N99.89 — Other postprocedural complications and disorders of genitourinary system
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.
- No explicit medical-record documentation requirements, ICD-10 diagnoses, frequency limits, or prior authorization criteria are specified in the provided document text.
- The document repeatedly notes the need for larger, rigorous trials and therefore implies that documentation of diagnosis, prior therapies, and rationale for use would be important, but no formal documentation checklist or required records are specified in the excerpt.
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.
5 Active Policies
AETNA-CPB-0446 — Endoscopic Ultrasonography
AETNA-CPB-0676 — Electrical Stimulation for Nausea, Vomiting and Motion Sickness (PrimaBella and ReliefBand) and Other Selected Indications
ANTHEM-SURG.00010 — SURG.00010 Treatments for Urinary Incontinence
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
Related Codes
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