T25.399S — Burn of third degree of multiple sites of unspecified ankle and foot, sequela
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The article provides billing/coding guidance that complements LCD L39400; use the documentation, prior authorization, and claim submission requirements specified in LCD L39400 and the local contractor's instructions.
- Clinical trial/reporting deficiencies noted: many studies lacked standardized reporting of laser parameters, allocation concealment, blinding, withdrawals, and treatment protocols — implying that documentation of laser parameters (wavelength, power, J/cm2, duration, frequency) would be important though not formally required in this text.
- No documentation requirements, billing criteria, ICD-10/CPT codes, or explicit medical necessity documentation instructions are specified in this document.
- Clinical notes supporting medical necessity and that the patient meets any applicable selection criteria (the CPB references 'selection criteria' for coverage of CPT 0552T but the selection criteria text is not included in this chunk).
Key Coverage Criteria
- No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
- Serum magnesium testing is covered when hypomagnesemia is suspected due to gastrointestinal or renal losses or when patients present with symptoms of low magnesium (weakness, muscle cramps, confusion, irregular heartbeat, or seizures).
- Serum magnesium testing is covered for patients with conditions known to cause hypomagnesemia (examples include cardiac arrhythmias, proton pump inhibitor use, chronic alcohol use, uncontrolled diabetes mellitus, hypercalcemia, post–organ transplant status, inherited renal magnesium wasting, malabsorption syndromes, aminoglycoside or amphotericin B nephrotoxicity, cisplatin, pentamidine, calcineurin inhibitor therapy, digoxin use, prolonged IV or nasogastric therapy, parenteral alimentation with [...]
- Serum magnesium testing is covered when hypermagnesemia is suspected in patients with impaired renal function or after a large magnesium load (IV, oral, or enema) or when symptoms of high magnesium (muscle weakness, fatigue, nausea/vomiting, respiratory difficulty, or cardiac arrest) are present.
- Serum magnesium testing is covered for conditions associated with hypermagnesemia such as familial hypocalciuric hypercalcemia, hypercatabolic states (e.g., tumor lysis syndrome), diabetic ketoacidosis, lithium ingestion, milk-alkali syndrome, adrenal insufficiency, and rhabdomyolysis.
- Peri-implant mucositis (p-iM)
6 Active Policies
AETNA-CPB-0244 — Skin and Soft Tissue Substitutes
AETNA-CPB-0363 — Cold Laser and High-Power Laser Therapies
ANTHEM-CG-MED-73 — CG-MED-73 Hyperbaric Oxygen Therapy (Systemic/Topical)
ANTHEM-CG-SURG-127 — CG-SURG-127 Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses
A59186 — Billing and Coding: Magnesium
Related Codes
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