D73.0 — Hyposplenism
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).
- Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
8 Active Policies
A57690 — Billing and Coding: Lab: Flow Cytometry
ANTHEM-CG-LAB-29 — CG-LAB-29 Gamma Glutamyl Transferase Testing
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
A56464 — Billing and Coding: Flow Cytometry
A57689 — Billing and Coding: Lab: Flow Cytometry
Related Codes
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