Local Coverage Determination (LCD) for Parathormone (Parathyroid Hormone) (L29251)

 

 

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 L29251

 

LCD Title Parathormone (Parathyroid Hormone)

 

Contractor's Determination Number 83970

 

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 10/01/2009

 

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. 100-4, Medicare Claims Processing Manual, Chapter 16, Section 10; 10.2; and 90.1

CMS Manual System, Pub. 100-4, Medicare Claims Processing Manual, Chapter 23, Section 40

CMS Manual System, Pub. 100-8, Medicare Program Integrity Manual, Chapter 13, Section 13.1.3

 

 

Indications and Limitations of Coverage and/or Medical Necessity

 

Parathyroid hormone (PTH), a polypeptide hormone produced in the parathyroid gland, along with Vitamin D, are the principal regulators of calcium and phosphorus homeostasis. The most important actions of PTH are (1) rapid mobilization of calcium and phosphate from bone and the long-term acceleration of bone resorption, (2) increasing renal tubular reabsorption of calcium, (3) increasing intestinal absorption of calcium (mediated by an action on the metabolism of vitamin D), and (4) decreasing renal tubular reabsorption of phosphate. These actions account for most of the important clinical manifestations of PTH excess or deficiency.

 

The PTH is normally measured concomitantly with serum calcium levels. Abnormally elevated PTH values may indicate primary, secondary, or tertiary hyperparathyroidism. Abnormally low PTH levels may result from hypoparathyroidism and from certain malignant diseases such as squamous cell carcinoma of the lung, renal carcinoma, pancreatic carcinoma, or ovarian carcinoma.

 

Medicare will consider a Parathormone test to be medically necessary under any of the following circumstances:

 

• Evaluation of patients with a combination of 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 a combination of 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;

 

• To distinguish nonparathyroid from parathyroid causes of hypercalcemia;

 

• Evaluation of patients with previously diagnosed hyper or hypoparathyroidism;

 

• Evaluation of patients with a magnesium deficiency and/or excessive Vitamin D;

 

• Evaluation of patients with ectopic parathyroid hormone producing neoplasms;

 

• To evaluate and monitor therapy of secondary hyperparathyroidism in chronic renal disease and/or status post renal transplantation;

 

• Immediate follow-up of patients that have undergone thyroidectomy and/or parathyroidectomy; and

 

• Evaluation of a patient with osteoporosis to rule out parathormone involvement.

 

 

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

83970 PARATHORMONE (PARATHYROID HORMONE)

 

ICD-9 Codes that Support Medical Necessity

 

227.1 BENIGN NEOPLASM OF PARATHYROID GLAND

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

275.3 DISORDERS OF PHOSPHORUS METABOLISM

275.41 HYPOCALCEMIA

275.42 HYPERCALCEMIA

275.49 OTHER DISORDERS OF CALCIUM METABOLISM

278.4 HYPERVITAMINOSIS D

293.0 DELIRIUM DUE TO CONDITIONS CLASSIFIED ELSEWHERE

293.83 MOOD DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE

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

 

728.85 SPASM OF MUSCLE

733.1 OSTEOPOROSIS UNSPECIFIED

733.2 SENILE OSTEOPOROSIS

733.3 IDIOPATHIC OSTEOPOROSIS

733.90 DISORDER OF BONE AND CARTILAGE UNSPECIFIED

780.79 OTHER MALAISE AND FATIGUE

781.0 ABNORMAL INVOLUNTARY MOVEMENTS

781.7 TETANY

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

V42.0* KIDNEY REPLACED BY TRANSPLANT

V67.00 FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY

V67.09 FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY

* According to the ICD-9-CM book, diagnosis code V42.0 is a secondary diagnosis code and should not be billed as the primary diagnosis.

 

Diagnoses that Support Medical Necessity N/A

ICD-9 Codes that DO NOT Support Medical Necessity N/A

 

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 record documentation must indicate the medical necessity of the test. In addition, documentation that the service was performed, including the test results, should be in the patient’s medical records. This information is usually found in the office/progress notes, hospital notes, and/or laboratory results.

 

If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies. The physician must state the clinical indication/medical necessity for the study in his order for the test.

 

Documentation supporting parathyroid hormone levels (83970) more frequently than the parameters in the Utilization Guidelines section of this LCD should include the following:

 

• Symptoms such as bone pain, weakness, fractures, difficulty walking, intractable itching, ectopic calcification, paresthesias, Chvostek’s and/or Trousseau’s signs, bronchospasm, laryngospasm, tetany and/or seizures;

 

• Non-compliance with treatment of renal osteodystrophy; or

 

• Need to monitor changes in therapy

 

 

Appendices

 

Utilization Guidelines CPT 83970 should not be billed with more than one (1) unit of service per day.

 

It is expected that parathormone levels for patients diagnosed with chronic kidney disease (CKD) will be performed according to Kidney/Dialysis Outcomes Quality Initiative (K/DOQI) clinical practice guidelines for bone metabolism and disease.

 

For stage 3 CKD patients with a glomerular filtration rate (GFR) of 30-59, it is expected that PTH level measurements will be performed every 12 months.

 

For stage 4 CKD patients with a glomerular filtration rate (GFR) of 15-29, it is expected that PTH level measurements will be performed every 3 months.

 

For stage 5 CKD patients with a glomerular filtration rate (GFR) less than 15 or dialysis, it is expected that PTH level measurements will be performed every 3 months.

 

It is expected that the frequency of parathormone level measurements will be performed according to K/DOQI clinical guidelines. If the measurement of PTH levels exceed recommended frequencies, documentation may be reviewed to support the excess measurements.

 

 

Sources of Information and Basis for Decision

Anderson, D.M., (2002). Mosby’s Medicare Dictionary (6th ed.). St. Louis: Mosby.

 

Black, D.M., Greenspan, S.L., Ensrud, K.E., Palermo, L., McGowan, J.A., Lang, T.F., et al. (2003). The Effects of Parathyroid Hormone and Alendronate Alone or in Combination in Postmenopausal Osteoporosis [Electronic version]. The New England Journal of Medicine, 349(13), 1207-1215.

 

Bringhurst, F.R., Demay, M.B., & Kronenberg, H.M. (2003). Hormones and Disorders of Mineral Metabolism. Larsen: Williams Textbook of Endocrinology, 10th ed. (pp. 1303-1308). St. Louis: Saunders.

 

Eknoyan, G., Levin, A., & Levin, N.W. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. American Journal of Kidney Diseases. (2003) 42: 1-201.

 

Nissl, J. (2004, August). Parathyroid Hormone. Retrieved August 4, 2005, from http://my.webmd.com/hw/hormonal_disorders/hw8101.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 advisory groups, which includes representatives from numerous societies.

 

Start Date of Comment Period

 

End Date of Comment Period

 

Start Date of Notice Period 10/01/2009

 

Revision History Number 1

 

Revision History Explanation 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-

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 (L29251) replaces LCD L6142 as the policy in notice. This document (L29251) is effective on 02/02/2009.

 

 

Reason for Change ICD9 Addition/Deletion

 

Related Documents This LCD has no Related Documents.

 

LCD Attachments There are no attachments for this LCD.

 

All Versions

Updated on 09/25/2009 with effective dates 10/01/2009 - N/A Updated on 11/30/2008 with effective dates 02/02/2009 - N/A