R31.21 — Asymptomatic microscopic hematuria
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Claims must include the appropriate CPT code (88120 or 88121) and an appropriate ICD-10 diagnosis code supporting the medical necessity.
- Laboratories must be CLIA-certified to bill UroVysion™ services and should maintain documentation of CLIA certification in the medical record or billing file.
- If only the technical component is billed, the claim must append the TC modifier and documentation must reflect the component performed.
- When billing the professional component, the medical record must document that the physician personally read, quantitated, and interpreted the specimen.
Key Coverage Criteria
- FISH bladder tumor marker testing performed using validated assays on urine specimens to monitor for tumor recurrence in patients previously diagnosed with bladder cancer.
- FISH bladder tumor marker testing performed using validated assays on urine specimens from persons with hematuria suspected of having bladder cancer to aid initial diagnosis.
- Coverage is available for the FDA-approved UroVysion™ Bladder Cancer Kit, which detects aneuploidy of chromosomes 3, 7, and 17 and loss of the 9p21 locus by FISH.
- 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.
- Diagnostic abdominal aortography and renal angiography are covered when they meet the reasonable and necessary clinical requirements specified in LCD L35092.
20 Active Policies
A57056 — Billing and Coding: Aortography and Peripheral Angiography
J09
L36767 — Aortography and peripheral angiography
J09
L33674 — Duplex Scanning
J09
L39367 — Genetic Testing in Oncology: Specific Tests
J09
A59123 — Billing and Coding: Genetic Testing in Oncology: Specific Tests
Related Codes
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