Z84.89 — Family history of other specified conditions
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Clinical documentation supporting a suspected or confirmed clinical diagnosis of hereditary arrhythmia or cardiomyopathy.
- Documentation that the decision to test and interpretation of results were performed by, or in consultation with, an expert in cardiac genetics.
- For cascade testing, documentation of the pathogenic or likely pathogenic variant identified in the affected proband to justify testing of asymptomatic relatives.
- Refer to the Concert Platform for a comprehensive list of registered tests and related coding information.
Key Coverage Criteria
- Post–heart transplant peripheral blood gene expression panels to assess rejection risk.
- ARVC confirmed in a first-degree relative who meets current Task Force Criteria.
- ARVC confirmed pathologically at autopsy or surgery in a first-degree relative.
- Family history of juvenile sudden cardiac death triggered by exercise or acute emotion.
- Exercise-induced bidirectional or polymorphic ventricular arrhythmias.
- Ventricular fibrillation occurring in the setting of acute stress.
1 Active Policy
AMBETTER-CG-Cardiac-Disorders-2025.1 — Concert Genetic Testing: Cardiac Disorders
Related Codes
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