Z92.82 — Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Intra-arterial mechanical embolectomy or thrombectomy is consideredmedically necessaryin the treatment of ischemic stroke whenanyof the following criteria sets (I, II, III, IVorV) have been met:
- Anterior cerebral artery (A1 or A2), middle cerebral artery (M1 or M2) or intracranial carotid artery occlusion whenallcriteria are met:Mechanical embolectomy is performed within 6 hours of onset of symptoms;andNIH Stroke Scale (NIHSS) score of 2 or greater;andNeuroimaging has ruled out intracranial hemorrhage or arterial dissection.
- Mechanical embolectomy is performed within 6 hours of onset of symptoms;and
- NIH Stroke Scale (NIHSS) score of 2 or greater;and
- Neuroimaging has ruled out intracranial hemorrhage or arterial dissection.
- Intracranial internal carotid arteryormiddle cerebral artery (M1) occlusion whenallcriteria are met:Mismatch between the severity of the clinical deficit and the infarct volume, as defined inanyof the following situations:80 years of age or older: NIHSS score of 10 or higher and an infarct volume of less than 21 ml;orLess than 80 years of age: NIHSS score of 10 or higher and an infarct volume of less than 31 ml;orLess than 80 years of age: NIHSS score of 20 or higher and an infarct volume from 3 [...]
1 Active Policy
ANTHEM-CG-SURG-115 — CG-SURG-115 Mechanical Embolectomy for Treatment of Stroke
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.