I82.469 — Acute embolism and thrombosis of unspecified calf muscular vein
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- The ordering/referring practitioner's assessment related to the patient's complaint and the specific reason for the test must be documented in the medical record.
Key Coverage Criteria
- 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.
- Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
- A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
- Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
15 Active Policies
A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
L40273 — MolDX: Genetic Testing for Hereditary Thrombophilia
J05
A60307 — Billing and Coding: MolDX: Genetic Testing for Hereditary Thrombophilia
J05
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