Automated World Health
Local Coverage Determination (LCD) for Ionized Calcium (L28896)
Contractor Information
Contractor Name First Coast Service Options, Inc.
Contractor Number
09101
Contractor Type
MAC - Part A
LCD Information
Document Information
LCD ID Number L28896
LCD Title Ionized Calcium
Contractor's Determination Number A82330
Primary Geographic Jurisdiction Florida
Oversight Region Region IV
AMA CPT/ADA CDT Copyright Statement
CPT only copyright 2002-2011 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association.
Original Determination Effective Date
For services performed on or after 02/16/2009
Original Determination Ending Date
Revision Effective Date
For services performed on or after 10/01/2010
Revision Ending Date
CMS National Coverage Policy
Language quoted from CMS National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals are italicized throughout the Local Coverage Determination (LCD). NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See § 1869 (f)(1)(A)(i) of the Social Security Act.
Unless other wise specified, italicized text represents quotation from one or more of the following CMS sources: CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, Section 20-20.3.2
CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80
CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, Section 50.2
Indications and Limitations of Coverage and/or Medical Necessity
Ionized calcium is a cation that circulates freely in the bloodstream and comprises 46-50% of all circulating calcium. Only the ionized calcium can be used by the body in such vital processes as muscular contraction, cardiac function, transmission of nerve impulses, and blood clotting. Ionized calcium is considered a more sensitive and accurate indicator for many operative procedures and disease processes. A normal serum ionized calcium for an adult is 4.65 - 5.28 mg/dl.
Medicare will consider an Ionized Calcium test medically necessary under any of the following circumstances:
• Evaluation of patients with clinical signs and symptoms of hyperparathyroidism such as weakness, fatigue, bone pain, confusion, depression, nausea, vomiting, polyuria, etc. in which parathyroid disease is suspected;
• Evaluation of patients with clinical signs and symptoms of hypoparathyroidism such as Chvostek’s sign, Trousseau’s sign, dysphagia, tetany, increased deep tendon reflexes, etc. in which parathyroid disease is suspected;
• Evaluation of a patient with an abnormal total calcium level;
• Monitoring of a patient with renal disease, renal transplantation, or hemodialysis;
• Patients with previously diagnosed hyper or hypoparathyroidism;
• Patients with pancreatitis as characterized by symptoms such as epigastric abdominal pain, nausea and/or vomiting, fever, hypotension, mild jaundice, umbilical discoloration (Cullen’s sign), etc.;
• Patients with a magnesium deficiency and/or excessive Vitamin D;
• Patients with sepsis as characterized by symptoms such as hypotension, tachycardia, tachypnea, change in mental status, etc.; and
• Patients with ectopic parathyroid hormone producing neoplasms.
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.
012x Hospital Inpatient (Medicare Part B only) 013x Hospital Outpatient
014x Hospital - Laboratory Services Provided to Non-patients 021x Skilled Nursing - Inpatient (Including Medicare Part A) 022x Skilled Nursing - Inpatient (Medicare Part B only) 023x Skilled Nursing - Outpatient
072x Clinic - Hospital Based or Independent Renal Dialysis Center
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.
0301 Laboratory - Chemistry
CPT/HCPCS Codes
82330 CALCIUM; IONIZED
ICD-9 Codes that Support Medical Necessity
038.0 - 038.9 opens in
new window STREPTOCOCCAL SEPTICEMIA - UNSPECIFIED SEPTICEMIA
252.1 - 252.08 opens in
new window HYPERPARATHYROIDISM, UNSPECIFIED - OTHER HYPERPARATHYROIDISM
252.2 HYPOPARATHYROIDISM
259.3 ECTOPIC HORMONE SECRETION NOT ELSEWHERE CLASSIFIED
275.2 DISORDERS OF MAGNESIUM METABOLISM
275.41 HYPOCALCEMIA
275.42 HYPERCALCEMIA
275.49 OTHER DISORDERS OF CALCIUM METABOLISM
278.4 HYPERVITAMINOSIS D
293.83 MOOD DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE
298.9 UNSPECIFIED PSYCHOSIS
458.9 HYPOTENSION UNSPECIFIED
577.1 ACUTE PANCREATITIS
577.2 CHRONIC PANCREATITIS
585.1 - 585.9 opens in
new window CHRONIC KIDNEY DISEASE, STAGE I - CHRONIC KIDNEY DISEASE, UNSPECIFIED
586 RENAL FAILURE UNSPECIFIED
588.81 - 588.89
SECONDARY HYPERPARATHYROIDISM (OF RENAL ORIGIN) - OTHER SPECIFIED DISORDERS RESULTING FROM IMPAIRED RENAL FUNCTION
733.90 DISORDER OF BONE AND CARTILAGE UNSPECIFIED
780.60 FEVER, UNSPECIFIED
780.61 FEVER PRESENTING WITH CONDITIONS CLASSIFIED ELSEWHERE
780.62 POSTPROCEDURAL FEVER
780.63 POSTVACCINATION FEVER
780.66 FEBRILE NONHEMOLYTIC TRANSFUSION REACTION
780.79 OTHER MALAISE AND FATIGUE
781.0 ABNORMAL INVOLUNTARY MOVEMENTS
781.7 TETANY
782.4 JAUNDICE UNSPECIFIED NOT OF NEWBORN
785.0 TACHYCARDIA UNSPECIFIED
786.06 TACHYPNEA
787.01 - 787.04 opens in
new window NAUSEA WITH VOMITING - BILIOUS EMESIS
787.20 - 787.29 opens in
new window DYSPHAGIA, UNSPECIFIED - OTHER DYSPHAGIA
788.42 POLYURIA
789.06 ABDOMINAL PAIN EPIGASTRIC
996.81 COMPLICATIONS OF TRANSPLANTED KIDNEY
V42.0* KIDNEY REPLACED BY TRANSPLANT
V45.11 RENAL DIALYSIS STATUS
V56.0 AFTERCARE INVOLVING EXTRACORPOREAL DIALYSIS
* According to the ICD-9-CM book, diagnosis codes V42.0 and V45.11 are secondary diagnosis codes and should not be billed as the primary diagnosis.
Note: Renal dialysis facilities (72x) should report a diagnosis code of 585.6 for submission of claims.
Diagnoses that Support Medical Necessity N/A
ICD-9 Codes that DO NOT Support Medical Necessity XX000 Not Applicable
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity N/A
General Information
Documentations Requirements
The medical records maintained in the patient’s file must document the medical necessity of the test including the test results. This information is usually found in the office/progress notes, hospital notes, and/or laboratory results.
Appendices
Utilization Guidelines N/A
Sources of Information and Basis for Decision
Anderson, D.M., Keith, J., Novak, P.D., & Elliot, M.A. (2002). Mosby’s Medical Dictionary, Sixth Edition. St. Louis: Mosby, Inc.
Beers, M., & Berkow, R. (1999-2005). Calcium Metabolism. {Electronic version}. The Merck Manual of Diagnosis and Therapy, Section 2, Chapter 12.
Nissl, J. (2004, November). Calcium (Ca) in Blood, Health Guide A-Z. Retrieved June 14, 2005, http://my.webmd.com/hw/lab_tests/hw3833.asp
Advisory Committee Meeting Notes This Local Coverage Determination (LCD) does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this LCD was developed in cooperation with the advisory groups, which includes representatives from numerous societies.
Start Date of Comment Period
End Date of Comment Period
Start Date of Notice Period 10/01/2010
Revision History Number 2
Revision History Explanation Revision Number:2 Start Date of Comment Period:N/A
Start Date of Notice Period:10/01/2010 Revised Effective Date:10/01/2010
LCR A2010-050
September 2010 Bulletin
Explanation of Revision: Annual 2011 ICD-9-CM Update. Added diagnosis code 780.66 and descriptor. The effective date of this revision is based on date of service.
Revision Number:1
Start Date of Comment Period:N/A Start Date of Notice Period:10/01/2009 Revised Effective Date: 10/01/2009
LCR A2009-081
September 2009 Bulletin
Explanation of Revision: Annual 2010 ICD-9-CM Update. Added new diagnosis code 787.04. The effective date of this revision is based on date of service
Revision Number:Original
Start Date of Comment Period:N/A Start Date of Notice Period:12/04/2008 Revised Effective Date:02/16/2009
LCR A2009-034FL
December 2008 Bulletin
This LCD consolidates and replaces all previous policies and publications on this subject by the fiscal intermediary predecessors of First Coast Service Options, Inc. (COSVI and FCSO).
For Florida (00090) this LCD (L28896) replaces LCD L1397 as the policy in notice. This document (L28896) is effective on 02/16/2009.
8/1/2010 - The description for Bill Type Code 12 was changed 8/1/2010 - The description for Bill Type Code 13 was changed 8/1/2010 - The description for Bill Type Code 14 was changed 8/1/2010 - The description for Bill Type Code 21 was changed 8/1/2010 - The description for Bill Type Code 22 was changed 8/1/2010 - The description for Bill Type Code 23 was changed 8/1/2010 - The description for Bill Type Code 72 was changed 8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0301 was changed
Reason for Change
Related Documents
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LCD Attachments
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All Versions
Updated on 09/17/2010 with effective dates 10/01/2010 - N/A Updated on 09/15/2010 with effective dates 10/01/2010 - N/A Updated on 08/01/2010 with effective dates 10/01/2009 - 09/30/2010 Updated on 08/01/2010 with effective dates 10/01/2009 - N/A Updated on 09/25/2009 with effective dates 10/01/2009 - N/A Updated on 11/29/2008 with effective dates 02/16/2009 - N/A