K44.9 — Diaphragmatic hernia without obstruction or gangrene
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- 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.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
Key Coverage Criteria
- Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
- 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).
8 Active Policies
L33583 — Diagnostic and Therapeutic Esophagogastroduodenoscopy
J09
A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
J09
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
A56580 — Billing and Coding: Computerized Axial Tomography (CT), Thorax
AETNA-CPB-0113 — Botulinum Toxin
Related Codes
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