Skip to main content

ICD-10-CM I63.342, Cerebral infarction due to thrombosis of left cerebellar artery | No Prior Auth

Backwork Sign up free

Ask Backwork/I63.342

`I63.342`, Cerebral infarction due to thrombosis of left cerebellar artery

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

When the service is performed in a hospital inpatient or outpatient setting, use modifier -26 to indicate the professional component.
Billing and coding must adhere to the coverage indications, limitations, and medical necessity criteria described in the associated LCD L34615 Visual Fields; follow that LCD for clinical eligibility and documentation requirements.
Prior to billing Medicare, verify applicable code combinations and correct coding guidelines with the CCI (Correct Coding Initiative).

A referral must be on record for each non-invasive vascular study performed; a referral for one type of study does not serve as referral for all other tests.

Medical record documentation must support medical necessity of the study, including signs/symptoms, physical findings, ABI/chart copies, abnormal physiologic study results, and rationale when multiple or simultaneous studies are performed.

Credentialing and accreditation documentation must be maintained and available: physicians must demonstrate competency; technologists should hold credentials (e.g., RPVI, RVT, RCVT, RVS, ARRT in vascular sonography); facilities should hold accreditation (e.g., ACR Vascular Ultrasound Program, ICAVL); transcutaneous oxygen measurements may be performed by NBDHMT-certified individuals (CHT or CHRN).

Key Coverage Criteria

Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
Non-invasive vascular studies are medically necessary when the ordering physician reasonably expects the test outcome will impact clinical management and there are significant signs or symptoms of arterial or venous disease, the information is necessary for medical/surgical management, and the test is not redundant of other diagnostics.
Cerebrovascular arterial studies (duplex or Doppler with spectral analysis) are indicated for patients with one or more of: cervical bruit, amaurosis fugax, focal cerebral/ocular TIA (e.g., unilateral weakness, sensory loss, slurred speech), syncope suggestive of vertebrobasilar/bilateral carotid disease, recent neurologic/cerebrovascular event, pre-major cardiac/vascular surgery with bruit or prior event, post-carotid endarterectomy (outside global period), pulsatile neck mass, blunt/penetratin [...]

20 Active Policies

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J18-L34337, Transesophageal Echocardiography (TEE)

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J18

CGS-J18-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J18

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L34394, Visual Fields Testing

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

J5

WPS-J5-L36523, MolDX: Biomarkers in Cardiovascular Risk Assessment

J5

WPS-J5-L34615, Visual Fields

J5

WPS-J5-L34623, Intraoperative Neurophysiological Testing

J5

WPS-J5-L34624, Somatosensory Testing

J5

A57483, Billing and Coding: Visual Fields

J5

Related Codes

I63.341(20 policies)I63.332(20 policies)I63.321(20 policies)I63.312(20 policies)I63.322(20 policies)I63.331(20 policies)I63.311(20 policies)I63.411(20 policies)

Have a follow-up question?

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

Ask Backwork about I63.342 Sign up free