T50.905S — Adverse effect of unspecified drugs, medicaments and biological substances, sequela
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Policy references and complements Local Coverage Determination L33417 for Allergy Skin Testing; full LCD and policy text required to determine specific documentation and billing rules.
- 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.
- When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
- If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.
Key Coverage Criteria
- Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
- Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
- Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
- Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
- Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
- RAST type tests are covered when medically necessary and supported by the related Local Coverage Determination (LCD) and current medical literature or standards of practice.
20 Active Policies
A57472 — Billing and Coding: Allergy Immunotherapy
J05
L36408 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
J05
L40195 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
J05
A56844 — Billing and Coding: RAST Type Tests
J06
L33591
Related Codes
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