Pathology/Lab Coding Alert

Question: The lab receives an order for serum levels of vitamin D2 and D3. What are the correct codes for these substances?

Codify Subscriber

Answer: Vitamin D2 (ergocalciferol) and D3 (cholecalciferol) are the fractions of 25-hydroxy vitamin D, also known as calcifediol or calcidiol. The code for total 25-hydroxy vitamin D is what you’re looking for, because it may include both D2 and D3 fractions.

CPT^® provides two codes for this test: 82306 (Vitamin D; 25 hydroxy, includes fraction(s), if performed), and proprietary laboratory analysis (PLA) code 0038U (Vitamin D, 25 hydroxy D2 and D3, by LC-MS/MS, serum microsample, quantitative).

One unit: Notice that 82306 states, “includes fraction(s), if performed.” That means you should not report two units of 82306 if the test you’re using provides distinct indication of both D2 and D2 fractions.

Because 0038U is a PLA code, you should report it only if you’re performing the specific, proprietary commercial test that the code describes, which is the Sensieva Droplet™ 25 OH vitamin D2/D3 microvolume LC/MS assay from InSource Diagnostics.

Caution: Some payers don’t cover the test described by 0038U. Because PLA codes take priority over Level 1 CPT^® codes, you should not use the Sensieva Droplet test and report it with 82306. Check with your carrier for coverage information.

Distinguish: Don’t confuse 25-hydroxyvitamin D with 1,25-dihydroxyvitamin D, which clinicians may order for different diagnostic information. You would report the latter test using 82652 (Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed). The 25-hydroxyvitamin D form is the precursor to the active form of vitamin D, which is 1,25-dihydroxyvitamin D. The precursor persists longer in the blood in higher concentration, so is often the focus of diagnostic testing.