T81.599A — Other complications of foreign body accidentally left in body following unspecified procedure, 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.
- CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.
- For evaluation of colon after incomplete colonoscopy, documentation of the prior incomplete colonoscopy.
- For treatment of Crohn's strictures with endoscopic balloon dilation: documentation that patient is symptomatic or imaging shows proximal bowel dilatation, measurement of stricture longitudinal length (≤5 cm), and documentation that stricture is not associated with fistula, fissure, abscess, deep ulcer, or severe adhesion/flexure
Key Coverage Criteria
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
- CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
- CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
- CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.
- CT abdomen is medically necessary to evaluate abdominal trauma.
3 Active Policies
AETNA-CPB-0737 — Double Balloon Enteroscopy
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
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