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ICD-10-CM S19.84XD, Other specified injuries of thyroid gland, subsequent encounter | No Prior Auth

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`S19.84XD`, Other specified injuries of thyroid gland, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

The submitted medical record must support the use of the selected ICD-10-CM code(s).

The submitted CPT/HCPCS code must accurately describe the service performed.

The ordering/referring physician's medical record must clearly indicate the reason for the EGD and the EGD results must be included in the patient's medical record.

Key Coverage Criteria

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Therapeutic EGD is covered for removal of foreign bodies from the esophagus or stomach.
EGD is covered for persistent upper abdominal distress (e.g., gastroesophageal reflux disease) that continues despite an appropriate trial of symptomatic therapy.
EGD is covered for upper abdominal distress accompanied by a short history of concerning signs or symptoms such as weight loss, anorexia, vomiting, or NSAID/other gastric irritant intake.

3 Active Policies

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

J9

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

Related Codes

C15.8(3 policies)C16.2(3 policies)C15.4(3 policies)C15.5(3 policies)C16.0(3 policies)C16.1(3 policies)C15.3(3 policies)C16.3(3 policies)

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