M79.643 — Pain in unspecified hand
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Claims and coding must follow the Local Coverage Determination L37642 that this article complements; medical record documentation should support the billed service in accordance with LCD L37642.
- For debridement of mycotic nails, the medical record must describe each affected nail (size including thickness, color) and the local symptomatology attributable to each nail for that service encounter.
- The patient's medical record must include assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report for the service.
- For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim; for Part B claims, the attending physician name and NPI and the date last seen (MM/DD/YYYY) must be reported for ICD-10 codes under the active care requirement.
Key Coverage Criteria
- Routine foot care and debridement of nails are payable under Medicare Part B when performed in approved places of service (POS 11,12,13,14,19,20[11720/11721 only],21,22,24,31,32,33,49,51,52,53,54,55,56,61,62,65,71,99).
- Debridement of mycotic (onychomycosis/dermatophytosis) nails is covered only when the claim lists a primary diagnosis of dermatophytosis of the nail plus either a secondary systemic condition or an ICD-10-CM code from the LCD 'ICD-10-CM Codes that Support Medical Necessity' indicating secondary infection or pain.
- Procedures to treat onychogryphosis or onychauxis are covered when the primary diagnosis is onychogryphosis or onychauxis and a secondary diagnosis from the LCD indicating secondary infection or pain is also reported.
- Removal of benign hyperkeratotic lesions performed by cutting/parring is reported with CPT 11055, 11056, or 11057 and is the appropriate code set for hyperkeratotic plaques of the foot.
- Removal of epidermal and dermal lesions by shaving is reported with CPT 11300–11313 when full-thickness excision is not performed and when anesthesia and hemostasis are provided.
- CPT 64450 is appropriate when a qualified health care professional performs a direct injection (nerve block) of an anesthetic agent and/or steroid into a peripheral nerve for treatment of peripheral neuropathy.
20 Active Policies
A57589 — Billing and Coding: Nerve Blocks for Peripheral Neuropathy
J05
L35222 — Nerve Blocks for Peripheral Neuropathy
J05
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
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