Does I78.8 require prior authorization?

No, I78.8 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`I78.8`, Other diseases of capillaries

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Claims submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code must best describe the patient's condition for the service performed.
The patient's medical record must contain documentation fully supporting medical necessity including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Medical record must document history and physical findings supporting a diagnosis of symptomatic varicose veins.
Medical record must document failure of an adequate trial of conservative treatment as described in the LCD.

Key Coverage Criteria

Interventional treatments are covered for symptomatic varicose veins of the lower extremity when the medical record documents history and physical findings supporting the diagnosis.
Coverage requires failure of an adequate trial of conservative treatment prior to interventional therapy as described in the LCD.
Coverage requires exclusion of other causes of limb edema, ulceration, and pain prior to treatment of varicose veins.
Coverage requires performance of appropriate diagnostic testing (e.g., duplex ultrasound) to confirm the presence and location of incompetent perforating veins when indicated.
Billing and coding guidance in this article applies when immune globulin use meets the reasonable and necessary coverage criteria established in LCD L35093.
Treatment (sclerotherapy, surgical ligation/stripping, ablation) of varicose veins of the lower extremities is appropriate when conservative measures (exercise, leg elevation, weight loss, graduated compression, avoidance of prolonged immobility) have been unsuccessful and symptoms persist.

18 Active Policies

WPS-J5-L34771, Immune Globulins

A56914, Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

A57554, Billing and Coding: Immune Globulins

WPS-J5-L34536, Treatment of Varicose Veins of the Lower Extremities

A59105

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I78.8, Other diseases of capillaries