Berks County Medical Society Medical Record Fall 2017 - 25

Vitamin D Laboratory Insurance Denials:
A Retrospective Study
by John Sheffield, MD; Kim Pryor, BSN, RN; Gregory Swan, DO; Timothy Dougherty;
Alexandra Short, MSLS, AHIP; Debra Stavarski
Reading Hospital, Family Medicine Department
Introduction: Vitamin D assay orders climbed over 600% in
the US between 2008 and 2014. Patients are bombarded with
information suggesting vitamin D deficiency is the cause of various
ailments. Vitamin D assays cost Medicare over 200 million dollars
in 2011. Insurance companies initially denied more than $150,000
in vitamin D testing claims submitted through Reading Health
System in 2016. Despite the popularity of vitamin D testing,
there is significant controversy surrounding the clinical utility of
assay results. An examination of the evidenced based indications
for vitamin D status monitoring was hypothesized to be useful in
combatting possibly unnecessary vitamin D testing. Conversely, an
evidence based review may reduce insurance claim denials.
Methods: Cochrane Foundation Reviews, USPSTF
recommendations, and government commissioned publications, as
well as both the Institute of Medicine's (IOM) and the Endocrine
Society's guidelines were all reviewed to examine the putative
relationships between vitamin D and various health outcomes. The
accuracy and comparability of vitamin D status testing was also
explored.

both providers and insurance companies base their policies on
available published evidence. Coupled with education, this approach
has the potential to reduce unnecessary vitamin D assay orders.

Timothy Dougherty is in his second year of the
Biomedical Sciences Master's program at the
Philadelphia College of Osteopathic Medicine,
having earned his undergraduate degree at The
Pennsylvania State University. He volunteers at
the front desk of a local free medical clinic, and
as an undergraduate he served as Community
Service Chair of the Student National Medical
Association PSU MAPS Chapter.

Results: There is a lack of definitive studies concerning vitamin
D. The accuracy and comparability of vitamin D assays may be
questionable. There are very few indications for 1,25 di-hydroxy
vitamin D assay orders, suggesting many 1,25 di-hydroxy vitamin D
assay orders are errors. Providers may mistake 1,25 hydroxy vitamin
D - a transient metabolite - for 25-hydroxy vitamin D, the more
clinically useful metabolite. Numerous studies suggest significant
variations in the accuracy and comparability of 25-hydroxy vitamin
D assay kits. The IOM and the Endocrine Society offer opposing
recommendations and opinions concerning vitamin D. While IOM
asserts that vitamin D deficiency is relatively rare, the Endocrine
Society claims deficiency is common. Supplementation is clearly
indicated during corticosteroid therapy and probably does reduce
asthma exacerbation. However, vitamin D has been clearly linked to
few other health outcomes.
Conclusions: Considering the uncertainties surrounding vitamin
D, many vitamin D assay orders may be unnecessary. In the
future, it would be useful to compare the initial assay claim denials
at Reading Health System to the results of the literature review
discussed above. Such an examination may reveal to what extent

FALL 2017

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Berks County Medical Society Medical Record Fall 2017

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