B45.3 — Osseous cryptococcosis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.
- The documentation must clearly support the ICD-10-CM code(s) reported on the claim.
Key Coverage Criteria
- Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
- A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
- Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
- T82.535S | Leakage of umbrella device, sequela
- M84.38XP | Stress fracture, other site, subsequent encounter for fracture with malunion
- M84.38XS | Stress fracture, other site, sequela
12 Active Policies
A57207 — Billing and Coding: Lumbar MRI
A57225 — Billing and Coding: Respiratory Care
A56580 — Billing and Coding: Computerized Axial Tomography (CT), Thorax
A56612 — Billing and Coding: CT of the Head
A57206 — Billing and Coding: Lumbar MRI
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.