E89.89 — Other postprocedural endocrine and metabolic complications and disorders
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For neonatal or infant hearing screening: documentation of the use of limited ABR or limited OAE for screening; if screening fails, documentation that referral for comprehensive ABR/OAE occurred
- General: medical records must support the specific covered indication, clinical findings, prior testing results (e.g., MRI/CT results when relevant), and that less invasive or standard diagnostic methods are inadequate or inconclusive when the policy requires prior evaluation
- Medical necessity criteria must be clearly documented in the member's medical record and made available on request.
- For cVEMP for suspected SCDS: documentation of a comprehensive evaluation including history, physical exam, audiometry, electronystagmography or videonystagmography, electrocochleography, and brainstem audiometry with inconclusive results prior to performing cVEMP
Key Coverage Criteria
- To localize the cause of a visual field defect not explained by lesions seen on CT or MRI, metabolic disorders, or infectious diseases
- Somatosensory evoked potentials (SEPs, SSEPs) or dermatosensory evoked potentials (DSEPs) are medically necessary for any of the following:
- To assess any decline which may warrant emergent surgery in unconscious spinal cord injury persons who show specific structural damage to the somatosensory system, and who are candidates for emergency spinal cord surgery
- To evaluate acute anoxic encephalopathy (within 3 days of the anoxic event)
- To evaluate persons with suspected brain death
- To identify clinically silent brain lesions in multiple sclerosis suspects to help establish the diagnosis when MS is suspected due to suggestive neurologic symptoms plus one or more other objective findings (brain plaques on MRI, clinical lesions by history and physical, and/or positive CSF determined by oligoclonal bands by established methods or increased IgG index)
2 Active Policies
AETNA-CPB-0181 — Evoked Potential Studies
ANTHEM-CG-LAB-20 — CG-LAB-20 Thyroid Testing
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.