Does D69.8 require prior authorization?

No, D69.8 does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`D69.8` — Other specified hemorrhagic conditions

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Maintain a complete, legible medical record with patient identification, dates of service, and the legible signature of the responsible physician or non-physician practitioner.
The submitted medical record must support the selected ICD-10-CM code(s) and the CPT/HCPCS code(s) billed must describe the service performed.
Documentation must include a plan of care for a 90-day episode that supports evaluation including history, physical exam, CEAP clinical classification, VCSS, and a formal venous duplex scan.
The plan of care must outline timing of interventions versus routine post-procedure follow-up, list planned treatments (e.g., thermal ablation, sclerotherapy, cyanoacrylate/chemical adhesive, mechanochemical ablation, surgical treatments), and must be supported by complete operative procedure notes.

Key Coverage Criteria

Injection sclerotherapy (CPT 36468) is appropriate for treatment of symptomatic spider veins / telangiectasia of the lower extremities.
Non-compounded foam (NCF) sclerotherapy is appropriate for treatment of incompetent extremity truncal veins (report with CPT 36465 or 36466).
NCF sclerotherapy for other incompetent extremity veins is reported with CPT 36470 or 36471.
Physician-compounded foam (PCF) sclerotherapy for treatment of incompetent extremity truncal and other incompetent extremity veins is reported with CPT 36470 or 36471.
When a molecular panel of 5–50 genes is ordered, bill the appropriate panel CPT code (81445, 81449, 81450, or 81451) instead of submitting individual single-gene CPT codes.
When 51 or more genes are ordered for molecular biomarkers, bill the appropriate large-panel CPT code (81455 or 81456) rather than individual gene codes.

20 Active Policies

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L38176 — MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

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A57878 — Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

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L40277 — MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

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Serial ablation procedures on the same leg within a 90-day episode must be specifically justified in the record with patient-specific clinical information demonstrating the procedures could not be performed on a single day.

Incompetent perforator vein intervention must be clearly supported in documentation per the LCD's covered indications.

A56199 — Billing and Coding: Molecular Pathology Procedures

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A59898 — Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

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A59926 — Billing and Coding: Molecular Pathology Procedures

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A56793 — Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

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L35000 — Molecular Pathology Procedures

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L37606 — Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

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A58250 — Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities

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L38720 — Treatment of Chronic Venous Insufficiency of the Lower Extremities

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L34924 — Treatment of Chronic Venous Insufficiency of the Lower Extremities

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A55229 — Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities

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L40209 — MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

L38047 — MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

L38070 — MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

A60238 — Billing and Coding: MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

A57837 — Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

A57873 — Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

D69.8 — Other specified hemorrhagic conditions