D41.20 — Neoplasm of uncertain behavior of unspecified ureter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identifiers (complete name, dates of service).
- Medical 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.
- Documentation should state whether the block was performed for diagnostic or therapeutic purposes.
Key Coverage Criteria
- Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
- ESAs are appropriate to treat symptomatic anemia of chronic kidney disease in patients on dialysis when billed using ESRD-specific HCPCS codes (J0882, J0887, Q4081, Q5105) and documented diagnoses D63.1 and N18.6.
- Non-ESRD ESA therapy for anemia due to myelosuppressive anticancer chemotherapy is indicated when billed with HCPCS codes J0881, J0885, J0888 or Q5106 with modifier EA and when the most recent hemoglobin is < 10.0 g/dL or hematocrit is < 30.0%.
- All ESA administrations (ESRD and non-ESRD) must be reported with one ESA-purpose modifier (EA, EB, or EC) and one route modifier (JA, JB, or JE) on the claim to be processed rather than returned.
- ESA administration is permitted only when medical record documents justify reasonable and necessary use for the individual patient, including Hb/Hct values, blood pressure control, weight, assessment of other causes of anemia, dose and route.
- Peripheral nerve block is reasonable when the patient's pain appears due to a classic mononeuritis but neuro-diagnostic studies fail to provide a structural explanation.
4 Active Policies
A57788 — Billing and Coding: Peripheral Nerve Blocks
A58982 — Billing and Coding: Erythropoiesis Stimulating Agents
L33933 — Peripheral Nerve Blocks
L39237 — Erythropoiesis Stimulating Agents
Related Codes
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