Does R71.0 require prior authorization?

No, R71.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R71.0` — Precipitous drop in hematocrit

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
When required, report the referring/ordering physician's name and NPI on the claim.

A colonoscopy may be billed when a sigmoidoscope is used only if the bowel is sufficiently short that the entire colon can be examined and this fact is clearly documented in the clinical record.
An incomplete colonoscopy (inability to advance the colonoscope to the cecum or colon‑small intestine anastomosis due to unforeseen circumstances) is billed using codes 44388, 45378, G0105 or G0121 with modifier -53.
When the colonoscopy procedure is unusual or difficult, report modifier -22 (unusual procedural services) on the claim.
A follow-on screening colonoscopy after a Medicare-covered non-invasive stool-based CRC screening test that is positive is included in a Complete Colorectal Cancer (CRC) Screening and should be billed as such with modifier -KX to confirm clinical requirements are met.
The most specific ICD-10-CM diagnosis code available must be selected and billed as the line diagnosis linked to the colonoscopy procedure.
Therapeutic colonoscopy is indicated for excision of colonic polyps (polypectomy).

L35074 — Heavy Metal Testing

J06

A56767 — Billing and Coding: Heavy Metal Testing

J06

A57343 — Billing and Coding: Diagnostic and Therapeutic Colonoscopy

L34213 — Diagnostic and Therapeutic Colonoscopy

L36868 — Diagnostic and Therapeutic Colonoscopy

Ask Verity about documentation requirements, denial risks, or coverage in your state.