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ICD-10-CM R62.51, Failure to thrive (child) | No Prior Auth

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`R62.51`, Failure to thrive (child)

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must comply with ICD-10-CM Coding Guidelines and the Local Coverage Determination (LCD) for Hospice The Adult Failure To Thrive Syndrome (L34558) when selecting and reporting the principal hospice diagnosis.
Prior exome or genome sequencing report(s) demonstrating prior testing results.
Documentation of the plan for returning secondary/incidental results prior to testing.
Clinical documentation that the infant is acutely ill and currently admitted to NICU, PICU, or CVICU.

Key Coverage Criteria

Use only ICD-10-CM diagnosis codes that are valid to report as a principal diagnosis under ICD-10-CM Coding Guidelines when submitting a hospice principal diagnosis.
Vitamin B12 blood testing is consideredmedically necessaryforanyof the following indications:
Alcohol dependence;or
Autoimmune condition such as intrinsic factor deficiency, thyroid disease, or pernicious anemia;or
Blood dyscrasia (for example cytopenia, leukopenia, or thrombocytopenia);or
Diabetes mellitus with neurologic symptoms;or

3 Active Policies

ANTHEM-CG-LAB-19, Laboratory Evaluation of Vitamin B12

AMBETTER-CG-Exome-Genome-Gntc-DO-2025.1, Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders

A56679, Billing and Coding: Hospice The Adult Failure To Thrive Syndrome

Related Codes

0209U(1 policies)0212U(1 policies)0213U(1 policies)0214U(1 policies)0215U(1 policies)0265U(1 policies)0425U(1 policies)0094U(1 policies)

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Document parental availability and plan if only one parent is tested initially and the second parent may be tested later.

Document pre-test counseling and informed consent addressing possibility of incidental/secondary findings and whether the patient opts to receive ACMG-recommended secondary findings (59-gene actionable list).