Z77.011 — Contact with and (suspected) exposure to lead
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation of the clinical indication or the applicable ICD-10 diagnosis code from the list of covered diagnoses when submitting CPT/diagnosis codes for reimbursement (e.g., listed ICD-10 codes such as D50.*, F98.3, T56.0X*, Z77.011, etc.).
- For occupational lead exposure screening, documentation of workplace lead exposure per OSHA requirements or employer/occupational exposure records supporting occupational exposure status.
- For pregnant or lactating women, documentation that at least one risk factor for lead exposure (from the Appendix table) was identified on risk assessment (ACOG-recommended risk assessment at earliest contact).
- Documentation of signs or symptoms of lead poisoning when testing is performed for diagnostic purposes (examples in policy: lowered IQ, decreased attention span, impaired hearing/speech/developmental delays, abdominal pain, headaches, vomiting, constipation).
Key Coverage Criteria
- Screening of preschool-age children in the following high-risk groups: abnormal oral behaviors (e.g., pica) placing them at risk.
- Screening of preschool-age children in the following high-risk groups: close contact with a person who has or had an elevated lead level.
- Lead screening for persons with occupational lead exposures (OSHA-mandated testing for workplace lead exposures).
- Screening of preschool-age children in the following high-risk groups: emigrated (or adopted) from countries where lead poisoning is prevalent.
- Screening of preschool-age children in the following high-risk groups: have iron deficiency.
- Screening of preschool-age children in the following high-risk groups: have unexplained illness (e.g., abdominal pain, lethargy, seizures, severe anemia).
2 Active Policies
AETNA-CPB-0553 — Lead Testing
ANTHEM-CG-MED-90 — CG-MED-90 Chelation Therapy
Related Codes
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