K76.9 — 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.
- 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
- Vitamin D assay testing billed to Medicare Part A or Part B MAC is covered when ordered by an authorized provider (physician or state-authorized non-physician) and the service is otherwise consistent with local coverage determination L33996.
- A valid ICD-10-CM diagnosis code that best describes the patient's condition prompting the Vitamin D assay must be reported on the claim; for diagnostic tests, report the test result if known, otherwise report the presenting symptoms.
- When a referring/ordering provider is required, the referring/ordering provider name and NPI must be reported on the claim.
- Vitamin D assay testing is covered when the medical record documents medical necessity for the test, including the clinical reason for testing and any planned repeat testing and frequency.
- Measure 25-hydroxyvitamin D for patients with chronic kidney disease stage III or greater.
- Measure 25-hydroxyvitamin D for patients with osteoporosis.
12 Active Policies
A56767 — Billing and Coding: Heavy Metal Testing
J06
A57736 — Billing and Coding: Vitamin D Assay Testing
J06
L37535 — Vitamin D Assay Testing
J06
L35074 — Heavy Metal Testing
J06
A57718 — Billing and Coding: Vitamin D Assay Testing
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.