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ICD-10-CM R93.9, Diagnostic imaging inconclusive due to excess body fat of patient | No Prior Auth

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`R93.9`, Diagnostic imaging inconclusive due to excess body fat of patient

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
Refills based upon documentation in cycle sheets.
Benefit plan documentation: because "Some plans exclude infertility services for ovarian failure; please check benefit plan descriptions," documentation of plan-specific coverage determinations may be required.
Semen analysis documentation: severe semen quantity or quality deficits require documentation on 2 separate occasions at least 2 weeks apart.

Key Coverage Criteria

N98.1: Hyperstimulation of ovaries
N99.83: Residual ovary syndrome
Benign neoplasm and neoplasm of uncertain behavior of pituitary gland and craniopharyngeal duct (D35.2 - D35.3; D44.3 - D44.4)
Neoplasm of uncertain behavior of female genital organs (D39.0 - D39.2)
Neoplasm of uncertain behavior of other and unspecified male genital organs (D40.8 - D40.9)
Iodine-deficiency related thyroid disorders and allied conditions (E01.8), subclinical iodine-deficiency hypothyroidism (E02), other hypothyroidism (E03.0 - E03.8)

3 Active Policies

ANTHEM-CG-LAB-20, Thyroid Testing

AETNA-CPB-0327, Infertility

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

Related Codes

C96.9(3 policies)C00.0(3 policies)D27.0(3 policies)C69.92(2 policies)B20(2 policies)C81.00(2 policies)A15.0(2 policies)A19.9(2 policies)

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For use of gonadotropin therapy in males (hypogonadotropic hypogonadism), documentation of normalization of serum testosterone levels is required prior to administration of recombinant follitropin for induction of spermatogenesis (policy text: "after normal serum testosterone levels are reached").

Documentation of prior responses to gonadotropin stimulation should be used to individualize initial dosing in subsequent cycles (policy text: initial dose in subsequent cycles is individualized based on prior response).