H04.211 — Epiphora due to excess lacrimation, right lacrimal gland
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- This article provides billing/coding guidelines that complement the Local Coverage Determination (LCD) L33458 for chemodenervation; follow LCD L33458 for specific coverage criteria and coding guidance.
- The patient's medical record must include the ordering provider's assessment related to the patient's complaint for that visit, relevant medical history, and results of pertinent tests or procedures.
- A signed and dated office visit record or operative report is required for all services (all services ordered or rendered to Medicare beneficiaries must be signed).
- For claims requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Key Coverage Criteria
- CPT codes 68801, 68810 and 68840 are payable under Medicare Part B when medically necessary and performed in the following places of service: office (11), assisted living facility (13), inpatient hospital (21), outpatient hospital (22), emergency room (23), ambulatory surgical center (24), skilled nursing facility (Part A stay) (31), nursing facility not in a Part A stay (32), custodial care facility (33), and independent clinic (49).
- CPT codes 68811 and 68815 are payable under Medicare Part B when medically necessary and performed in the following places of service: office (11), inpatient hospital (21), outpatient hospital (22), emergency room (23), ambulatory surgical center (24), and independent clinic (49).
- Procedures represented by CPT 68801, 68810-68815, and 68840 are covered only when reasonable and necessary for the patient's nasolacrimal punctum or nasolacrimal duct condition, supported by appropriate clinical documentation and diagnosis codes.
- Chemodenervation of muscles innervated by the facial nerve for management of blepharospasm or hemifacial spasm.
- Chemodenervation of cervical spinal muscles for management of spasmodic torticollis (cervical dystonia).
- Chemodenervation of extremity muscles for management of dystonias, cerebral palsy, upper and lower limb spasticity, and multiple sclerosis–related spasticity.
4 Active Policies
A56646 — Billing and Coding: Chemodenervation
A57284 — Billing and Coding: Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation
L34171 — Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation
L33458 — Chemodenervation
Related Codes
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