B16.0 — Acute hepatitis B with delta-agent with hepatic coma
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
- CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.
- For HUS and ITP: documentation of clinical evidence of serious bleeding and measured platelet counts demonstrating either <50,000 or risk/potential for serious bleeding with platelet count <20,000 (lab results and clinical notes).
- For ITP: documentation of prior management and rationale for ECI (e.g., prior therapies tried, splenectomy status if relevant) and that ECI is indicated given severity and platelet thresholds.
Key Coverage Criteria
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
- CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
- CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
- CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.
- CT abdomen is medically necessary to evaluate abdominal trauma.
8 Active Policies
A57802 — Billing and Coding: Hepatic (Liver) Function Panel
AETNA-CPB-0355 — Extracorporeal Immunoadsorption (Prosorba Column)
AETNA-CPB-0544 — Immune Globulins for Post-Exposure Prophylaxis
AETNA-CPB-0650 — Polymerase Chain Reaction Testing: Selected Indications
ANTHEM-LAB.00019 — LAB.00019 Proprietary Algorithms for Liver Fibrosis
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