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ICD-10-CM E71.39, Other disorders of fatty-acid metabolism | No Prior Auth

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`E71.39`, Other disorders of fatty-acid metabolism

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.
Documentation of infant age (≤ 12 months) when requesting coverage under the infant nutritional formula indication.
Documentation that the formula is specifically formulated for the treatment of an inborn error of metabolism and medical necessity for that IEM.
Use of appropriate ICD-10-CM diagnosis code(s) from the policy's listed IEM diagnoses to support the claim.

Key Coverage Criteria

Infant (i.e., ≤ 12 months of age) nutritional formula is considered medically necessary when specifically formulated for the treatment of an inborn error of metabolism (e.g., disorder of amino acid or organic acid metabolism).
Individuals with malabsorption syndromes may benefit from enteral nutritional support. Enteral nutritional support may be indicated when the formula comprises the primary source of nutrition (i.e., 60% or more of caloric nutritional intake).
D81.810 - Biotinidase deficiency
D81.818 - Other biotin-dependent carboxylase deficiency
E70.0 - Classical phenylketonuria
E70.1 - Other hyperphenylalaninemias

2 Active Policies

CIGNA-0136, Infant Nutritional Formula

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

Related Codes

72193(1 policies)72194(1 policies)74150(1 policies)74160(1 policies)74170(1 policies)74176(1 policies)74177(1 policies)72192(1 policies)

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Use of appropriate HCPCS/CPT codes as listed in the policy (examples: B4154, B4155, B4157, B4162, S9435) and submission with the covered code(s) in order to be considered for reimbursement.

When enteral nutritional support is claimed for malabsorption syndromes, documentation that the formula comprises ≥60% of caloric intake (primary source of nutrition).