R76.81 — Abnormal rheumatoid factor and anti-citrullinated protein antibody without rheumatoid arthritis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must include the appropriate CPT code (88120 or 88121), 1 unit of service, and an appropriate ICD-10 diagnosis code for the clinical indication.
- Laboratories reporting only the technical component should append the TC modifier to CPT 88120 or 88121.
- Billing entities must be CLIA certified to submit UroVysion claims and should maintain CLIA certification documentation in the medical record/claims file.
- To bill a professional component, the physician must personally read, quantitate, and interpret the probe-stained cells/tissues and document that interpretive work in the medical record.
Key Coverage Criteria
- 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.
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
- CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
- CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
6 Active Policies
A55029 — Billing and Coding: Lab: Bladder/Urothelial Tumor Markers
A55028 — Billing and Coding: Lab: Bladder/Urothelial Tumor Markers
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L36678 — Lab: Bladder/Urothelial Tumor Markers
L34415 — CT of the Abdomen and Pelvis
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.