K75.9 — Inflammatory liver disease, 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.
- CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.
- Documented clinical indication for MRCP (e.g., symptoms such as obstructive jaundice, cholangitis, biliary-type abdominal pain, pancreatitis).
- Pre-test probability and relevant clinical context (e.g., suspected choledocholithiasis, cholestatic liver enzyme pattern, prior imaging findings).
Key Coverage Criteria
- 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.
- CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.
- CT abdomen is medically necessary to evaluate abdominal trauma.
6 Active Policies
A57802 — Billing and Coding: Hepatic (Liver) Function Panel
AETNA-CPB-0384 — Magnetic Resonance Cholangiopancreatography
ANTHEM-CG-DME-41 — CG-DME-41 Ultraviolet Light Therapy Delivery Devices for Home Use
ANTHEM-CG-LAB-26 — CG-LAB-26 Outpatient Alpha-Fetoprotein Testing
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
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