Healthcare Fraud Shield’s Latest Article: Vitamin D Deficiency

14 Nov
Vitamin D is often referred to as the sunshine vitamin. Who doesn’t love sunshine? Our bodies produce Vitamin D when we are exposed to direct sunlight. It converts a chemical in our skin into an active form of Vitamin D (calciferol).[1] Vitamin D can also be found in many foods such as fish, fish oils, mushrooms and more.

Why are we talking about Vitamin D?
In recent years we have seen an increase in testing for Vitamin D deficiency. While there are exceptions, most individuals do not need to be tested for Vitamin D deficiency.   Many organizations and individual health experts assert that testing for Vitamin D deficiency is not necessary.[2]

How is it billed?
These are the codes[3] you will typically see on claims:
  • 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed
  • 82652 Vitamin D; 1,25 dihydroxy, includes fraction(s), if performed
  • 0038U Vitamin D, 25 hydroxy D2 and D3, by LC-MS/MS, serum microsample, quantitative
When is it covered?
Check your plan’s medical policies for the symptoms and risk factors that are deemed appropriate for testing.   Many plans consider it medically necessary if patients have Chronic stage kidney disease, liver disease, osteoporosis and more.[4] According to one plan only 1 in 10 of the folks in their area have a medical reason to be tested. Additionally, the results of the test most likely will not impact treatment.[5]

What to look for?
One can adopt several simple data mining approaches to identify potential fraud, waste and abuse.
  • Identify providers billing this code excessively compared to their peers
  • Look for providers billing the code multiple times per patient
  • Review patient diagnoses to determine if medically necessary
  • Look for providers billing the same diagnosis code (vitamin D deficiency) for every patient
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