Z13.828 — Encounter for screening for other musculoskeletal disorder
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- No documentation requirements or specific selection criteria are specified in this Clinical Policy Bulletin. (Note: table header states 'CPT codes covered if selection criteria are met' but the CPB does not provide or list those selection criteria.)
- Where thermography findings are discussed in studies, results are generally recommended to be correlated with alternative imaging techniques (e.g., mammography, ultrasound, MRI) — i.e., thermography should not be used as a standalone diagnostic test and correlation with standard diagnostic imaging/clinical findings is needed.
- No specific documentation requirements are stated in the Clinical Policy Bulletin. (The policy does not list required medical records, test results, or clinical documentation for thermography because thermography is considered experimental/investigational and not covered for the listed indications.)
Key Coverage Criteria
- No covered indications are stated in this document. (The policy background notes that, based on an OHTA study, the Health Care Financing Administration/CMS withdrew Medicare coverage of thermography.)
- Dynamic infrared blood perfusion imaging (DIRI) for intra-operative and post-operative perfusion assessment is considered experimental and investigational (effectiveness not established).
- None. Aetna considers thermography (including digital infrared thermal imaging, magnetic resonance (MR) thermography and temperature gradient studies) experimental and investigational for all indications because available medical literature indicates that the effectiveness of thermography as a diagnostic technique has not been established.
- 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).
3 Active Policies
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
AETNA-CPB-0029 — Thermography
AETNA-CPB-0212 — Musculoskeletal Assessment Systems
Related Codes
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