D09.9 — Carcinoma in situ, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is 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 must be legible and include patient identifiers (complete name, dates of service).
- 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) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Documentation should state whether the block was performed for diagnostic or therapeutic purposes.
Key Coverage Criteria
- Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
- Peripheral nerve block is reasonable when the patient's pain appears due to a classic mononeuritis but neuro-diagnostic studies fail to provide a structural explanation.
- Peripheral nerve blocks are reasonable for peripheral nerve injuries/entrapment or extremity trauma that lead to complex regional pain syndrome (CRPS).
- Selective peripheral nerve blockade is reasonable diagnostically when the clinical picture is unclear to isolate the specific pain source.
- Occipital nerve block is reasonable to confirm suspected occipital neuralgia (used diagnostically and therapeutically).
- Suprascapular nerve block is reasonable to confirm suspected suprascapular nerve entrapment producing shoulder pain and weakness.
17 Active Policies
CIGNA-CPG030 — Low-Level Laser and High-Power Laser Therapy - (CPG030)
AETNA-CPB-0022 — Calcitriol, Etelcalcetide, and Paricalcitol Injections
AETNA-CPB-0115 — Varicella and Herpes Zoster Vaccines
AETNA-CPB-0194 — Spinal Cord Stimulation
AETNA-CPB-0270 — Proton Beam, Neutron Beam, and Carbon Ion Radiotherapy
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.