Health Information Management

Q&A: Reporting CPT code 82306 for vitamin D testing

JustCoding News: Outpatient, October 21, 2009

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QUESTION: We have been getting a medical necessity edit for CPT code 82306 (Calcifediol [25-OH Vitamin D-3]). I can’t find a local medical review policy about this, and the most recent index of updated national coverage determinations does not include this either. Do you have any information regarding the policy?

ANSWER: When a denial comes back due to lack of medical necessity, coders should first look at the diagnosis codes. What diagnosis codes are you reporting to justify the vitamin D test? The job of the diagnosis code is to identify the legitimate medical necessity for providing the procedure, treatment, or service. Therefore, to prove this point, the facility would be able to appeal the denial using documentation of evidence-based research from the healthcare industry to identify that the reason for performing the test was, indeed, medically necessary.

The healthcare industry has identified insufficient vitamin D levels as a cause of thin, brittle, or misshapen bones, as well as the degradation of cartilage. There are studies that have investigated the cause and effect of low serum vitamin D levels to all-cause mortality, cancer, and cardiovascular disease mortality.

Check the research that supports the testing of the patient’s vitamin D levels with the diagnosis or signs and symptoms you reported linked to CPT code 82306. Provide a copy of this research with your appeal to the third-party payer.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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