Z04.3 — Encounter for examination and observation following other accident
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Billing and coding guidance for chest X-ray must be used in conjunction with the associated Local Coverage Determination (LCD).
- Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.
- CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §§100 and 100.1: Medicare will pay for the interpretation and report that directly contributes to the diagnosis and treatment of the individual patient.
- The clinical chart must clearly document the reason(s) for the chest radiograph and explain how the x-ray results will be used to make treatment decisions or affect patient care.
Key Coverage Criteria
- Chest radiographs are covered when used to diagnose or guide treatment for pulmonary diseases.
- Chest radiographs are covered when used to diagnose or guide treatment for cardiac diseases.
- Chest radiographs are covered when used to diagnose or guide treatment for infections and inflammatory diseases of the chest or upper abdomen.
- Chest radiographs are covered for evaluation of chest and upper abdominal trauma.
- Chest radiographs are covered for evaluation and management of malignant or metastatic disease affecting the chest.
- Chest radiographs are covered for allergic or drug-related diseases affecting the chest when used to aid diagnosis or management.
4 Active Policies
A57498 — Billing and Coding: Chest X-Ray Policy
A57497 — Billing and Coding: Chest X-Ray Policy
L37549 — Chest X-Ray Policy
L37547 — Chest X-Ray Policy
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