Z85.20 — Personal history of malignant neoplasm of unspecified respiratory organ
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Use CPT codes 78472, 78473, 78481, 78483, 78494, or 78496 when billing cardiac blood pool imaging (MUGA, ventriculography).
- When applicable, include the additional secondary code indicating personal history of malignant neoplasm (Z85 series) per Correct Coding Initiative (CCI) guidelines alongside the appropriate C-code or D-code family entry.
- Refer to the policy's Covered ICD-10 Codes section to select the appropriate C-code, D-code, and Z85 family codes for billing cardiac blood pool imaging.
- When PET Rb-82 is performed after an equivocal, technically uninterpretable, or discordant SPECT, the clinical reason and medical necessity for PET must be clearly documented in the patient's medical record.
Key Coverage Criteria
- Cardiac blood pool imaging (MUGA, ventriculography) is covered when performed for patients receiving cardiotoxic chemotherapy.
- Cardiac blood pool imaging is covered for evaluation of valvular disease or cardiomyopathies.
- Prior to initiation of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z01.89 plus the appropriate C-code or D-code family entry.
- During or for interval assessment while receiving cardiotoxic chemotherapy, bill using the appropriate T45.1X5* encounter code (T45.1X5A, T45.1X5D, or T45.1X5S) to indicate ongoing exposure.
- At completion of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z08 and the appropriate C-code or D-code family entry.
- Myocardial perfusion imaging (MPI/SPECT) is covered for diagnosis and management of coronary artery disease (CAD), including evaluation of atypical chest pain, abnormal or suspected false-positive stress ECG, and other symptoms suspicious for CAD.
3 Active Policies
AETNA-CPB-0071 — Positron Emission Tomography (PET)
A54768 — Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
L33457 — Cardiac Radionuclide Imaging
Related Codes
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