Does R93.421 require prior authorization?

No, R93.421 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`R93.421`, Abnormal radiologic findings on diagnostic imaging of right kidney

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.

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.

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.

This billing and coding guideline complements Local Coverage Determination (LCD) L34424 for Magnetic Resonance Angiography; refer to LCD L34424 for clinical indications, medical necessity criteria, and specific coding rules.

Key Coverage Criteria

Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
Bill HCPCS code G0278 for femoral or iliac angiography performed at the time of coronary angiography.
Aortography and peripheral angiography are covered when reasonable and necessary per Local Coverage Determination L36767 and when documentation supports the selected ICD-10-CM diagnosis and medical necessity.
Selective renal angiography is medically necessary for renovascular occlusive disease including renal artery stenosis, severe or difficult-to-control renal hypertension, resistant hypertension, or progressive renal insufficiency.
Selective renal angiography is medically necessary for renal aneurysm, renovascular trauma, primary vascular abnormalities (aneurysms, vascular malformations, vasculitis), renal neoplasm, hematuria of unknown cause, and other intrinsic renal defects prior to intervention.

6 Active Policies

FIRST_COAST-L36767, Aortography and peripheral angiography

A57056, Billing and Coding: Aortography and Peripheral Angiography

A55336, Billing and Coding: Retroperitoneal Ultrasound

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

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A56775, Billing and Coding: Magnetic Resonance Angiography

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R93.421, Abnormal radiologic findings on diagnostic imaging of right kidney