(Reproduced by permission from Medicare Focus, July, 1997, pp. 77 - 80.)

Medicare Part A
Local Medical Review Policy
Ionized Calcium

Policy Number: 97-18

Description

Ionized calcium testing is used to evaluate non bound calcium, a measure of physiologically active calcium fraction. Total serum calcium is most often satisfactory for the evaluation of calcium metabolism.

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

Revenue Code: 300, 31X
                                        31X Added per MedicareFocus, November, 2001, pg. 30

Indications

• hyperparathyroidism
• ectopic parathyroid hormone-producing neoplasms
• excessive vitamin D
• renal failure and/or kidney transplantation, in whom problems include secondary hyperparathyroidism; balance in dialysis patients
• ill premature infants with hypoproteinemia and acidosis
• occasionally useful when hypercalcemia coexists with abnormal protein state such as myeloma
• in disturbances of acid base balance cirrhosis
• hypoparathyroidism
• vitamin D deficiency
• pseudohypoparathyroidism
• cardiac thoracic and heart transplantation
• may have some use in patients having cardiac arrest

HCPCS Codes: 82330 Calcium, ionized

Diagnosis Codes for Coverage

Category:

Pathology and Laboratory

HCFA's National Policy

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

Reason for Denial

Testing for ionized calcium or free calcium will be denied when performing as a screening tests, billed without a covered diagnosis, or when the physician's documentation does not support medical necessity.

Noncovered Diagnosis Codes

Any that are not listed as covered diagnosis codes in the "Covered ICD-9 Codes" section in this policy.

Sources of Information

• Jacobs, Demott, Finley, Horvat, Kasten, Tilzer, Laboratory Test Handbook, 3rd Edition, Lexi-Comp, Inc., 1994. p. 159.
• Expert Medical Opinions
• Carrier Medical Director (CMD) Clinical Laboratory Workgroup

Coding Guides

ICD-9 code V82.9 (Special screening of other conditions, unspecified condition) or comparable narratives should be used to indicate screening tests performed in the absence of a specified sign, symptom, or complaint. Use of ICD-9 code V82.9 or comparable narrative will result in the denial of claims as non-covered screening services.

Documentation Required

ICD-9 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:

• History and Physical;
• MD orders/progress notes
• Diagnosis/reason for test
• Test results
• Itemization of charges

Comments

This policy is being adapted from the Carrier policy. It does not represent the sole opinion of the Intermediary/Medical Director. This policy was developed in consultation with the medical community via the Carrier Advisory Committee.