L29206-LCD

Automated World Health

Local Coverage Determination (LCD) for Ionized Calcium (L29206)

Contractor Information

Contractor Name First Coast Service Options, Inc. opens in new window

Contractor Number

09102

Contractor Type

MAC - Part B

LCD Information

Document Information

LCD ID Number L29206

LCD Title Ionized Calcium

Contractor's Determination Number 82330

Primary Geographic Jurisdiction opens in new window 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 02/02/2009

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.

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.

99999 Not Applicable

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 opens in new window

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 diagnoses codes. These should not be billed alone. A primary diagnosis code should be billed in addition to the secondary diagnoses codes.

Diagnoses that Support Medical Necessity

ICD-9 Codes that DO NOT Support Medical Necessity

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

Diagnoses that DO NOT Support Medical Necessity

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

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 B2010-071

September 2010 Update

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 B2009-098

September 2009 Update

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:02/02/2009

LCR B2009-044FL

December 2008 Bulletin

This LCD consolidates and replaces all previous policies and publications on this subject by the carrier predecessors of First Coast Service Options, Inc. (Triple S and FCSO).

For Florida (00590) this LCD (L29206) replaces LCD L5742 as the policy in notice. This document (L29206) is effective on 02/02/2009.

Reason for Change