M48.42XA — Fatigue fracture of vertebra, cervical region, initial encounter for fracture
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 available to the contractor upon request.
- Every page of the medical record must be legible and include appropriate patient identification (e.g., complete name, dates of service).
- The record must include the physician or non-physician practitioner responsible for providing the care of the patient.
- The patient's medical record should document the time spent in monitoring in correlation to the surgery performed.
Key Coverage Criteria
- Intraoperative neurophysiological testing is billable only when coverage criteria and medical necessity in related LCD L34623 are met.
- Erythrocyte sedimentation rate (ESR) testing is covered only when reasonable and necessary as defined by Local Coverage Determination L34021.
- ESR performed for rheumatoid arthritis patients to assess the need for medication adjustments should be billed with a diagnosis code that reflects the specific antirheumatic medication the patient is receiving.
- Use ICD-10 codes T39.4X5A–T39.4X5S for ESR billing when the patient with rheumatoid arthritis is receiving antirheumatics such as gold salts for medication evaluation.
- Use ICD-10 codes T45.1X5A–T45.1X5S for ESR billing when the patient with rheumatoid arthritis is receiving antineoplastic or immunosuppressive drugs such as methotrexate for medication evaluation.
- Use ICD-10 codes T45.8X5A–T45.8X5S for ESR billing when the patient with rheumatoid arthritis is receiving other primarily systemic and hematological agents such as heavy metal antagonists for medication evaluation.
20 Active Policies
A57604 — Billing and Coding: Intraoperative Neurophysiological Testing
J05
A59664 — Billing and Coding: Cervical Fusion
J05
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
L39788 — Cervical Fusion
J05
Related Codes
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