T46.991S — Poisoning by other agents primarily affecting the cardiovascular system, accidental (unintentional), sequela
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- Document the medical necessity for the chosen test frequency in the medical record (preferably on the test report).
- Document that any applicable physician supervision requirement is met (preferably on the test report).
- Medical record must document a clinical diagnosis and the specific reason for the study to substantiate medical necessity.
Key Coverage Criteria
- Stress testing (exercise or pharmacological, including stress echocardiography) is covered when the results will potentially affect the patient’s treatment plan.
- An initial follow-up stress test may be indicated several months after myocardial infarction (MI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) when clinically appropriate.
- A second follow-up stress test may be indicated approximately one year after the first follow-up test following MI, CABG, or PTCA when clinically appropriate.
- Patients with silent coronary disease (no reliable signs or symptoms) may require stress testing as often as annually when clinically indicated.
- Patients who present with reliable symptoms or signs of coronary artery disease (e.g., angina pectoris) may require stress testing as dictated by symptoms but typically will not require annual testing.
- ICD-10-CM Codes that Support Medical Necessity — Group 1: The following list of ICD-10-CM codes applies to cardiovascular stress testing CPT codes 93015, 93016, 93017, 93018, 93350, 93351 93352 and J0153.
14 Active Policies
A57472 — Billing and Coding: Allergy Immunotherapy
J05
L36408 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
J05
L36402 — Allergy Testing
J05
A57473 — Billing and Coding: Allergy Testing
J05
L40195 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.