(Reproduced by permission from Medicare Focus, June, 1998, pp. 15-18.)

Medicare Part A
Local Medical Review Policy
Ferritin Level

Policy Number: A96-06 (Revision - Republished for Diagnosis List Verification

Description

82728 Ferritin


Type of Bill: 12X, 13X, 14X, 22X, 23X, 71X, 74X, 75X

Revenue Codes: 300-319

Indications and Limitations of Coverage and/or Medical Necessity

Ferritin levels are used to:


HCPCS Codes: 82728

ICD9 Codes That Support Medical Necessity

A ferritin level will be eligible for coverage when medically necessary and reasonable for the following diagnosis codes:

ICD-9-CM Code Description
269.3 Nutritional Deficiencies
275.0 Other Metabolic and Immunity Disorders
280.0 - 280.1
280.8-280.9
281.0 - 281.2
281.9
285.0 - 285.1
285.9
Diseases of the Blood and Blood-Forming Organs
Note: 280.8-280.9 added per Medicare Focus January, 2002
571.8
571.9
Other Diseases of Digestive System
585 Nephritis, Nephrotic Syndrome, and Nephrosis


ICD-9 diagnosis codes should be used at their highest level of specific.

HCPCS Section and Benefit Category: Pathology and Laboratory

HCFA National Coverage Policy

Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be reasonable and medically necessary, i.e., reasonable and necessary are those tests used in the diagnosis and management of illness or injury or to improve the function of a malformed body part.

Title XVIII of the Social Security Act, section 1862(a)(7). This section excludes routine physical examinations.

Reason for Denial

Tests performed during annual physical exams or other routine screening situations without signs, symptoms or illness will result in denial as a non-covered benefit.

Non-Covered ICD-9 Diagnosis Codes

All other diagnosis codes not listed as covered in the "Covered ICD-9-CM Code(s)" section of this policy.

Sources of Information


Coding Guides

Use CPT code 82728 when billing for a ferritin level unless it is included in a multi-channel test.

Documentation Required

ICD-9-CM diagnosis codes are required on claim.

Medical records must clearly document the medical necessity for the test and the frequency of the test.

If documentation is requested for review, submit the following:


Comments

Start Date of Comment Period:April 16, 1996
Start Date of Notice Period:October 1996
Original Effective Date:November 1, 1996
Revised Effective Date:June 1, 1998

Approval

This policy does not reflect the sole opinion of the Intermediary/Medical Director. Although the final decision rests with the Intermediary, this policy his policy was developed in cooperation with the Carrier Advisory Committee, which includes representatives from physician specialties, representatives from the Medical Association of the State of Alabama and other Association Representatives.