Nerve Blockade: Somatic, Selective Nerve Root, and Epidural Noridian Administrative Services, LLC
Please note: This is a Draft policy. Proposed/Draft LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed/Draft LCDs are not necessarily a reflection of the current policies or practices of the contractor. Contractor Information
Contractor Name
Noridian Administrative Services, LLC
Contract Number
03102
Contract Type
MAC - Part B
Associated Contract Numbers
(MAC (MAC (MAC (MAC (MAC (MAC (MAC (MAC (MAC
-
Part Part Part Part Part Part Part Part Part
B B B B B B B B B
-
03202) 03302) 03502) 03602) 03402) 02202) 02102) 02402) 02302)
Noridian Noridian Noridian Noridian Noridian Noridian Noridian Noridian Noridian
Administrative Administrative Administrative Administrative Administrative Administrative Administrative Administrative Administrative
Services, Services, Services, Services, Services, Services, Services, Services, Services,
LLC, LLC, LLC, LLC, LLC, LLC, LLC, LLC, LLC
Proposed/Draft LCD Information
Source LCD ID
N/A
1
Contractor Information Proposed LCD ID
DL33188
Proposed LCD Version Number
4
Proposed LCD Title
Nerve Blockade: Somatic, Selective Nerve Root, and Epidural
AMA CPT / ADA CDT Copyright Statement
CPT only copyright 2002-2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright (c) American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association.
CMS National Coverage Policy
Title XVIII of the Social Security Act, Section 1862(a)(1)(A) section allows coverage and payment for only those services that are considered to be reasonable and necessary. Title XVIII of the Social Security Act; Section 1833(e). This section prohibits Medicare payment for any claim, which lacks the necessary information to process the claim. Title XVIII of the Social Security Act, Section 1862(a)(7) is excludes routine physicals (except screening examinations allowed by statute). IOM 100-3 (1) 30.3.1 and 30.3.2 and PIM 7.2.8.4: Acupuncture is a non-covered service. IOM 100-4 (23) 20.9: Anesthesia is included in surgical procedures.
Jurisdiction
AZ
Coverage Guidance Coverage Indications, Limitations and/or Medical Necessity
Note: Providers should seek information related to National Coverage Determinations (NCD) and other Centers for Medicare & Medicaid Services (CMS) instructions in CMS Manuals. This LCD only pertains to the contractor's discretionary coverage related to this service.
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Contractor Information This LCD solely addresses the use of these blocks in the definition and treatment of pain and conditions primarily treated with nerve blockade, such as complex regional pain syndrome and certain hyperhidroses. For the purposes of this LCD and consistent with standard community understanding and the recommendations of specialty societies, pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. PAIN is chronic when it has been present, continuously or intermittently, despite therapy for three months or more. 1 An appropriate injection of local anesthetic induces a temporary interruption in the conduction of impulses by peripheral nerves or nerve trunks. Longer-lasting or permanent blockade may be induced with the injection of neurolytic agents and/or application of thermal (not pulsed) radiofrequency. Prior to blockade, all patients with pain complaints require an evaluation that includes, at a minimum, an assessment of the source of the pain and treatment of any underlying pathology. Evaluation must be documented in the patient’s records. In addition, those patients who do not respond to injections or otherwise continue with persistent or poorly responsive pain should be referred for a multi-disciplinary or other collaborative comprehensive evaluation. Nerve blocks may be performed for several reasons and may be covered for the following purposes: • Diagnostic - to determine the source of pain e.g., to identify or pinpoint a nerve that acts as a pathway for pain; to determine the type of nerve that conducts the pain; to distinguish between pain that is central (within the spinal cord) or peripheral (outside the spinal cord) in origin; or to determine whether a neurolytic block or surgical lysis of the nerve should be performed. The type of diagnostic test may include injecting saline to stimulate pain or injecting an anesthetic agent to evaluate the patient's response, as an initial diagnostic step so that other pain relief options may be considered. • Therapeutic - to treat painful conditions that respond to nerve blocks (e.g., celiac block for pain of pancreatic cancer) and /or “inappropriate” sympathetic nervous system activity. Note: Epidural steroids should be used only in the presence of radiculopathy. • Prognostic - to predict the outcome of long-lasting interventions
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Contractor Information (e.g., infusions, neurolysis, rhizotomy). In general, different types of nerve block should not be performed at the same setting as other blocks in the same body region. However, in patients with pain problems that involve more than one area of the body, a somatic nerve block may be provided on the same day as another type of block, such as, an epidural block, selective nerve root block, bilateral sacroiliac joint injection, etc. In this situation, the body areas blocked must be discrete from each other and separated by physical distance, e.g. a lumbar paravertebral somatic nerve block and a cervical facet block. In most cases, treatment of pain requires less than and no more than three of the same type of injection (or sets of injections) to alleviate pain. If a previous series of epidural injections provided significant relief of pain as evidenced by objective criteria and the pain reoccurs, a repeat series of epidural injections-not to exceed three in a series may be performed. Additional treatment will be denied as not reasonable and necessary unless significant improvement is documented with subjective evidence, such as, return to work, decrease in other forms of analgesia, etc. See “Documentation Requirements” below. Reimbursement for the control or management of pain in the immediate postoperative period is bundled into the payment for the procedure, surgical or anesthetic-regardless of the method by which the care provider, including the anesthesiologist, decides to manage pain. Following discharge from the post-anesthesia care unit (PACU), the medically reasonable and necessary placement of regional or peripheral pain blocks or initiation of other new pain interventions or “top-up” dosing may be reimbursable. Providers should not expect separate payment for the establishment of epidural or other pain blocks unless the block is placed following discharge from PACU due to documented inadequate pain control. SOMATIC NERVE BLOCK This nerve blockade is commonly accomplished through injections of local anesthetic in the near proximity of the nerve. The exact technique varies both with anatomy and clinical objective. Indications Diagnostically, the block may be used to delineate uncertain pain generators (for example, sympathetic vs. somatic). Therapeutically, the block may be used to achieve relief from the acute pain associated with trauma, acute herpetic and other types of neuralgias, and chronic cancer-related pain. Blockade of multiple somatic nerves (at different levels) may be necessary for proper evaluation and/or management of acute and chronic pain in
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Contractor Information any given patient. When blockade has been of value in the relief of acute or cancer pain, somatic blockade may be maintained through the infusion of local anesthetics via indwelling catheter. Fluoroscopy and ultrasound may be necessary to the performance of this type of block. Limitations Radiculopathy and other neurological deficit that may require further evaluation and management should be ruled out or established by physical/electrophysiologic/other examinations prior to performing the blocks and evaluated. SELECTIVE NERVE ROOT BLOCK Selective nerve root block (SNRB) is primarily a diagnostic procedure, in which a selective, reproducible blockade of a specific nerve root(s) is achieved with the injection of a local anesthetic with or without steroid. Any nerve root from C-2 to S-5 can be selectively blocked. Fluoroscopic or CT imaging should be used to facilitate the proper placement of the tip of the injecting needle adjacent to the lateral margin of the neuroforamen. Radiologic guidance should include the use of dye, when not contraindicated, to ascertain that the infusion of the medication does not appear to reach the epidural space. Nerve stimulation and paresthesia can be used as additional confirmation AND/ or if dye is contraindicated. Definitive diagnosis cannot be made solely based upon the outcome of this block, but this block can be used to confirm the findings of a carefully conducted evaluation, including history, physical, and careful neurologic testing. Indications The SNRB may be useful in the diagnosis of presumed acute radicular pain, of less than three months duration, in which surgical intervention is planned and the SNRB is to confirm the results of careful history, physical and neurological testing. The SNRB may also be useful in differential diagnosis: in establishing the type of pain (somatic, visceral or functional) and source(s) or foci. Clinical scenarios include but are not limited to the following. 1. The patient's pain appears to be due to classic monoradiculopathy but the neuro-diagnostic studies fail to provide a structural explanation (i.e., selective nerve root blockade helps establish or rule out the diagnosis of radiculopathy).
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Contractor Information 2. The patient has a classic monoradicular pain and the radiological studies demonstrate an abnormality only related to another nerve root. 3. The clinical picture is suggestive but not typical for both nerve root and distal nerve or joint disease and SNRB may determine the etiology. Selective nerve root blockade may be used as a therapeutic procedure for the treatment of pain due to Complex Regional Pain Syndrome (CRPS), radicular pain secondary to post-surgical scarring and monoradicular pain for which no surgically correctable lesion can be found. In these cases, it is standard procedure is to limit the number of blocks to three or less in any given treatment period unless a documented and reasonable expectation of progressive and significant improvement with an additional block(s) exists. If there is reason to suspect that the treatment of pain may require more than three blocks, for example, the pain of herpes zoster or cancer, more definitive pain control techniques, including, infusions, should be considered. Therapeutic blockade with local anesthetic may be combined with depository steroids to produce longer-lasting relief. EPIDURAL BLOCK There are several routes of epidural injection: interlaminar, transforaminal, and caudal. Epidural blocks may be performed with or without insertion of a directional catheter to target specific pathology. The site of pathology should be considered when choosing the route and level of injection. Fluoroscopy and contrast may document the adequacy and appropriateness of the site and spread of the medication. Indications Epidural injections of local anesthetics are indicated in the treatment of diseases listed under covered ICD-9-CM codes. Epidural injections should be applied with a frequency appropriate to their value. In most cases these discrete injections should not be repeated in less than five days, should be limited to a total of three injections in a three to six month period of time and should only be repeated if the injections produced significant and sustained relief documented by objective evidence, such as improvements in the ability to perform ADL’s. When steroids are used, consideration should be given to the potential complications of STEROIDS and ESPECIALLY repetitive steroid dosing. Steroids should be used only in the presences
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Contractor Information of radiculopathy. Proposed/Draft Process Information Associated Information
The medical record must be made available to Medicare upon request. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits in addition to guidance in this LCD. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare. Whichever guidance is more restrictive should be adhered to. When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862(a)(1) of the Social Security Act. When requesting an individual consideration through the written redetermination (formerly appeal) process, providers must include all relevant medical records and any pertinent peer-reviewed literature that supports the request. At a minimum, literature such as two (2) Phase II studies (human studies of efficacy, pivotal) or one (1) Phase III study (evidence of safety and efficacy, pivotal) must be submitted for the Medical Director’s review. This policy does not reflect the sole opinion of the contractor or the Contractor Medical Director(s). Although the final decision rests with the contractor, this policy was developed in cooperation with the Carrier Advisory Committee(s), which include representatives of various medical specialty societies. The Section titled "Does the ‘CPT 30% Rule' apply?" needs clarification. This rule comes from the AMA (American Medical Association), the organization that holds the copyrights for all CPT codes. The rule states that if, in a given section (e.g., surgery) or subsection (e.g., surgery, integumentary) of the CPT Manual, more than 30% of the codes are listed in the LCD, then the short descriptors must be used rather than the long descriptors found in the CPT Manual. This policy is subject to the reasonable and necessary guidelines and the limitation of liability provision. This medical policy consolidates and replaces all previous policies and publications on this subject by NAS and its predecessors for Medicare Part B.
Sources of
1
Merskey H, Bogduk N. Description of chronic pain syndromes and
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Contractor Information Information and Basis for Decision
definitions of pain terms. In: Classification of Chronic Pain, 2nd ed. Seattle, WA: IASP press; 1994. Satterthwaite, Dollison. Handbook of Pain Management, 2nd Edition, 1994, Williams and Wilkins. Karmakar MK et al. Thoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma. Reg Anesth Pain Med 2001; 26:169-173 Lang SA. The use of a nerve stimulator for thoracic paravertebral block (letter). Anesth 2002; 97:521. Naja MZ et al. Nerve-stimulator guided paravertebral blockade vs. general anesthesia for breast surgery. Euro J. Anaesth. 2003;20:897-903. Raj P.P. Peripheral neurolysis in the management of pain. In Waldman, Winnie ed. Interventional Pain Management. 1996, WB Saunders, Phil, PA. pp. 395-400. Klein SM et al. Thoracic paravertebral block for breast surgery. Anesth and Analg. 2000;90:1402-5. Boezaart A et al. Paravertebral approach to the brachial plexus: an anatomic improvement in technique. Reg Anesth Pain Med. 2003;28:241-4. Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001; 95:771-80. Kelly FE et al. Continuous paravertebral block for thoracoabdominal oesophageal surgery (letter). Anaesth. 2005; 60:98. Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001; 95:771-80. NAS Intermediary Advisory Committee (IAC) on Pain ASA Pain Committee Yale University School of Medicine, Department of Pain Management. Connecticut Society of Anesthesiology Local Medical Review Policy from Nationwide Insurance Company. Medicare Operations Spine Five: 193-200, 1980.
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Contractor Information Journal of Neurosurgery 43:448-451, 1975. Joint section on pain, the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Carrier Advisory Committee (CAC) Meetings
Meeting Date 03/26/2013
Meeting Information Advisory Committee Meeting Notes This medical policy will be presented at the Medicare Part B Open Public Meeting March 26, 2013. It will again be discussed at the following Carrier Advisory Committee meetings on the following dates: Alaska 05/09/2013 Arizona 05/28/2013 Idaho 05/22/2013 Montana 05/09/2013 North Dakota 05/14/2013 Oregon 04/13/2013 South Dakota 05/16/2013 Utah 05/02/2013 Washington 04/09/2013 Wyoming 05/02/2013
Comment Period Start Date
03/26/2013
Comment Period End Date
07/11/2013
Released to Final LCD Date
Not yet released.
Reason for Proposed LCD
Creation of Uniform LCDs Within a MAC Jurisdiction
Proposed LCD Contact
Noridian Administrative Services LLC Contractor Medical Director(s) Policy Development - Medicare Part B - Drafts 900 42nd Street S. Fargo, ND 58108
[email protected]
Coding Information
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Contractor Information
Bill Type Codes
012x
Hospital Inpatient (Medicare Part B only)
013x
Hospital Outpatient
022x
Skilled Nursing - Inpatient (Medicare Part B only)
023x
Skilled Nursing - Outpatient
085x
Critical Access Hospital
Revenue Codes
CPT/HCPCS Codes
045X
Emergency Room - General Classification
051X
Clinic - General Classification
052X
Free-Standing Clinic - General Classification
076X
Specialty Services - General Classification
096X
Professional Fees - General Classification
Group 1: Paragraph FOR SOMATIC NERVE BLOCK: Group 1: Codes 64400
N block inj trigeminal
64402
N block inj facial
64405
N block inj occipital
64408
N block inj vagus
64410
N block inj phrenic
64412
N block inj spinal accessor
64413
N block inj cervical plexus
64415
N block inj brachial plexus
64416
N block cont infuse b plex
64417
N block inj axillary
64418
N block inj suprascapular
64420
N block inj intercost sng
10
Contractor Information 64421
N block inj intercost mlt
64425
N block inj ilio-ing/hypogi
64430
N block inj pudendal
64435
N block inj paracervical
64445
N block inj sciatic sng
64446
N blk inj sciatic cont inf
64447
N block inj fem single
64448
N block inj fem cont inf
64449
N block inj lumbar plexus
64450
N block other peripheral
64455
N block inj plantar digit
64505
N block spenopalatine gangl
64508
N block carotid sinus s/p
64510
N block stellate ganglion
64517
N block inj hypogas plxs
64520
N block lumbar/thoracic
64530
N block inj celiac pelus
64620
Injection treatment of nerve
64632
N block inj common digit
64640
Injection treatment of nerve
Group 2: Paragraph FOR SELECTIVE NERVE ROOT BLOCK (SNRB): Do not report 77003 in conjunction with 64479, 64483, or 64484. Group 2: Codes 62281
Treat spinal cord lesion
62282
Treat spinal canal lesion
64479
Inj foramen epidural c/t
64483
Inj foramen epidural l/s
64484
Inj foramen epidural add-on
Group 3: Paragraph
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Contractor Information FOR EPIDURAL BLOCK: Group 3: Codes 62281
Treat spinal cord lesion
62282
Treat spinal canal lesion
62310
Inject spine cerv/thoracic
62311
Inject spine lumbar/sacral
62318
Inject spine w/cath crv/thrc
62319
Inject spine w/cath lmb/scrl
Group 4: Paragraph FOR IMAGING GUIDANCE: Group 4: Codes 77003
Does the CPT 30% Coding Rule Apply? ICD-9 Codes that Support Medical Necessity
Fluoroguide for spine inject
Yes
Group 1: Paragraph Group 1: Codes 053.0
HERPES ZOSTER WITH MENINGITIS
053.10
HERPES ZOSTER WITH UNSPECIFIED NERVOUS SYSTEM COMPLICATION
053.11
GENICULATE HERPES ZOSTER
053.12
POSTHERPETIC TRIGEMINAL NEURALGIA
053.13
POSTHERPETIC POLYNEUROPATHY
053.14
HERPES ZOSTER MYELITIS
053.8
HERPES ZOSTER WITH UNSPECIFIED COMPLICATION
053.9
HERPES ZOSTER WITHOUT COMPLICATION
337.20
REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED
337.21
REFLEX SYMPATHETIC DYSTROPHY OF THE UPPER LIMB
337.22
REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER
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Contractor Information LIMB 337.29
REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE
338.11*
ACUTE PAIN DUE TO TRAUMA
338.12*
ACUTE POST-THORACOTOMY PAIN
338.18*
OTHER ACUTE POSTOPERATIVE PAIN
338.19*
OTHER ACUTE PAIN
338.21
CHRONIC PAIN DUE TO TRAUMA
338.22
CHRONIC POST-THORACOTOMY PAIN
338.28
OTHER CHRONIC POSTOPERATIVE PAIN
338.29
OTHER CHRONIC PAIN
338.3
NEOPLASM RELATED PAIN (ACUTE) (CHRONIC)
350.1
TRIGEMINAL NEURALGIA
353.0
BRACHIAL PLEXUS LESIONS
353.1
LUMBOSACRAL PLEXUS LESIONS
353.2
CERVICAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED
353.3
THORACIC ROOT LESIONS NOT ELSEWHERE CLASSIFIED
353.4
LUMBOSACRAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED
353.5
NEURALGIC AMYOTROPHY
353.6
PHANTOM LIMB (SYNDROME)
353.8
OTHER NERVE ROOT AND PLEXUS DISORDERS
354.0
CARPAL TUNNEL SYNDROME
354.1
OTHER LESION OF MEDIAN NERVE
354.2
LESION OF ULNAR NERVE
354.3
LESION OF RADIAL NERVE
354.4
CAUSALGIA OF UPPER LIMB
354.5
MONONEURITIS MULTIPLEX
354.8
OTHER MONONEURITIS OF UPPER LIMB
354.9
MONONEURITIS OF UPPER LIMB UNSPECIFIED
13
Contractor Information 355.0
LESION OF SCIATIC NERVE
355.1
MERALGIA PARESTHETICA
355.2
OTHER LESION OF FEMORAL NERVE
355.3
LESION OF LATERAL POPLITEAL NERVE
355.4
LESION OF MEDIAL POPLITEAL NERVE
355.5
TARSAL TUNNEL SYNDROME
355.6
LESION OF PLANTAR NERVE
355.71
CAUSALGIA OF LOWER LIMB
355.79
OTHER MONONEURITIS OF LOWER LIMB
355.8
MONONEURITIS OF LOWER LIMB UNSPECIFIED
355.9
MONONEURITIS OF UNSPECIFIED SITE
443.0
RAYNAUD'S SYNDROME
705.21
PRIMARY FOCAL HYPERHIDROSIS
719.41
PAIN IN JOINT INVOLVING SHOULDER REGION
719.45
PAIN IN JOINT INVOLVING PELVIC REGION AND THIGH
719.46
PAIN IN JOINT INVOLVING LOWER LEG
720.2
SACROILIITIS NOT ELSEWHERE CLASSIFIED
722.80
POSTLAMINECTOMY SYNDROME OF UNSPECIFIED REGION
722.81
POSTLAMINECTOMY SYNDROME OF CERVICAL REGION
722.82
POSTLAMINECTOMY SYNDROME OF THORACIC REGION
722.83
POSTLAMINECTOMY SYNDROME OF LUMBAR REGION
723.1
CERVICALGIA
723.4
BRACHIAL NEURITIS OR RADICULITIS NOS
723.8
OTHER SYNDROMES AFFECTING CERVICAL REGION
724.03
SPINAL STENOSIS, LUMBAR REGION, WITH NEUROGENIC CLAUDICATION
724.1
PAIN IN THORACIC SPINE
14
Contractor Information 724.2
LUMBAGO
724.3
SCIATICA
724.4
THORACIC OR LUMBOSACRAL NEURITIS OR RADICULITIS UNSPECIFIED
724.79
OTHER DISORDERS OF COCCYX
729.2
NEURALGIA NEURITIS AND RADICULITIS UNSPECIFIED
733.6
TIETZE'S DISEASE
780.1
HALLUCINATIONS
781.0
ABNORMAL INVOLUNTARY MOVEMENTS
784.92
JAW PAIN
786.50*
UNSPECIFIED CHEST PAIN
786.52
PAINFUL RESPIRATION
789.09
ABDOMINAL PAIN OTHER SPECIFIED SITE
953.0
INJURY TO CERVICAL NERVE ROOT
953.1
INJURY TO DORSAL NERVE ROOT
953.2
INJURY TO LUMBAR NERVE ROOT
953.3
INJURY TO SACRAL NERVE ROOT
953.4
INJURY TO BRACHIAL PLEXUS
953.5
INJURY TO LUMBOSACRAL PLEXUS
953.8
INJURY TO MULTIPLE SITES OF NERVE ROOTS AND SPINAL PLEXUS
953.9
INJURY TO UNSPECIFIED SITE OF NERVE ROOTS AND SPINAL PLEXUS
954.0
INJURY TO CERVICAL SYMPATHETIC NERVE EXCLUDING SHOULDER AND PELVIC GIRDLES
954.1
INJURY TO OTHER SYMPATHETIC NERVE EXCLUDING SHOULDER AND PELVIC GIRDLES
954.8
INJURY TO OTHER SPECIFIED NERVE(S) OF TRUNK EXCLUDING SHOULDER AND PELVIC GIRDLES
954.9
INJURY TO UNSPECIFIED NERVE OF TRUNK EXCLUDING SHOULDER AND PELVIC GIRDLES
955.0
INJURY TO AXILLARY NERVE
15
Contractor Information 955.1
INJURY TO MEDIAN NERVE
955.2
INJURY TO ULNAR NERVE
955.3
INJURY TO RADIAL NERVE
955.4
INJURY TO MUSCULOCUTANEOUS NERVE
955.5
INJURY TO CUTANEOUS SENSORY NERVE UPPER LIMB
955.6
INJURY TO DIGITAL NERVE UPPER LIMB
955.7
INJURY TO OTHER SPECIFIED NERVE(S) OF SHOULDER GIRDLE AND UPPER LIMB
955.8
INJURY TO MULTIPLE NERVES OF SHOULDER GIRDLE AND UPPER LIMB
955.9
INJURY TO UNSPECIFIED NERVE OF SHOULDER GIRDLE AND UPPER LIMB
956.0
INJURY TO SCIATIC NERVE
956.1
INJURY TO FEMORAL NERVE
956.2
INJURY TO POSTERIOR TIBIAL NERVE
956.3
INJURY TO PERONEAL NERVE
956.4
INJURY TO CUTANEOUS SENSORY NERVE LOWER LIMB
956.5
INJURY TO OTHER SPECIFIED NERVE(S) OF PELVIC GIRDLE AND LOWER LIMB
956.8
INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB
956.9
INJURY TO UNSPECIFIED NERVE OF PELVIC GIRDLE AND LOWER LIMB
957.0
INJURY TO SUPERFICIAL NERVES OF HEAD AND NECK
957.1
INJURY TO OTHER SPECIFIED NERVE(S)
957.8
INJURY TO MULTIPLE NERVES IN SEVERAL PARTS
957.9
INJURY TO NERVES UNSPECIFIED SITE
V58.42
AFTERCARE FOLLOWING SURGERY FOR NEOPLASM
V58.43
AFTERCARE FOLLOWING SURGERY FOR INJURY AND TRAUMA
V58.49
OTHER SPECIFIED AFTERCARE FOLLOWING
16
Contractor Information SURGERY Group 1: Asterisk *Reimbursement for the control or management of pain in the immediate postoperative period is bundled into the payment for the procedure, surgical or anesthetic-regardless of the method by which the care provider, including the anesthesiologist, decides to manage the pain. Following discharge from the postanesthesia care unit (PACU), the medically reasonable and necessary placement of regional or peripheral pain blocks or initiation of other new pain interventions or “top-up” dosing may be reimbursable. Providers should not expect separate payment for the establishment of epidural or other pain blocks unless the block is placed following discharge from PACU due to documented inadequate pain control. *ICD-9-CM code 786.50 is to be used to describe rib pain.
ICD-9 Codes that DO NOT Support Medical Necessity
All ICD-9-CM codes not listed in this policy under "ICD-9-CM Codes that Support Medical Necessity" above.
Associated Documents Attachments
There are no attachments for this LCD
Related Local Coverage Documents
This LCD version has no Related Local Coverage Documents.
Related National Coverage Documents
This LCD version has no Related National Coverage Documents.
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