S44.30XS — Injury of axillary nerve, unspecified arm, sequela
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, be legible, include appropriate patient identification (e.g., full name, dates of service), and be available to the contractor upon request.
- The medical record must identify the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Medical records must be maintained and available upon request; every page must be legible and include patient identification (e.g., full name, dates of service) and identify the physician or non-physician practitioner responsible for care.
Key Coverage Criteria
- Regional or local nerve blocks performed as part of an operative procedure (e.g., adjunct to or sole means of regional/local anesthesia for the procedure) are not affected by this non-coverage policy and may be billed as anesthesia for the operative procedure.
- Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
- No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
- Nerve block evaluation and treatment is indicated for chronic pain defined as pain present continuously or intermittently for >= 3 months despite prior therapy.
- Diagnostic nerve blocks (including injection of saline or local anesthetic) are indicated to identify the pain-generating nerve, determine nerve type, or distinguish peripheral versus central pain origin and to assess suitability for neurolytic or surgical interventions.
- Therapeutic nerve blocks are indicated for painful conditions known to respond to nerve blockade, including sympathetic-mediated syndromes and celiac plexus block for pancreatic cancer pain.
6 Active Policies
A52725 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
A56034 — Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
A56607 — Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
L35456 — Nerve Blockade for Treatment of Chronic Pain and Neuropathy
L35457 — Nerve Blockade for Treatment of Chronic Pain and Neuropathy
Related Codes
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