Z12.73 — Encounter for screening for malignant neoplasm of ovary
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For hepatic RBC SPECT for hemangioma evaluation: documentation that labeled RBC technique was used and correlation with other imaging (e.g., ultrasound/CT) to support non-invasive differentiation from malignant lesions.
- For parathyroid SPECT/SPECT-CT: documentation of prior planar imaging and targeted use to localize ectopic parathyroid adenomas when surgical planning requires precise anatomic localization.
- For SPECT/CT in bone metastasis characterization or indeterminate bone lesions: documentation of prior whole-body planar bone scan findings (indeterminate lesions) and correlation with clinical/imaging follow-up or histopathology when available.
- For assessment of myocardial viability and use to guide revascularization decisions: documentation of clinical decision-making linking SPECT findings to proposed revascularization planning.
Key Coverage Criteria
- Localization of abscess for suspected or known localized infection or inflammatory process
- Lymphoma, to distinguish tumor from necrosis
- Diagnosing and assessing hemangiomas of the liver
- Diagnosing pulmonary embolism by means of SPECT ventilation/perfusion scintigraphy (V/P SPECT)
- Differentiation of necrotic tissue from tumor of the brain
- Distinguishing Parkinson's disease from essential tremor (e.g., DaTSCAN [Ioflupane I-123 injection])
4 Active Policies
AETNA-CPB-0352 — Tumor Markers
AETNA-CPB-0376 — Single Photon Emission Computed Tomography (SPECT)
AETNA-CPB-0530 — Transvaginal Ultrasonography
ANTHEM-CG-MED-84 — CG-MED-84 Non-Obstetric Gynecologic Duplex Ultrasonography of the Abdomen and Pelvis in the Outpatient Setting
Related Codes
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