D44.10 — Neoplasm of uncertain behavior of unspecified adrenal gland
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- The patient's medical record must contain documentation that fully supports medical necessity for services included in the related LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- Include a treatment prescription that defines treatment goals and specific dose-volume parameters for the target and nearby critical structures, and details of beam delivery such as method of beam modulation, field arrangement, and expected positional and range uncertainties.
- Include a physician-signed treatment plan that meets the prescribed dose-volume parameters for the clinical target volume (CTV) and surrounding organs at risk (OARs) accounting for expected uncertainties.
Key Coverage Criteria
- Proton beam therapy is covered when the service meets the medical necessity criteria specified in the related Local Coverage Determination (LCD) and those criteria are documented in the medical record.
- Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
- 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.
- Peripheral nerve blocks are reasonable for peripheral nerve injuries/entrapment or extremity trauma that lead to complex regional pain syndrome (CRPS).
- Selective peripheral nerve blockade is reasonable diagnostically when the clinical picture is unclear to isolate the specific pain source.
- Occipital nerve block is reasonable to confirm suspected occipital neuralgia (used diagnostically and therapeutically).
7 Active Policies
A56827 — Billing and Coding: Proton Beam Therapy
J06
L35075 — Proton Beam Therapy
J06
AETNA-CPB-0071 — Positron Emission Tomography (PET)
L34417 — CT of the Head
L33933 — Peripheral Nerve Blocks
Related Codes
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