Z82.3 — Family history of stroke
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Laboratory evidence to support diagnosis of B-12 deficiency: serum cobalamin (vitamin B-12) measurement, with interpretation guidance (appendix): >300 pg/mL (>241 pmol/L) = normal; 200–300 pg/mL (148–241 pmol/L) = borderline; <200 pg/mL (<148 pmol/L) = low/consistent with deficiency.
- Recommended diagnostic tests in suspected deficiency: CBC, blood film, and serum cobalamin.
- Consideration of functional markers in borderline/uncertain cases: methylmalonic acid (MMA) and homocysteine (Hcy) (MMA and Hcy are increased in B-12 deficiency); measurement of MMA and/or Hcy may be recommended for borderline serum B-12 results.
- Holo-transcobalamin (holoTC) may be used as an early marker in certain settings but is not reliable in patients with renal dysfunction; documentation of renal function if holoTC used.
Key Coverage Criteria
- Macrocytic anemia
- Documented cobalamin (vitamin B-12) deficiency (clinical and/or laboratory evidence such as low serum B-12 and/or elevated MMA/Hcy) requiring replacement therapy.
- Pernicious anemia (decreased production or action of intrinsic factor) causing vitamin B-12 deficiency.
- Post-gastrectomy vitamin B-12 deficiency (loss of intrinsic factor production).
- Blind loop syndrome / bacterial overgrowth resulting in competition for vitamin B-12 and causing deficiency.
- Surgical resection of the ileum resulting in loss of the site of vitamin B-12 absorption.
1 Active Policy
AETNA-CPB-0536 — Vitamin B-12 Therapy
Related Codes
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