S44.91XS — Injury of unspecified nerve at shoulder and upper arm level, right 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.
- An updated and completed OASIS M2200 for the billing period must be in the patient's medical record and made available to the Medicare Administrative Contractor upon request to support medical necessity for therapy services.
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.
- Occupational therapy is covered for patients with migraine (G43.xx) who require training to reduce pain during basic and instrumental activities of daily living, typically completed in 3–4 sessions.
- Electrical stimulation (attended CPT 97032 or unattended HCPCS G0283) may be covered as part of a therapy plan of care to improve function when the nerve supply to the muscle is intact and atrophy is due to non-neurological disuse (e.g., post-casting, splinting, soft-tissue scarring).
- Wheelchair management training (CPT 97542) is covered for patient and/or caregiver training in transfers and propulsion when documentation ties the training to attainable functional goals.
- Therapeutic exercise (CPT 97110) is covered when used to address impairments of exercise tolerance due to cardiopulmonary impairments.
- Range of motion testing (CPT 95851) may be used for extremity ROM when every joint of the extremity is tested and documentation explains why such comprehensive assessment was warranted.
20 Active Policies
L35098 — Nerve Conduction Studies and Electromyography
J06
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
A53057 — Billing and Coding: Home Health Occupational Therapy
A53064 — Billing and Coding: Outpatient Occupational Therapy
A53065 — Billing and Coding: Outpatient Physical Therapy
Related Codes
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