G56.40 — Causalgia of unspecified upper limb
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
- Claims and coding must follow the Local Coverage Determination L37642 that this article complements; medical record documentation should support the billed service in accordance with LCD L37642.
- Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
- Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Key Coverage Criteria
- No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
- CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
- Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
- G71.21 | Nemaline myopathy
- G83.0 | Diplegia of upper limbs
- H44.19 | Other endophthalmitis
14 Active Policies
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
L35098 — Nerve Conduction Studies and Electromyography
J06
AETNA-CPB-0552 — Laser Neurolysis
A56607 — Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
A56731 — Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathy
Related Codes
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