R41.85 — Anosognosia
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When billing with a Z-code as the diagnosis, document the orthotic/prosthetic device name, date the patient received the device, and the date training/teaching began (if applicable).
- Document actual SLP patient contact time in 15-minute increments and link units billed to the clinical notes showing time and skilled service provided.
- For SGD services billed with CPT 92607 or 92609, retain documentation supporting selection/prescription, adaptation, and training provided to the patient.
- If performing a re-evaluation, document clinical rationale and use the applicable evaluation CPT code with supporting clinical findings since no separate SLP re-evaluation CPT exists.
Key Coverage Criteria
- Home health speech-language pathology services must be billed using HCPCS G0153 (Speech-Language Pathology).
- When treating memory disturbances not associated with mental disorders (e.g., post cerebrovascular accident), use ICD-10 R68.89 as the diagnosis code for the related LCD.
- Use CPT 92607 for selection and prescription of speech-generating devices (SGDs) and CPT 92609 for SGD adaptation and training.
- Use CPT 92507 for speech/hearing treatment services (treatment code).
- For re-evaluation in speech-language pathology, use the appropriate evaluation CPT code because CPT does not define a separate SLP re-evaluation code.
- CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
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