R09.01 — Asphyxia
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
- Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
- For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.
- Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Key Coverage Criteria
- Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
- CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
- CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
- 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
19 Active Policies
L35434 — Oximetry Services
J12
A57205 — Billing and Coding: Oximetry Services
J12
A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck
A57225 — Billing and Coding: Respiratory Care
A57327 — Billing and Coding: Electrocardiograms
Related Codes
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