K72.11 — Chronic hepatic failure with coma
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.
- Each claim must be submitted with ICD-10-CM code(s) that accurately reflect the patient’s condition and indicate the reason(s) the service was performed.
- The medical record must include the ordering/referring provider’s name and NPI for services that require a referring/ordering physician.
- The patient’s medical record should include the assessment by the ordering provider related to the patient’s complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.
Key Coverage Criteria
- Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
- Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
- A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
- Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
- Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
- Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.
14 Active Policies
A56758 — Billing and Coding: Non-Invasive Vascular Studies
J06
L33627 — Non-Invasive Vascular Studies
J06
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
A56500 — Billing and Coding: Cardiac Catheterization and Coronary Angiography
A56612 — Billing and Coding: CT of the Head
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.