Does I97.621 require prior authorization?

No, I97.621 does not require prior authorization (high confidence). Covered without prior authorization.

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`I97.621`, Postprocedural hematoma of a circulatory system organ or structure following other procedure

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.

Key Coverage Criteria

Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).

15 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

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

A57594, Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

WPS-J5-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

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

WPS-J8-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

WPS-J8-L35761, Non-Invasive Peripheral Arterial Vascular Studies

A57056, Billing and Coding: Aortography and Peripheral Angiography

FIRST_COAST-L36767, Aortography and peripheral angiography

A57064, Billing and Coding: Duplex Scan of Lower Extremity Arteries

A55336, Billing and Coding: Retroperitoneal Ultrasound

A57326, Billing and Coding: Electrocardiograms

A56697, Billing and Coding: Non-Invasive Vascular Studies

A56421, Billing and Coding: CT of the Abdomen and Pelvis

`I97.621`, Postprocedural hematoma of a circulatory system organ or structure following other procedure

Prior Authorization

Documentation Required

Key Coverage Criteria

15 Active Policies

Related Codes

Have a follow-up question?

I97.621, Postprocedural hematoma of a circulatory system organ or structure following other procedure

Prior Authorization

Documentation Required

Key Coverage Criteria

15 Active Policies

Related Codes

Have a follow-up question?

`I97.621`, Postprocedural hematoma of a circulatory system organ or structure following other procedure