S14.104A — Unspecified injury at C4 level of cervical spinal cord, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Key Coverage Criteria
- Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
- Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
- Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
- G71.21 | Nemaline myopathy
- G83.0 | Diplegia of upper limbs
- H44.19 | Other endophthalmitis
20 Active Policies
A57597 — Billing and Coding: Somatosensory Testing
J05
L34624 — Somatosensory Testing
J05
L34594 — Nerve Conduction Studies and Electromyography
J05
A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography
J05
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.