B19.11 — Unspecified viral hepatitis B 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.
- Medical records must document the indication(s) supporting use of IVIG for each claim.
- For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.
- Documentation must support objective clinical response to IVIG for continued coverage.
Key Coverage Criteria
- IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
- 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.
9 Active Policies
L34771 — Immune Globulins
J05
A57554 — Billing and Coding: Immune Globulins
J05
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
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.