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ICD-10-CM T71.21XA, Asphyxiation due to cave-in or falling earth, initial encounter | No Prior Auth

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`T71.21XA`, Asphyxiation due to cave-in or falling earth, 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.

An interpretation and report must be a complete, separately identifiable written report addressing findings, relevant clinical issues, comparative data (when available), and must be included in the medical record.

The patient's medical record must be legible and clearly document the reasonableness and necessity of the ECG and show that the service was necessary for at least one covered condition in the policy.

A laboratory or portable X‑ray supplier that furnishes an ECG must retain the referring physician’s written order and the identity of the employee who took the tracing.

Key Coverage Criteria

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).
Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.
A second professional component (PC) interpretation may be paid when a second physician’s substantially greater expertise is necessary and reasonable to clarify a questionable or confusing ECG finding and contributes substantially to diagnosis or treatment.
Oximetry is medically necessary for patients exhibiting acute respiratory dysfunction signs or symptoms (tachypnea, dyspnea, cyanosis, respiratory distress, confusion, or hypoxia).

5 Active Policies

NOVITAS-JH-L35434, Oximetry Services

JH

NOVITAS-JL-L35434, Oximetry Services

JL

A57205, Billing and Coding: Oximetry Services

JL

A56612, Billing and Coding: CT of the Head

A57326, Billing and Coding: Electrocardiograms

Related Codes

D86.3(5 policies)D86.83(5 policies)D86.1(5 policies)D86.2(5 policies)D86.81(5 policies)D86.82(5 policies)D86.0(5 policies)D86.84(5 policies)

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