B47.0 — Eumycetoma
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.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be made available to the contractor upon request.
- The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- Nail debridement is covered only when the service meets all indications and limitations specified in LCD L33922 and applicable CMS medical necessity and payment rules.
- Nail debridement for symptomatic mycotic nails is covered when there is documented clinical evidence of mycosis and qualifying symptoms for toenail debridement.
- CT thorax is covered for diagnosis and/or staging of neoplastic and hematologic processes arising in or involving the thorax.
- CT thorax is covered to evaluate pulmonary, mediastinal, pleural, and chest wall infections and their complications.
- CT thorax is covered to detect and characterize mediastinal neoplasms and other mediastinal processes.
- CT thorax is covered for assessment of cardiopulmonary failure or insufficiency.
6 Active Policies
AETNA-CPB-0383 — Mohs Micrographic Surgery
ANTHEM-CG-SURG-24 — CG-SURG-24 Functional Endoscopic Sinus Surgery (FESS)
A56580 — Billing and Coding: Computerized Axial Tomography (CT), Thorax
A57672 — Billing and Coding: Nail Debridement
L33459 — Computerized Axial Tomography (CT), Thorax
Related Codes
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