I70.618 — Atherosclerosis of nonbiological 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
- ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim.
- The submitted medical record must document and support the use of the selected ICD-10-CM code(s) and the medical necessity for supervised exercise therapy.
- The submitted CPT/HCPCS code must accurately describe the service performed.
- A physician referral is required for the initial course of supervised exercise therapy and the second 36-session course; the second referral must meet the same requirements as the initial referral.
Key Coverage Criteria
- Supervised exercise therapy is covered for beneficiaries with peripheral arterial disease (PAD) presenting with symptomatic lower-extremity intermittent claudication when documented with appropriate ICD-10-CM diagnosis code(s).
- Coverage for non-emergent outpatient stress testing is subject to the reasonable and necessary requirements in Local Coverage Determination L35083 and is allowed only when L35083 clinical criteria are met.
- 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.
20 Active Policies
L35761 — Non-Invasive Peripheral Arterial Vascular Studies
J05
A57593 — Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies
J05
A56758 — Billing and Coding: Non-Invasive Vascular Studies
J06
L33633 — Magnetic Resonance Angiography (MRA)
J06
L33627
Related Codes
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