I89.9 — Noninfective disorder of lymphatic vessels and lymph nodes, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Reason for the study, clinical history and examination findings are required
- Numerical values are required - latency, amplitude and nerve conduction
- Type of needle used must be documented - monopolar or concentric
- When documentation is required submit hard copy of waveforms and complete written report, including test interpretation
Key Coverage Criteria
- Nerve conduction velocity (NCV) testing AND needle electromyography testing (NEMG) are medically necessary when conducted and interpreted at the same time for any of the following indications:
- Myopathy, including but not limited to: inflammatory myopathy and myositis (e.g., polymyositis, dermatomyositis, inclusion body myositis)
- Congenital and hereditary dystrophic and nondystrophic myopathies, including myotonic muscular dystrophy
- Acquired myopathies (drug induced myopathy associated with statins, thyroid related)
- Metabolic myopathies (such as McArdle disease)
- Disorder of brachial or lumbosacral plexus (e.g., inflammatory idiopathic, traumatic, infiltrative plexopathy, thoracic outlet syndrome, Parsonage Turner syndrome)
2 Active Policies
CIGNA-0538 — Flow Cytometry - (0538)
CIGNA-CPG129 — Electrodiagnostic Testing (EMG/NCV) - (CPG129)
Related Codes
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