Does I78.9 require prior authorization?

No, I78.9 does not require prior authorization (high confidence). No active policy covers this code.

`I78.9`, Disease of capillaries, unspecified

ICD-10-CM

No Prior Auth Required

No active policy covers this code (high confidence)

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.

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.
Coverage requires documented failure of an adequate trial of conservative treatment prior to interventional treatment.
Treatment is covered for patients with a documented diagnosis of symptomatic varicose veins of the lower extremity.

A52870, Billing and Coding: Treatment of Varicose Veins of the Lower Extremity

A57305, Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of

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