LCD Reference Article Billing and Coding Article

Billing and Coding: Lab: Cystatin C Measurement

A57644

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57644
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Lab: Cystatin C Measurement
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
06/09/2022
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, §50.5 Jurisdiction of Laboratory Claims, §60.1.2 Independent Laboratory Specimen Drawing, §60.2 Travel Allowance

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §10 Reporting ICD Diagnosis and Procedure Codes

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, §80.1.1 Certification Changes, §80.1.2 A/B MAC (B) Contacts With Independent Clinical Laboratories

Article Guidance

Article Text

The information in this article contains billing, coding, or, other guidelines that complement the Local Coverage Determination (LCD) for Lab: Cystatin C Measurement Policy L37618.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. The medical record documentation must support the medical necessity of the services as directed in this policy.
  5. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition (ICD-10-CM code) that warrants the test(s).
  6. Examples of documentation requirements of the ordering physician/non-physician practitioner (NPP) include, but are not limited to, history and physical or exam findings that support the decision making, problems/diagnoses, relevant data (e.g., lab testing).
  7. Medical record documentation must support cystatin C test was performed on an adult patient with creatinine based eGFR 45–59 ml/min/1.73 m2 who does not have markers of kidney damage.
  8. Medical record documentation must clearly indicate the rationale which supports the medical necessity for performing eGFR by measurement of cystatin C (i.e. support GFR estimates based on serum creatinine are thought to be inaccurate and what decisions depend on more accurate knowledge of the GFR) and must reflect how the test result were used in the patient’s plan of care.

To report a Cystatin C service, please submit the following claim information:

  • Select CPT® code 82610
  • Enter 1 unit of service (UOS)
  • Select the appropriate ICD-10-CM code

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT®/HCPCS codes included in this article. Providers are reminded that not all CPT®/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT®/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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(19 Codes)
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Group 1 Codes
Code Description
N18.30 Chronic kidney disease, stage 3 unspecified
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
T50.904A Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter
T50.904D Poisoning by unspecified drugs, medicaments and biological substances, undetermined, subsequent encounter
T50.904S Poisoning by unspecified drugs, medicaments and biological substances, undetermined, sequela
T50.905A Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter
T50.905D Adverse effect of unspecified drugs, medicaments and biological substances, subsequent encounter
T50.905S Adverse effect of unspecified drugs, medicaments and biological substances, sequela
T50.994A Poisoning by other drugs, medicaments and biological substances, undetermined, initial encounter
T50.994D Poisoning by other drugs, medicaments and biological substances, undetermined, subsequent encounter
T50.994S Poisoning by other drugs, medicaments and biological substances, undetermined, sequela
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995D Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T65.94XA Toxic effect of unspecified substance, undetermined, initial encounter
T65.94XD Toxic effect of unspecified substance, undetermined, subsequent encounter
T65.94XS Toxic effect of unspecified substance, undetermined, sequela
Z52.4 Kidney donor
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.

 


Code Description

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Other Coding Information

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
06/09/2022 R4

Updated to indicate this article is an LCD Reference Article.

06/09/2022 R3

Under Article Title revised the title to read Billing and Coding: Lab: Cystatin C Measurement. Under Article Text revised title to Lab: Cystatin C Measurement. Formatting and punctuation were corrected throughout the article.

10/29/2020 R2

Under CMS National Coverage Policy added regulation CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.0, §80.1.1, and §80.1.2. Under Article Text added Documentation Requirements section and corresponding verbiage. Acronyms were inserted where appropriate throughout the article. Formatting, punctuation and typographical errors were corrected throughout the article.

10/01/2020 R1

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added N18.30, N18.31, and N18.32 and deleted N18.3. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
11/08/2023 06/09/2022 - N/A Currently in Effect You are here
06/02/2022 06/09/2022 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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