G90.81 — Serotonin syndrome
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- For claims using CPT codes not listed in this article, submit supporting clinical and billing documentation for individual review.
- A claim for the prior routine EEG must have been submitted to Medicare with a date of service within 1 year of the ambulatory EEG date of service; documentation/proof of that prior claim must be available.
- When billing only the professional or the technical component, documentation must indicate which component was provided and support billing of that single component.
Key Coverage Criteria
- Ambulatory continuous EEG is covered only if a prior routine “resting” EEG was performed before the ambulatory EEG.
- Routine EEGs covered under this policy are those described by CPT codes 95812, 95813, 95816, 95819, or 95822.
- A routine EEG is defined as a recording of less than a 24-hour continuous duration.
- NC-stat testing (CPT 95905) is allowed when the beneficiary has a high pre-test or prior probability of Carpal Tunnel Syndrome (CTS), limited to one service per arm.
- Use CPT 95870 for sampling muscles other than the paraspinals associated with the extremities that have been tested.
- Ambulatory EEG is indicated when a seizure diathesis is suspected but not defined by history, physical exam, or routine resting EEG.
7 Active Policies
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
L35098 — Nerve Conduction Studies and Electromyography
J06
A56771 — Billing and Coding: Special Electroencephalography
CIGNA-0506 — Autonomic Nerve Function Testing - (0506)
L34417 — CT of the Head
Related Codes
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