P03.819 — Newborn affected by abnormality in fetal (intrauterine) heart rate or rhythm, unspecified as to time of onset
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The article provides billing/coding guidance that complements LCD L39400; use the documentation, prior authorization, and claim submission requirements specified in LCD L39400 and the local contractor's instructions.
- Note on Documentation Requirements: Physicians are reminded to bill the findings of the diagnostic test as the primary indication rather than the referring physician’s diagnosis, as indicated by Medicare’s Diagnostic Imaging Billing guidelines.
- These guidelines are available in the Medicare Claims Processing Manual, Chapter 13 - Radiology Services and Other Diagnostic Procedures (revised November 2016).
- Policy table headings and entries indicate that CPT and ICD-10 codes are "covered if selection criteria are met" — documentation should support that selection criteria/medical necessity are met (implied requirement).
Key Coverage Criteria
- No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
- Serum magnesium testing is covered when hypomagnesemia is suspected due to gastrointestinal or renal losses or when patients present with symptoms of low magnesium (weakness, muscle cramps, confusion, irregular heartbeat, or seizures).
- Serum magnesium testing is covered for patients with conditions known to cause hypomagnesemia (examples include cardiac arrhythmias, proton pump inhibitor use, chronic alcohol use, uncontrolled diabetes mellitus, hypercalcemia, post–organ transplant status, inherited renal magnesium wasting, malabsorption syndromes, aminoglycoside or amphotericin B nephrotoxicity, cisplatin, pentamidine, calcineurin inhibitor therapy, digoxin use, prolonged IV or nasogastric therapy, parenteral alimentation with [...]
- Serum magnesium testing is covered when hypermagnesemia is suspected in patients with impaired renal function or after a large magnesium load (IV, oral, or enema) or when symptoms of high magnesium (muscle weakness, fatigue, nausea/vomiting, respiratory difficulty, or cardiac arrest) are present.
- Serum magnesium testing is covered for conditions associated with hypermagnesemia such as familial hypocalciuric hypercalcemia, hypercatabolic states (e.g., tumor lysis syndrome), diabetic ketoacidosis, lithium ingestion, milk-alkali syndrome, adrenal insufficiency, and rhabdomyolysis.
- During excision of left atrial mass;
3 Active Policies
AETNA-CPB-0008 — Color-Flow Doppler Echocardiography in Adults
A59186 — Billing and Coding: Magnesium
L39400 — Magnesium
Related Codes
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