Does R11.14 require prior authorization?

No, R11.14 does not require prior authorization (high confidence). Covered without prior authorization.

`R11.14`, Bilious vomiting

ICD-10-CM

No Prior Auth Required

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.
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 (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).
No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
Prevention of acute nausea or vomiting associated with initial and repeat courses of moderately and highly emetogenic cancer chemotherapy, including high-dose cisplatin (palonosetron (Aloxi) or fosaprepitant dimeglumine (Emend)).
O21.0 - O21.9 — Excessive vomiting in pregnancy (when clinical signs of dehydration are present or nausea and vomiting have persisted more than 3 weeks and criteria A, B, and C are met)

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57122, Billing and Coding: Parathormone (Parathyroid Hormone)

FIRST_COAST-L34018, Parathormone (Parathyroid Hormone)

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

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