I87.311 — Chronic venous hypertension (idiopathic) 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.
- Skilled therapy services are covered when the skills of a qualified therapist are necessary to improve the patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration.
- Rehabilitative therapy is covered when therapist skills are necessary to safely and effectively furnish a recognized therapy service with the goal of improving an impairment or functional limitation.
20 Active Policies
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A59739 — Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers
J05
A59740 — Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers
J05
A56914 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremities
J05
Related Codes
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