R04.9 — Hemorrhage from respiratory passages, unspecified
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.
- 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.
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.
- Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
- A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
- Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
- Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
- Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.
15 Active Policies
A57056 — Billing and Coding: Aortography and Peripheral Angiography
J09
L36767 — Aortography and peripheral angiography
J09
A56631 — Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography
J12
L35035 — Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography
J12
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.