Does T82.817A require prior authorization?

No, T82.817A does not require prior authorization (high confidence). Covered without prior authorization.

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`T82.817A`, Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims for PCI must include the appropriate coronary vessel modifiers: LD (left anterior descending), LC (left circumflex), RC (right coronary), LM (left main), or RI (ramus intermedius).
To separately report diagnostic coronary angiography at the time of intervention when no prior catheter-based angiography exists, document that a full diagnostic study was performed and that the decision to intervene was based on that diagnostic angiography.
To separately report diagnostic angiography despite a prior study, document medical-record evidence that the patient's condition changed, visualization was inadequate, or a clinical change during the procedure required new evaluation outside the target area.

Key Coverage Criteria

If a single lesion extends from one target vessel into another but can be revascularized with a single bridging intervention, report it with a single code (CPT 92928).
CPT codes 92920-92944 describe percutaneous revascularization (PCI) for occlusive disease of coronary vessels, including major coronary arteries, coronary artery branches, and coronary artery bypass grafts.
PCI codes include angioplasty (balloon, cutting, wired, cryoplasty), atherectomy (directional, rotational, laser), and stenting (balloon-expandable, self-expanding, bare metal, drug-eluting, covered).
Diagnostic coronary angiography (CPT 93454-93461) and injection procedures (CPT 93563-93564) may be separately reportable at the time of an interventional procedure when no prior catheter-based coronary angiography study is available, a full diagnostic study is performed, and the decision to intervene is based on that diagnostic angiography.
Diagnostic coronary angiography may also be separately reportable at the time of an interventional procedure if a prior study exists but documentation shows the patient's condition changed, there is inadequate visualization, or a clinical change during the procedure requires new evaluation outside the target area of intervention.
Diagnostic coronary angiography performed in a separate session from an interventional PCI procedure is separately reportable.

20 Active Policies

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L34087, Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based

J15

CGS-J18-L34337, Transesophageal Echocardiography (TEE)

J18

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L34087, Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based

J18

WPS-J5-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

WPS-J5-L34761, Percutaneous Coronary Interventions

WPS-J5-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

A57591, Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

A57594, Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

A57479, Billing and Coding: Percutaneous Coronary Interventions

NGS-J6-L39995, Pharmacogenomic Testing

NGS-J6-L33623, Percutaneous Coronary Intervention

NGS-J6-L33579, Transesophageal Echocardiography (TEE)

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

`T82.817A`, Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T82.817A, Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T82.817A`, Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter