Does K38.9 require prior authorization?

No, K38.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K38.9` — Disease of appendix, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
When performed for surveillance of colonic neoplasia, report the appropriate CPT/HCPCS procedure code and the appropriate primary ICD-10-CM code plus one of the following secondary diagnosis codes: Z85.038, Z85.048, Z86.0100, Z86.0101, Z86.0102, or Z86.0109.
For high-risk post-surgical follow-up at 1 year (with continued 24-month screening eligibility), report HCPCS code G0105 as the appropriate screening/high-risk colonoscopy code.
CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.

Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
CT abdomen is medically necessary to evaluate abdominal pain.
CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
CT abdomen is medically necessary to evaluate abdominal inflammatory processes.

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

A56632 — Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

L34454 — Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

L34415 — CT of the Abdomen and Pelvis

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