Q51.21 — Complete doubling of uterus
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.
- Documented medical indication for the ultrasound/examination in the medical record (reason for test, clinical question to be answered).
- For detailed fetal anatomic examination: documentation of the specific covered indication (eg, SUA on initial imaging; presence of soft sonographic marker(s) with description; abnormal serum aneuploidy screening results; known or suspected fetal anatomic abnormality; prior pregnancy with omphalocele or other recurrent ultrasound-detectable congenital anomaly; pregnancy resulting from ART; maternal obesity with prepregnancy BMI ≥ 30 kg/m2; known/suspected Zika exposure; pregnancy in woman with untreated or inadequately treated syphilis; previous child with DiGeorge syndrome).
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.
4 Active Policies
AETNA-CPB-0199 — Ultrasound for Pregnancy
ANTHEM-CG-RAD-26 — CG-RAD-26 Maternity Ultrasound in the Outpatient Setting
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
Related Codes
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