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ICD-10-CM S85.091S, Other specified injury of popliteal artery, right leg, sequela | No Prior Auth

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`S85.091S`, Other specified injury of popliteal artery, right leg, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
A valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed must be reported on the claim; claims without a valid code will be returned as incomplete.
For diagnostic MRA tests, report the result of the test if known; if not known, report the symptoms that prompted the test.

The patient's medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Procedure codes for MRA may be subject to National Correct Coding Initiative (NCCI) edits or Outpatient Prospective Payment System (OPPS) packaging edits and should be reviewed prior to billing Medicare.

The medical record must contain relevant medical history, physical examination, and results of pertinent diagnostic tests that fully support the medical necessity of each non-invasive vascular study.

Key Coverage Criteria

MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).
MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair when it is comparable to CA for determining extent of AAA and evaluating aortoiliac occlusive disease and renal artery pathology necessary for surgical planning.
MRA of the renal arteries and aortoiliac arteries (in the absence of AAA or aortic dissection) is covered when MRA is expected to avoid CA, physician history/physical and standard assessments are insufficient, and obtaining MRA has a high probability of positively affecting patient management.
MRA of the chest is covered for diagnosis of suspected pulmonary embolism when the patient has a contraindication to receiving intravascular iodinated contrast material.
MRA of the chest is covered for pre-operative and post-operative evaluation of thoracic aortic dissection and thoracic aortic aneurysm and may be used as an alternative to other non-invasive imaging when clinically appropriate.

20 Active Policies

NGS-J6-L33627, Non-Invasive Vascular Studies

J6

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

J6

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

J6

A56758, Billing and Coding: Non-Invasive Vascular Studies

J6

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

J9

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

J9

A57064, Billing and Coding: Duplex Scan of Lower Extremity Arteries

J9

FIRST_COAST-L33693, Peripheral Venous Ultrasound

J9

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

JH

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

JH

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

JH

NOVITAS-JH-L35451, Peripheral Venous Ultrasound

JH

NGS-JK-L33627, Non-Invasive Vascular Studies

JK

NGS-JK-L33633, Magnetic Resonance Angiography (MRA)

JK

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

JL

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

JL

NOVITAS-JL-L35451, Peripheral Venous Ultrasound

JL

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

JL

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

JL

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

Related Codes

I70.223(20 policies)I70.231(20 policies)I70.213(20 policies)I70.212(20 policies)I70.221(20 policies)I70.222(20 policies)I70.211(20 policies)I70.232(20 policies)

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