R93.5 — Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
- All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
- This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
- For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
Key Coverage Criteria
- MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
- MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).
- MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair when it is comparable to CA for determining extent of AAA and evaluating aortoiliac occlusive disease and renal artery pathology necessary for surgical planning.
- MRA of the renal arteries and aortoiliac arteries (in the absence of AAA or aortic dissection) is covered when MRA is expected to avoid CA, physician history/physical and standard assessments are insufficient, and obtaining MRA has a high probability of positively affecting patient management.
- MRA of the chest is covered for diagnosis of suspected pulmonary embolism when the patient has a contraindication to receiving intravascular iodinated contrast material.
- MRA of the chest is covered for pre-operative and post-operative evaluation of thoracic aortic dissection and thoracic aortic aneurysm and may be used as an alternative to other non-invasive imaging when clinically appropriate.
20 Active Policies
A56747 — Billing and Coding: Magnetic Resonance Angiography (MRA)
J06
L33633 — Magnetic Resonance Angiography (MRA)
J06
A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
J09
A57636 — Billing and Coding: Duplex Scanning
J09
L33583
Related Codes
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