G89.21 — Chronic pain due to trauma
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification (e.g., full name, dates of service), and be available to the contractor upon request.
- The medical record must identify the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
Key Coverage Criteria
- Regional or local nerve blocks performed as part of an operative procedure (e.g., adjunct to or sole means of regional/local anesthesia for the procedure) are not affected by this non-coverage policy and may be billed as anesthesia for the operative procedure.
- Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
- CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
- HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
- Trigger point injections (TPIs) reported with CPT 20552 (1–2 muscles) or CPT 20553 (3+ muscles) are covered when determined medically reasonable and necessary per the applicable Local Coverage Determination (LCD).
- Only services that meet the LCD reasonable and necessary requirements and frequency limitations are considered covered; billing of TPIs must follow CPT coding guidance in the AMA CPT manual.
20 Active Policies
L39713 — Trigger Point Injections
J05
A59553 — Billing and Coding: Trigger Point Injections
J05
L39662 — Trigger Point Injections (TPI)
J06
A59487 — Billing and Coding: Trigger Point Injections (TPI)
J06
Related Codes
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