I82.603 — Acute embolism and thrombosis of unspecified veins of upper extremity, bilateral
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the medical record must be legible and include appropriate patient identification information such as complete name and dates of service.
- The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- Coverage determinations for biomarker testing follow Local Coverage Determination L35062 and services are covered when reasonable and necessary per that LCD.
- MRA (with or without contrast) is covered when it can replace a more invasive diagnostic test (e.g., contrast angiography) and thereby reduce risk to the beneficiary.
- MRA is covered for diagnosis and assessment of diseases and abnormalities of the arterial, venous, and lymphatic systems at any anatomic location when reasonable and necessary for the specific patient's diagnosis or treatment.
- Coverage and definition of MRA are subject to the CMS Internet-Only Manual, Pub. 100-03, Medicare NCD Manual, Chapter 1, Part 4, §220.2; MRA is considered appropriate consistent with that NCD.
- Genetic (germline/hereditary) testing is medically necessary to establish a molecular diagnosis of an inheritable disease when (1) the beneficiary displays clinical features of the associated disease (carrier status or family studies excluded), (2) the test result will directly impact the beneficiary's treatment, and (3) a definitive diagnosis remains uncertain after history, physical exam, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies.
- Factor II (F2) and Factor V (F5) germline mutation testing are considered medically reasonable and necessary when performed for evaluation of venous thromboembolism.
6 Active Policies
A56541 — Billing and Coding: Biomarkers Overview
J12
L39063 — Pharmacogenomics Testing
J12
L35062 — Biomarkers Overview
J12
A59845 — Billing and Coding: Magnetic Resonance Angiography
A56775 — Billing and Coding: Magnetic Resonance Angiography
Related Codes
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