S35.416A — Laceration of unspecified renal vein, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (for example, full name and dates of service).
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected ICD-10-CM code(s).
Key Coverage Criteria
- Magnetic resonance angiography (MRA) is covered only when the service meets the reasonable and necessary coverage criteria specified in Local Coverage Determination L34865.
- Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
- A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
- Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.
- Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.
- Duplex scanning is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33674.
6 Active Policies
A57591 — Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies
J05
L35755 — Non-Invasive Abdominal / Visceral Vascular Studies
J05
A57636 — Billing and Coding: Duplex Scanning
J09
L33674 — Duplex Scanning
J09
A56805 — Billing and Coding: Magnetic Resonance Angiography (MRA)
Related Codes
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