L29206

 

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.

 

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 / ADA CDT 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. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

 

CMS LCD IONIZED CALCIUM