T56.0X4A — Toxic effect of lead and its compounds, undetermined, initial encounter
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.
- Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
- Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
- For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
Key Coverage Criteria
- Cranial CT (with or without contrast) is covered when the patient has clinical evidence of an intracranial disorder or an established intracranial disorder/disease.
- Contrast-enhanced CT is reasonable and necessary to assess cerebral perfusion, for example in suspected or known cerebrovascular accident (CVA).
- Contrast-enhanced CT is covered to characterize a specific intracranial lesion.
- Contrast-enhanced CT is covered to detect blood–brain barrier defects such as infarcts, tumors, infection, or vasculitis.
- Contrast-enhanced CT is covered to detect neovascularity associated with intracranial tumors.
- Contrast-enhanced CT is covered for staging when there is known primary lung cancer, breast cancer, or lymphoma that are likely to metastasize early to the brain.
6 Active Policies
A56767 — Billing and Coding: Heavy Metal Testing
J06
L35074 — Heavy Metal Testing
J06
A57205 — Billing and Coding: Oximetry Services
J12
L35434 — Oximetry Services
J12
A56612 — Billing and Coding: CT of the Head
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.