 are limited to 4 per year, for the previously identified deficient form of vitamin D.

The patient’s medical record must contain documentation that fully supports the medical necessity for services included within this LCD. This includes, but is not limited to: relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

According to the Centers for Disease Control and Prevention (CDC), the number of blood tests for vitamin D levels among Medicare beneficiaries, generally people 65 and older, rose 83-fold from 2000 to 2010, and testing rates rose 2.5-fold from 2009 to 2014 among patients with private insurance. In this scenario, outsourcing medical billing and coding can be a feasible option to ensure that claims are submitted to meet private payers and CMS reimbursement guidelines.

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