D57.412 — Sickle-cell thalassemia, unspecified, with splenic sequestration
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high 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.
- For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- Diagnostic test claims should include the test result if known; if result is not available, report the symptoms that prompted the test.
- The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.
Key Coverage Criteria
- CPT 88182 reports the physician professional and facility technical components of DNA ploidy and S-phase analysis of tumor by flow cytometry.
- CPT 88184 (first marker) and CPT 88185 (each additional marker) report the facility technical component of flow cytometric immunophenotyping for assessment of potential hematolymphoid neoplasia.
- Flow cytometry interpretation is reported using CPT codes 88187–88189 (one interpretation code per specimen).
- Quantitative cell counts by flow cytometry are billed using CPT codes 86355, 86356, 86357, 86359, 86360, 86361, and 86367.
- Flow cytometry services are payable under Medicare Part B at specified places of service according to CPT: groups of CPTs have defined allowable POS (see mapping in policy).
- Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
20 Active Policies
L38441 — MolDX: Blood Product Molecular Antigen Typing
J05
A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies
J05
L35753 — Non-Invasive Cerebrovascular Studies
J05
A57110 — Billing and Coding: MolDX: Blood Product Molecular Antigen Typing
J05
A56758
Related Codes
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