R53.81 — Other malaise
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- The clinical history from the referral source must indicate the need for testing and the medical record must contain pertinent clinical information available for review upon request.
- If an E/M service is separately billable, the medical record must document medical necessity for the separate E/M and the CPT must be billed with modifier 25.
- When testing exceeds the reasonable maximum number of studies listed in the policy table, the physician must provide supplementary documentation justifying the additional testing.
- Documentation must support the medical necessity of testing an asymptomatic contralateral limb when used to establish normative values.
Key Coverage Criteria
- Nerve conduction studies (CPT 95907-95913) and/or needle electromyography (CPT 95860-95864, 95867-95872, 95885-95887) are covered when medically necessary to evaluate Carpal Tunnel Syndrome (unilateral).
- Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate Carpal Tunnel Syndrome (bilateral).
- Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate radiculopathy.
- Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate mononeuropathy.
- Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate polyneuropathy or mononeuropathy multiplex.
- Needle EMG and nerve conduction studies are covered when medically necessary to evaluate myopathy.
20 Active Policies
A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography
J05
L34594 — Nerve Conduction Studies and Electromyography
J05
L35098 — Nerve Conduction Studies and Electromyography
J06
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
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