T86.8429 — Corneal transplant infection, unspecified eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must report the appropriate CPT code for the flow cytometry service, include 1 unit of service (UOS), and list the appropriate ICD-10-CM diagnosis code.
- Medical necessity documentation per LCD L34513 is required when coverage criteria are not fully met in this billing guideline (for example, when >24 markers are requested).
- The FCM report must document the specific clinical indication for each marker used beyond the 24-marker panel limit; lack of clear justification for markers >24 will result in denial.
- When performing FCM for HIV assessment, a concurrent WBC count with differential must be performed and documented to allow calculation of absolute CD4 count.
Key Coverage Criteria
- Coverage and medical necessity determinations for flow cytometry are governed by Local Coverage Determination L34513.
- Flow cytometry may be used to analyze cellular components of body fluids and lymphoreticular tissues, including peripheral blood, cerebrospinal fluid (CSF), bone marrow, lymph nodes, tonsil, spleen, and fine needle aspirate material.
- Peripheral blood or fine needle aspirate specimens may be used to avoid more invasive diagnostic procedures when clinically appropriate.
- FCM may be used in hypercellular hematolymphoid disorders to differentiate reactive conditions from neoplastic conditions.
- Flow cytometry (FCM) is indicated to evaluate single-cell characteristics from peripheral blood, body fluids, cerebrospinal fluid, bone marrow, lymph node, tonsil, spleen, and other solid tissues.
- FCM is indicated to evaluate suspected hematolymphoid neoplasia in patients with unexplained cytopenias or elevated leukocyte counts when preliminary testing is non-diagnostic and bone marrow aspiration/biopsy is indicated to rule out infiltrative or stem cell disorders.
2 Active Policies
A55717 — Billing and Coding: Lab: Flow Cytometry
L34513 — Lab: Flow Cytometry
Related Codes
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