L29251

 

PARATHORMONE (PARATHYROID HORMONE)

 

10/01/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

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

o Weakness.

o Fatigue.

o Bone pain.

o Confusion.

o Depression.

o Nausea.

o Vomiting.

o Polyuria.

o In which parathyroid disease is suspected.

• Evaluation of patients with a combination of clinical signs and symptoms of hypoparathyroidism such as

o Chvostek’s sign.

o Trousseau’s sign.

o Dysphagia, tetany.

o Increased deep tendon reflexes.

o 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.

o In chronic renal disease.

And/Or

o Status post renal transplantation.

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

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

 

CPT/HCPCS Codes

 

83970 PARATHORMONE (PARATHYROID HORMONE)

 

 

ICD-9 Codes that Support Medical Necessity

 

227.1 BENIGN NEOPLASM OF PARATHYROID GLAND

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

275.3 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 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

728.85 SPASM OF MUSCLE

733.00 OSTEOPOROSIS UNSPECIFIED

733.01 SENILE OSTEOPOROSIS

733.02 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 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

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.

 

 

Documentation Requirements

• The medical record documentation must indicate the medical necessity of the test.

o In addition, documentation that the service was performed, including the test results, should be in the patient’s medical records.

o 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.

o 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:

o Symptoms such as:

 Bone pain.

 Weakness.

 Fractures.

 Difficulty walking.

 Intractable itching.

 Ectopic calcification.

 Paresthesias.

 Chvostek’s and/or Trousseau’s signs.

 Bronchospasm.

 Laryngospasm.

 Tetany.

 Seizures.

o Non-compliance with treatment of renal osteodystrophy.

o Need to monitor changes in therapy.

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:

o a glomerular filtration rate (GFR) of 30-59.

o It is expected that PTH level measurements will be performed every 12 months.

• For stage 4 CKD patients with:

o a glomerular filtration rate (GFR) of 15-29.

o It is expected that PTH level measurements will be performed every 3 months.

• For stage 5 CKD patients with:

o a glomerular filtration rate (GFR) less than 15 or dialysis.

o 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.

o If the measurement of PTH levels exceeds recommended frequencies, documentation may be reviewed to support the excess measurements.

Treatment Logic

• Parathyroid hormones (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:

o Rapid mobilization of calcium and phosphate from bone and the long-term acceleration of bone resorption.

o Increasing renal tubular reabsorption of calcium.

o Increasing intestinal absorption of calcium (mediated by an action on the metabolism of vitamin D).

o 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:

o From hypoparathyroidism.

o From certain malignant diseases such as:

 Squamous cell carcinoma of the lung.

 Renal carcinoma.

 Pancreatic carcinoma.

 Ovarian carcinoma.

 

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.

 

FCSO LCD 29251, Parathormone (Parathyroid Hormone), 10/01/2009. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Nissl, J. (2004, August). Parathyroid Hormone. Retrieved August 4, 2005, from http://my.webmd.com/hw/hormonal_disorders/hw8101.asp

 

 

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CPT codes, descriptions and other data only are copyright 2011 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 PARATHORMONE (PARATHYROID HORMONE)