Does K71.7 require prior authorization?

No, K71.7 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K71.7`, Toxic liver disease with fibrosis and cirrhosis of liver

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
This article provides billing, coding, and guideline information that complements Local Coverage Determination (LCD) L34544; consult LCD L34544 for clinical eligibility, coverage criteria, and required documentation for hospice services for liver disease.
All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete patient name and dates of service.

Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
No explicit covered indications are stated in this document. The text describes investigational/experimental uses of stem cell and cell-based therapies in multiple clinical scenarios, including:
Ischemic heart disease / acute myocardial infarction (AMI) — investigations of intracoronary or intramyocardial delivery of bone marrow mononuclear cells (BMCs/BM-MNC), mesenchymal stem cells (MSCs), cardiosphere-derived cells (CDCs), autologous skeletal myoblasts (ASM), and allogeneic MSCs.
Chronic ischemic heart disease / heart failure (including ischemic cardiomyopathy, advanced heart failure, reduced LVEF) — trials of transendocardial, intracoronary, and intramyocardial delivery of various cell types (BMC, MSC, cardiopoietic cells, CDCs, skeletal myoblasts).
Peripheral arterial disease (PAD) and critical limb ischemia (CLI) — intra-arterial or intramuscular implantation/infusion of autologous bone marrow mononuclear cells (BMMNCs / mBMCs) or peripheral blood mononuclear cells.
Dilated cardiomyopathy (DCM) — intracoronary infusion of BMMCs or BMSCs evaluated in small randomized studies.

NOVITAS-JH-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

NOVITAS-JL-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

A57414, Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

AETNA-CPB-0599, Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation

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