Does S27.809S require prior authorization?

No, S27.809S does not require prior authorization (high confidence). Code is covered without prior authorization.

`S27.809S` — Unspecified injury of diaphragm, sequela

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
Medical necessity for the CT must be documented in the medical record.
Documented chest x-ray and/or physical examination findings suggestive of chest pathology should be recorded prior to proceeding to CT thorax.

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
CT thorax is covered for diagnosis and/or staging of neoplastic and hematologic processes arising in or involving the thorax.
CT thorax is covered to evaluate pulmonary, mediastinal, pleural, and chest wall infections and their complications.
CT thorax is covered to detect and characterize mediastinal neoplasms and other mediastinal processes.
CT thorax is covered for assessment of cardiopulmonary failure or insufficiency.
CT thorax is covered to detect and determine the nature and extent of cardiovascular abnormalities (e.g., aneurysm, dissection, embolism, thrombosis, congenital anomalies, postoperative complications, atherosclerotic sequelae).

A56580 — Billing and Coding: Computerized Axial Tomography (CT), Thorax

A56717 — Billing and Coding: Respiratory Therapy (Respiratory Care)

L34430 — Respiratory Therapy (Respiratory Care)

L33459 — Computerized Axial Tomography (CT), Thorax

Ask Verity about documentation requirements, denial risks, or coverage in your state.