Z02.4 — Encounter for examination for driving license
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When pre-surgical localization is the indication, documentation that the person has intractable epilepsy and is being considered for surgery (see CPB 0394 - Epilepsy Surgery for related requirements).
- Documentation that diagnosis remains uncertain after recent (within the past 90 days) neurological examinations and standard EEG studies (unless monitoring is being performed in the ICU, in which case this requirement is waived).
- Documentation that non-neurological causes of symptoms (e.g., syncope, cardiac arrhythmias) have been ruled out.
- Clinical rationale for the specific indication being requested (e.g., differentiation of epileptic vs psychogenic seizures; first diagnosis of seizure disorder; need to characterize poorly defined seizure types to guide therapy; evaluation of very young children ≤3 years, children with severe cognitive deficits, or older persons who cannot communicate; pre-surgical localization in intractable epilepsy).
Key Coverage Criteria
- Attended electroencephalographic (EEG) video monitoring performed in a healthcare facility is medically necessary when the diagnosis remains uncertain after recent (within the past 90 days) neurological examinations and standard EEG studies, and non-neurological causes of symptoms (e.g., syncope, cardiac arrhythmias) have been ruled out, for any of the following:
- To differentiate epileptic events from psychogenic seizures (conversion disorder with seizures or convulsions).
- To establish the first diagnosis of a seizure disorder (epilepsy and recurrent seizures - ICD-10 G40.001–G40.919).
- To establish the specific type of epilepsy in poorly characterized seizure types when such characterization is medically necessary to select the most appropriate therapeutic regimen (including absence and juvenile myoclonic epilepsy - ICD-10 G40.A01–G40.B19).
- To establish the diagnosis of epilepsy and evaluate response to treatment in very young children (3 years of age or younger) and in children with severe cognitive deficits, or older persons who are unable to communicate due to disability.
- Attended EEG video monitoring in a healthcare facility is medically necessary for identification and localization of a seizure focus in persons with intractable epilepsy who are being considered for surgery (pre-surgical localization).
1 Active Policy
AETNA-CPB-0322 — Electroencephalographic (EEG) Video Monitoring
Related Codes
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