R39.853 — Costovertebral (angle) tenderness, bilateral
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (for example, full name and dates of service).
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected ICD-10-CM code(s).
Key Coverage Criteria
- Magnetic resonance angiography (MRA) is covered only when the service meets the reasonable and necessary coverage criteria specified in Local Coverage Determination L34865.
- MRA is appropriate to verify the presence of a vascular condition suspected on prior testing (usually another imaging study) rather than as an initial screening test.
- Head/neck MRA is indicated to evaluate carotid stenosis for possible surgical or percutaneous intervention when noninvasive testing (eg, Doppler ultrasound) demonstrates carotid stenosis or when clinical findings (eg, carotid bruit) corroborate stenosis.
- Head MRA (or cerebral angiogram) is indicated to evaluate for an intracranial aneurysm when there is clinically significant subarachnoid blood on CSF testing or signs/symptoms strongly suggesting an unruptured intracranial aneurysm.
- MRA of the peripheral arteries of the lower extremities is covered for evaluation of peripheral arterial disease per the CMS NCD guidance.
- Abdominal/pelvic MRA is indicated for pre-operative evaluation in patients undergoing elective abdominal aortic aneurysm (AAA) repair to assess vascular anatomy.
2 Active Policies
A56805 — Billing and Coding: Magnetic Resonance Angiography (MRA)
J12
L34865 — Magnetic Resonance Angiography (MRA)
J12
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