Does S36.593A require prior authorization?

No, S36.593A does not require prior authorization (high confidence). Covered without prior authorization.

`S36.593A`, Other injury of sigmoid colon, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
When performed for surveillance of colonic neoplasia, report the appropriate CPT/HCPCS procedure code and the appropriate primary ICD-10-CM code plus one of the following secondary diagnosis codes: Z85.038, Z85.048, Z86.0100, Z86.0101, Z86.0102, or Z86.0109.
For high-risk post-surgical follow-up at 1 year (with continued 24-month screening eligibility), report HCPCS code G0105 as the appropriate screening/high-risk colonoscopy code.
Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.

Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
Oximetry is medically necessary for patients exhibiting acute respiratory dysfunction signs or symptoms (tachypnea, dyspnea, cyanosis, respiratory distress, confusion, or hypoxia).
Oximetry is medically necessary for patients with chronic lung disease, severe cardiopulmonary disease, or neuromuscular disease affecting respiratory muscles when used for initial evaluation to determine the severity of respiratory impairment.
Oximetry is medically necessary for patients with chronic lung disease, severe cardiopulmonary disease, or neuromuscular respiratory muscle disease to evaluate an acute change in condition.
Oximetry is medically necessary to evaluate exercise tolerance in a patient with respiratory disease.

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

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

A56632, Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

Ask Backwork about documentation requirements, denial risks, or coverage in your state.