P04.49 — Newborn affected by maternal use of other drugs of addiction
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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
- During excision of left atrial mass;
- Evaluation of angina;
- Evaluation of aortic diseases;
- Evaluation of aortocoronary bypass grafts;
- Evaluation of atrial fibrillation/flutter;
- ICD-10 I05.0 - I05.9: Diseases of mitral valve
1 Active Policy
AETNA-CPB-0008 — Color-Flow Doppler Echocardiography in Adults
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.