S44.90XD — Injury of unspecified nerve at shoulder and upper arm level, unspecified arm, subsequent 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.
- An evaluation prior to blockade must be documented in the patient's record, including assessment of the pain source and treatment of any underlying pathology.
- Patients who do not respond to injections or who continue with persistent or poorly responsive pain should be referred for a multidisciplinary comprehensive evaluation and that referral and evaluation should be documented.
- When PNS is used, documentation of nerve stimulation findings (e.g., stimulation at 0.5 mA or less consistent with accurate needle placement) and of use of real-time ultrasound imaging when employed should be included in the record.
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 peripheral nerve blocks (CPNB) are covered when performed as continuous paravertebral, interscalene, supraclavicular, infraclavicular, interscalene brachial plexus, axillary, femoral, lumbar plexus, sciatic, or popliteal (sciatic) nerve blocks.
- CPNB may be covered for therapeutic purposes to treat painful conditions, including complex regional pain syndrome (CRPS), and certain hyperhidroses that respond to nerve blocks.
- CPNB may be covered for prognostic purposes to predict the outcome of long-lasting interventions (e.g., neurolysis, rhizotomy).
- Pain is considered chronic for CPNB considerations when it has been present continuously or intermittently despite therapy for 3 months or more.
- When not used as the primary mode of anesthesia, medically reasonable and necessary placement of CPNB for postoperative or other pain control may be reimbursable.
2 Active Policies
A56607 — Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
L37641 — Continuous Peripheral Nerve Blocks (CPNB)
Related Codes
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