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ICD-10-CM T87.30, Neuroma of amputation stump, unspecified extremity | No Prior Auth

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`T87.30`, Neuroma of amputation stump, unspecified extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identifiers (complete name, dates of service).
Medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the 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.
Documentation should state whether the block was performed for diagnostic or therapeutic purposes.

Key Coverage Criteria

Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
O00.00 - O00.91 — Ectopic pregnancy
O08.1 — Delayed or excessive hemorrhage following ectopic and molar pregnancy
O44.10 - O44.13 — Placenta previa with hemorrhage
O45.001 - O45.099 — Premature separation of placenta with coagulation defect
O46.001 - O46.099 — Antepartum hemorrhage with coagulation defect

5 Active Policies

FIRST_COAST-L33933, Peripheral Nerve Blocks

J9

AETNA-CPB-0100, Cryoablation

AETNA-CPB-0630, Prosthetic Limb Vacuum Systems

AETNA-CPB-0639, Autotransfusers and Red Blood Cell Genotyping

A57788, Billing and Coding: Peripheral Nerve Blocks

Related Codes

C20(3 policies)C49.0(3 policies)C15.9(3 policies)C18.0(3 policies)C22.0(3 policies)C48.0(3 policies)C15.3(3 policies)C49.8(3 policies)

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Documentation should include pre-procedure and post-procedure evaluations of the patient.

Documentation should include patient education provided related to the procedure and expected outcomes.