I80.3 — Phlebitis and thrombophlebitis of lower extremities, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code must best describe the patient's condition for the service performed.
- The patient's medical record must contain documentation fully supporting medical necessity including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- Medical record must document history and physical findings supporting a diagnosis of symptomatic varicose veins.
- Medical record must document failure of an adequate trial of conservative treatment as described in the LCD.
Key Coverage Criteria
- Interventional treatments are covered for symptomatic varicose veins of the lower extremity when the medical record documents history and physical findings supporting the diagnosis.
- Coverage requires failure of an adequate trial of conservative treatment prior to interventional therapy as described in the LCD.
- Coverage requires exclusion of other causes of limb edema, ulceration, and pain prior to treatment of varicose veins.
- Coverage requires performance of appropriate diagnostic testing (e.g., duplex ultrasound) to confirm the presence and location of incompetent perforating veins when indicated.
- Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
- Foot care services are covered when the beneficiary has a listed systemic condition that justifies coverage per Medicare Benefit Policy Manual Pub.100-02, Ch.15, Section 290.4D.
16 Active Policies
A56232 — Billing and Coding: Foot Care
J05
L33575 — Varicose Veins of the Lower Extremity, Treatment of
J06
L33627 — Non-Invasive Vascular Studies
J06
A56758 — Billing and Coding: Non-Invasive Vascular Studies
J06
A52870 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremity
Related Codes
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