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ICD-10-CM R76.89, Other specified abnormal immunological findings in serum | No Prior Auth

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`R76.89`, Other specified abnormal immunological findings in serum

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must include the appropriate CPT code (88120 or 88121), 1 unit of service, and an appropriate ICD-10 diagnosis code for the clinical indication.
Laboratories reporting only the technical component should append the TC modifier to CPT 88120 or 88121.
Billing entities must be CLIA certified to submit UroVysion claims and should maintain CLIA certification documentation in the medical record/claims file.
To bill a professional component, the physician must personally read, quantitate, and interpret the probe-stained cells/tissues and document that interpretive work in the medical record.

Key Coverage Criteria

FISH bladder tumor marker testing using a validated assay (e.g., UroVysion) is covered when performed on urine specimens from persons with hematuria suspected of having bladder cancer to aid initial diagnosis.
FISH bladder tumor marker testing using a validated assay (e.g., UroVysion) is covered for monitoring tumor recurrence in patients previously diagnosed with bladder cancer using urine specimens.

2 Active Policies

A55028, Billing and Coding: Lab: Bladder/Urothelial Tumor Markers

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

Related Codes

C67.3(2 policies)C67.6(2 policies)C67.1(2 policies)C67.2(2 policies)C67.4(2 policies)C67.5(2 policies)C67.0(2 policies)C67.7(2 policies)

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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.