I70.318 — Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, other extremity
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims for stress tests performed as preoperative evaluation of asymptomatic, moderate-risk patients must include medical record documentation of at least one of: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
- Medical record must document suspected B12 or folate deficiency or the specific ICD-10-CM code from LCD L34419 supporting risk stratification medical necessity.
- For repeat testing, medical records must document prior appropriate treatment and objective evidence that the treatment did not correct the anemia or symptoms.
- Claims should reference the applicable ICD-10-CM diagnosis code(s) that support medical necessity per LCD L34419.
Key Coverage Criteria
- Preoperative cardiac stress testing with radionuclide imaging for asymptomatic patients deemed at moderate risk is covered only if the medical record documents at least one of the following: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
- Serum homocysteine testing is covered for evaluation of suspected vitamin B12 (cobalamin) deficiency.
- Serum homocysteine testing is covered for risk stratification for the conditions listed in the ICD-10-CM Codes that Support Medical Necessity in LCD L34419.
- Serum homocysteine testing is covered for evaluation of suspected folate (vitamin B9) deficiency.
- Nail debridement (CPT 11720 or 11721) for mycotic nails is covered when billed with ICD-10-CM B35.1 as the primary diagnosis and one of the following as a secondary diagnosis: L02.611, L02.612, L03.031, L03.032, L03.041, L03.042, M79.671, M79.672, M79.674, M79.675, or R26.2.
- Routine foot care services are covered when the patient has one of the specified systemic conditions (e.g., diabetes mellitus; arteriosclerosis obliterans; Buerger's disease; chronic thrombophlebitis; peripheral neuropathies of the feet including those associated with malnutrition, alcoholism, malabsorption, pernicious anemia, carcinoma, drugs/toxins, multiple sclerosis, uremia, traumatic injury, leprosy/neurosyphilis, hereditary disorders including hereditary sensory radicular neuropathy, Fabry [...]
20 Active Policies
L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
A57559 — Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
A56476 — Billing and Coding: Cardiac Radionuclide Imaging
A56675 — Billing and Coding: Homocysteine Level, Serum
A56680 — Billing and Coding: Routine Foot Care
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