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ICD-10-CM K30, Functional dyspepsia | No Prior Auth

`K30`, Functional dyspepsia

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
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.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Key Coverage Criteria

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Plantar Fasciitis
Peptic Ulcer
Post-Operative Ileus
Post-Prandial Distress Syndrome
Post-Stroke Shoulder Pain

9 Active Policies

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9

AETNA-CPB-0616, Gastrointestinal Manometry

AETNA-CPB-0678, Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy

AETNA-CPB-0135

Related Codes

K21.9(7 policies)K31.84(7 policies)K21.00(6 policies)R11.2(6 policies)K50.00(6 policies)

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Ask Verity about documentation requirements, denial risks, or coverage in your state.

Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).

The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

, Acupuncture and Dry Needling

A56389, Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

A56421, Billing and Coding: CT of the Abdomen and Pelvis

AETNA-CPB-0783, In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions

AETNA-CPB-0396, Gastrointestinal Function: Selected Tests

K25.0(5 policies)

C17.9(5 policies)

C15.3(5 policies)