R10.A0 — Flank pain, unspecified side
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must include the appropriate CPT code (88120 or 88121), 1 unit of service, and an appropriate ICD-10 diagnosis code for the clinical indication.
- Laboratories reporting only the technical component should append the TC modifier to CPT 88120 or 88121.
- Billing entities must be CLIA certified to submit UroVysion claims and should maintain CLIA certification documentation in the medical record/claims file.
- To bill a professional component, the physician must personally read, quantitate, and interpret the probe-stained cells/tissues and document that interpretive work in the medical record.
Key Coverage Criteria
- FISH bladder tumor marker testing using a validated assay (e.g., UroVysion) is covered when performed on urine specimens from persons with hematuria suspected of having bladder cancer to aid initial diagnosis.
- FISH bladder tumor marker testing using a validated assay (e.g., UroVysion) is covered for monitoring tumor recurrence in patients previously diagnosed with bladder cancer using urine specimens.
- Bladder tumor marker testing (BTA TRAK/BTA stat, NMP-22 quantitative, NMP-22 BladderChek, UroVysion FISH, ImmunoCyt) is covered when performed as an adjunct to cystoscopy to evaluate patients with signs or symptoms suggestive of bladder/urothelial carcinoma or to monitor treated urothelial carcinoma for recurrence or progression.
- Bladder tumor marker testing is covered for surveillance of patients with previously diagnosed urothelial carcinoma when used together with cystoscopy according to standard surveillance protocols.
- UroVysion FISH testing is covered for detection and surveillance of bladder cancer, including use in patients recently treated with intravesical BCG, since specificity is adequate for post-BCG evaluation and for predicting recurrence.
- Bladder tumor marker testing may be performed when cystoscopy cannot be performed (eg, post-radical cystectomy or other documented exception) as an alternative adjunctive test for surveillance or evaluation.
4 Active Policies
A55029 — Billing and Coding: Lab: Bladder/Urothelial Tumor Markers
A55028 — Billing and Coding: Lab: Bladder/Urothelial Tumor Markers
L36678 — Lab: Bladder/Urothelial Tumor Markers
L36680 — Lab: Bladder/Urothelial Tumor Markers
Related Codes
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