T45.AX3D — Poisoning by immune checkpoint inhibitors and immunostimulant drugs, assault, subsequent encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Maintain a legible medical record for each patient that includes complete patient identification (e.g., full name, dates of service) and is available to the contractor upon request.
- Medical records must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the medical necessity of the cystatin C test as directed in the related LCD (L37581).
- The laboratory or billing provider must have on file the physician requisition that states the diagnosis/condition (ICD-10-CM code) that warrants the test.
Key Coverage Criteria
- Cystatin C measurement is covered when performed on an adult (age >=18) patient with a creatinine-based eGFR of 45–59 ml/min/1.73 m2 and who does not have markers of kidney damage.
- Cystatin C measurement is covered when the medical record documents a clear rationale that creatinine-based eGFR estimates are thought to be inaccurate and that more accurate knowledge of GFR will affect clinical decision-making or the patient’s plan of care.
- Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
- Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.
- Standard skin testing is the preferred method when allergy testing is necessary.
- When a percutaneous or intracutaneous single test (CPT 95004 or 95024) and sequential/incremental tests (CPT 95017, 95018, 95027) are performed the same day, both code types may be reported only if they are for different allergens or for different dilutions of the same allergen.
6 Active Policies
A57473 — Billing and Coding: Allergy Testing
J05
L36402 — Allergy Testing
J05
A57657 — Billing and Coding: Sedimentation Rate, Erythrocyte
J09
L34021 — Sedimentation Rate, Erythrocyte
J09
A56948 — Billing and Coding: Lab: Cystatin C Measurement
Related Codes
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