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ICD-10-CM S65.311A, Laceration of deep palmar arch of right hand, initial encounter | No Prior Auth

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`S65.311A`, Laceration of deep palmar arch of right hand, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

When expecting Medicare denial due to medical necessity, an Advance Beneficiary Notice (ABN) Form CMS‑R‑131 should be signed and retained and the correct denial modifier (GA/GX/GZ/GY) reported per CMS instruction; for Part A MAC include occurrence code 32 and the ABN date.

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.

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

A57593, Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies

J5

WPS-J5-L35761, Non-Invasive Peripheral Arterial Vascular Studies

J5

A56758, Billing and Coding: Non-Invasive Vascular Studies

J6

NGS-J6-L33627, Non-Invasive Vascular Studies

J6

WPS-J8-L35761, Non-Invasive Peripheral Arterial Vascular Studies

J8

FIRST_COAST-L33693, Peripheral Venous Ultrasound

J9

FIRST_COAST-L40288, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

J9

FIRST_COAST-L40289, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

J9

NOVITAS-JH-L40276, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

JH

NOVITAS-JH-L40275, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

JH

NOVITAS-JH-L35451, Peripheral Venous Ultrasound

JH

NGS-JK-L33627, Non-Invasive Vascular Studies

JK

NOVITAS-JL-L35451, Peripheral Venous Ultrasound

JL

NOVITAS-JL-L40276, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

JL

NOVITAS-JL-L40275, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

JL

A60318, Billing and Coding: Non-Invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

A60315, Billing and Coding: Non-Invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

A56697, Billing and Coding: Non-Invasive Vascular Studies

Related Codes

E09.59(20 policies)93931(20 policies)E08.52(20 policies)E09.52(20 policies)93926(20 policies)93930(20 policies)93925(20 policies)E10.52(20 policies)

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