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.
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
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
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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