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ICD-10-CM S64.30XA, Injury of digital nerve of unspecified thumb, initial encounter | No Prior Auth

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`S64.30XA`, Injury of digital nerve of unspecified thumb, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.

The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

The test must be ordered by the operating surgeon and the order must be present in the medical record.

Documentation must show a specifically trained technician in continuous attendance for the single case, including credentials (preferably ABNM or ABRET) and evidence of real-time communication capability with the supervising physician.

Key Coverage Criteria

No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
Covered for surgery resulting from traumatic injury to the spinal cord or brain when monitoring can identify or prevent further neurologic injury.
Covered for surgery or embolization of intracranial arteriovenous malformations (AVMs) and for spinal cord AVM surgery.

4 Active Policies

NOVITAS-JH-L35003, Intraoperative Neurophysiological Testing

JH

NOVITAS-JL-L35003, Intraoperative Neurophysiological Testing

JL

A56722, Billing and Coding: Intraoperative Neurophysiological Testing

JL

A56607, Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)

Related Codes

G54.2(4 policies)M50.11(4 policies)G54.0(4 policies)G54.1(4 policies)G54.3(4 policies)G54.4(4 policies)G50.0(4 policies)M50.121(4 policies)

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