Primary Care Coding Alert

Question: Is anyone using 268.9 in coding for screening tests for vitamin D deficiencies?

Illinois Subscriber

Answer: Since Vitamin D screening tests are ordered as part of a general screening test for nutritional disorders, instead of 268.9, you should use a V code:

• V77.99 " Special screening for endocrine, nutritional, metabolic, and immunity disorders; other and unspecified endocrine, nutritional, metabolic, and immunity disorders.

Physicians who order the tests usually already have a disease in mind which justifies the laboratory request. For example, if an FP uses 268.9 (Unspecified vitamin D deficiency), it is understood that there is already an established diagnosis of vitamin D deficiency which has no clear etiology or cause. Therefore, using this code simply for screening tests for vitamin D deficiency will not be appropriate.

Other conditions which will require testing for vitamin D deficiency are diseases associated with aging, fat malabsorption, hyperpigmented skin, low sunlight exposure, rickets, osteomalacia, osteoporosis, malignancies, obesity, etc. Therefore, it would be more appropriate to use codes related to these diseases rather than 268.9, if it is presumed that the vitamin D deficiency is caused by or will result in these conditions. For example, a patient was diagnosed with osteomalacia by his FP and the doctor orders a vitamin D screening test to establish whether the patient also has a vitamin D deficiency. In this situation, use this code:

• 268.2 -- Osteomalacia, unspecified.