Does K91.5 require prior authorization?

No, K91.5 does not require prior authorization (high confidence). Covered without prior authorization.

`K91.5`, Postcholecystectomy syndrome

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
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.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
Adjunctive imaging in suspected autoimmune pancreatitis (AIP) to evaluate main pancreatic duct narrowing, MPD integrity (secretin-MRCP may demonstrate duct-penetrating sign), and parenchymal features (but MRCP cannot fully replace ERCP in AIP diagnostic workup).
Imaging of biliary tree to help plan directed interventions (endoscopic or transhepatic) in complex biliary disease where MRCP may increase likelihood of success and decrease risk.
Preoperative evaluation of the common bile duct prior to laparoscopic cholecystectomy in persons with elevations of their transaminases or common bile duct dilatation on abdominal imaging (ultrasound or CT scan).
Non-invasive imaging to demonstrate biliary calculi and pancreatic ductal disease (general role of MRCP in biliary/pancreatic evaluation).

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

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

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

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