I27.848 — Other Fontan-associated condition
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.
- Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
- Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
- Coverage and clinical indications for Cardiac Computed Tomography & Angiography (CCTA) follow the Local Coverage Determination LCD L33423; this billing article provides complementary coding guidance only.
- Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
- CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
20 Active Policies
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
L35755 — Non-Invasive Abdominal / Visceral Vascular Studies
J05
A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A57591 — Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies
J05
Related Codes
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