Does K40.00 require prior authorization?

No, K40.00 does not require prior authorization (high confidence). Covered without prior authorization.

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`K40.00`, Bilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM codes that reflect the patient's condition and the reason for the service; claims without ICD-10-CM codes will be returned.

A permanent record of the ultrasound and its interpretation must be kept in the patient's record, including images labeled with exam date, patient identification, and image orientation; documentation of variations from normal with measurements; and a formal interpretation.

Key Coverage Criteria

Nonvascular extremity ultrasound is covered when medical necessity is documented in the patient's record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Diagnostic nonvascular extremity ultrasound is covered when the claim includes an ICD-10-CM diagnosis code that best describes the patient's condition and the test result or the symptoms prompting the test are documented.
Postoperative analgesia after open abdominal surgery (including colorectal and aortic surgery) using continuous wound instillation/infusion
CPT range 43842 - 43848 — Gastric restrictive procedure (listed as 'Other CPT codes related to the CPB')
Postoperative analgesia using continuous wound infusion/local anesthetic infusion pumps after shoulder surgery (including subacromial decompression and rotator cuff repair)
Postoperative analgesia using continuous wound infusion/local anesthetic infusion pumps after arthroscopic shoulder surgery

6 Active Policies

NGS-J6-L33619, Nonvascular Extremity Ultrasound

A56787, Billing and Coding: Nonvascular Extremity Ultrasound

NGS-JK-L33619, Nonvascular Extremity Ultrasound

AETNA-CPB-0244, Skin and Soft Tissue Substitutes

AETNA-CPB-0607, Anesthetic and Antiemetic Infusion Pumps

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

`K40.00`, Bilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

K40.00, Bilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`K40.00`, Bilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent