S34.109S — Unspecified injury to unspecified level of lumbar spinal cord, sequela
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- All documentation must be maintained in the medical record, be legible, include patient identification (e.g., full name, dates of service), and include the legible signature of the treating physician or non-physician practitioner.
- The submitted medical record must support the selected ICD-10-CM code(s) and the CPT/HCPCS code must accurately describe the service performed.
- When Q7, Q8, or Q9 is used, the medical record must document the specific Class A, B, and/or C findings and the complicating condition(s) that justify the modifier.
- For podiatrist-submitted claims with ICD-10 codes marked with an asterisk, the claim must include the name of the M.D., D.O., or non-physician practitioner who diagnosed the complicating condition and the approximate date the beneficiary was last seen by that provider.
Key Coverage Criteria
- Routine foot care is covered only when the patient has one or more diagnoses listed in the LCD L33941 “ICD-10 Codes that Support Medical Necessity.”
- Patients with peripheral neuropathy involving the feet (without vascular impairment) are covered when billed with the Group 3 ICD-10 codes appropriate for peripheral neuropathy.
- Patients requiring anticoagulation therapy are covered when billed with the Group 4 ICD-10 codes documenting anticoagulation-related risk.
- Patients with Group 2 (complicating) diagnoses may be covered when the claim includes the appropriate Q modifier (Q7, Q8, or Q9) and the medical record documents the required Class A, B, and/or C findings per the definitions.
- Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
- Somatosensory evoked potential (SEP) testing should be billed using CPT codes 95925, 95926, 95927, or 95938 when an SEP study (not QST) is performed.
8 Active Policies
A57455 — Billing and Coding: Urodynamics
J06
L33576 — Urodynamics
J06
A57188 — Billing and Coding: Routine Foot Care
A57540 — Billing and Coding: Somatosensory Testing
L33941 — Routine Foot Care
Related Codes
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