Notification

Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing


Notification Issue Date: 04/29/2019



Policy Attachment



Attachment to Policy # 06.02.54


Attachment:A

Policy #:06.02.54

Description:MEDICALLY NECESSARY ICD 10 CODES FOR
COBALAMIN (VITAMIN B12) AND/OR FOLIC ACID TESTING (CPT CODES 82607, 82608, 82746, AND 82747)

Title:Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing



COBALAMIN (VITAMIN B12) AND/OR FOLIC ACID TESTING (CPT CODES 82607, 82608, 82746, AND 82747) ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES


B20 Human immunodeficiency virus [HIV] disease

B97.35 Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere

C91.00 Acute lymphoblastic leukemia not having achieved remission

C91.01 Acute lymphoblastic leukemia, in remission

C91.02 Acute lymphoblastic leukemia, in relapse

D46.0 Refractory anemia without ring sideroblasts, so stated

D46.1 Refractory anemia with ring sideroblasts

D46.20 Refractory anemia with excess of blasts, unspecified

D46.21 Refractory anemia with excess of blasts 1

D46.22 Refractory anemia with excess of blasts 2

D46.4 Refractory anemia, unspecified

D46.9 Myelodysplastic syndrome, unspecified

D46.A Refractory cytopenia with multilineage dysplasia

D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts

D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality

D46.Z Other myelodysplastic syndromes

D47.01 Cutaneous mastocytosis

D47.02 Systemic mastocytosis

D47.09 Other mast cell neoplasms of uncertain behavior

D47.4 Osteomyelofibrosis

D50.0 Iron deficiency anemia secondary to blood loss (chronic)

D50.1 Sideropenic dysphagia

D50.8 Other iron deficiency anemias

D50.9 Iron deficiency anemia, unspecified

D51.0 Vitamin B12 deficiency anemia due to intrinsic factor deficiency

D51.1 Vitamin B12 deficiency anemia due to selective vitamin B12 malabsorption with proteinuria

D51.2 Transcobalamin II deficiency

D51.3 Other dietary vitamin B12 deficiency anemia

D51.8 Other vitamin B12 deficiency anemias

D51.9 Vitamin B12 deficiency anemia, unspecified

D52.0 Dietary folate deficiency anemia

D52.1 Drug-induced folate deficiency anemia

D52.8 Other folate deficiency anemias

D52.9 Folate deficiency anemia, unspecified

D53.0 Protein deficiency anemia

D53.1 Other megaloblastic anemias, not elsewhere classified

D53.2 Scorbutic anemia

D53.8 Other specified nutritional anemias

D53.9 Nutritional anemia, unspecified

D55.0 Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency

D55.1 Anemia due to other disorders of glutathione metabolism

D55.2 Anemia due to disorders of glycolytic enzymes

D55.3 Anemia due to disorders of nucleotide metabolism

D55.8 Other anemias due to enzyme disorders

D55.9 Anemia due to enzyme disorder, unspecified

D58.8 Other specified hereditary hemolytic anemias

D58.9 Hereditary hemolytic anemia, unspecified

D59.0 Drug-induced autoimmune hemolytic anemia

D59.1 Other autoimmune hemolytic anemias

D59.2 Drug-induced nonautoimmune hemolytic anemia

D59.4 Other nonautoimmune hemolytic anemias

D59.8 Other acquired hemolytic anemias

D59.9 Acquired hemolytic anemia, unspecified

D61.09 Other constitutional aplastic anemia

D61.1 Drug-induced aplastic anemia

D61.2 Aplastic anemia due to other external agents

D61.3 Idiopathic aplastic anemia

D61.89 Other specified aplastic anemias and other bone marrow failure syndromes

D61.9 Aplastic anemia, unspecified

D62 Acute posthemorrhagic anemia

D63.0 Anemia in neoplastic disease

D63.1 Anemia in chronic kidney disease

D63.8 Anemia in other chronic diseases classified elsewhere

D64.0 Hereditary sideroblastic anemia

D64.1 Secondary sideroblastic anemia due to disease

D64.2 Secondary sideroblastic anemia due to drugs and toxins

D64.3 Other sideroblastic anemias

D64.4 Congenital dyserythropoietic anemia

D64.81 Anemia due to antineoplastic chemotherapy

D64.89 Other specified anemias

D64.9 Anemia, unspecified

D69.6 Thrombocytopenia, unspecified

D75.0 Familial erythrocytosis

D75.1 Secondary polycythemia

D75.81 Myelofibrosis

D75.82 Heparin induced thrombocytopenia (HIT)

D75.89 Other specified diseases of blood and blood forming organs

D75.9 Disease of blood and blood-forming organs, unspecified

D77 Other disorders of blood and blood forming organs in diseases classified elsewhere

D81.818 Other biotin dependent carboxylase deficiency

D81.819 Biotin dependent carboxylase deficiency, unspecified

D89.0 Polyclonal hypergammaglobulinemia

D89.2 Hypergammaglobulinemia, unspecified

E00.0 Congenital iodine-deficiency syndrome, neurological type

E00.1 Congenital iodine-deficiency syndrome, myxedematous type

E00.2 Congenital iodine-deficiency syndrome, mixed type

E00.9 Congenital iodine-deficiency syndrome, unspecified

E01.0 Iodine-deficiency related diffuse (endemic) goiter

E01.1 Iodine-deficiency related multinodular (endemic) goiter

E01.2 Iodine-deficiency related (endemic) goiter, unspecified

E01.8 Other iodine-deficiency related thyroid disorders and allied conditions

E02 Subclinical iodine-deficiency hypothyroidism

E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy

E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy

E08.44 Diabetes mellitus due to underlying condition with diabetic amyotrophy

E08.49 Diabetes mellitus due to underlying condition with other diabetic neurological complication

E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified

E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy

E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy

E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy

E10.44 Type 1 diabetes mellitus with diabetic amyotrophy

E10.49 Type 1 diabetes mellitus with other diabetic neurological complication

E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified

E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy

E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

E11.44 Type 2 diabetes mellitus with diabetic amyotrophy

E11.49 Type 2 diabetes mellitus with other diabetic neurological complication

E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy

E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified

E13.41 Other specified diabetes mellitus with diabetic mononeuropathy

E13.42 Other specified diabetes mellitus with diabetic polyneuropathy

E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy

E13.44 Other specified diabetes mellitus with diabetic amyotrophy

E13.49 Other specified diabetes mellitus with other diabetic neurological complication

E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy

E34.0 Carcinoid syndrome

E34.1 Other hypersecretion of intestinal hormones

E34.2 Ectopic hormone secretion, not elsewhere classified

E34.3 Short stature due to endocrine disorder

E34.4 Constitutional tall stature

E34.50 Androgen insensitivity syndrome, unspecified

E34.51 Complete androgen insensitivity syndrome

E34.52 Partial androgen insensitivity syndrome

E34.8 Other specified endocrine disorders

E34.9 Endocrine disorder, unspecified

E35 Disorders of endocrine glands in diseases classified elsewhere

E41 Nutritional marasmus

E43 Unspecified severe protein calorie malnutrition

E44.0 Moderate protein calorie malnutrition

E45 Retarded development following protein calorie malnutrition

E46 Unspecified protein calorie malnutrition

E50.0 Vitamin A deficiency with conjunctival xerosis

E50.1 Vitamin A deficiency with Bitot's spot and conjunctival xerosis

E50.2 Vitamin A deficiency with corneal xerosis

E50.3 Vitamin A deficiency with corneal ulceration and xerosis

E50.4 Vitamin A deficiency with keratomalacia

E50.5 Vitamin A deficiency with night blindness

E50.6 Vitamin A deficiency with xerophthalmic scars of cornea

E50.7 Other ocular manifestations of vitamin A deficiency

E50.8 Other manifestations of vitamin A deficiency

E50.9 Vitamin A deficiency, unspecified

E51.8 Other manifestations of thiamine deficiency

E51.9 Thiamine deficiency, unspecified

E52 Niacin deficiency [pellagra]

E53.0 Riboflavin deficiency

E53.1 Pyridoxine deficiency

E53.8 Deficiency of other specified B group vitamins

E53.9 Vitamin B deficiency, unspecified

E54 Ascorbic acid deficiency

E55.0 Rickets, active

E55.9 Vitamin D deficiency, unspecified

E56.0 Deficiency of vitamin E

E56.1 Deficiency of vitamin K

E56.8 Deficiency of other vitamins

E56.9 Vitamin deficiency, unspecified

E58 Dietary calcium deficiency

E63.0 Essential fatty acid [EFA] deficiency

E63.1 Imbalance of constituents of food intake

E63.8 Other specified nutritional deficiencies

E63.9 Nutritional deficiency, unspecified

E64.0 Sequelae of proteincalorie malnutrition

E64.1 Sequelae of vitamin A deficiency

E64.2 Sequelae of vitamin C deficiency

E64.3 Sequelae of rickets

E64.8 Sequelae of other nutritional deficiencies

E64.9 Sequelae of unspecified nutritional deficiency

E65 Localized adiposity

E72.10 Disorders of sulfur bearing amino acid metabolism, unspecified

E72.11 Homocystinuria

E72.12 Methylenetetrahydrofolate reductase deficiency

E72.19 Other disorders of sulfur bearing amino‐acid metabolism

E88.01 Alpha-1-antitrypsin deficiency

E88.02 Plasminogen deficiency

E88.09 Other disorders of plasma-protein metabolism, not elsewhere classified

E88.1 Lipodystrophy, not elsewhere classified

E88.3 Tumor lysis syndrome

E88.40 Mitochondrial metabolism disorder, unspecified

E88.41 MELAS syndrome

E88.42 MERRF syndrome

E88.49 Other mitochondrial metabolism disorders

E88.81 Metabolic syndrome

E88.89 Other specified metabolic disorders

E88.9 Metabolic disorder, unspecified

E89.0 Postprocedural hypothyroidism

E89.1 Postprocedural hypoinsulinemia

E89.2 Postprocedural hypoparathyroidism

E89.3 Postprocedural hypopituitarism

E89.40 Asymptomatic postprocedural ovarian failure

E89.41 Symptomatic postprocedural ovarian failure

E89.5 Postprocedural testicular hypofunction

E89.6 Postprocedural adrenocortical (-medullary) hypofunction

E89.810 Postprocedural hemorrhage of an endocrine system organ or structure following an endocrine system procedure

E89.81 Postprocedural hemorrhage of an endocrine system organ or structure following other procedure

E89.89 Other postprocedural endocrine and metabolic complications and disorders

F03.90 Unspecified dementia without behavioral disturbance

F03.91 Unspecified dementia with behavioral disturbance

F10.20 Alcohol dependence, uncomplicated

F10.21 Alcohol dependence, in remission

F10.220 Alcohol dependence with intoxication, uncomplicated

F10.221 Alcohol dependence with intoxication delirium

F10.229 Alcohol dependence with intoxication, unspecified

F10.230 Alcohol dependence with withdrawal, uncomplicated

F10.231 Alcohol dependence with withdrawal delirium

F10.232 Alcohol dependence with withdrawal with perceptual disturbance

F10.239 Alcohol dependence with withdrawal, unspecified

F10.24 Alcohol dependence with alcohol-induced mood disorder

F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions

F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations

F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified

F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder

F10.27 Alcohol dependence with alcohol-induced persisting dementia

F10.280 Alcohol dependence with alcohol-induced anxiety disorder

F10.281 Alcohol dependence with alcohol-induced sexual dysfunction

F10.282 Alcohol dependence with alcohol-induced sleep disorder

F10.288 Alcohol dependence with other alcohol-induced disorder

F10.29 Alcohol dependence with unspecified alcohol-induced disorder

F50.00 Anorexia nervosa, unspecified

F50.01 Anorexia nervosa, restricting type

F50.02 Anorexia nervosa, binge eating/purging type

F50.2 Bulimia nervosa

F50.81 Binge eating disorder

F50.82 Avoidant/restrictive food intake disorder

F50.89 Other specified eating disorder

F50.9 Eating disorder, unspecified

F98.21 Rumination disorder of infancy

F98.29 Other feeding disorders of infancy and early childhood

F98.3 Pica of infancy and childhood

G25.70 Drug induced movement disorder, unspecified

G25.71 Drug induced akathisia

G25.79 Other drug induced movement disorders

G25.89 Other specified extrapyramidal and movement disorders

G25.9 Extrapyramidal and movement disorder, unspecified

G26 Extrapyramidal and movement disorders in diseases classified elsewhere

G30.0 Alzheimer's disease with early onset

G30.1 Alzheimer's disease with late onset

G30.8 Other Alzheimer's disease

G30.9 Alzheimer's disease, unspecified

G60.3 Idiopathic progressive neuropathy

G60.9 Hereditary and idiopathic neuropathy, unspecified

G90.09 Other idiopathic peripheral autonomic neuropathy

K14.0 Glossitis

K14.6 Glossodynia

K31.83 Achlorhydria

K50.00 Crohn's disease of small intestine without complications

K50.011 Crohn's disease of small intestine with rectal bleeding

K50.012 Crohn's disease of small intestine with intestinal obstruction

K50.013 Crohn's disease of small intestine with fistula

K50.014 Crohn's disease of small intestine with abscess

K50.018 Crohn's disease of small intestine with other complication

K50.019 Crohn's disease of small intestine with unspecified complications

K50.10 Crohn's disease of large intestine without complications

K50.111 Crohn's disease of large intestine with rectal bleeding

K50.112 Crohn's disease of large intestine with intestinal obstruction

K50.113 Crohn's disease of large intestine with fistula

K50.114 Crohn's disease of large intestine with abscess

K50.118 Crohn's disease of large intestine with other complication

K50.119 Crohn's disease of large intestine with unspecified complications

K50.80 Crohn's disease of both small and large intestine without complications

K50.811 Crohn's disease of both small and large intestine with rectal bleeding

K50.812 Crohn's disease of both small and large intestine with intestinal obstruction

K50.813 Crohn's disease of both small and large intestine with fistula

K50.814 Crohn's disease of both small and large intestine with abscess

K50.818 Crohn's disease of both small and large intestine with other complication

K50.819 Crohn's disease of both small and large intestine with unspecified complications

K50.90 Crohn's disease, unspecified, without complications

K50.911 Crohn's disease, unspecified, with rectal bleeding

K50.912 Crohn's disease, unspecified, with intestinal obstruction

K50.913 Crohn's disease, unspecified, with fistula

K50.914 Crohn's disease, unspecified, with abscess

K50.918 Crohn's disease, unspecified, with other complication

K50.919 Crohn's disease, unspecified, with unspecified complications

K90.0 Celiac disease

K90.1 Tropical sprue

K90.2 Blind loop syndrome, not elsewhere classified

K90.3 Pancreatic steatorrhea

K90.4 Malabsorption due to intolerance, not elsewhere classified

K90.41 Non-celiac gluten sensitivity

K90.49 Malabsorption due to intolerance, not elsewhere classified

K90.81 Whipple's disease

K90.89 Other intestinal malabsorption

K90.9 Intestinal malabsorption, unspecified

K91.2 Postsurgical malabsorption, not elsewhere classified

M83.0 Puerperal osteomalacia

M83.1 Senile osteomalacia

M83.2 Adult osteomalacia due to malabsorption

M83.3 Adult osteomalacia due to malnutrition

M83.4 Aluminum bone disease

M83.5 Other drug-induced osteomalacia in adults

M83.8 Other adult osteomalacia

M83.9 Adult osteomalacia, unspecified

P61.2 Anemia of prematurity

P61.3 Congenital anemia from fetal blood loss

P61.4 Other congenital anemias, not elsewhere classified

R20.0 Anesthesia of skin

R20.1 Hypoesthesia of skin

R20.2 Paresthesia of skin

R20.3 Hyperesthesia

R20.8 Other disturbances of skin sensation

R20.9 Unspecified disturbances of skin sensation

R26.0 Ataxic gait

R26.1 Paralytic gait

R26.2 Difficulty in walking, not elsewhere classified

R26.81 Unsteadiness on feet

R26.89 Other abnormalities of gait and mobility

R26.9 Unspecified abnormalities of gait and mobility

R27.0 Ataxia, unspecified

R27.8 Other lack of coordination

R27.9 Unspecified lack of coordination

R41.1 Anterograde amnesia

R41.2 Retrograde amnesia

R41.3 Other amnesia

R41.82 Altered mental status, unspecified

R41.9 Unspecified symptoms and signs involving cognitive functions and awareness

R45.84 Anhedonia

R62.51 Failure to thrive (child)

R63.0 Anorexia

R68.12 Fussy infant (baby)

Z51.11 Encounter for antineoplastic chemotherapy

Z79.3 Long term (current) use of hormonal contraceptives

Z79.84 Long term (current) use of oral hypoglycemic drugs

Z79.891 Long term (current) use of opiate analgesic

Z79.899 Other long term (current) drug therapy

Z86.2 Personal history of diseases of the blood and blood forming organs and certain disorders involving the immune mechanism

Z86.39 Personal history of other endocrine, nutritional and metabolic disease



Version Effective Date: 05/28/2019
Version Issued Date: 05/28/2019
Version Reissued Date: N/A



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