N19 — Unspecified kidney failure
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- When required, report the referring/ordering physician's name and NPI on the claim.
Key Coverage Criteria
- Magnetic resonance angiography (MRA) is covered only when the service meets the reasonable and necessary coverage criteria specified in Local Coverage Determination L34865.
- Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
- For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).
- Routine foot care is covered only when the patient has one or more diagnoses listed in the LCD L33941 “ICD-10 Codes that Support Medical Necessity.”
- Patients with peripheral neuropathy involving the feet (without vascular impairment) are covered when billed with the Group 3 ICD-10 codes appropriate for peripheral neuropathy.
- Patients requiring anticoagulation therapy are covered when billed with the Group 4 ICD-10 codes documenting anticoagulation-related risk.
20 Active Policies
L35074 — Heavy Metal Testing
J06
A56767 — Billing and Coding: Heavy Metal Testing
J06
L34018 — Parathormone (Parathyroid Hormone)
J09
A57122 — Billing and Coding: Parathormone (Parathyroid Hormone)
J09
A57361 — Billing and Coding: Monitored Anesthesia Care
Related Codes
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