S06.89AD — Other specified intracranial injury with loss of consciousness status unknown, subsequent encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
- The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- For claims using CPT codes not listed in this article, submit supporting clinical and billing documentation for individual review.
Key Coverage Criteria
- Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
- Ambulatory continuous EEG is covered only if a prior routine “resting” EEG was performed before the ambulatory EEG.
- Routine EEGs covered under this policy are those described by CPT codes 95812, 95813, 95816, 95819, or 95822.
- A routine EEG is defined as a recording of less than a 24-hour continuous duration.
- Coverage for programming and modification of speech-generating devices using CPT 92609.
- Coverage for individual outpatient treatment of speech, language, voice, communication, and/or auditory processing disorders using CPT 92507.
20 Active Policies
A57483 — Billing and Coding: Visual Fields
J05
L34615 — Visual Fields
J05
A56537 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
L33632 — Psychiatry and Psychology Services
J06
L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Related Codes
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