I82.539 — Chronic embolism and thrombosis of unspecified popliteal vein
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Select and report the appropriate ICD-10-CM diagnosis code(s) that support medical necessity when submitting the claim.
- Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for Part B claims (Loop 2400 or SV101-7 for 837P, Box 19 for paper claims).
- Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for Part A claims (Line SV202-7 for 837I electronic claims, Block 80 for the UB04 form).
- For Part B claims, place the DEX Z-Code adjacent to the CPT code in the SV101-7 field without adding other characters or information on that line.
Key Coverage Criteria
- Bill CPT codes 81240, 81241, or 81479 for MolDX genetic testing for hereditary thrombophilia in accordance with LCD DL40238.
- Enter 1 unit of service (UOS) for each billed CPT code for this testing.
- Genetic testing for hereditary thrombophilia should be billed using CPT codes 81240, 81241, or 81479 in accordance with LCD DL40242.
- Bill molecular/genetic testing for hereditary thrombophilia using CPT code 81240, 81241, or 81479 per LCD DL40274.
- Genetic testing for hereditary thrombophilia (hereditary germline testing) is covered for lab-developed tests (LDTs), FDA-cleared, and FDA-approved clinical laboratory tests, including NGS, when all other coverage criteria are met.
- Covered when the patient presents with venous thromboembolism (VTE) associated with non-surgical major transient or hormonal risk factors (as defined by American Society of Hematology) and testing will inform clinical management.
8 Active Policies
A60307 — Billing and Coding: MolDX: Genetic Testing for Hereditary Thrombophilia
J05
L40273 — MolDX: Genetic Testing for Hereditary Thrombophilia
J05
A60293 — Billing and Coding: MolDX: Genetic Testing for Hereditary Thrombophilia
A60255 — Billing and Coding: MolDX: Genetic Testing for Hereditary Thrombophilia
L40237 — MolDX: Genetic Testing for Hereditary Thrombophilia
Related Codes
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