R11.10 — Vomiting, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
- All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
- Providers must follow the billing, coding, and documentation requirements referenced in LCD L33455; this article provides supplementary coding guidance only.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Key Coverage Criteria
- Coverage and medical necessity for wireless gastrointestinal motility monitoring systems are determined according to Local Coverage Determination L33455.
- Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
- Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
- For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).
- Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
- Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
20 Active Policies
A57473 — Billing and Coding: Allergy Testing
J05
L36402 — Allergy Testing
J05
L34018 — Parathormone (Parathyroid Hormone)
J09
A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
J09
L33583 — Diagnostic and Therapeutic Esophagogastroduodenoscopy
Related Codes
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