E86.1 — Hypovolemia
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Each claim must be submitted with ICD-10-CM code(s) that accurately reflect the patient’s condition and indicate the reason(s) the service was performed.
- The medical record must include the ordering/referring provider’s name and NPI for services that require a referring/ordering physician.
- The patient’s medical record should include the assessment by the ordering provider related to the patient’s complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.
- For diagnostic tests, report the test result on the claim when known; otherwise report the symptoms that prompted performance of the test.
Key Coverage Criteria
- Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
- CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.
- When contrast is used for a complete TEE procedure (probe placement, image acquisition, interpretation and report), bill CPT code 93312 (HCPCS C8925 for OPPS billing).
- For congenital anomalies, use CPT code 93315 (HCPCS C8926 for OPPS billing) for the complete contrast TEE procedure.
- Hospitals should bill echocardiograms without contrast using the applicable Level 1 CPT code descriptors and guidelines.
- Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
17 Active Policies
A57361 — Billing and Coding: Monitored Anesthesia Care
J12
L35016 — Transesophageal Echocardiography (TEE)
J12
L35049 — Monitored Anesthesia Care
J12
A56505 — Billing and Coding: Transesophageal Echocardiography (TEE)
J12
A57189 — Billing and Coding: Serum Magnesium
Related Codes
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