N28.82 — Megaloureter
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).
- Duplex scanning is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33674.
- Duplex scanning is covered to evaluate suspected chronic intestinal ischemia in patients with postprandial epigastric or periumbilical pain lasting 1–3 hours and associated weight loss from decreased oral intake.
- Duplex scanning is covered to evaluate suspected acute intestinal ischemia in patients with acute crampy or steady epigastric/periumbilical pain with minimal abdominal exam findings and leukocytosis.
- Duplex scanning is covered to evaluate possible injury to arterial inflow or venous outflow of abdominal, pelvic and/or retroperitoneal organs after trauma to those regions.
6 Active Policies
A57636 — Billing and Coding: Duplex Scanning
J09
L33674 — Duplex Scanning
J09
A55336 — Billing and Coding: Retroperitoneal Ultrasound
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34577 — Retroperitoneal Ultrasound
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.