R63.4 — Abnormal weight loss
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The submitted CPT/HCPCS code must accurately describe the service performed.
- All documentation must be maintained in the patient medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
Key Coverage Criteria
- Diagnostic colonoscopy is covered when the service meets the reasonable and necessary requirements specified in Local Coverage Determination L33671.
- Use only ICD-10-CM diagnosis codes that are valid to report as a principal diagnosis under ICD-10-CM Coding Guidelines when submitting a hospice principal diagnosis.
- Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
- Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
- Duplex scanning is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33674.
- Erythrocyte sedimentation rate (ESR) testing is covered only when reasonable and necessary as defined by Local Coverage Determination L34021.
20 Active Policies
L35074 — Heavy Metal Testing
J06
A56767 — Billing and Coding: Heavy Metal Testing
J06
L33671 — Diagnostic Colonoscopy
J09
A55937 — Billing and Coding: Diagnostic Colonoscopy
J09
L33674 — Duplex Scanning
Related Codes
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