Does I25.810 require prior authorization?

No, I25.810 does not require prior authorization (high confidence). Covered without prior authorization.

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`I25.810`, Atherosclerosis of coronary artery bypass graft(s) without angina pectoris

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

Key Coverage Criteria

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.

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L33947, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L33947, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

WPS-J5-L35490, Category III Codes

WPS-J5-L39913, Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

WPS-J5-L34761, Percutaneous Coronary Interventions

WPS-J5-L35121, Coronary Computed Tomography Angiography (CCTA)

A57479, Billing and Coding: Percutaneous Coronary Interventions

A57552, Billing and Coding: Coronary Computed Tomography Angiography (CCTA)

WPS-J5-L35761, Non-Invasive Peripheral Arterial Vascular Studies

A57593, Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies

NGS-J6-L33627, Non-Invasive Vascular Studies

NGS-J6-L33623, Percutaneous Coronary Intervention

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33560, Cardiovascular Nuclear Medicine

`I25.810`, Atherosclerosis of coronary artery bypass graft(s) without angina pectoris

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I25.810, Atherosclerosis of coronary artery bypass graft(s) without angina pectoris

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I25.810`, Atherosclerosis of coronary artery bypass graft(s) without angina pectoris