LCD Reference Article Response To Comments Article

Response to Comments: Vitamin D Assay Testing

A55372

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Article ID
A55372
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Article Title
Response to Comments: Vitamin D Assay Testing
Article Type
Response to Comments
Original Effective Date
02/03/2017
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Article Text
Noridian's Response to Provider Recommendations for Vitamin D Assay Testing (for comment period ending 08/08/2016).

Response To Comments

Number Comment Response
1 Comments from ACLA (American Clinical Laboratory Association) recommended a number of additional diagnostic codes for testing of Vitamin D, including inflammatory gastrointestinal diseases, certain infections, radiation enteritis, certain lymphomas, selected bone and cartilages conditions, hepatobiliary diseases and others. Noridian will add these codes. Noridian does not feel that bariatric surgery, as a specific entity, should be included because the more recent forms of surgery may not require constant measurements of the vitamin; and if any sign or symptom of malabsorption or enteritis are present, those diagnoses would allow for the testing-as well as post-surgical malabsorption already in the policy.
2 The College of American Pathology commented with suggestions of wording changes in the language of the policy. The recommended wording changes: “although it is not the active form of the hormone, 25-OH vitamin D is much more commonly measured because it better reflects the sum total of vitamin D produced endogenously and absorbed from the diet than does the level of the active hormone 1,25-dihydroxy vitamin D. Deficiency of 1,25-dihydroxy vitamin D, which is present at much lower concentrations, does not necessarily reflect deficiency of 25-OH vitamin D and its measurement should be limited to the indications listed.” Wording changes have been added to the policy.
3 The Endocrine Society recommends evaluation for patients on anticonvulsants, antiretroviral HIV therapy, glucocorticoids, antifungals, and cholestyramine. Rather than list all the diagnoses or drugs involved. Noridian believes using codes for long term drug use should be simpler and more efficient for both the physician and reviewer.
4 Comment from a Contractor Advisory Committee Member: recommendation to add graft versus host disease with associated malnutrition, prolonged steroid therapy with or without treatment of bisphosphonates. Noridian feels the codes for long term drug use will work for long term steroids, and will add graft versus host disease diagnosis.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Updated On Effective Dates Status
12/01/2016 02/03/2017 - N/A Currently in Effect You are here

Keywords

  • Vitamin D
  • Assay
  • Testing
  • 82306
  • 82652