J84.10 — Pulmonary fibrosis, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
- Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
- For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.
- Billing and coding for pulmonary stress testing must follow Local Coverage Determination (LCD) L33444; consult LCD L33444 for specific medical necessity, coding, and billing criteria.
Key Coverage Criteria
- CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
- CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
- Use these billing and coding instructions when reporting the Envisia™ Genomic Classifier (Veracyte) test for diagnosis/evaluation of suspected idiopathic pulmonary fibrosis as governed by LCD L37857.
- Noninvasive ear or pulse oximetry (CPT 94760, 94761) is covered when ordered by a physician or non-physician practitioner and determined medically necessary per LCD L33923.
- Envisia™ Genomic Classifier testing for evaluation of suspected idiopathic pulmonary fibrosis/interstitial lung disease when coverage and medical necessity criteria of LCD L37919 are met.
- Respiratory pathogen panel testing is covered when performed in an outpatient, non-institutional Part B setting from a single biologic specimen on a single date of service and the order is not a reflex test.
20 Active Policies
A57568 — Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
J05
L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J05
A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J05
L37919 — MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
J05
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