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ICD-10-CM S99.811D, Other specified injuries of right ankle, subsequent encounter | No Prior Auth

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`S99.811D`, Other specified injuries of right ankle, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When billing CPT 95905 for carpal tunnel, the diagnosis code must be G56.01 or G56.02.
Data gathered during NCS should be available to support the claim, although it is not necessary to include documentation with every claim submission.
Providers are expected to use CPT 95870 for sampling muscles other than paraspinals associated with tested extremities; CPT 95870 should not be billed for paraspinal sampling when extremity EMG codes 95860, 95861, 95863, or 95864 are also billed.

PTs performing the technical portion of needle EMG under the 6A designation must be ABPTS-certified as a qualified electrophysiologic clinical specialist and must be authorized by state law to perform the service.

For ICD-10-CM codes designated with an asterisk, the patient must be under the active care of a MD/DO who documents the condition and the claim must include the attending physician's name and NPI in CMS-1500 blocks 17/17B, the date patient was last seen (DPLS) in block 19, and the complicating systemic disease in block 21.

All claims for routine foot care based on a systemic condition must include a billing indicator modifier Q7, Q8, or Q9 as appropriate to be considered for payment.

Key Coverage Criteria

Automated nerve conduction testing using the NC-stat (CPT 95905) is allowed only when there is a high pre-test or prior probability of carpal tunnel syndrome and the claim uses diagnosis code G56.01 or G56.02; allowed one service per arm.
If authorized by state law, physical therapists (PTs) are allowed to perform the technical and professional components of nerve conduction studies represented by CPT codes 95907-95913 consistent with a 7A supervision designation (effective 01/01/2013).
If authorized by state law, the technical component of neuromuscular junction testing CPT 95937 (TC) with supervision designation 7A is allowable for PTs consistent with the 7A description (effective 01/01/2013).
Needle electromyography CPT codes 95860-95872 and 95885-95887 have a 6A designation for the technical portion; PTs who are ABPTS-certified as qualified electrophysiologic clinical specialists and are authorized by state law may perform the technical and professional components according to the 6A description.
Electrodiagnostic nerve conduction studies and electromyography that provide real-time response parameters (amplitude, latency, configuration, conduction velocity) are acceptable for Medicare payment and should be used for provider interpretation.
Nail debridement (CPT 11720 or 11721) for mycotic nails is covered when billed with ICD-10-CM B35.1 as the primary diagnosis and one of the following as a secondary diagnosis: L02.611, L02.612, L03.031, L03.032, L03.041, L03.042, M79.671, M79.672, M79.674, M79.675, or R26.2.

2 Active Policies

A56619, Billing and Coding: Nerve Conduction Studies and Electromyography

A56680, Billing and Coding: Routine Foot Care

Related Codes

A30.3(2 policies)A30.8(2 policies)A30.1(2 policies)A30.2(2 policies)A30.4(2 policies)A30.5(2 policies)A30.0(2 policies)A30.9(2 policies)

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