Supplement Your Vitamin Level Test Coding
Understand what essential nutrients do and what happens when you don’t get enough of them.
Vitamins are organic compounds that our bodies need in small quantities for proper development and normal physiologic functioning. There are 13 known vitamins — vitamins A, C, D, E, K, and the B vitamins — that help the body grow and work the way it should. Proper coding of vitamin level testing requires understanding what these essential substances do and how they contribute to our overall health, as well as recognizing the impact of vitamin deficiencies.
How to Get the Nutrients You Need
Vitamins are classified as either fat-soluble or water-soluble, depending on which substance they dissolve best in. The primary difference between these two groups of vitamins is how they interact with the body when ingested. Most vitamins are water-soluble, meaning they dissolve in water, and any excess amounts are excreted in body fluids. Since your body cannot store these vitamins, you must replenish your sources every day. Fat-soluble vitamins are soluble in lipids, and your body can store excess amounts in your fatty tissue. It’s not necessary to ingest these vitamins daily, as long as you get enough overall.
Experts agree that the best way to get the nutrients we need is through food. The reason most vitamins must come from our diet is that the human body either does not produce enough of them or it does not produce any at all. The Dietary Guidelines for Americans 2015-2020 recommend that people should aim to meet their nutrient requirements through a healthy eating pattern that includes nutrient-dense foods. However, some people who don’t get enough vitamins from food alone, or who have certain medical conditions, may benefit from taking a vitamin supplement.
Why Is Adequate Vitamin Intake So Important?
Vitamins have different jobs — boosting the immune system, helping your body get energy from food, shoring up bones, healing wounds, and building proteins and cells, to name a few. When the body does not absorb or get from food the necessary amount of a vitamin, certain health problems may result. Vitamin deficiencies can result in diseases, such as scurvy, blindness, and rickets, and create or exacerbate chronic medical conditions. Let’s take a closer look at the 13 vitamins that are essential for supporting normal physiologic function.
9 Water-Soluble Vitamins
The nine water-soluble vitamins, their functions, and symptoms of deficiency include:
- Vitamin B1 (thiamine): All B vitamins help the body convert food (carbohydrates) into fuel (glucose), which is used to produce energy. They also help metabolize fats and proteins. Thiamine also supports nervous system function. Symptoms of deficiency include burning feet, weakness in extremities, rapid heart rate, swelling, weight loss, nausea, fatigue, and gastrointestinal problems. Thiamine deficiency (E51) is a common cause of Wernicke-Korsakoff syndrome, a form of dementia (E51.2 Wernicke encephalopathy), and beriberi (E51.11 Dry beriberi; E51.12 Wet beriberi).
- Vitamin B2 (riboflavin): In addition to producing energy for the body, riboflavin works as an antioxidant, supports growth and development, assists with red blood cell formation, and is important for normal vision. Deficiency may cause ariboflavinosis (E53.0); cracks, fissures, and sores at the corner of the mouth (K13.0 Diseases of the lips); dermatitis (L30.9); conjunctivitis (H10.89); photophobia (H53.14); glossitis of tongue (K14.0); and fatigue (R53.83).
- Vitamin B3 (niacin): In addition to producing energy for the body, niacin helps keep your nervous system, digestive system, and skin healthy. Niacin deficiency may cause pellagra (E52), with symptoms including dermatitis (L30.9), diarrhea (R19.7), dementia (F03.90), and stomatitis (K12.1).
- Vitamin B5 (pantothenic acid): In addition to producing energy for the body, pantothenic acid plays a role in nervous system function and red blood cell production. Vitamin B5 deficiency (E53.8 Deficiency of other specified B group vitamins) is typically only seen in cases of severe malnutrition (E43) and may cause paresthesias (R20.2).
- Vitamin B6 (pyridoxine): In addition to producing energy for the body, pyridoxine aids in the creation of red blood cells and supports the immune and nervous systems. Vitamin B6 deficiency (E53.1) may cause anemia (D64.3 Other sideroblastic anemias) and peripheral neuropathy (G62.9), with symptoms including glossitis (K14.0), stomatitis (K12.1), dermatitis (L30.9), confusion (R41.0), nervousness (R45.0), and irritability (R45.4).
- Vitamin B7, H (biotin): In addition to producing energy for the body, biotin plays an important role in the health of your hair, skin, and nails. Vitamin B7 deficiency (E53.8) is rare in humans. Symptoms of deficiency include dermatitis (L30.9) and enteritis (K52.9).
- Vitamin B9 (folic acid): In addition to aiding metabolism, folic acid is required for red blood cell synthesis and to make and repair DNA. Folic acid deficiency (E53) may cause anemia (D52.9), sprue (K90.1), leukopenia (D72.819), thrombocytopenia (D69.49), weakness (R53), weight loss (R63.4), and diarrhea (R19.7).
- Vitamin B12 (cobalamin): In addition to aiding metabolism, cobalamin plays an important role in red blood cell production and helps your nervous system function properly. Vitamin B12 deficiency (E53.8) may cause pernicious anemia (D51.0 Vitamin B12 deficiency anemia due to intrinsic factor deficiency), neurological problems, and sprue (K90.1).
- Vitamin C (ascorbic acid): Vitamin C acts as an antioxidant, creates collagen and connective tissue, supports immune function, and aids wound healing. Ascorbic acid deficiency (E54) may cause scorbutic anemia (D53.2) and symptoms including gum infections (K05.6), dental cavities (K02.9), dry skin (L85.3 Xerosis cutis), dry eyes (H04.12), hair loss (L65.9), joint pain (M25.50), pitting edema (R60.9), and delayed wound healing.
4 Fat-Soluble Vitamins
Fat-soluble vitamins are absorbed through the intestinal tract with the help of fats (lipids) and are stored in the fatty tissues of the body and liver, staying in the body as reserves for days, and sometimes months. The four fat-soluble vitamins, their functions, and symptoms of deficiency include:
- Vitamin A (retinoic acid): Retinol aids growth and development and the formation of red blood cells, skin, and bone. It also promotes healthy vision; reproduction; and immune function, growth, and cell development, in addition to its antioxidant properties. Vitamin A deficiency (E50.9) may cause night blindness (E50.5), xerophthalmia (E50.7), or other sequelae (E64.1 Sequelae of vitamin A deficiency).
- Vitamin D (calciferol): The “sunshine vitamin” is produced by the skin in response to sunlight. Calciferol regulates the absorption of calcium and phosphorus, facilitating normal immune function. Getting a sufficient amount of vitamin D is important for normal growth and development of bones and teeth. Vitamin D deficiency (E55) may cause rickets (E55.0), deformed bones (M85), retarded growth (E45), and soft teeth in children and osteomalacia (M83), spontaneous fractures, and tooth decay (K02) in adults.
- Vitamin E (tocopherol): Vitamin E is a powerful antioxidant that helps protect your cells from damage. Tocopherol also supports immune function, helps protect eyesight, and plays an important role in the health of your blood, brain, and skin. Vitamin E deficiency (E56.0) is uncommon, but it may cause hemolytic anemia in newborns (P55.8) in cases of severe malnutrition (E43).
- Vitamin K (phylloquinone): This vitamin plays a key role in blood clotting, bone metabolism, and regulating blood calcium levels. Vitamin K deficiency (E56.1) may cause an unusual susceptibility to bleeding (D68.4 Acquired coagulation factor deficiency).
Coding for Vitamin Level Testing
If a nutritional deficiency is suspected, the provider will start by discussing the patient’s diet and eating habits with them and inquiring about the presence of any symptoms. Doctors diagnose most vitamin deficiencies by running routine blood tests to check vitamin levels. Further testing may be performed to determine the cause of the deficiency, such as a diet low in nutrient-rich food or genetics.
When a provider orders a test for a vitamin level, it’s helpful to know the alternative chemical names these vitamins have to appropriately assign CPT® codes. The table above provides a crosswalk between each vitamin, its alternative name, test CPT® code, and dietary sources.
Andrews, R. “All About Vitamins & Minerals,” PrecisionNutrition: www.precisionnutrition.com/all-about-vitamins-minerals
Medical News Today, “What are vitamins and how do they work?”: www.medicalnewstoday.com/articles/195878