Does I25.3 require prior authorization?

No, I25.3 does not require prior authorization (high confidence). Covered without prior authorization.

`I25.3`, Aneurysm of heart

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims for PCI must include the appropriate coronary vessel modifiers: LD (left anterior descending), LC (left circumflex), RC (right coronary), LM (left main), or RI (ramus intermedius).
To separately report diagnostic coronary angiography at the time of intervention when no prior catheter-based angiography exists, document that a full diagnostic study was performed and that the decision to intervene was based on that diagnostic angiography.
To separately report diagnostic angiography despite a prior study, document medical-record evidence that the patient's condition changed, visualization was inadequate, or a clinical change during the procedure required new evaluation outside the target area.
When requesting additional reimbursement for an 'unusual procedural service' after placement of four or more stents in a single vessel, document the number of stents and provide justification supporting additional reimbursement equivalent to an additional treated vessel.

If a single lesion extends from one target vessel into another but can be revascularized with a single bridging intervention, report it with a single code (CPT 92928).
CPT codes 92920-92944 describe percutaneous revascularization (PCI) for occlusive disease of coronary vessels, including major coronary arteries, coronary artery branches, and coronary artery bypass grafts.
PCI codes include angioplasty (balloon, cutting, wired, cryoplasty), atherectomy (directional, rotational, laser), and stenting (balloon-expandable, self-expanding, bare metal, drug-eluting, covered).
Diagnostic coronary angiography (CPT 93454-93461) and injection procedures (CPT 93563-93564) may be separately reportable at the time of an interventional procedure when no prior catheter-based coronary angiography study is available, a full diagnostic study is performed, and the decision to intervene is based on that diagnostic angiography.
Diagnostic coronary angiography may also be separately reportable at the time of an interventional procedure if a prior study exists but documentation shows the patient's condition changed, there is inadequate visualization, or a clinical change during the procedure requires new evaluation outside the target area of intervention.
Diagnostic coronary angiography performed in a separate session from an interventional PCI procedure is separately reportable.

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

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