N73.9 — Female pelvic inflammatory 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.
- CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.
- Procedure-specific intra- and post-procedure documentation: procedural details, device used, non-perfused volume (NPV) measures when applicable, analgesia/pain control measures, and adverse events/complications, as reported in trials.
- Documented persistence of one or more symptoms directly attributable to uterine fibroids (examples required/acceptable: excessive menstrual bleeding/menorrhagia, bulk-related pelvic pain, pelvic pressure/discomfort, urinary symptoms from compression of ureter or bladder, dyspareunia).
Key Coverage Criteria
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
- CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
- CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
- CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.
- CT abdomen is medically necessary to evaluate abdominal trauma.
7 Active Policies
AETNA-CPB-0304 — Fibroid Treatment
AETNA-CPB-0327 — Infertility
AETNA-CPB-0657 — Tubal Sterilization
AETNA-CPB-0754 — Chronic Pelvic Pain, Endometriosis, and Other Indications: Selected Treatments
ANTHEM-CG-LAB-32 — CG-LAB-32 Cancer Antigen 125 Testing
Related Codes
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