N17.0 — Acute kidney failure with tubular necrosis
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
- If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
- Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.
- Required documentation, prior authorization requirements, and coding instructions for hospice renal care follow the LCD L34559 and local Medicare contractor policies; retain medical records supporting hospice eligibility and renal diagnosis as specified by the LCD.
Key Coverage Criteria
- Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
- A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
- Coverage for hospice renal care is determined by the Local Coverage Determination (LCD) L34559; refer to LCD L34559 for specific covered diagnoses and clinical criteria for hospice renal services.
- 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).
20 Active Policies
L38680 — MolDx: Molecular Testing for Solid Organ Allograft Rejection
J05
A57591 — Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies
J05
L35755 — Non-Invasive Abdominal / Visceral Vascular Studies
J05
A60273 — Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection
J05
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