Q89.09 — Congenital malformations of spleen
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.
- The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
- A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.
Key Coverage Criteria
- Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
- Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
- Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
- Echocardiograms performed as part of the CAMZYOS REMS program are covered when billed with modifier KX and all REMS program requirements are met for patients with NYHA Class II–III obstructive hypertrophic cardiomyopathy (I42.1).
- TTE is indicated to assess cardiac effects of systemic hypertension, including detection of left ventricular hypertrophy to guide long-term antihypertensive therapy.
- TTE is indicated to evaluate ventricular function, cardiomyopathies, and heart failure when history, physical exam, or routine labs suggest or cannot exclude cardiac disease.
6 Active Policies
A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)
J06
L33577 — Transthoracic Echocardiography (TTE)
J06
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
A57306 — Billing and Coding: Transthoracic Echocardiography (TTE)
L34338 — Transthoracic Echocardiography (TTE)
Related Codes
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