S32.2XXA — Fracture of coccyx, initial encounter for closed fracture
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
- Refer to LCD L34975 for the detailed reasonable and necessary clinical criteria and documentation required to support coverage of NEPs.
- Use CPT codes 95925, 95926, 95927, 95928, 95929, 95938, and 95939 for Somatosensory Evoked Potentials/Responses (SEPs/SERs).
- Use CPT codes 92651, 92652, and 92653 for Brainstem Auditory Evoked Potentials/Responses (BAEPs/BAERs).
Key Coverage Criteria
- Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
- Cystometrogram (CPT 51725, 51726) is covered when performed to evaluate detrusor contractions, abnormalities of bladder compliance, measure post-void residual, determine bladder capacity, or detect detrusor sphincter dyssynergia (DSD).
- Uroflowmetry (CPT 51736, 51741) is covered when used to measure urine flow rate to evaluate suspected reduced detrusor function (eg, neurologic lesion), obstructive causes (eg, BPH, cystocele), or increased flow suggesting stress urinary incontinence (SUI) or intrinsic sphincter dysfunction (ISD).
- Urethral pressure profile studies (CPT 51727) are covered when other noninvasive tests are inconclusive and the study is needed to rule out severe urethral incompetence or for limited applications such as artificial urinary sphincter evaluation.
- Stimulus evoked response testing (CPT 51792) is covered when used to evaluate suspected cauda equina syndrome or other indications where this neurophysiologic test is clinically indicated.
- Voiding pressure studies (CPT 51728, 51729) are covered when the patient is able to void and the test is needed to measure detrusor contractility and detect outlet pressure obstruction.
20 Active Policies
A57597 — Billing and Coding: Somatosensory Testing
J05
A57604 — Billing and Coding: Intraoperative Neurophysiological Testing
J05
L34624 — Somatosensory Testing
J05
L34623 — Intraoperative Neurophysiological Testing
J05
A56773 — Billing and Coding: Neurophysiology Evoked Potentials (NEPs)
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