Z13.30 — Encounter for screening examination for mental health and behavioral disorders, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- For MindX tests: "A qualified laboratory professional compiles the report that is communicated to the ordering provider detailing risk and medication suggestions."
- "Requested by a psychiatrist as an aid to differentiate psychotic depression from schizophrenia."
- Claims must be submitted in accordance with the relevant criteria outlined in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s); services billed for conditions or diagnoses that are not covered under this Coverage Policy will be denied.
- When billing, providers must use the most appropriate codes as of the effective date of the submission.
Key Coverage Criteria
- Dexamethasone suppression test (DST) — "medically necessary when it is requested by a psychiatrist as an aid to differentiate psychotic depression from schizophrenia."
- Non-obstetrical transvaginal ultrasound is considered medically necessary for the evaluation of suspected pelvic pathology.
- Non-obstetrical transvaginal ultrasound is considered medically necessary for screening or surveillance of a woman at increased risk for ovarian or endometrial cancer.
- Evaluation of unexplained bleeding in the postmenopausal woman (TVUS can suggest presence of polyps, abnormal endometrial histology such as adenomatous hyperplasia, or cancer).
- Evaluation of a pelvic mass to provide information about the location of a pelvic mass relative to the ovary and uterus and to better delineate internal architectural characteristics.
- Evaluation of patients with acute pelvic pain (TVUS can help rule out ovarian primary source for acute pain when ovaries appear normal and no free intraperitoneal fluid is present).
2 Active Policies
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
AETNA-CPB-0306 — Laboratory Tests for Depression and Other Psychiatric Disorders
Related Codes
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