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ICD-10-CM S25.812S, Laceration of other blood vessels of thorax, left side, sequela | No Prior Auth

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`S25.812S`, Laceration of other blood vessels of thorax, left side, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
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.

Signed and dated office visit notes and operative reports must be present in the record for the services ordered or rendered to Medicare beneficiaries.

Providers must maintain documentation of staff training and experience for those who perform and interpret the technical and interpretation portions of the examinations for post‑payment audit.

Key Coverage Criteria

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.
After carotid endarterectomy, repeat ipsilateral (unilateral) duplex examinations are allowable at approximately six weeks, six months, and one year post‑procedure during the first year.

8 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

NGS-J6-L33627, Non-Invasive Vascular Studies

J6

A56758, Billing and Coding: Non-Invasive Vascular Studies

J6

NGS-JK-L33627, Non-Invasive Vascular Studies

JK

A57326, Billing and Coding: Electrocardiograms

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A56697, Billing and Coding: Non-Invasive Vascular Studies

Related Codes

D57.1(8 policies)D57.411(8 policies)D57.04(8 policies)D57.09(8 policies)D57.01(8 policies)D57.40(8 policies)D57.02(8 policies)D57.412(8 policies)

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