S06.A1XA — Traumatic brain compression with herniation, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
- When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
- When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.
Key Coverage Criteria
- Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
- CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
- HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
- CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
- Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
- G71.21 | Nemaline myopathy
10 Active Policies
L34520 — Psychological and Neuropsychological Tests
J09
A57780 — Billing and Coding: Psychological and Neuropsychological Tests
J09
L35101 — Psychiatric Codes
J12
A57130 — Billing and Coding: Psychiatric Codes
J12
L35175 — MRI and CT Scans of the Head and Neck
Related Codes
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