Does G97.31 require prior authorization?

No, G97.31 does not require prior authorization (high confidence). Code is covered without prior authorization.

`G97.31` — Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When billing these procedures after carotid endarterectomy, include the surgery date and the phrase 'carotid endarterectomy' in the claim narrative.
When reporting a reduced (unilateral/limited) service, append modifier -52 and include an explanation of the reduced service in Item 19 of the CMS-1500 form or electronic equivalent; any appropriate supporting documentation may be submitted with the claim.
Follow Novitas LCD L35397 for the reasonable and necessary documentation requirements and frequency limitations, and consult NCCI edits for correct coding combinations prior to billing Medicare.
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.

Non-invasive cerebrovascular arterial studies are covered when reasonable and necessary as defined by Novitas Local Coverage Determination (LCD) L35397.
Duplex post-interventional follow-up studies (typically limited and unilateral) are covered for evaluation after cerebrovascular intervention.
Vascular studies performed after carotid endarterectomy are covered when the claim includes the procedure date and the narrative 'carotid endarterectomy.'
Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
Bill HCPCS code G0278 for femoral or iliac angiography performed at the time of coronary angiography.
Aortography and peripheral angiography are covered when reasonable and necessary per Local Coverage Determination L36767 and when documentation supports the selected ICD-10-CM diagnosis and medical necessity.

L35753 — Non-Invasive Cerebrovascular Studies

J05

A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies

J05

A57064 — Billing and Coding: Duplex Scan of Lower Extremity Arteries

J09

A57056 — Billing and Coding: Aortography and Peripheral Angiography

J09

L33667

Ask Verity about documentation requirements, denial risks, or coverage in your state.