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ICD-10-CM S04.039S, Injury of optic tract and pathways, unspecified side, sequela | No Prior Auth

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`S04.039S`, Injury of optic tract and pathways, unspecified side, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Maintain all documentation in the patient’s medical record; every page must be legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

The submitted CPT/HCPCS code must accurately describe the service performed.

The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.

The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Key Coverage Criteria

Speech-language pathology (SLP) services for treatment or evaluation of communication disorders when determined reasonable and necessary per LCD L35070.
Selection and prescription of speech-generating devices should be billed with CPT code 92607.
Adaptation and training for speech-generating devices should be billed with CPT code 92609.
Report group therapy with CPT code 92508 when patients are not receiving direct one-on-one contact and are supervised by the therapist.
Use the appropriate CPT evaluation code for re-evaluations in SLP because CPT does not define a distinct re-evaluation code.
Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.

17 Active Policies

A57599, Billing and Coding: Visual Electrophysiology Testing

J5

WPS-J5-L37015, Visual Electrophysiology Testing

J5

NGS-J6-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J6

NGS-J6-L36831, Visual Electrophysiology Testing

J6

A57060, Billing and Coding: Visual Electrophysiology Testing

J6

A56551, Billing and Coding: Visual Fields Testing

J6

NGS-J6-L33574, Visual Fields Testing

J6

A56537, Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J6

WPS-J8-L37015, Visual Electrophysiology Testing

J8

A57637, Billing and Coding: Visual Field Examination

J9

FIRST_COAST-L33766, Visual Field Examination

J9

NOVITAS-JH-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

JH

NGS-JK-L36831, Visual Electrophysiology Testing

JK

NGS-JK-L34380, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

JK

NGS-JK-L33574, Visual Fields Testing

JK

A54111, Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders

JL

NOVITAS-JL-L35070, Speech - Language Pathology (SLP) Services: Communication Disorders

JL

Related Codes

S04.041S(17 policies)E08.3213(14 policies)E08.311(14 policies)E08.319(14 policies)E08.3211(14 policies)E08.3212(14 policies)E08.3291(14 policies)E08.3292(14 policies)

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