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ICD-10-CM T86.8499, Unspecified complication of corneal transplant, unspecified eye | No Prior Auth

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`T86.8499`, Unspecified complication of corneal transplant, unspecified eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must report the appropriate CPT code for the flow cytometry service, include 1 unit of service (UOS), and list the appropriate ICD-10-CM diagnosis code.
Medical necessity documentation per LCD L34513 is required when coverage criteria are not fully met in this billing guideline (for example, when >24 markers are requested).

Key Coverage Criteria

Coverage and medical necessity determinations for flow cytometry are governed by Local Coverage Determination L34513.
Flow cytometry may be used to analyze cellular components of body fluids and lymphoreticular tissues, including peripheral blood, cerebrospinal fluid (CSF), bone marrow, lymph nodes, tonsil, spleen, and fine needle aspirate material.
Peripheral blood or fine needle aspirate specimens may be used to avoid more invasive diagnostic procedures when clinically appropriate.

Keratoprosthesis using the Dohlman Doane Boston KPro (“Boston KPro”) device is consideredmedically necessaryfor the treatment of corneal blindness wheneitherof the following criteria are met (AorB):

For individuals with prior corneal transplant:The cornea is severely opaque and vascularized;andThere is documentation of at least one prior failed corneal transplant procedure;or

The cornea is severely opaque and vascularized;and

2 Active Policies

ANTHEM-CG-SURG-94, Keratoprosthesis

A55717, Billing and Coding: Lab: Flow Cytometry

Related Codes

T86.8401(2 policies)86355(1 policies)86361(1 policies)86357(1 policies)86359(1 policies)86360(1 policies)86356(1 policies)65770(1 policies)

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