G93.39 — Other post infection and related fatigue syndromes
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 identification and dates of service.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must describe the service performed.
- If the service provider is not the ordering/referring physician, that provider must maintain hard-copy documentation of test results and interpretation plus copies of the ordering/referring physician’s order.
Key Coverage Criteria
- Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
- For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).
- An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
- A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
- Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
- Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.
20 Active Policies
A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography
J05
L34594 — Nerve Conduction Studies and Electromyography
J05
L35098 — Nerve Conduction Studies and Electromyography
J06
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
Related Codes
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