I97.648 — Postprocedural seroma of a circulatory system organ or structure following other circulatory system procedure
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
- If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
- Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.
- 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.
Key Coverage Criteria
- Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
- A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
- Non-invasive peripheral arterial vascular studies are covered when the study results will be used in the clinical management of the patient and the medical necessity is documented in the medical record.
- One preoperative non-invasive vascular scan for bypass surgery is reasonable and covered to guide surgical planning.
- Immediate postoperative studies are covered when re-established pulses are lost or become equivocal, or the patient develops signs or symptoms of ischemia suggesting impending repeat intervention.
- Medically necessary follow-up noninvasive studies after angioplasty are covered, with the follow-up frequency determined by the vascular distribution treated and documented medical necessity.
8 Active Policies
A57593 — Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies
J05
L35761 — Non-Invasive Peripheral Arterial Vascular Studies
J05
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
Related Codes
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