Billing and Coding: Lab: Cystatin C Measurement (A57643)


Related Local Coverage Determination (LCD)
L37616-Lab: Cystatin C Measurement


Contractor NameContract NumberStates
Noridian Healthcare Solutions, LLC 01111 - A and B MAC California - Entire State
01112 - A and B MAC California - Northern
01182 - A and B MAC California - Southern
01211 - A and B MAC American Samoa
Guam
Hawaii
Northern Mariana Islands
01212 - A and B MAC American Samoa
Guam
Hawaii
Northern Mariana Islands
01311 - A and B MAC Nevada
01312 - A and B MAC Nevada
01911 - A and B MAC American Samoa
California - Entire State
Guam
Hawaii
Nevada
Northern Mariana Islands

Article Information

Article ID Number: A57643 Status: A-Approved

Article Title: Billing and Coding: Lab: Cystatin C Measurement

Original Article Effective Date: 11/01/2019

Revision Effective Date: 01/01/2023

Article Text:

The information in this article contains billing, coding, or, other guidelines that complement the Local Coverage Determination (LCD) for Lab: Cystatin C Measurement policy L37616.

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. The medical record documentation must support the medical necessity of the services as directed in this policy.
  5. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition (ICD-10-CM code) that warrants the test(s).
  6. Examples of documentation requirements of the ordering physician/non-physician practitioner (NPP) include, but are not limited to, history and physical or exam findings that support the decision making, problems/diagnoses, relevant data (e.g., lab testing).
  7. Medical record documentation must support cystatin C test was performed on an adult patient with creatinine based eGFR 45–59 ml/min/1.73 m2 who does not have markers of kidney damage.
  8. Medical record documentation must clearly indicate the rationale which supports the medical necessity for performing eGFR by measurement of cystatin C (i.e. support GFR estimates based on serum creatinine are thought to be inaccurate and what decisions depend on more accurate knowledge of the GFR) and must reflect how the test result were used in the patient’s plan of care.

To report a Cystatin C service, please submit the following claim information:

  • Select CPT® code 82610
  • Enter 1 unit of service (UOS)
  • Select the appropriate ICD-10-CM code

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT®/HCPCS codes included in this article. Providers are reminded that not all CPT®/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT®/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.

Coding Information
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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

12Hospital Inpatient (Medicare Part B only)
13Hospital Outpatient
14Hospital - Laboratory Services Provided to Non-patients
22Skilled Nursing - Inpatient (Medicare Part B only)
23Skilled Nursing - Outpatient
71Clinic - Rural Health
72Clinic - Hospital Based or Independent Renal Dialysis Center
75Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
77Clinic - Federally Qualified Health Center (FQHC)
85Critical Access Hospital

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 policy 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 policy should be assumed to apply equally to all Revenue Codes.

0300 Laboratory - General Classification
0301 Laboratory - Chemistry
0302 Laboratory - Immunology
0303 Laboratory - Renal Patient (Home)
0304 Laboratory - Non-Routine Dialysis
0305 Laboratory - Hematology
0306 Laboratory - Bacteriology & Microbiology
0307 Laboratory - Urology
0309 Laboratory - Other Laboratory
0310 Laboratory Pathology - General Classification
0311 Laboratory Pathology - Cytology
0312 Laboratory Pathology - Histology
0314 Laboratory Pathology - Biopsy
0319 Laboratory Pathology - Other Laboratory Pathology

CPT/HCPCS Codes:

Group 1 Paragraph:

N/A



Group 1 CPT Codes:
82610 CYSTATIN C


ICD-10 Codes That Are Covered

N/A

N06.0 Isolated proteinuria with minor glomerular abnormality
N06.3 Isolated proteinuria with diffuse mesangial proliferative glomerulonephritis
N06.4 Isolated proteinuria with diffuse endocapillary proliferative glomerulonephritis
N06.5 Isolated proteinuria with diffuse mesangiocapillary glomerulonephritis
N06.6 Isolated proteinuria with dense deposit disease
N06.7 Isolated proteinuria with diffuse crescentic glomerulonephritis
N06.8 Isolated proteinuria with other morphologic lesion
N06.9 Isolated proteinuria with unspecified morphologic lesion
N06.A Isolated proteinuria with C3 glomerulonephritis
N17.0 Acute kidney failure with tubular necrosis
N17.1 Acute kidney failure with acute cortical necrosis
N17.2 Acute kidney failure with medullary necrosis
N17.8 Other acute kidney failure
N17.9 Acute kidney failure, unspecified
N18.2 Chronic kidney disease, stage 2 (mild)
N18.30 Chronic kidney disease, stage 3 unspecified
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
O12.10 Gestational proteinuria, unspecified trimester
O12.11 Gestational proteinuria, first trimester
O12.12 Gestational proteinuria, second trimester
O12.13 Gestational proteinuria, third trimester
O12.14 Gestational proteinuria, complicating childbirth
O12.15 Gestational proteinuria, complicating the puerperium
O12.20 Gestational edema with proteinuria, unspecified trimester
O12.21 Gestational edema with proteinuria, first trimester
O12.22 Gestational edema with proteinuria, second trimester
O12.23 Gestational edema with proteinuria, third trimester
O12.24 Gestational edema with proteinuria, complicating childbirth
O12.25 Gestational edema with proteinuria, complicating the puerperium
Q61.00 Congenital renal cyst, unspecified
Q61.01 Congenital single renal cyst
Q61.02 Congenital multiple renal cysts
Q61.11 Cystic dilatation of collecting ducts
Q61.19 Other polycystic kidney, infantile type
Q61.2 Polycystic kidney, adult type
Q61.3 Polycystic kidney, unspecified
Q61.4 Renal dysplasia
Q61.5 Medullary cystic kidney
Q61.8 Other cystic kidney diseases
Q61.9 Cystic kidney disease, unspecified
R31.0 Gross hematuria
R31.1 Benign essential microscopic hematuria
R31.21 Asymptomatic microscopic hematuria
R31.29 Other microscopic hematuria
R31.9 Hematuria, unspecified
R79.89 Other specified abnormal findings of blood chemistry
R80.0 Isolated proteinuria
R80.1 Persistent proteinuria, unspecified
R80.2 Orthostatic proteinuria, unspecified
R80.3 Bence Jones proteinuria
R80.8 Other proteinuria
R80.9 Proteinuria, unspecified
T50.904A Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter
T50.904D Poisoning by unspecified drugs, medicaments and biological substances, undetermined, subsequent encounter
T50.904S Poisoning by unspecified drugs, medicaments and biological substances, undetermined, sequela
T50.905A Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter
T50.905D Adverse effect of unspecified drugs, medicaments and biological substances, subsequent encounter
T50.905S Adverse effect of unspecified drugs, medicaments and biological substances, sequela
T50.994A Poisoning by other drugs, medicaments and biological substances, undetermined, initial encounter
T50.994D Poisoning by other drugs, medicaments and biological substances, undetermined, subsequent encounter
T50.994S Poisoning by other drugs, medicaments and biological substances, undetermined, sequela
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995D Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T65.94XA Toxic effect of unspecified substance, undetermined, initial encounter
T65.94XD Toxic effect of unspecified substance, undetermined, subsequent encounter
T65.94XS Toxic effect of unspecified substance, undetermined, sequela
Z52.4 Kidney donor
ICD-10 Codes That Are Not Covered

N/A


Revision History Information
Revision History DateRevision History NumberRevision History Explanation
01/01/2023
R5

Revision Effective Date: 01/01/2023
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM codes N06.0, N06.3, N06.4, N06.5, N06.6, N06.7, N06.8, N06.9, N06.A, N17.0, N17.1, N17.2, N17.8, N17.9, N18.2, N18.4, N18.5, O12.10, O12.11, O12.12, O12.13, O12.14, O12.15, O12.20, O12.21, O12.22, O12.23, O12.24, O12.25, Q61.00, Q61.01, Q61.02, Q61.11, Q61.19, Q61.2, Q61.3, Q61.4, Q61.5, Q61.8, Q61.9, R31.0, R31.1, R31.21, R31.29, R31.9, R79.89, R80.0, R80.1, R80.2, R80.3, R80.8, R80.9 to Group 1 Codes

10/24/2024: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination. This revision is due to the 2024 Annual ICD-10 updates.

06/09/2022
R4

Updated to indicate this article is an LCD Reference Article.

06/09/2022
R3

Under Article Title revised the title to read Billing and Coding: Lab: Cystatin C Measurement. Under Article Text revised title to Lab: Cystatin C Measurement. Formatting and punctuation were corrected throughout the article.

10/29/2020
R2

Under CMS National Coverage Policy added regulation CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.0, §80.1.1, and §80.1.2. Under Article Text added Documentation Requirements section and corresponding verbiage. Acronyms were inserted where appropriate throughout the article. Formatting, punctuation and typographical errors were corrected throughout the article.

10/01/2020
R1

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added N18.30, N18.31, and N18.32 and deleted N18.3. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.