E42, Marasmic kwashiorkor
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Medical records must document the medical necessity of the serum magnesium test, including the signs, symptoms, and/or diagnosis that prompted the test.
- Laboratories must maintain the physician's order for the serum magnesium test in their records.
- Medical records must contain the serum magnesium lab test results.
- When requesting individual consideration through written redetermination, providers must include all relevant medical records and supporting literature.
Key Coverage Criteria
- Vitamin B12 injections are covered only when reasonable and necessary per Local Coverage Determination L33967.
- No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
- Serum folate testing (CPT® 82746) is considered medically necessary for EITHER of the following: Suspected diagnosis of folate deficiency associated with ANY of the following:
- Anemia, where folate deficiency is in the differential diagnosis (e.g., megaloblastic anemia with or without other associated cytopenias).
- Neural tube defects and neurologic disorders where folate deficiency is known to be a potential underlying cause.
- Diseases of the digestive system associated with malabsorption.
5 Active Policies
FIRST_COAST-L33967, Vitamin B<sub>12</sub> Injections
J9
CIGNA-0567, Serum Folate and Red Blood Cell Folate Testing
A57189, Billing and Coding: Serum Magnesium
A57755, Billing and Coding: Vitamin B12 Injections
A59186, Billing and Coding: Magnesium
Related Codes
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