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ICD-10-CM N81.84, Pelvic muscle wasting | No Prior Auth

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`N81.84`, Pelvic muscle wasting

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
None specified in the CPB. (The document does not list explicit medical record, test result, or clinical documentation requirements for coverage or for investigational determinations.)

Key Coverage Criteria

Endometriosis
None explicitly listed as covered in this CPB. The policy identifies the following procedures as experimental and investigational (i.e., effectiveness not established and thus not supported by this policy): dorsal root ganglion stimulation; hypogastric plexus neurolysis for the treatment of chronic pelvic pain associated with endometriosis; peritoneal excision (stripping) for the treatment of endometriosis; uterine nerve ablation (UNA), laparoscopic uterine nerve ablation (LUNA) and presacral n [...]
Other indications related to pelvic pain addressed by selected treatments (policy scope: selected treatments for chronic pelvic pain, endometriosis, and other indications)

2 Active Policies

AETNA-CPB-0754, Chronic Pelvic Pain, Endometriosis, and Other Indications: Selected Treatments

A56421, Billing and Coding: CT of the Abdomen and Pelvis

Related Codes

N70.01(2 policies)N71.9(2 policies)N30.10(2 policies)N30.11(2 policies)N70.93(2 policies)N71.0(2 policies)A34(2 policies)N73.0(2 policies)

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