R04.1 — Hemorrhage from throat
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must meet the reasonable and necessary documentation requirements specified in LCD L35035; include clinical records demonstrating medical necessity per the LCD.
- Follow the NCCI Coding Policy Manual (Chapters V and IX) for proper coding; retain documentation supporting compliance with NCCI edits.
- When billing services that the LCD does not cover, use the appropriate Medicare modifier and document the basis for billing a non-covered service.
- Billing and coding guidance in this policy complements and references Local Coverage Determination L34425; claims should be supported per the documentation requirements specified in LCD L34425.
Key Coverage Criteria
- Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
- No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
- CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
- Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
- G71.21 | Nemaline myopathy
- G83.0 | Diplegia of upper limbs
9 Active Policies
A56631 — Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography
J12
L35035 — Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography
J12
A56729 — Billing and Coding: Magnetic Resonance Imaging of the Head and Neck
A57204 — Billing and Coding: MRI and CT Scans of the Head and Neck
L34425
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.