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ICD-10-CM K62.9, Disease of anus and rectum, unspecified | No Prior Auth

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`K62.9`, Disease of anus and rectum, unspecified

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.

Key Coverage Criteria

To guide application of cryotherapy or brachytherapy for treatment of prostate cancer;or
To evaluate and stage prostate cancer or rectal cancer;or
Prostate-specific antigen (PSA) level greater than 3.0 ng/ml;or
Transrectal ultrasonography (TRUS) is consideredmedically necessaryforanyof the following indications:
To guide prostate biopsy when prostate cancer is suspected based onanyof the following:Abnormal digital rectal examination (DRE);orProstate-specific antigen (PSA) level greater than 3.0 ng/ml;orMedical history;or
Abnormal digital rectal examination (DRE);or

2 Active Policies

ANTHEM-CG-RAD-28, Transrectal Ultrasonography

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

Related Codes

C78.5(2 policies)D07.5(2 policies)C21.8(2 policies)C76.3(2 policies)C79.82(2 policies)D01.1(2 policies)C21.0(2 policies)D37.5(2 policies)

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