S35.99XA — Other specified injury of unspecified blood vessel at abdomen, lower back and pelvis level, initial 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.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the medical record must be legible and include appropriate patient identification information (e.g., full name, dates of service).
- Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
Key Coverage Criteria
- Duplex scanning is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33674.
- Duplex scanning is covered to evaluate suspected chronic intestinal ischemia in patients with postprandial epigastric or periumbilical pain lasting 1–3 hours and associated weight loss from decreased oral intake.
- Duplex scanning is covered to evaluate suspected acute intestinal ischemia in patients with acute crampy or steady epigastric/periumbilical pain with minimal abdominal exam findings and leukocytosis.
- Duplex scanning is covered to evaluate possible injury to arterial inflow or venous outflow of abdominal, pelvic and/or retroperitoneal organs after trauma to those regions.
- Duplex scanning is covered to evaluate suspected aneurysm of the renal artery or another visceral artery based on signs/symptoms or incidental radiologic finding.
- Duplex scanning is covered to evaluate renovascular causes of uncontrolled hypertension in hypertensive patients who have failed first-line antihypertensive therapy (to rule out renal artery stenosis, renal arteriovenous fistula, or renal aneurysm).
4 Active Policies
A57636 — Billing and Coding: Duplex Scanning
J09
L33674 — Duplex Scanning
J09
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
Related Codes
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