S06.5X6D — Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, subsequent 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.
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
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.
- Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
- 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.
20 Active Policies
A56747 — Billing and Coding: Magnetic Resonance Angiography (MRA)
J06
A56937 — Billing and Coding: Psychiatry and Psychology Services
J06
L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
A56537 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
Related Codes
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