H74.40 — Polyp of middle ear, unspecified ear
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made 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 care to the patient.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- The test must be ordered by the operating surgeon and the order must be present in the medical record.
Key Coverage Criteria
- Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
- Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
- Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
- Covered for surgery or embolization of intracranial arteriovenous malformations (AVMs) and for spinal cord AVM surgery.
- Intraoperative neurophysiological testing is covered for surgery of the aortic arch, its branch vessels, or thoracic aorta (including carotid artery surgery) when there is risk of cerebral or spinal cord ischemia.
- Covered for resection of epileptogenic brain tissue or brain tumor where intraoperative monitoring can identify or prevent neurologic injury.
3 Active Policies
A56722 — Billing and Coding: Intraoperative Neurophysiological Testing
J12
L35003 — Intraoperative Neurophysiological Testing
J12
AETNA-CPB-0697 — Intraoperative Neurophysiological Monitoring
Related Codes
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