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ICD-10-CM P04.11, Newborn affected by maternal antineoplastic chemotherapy | No Prior Auth

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`P04.11`, Newborn affected by maternal antineoplastic chemotherapy

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Note on Documentation Requirements: Physicians are reminded to bill the findings of the diagnostic test as the primary indication rather than the referring physician’s diagnosis, as indicated by Medicare’s Diagnostic Imaging Billing guidelines.
These guidelines are available in the Medicare Claims Processing Manual, Chapter 13 - Radiology Services and Other Diagnostic Procedures (revised November 2016).
Policy table headings and entries indicate that CPT and ICD-10 codes are "covered if selection criteria are met" — documentation should support that selection criteria/medical necessity are met (implied requirement).

Key Coverage Criteria

During excision of left atrial mass;
Evaluation of angina;
Evaluation of aortic diseases;
Evaluation of aortocoronary bypass grafts;
Evaluation of atrial fibrillation/flutter;
ICD-10 I05.0 - I05.9: Diseases of mitral valve

1 Active Policy

AETNA-CPB-0008, Color-Flow Doppler Echocardiography and Myocardial Strain Imaging

Related Codes

33617(1 policies)75561(1 policies)76825(1 policies)76826(1 policies)76827(1 policies)76828(1 policies)93303(1 policies)33615(1 policies)

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