Does E89.823 require prior authorization?

No, E89.823 does not require prior authorization (high confidence). Covered without prior authorization.

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`E89.823`, Postprocedural seroma of an endocrine system organ or structure following other procedure

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
Claims must include the documentation and coding required by LCD L34426 and applicable billing/coding guidelines (procedure codes, supporting clinical rationale, and any required authorizations), as this article supplements that LCD.
The medical record must clearly document the necessity for the vitamin D test(s), including the clinical indication, and must document any repeat testing and the frequency of repeat testing.

Medical records relating to the test must be made available to Medicare upon request.

Providers must follow Correct Coding Initiative (CCI) guidance for correct HCPCS/CPT coding and appropriate code combinations prior to billing Medicare; documentation must support the CPT/HCPCS codes billed.

For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

Key Coverage Criteria

Coverage for ophthalmic angiography (fluorescein and indocyanine green) is determined by the Local Coverage Determination L34426 and applies when that LCD's clinical criteria are met.
Vitamin D assay testing is covered when the medical record documents medical necessity for the test, including the clinical reason for testing and any planned repeat testing and frequency.
Measure 25-hydroxyvitamin D (25-OH) for patients with chronic kidney disease stage III or greater.
Measure 25-OH for patients with cirrhosis.
Measure 25-OH for patients with hypocalcemia.
Measure 25-OH for patients with hypercalcemia.

6 Active Policies

NGS-J6-L37535, Vitamin D Assay Testing

A57736, Billing and Coding: Vitamin D Assay Testing

NGS-JK-L37535, Vitamin D Assay Testing

A56612, Billing and Coding: CT of the Head

A56774, Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green)

A57718, Billing and Coding: Vitamin D Assay Testing

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E89.823, Postprocedural seroma of an endocrine system organ or structure following other procedure