S35.12XD — Major laceration of inferior vena cava, subsequent encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
- The medical record must contain relevant medical history, physical examination, and results of pertinent diagnostic tests that fully support the medical necessity of each non-invasive vascular study.
- Diagnostic tests must be ordered by the treating practitioner (or consulting physician) who will use the test results in managing the patient's specific medical problem; the ordering practitioner's name and NPI must be reported on the claim when required.
Key Coverage Criteria
- Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
- Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
- Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.
- Pre-surgical radial artery conduit mapping may be performed and accompanied by vein-mapping when either study shows insufficient conduits for multiple bypass procedures.
- Immediate post-operative studies of an access or bypass site are covered if pulses are lost, become equivocal, or the patient develops signs or symptoms of ischemia suggesting need for repeat intervention.
- CT thorax is covered for diagnosis and/or staging of neoplastic and hematologic processes arising in or involving the thorax.
6 Active Policies
A56758 — Billing and Coding: Non-Invasive Vascular Studies
J06
L33627 — Non-Invasive Vascular Studies
J06
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
A56580 — Billing and Coding: Computerized Axial Tomography (CT), Thorax
L33459 — Computerized Axial Tomography (CT), Thorax
Related Codes
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