K73.9 — Chronic hepatitis, unspecified
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.
- Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
- Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
- For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
Key Coverage Criteria
- Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
- Monitored Anesthesia Care (MAC) is medically necessary when the patient has one or more documented diagnoses listed as supporting medical necessity (e.g., F91.9, G97.81, T81.9XXA, T88.8XXA, F79) and the diagnosis is matched to the anesthesia/CPT/HCPCS procedure performed.
- Use G9 anesthesia modifier to indicate need for MAC due to a history of severe or advanced cardiopulmonary disease when the proceduralist determines additional monitoring is required.
- Use G8 anesthesia modifier for certain deep, complex, complicated, or markedly invasive surgical procedures when applied to anesthesia codes 00100, 00300, 00400, 00160, 00532, or 00920.
- MAC may be appropriate for pediatric patients (Medicare-eligible and younger than 18) when documented using ICD-10-CM code T88.8XXA and clinical records justify the need for MAC.
- Pharmacogenomics (PGx) testing is covered when it is reasonable and necessary per LCD L39063 and Medicare coverage rules for the beneficiary's clinical indication.
20 Active Policies
L39995 — Pharmacogenomic Testing
J06
A59915 — Billing and Coding: Pharmacogenomic Testing
J06
L35074 — Heavy Metal Testing
J06
A56767 — Billing and Coding: Heavy Metal Testing
J06
A59914 — Billing and Coding: Pharmacogenomic Testing
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