I63.231 — Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The patient's medical record must fully document medical necessity for the cardiac catheterization and support the diagnosis and procedures billed.
- Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and reason for the procedure and these codes must be linked to the CPT procedure codes on the claim.
- When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim; for extra-cardiac angiographic services the treating physician's name and NPI must be submitted in items 17/17a of CMS-1500 or electronic equivalent.
- For patients post-heart transplant without evidence of rejection, use primary diagnosis Z09 (follow-up after completed treatment) and secondary diagnosis Z94.1 (heart transplant status); add the underlying disorder code when coding I25.82 or I31.4.
Key Coverage Criteria
- Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
- Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
- Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
- Billing and coding for Category III codes is allowed only when the service meets the coverage indications, limitations, and medical necessity criteria described in LCD L35490 and the performing physician (MD/DO) meets all criteria in that LCD and this Billing and Coding Article.
- CPT 0446T, 0447T, and 0448T (creation/removal/replacement of implantable interstitial glucose sensor) are billed and covered only per LCD L38686 and Billing and Coding Article A58213 when all criteria in that LCD/article are met.
- CPT 0421T and HCPCS C2596 (transurethral waterjet ablation of the prostate and associated probe) are billed and covered only per LCD L38682 and Billing and Coding Article A58209 when all criteria in that LCD/article are met.
20 Active Policies
A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies
J05
A57597 — Billing and Coding: Somatosensory Testing
J05
L35753 — Non-Invasive Cerebrovascular Studies
J05
L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
L35121
Related Codes
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