Does I87.009 require prior authorization?

No, I87.009 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`I87.009`, Postthrombotic syndrome without complications of unspecified extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

When routine foot care needs to meet one of the exclusions, include the applicable Q modifier on the claim: Q7 for 1 Class A finding, Q8 for 2 Class B findings, and Q9 for 1 Class B plus 2 Class C findings.
For all foot-care claims report an appropriate foot/toe location modifier (e.g., LT, RT, TA, T1-T9) to identify laterality and specific toe when applicable.
If a significant, separately identifiable evaluation and management service is provided on the same day as routine foot care, append modifier -25 to the E/M claim line.

When reporting an ICD-10-CM code that falls under the active care requirement, report the date the beneficiary was last seen by the MD, DO, or qualified NPP responsible for treating the underlying condition in line 19 of the CMS-1500 or the electronic equivalent.

Key Coverage Criteria

Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
Coverage requires documented failure of an adequate trial of conservative treatment prior to interventional treatment.
Treatment is covered for patients with a documented diagnosis of symptomatic varicose veins of the lower extremity.
Procedures are covered when appropriate diagnostic testing confirms the presence and location of incompetent perforating or saphenous system veins correlating with clinical symptoms.
Coverage may be allowed when the patient has Amyotrophic Lateral Sclerosis (ALS) resulting in a need for routine foot care.
Coverage may be allowed when the patient has arteritis of the feet resulting in a need for routine foot care.

4 Active Policies

NOVITAS-JH-L35138, Routine Foot Care

NOVITAS-JL-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

A57305, Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of

`I87.009`, Postthrombotic syndrome without complications of unspecified extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

I87.009, Postthrombotic syndrome without complications of unspecified extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`I87.009`, Postthrombotic syndrome without complications of unspecified extremity