T65.94XA — Toxic effect of unspecified substance, 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.
- 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).
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.
- Cystatin C measurement is covered for adult patients (age >=18) with creatinine-based eGFR 45–59 ml/min/1.73 m2 who do not have markers of kidney damage.
- Cystatin C measurement is covered when documentation shows creatinine-based GFR estimates are believed to be inaccurate and more accurate GFR knowledge will affect clinical decision making or the patient's plan of care.
- Cystatin C measurement is covered when medical record documents an adult patient (>=18 years) with a creatinine-based eGFR of 45–59 ml/min/1.73 m2 and no markers of kidney damage.
- Cystatin C measurement is covered when the ordering documentation demonstrates that creatinine-based GFR estimates are believed to be inaccurate and more accurate GFR knowledge will affect clinical decision-making or the patient's plan of care.
8 Active Policies
A56612 — Billing and Coding: CT of the Head
A56948 — Billing and Coding: Lab: Cystatin C Measurement
A56988 — Billing and Coding: Cystatin C Measurement
A57643 — Billing and Coding: Lab: Cystatin C Measurement
L34417 — CT of the Head
Related Codes
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