Does E86.9 require prior authorization?

No, E86.9 does not require prior authorization (high confidence). Covered without prior authorization.

`E86.9`, Volume depletion, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Each claim must be submitted with ICD-10-CM code(s) that accurately reflect the patient’s condition and indicate the reason(s) the service was performed.
The medical record must include the ordering/referring provider’s name and NPI for services that require a referring/ordering physician.
The patient’s medical record should include the assessment by the ordering provider related to the patient’s complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.
For diagnostic tests, report the test result on the claim when known; otherwise report the symptoms that prompted performance of the test.

Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
Monitored Anesthesia Care (MAC) is medically necessary when the patient has one or more documented diagnoses listed as supporting medical necessity (e.g., F91.9, G97.81, T81.9XXA, T88.8XXA, F79) and the diagnosis is matched to the anesthesia/CPT/HCPCS procedure performed.
Use G9 anesthesia modifier to indicate need for MAC due to a history of severe or advanced cardiopulmonary disease when the proceduralist determines additional monitoring is required.
Use G8 anesthesia modifier for certain deep, complex, complicated, or markedly invasive surgical procedures when applied to anesthesia codes 00100, 00300, 00400, 00160, 00532, or 00920.

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57361

Ask Backwork about documentation requirements, denial risks, or coverage in your state.