G97.63 — Postprocedural seroma of a nervous system organ or structure following a nervous system procedure
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.
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.
- Medical record documentation must demonstrate clinical evidence of an intracranial disorder or documentation of an established intracranial disease to support coverage of cranial CT.
Key Coverage Criteria
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
- CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
- CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
- CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.
- CT abdomen is medically necessary to evaluate abdominal trauma.
6 Active Policies
CIGNA-CPG038 — Spinal Ultrasound - (CPG038)
AETNA-CPB-0628 — Spinal Ultrasound
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
A56612 — Billing and Coding: CT of the Head
L34417 — CT of the Head
Related Codes
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