D89.84 — IgG4-related disease
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must report the appropriate CPT code for the flow cytometry service, include 1 unit of service (UOS), and list the appropriate ICD-10-CM diagnosis code.
- Medical necessity documentation per LCD L34513 is required when coverage criteria are not fully met in this billing guideline (for example, when >24 markers are requested).
- Refer to Local Coverage Determination L35026 for clinical coverage criteria, medical necessity requirements, and any required prior authorization; this article complements that LCD with billing/coding guidance.
- 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.
Key Coverage Criteria
- Coverage and medical necessity determinations for flow cytometry are governed by Local Coverage Determination L34513.
- Flow cytometry may be used to analyze cellular components of body fluids and lymphoreticular tissues, including peripheral blood, cerebrospinal fluid (CSF), bone marrow, lymph nodes, tonsil, spleen, and fine needle aspirate material.
- Peripheral blood or fine needle aspirate specimens may be used to avoid more invasive diagnostic procedures when clinically appropriate.
- 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.
- IVIG is covered for patients with common variable immunodeficiency (CVID) when initial presenting IgG levels, evidence of Pneumovax vaccination, and pre- and post-vaccine pneumococcal antibody titers demonstrate inability to produce an antibody response to protein or carbohydrate antigens, and documentation includes dual diagnoses and a statement of lack of response to protein antigen.
- IVIG is covered for patients with HIV disease and immune thrombocytopenic purpura (ITP) when the medical record documents a platelet count less than 30,000 and active bleeding supported by laboratory results.
15 Active Policies
L40180 — Off-label Use of Rituximab and Rituximab Biosimilars
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A59101 — Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars
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A60186 — Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars
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L39297 — Off-label Use of Rituximab and Rituximab Biosimilars
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