Q79.1 — Other congenital malformations of diaphragm
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
- Medical necessity for the CT must be documented in the medical record.
- Documented chest x-ray and/or physical examination findings suggestive of chest pathology should be recorded prior to proceeding to CT thorax.
- The CT scan must be performed on FDA-recognized CT equipment that has achieved the full market phase of development; equipment model and FDA status should be documented.
Key Coverage Criteria
- CT thorax is covered for diagnosis and/or staging of neoplastic and hematologic processes arising in or involving the thorax.
- CT thorax is covered to evaluate pulmonary, mediastinal, pleural, and chest wall infections and their complications.
- CT thorax is covered to detect and characterize mediastinal neoplasms and other mediastinal processes.
- CT thorax is covered for assessment of cardiopulmonary failure or insufficiency.
- CT thorax is covered to detect and determine the nature and extent of cardiovascular abnormalities (e.g., aneurysm, dissection, embolism, thrombosis, congenital anomalies, postoperative complications, atherosclerotic sequelae).
- CT thorax is covered to assess or guide drainage of pulmonary or pleural fluid collections such as abscess, empyema, effusion, or pneumothorax.
3 Active Policies
AETNA-CPB-0449 — Fetal Surgery In Utero
A56580 — Billing and Coding: Computerized Axial Tomography (CT), Thorax
L33459 — Computerized Axial Tomography (CT), Thorax
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