I87.011 — Postthrombotic syndrome with ulcer of right lower extremity
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low 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.
- Traditional negative pressure wound therapy (NPWT) devices, units, and supplies are covered under the Durable Medical Equipment (DME) benefit when they meet DME LCD coverage criteria and medical necessity.
- CPT codes 97597, 97598, and wound debridement codes 11042-11047 may be covered when the medical record documents medical necessity consistent with L37228 Wound Care criteria and Medicare reasonable-and-necessary requirements.
20 Active Policies
L34536 — Treatment of Varicose Veins of the Lower Extremities
J05
A59740 — Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers
J05
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
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