Z12.9 — Encounter for screening for malignant neoplasm, site unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No explicit documentation requirements are stated in this Clinical Policy Bulletin.
- For persistent knee pain/swelling/instability not associated with injury: documentation of failure to respond to at least 3 weeks of conservative therapy (where conservative therapy consists of a combination of rest, ice, compression, elevation, non-steroidal anti-inflammatory drugs (NSAIDs), crutches, and range of motion (ROM) exercises)
- For persistent knee pain/swelling/instability secondary to injury: documentation that patient did not respond to conservative therapy and that multi-view x-rays have ruled out a fracture or loose body in the knee and that the clinical picture remains uncertain
- For persistent true locking of the knee: documentation describing the locking (true locking defined in policy as more than a momentary locking with the knee in a flexed position) indicating suspicion for torn meniscus or loose body
Key Coverage Criteria
- None specified. Aetna considers the analysis of volatile organic compounds experimental and investigational for the indications listed below (see Limitations).
- ICD-10 code covered if selection criteria are met for MRI-lymphangiography: I89.0 (Lymphedema, not elsewhere classified)
- MRI for the diagnosis of CLOVES syndrome
- MRI for the diagnosis of osteomyelitis in the foot
- Detection, staging, and post-treatment evaluation of tumor of the knee
- Persistent knee pain/swelling and/or instability (giving way) when: Not associated with an injury and not responding to at least 3 weeks of conservative therapy
4 Active Policies
AETNA-CPB-0029 — Thermography
AETNA-CPB-0171 — Magnetic Resonance Imaging (MRI) of the Extremities
AETNA-CPB-0608 — Salivary Tests
AETNA-CPB-0717 — Analysis of Volatile Organic Compounds
Related Codes
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