K76.6 — Portal hypertension
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must be submitted with an ICD-10-CM code that represents the reason for the procedure, billed to the highest level of specificity and linked to the appropriate procedure code.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Medical record documentation should list the type and length of conservative treatment attempted, as applicable per LCD L37893.
Key Coverage Criteria
- Endovenous stenting is covered when performed to treat severely symptomatic venous obstructions in accordance with LCD L37893.
- Endovenous stenting is covered when used to treat severely symptomatic venous obstructions in accordance with LCD L38231.
- Wireless capsule endoscopy of the small bowel (including esophagus through ileum) is billed with CPT 91110 when clinically indicated.
- Wireless capsule endoscopy limited to the esophagus is billed with CPT 91111 when clinically indicated.
- Capsule endoscopy may be used when attempts were made to identify a gastrointestinal bleeding source but the site was not identified by prior colonoscopy or endoscopy.
- Capsule endoscopy is indicated when the patient is not a candidate for conventional endoscopy and the medical record documents specific comorbidities/complicating conditions and explains why the risk/benefit ratio for conventional endoscopy is unfavorable.
20 Active Policies
L35755 — Non-Invasive Abdominal / Visceral Vascular Studies
J05
A57591 — Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies
J05
A56758 — Billing and Coding: Non-Invasive Vascular Studies
J06
L33627 — Non-Invasive Vascular Studies
J06
L38231
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.