Local Coverage Article Response to Comments

Response to Comments: Serum Magnesium


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The Comment #2 response should read, "Noridian agrees with adding the codes for these conditions. However, Z92.91 and Z92.92 are not valid codes. We will add the appropriate codes Z92.21 – Personal history of antineoplastic chemotherapy and Z92.22 - Personal history of monoclonal drug therapy." Z92.21 and Z92.22 replaces Z79.21 and Z79.21 in the response below.

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Article ID
Article Title
Response to Comments: Serum Magnesium
Article Type
Response to Comments
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Article Text
Noridian's Response to Provider Recommendations (for comment period ending 08/08/2016)

Response To Comments

1Comment 1: I have reviewed the proposed LCD # DL36700 regarding serum magnesium levels and the causes of hypomagnesemia on behalf of the Washington State Medical Oncology Society (WSMOS). In addition to your listed causes I suggest the following be considered for addition to the LCD as potential causes of hypomagnesemia and therefore justification for serum magnesium level monitoring. Use of the following medications in patients: aminoglycosides, Pentamadine, Cyclosporin, Tacrolimus and chronic exposure to proton pump inhibitors (PPIs) as in, for example, chronic use of omeperazole which as you know is OTC available. In addition, hypomagnesemia has been identified in the following situations warranting its monitoring: acute renal tubular necrosis, especially in the early diuretic phase, post stem cell autologous and allogeneic transplant, post renal transplant, and during episodes of hypercalcemia. As oncology specialists, we encounter these issues frequently and we suggest that these exposures or conditions also justify frequent use of serum magnesium monitoring and supplementation. References on these observations can be provided if needed but can also be found online at UpToDate.I believe most of the above conditions are covered including encounter for antineoplastic drugs and personal use of antineoplastic chemotherapy and encounter for and personal use of monoclonal drug therapy, post-transplant status (including use of immunosuppressive drugs post-transplant. We will add Z79.2 - Long term (current) use of antibiotics, Z79.4 - Long term (current) use of insulin, Z79.51 - Long term (current) use of inhaled steroids, Z79.52 - Long term (current) use of systemic steroids, Z79.83 - Long term (current) use of bisphosphonates, Z79.84 - Long term (current) use of oral hypoglycemic drugs and Z79.891 - Long term (current) use of opiate analgesic for long term use of drug therapy.
2I would like to comment on the Proposed/Draft LCD DL36700 Serum Magnesium. I would like to request that diagnosis codes Z92.91 - Personal history of antineoplastic chemotherapy and Z92.92 - Personal history of monoclonal drug therapy be added to the policy. My reasoning for this reconsideration request is that the current indications on the policy include cisplatin treatment and EGFR monoclonal antibodies. Noridian agrees with adding the codes for these conditions. However, Z92.91 and Z92.92 are not valid codes. We will add the appropriate codes Z79.21 – Personal history of antineoplastic chemotherapy and Z79.22 - Personal history of monoclonal drug therapy.

Associated Documents

Related Local Coverage Documents
L36702 - Serum Magnesium
Related National Coverage Documents
Public Versions
Updated On Effective Dates Status
01/11/2017 03/13/2017 - N/A Currently in Effect You are here


  • Response to Comments,
  • RTC,
  • Z79.2,
  • Z79.4,
  • Z79.51,
  • Z79.52,
  • Z79.83,
  • Z79.84,
  • Z79.891,
  • Z92.21,
  • Z92.22,
  • Z92.91,
  • Z92.92