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ICD-10-CM N30.40, Irradiation cystitis without hematuria | No Prior Auth

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`N30.40`, Irradiation cystitis without hematuria

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

Cyanide poisoning;or
Decompression sickness;or
Systemic hyperbaric oxygen pressurization is consideredmedically necessaryin the treatment of any of the following conditions when performed in accordance with Undersea and Hyperbaric Medical Society (UHMS) guidelines:
Acute peripheral arterial insufficiency;or
Acute thermal burns: deep second degree or third degree in nature;or
Acute traumatic ischemia;or

2 Active Policies

ANTHEM-CG-MED-73, Hyperbaric Oxygen Therapy (Systemic/Topical)

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

Related Codes

S31.839S(2 policies)K62.7(2 policies)N30.41(2 policies)S31.000S(2 policies)S38.1XXS(2 policies)T79.A9XS(2 policies)74176(1 policies)74170(1 policies)

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