T80.89XA — Other complications following infusion, transfusion and therapeutic injection, 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.
- 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.
- Off-label IVIG use may be billed when supported by the applicable Local Coverage Determination (LCD) and by documentation of medical necessity; off-label is defined as not in Medicare-approved compendia or the FDA label.
- IVIG may be used in bone marrow/stem cell transplantation when the recipient was CMV seropositive before transplantation, or after allogeneic transplantation for hematologic neoplasm when both donor and recipient were CMV seronegative.
9 Active Policies
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A60187 — Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
L40181 — Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
Related Codes
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