Does K40.01 require prior authorization?

No, K40.01 does not require prior authorization (high confidence). Covered without prior authorization.

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`K40.01`, Bilateral inguinal hernia, with obstruction, without gangrene, 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.
Extremity ultrasound is indicated to detect and evaluate cysts, abscesses, tumors (including assessment of tumor size), and joint or soft-tissue effusions in the arms and legs.
Extremity ultrasound is indicated to distinguish solid masses from fluid-filled cysts and evaluate soft-tissue masses, ganglion cysts, intermetatarsal neuromas, and stress fractures of the metatarsals.
Extremity ultrasound is indicated to evaluate tendons (including tears, tendonitis, tenosynovitis), joints, plantar fascia, and ligaments in the arms and legs.
Extremity ultrasound is indicated to aid in the diagnosis and to assist surgical removal/localization of foreign bodies in the extremities.

4 Active Policies

NGS-J6-L33619, Nonvascular Extremity Ultrasound

A56787, Billing and Coding: Nonvascular Extremity Ultrasound

NGS-JK-L33619, Nonvascular Extremity Ultrasound

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

`K40.01`, Bilateral inguinal hernia, with obstruction, without gangrene, recurrent

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

K40.01, Bilateral inguinal hernia, with obstruction, without gangrene, recurrent

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`K40.01`, Bilateral inguinal hernia, with obstruction, without gangrene, recurrent