R35.0 — Frequency of micturition
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- When NCSs and NEMG are performed on the same day for the same patient they must be reported on the same claim.
- When billing non-covered services/tests report unlisted neurological CPT 95999 and provide a description of the service/test in block 80 (Part A) or box 19 (Part B) or electronic equivalent; failure to include this information will result in Part A claims being returned and Part B claims rejected.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.
- The submitted medical record must support the selected ICD-10-CM code(s), the submitted CPT/HCPCS code must describe the service performed, and the record must clearly document the medical necessity, the indication for ordering the test(s), and a clear diagnostic impression.
Key Coverage Criteria
- Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis codes 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 is reported.
- NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when diagnosis code I89.0 is reported in addition to the primary diagnosis.
- NCS without NEMG is allowed for individuals treated with anticoagulants when diagnosis code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
- Measurement of post-void residual urine and/or bladder capacity by ultrasound (CPT 51798) is covered when ordered by the attending/treating/referring physician to evaluate a patient's urinary complaint and the medical record documents medical necessity (relevant history, physical exam, and supporting diagnostic results).
- Therapy services are covered when the medical record and claim consistently and accurately document that the services are covered and medically necessary.
- Therapy is covered when the patient has impairments and functional limitations that require the unique skills of a clinician (therapist) to improve functioning.
20 Active Policies
L34635 — Botulinum Toxin Type A & Type B
J05
L35486 — Pelvic Floor Dysfunction: Anorectal Manometry and EMG
J05
A57474 — Billing and Coding: Botulinum Toxin Type A & Type B
J05
A57595 — Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG
J05
A57453
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