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Some patients with pernicious anemia may present with non-anemic macrocytosis for several months prior to diagnosis

It is important to note that if RHCs and FQHCs report these new codes, they are per calendar month bundles

We list it as our high-potency pick for two specific scenarios: anyone with documented deficiency working to replete liver stores, and anyone whose absorption is significantly compromised (long-term metformin + PPI combination, post-bariatric surgery, atrophic gastritis on biopsy)

Each addresses inflammation through distinct mechanisms, and emerging evidence suggests their combination may produce synergistic benefits exceeding what either achieves independently