Automated World Health
L28896
IONIZED CALCIUM
10/01/2010
Indications and Limitations of Coverage and/or Medical Necessity
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.
• 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.
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
82330 CALCIUM; IONIZED
ICD-9 Codes that Support Medical Necessity
038.0 STREPTOCOCCAL SEPTICEMIA
038.10 STAPHYLOCOCCAL SEPTICEMIA UNSPECIFIED
038.11 METHICILLIN SUSCEPTIBLE STAPHYLOCOCCUS AUREUS SEPTICEMIA
038.12 METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS SEPTICEMIA
038.19 OTHER STAPHYLOCOCCAL SEPTICEMIA
038.2 PNEUMOCOCCAL SEPTICEMIA
038.3 SEPTICEMIA DUE TO ANAEROBES
038.40 SEPTICEMIA DUE TO GRAM-NEGATIVE ORGANISM UNSPECIFIED
038.41 SEPTICEMIA DUE TO HEMOPHILUS INFLUENZAE (H. INFLUENZAE)
038.42 SEPTICEMIA DUE TO ESCHERICHIA COLI (E. COLI)
038.43 SEPTICEMIA DUE TO PSEUDOMONAS
038.44 SEPTICEMIA DUE TO SERRATIA
038.49 OTHER SEPTICEMIA DUE TO GRAM-NEGATIVE ORGANISMS
038.8 OTHER SPECIFIED SEPTICEMIAS
038.9 UNSPECIFIED SEPTICEMIA
252.00 HYPERPARATHYROIDISM, UNSPECIFIED
252.01 PRIMARY HYPERPARATHYROIDISM
252.02 SECONDARY HYPERPARATHYROIDISM, NON-RENAL
252.08 OTHER HYPERPARATHYROIDISM
252.1 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
577.0 ACUTE PANCREATITIS
577.1 CHRONIC PANCREATITIS
585.1 CHRONIC KIDNEY DISEASE, STAGE I
585.2 CHRONIC KIDNEY DISEASE, STAGE II (MILD)
585.3 CHRONIC KIDNEY DISEASE, STAGE III (MODERATE)
585.4 CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE)
585.5 CHRONIC KIDNEY DISEASE, STAGE V
585.6 END STAGE RENAL DISEASE
585.9 CHRONIC KIDNEY DISEASE, UNSPECIFIED
586 RENAL FAILURE UNSPECIFIED
588.81 SECONDARY HYPERPARATHYROIDISM (OF RENAL ORIGIN)
588.89 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 NAUSEA WITH VOMITING
787.02 NAUSEA ALONE
787.03 VOMITING ALONE
787.04 BILIOUS EMESIS
787.20 DYSPHAGIA, UNSPECIFIED
787.21 DYSPHAGIA, ORAL PHASE
787.22 DYSPHAGIA, OROPHARYNGEAL PHASE
787.23 DYSPHAGIA, PHARYNGEAL PHASE
787.24 DYSPHAGIA, PHARYNGOESOPHAGEAL PHASE
787.29 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 diagnoses codes. These should not be billed alone. A primary diagnosis code should be billed in addition to the secondary diagnoses codes.
Documentation 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.
Treatment Logic
• 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.
• Normal serum ionized calcium for an adult is 4.65 - 5.28 mg/dl.
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.
FCSO LCD 29206, Ionized Calcium, 10/01/2010. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.
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
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 L28896 IONIZED CALCIUM