N22, Calculus of urinary tract in diseases classified elsewhere
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high 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.
- 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.
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).
- 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.
- Vitamin D assay testing is covered when ordered for evaluation of a patient's vitamin D status and billed with a valid ICD-10-CM diagnosis code that best describes the patient's condition.
- Policy text: "The best candidates for nesiritide therapy are patients with decompensated HF who have clinical evidence of fluid over-load and/or raised central venous pressure [Quality of evidence: Low]."
- Aetna considers nesiritide (Natrecor) medically necessary for the acute management of members with acutely decompensated congestive heart failure (CHF) who have dyspnea at rest or with minimal activity.
7 Active Policies
A57736, Billing and Coding: Vitamin D Assay Testing
J6
NGS-L37535, Vitamin D Assay Testing
JK
AETNA-CPB-0709, Nesiritide (Natrecor)
A57718, Billing and Coding: Vitamin D Assay Testing
A59170, Billing and Coding: Vitamin D Assay Testing
Related Codes
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