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ICD-10-CM T63.463D, Toxic effect of venom of wasps, assault, subsequent encounter | No Prior Auth

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`T63.463D`, Toxic effect of venom of wasps, assault, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Maintain all documentation in the patient's medical record and make it available to the contractor upon request.
Every page of the medical record must be legible and include patient identification information (e.g., full name, dates of service).
The medical record 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 selected ICD-10-CM code(s) used for billing.

Submitted CPT/HCPCS codes must accurately describe the service performed.

Document therapeutic expectations, antigen levels, time frame for administration, and any adjustments due to local/systemic reactions or missed doses.

Key Coverage Criteria

Allergen immunotherapy is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L36240.
Allergy testing is covered when the medical record documents a history indicating the possible presence of allergy and the clinician selected a minimal number of tests/antigens based on patient-specific history and physician examination.
Allergy testing is covered when the medical record documents the test(s) used, the interpretation(s), and objective measurement of reaction size (wheal and erythema in mm) or a standardized in vivo grading system.
RAST type tests are covered when medically necessary and supported by the related Local Coverage Determination (LCD) and current medical literature or standards of practice.
An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).

16 Active Policies

NGS-J6-L33591, RAST Type Tests

J6

A56844, Billing and Coding: RAST Type Tests

J6

A57531, Billing and Coding: Allergy Testing

J9

FIRST_COAST-L37800, Allergen Immunotherapy

J9

FIRST_COAST-L33261, Allergy Testing

J9

A57678, Billing and Coding: Allergen Immunotherapy

J9

NOVITAS-JH-L36240, Allergen Immunotherapy

JH

NOVITAS-JH-L36241, Allergy Testing

JH

NGS-JK-L33591, RAST Type Tests

JK

A56538, Billing and Coding: Allergen Immunotherapy

JL

NOVITAS-JL-L36241, Allergy Testing

JL

NOVITAS-JL-L36240, Allergen Immunotherapy

JL

A56558, Billing and Coding: Allergy Testing

JL

A57326, Billing and Coding: Electrocardiograms

A56612, Billing and Coding: CT of the Head

A56559, Billing and Coding: Allergy Skin Testing

Related Codes

T63.422S(16 policies)T63.424D(16 policies)T63.421S(16 policies)T63.422D(16 policies)T63.423D(16 policies)T63.423S(16 policies)T63.421D(16 policies)T63.424S(16 policies)

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