N81.3 — Complete uterovaginal prolapse
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and the reason(s) the urodynamic service was performed.
- For diagnostic urodynamic tests, report the test result if known; if results are not available at time of claim, report the symptoms that prompted the test.
- When a penile pressure cuff is used during a voiding pressure study, report CPT code 55899 and note the non-invasive urodynamic study in the narrative portion of the claim.
- When a referring/ordering physician is required, the referring/ordering physician's name and NPI must be reported on the claim.
Key Coverage Criteria
- Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
- Urodynamic testing is covered for symptomatic pelvic organ prolapse that extends beyond the hymen.
- Urodynamic studies are indicated only after an initial evaluation that includes an appropriate history, physical examination, and urinalysis with microscopy.
- Active urinary infection must be treated and effectiveness of treatment observed before performing urodynamic testing.
- Urodynamic testing is covered when medically necessary to assist diagnosis if the diagnosis is uncertain and an appropriate treatment plan cannot be developed from the basic diagnostic evaluation.
- Urodynamic testing is covered when there is failure to respond to an adequate therapeutic trial.
2 Active Policies
A57455 — Billing and Coding: Urodynamics
J06
L33576 — Urodynamics
J06
Related Codes
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