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ICD-10-CM S15.001A, Unspecified injury of right carotid artery, initial encounter | No Prior Auth

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`S15.001A`, Unspecified injury of right carotid artery, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must meet the reasonable and necessary documentation requirements specified in LCD L35035; include clinical records demonstrating medical necessity per the LCD.
Follow the NCCI Coding Policy Manual (Chapters V and IX) for proper coding; retain documentation supporting compliance with NCCI edits.
When billing services that the LCD does not cover, use the appropriate Medicare modifier and document the basis for billing a non-covered service.

The ordering/referring practitioner's assessment related to the patient's complaint and the specific reason for the test must be documented in the medical record.

The medical record must contain a referral/order on file for each non‑invasive vascular study performed.

Results of pertinent tests and procedures performed that relate to the indication must be included in the medical record and reported on the claim if known; otherwise report the symptoms that prompted the test.

Key Coverage Criteria

Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.

15 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

A57670, Billing and Coding: Non-invasive Extracranial Arterial Studies

J9

FIRST_COAST-L33695, Non-invasive Extracranial Arterial Studies

J9

FIRST_COAST-L36767, Aortography and peripheral angiography

J9

A57056, Billing and Coding: Aortography and Peripheral Angiography

J9

NOVITAS-JH-L34865, Magnetic Resonance Angiography (MRA)

JH

NOVITAS-JH-L35035, Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

JH

NOVITAS-JL-L35035, Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

JL

NOVITAS-JL-L34865, Magnetic Resonance Angiography (MRA)

JL

A56631, Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

JL

A56805, Billing and Coding: Magnetic Resonance Angiography (MRA)

JL

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

A56697, Billing and Coding: Non-Invasive Vascular Studies

A56775, Billing and Coding: Magnetic Resonance Angiography

Related Codes

H34.12(15 policies)H34.11(15 policies)H34.02(15 policies)H34.01(15 policies)G45.8(15 policies)H34.03(15 policies)G45.3(15 policies)H34.13(15 policies)

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