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ICD-10-CM R10.83, Colic | No Prior Auth

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`R10.83`, Colic

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.
All services ordered or rendered must be signed and dated in the medical record, including a signed and dated office visit record or operative report.
An Advance Beneficiary Notice (ABN), Form CMS-R-131, should be signed by the beneficiary when applicable to indicate acceptance of financial responsibility.
The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.

Key Coverage Criteria

Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
Plantar Fasciitis
Peptic Ulcer
Post-Operative Ileus
Post-Prandial Distress Syndrome

9 Active Policies

CGS-J15-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15

CGS-J18-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J18

AETNA-CPB-0107, Chiropractic Services

AETNA-CPB-0135, Acupuncture and Dry Needling

AETNA-CPB-0177, Helicobacter Pylori Infection Testing

Related Codes

K59.00(6 policies)K91.89(6 policies)K58.0(6 policies)K58.9(6 policies)K59.09(6 policies)K63.1(6 policies)K56.0(6 policies)A18.39(5 policies)

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The medical record must document relevant medical history and the results of pertinent tests or procedures.

For diagnostic tests, report the test result if known; if the result is not known at time of billing, report the symptoms that prompted the performance of the test.

AETNA-CPB-0523, Car-Ride Simulators for Infantile Colic

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

A56456, Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

A56632, Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy