I97.631 — Postprocedural hematoma of a circulatory system organ or structure following cardiac bypass
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
- Maintain complete, legible medical records for the patient with patient identification (e.g., full name, dates of service) available to the contractor upon request.
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing care.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- Bill HCPCS code G0278 for femoral or iliac angiography performed at the time of coronary angiography.
- Aortography and peripheral angiography are covered when reasonable and necessary per Local Coverage Determination L36767 and when documentation supports the selected ICD-10-CM diagnosis and medical necessity.
- An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
- A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
- Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
- Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.
11 Active Policies
L35761 — Non-Invasive Peripheral Arterial Vascular Studies
J05
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A57593 — Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies
J05
A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
Related Codes
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