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Dose adjustment may be required based on overall health condition

Common Causes of B12 Deficiency Document the cause of B12 deficiency to support the specific code : Pernicious anemia Autoimmune destruction of stomach cells Gastrectomy or weight loss surgery Loss of intrinsic factor production Strict vegetarian diet Inadequate dietary intake Crohns disease or celiac disease Malabsorption in the small intestine Chronic pancreatitis Insufficient pancreatic enzymes Bacterial overgrowth in the small intestine Bacteria consume B12 Long-term metformin use Interferes with B12 absorption Neurologic Symptoms in B12 Deficiency B12 deficiency causes nerve damage

For individuals with pernicious anaemia or a condition that prevents B12 absorption, injections are medically necessary because oral supplementation will not be absorbed effectively

When the same provider performs both an evaluation and management service and administers an injection on the same date, the E/M must be appended with Modifier 25 to signal it was a significant, separately identifiable service