Z13.220 — Encounter for screening for lipoid disorders
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- None specified in the policy (no documentation requirements listed because the devices are designated experimental/investigational and not covered).
- No explicit separate 'Documentation Requirements' section is provided in the CPB. Inferred required documentation to support medical necessity includes:
- Clinical documentation of hypertriglyceridemia (laboratory triglyceride value), particularly triglyceride >250 mg/dL (policy specifically references directly measured LDL-C indication at >250 mg/dL) or >400 mg/dL where calculated LDL is inaccurate
- Clinical documentation of type 2 diabetes diagnosis when claiming direct LDL-C measurement for diabetes patients (ICD-10 E08.00–E13.9 shown as covered when selection criteria met)
Key Coverage Criteria
- None — Aetna considers cholesterol monitors for home use (e.g., Cholestron cholesterol monitor, molecularly imprinted membrane modified gel colorimetric device) experimental and investigational and does not identify any covered indications in this policy.
- For hypertriglyceridemia: CPT 83721 (Lipoprotein, direct measurement; LDL cholesterol) covered if selection criteria are met
- ICD-10 E78.1 (Pure hyperglyceridemia) — covered if selection criteria are met
- ICD-10 E78.2 (Mixed hyperlipidemia) — covered if selection criteria are met
- ICD-10 Z13.220 (Encounter for screening for lipoid disorders) — covered if selection criteria are met
- For hypertriglyceridemia the following ICD-10 codes covered if selection criteria are met: E08.00 - E13.9 (Diabetes mellitus), E78.1, E78.2
3 Active Policies
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
AETNA-CPB-0367 — Home Cholesterol Monitors
AETNA-CPB-0525 — Screening for Lipid Disorders
Related Codes
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