Z13.9 — Encounter for screening, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- A referral must be on record for each non-invasive study performed; referrals are specific to each type of study.
- Medical record documentation that the ordering physician reasonably expects the study outcome will potentially impact clinical management (i.e., medical necessity).
- Documentation of signs/symptoms or clinical findings that meet the stated indications for the specific type of vascular study (e.g., descriptions of claudication severity, rest pain, tissue loss, neurologic deficits, bruit, evidence of DVT/PE signs, dialysis access parameters).
- For ESRD/hemodialysis access studies, documentation of objective dialysis access parameters when applicable (e.g., venous pressure >200 mm Hg on 200 cc/min pump; recirculation ≥12%; urea reduction rate <60%; palpable water-hammer pulse).
Key Coverage Criteria
- Cerebrovascular Arterial Studies: Pulsatile neck mass.
- Cerebrovascular Arterial Studies: Evaluation of blunt or penetrating neck trauma.
- Cerebrovascular Arterial Studies: Ocular microembolism (optic nerve/retinal arterial - Hollenhorst plaques).
- General: Non-invasive vascular studies are medically necessary if the ordering physician has reasonable expectation that their outcomes will potentially impact the clinical management of the patient.
- General: Significant signs/symptoms of arterial or venous disease are present.
- General: The information obtained is necessary for appropriate medical and/or surgical management.
3 Active Policies
AMBETTER-CP.MP.97 — Testing for Select Genitourinary Conditions
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
L40001 — Non-Invasive Vascular Studies
Related Codes
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