S84.809D — Injury of other nerves at lower leg level, unspecified leg, 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.
- 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.
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).
- 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.
- NC-stat testing (CPT 95905) is allowed when the beneficiary has a high pre-test or prior probability of Carpal Tunnel Syndrome (CTS), limited to one service per arm.
6 Active Policies
A57668 — Billing and Coding: Nerve Conduction Studies and Electromyography
J06
L35098 — Nerve Conduction Studies and Electromyography
J06
A56607 — Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
A57188 — Billing and Coding: Routine Foot Care
L37641 — Continuous Peripheral Nerve Blocks (CPNB)
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.