Does I87.019 require prior authorization?

No, I87.019 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`I87.019`, Postthrombotic syndrome with ulcer of unspecified lower 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.

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.
CPT 97032 (attended/manual electrical stimulation) is covered when delivered with direct 1-on-1 contact by qualified personnel (examples: direct motor point stimulation; FES/NMES when performed with therapeutic exercise, neuromuscular reeducation, or functional activities).
CPT 97032 may be billed for the application, instruction, and adjustment of a TENS unit or other probe-based stimulation (including determining trigger points) when provided as an attended/manual modality.
Non-implantable pelvic floor electrical stimulation (97032 for probes; G0283 for electrode-based delivery) is covered for treatment of stress and/or urge urinary incontinence in cognitively intact, motivated patients who have failed a documented 4-week trial of pelvic muscle exercise (PME) training.
HCPCS G0283 (unattended/supervised electrical stimulation) is covered for non-wound-care indications as part of a therapy plan of care when delivered without constant direct contact after skilled application (examples: TENS, IFC, cyclical muscle stimulation).
HCPCS G0329 (electromagnetic therapy) is covered for chronic stage III/IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that show no measurable signs of healing after 30 days of conventional care as part of a therapy plan of care.

7 Active Policies

A56566, Billing and Coding: Outpatient Physical and Occupational Therapy Services

NOVITAS-JH-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

NOVITAS-JL-L35138, Routine Foot Care

A53064, Billing and Coding: Outpatient Occupational Therapy

A57067, Billing and Coding: Outpatient Physical and Occupational Therapy Services

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

`I87.019`, Postthrombotic syndrome with ulcer of unspecified lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

I87.019, Postthrombotic syndrome with ulcer of unspecified lower extremity

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`I87.019`, Postthrombotic syndrome with ulcer of unspecified lower extremity