S06.1X7A — Traumatic cerebral edema with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
- The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- The medical record must fully support medical necessity and include relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Key Coverage Criteria
- Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
- Psychiatric/psychological services are covered when there is a reasonable expectation that withdrawing treatment would cause the patient's condition to deteriorate, relapse, or require hospitalization.
- CORF social and psychological services are covered when indicated and may be provided by qualified social workers (minimum BS) or psychologists (minimum Master’s level).
- Psychiatric diagnostic procedures may be billed once per day and are covered at the outset of an illness or suspected illness, or again for a new episode after a hiatus or on (re)admission for complications of the underlying condition.
- Psychotherapy codes that include an E/M component are payable when performed by physicians, physician assistants (PA), nurse practitioners (NP), or clinical nurse specialists (CNS) and the E/M component is documented in the record.
- Interactive complexity add-on code 90785 may be reported in conjunction with specified diagnostic and psychotherapy codes when interactive complexity is present.
16 Active Policies
A56537 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
A56937 — Billing and Coding: Psychiatry and Psychology Services
J06
L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
L33632 — Psychiatry and Psychology Services
J06
Related Codes
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