L28810

 

CREATINE KINASE (CK); (CPK)

 

02/02/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

• Statins are low-density lipoprotein (LDL) lowering drugs that are widely used in clinical practice.

• The use of statins may produce muscle toxicity under some circumstances.

• Therefore, it would be expected that a baseline measurement of CK would be done prior to initiating statin therapy, as well as, titration of statin therapy or with clinical signs and symptoms of myopathy (i.e., muscle discomfort, weakness, brown urine, etc.).

• However, medical literature does NOT support routine monitoring of CK in the absence of clinical signs and symptoms.

Medicare will consider a CK test to be medically reasonable and necessary for the following conditions:

• Acute myocardial infarction.

• Acute cerebrovascular disease.

• Myocarditis.

• Myositis.

• Rhabdomyolysis.

• Stroke.

•  Central nervous system trauma.

• Neuroleptic malignant syndrome.

• Muscle disease.

• Rheumatoid arthritis.

• Hypothyroidism.

• Hypokalemia.

• Malignant hyperthermia.

• Alcoholic liver disease.

• Acute renal failure.

• Signs and symptoms of cardiac disease:

o Chest pain.

o Nausea.

o Shortness of breath.

• Signs and symptoms of side effects from statin medications:

o Muscle pain.

o Tenderness.

o Weakness.

Coding Information

 

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 Hospital Inpatient (Medicare Part B only)

13x Hospital Outpatient

14x Hospital - Laboratory Services Provided to Non-patients

21x Skilled Nursing - Inpatient (Including Medicare Part A)

22x Skilled Nursing - Inpatient (Medicare Part B only)

23x Skilled Nursing - Outpatient

72x Clinic - Hospital Based or Independent Renal Dialysis Center

85x 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.

 

 

0301 Laboratory - Chemistry

 

 

CPT/HCPCS Codes

 

82550 CREATINE KINASE (CK), (CPK); TOTAL

82552 CREATINE KINASE (CK), (CPK); ISOENZYMES

82553 CREATINE KINASE (CK), (CPK); MB FRACTION ONLY

82554 CREATINE KINASE (CK), (CPK); ISOFORMS

 

 

Documentation Requirements

• Documentation must support that the services were ordered by a physician/non-physician practitioner, the service was performed, and the reason the service was performed.

• Documentation must support the medical necessity of services performed above the utilization parameters stated below.

Utilization Guidelines

• The frequency at which a CK test is performed is dependent on the clinical presentation of the patient.

• It is expected that a CK would be performed as indicated by current medical literature and/or standards of practice.

• When services are performed in excess of established parameters, they may be subject to review for medical necessity.

• Literature supports performing a CK for the following:

o Chest pain/cardiac symptoms on arrival at the emergency room, with follow-up test at established intervals for a total of three CK tests.

o A patient presenting to the physician’s office with chest pain/cardiac symptoms to rule out cardiac involvement.

o Prior to initiating statin therapy and for titration of medication.

o However, if the patient is asymptomatic and has two normal results returned, it would not be expected to repeat this test routinely.

Treatment Logic

• Creatine kinase (CK or CPK) is an enzyme found in heart muscle (CK-MB), skeletal muscle and heart (CK-MM), and brain (CK-BB).

• The MM fraction is present in both cardiac and skeletal muscle, but the MB fraction is much more specific for cardiac muscle.

• Therefore, elevation in total CK is not specific for myocardial injury, because most CK is located in skeletal muscle.

• Elevations in total CK are possible from a variety of non-cardiac conditions, such as muscle disease, stroke, hypothyroidism, and may even be elevated after normal exercise.

• Other cardiac biomarkers (i.e., troponin, myoglobin) may be used in place of or in addition to CK to determine if there is myocardial damage.

 

 

Sources of Information and Basis for Decision

 

Bristol-Myers Squibb Company (2003). Package insert for Pravachol (Pravastatin Sodium), including indications, warnings, precautions, and side-effects.

 

FCSO LCD 29126, Creatine Kinase (CK); (CPK), 02/02/2009. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

National Guideline Clearinghouse. Guidelines on the diagnosis and treatment of acute heart failure. Retrieved from the web on 3/23/06, located at www.guideline.gov/summary/summary.aspx?doc_id=004184

 

National Guideline Clearinghouse. Guidelines on managing abnormal blood lipids. A collaborative approach. Retrieved from the web on 3/23/06, located at www.guideline.gov/summary/summary.aspx?doc_id=8463

 

Lab Tests Online (2004). Cardiac biomarkers. Retrieved from the web on 3/28/06, located at http://www.labtestsonline.org/understanding/analytes/cardiac_biomarkers/glance.html.

 

Pasternak, R., Smith, S.C., Bairey-Merz, C.N., Grundy, S.M., Cleeman, J., Lenfant, C. (2002). ACC/AHA/NHLBI clinical advisory on the use and safety of statins. Journal of the American College of Cardiology, Vol. 40, No. 3, p. 567-572.

 

 

AMA CPT Copyright Statement

CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply.

 

 

CMS LCD L28810 CREATINE KINASE (CK); (CPK)