T87.1X2 — Complications of reattached (part of) left lower extremity
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing and coding guideline complements Local Coverage Determination (LCD) L34424 for Magnetic Resonance Angiography; refer to LCD L34424 for clinical indications, medical necessity criteria, and specific coding rules.
- A permanent record of the studies performed and the interpretation must be maintained in the medical record.
- Documentation must include a description of the studies performed, any contrast media or radiopharmaceuticals used, any known significant patient reactions or complications, comparisons with prior relevant studies, and both normal and abnormal findings with measurements of variations from normal.
- The report should address specific clinical questions or explain factors that prevent answering those questions.
Key Coverage Criteria
- Non-invasive peripheral arterial vascular studies are covered when the study results will be used in the clinical management of the patient and the medical necessity is documented in the medical record.
- One preoperative non-invasive vascular scan for bypass surgery is reasonable and covered to guide surgical planning.
- Immediate postoperative studies are covered when re-established pulses are lost or become equivocal, or the patient develops signs or symptoms of ischemia suggesting impending repeat intervention.
- Medically necessary follow-up noninvasive studies after angioplasty are covered, with the follow-up frequency determined by the vascular distribution treated and documented medical necessity.
- Duplex scanning and physiologic studies performed during the same encounter may be covered when the physiologic studies are abnormal and/or to evaluate vascular trauma, thromboembolic events, or aneurysmal disease, with documentation supporting medical necessity.
- Pre-surgical radial artery mapping may be performed, and accompanying vein-mapping is covered only when the arterial studies demonstrate a non-acceptable conduit or there is insufficient arterial conduit for multiple bypass procedures.
9 Active Policies
L35761 — Non-Invasive Peripheral Arterial Vascular Studies
J05
A57593 — Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies
J05
A60317 — Billing and Coding: Non-Invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities
J09
L40288 — Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities
J09
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