LCD Reference Article Billing and Coding Article

Billing and Coding: Parathormone (Parathyroid Hormone)

A57122

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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
A57122
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Parathormone (Parathyroid Hormone)
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34018 Parathormone (Parathyroid Hormone). Please refer to the LCD for reasonable and necessary requirements and limitations.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Renal dialysis facilities should report a diagnosis code of N18.6 for submission of claims.

CPT 83970 should not be billed with more than one (1) unit of service per day.

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. If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies. The physician must state the clinical indication/medical necessity for the study in his order for the test. 

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

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(106 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 83970

Group 1 Codes
Code Description
D35.1 Benign neoplasm of parathyroid gland
E20.0 Idiopathic hypoparathyroidism
E20.1 Pseudohypoparathyroidism
E20.810 Autosomal dominant hypocalcemia
E20.811 Secondary hypoparathyroidism in diseases classified elsewhere
E20.812 Autoimmune hypoparathyroidism
E20.818 Other specified hypoparathyroidism due to impaired parathyroid hormone secretion
E20.9 Hypoparathyroidism, unspecified
E21.0 Primary hyperparathyroidism
E21.1 Secondary hyperparathyroidism, not elsewhere classified
E21.2 Other hyperparathyroidism
E21.3 Hyperparathyroidism, unspecified
E34.2 Ectopic hormone secretion, not elsewhere classified
E67.3 Hypervitaminosis D
E83.30 Disorder of phosphorus metabolism, unspecified
E83.31 Familial hypophosphatemia
E83.32 Hereditary vitamin D-dependent rickets (type 1) (type 2)
E83.39 Other disorders of phosphorus metabolism
E83.40 Disorders of magnesium metabolism, unspecified
E83.41 Hypermagnesemia
E83.42 Hypomagnesemia
E83.49 Other disorders of magnesium metabolism
E83.51 Hypocalcemia
E83.52 Hypercalcemia
E83.59 Other disorders of calcium metabolism
E89.2 Postprocedural hypoparathyroidism
F05 Delirium due to known physiological condition
F06.30 Mood disorder due to known physiological condition, unspecified
F06.31 Mood disorder due to known physiological condition with depressive features
F06.32 Mood disorder due to known physiological condition with major depressive-like episode
F06.33 Mood disorder due to known physiological condition with manic features
F06.34 Mood disorder due to known physiological condition with mixed features
G93.31 Postviral fatigue syndrome
G93.32 Myalgic encephalomyelitis/chronic fatigue syndrome
G93.39 Other post infection and related fatigue syndromes
M62.40 Contracture of muscle, unspecified site
M62.411 Contracture of muscle, right shoulder
M62.412 Contracture of muscle, left shoulder
M62.419 Contracture of muscle, unspecified shoulder
M62.421 Contracture of muscle, right upper arm
M62.422 Contracture of muscle, left upper arm
M62.429 Contracture of muscle, unspecified upper arm
M62.431 Contracture of muscle, right forearm
M62.432 Contracture of muscle, left forearm
M62.439 Contracture of muscle, unspecified forearm
M62.441 Contracture of muscle, right hand
M62.442 Contracture of muscle, left hand
M62.449 Contracture of muscle, unspecified hand
M62.451 Contracture of muscle, right thigh
M62.452 Contracture of muscle, left thigh
M62.459 Contracture of muscle, unspecified thigh
M62.461 Contracture of muscle, right lower leg
M62.462 Contracture of muscle, left lower leg
M62.469 Contracture of muscle, unspecified lower leg
M62.471 Contracture of muscle, right ankle and foot
M62.472 Contracture of muscle, left ankle and foot
M62.479 Contracture of muscle, unspecified ankle and foot
M62.48 Contracture of muscle, other site
M62.49 Contracture of muscle, multiple sites
M62.831 Muscle spasm of calf
M62.838 Other muscle spasm
M81.0 Age-related osteoporosis without current pathological fracture
M81.8 Other osteoporosis without current pathological fracture
M85.9 Disorder of bone density and structure, unspecified
M89.9 Disorder of bone, unspecified
M94.9 Disorder of cartilage, unspecified
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N18.9 Chronic kidney disease, unspecified
N19 Unspecified kidney failure
N25.81 Secondary hyperparathyroidism of renal origin
N25.89 Other disorders resulting from impaired renal tubular function
R11.0 Nausea
R11.10 Vomiting, unspecified
R11.11 Vomiting without nausea
R11.12 Projectile vomiting
R11.14 Bilious vomiting
R11.15 Cyclical vomiting syndrome unrelated to migraine
R11.2 Nausea with vomiting, unspecified
R13.0 Aphagia
R13.10 Dysphagia, unspecified
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia
R25.0 Abnormal head movements
R25.1 Tremor, unspecified
R25.2 Cramp and spasm
R25.3 Fasciculation
R25.8 Other abnormal involuntary movements
R25.9 Unspecified abnormal involuntary movements
R29.0 Tetany
R35.89 Other polyuria
R53.0 Neoplastic (malignant) related fatigue
R53.1 Weakness
R53.81 Other malaise
R53.83 Other fatigue
Z09* Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z48.22 Encounter for aftercare following kidney transplant
Z94.0 Kidney transplant status
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

* Diagnosis code Z09 should not be billed as the primary diagnosis.

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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 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.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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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
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R4

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following code has been deleted from the article: Group 1: E20.8. The following codes have been added to Group 1: E20.810, E20.811, E20.812, and E20.818.

10/01/2022 R3

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the Article: G93.31, G93.32, G93.39 to the ‘Group 1 Codes’ and the following ICD-10-CM code has been deleted and therefore has been removed from the article: G93.3.

10/01/2021 R2

Article revised and published on 10/14/2021 effective for dates of service on and after 10/01/2021 to reflect the Annual ICD-10-CM Code Updates.

The following ICD-10 code has been deleted and therefore has been removed from the article: R35.8 in Group 1. The following ICD-10-CM code has been added to the Article: R35.89 in Group 1.

10/01/2020 R1

Revision Number: 1
Publication: September 2020 Connection
LCR A/B2020-065

Explanation of revision: Based on CR 11895 and CR 11845 (Annual 2021 ICD-10-CM Update) the billing and coding article was revised to remove ICD-10 code N18.3 and to add ICD-10 Codes N18.31, and N18.32 to the “ICD-10 Codes that Support Medical Necessity/Group 1 codes: “section of this billing and coding article. In addition, formatting changes have been made throughout the article. The effective date of this revision is based on date of service.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34018 - Parathormone (Parathyroid Hormone)
Related National Coverage Documents
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