Z01.812 — Encounter for preprocedural laboratory examination
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act; diagnosis must best describe the patient's condition for which the service was performed.
- For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- For diagnostic (non-screening) use of the test, report the test result if known; if result is not available, report the symptoms prompting the test.
- When billing CPT 87641 for screening purposes (statutorily non-covered), ICD-10-CM diagnosis codes may be reported but payment will still be denied.
Key Coverage Criteria
- An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
- A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
- Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
- Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.
- A second professional component (PC) interpretation may be paid when a second physician’s substantially greater expertise is necessary and reasonable to clarify a questionable or confusing ECG finding and contributes substantially to diagnosis or treatment.
- S22.21XS | Fracture of manubrium, sequela
8 Active Policies
A52379 — Billing and Coding: CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique)
J06
CIGNA-0510 — Transthoracic Echocardiography in Adults - (0510)
A57327 — Billing and Coding: Electrocardiograms
AETNA-CPB-0158 — Neuropsychological and Psychological Testing
ANTHEM-CG-MED-61
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