S44.8X9A — Injury of other nerves at shoulder and upper arm level, unspecified arm, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
- 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.
Key Coverage Criteria
- 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).
- 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.
- Covered for surgery or embolization of intracranial arteriovenous malformations (AVMs) and for spinal cord AVM surgery.
- Intraoperative neurophysiological testing is covered for surgery of the aortic arch, its branch vessels, or thoracic aorta (including carotid artery surgery) when there is risk of cerebral or spinal cord ischemia.
4 Active Policies
A56722 — Billing and Coding: Intraoperative Neurophysiological Testing
J12
L35003 — Intraoperative Neurophysiological Testing
J12
A56607 — Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
L37641 — Continuous Peripheral Nerve Blocks (CPNB)
Related Codes
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