J93.9 — Pneumothorax, 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.
- Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
- Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
- Report overnight oximetry using CPT code 94762 on claims.
Key Coverage Criteria
- Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
- CT thorax is covered for diagnosis and/or staging of neoplastic and hematologic processes arising in or involving the thorax.
- CT thorax is covered to evaluate pulmonary, mediastinal, pleural, and chest wall infections and their complications.
- CT thorax is covered to detect and characterize mediastinal neoplasms and other mediastinal processes.
- CT thorax is covered for assessment of cardiopulmonary failure or insufficiency.
- CT thorax is covered to detect and determine the nature and extent of cardiovascular abnormalities (e.g., aneurysm, dissection, embolism, thrombosis, congenital anomalies, postoperative complications, atherosclerotic sequelae).
7 Active Policies
A57205 — Billing and Coding: Oximetry Services
J12
L35434 — Oximetry Services
J12
A56717 — Billing and Coding: Respiratory Therapy (Respiratory Care)
AETNA-CPB-0160 — Lung Denervation Therapy and Lung Volume Reduction Surgery
L34430 — Respiratory Therapy (Respiratory Care)
Related Codes
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