Does R40.2444 require prior authorization?

No, R40.2444 does not require prior authorization (high confidence). Covered without prior authorization.

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`R40.2444`, Other coma, without documented Glasgow coma scale score, or with partial score reported, 24 hours or more after hospital admission

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Medical necessity for each test must be documented in the patient's medical record as required by LCD L35006.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.

Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.

The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

Claims must include documentation supporting medical necessity per LCD L34433, such as relevant clinical history, indication for testing, the somatosensory test report, and the interpreting clinician's signature.

Key Coverage Criteria

Urine drug testing (UDT) and drugs-of-abuse testing are covered when reasonable and necessary per LCD L35006 and ordered on an individual patient basis by the treating clinician with medical-record documentation of medical necessity.
Patients with a documented diagnosis consistent with substance use disorder (SUD) may qualify for an exception to the standard presumptive UDT annual limits.
Coverage indications for somatosensory testing follow the Local Coverage Determination L34433; this article provides billing and coding guidance only.
ICD-10 G92.00 - G92.9 Toxic encephalopathy (covered if selection criteria are met).
Rehabilitation for visuo-spatial deficits (generally entails 20 1-hour sessions delivered over the course of 4 weeks).
Rehabilitation for language and communication deficits (persons usually receive 8 hours of weekly therapy, beginning at 4 weeks post-onset and continuing up to 48 weeks post-onset).

7 Active Policies

NOVITAS-JH-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

A56645, Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

NOVITAS-JL-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

A56769, Billing and Coding: Somatosensory Testing

AETNA-CPB-0214, Cognitive Rehabilitation

ANTHEM-CG-LAB-24, Outpatient Urine Culture

A56612, Billing and Coding: CT of the Head

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R40.2444, Other coma, without documented Glasgow coma scale score, or with partial score reported, 24 hours or more after hospital admission