Z74.01 — Bed confinement status
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Inferred documentation items (from the text and cited trials/guidelines) that would support medical necessity: documentation of the clinical indication (e.g., trauma, recent orthopedic surgery, neurosurgery, acute ischemic stroke with restricted mobility, documented immobility such as inability to walk to the toilet without help),
- For CLI: documentation that the patient has severe or critical limb ischemia and is not a candidate for surgical revascularization (text: "non-revascularization-based therapies used to treat patients with severe or critical limb ischemia (CLI) who are not candidates for surgical revascularization").
- For lymphedema: documentation that intermittent pneumatic compression is being used as an adjunct to complex decongestive therapy (CDT), particularly where mobility or exercise is compromised.
Key Coverage Criteria
- In patients with acute ischemic stroke and restricted mobility, the guideline authors suggested the use of prophylactic-dose heparin or IPC devices (Grade 2B).
- CLOTS 3 trial finding: IPC is an effective method of reducing the risk of DVT and possibly improving survival in a wide variety of patients who are immobile after stroke.
- IPC devices have been used for thrombosis prophylaxis after total hip replacement (THR) and total knee arthroplasty (TKA) (various devices and configurations described).
- Intermittent pneumatic compression has been used as a modality to aid fracture and soft-tissue healing and as adjunct in rehabilitation (small/suggestive studies).
- Intermittent pneumatic compression has been used to treat or aid healing of venous leg ulcers and venous insufficiency (evidence mixed/limited).
- IPC has been used as adjunctive therapy for critical limb ischemia (CLI) in patients who are not candidates for surgical revascularization (studies suggest possible limb-salvage benefit but evidence low quality).
2 Active Policies
AETNA-CPB-0430 — Pressure Reducing Support Surfaces
AETNA-CPB-0500 — Intermittent Pneumatic Compression Devices
Related Codes
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