D61.811 — Other drug-induced pancytopenia
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims should reference and be supported by LCD L34580 and follow the billing/coding guidelines in this article; specific documentation requirements (e.g., medical records, prior authorization) are those detailed in LCD L34580.
- Claims must include the appropriate CPT code, 1 unit of service (UOS), and the appropriate ICD-10-CM diagnosis code.
- Additional medical necessity documentation must be submitted when more than 24 markers are tested.
- Follow the associated Local Coverage Determination LCD L34215 for full documentation and coverage requirements not detailed here.
Key Coverage Criteria
- Billing and coding for intravenous immunoglobulin (IVIG) should follow the Local Coverage Determination (LCD) L34580 and the billing/coding guidelines in this article as a complement to that LCD.
- Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
- Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
- Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.
- Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT®/PLA code (or CPT® 87999 if no specific code exists) and accompanied by ICD-10-CM diagnosis codes that support medical necessity documented in the patient record.
- FDA-approved or cleared molecular infectious disease tests performed consistent with their intended use labeling are covered without a DEX Z-Code and Technical Assessment when billed with appropriate ICD-10-CM diagnosis codes and supporting documentation.
20 Active Policies
L38835 — MolDX: Minimal Residual Disease Testing for Cancer
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A59004 — Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers
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A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J05
L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J05
Related Codes
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