T79.A21A — Traumatic compartment syndrome of right lower extremity, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
- The referring physician/nonphysician practitioner must state the clinical indication/medical necessity in the order for the test and provide the order to the performing provider.
- The medical record must include a permanent report describing studies performed, any contrast or radiopharmaceuticals used, known significant reactions/complications, and comparisons with prior relevant studies.
- Reports must document both normal and abnormal findings, measurements for variations from normal, and explicitly address the clinical question or explain why it cannot be answered.
Key Coverage Criteria
- Non-invasive peripheral venous and hemodialysis access studies are covered when the results will be used to guide the clinical management of the patient.
- Duplex scanning and physiologic studies may be performed and reimbursed during the same encounter when physiologic studies are abnormal or when evaluating vascular trauma, thromboembolic events, or aneurysmal disease.
- One preoperative scan for hemodialysis access site surgery is covered to plan access creation.
- Pre-surgical radial artery conduit mapping may be accompanied by vein mapping only when arterial studies show an unacceptable conduit or insufficient arterial conduit is available for multiple bypass procedures.
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
4 Active Policies
A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
Related Codes
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