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ICD-10-CM T42.5X3A, Poisoning by mixed antiepileptics, assault, initial encounter | No Prior Auth

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`T42.5X3A`, Poisoning by mixed antiepileptics, assault, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.

When E/M services are reported with allergy testing, medical documentation of the separately identifiable E/M service must be present in the medical record and modifier -25 must be used.

Part B providers must indicate the actual number of tests (one unit per antigen/test) in Box 24G of Form CMS-1500 (paper) or in the service field on EMC claims; the number of tests must also be shown on the claim for MPFSDB payment.

Medical records must document history (including immunologic history), physical exam, antigens chosen, test performance, and interpretation; counseling and prescriptions should be documented and reported as a visit.

Key Coverage Criteria

Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.
Standard skin testing is the preferred method when allergy testing is necessary.
When a percutaneous or intracutaneous single test (CPT 95004 or 95024) and sequential/incremental tests (CPT 95017, 95018, 95027) are performed the same day, both code types may be reported only if they are for different allergens or for different dilutions of the same allergen.
CPT code 95060 is payable in office, outpatient hospital (on-campus/off-campus), inpatient hospital, and emergency room settings.
Delayed hypersensitivity skin testing is covered for anergy testing, diagnosing intracellular pathogen infections, and evaluating sensitivity to contact allergens when testing is limited to allergens associated with contact reactions.

7 Active Policies

A57473, Billing and Coding: Allergy Testing

J5

WPS-J5-L36402, Allergy Testing

J5

WPS-J8-L36402, Allergy Testing

J8

NOVITAS-JH-L35434, Oximetry Services

JH

A57205, Billing and Coding: Oximetry Services

JL

NOVITAS-JL-L35434, Oximetry Services

JL

A56612, Billing and Coding: CT of the Head

Related Codes

T40.0X4A(7 policies)T40.1X3A(7 policies)T40.0X2A(7 policies)T40.0X3A(7 policies)T40.1X1A(7 policies)T40.1X2A(7 policies)T40.0X1A(7 policies)T40.1X4A(7 policies)

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