Does S36.893A require prior authorization?

No, S36.893A does not require prior authorization (high confidence). Covered without prior authorization.

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`S36.893A`, Laceration of other intra-abdominal organs, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

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.

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).
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.

5 Active Policies

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

A55336, Billing and Coding: Retroperitoneal Ultrasound

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

`S36.893A`, Laceration of other intra-abdominal organs, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

S36.893A, Laceration of other intra-abdominal organs, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`S36.893A`, Laceration of other intra-abdominal organs, initial encounter