M47.11 — Other spondylosis with myelopathy, occipito-atlanto-axial region
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low 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.
- All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
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.
- Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53.
- NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
- NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
20 Active Policies
L34623 — Intraoperative Neurophysiological Testing
J05
A57595 — Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG
J05
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
L34624 — Somatosensory Testing
J05
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