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ICD-10-CM S95.219S, Laceration of dorsal vein of unspecified foot, sequela | No Prior Auth

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`S95.219S`, Laceration of dorsal vein of unspecified foot, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
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 ordering/referring physician/nonphysician practitioner must state the reason for the duplex scan in the order and provide relevant diagnostic information to the performing provider.

Key Coverage Criteria

Duplex scan of lower extremity arteries is covered when medically necessary per LCD L33667, with the ordering/referring provider documenting signs and symptoms, relevant history (including known diagnoses and/or prior imaging) supporting evaluation of lower extremity arterial disease.

1 Active Policy

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

J9

Related Codes

93926(1 policies)G97.31(1 policies)G97.32(1 policies)G97.51(1 policies)G97.52(1 policies)G97.61(1 policies)G97.62(1 policies)93925(1 policies)

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If a different provider performs the duplex scan, that provider must maintain a copy of the test results and interpretation along with copies of the ordering/referring provider's order.

Results of the duplex scan must be included in the patient's medical record as a hard copy or a soft copy convertible to a hard copy and of a quality that meets accepted medical standards.