Does E36.02 require prior authorization?

No, E36.02 does not require prior authorization (high confidence). Covered without prior authorization.

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`E36.02`, Intraoperative hemorrhage and hematoma of an endocrine system organ or structure complicating other procedure

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
The ordering/referring practitioner's assessment related to the patient's complaint and the specific reason for the test must be documented in the medical record.

The medical record must contain a referral/order on file for each non‑invasive vascular study performed.

Results of pertinent tests and procedures performed that relate to the indication must be included in the medical record and reported on the claim if known; otherwise report the symptoms that prompted the test.

Signed and dated office visit notes and operative reports must be present in the record for the services ordered or rendered to Medicare beneficiaries.

Key Coverage Criteria

Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.
After carotid endarterectomy, repeat ipsilateral (unilateral) duplex examinations are allowable at approximately six weeks, six months, and one year post‑procedure during the first year.

5 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A56612, Billing and Coding: CT of the Head

A56697, Billing and Coding: Non-Invasive Vascular Studies

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E36.02, Intraoperative hemorrhage and hematoma of an endocrine system organ or structure complicating other procedure