LCD Reference Article Billing and Coding Article

Billing and Coding: Somatosensory Testing

A57597

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
N/A
Article ID
A57597
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Somatosensory Testing
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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.

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS transmittals. Contractors are prohibited from changing national language.

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary
information to process the claim.

Code of Federal Regulations:

42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests

CMS Publication 100-03, Medicare Benefit Policy Manual, Chapter 1, Part 2: Section 160.23 Sensory Nerve Conduction Threshold Tests (sNCTs)

CMS Publication 100-04, Medicare Benefit Policy Manual, Chapter 23 - Fee Schedule Administration and Coding Requirements: Section 10 - Reporting ICD Diagnosis and Procedure Codes

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD.

Utilization Guidelines
It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

The Medicare Physician Fee Schedule Database (MPFSDB) physician supervision indicator for CPT codes 95925, 92526, 95927 and 95938 have Level 21 for the technical component. Level 21 defined as: Procedure may be performed by a technician with certification under general supervision of a physician. Otherwise the procedure must be performed under direct supervision of a physician. Procedure may also be performed by a PT with ABPTS certification without physician supervision.

Program Memorandum Transmittal B-01-28/Change Request 850 sets forth revised levels of physician supervision required for diagnostic tests payable under the Medicare Physician Fee Schedule. Effective July 1, 2001, certain codes in the range of CPT 95860-95937 were assigned new supervision levels (21, 22, 6a, 66, 77 or 77a). This implementation date would make it possible for physical therapists to acquire the certification required to perform these services without supervision. A physical therapist who is presently certified by the American Board of Physical Therapy Specialties can perform procedures assigned level of 21, 22, 66, 6a, 77, or 77a without supervision. These numeric levels assigned to the CPT codes are listed in the Medicare Physician Fee Schedule Database (MFSDB). Physical therapists who do not possess the ABPTS (American Board of Physical Therapy Specialties) certification by July 1, 2001, may continue to furnish those tests that require the certification if they have been furnishing such diagnostic tests prior to May 1, 2001.

Therefore, if authorized by state law Physical Therapists are allowed the technical portion of the test.

Nurse practitioners, clinical nurse specialists, and physician assistants are not defined as physicians under §1861(r) of the Act. Therefore, they may not function as supervisory physicians under the diagnostic tests benefit (§1861(s)(3) of the Act). However, when these practitioners personally perform diagnostic tests as provided under §1861(s)(2)(K) of the Act, §1861(s)(3) does not apply and they may perform diagnostic tests pursuant to State scope of practice laws and under the applicable State requirements for physician supervision or collaboration. (CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15: Section 80: Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests).

CMS Publication 100-08, Program Integrity Manual, Chapter 13, Section 5.4 outlines that “reasonable and necessary” services are “ordered and/or furnished by qualified personnel.” Provision of interpretation and/or supervision of these tests will be considered medically reasonable and necessary only if performed by appropriately trained providers. Training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty, certification by a nationally recognized organization, or by an accredited post-graduate training course covering anatomy, neurophysiology and forms of electrodiagnostics (including both NCS and EMG). If this skill has been acquired as continuing medical education, the courses must be comprehensive, offered, sponsored, or endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States, and designated by the American Medical Association (AMA) or the American Osteopathic Association (AOA) as Category 1 Credit. Documentation of training must be available upon request.

It is expected that the training and experience would include:

  • existing knowledge of the anatomic structures and neurophysiologic events underlying the generation of evoked potentials;
  • the influences of stimulus parameters and other experimental variables on the responses that are recorded;
  • relevant normative data and statistics; and
  • the clinical significance and pathologic correlates of dysfunctional neural pathways demonstrated by evoked potential alterations.

CMS long-standing policy that the concept of physician supervision does not apply (PSI of “09”) to these PT-designated diagnostic services, which allows payment to be made for the PC or global code to the ABPTS-PT, excepted by regulation, as long as it is legal for the ABPTS-PT to provide the service in that state, and the TC has been either personally performed by the ABPTS-PT or the PT without the ABPTS certification has met the supervision requirements for the technical component portion of the service consistent with the applicable supervision indicator.

Documentations Requirements
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this Article and related LCD. This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Medical record documentation maintained by the performing provider must clearly indicate the medical necessity of the service being billed. There should be evidence in the medical record that the test results were noted and influenced or contributed to the patient’s course of treatment. In addition, documentation that the service was performed must be included in the patient’s medical record. This documentation should include a hard copy computer generated recording of the test results along with the provider’s interpretation. The provider’s SEP report should note which nerves were tested, latencies at various testing points, and an evaluation of whether the resulting values are normal or abnormal. This information is normally found in the office/progress notes, hospital records, and/or procedure notes.

If the provider of somatosensory testing is other than the ordering or referring physician or nonphysician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies.

Providers of interpretations, supervision, and performance of the technical portions of the studies must be capable of demonstrating documented training and experience for post-payment audit.

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Coding Information

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(465 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
A18.01 Tuberculosis of spine
C41.2 Malignant neoplasm of vertebral column
C70.0 Malignant neoplasm of cerebral meninges
C70.1 Malignant neoplasm of spinal meninges
C72.0 Malignant neoplasm of spinal cord
C72.1 Malignant neoplasm of cauda equina
C72.21 Malignant neoplasm of right olfactory nerve
C72.22 Malignant neoplasm of left olfactory nerve
C72.31 Malignant neoplasm of right optic nerve
C72.32 Malignant neoplasm of left optic nerve
C72.41 Malignant neoplasm of right acoustic nerve
C72.42 Malignant neoplasm of left acoustic nerve
C72.59 Malignant neoplasm of other cranial nerves
C73 Malignant neoplasm of thyroid gland
C79.31 Secondary malignant neoplasm of brain
C79.32 Secondary malignant neoplasm of cerebral meninges
C79.49 Secondary malignant neoplasm of other parts of nervous system
D21.0 Benign neoplasm of connective and other soft tissue of head, face and neck
D32.0 Benign neoplasm of cerebral meninges
D32.1 Benign neoplasm of spinal meninges
D33.0 Benign neoplasm of brain, supratentorial
D33.1 Benign neoplasm of brain, infratentorial
D33.3 Benign neoplasm of cranial nerves
D33.4 Benign neoplasm of spinal cord
D33.7 Benign neoplasm of other specified parts of central nervous system
D42.0 Neoplasm of uncertain behavior of cerebral meninges
D42.1 Neoplasm of uncertain behavior of spinal meninges
D43.0 Neoplasm of uncertain behavior of brain, supratentorial
D43.1 Neoplasm of uncertain behavior of brain, infratentorial
D43.3 Neoplasm of uncertain behavior of cranial nerves
D43.4 Neoplasm of uncertain behavior of spinal cord
D43.8 Neoplasm of uncertain behavior of other specified parts of central nervous system
D44.3 Neoplasm of uncertain behavior of pituitary gland
D44.4 Neoplasm of uncertain behavior of craniopharyngeal duct
D44.5 Neoplasm of uncertain behavior of pineal gland
D44.6 Neoplasm of uncertain behavior of carotid body
D44.7 Neoplasm of uncertain behavior of aortic body and other paraganglia
D49.6 Neoplasm of unspecified behavior of brain
E03.5 Myxedema coma
G06.1 Intraspinal abscess and granuloma
G11.11 Friedreich ataxia
G11.19 Other early-onset cerebellar ataxia
G11.3 Cerebellar ataxia with defective DNA repair
G11.4 Hereditary spastic paraplegia
G11.8 Other hereditary ataxias
G12.23 Primary lateral sclerosis
G12.24 Familial motor neuron disease
G12.25 Progressive spinal muscle atrophy
G25.3 Myoclonus
G35 Multiple sclerosis
G36.0 Neuromyelitis optica [Devic]
G37.0 Diffuse sclerosis of central nervous system
G37.3 Acute transverse myelitis in demyelinating disease of central nervous system
G37.5 Concentric sclerosis [Balo] of central nervous system
G40.011 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus
G40.019 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus
G40.111 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus
G40.119 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus
G40.211 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus
G40.219 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus
G45.0 Vertebro-basilar artery syndrome
G45.1 Carotid artery syndrome (hemispheric)
G45.2 Multiple and bilateral precerebral artery syndromes
G45.8 Other transient cerebral ischemic attacks and related syndromes
G46.0 Middle cerebral artery syndrome
G46.1 Anterior cerebral artery syndrome
G46.2 Posterior cerebral artery syndrome
G50.0 Trigeminal neuralgia
G50.1 Atypical facial pain
G53 Cranial nerve disorders in diseases classified elsewhere
G54.0 Brachial plexus disorders
G54.1 Lumbosacral plexus disorders
G54.2 Cervical root disorders, not elsewhere classified
G54.3 Thoracic root disorders, not elsewhere classified
G54.4 Lumbosacral root disorders, not elsewhere classified
G80.4 Ataxic cerebral palsy
G80.8 Other cerebral palsy
G93.5 Compression of brain
G95.0 Syringomyelia and syringobulbia
G95.20 Unspecified cord compression
G95.29 Other cord compression
G95.9 Disease of spinal cord, unspecified
H71.01 Cholesteatoma of attic, right ear
H71.02 Cholesteatoma of attic, left ear
H71.03 Cholesteatoma of attic, bilateral
H71.11 Cholesteatoma of tympanum, right ear
H71.12 Cholesteatoma of tympanum, left ear
H71.13 Cholesteatoma of tympanum, bilateral
H71.21 Cholesteatoma of mastoid, right ear
H71.22 Cholesteatoma of mastoid, left ear
H71.23 Cholesteatoma of mastoid, bilateral
H71.31 Diffuse cholesteatosis, right ear
H71.32 Diffuse cholesteatosis, left ear
H71.33 Diffuse cholesteatosis, bilateral
H74.41 Polyp of right middle ear
H74.42 Polyp of left middle ear
H74.43 Polyp of middle ear, bilateral
H83.11 Labyrinthine fistula, right ear
H83.12 Labyrinthine fistula, left ear
H83.13 Labyrinthine fistula, bilateral
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.8 Other nontraumatic subarachnoid hemorrhage
I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical
I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical
I61.3 Nontraumatic intracerebral hemorrhage in brain stem
I61.4 Nontraumatic intracerebral hemorrhage in cerebellum
I61.5 Nontraumatic intracerebral hemorrhage, intraventricular
I61.6 Nontraumatic intracerebral hemorrhage, multiple localized
I61.8 Other nontraumatic intracerebral hemorrhage
I62.01 Nontraumatic acute subdural hemorrhage
I62.02 Nontraumatic subacute subdural hemorrhage
I62.03 Nontraumatic chronic subdural hemorrhage
I62.1 Nontraumatic extradural hemorrhage
I63.00 Cerebral infarction due to thrombosis of unspecified precerebral artery
I63.011 Cerebral infarction due to thrombosis of right vertebral artery
I63.012 Cerebral infarction due to thrombosis of left vertebral artery
I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.02 Cerebral infarction due to thrombosis of basilar artery
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.09 Cerebral infarction due to thrombosis of other precerebral artery
I63.10 Cerebral infarction due to embolism of unspecified precerebral artery
I63.111 Cerebral infarction due to embolism of right vertebral artery
I63.112 Cerebral infarction due to embolism of left vertebral artery
I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries
I63.12 Cerebral infarction due to embolism of basilar artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.19 Cerebral infarction due to embolism of other precerebral artery
I63.20 Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries
I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries
I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar artery
I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I65.01 Occlusion and stenosis of right vertebral artery
I65.02 Occlusion and stenosis of left vertebral artery
I65.03 Occlusion and stenosis of bilateral vertebral arteries
I65.1 Occlusion and stenosis of basilar artery
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.8 Occlusion and stenosis of other precerebral arteries
I65.9 Occlusion and stenosis of unspecified precerebral artery
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I67.0 Dissection of cerebral arteries, nonruptured
I67.1 Cerebral aneurysm, nonruptured
I67.5 Moyamoya disease
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I71.010 Dissection of ascending aorta
I71.011 Dissection of aortic arch
I71.012 Dissection of descending thoracic aorta
I71.019 Dissection of thoracic aorta, unspecified
I71.02 Dissection of abdominal aorta
I71.03 Dissection of thoracoabdominal aorta
I71.10 Thoracic aortic aneurysm, ruptured, unspecified
I71.11 Aneurysm of the ascending aorta, ruptured
I71.12 Aneurysm of the aortic arch, ruptured
I71.13 Aneurysm of the descending thoracic aorta, ruptured
I71.20 Thoracic aortic aneurysm, without rupture, unspecified
I71.21 Aneurysm of the ascending aorta, without rupture
I71.22 Aneurysm of the aortic arch, without rupture
I71.23 Aneurysm of the descending thoracic aorta, without rupture
I71.30 Abdominal aortic aneurysm, ruptured, unspecified
I71.31 Pararenal abdominal aortic aneurysm, ruptured
I71.32 Juxtarenal abdominal aortic aneurysm, ruptured
I71.33 Infrarenal abdominal aortic aneurysm, ruptured
I71.40 Abdominal aortic aneurysm, without rupture, unspecified
I71.41 Pararenal abdominal aortic aneurysm, without rupture
I71.42 Juxtarenal abdominal aortic aneurysm, without rupture
I71.43 Infrarenal abdominal aortic aneurysm, without rupture
I71.50 Thoracoabdominal aortic aneurysm, ruptured, unspecified
I71.51 Supraceliac aneurysm of the thoracoabdominal aorta, ruptured
I71.52 Paravisceral aneurysm of the thoracoabdominal aorta, ruptured
I71.60 Thoracoabdominal aortic aneurysm, without rupture, unspecified
I71.61 Supraceliac aneurysm of the thoracoabdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the thoracoabdominal aorta, without rupture
I71.8 Aortic aneurysm of unspecified site, ruptured
I77.71 Dissection of carotid artery
I77.74 Dissection of vertebral artery
I77.79 Dissection of other specified artery
I79.0 Aneurysm of aorta in diseases classified elsewhere
M40.03 Postural kyphosis, cervicothoracic region
M40.04 Postural kyphosis, thoracic region
M40.05 Postural kyphosis, thoracolumbar region
M40.12 Other secondary kyphosis, cervical region
M40.13 Other secondary kyphosis, cervicothoracic region
M40.14 Other secondary kyphosis, thoracic region
M40.15 Other secondary kyphosis, thoracolumbar region
M40.202 Unspecified kyphosis, cervical region
M40.203 Unspecified kyphosis, cervicothoracic region
M40.204 Unspecified kyphosis, thoracic region
M40.205 Unspecified kyphosis, thoracolumbar region
M40.292 Other kyphosis, cervical region
M40.293 Other kyphosis, cervicothoracic region
M40.294 Other kyphosis, thoracic region
M40.295 Other kyphosis, thoracolumbar region
M40.35 Flatback syndrome, thoracolumbar region
M40.36 Flatback syndrome, lumbar region
M40.37 Flatback syndrome, lumbosacral region
M40.45 Postural lordosis, thoracolumbar region
M40.46 Postural lordosis, lumbar region
M40.47 Postural lordosis, lumbosacral region
M40.55 Lordosis, unspecified, thoracolumbar region
M40.56 Lordosis, unspecified, lumbar region
M40.57 Lordosis, unspecified, lumbosacral region
M41.02 Infantile idiopathic scoliosis, cervical region
M41.03 Infantile idiopathic scoliosis, cervicothoracic region
M41.04 Infantile idiopathic scoliosis, thoracic region
M41.05 Infantile idiopathic scoliosis, thoracolumbar region
M41.06 Infantile idiopathic scoliosis, lumbar region
M41.07 Infantile idiopathic scoliosis, lumbosacral region
M41.08 Infantile idiopathic scoliosis, sacral and sacrococcygeal region
M41.112 Juvenile idiopathic scoliosis, cervical region
M41.113 Juvenile idiopathic scoliosis, cervicothoracic region
M41.114 Juvenile idiopathic scoliosis, thoracic region
M41.115 Juvenile idiopathic scoliosis, thoracolumbar region
M41.116 Juvenile idiopathic scoliosis, lumbar region
M41.117 Juvenile idiopathic scoliosis, lumbosacral region
M41.122 Adolescent idiopathic scoliosis, cervical region
M41.123 Adolescent idiopathic scoliosis, cervicothoracic region
M41.124 Adolescent idiopathic scoliosis, thoracic region
M41.125 Adolescent idiopathic scoliosis, thoracolumbar region
M41.126 Adolescent idiopathic scoliosis, lumbar region
M41.127 Adolescent idiopathic scoliosis, lumbosacral region
M41.22 Other idiopathic scoliosis, cervical region
M41.23 Other idiopathic scoliosis, cervicothoracic region
M41.24 Other idiopathic scoliosis, thoracic region
M41.25 Other idiopathic scoliosis, thoracolumbar region
M41.26 Other idiopathic scoliosis, lumbar region
M41.27 Other idiopathic scoliosis, lumbosacral region
M41.34 Thoracogenic scoliosis, thoracic region
M41.35 Thoracogenic scoliosis, thoracolumbar region
M41.41 Neuromuscular scoliosis, occipito-atlanto-axial region
M41.42 Neuromuscular scoliosis, cervical region
M41.43 Neuromuscular scoliosis, cervicothoracic region
M41.44 Neuromuscular scoliosis, thoracic region
M41.45 Neuromuscular scoliosis, thoracolumbar region
M41.46 Neuromuscular scoliosis, lumbar region
M41.47 Neuromuscular scoliosis, lumbosacral region
M41.52 Other secondary scoliosis, cervical region
M41.53 Other secondary scoliosis, cervicothoracic region
M41.54 Other secondary scoliosis, thoracic region
M41.55 Other secondary scoliosis, thoracolumbar region
M41.56 Other secondary scoliosis, lumbar region
M41.57 Other secondary scoliosis, lumbosacral region
M41.82 Other forms of scoliosis, cervical region
M41.83 Other forms of scoliosis, cervicothoracic region
M41.84 Other forms of scoliosis, thoracic region
M41.85 Other forms of scoliosis, thoracolumbar region
M41.86 Other forms of scoliosis, lumbar region
M41.87 Other forms of scoliosis, lumbosacral region
M43.8X1 Other specified deforming dorsopathies, occipito-atlanto-axial region
M43.8X2 Other specified deforming dorsopathies, cervical region
M43.8X3 Other specified deforming dorsopathies, cervicothoracic region
M43.8X4 Other specified deforming dorsopathies, thoracic region
M43.8X5 Other specified deforming dorsopathies, thoracolumbar region
M43.8X6 Other specified deforming dorsopathies, lumbar region
M43.8X7 Other specified deforming dorsopathies, lumbosacral region
M43.8X8 Other specified deforming dorsopathies, sacral and sacrococcygeal region
M43.9 Deforming dorsopathy, unspecified
M47.011 Anterior spinal artery compression syndromes, occipito-atlanto-axial region
M47.012 Anterior spinal artery compression syndromes, cervical region
M47.013 Anterior spinal artery compression syndromes, cervicothoracic region
M47.014 Anterior spinal artery compression syndromes, thoracic region
M47.015 Anterior spinal artery compression syndromes, thoracolumbar region
M47.016 Anterior spinal artery compression syndromes, lumbar region
M47.021 Vertebral artery compression syndromes, occipito-atlanto-axial region
M47.022 Vertebral artery compression syndromes, cervical region
M47.11 Other spondylosis with myelopathy, occipito-atlanto-axial region
M47.12 Other spondylosis with myelopathy, cervical region
M47.13 Other spondylosis with myelopathy, cervicothoracic region
M47.14 Other spondylosis with myelopathy, thoracic region
M47.15 Other spondylosis with myelopathy, thoracolumbar region
M47.16 Other spondylosis with myelopathy, lumbar region
M47.24 Other spondylosis with radiculopathy, thoracic region
M47.25 Other spondylosis with radiculopathy, thoracolumbar region
M47.26 Other spondylosis with radiculopathy, lumbar region
M47.27 Other spondylosis with radiculopathy, lumbosacral region
M47.28 Other spondylosis with radiculopathy, sacral and sacrococcygeal region
M47.814 Spondylosis without myelopathy or radiculopathy, thoracic region
M47.815 Spondylosis without myelopathy or radiculopathy, thoracolumbar region
M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region
M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.818 Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region
M47.894 Other spondylosis, thoracic region
M47.895 Other spondylosis, thoracolumbar region
M47.896 Other spondylosis, lumbar region
M47.897 Other spondylosis, lumbosacral region
M47.898 Other spondylosis, sacral and sacrococcygeal region
M48.01 Spinal stenosis, occipito-atlanto-axial region
M48.02 Spinal stenosis, cervical region
M48.03 Spinal stenosis, cervicothoracic region
M48.04 Spinal stenosis, thoracic region
M48.05 Spinal stenosis, thoracolumbar region
M48.061 Spinal stenosis, lumbar region without neurogenic claudication
M48.062 Spinal stenosis, lumbar region with neurogenic claudication
M48.07 Spinal stenosis, lumbosacral region
M50.01 Cervical disc disorder with myelopathy, high cervical region
M50.021 Cervical disc disorder at C4-C5 level with myelopathy
M50.022 Cervical disc disorder at C5-C6 level with myelopathy
M50.023 Cervical disc disorder at C6-C7 level with myelopathy
M50.03 Cervical disc disorder with myelopathy, cervicothoracic region
M51.04 Intervertebral disc disorders with myelopathy, thoracic region
M51.05 Intervertebral disc disorders with myelopathy, thoracolumbar region
M51.06 Intervertebral disc disorders with myelopathy, lumbar region
M96.2 Postradiation kyphosis
M96.3 Postlaminectomy kyphosis
M96.4 Postsurgical lordosis
M96.5 Postradiation scoliosis
M99.20 Subluxation stenosis of neural canal of head region
M99.21 Subluxation stenosis of neural canal of cervical region
M99.22 Subluxation stenosis of neural canal of thoracic region
M99.23 Subluxation stenosis of neural canal of lumbar region
M99.30 Osseous stenosis of neural canal of head region
M99.31 Osseous stenosis of neural canal of cervical region
M99.32 Osseous stenosis of neural canal of thoracic region
M99.33 Osseous stenosis of neural canal of lumbar region
M99.40 Connective tissue stenosis of neural canal of head region
M99.41 Connective tissue stenosis of neural canal of cervical region
M99.42 Connective tissue stenosis of neural canal of thoracic region
M99.43 Connective tissue stenosis of neural canal of lumbar region
M99.50 Intervertebral disc stenosis of neural canal of head region
M99.51 Intervertebral disc stenosis of neural canal of cervical region
M99.52 Intervertebral disc stenosis of neural canal of thoracic region
M99.53 Intervertebral disc stenosis of neural canal of lumbar region
M99.60 Osseous and subluxation stenosis of intervertebral foramina of head region
M99.61 Osseous and subluxation stenosis of intervertebral foramina of cervical region
M99.62 Osseous and subluxation stenosis of intervertebral foramina of thoracic region
M99.63 Osseous and subluxation stenosis of intervertebral foramina of lumbar region
M99.70 Connective tissue and disc stenosis of intervertebral foramina of head region
M99.71 Connective tissue and disc stenosis of intervertebral foramina of cervical region
M99.72 Connective tissue and disc stenosis of intervertebral foramina of thoracic region
M99.73 Connective tissue and disc stenosis of intervertebral foramina of lumbar region
P11.3 Birth injury to facial nerve
P11.4 Birth injury to other cranial nerves
P11.5 Birth injury to spine and spinal cord
P14.0 Erb's paralysis due to birth injury
P14.1 Klumpke's paralysis due to birth injury
P14.2 Phrenic nerve paralysis due to birth injury
P14.3 Other brachial plexus birth injuries
P14.8 Birth injuries to other parts of peripheral nervous system
P14.9 Birth injury to peripheral nervous system, unspecified
Q05.0 Cervical spina bifida with hydrocephalus
Q05.1 Thoracic spina bifida with hydrocephalus
Q05.2 Lumbar spina bifida with hydrocephalus
Q05.3 Sacral spina bifida with hydrocephalus
Q05.4 Unspecified spina bifida with hydrocephalus
Q05.5 Cervical spina bifida without hydrocephalus
Q05.6 Thoracic spina bifida without hydrocephalus
Q05.7 Lumbar spina bifida without hydrocephalus
Q05.8 Sacral spina bifida without hydrocephalus
Q07.00 Arnold-Chiari syndrome without spina bifida or hydrocephalus
Q07.01 Arnold-Chiari syndrome with spina bifida
Q07.02 Arnold-Chiari syndrome with hydrocephalus
Q07.03 Arnold-Chiari syndrome with spina bifida and hydrocephalus
Q27.9 Congenital malformation of peripheral vascular system, unspecified
Q28.2 Arteriovenous malformation of cerebral vessels
Q28.3 Other malformations of cerebral vessels
Q85.01 Neurofibromatosis, type 1
Q85.02 Neurofibromatosis, type 2
Q85.03 Schwannomatosis
Q85.09 Other neurofibromatosis
R20.0 Anesthesia of skin
R20.1 Hypoesthesia of skin
R20.2 Paresthesia of skin
R20.3 Hyperesthesia
R20.8 Other disturbances of skin sensation
R40.2110 Coma scale, eyes open, never, unspecified time
R40.2112 Coma scale, eyes open, never, at arrival to emergency department
R40.2113 Coma scale, eyes open, never, at hospital admission
R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2120 Coma scale, eyes open, to pain, unspecified time
R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department
R40.2123 Coma scale, eyes open, to pain, at hospital admission
R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2210 Coma scale, best verbal response, none, unspecified time
R40.2212 Coma scale, best verbal response, none, at arrival to emergency department
R40.2213 Coma scale, best verbal response, none, at hospital admission
R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time
R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2310 Coma scale, best motor response, none, unspecified time
R40.2312 Coma scale, best motor response, none, at arrival to emergency department
R40.2313 Coma scale, best motor response, none, at hospital admission
R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2320 Coma scale, best motor response, extension, unspecified time
R40.2322 Coma scale, best motor response, extension, at arrival to emergency department
R40.2323 Coma scale, best motor response, extension, at hospital admission
R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time
R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission
R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
R40.2A Nontraumatic coma due to underlying condition

Group 2

(156 Codes)
Group 2 Paragraph

The following codes may be billed with any of the 7th digits that apply to this group; A-initial encounter, D-subsequent encounter, S-sequela

Group 2 Codes
Code Description
S14.101A Unspecified injury at C1 level of cervical spinal cord, initial encounter
S14.102A Unspecified injury at C2 level of cervical spinal cord, initial encounter
S14.103A Unspecified injury at C3 level of cervical spinal cord, initial encounter
S14.104A Unspecified injury at C4 level of cervical spinal cord, initial encounter
S14.105A Unspecified injury at C5 level of cervical spinal cord, initial encounter
S14.106A Unspecified injury at C6 level of cervical spinal cord, initial encounter
S14.107A Unspecified injury at C7 level of cervical spinal cord, initial encounter
S14.111A Complete lesion at C1 level of cervical spinal cord, initial encounter
S14.112A Complete lesion at C2 level of cervical spinal cord, initial encounter
S14.113A Complete lesion at C3 level of cervical spinal cord, initial encounter
S14.114A Complete lesion at C4 level of cervical spinal cord, initial encounter
S14.115A Complete lesion at C5 level of cervical spinal cord, initial encounter
S14.116A Complete lesion at C6 level of cervical spinal cord, initial encounter
S14.117A Complete lesion at C7 level of cervical spinal cord, initial encounter
S14.121A Central cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.122A Central cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.123A Central cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.124A Central cord syndrome at C4 level of cervical spinal cord, initial encounter
S14.125A Central cord syndrome at C5 level of cervical spinal cord, initial encounter
S14.126A Central cord syndrome at C6 level of cervical spinal cord, initial encounter
S14.127A Central cord syndrome at C7 level of cervical spinal cord, initial encounter
S14.131A Anterior cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.132A Anterior cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.133A Anterior cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.134A Anterior cord syndrome at C4 level of cervical spinal cord, initial encounter
S14.135A Anterior cord syndrome at C5 level of cervical spinal cord, initial encounter
S14.136A Anterior cord syndrome at C6 level of cervical spinal cord, initial encounter
S14.137A Anterior cord syndrome at C7 level of cervical spinal cord, initial encounter
S14.151A Other incomplete lesion at C1 level of cervical spinal cord, initial encounter
S14.152A Other incomplete lesion at C2 level of cervical spinal cord, initial encounter
S14.153A Other incomplete lesion at C3 level of cervical spinal cord, initial encounter
S14.154A Other incomplete lesion at C4 level of cervical spinal cord, initial encounter
S14.155A Other incomplete lesion at C5 level of cervical spinal cord, initial encounter
S14.156A Other incomplete lesion at C6 level of cervical spinal cord, initial encounter
S14.157A Other incomplete lesion at C7 level of cervical spinal cord, initial encounter
S14.2XXA Injury of nerve root of cervical spine, initial encounter
S14.3XXA Injury of brachial plexus, initial encounter
S24.101A Unspecified injury at T1 level of thoracic spinal cord, initial encounter
S24.102A Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter
S24.103A Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter
S24.104A Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter
S24.111A Complete lesion at T1 level of thoracic spinal cord, initial encounter
S24.112A Complete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.113A Complete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.114A Complete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S24.131A Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter
S24.132A Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter
S24.133A Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter
S24.134A Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter
S24.151A Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter
S24.152A Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.153A Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.154A Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S24.2XXA Injury of nerve root of thoracic spine, initial encounter
S34.101A Unspecified injury to L1 level of lumbar spinal cord, initial encounter
S34.102A Unspecified injury to L2 level of lumbar spinal cord, initial encounter
S34.103A Unspecified injury to L3 level of lumbar spinal cord, initial encounter
S34.104A Unspecified injury to L4 level of lumbar spinal cord, initial encounter
S34.105A Unspecified injury to L5 level of lumbar spinal cord, initial encounter
S34.111A Complete lesion of L1 level of lumbar spinal cord, initial encounter
S34.112A Complete lesion of L2 level of lumbar spinal cord, initial encounter
S34.113A Complete lesion of L3 level of lumbar spinal cord, initial encounter
S34.114A Complete lesion of L4 level of lumbar spinal cord, initial encounter
S34.115A Complete lesion of L5 level of lumbar spinal cord, initial encounter
S34.121A Incomplete lesion of L1 level of lumbar spinal cord, initial encounter
S34.122A Incomplete lesion of L2 level of lumbar spinal cord, initial encounter
S34.123A Incomplete lesion of L3 level of lumbar spinal cord, initial encounter
S34.124A Incomplete lesion of L4 level of lumbar spinal cord, initial encounter
S34.125A Incomplete lesion of L5 level of lumbar spinal cord, initial encounter
S34.131A Complete lesion of sacral spinal cord, initial encounter
S34.132A Incomplete lesion of sacral spinal cord, initial encounter
S34.139A Unspecified injury to sacral spinal cord, initial encounter
S34.21XA Injury of nerve root of lumbar spine, initial encounter
S34.22XA Injury of nerve root of sacral spine, initial encounter
S34.3XXA Injury of cauda equina, initial encounter
S34.4XXA Injury of lumbosacral plexus, initial encounter
S44.01XA Injury of ulnar nerve at upper arm level, right arm, initial encounter
S44.02XA Injury of ulnar nerve at upper arm level, left arm, initial encounter
S44.11XA Injury of median nerve at upper arm level, right arm, initial encounter
S44.12XA Injury of median nerve at upper arm level, left arm, initial encounter
S44.21XA Injury of radial nerve at upper arm level, right arm, initial encounter
S44.22XA Injury of radial nerve at upper arm level, left arm, initial encounter
S44.31XA Injury of axillary nerve, right arm, initial encounter
S44.32XA Injury of axillary nerve, left arm, initial encounter
S44.41XA Injury of musculocutaneous nerve, right arm, initial encounter
S44.42XA Injury of musculocutaneous nerve, left arm, initial encounter
S44.51XA Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, initial encounter
S44.52XA Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, initial encounter
S44.8X1A Injury of other nerves at shoulder and upper arm level, right arm, initial encounter
S44.8X2A Injury of other nerves at shoulder and upper arm level, left arm, initial encounter
S44.91XA Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter
S44.92XA Injury of unspecified nerve at shoulder and upper arm level, left arm, initial encounter
S54.01XA Injury of ulnar nerve at forearm level, right arm, initial encounter
S54.02XA Injury of ulnar nerve at forearm level, left arm, initial encounter
S54.11XA Injury of median nerve at forearm level, right arm, initial encounter
S54.12XA Injury of median nerve at forearm level, left arm, initial encounter
S54.21XA Injury of radial nerve at forearm level, right arm, initial encounter
S54.22XA Injury of radial nerve at forearm level, left arm, initial encounter
S54.31XA Injury of cutaneous sensory nerve at forearm level, right arm, initial encounter
S54.32XA Injury of cutaneous sensory nerve at forearm level, left arm, initial encounter
S54.8X1A Injury of other nerves at forearm level, right arm, initial encounter
S54.8X2A Injury of other nerves at forearm level, left arm, initial encounter
S54.91XA Injury of unspecified nerve at forearm level, right arm, initial encounter
S54.92XA Injury of unspecified nerve at forearm level, left arm, initial encounter
S64.01XA Injury of ulnar nerve at wrist and hand level of right arm, initial encounter
S64.02XA Injury of ulnar nerve at wrist and hand level of left arm, initial encounter
S64.11XA Injury of median nerve at wrist and hand level of right arm, initial encounter
S64.12XA Injury of median nerve at wrist and hand level of left arm, initial encounter
S64.21XA Injury of radial nerve at wrist and hand level of right arm, initial encounter
S64.22XA Injury of radial nerve at wrist and hand level of left arm, initial encounter
S64.31XA Injury of digital nerve of right thumb, initial encounter
S64.32XA Injury of digital nerve of left thumb, initial encounter
S64.490A Injury of digital nerve of right index finger, initial encounter
S64.491A Injury of digital nerve of left index finger, initial encounter
S64.492A Injury of digital nerve of right middle finger, initial encounter
S64.493A Injury of digital nerve of left middle finger, initial encounter
S64.494A Injury of digital nerve of right ring finger, initial encounter
S64.495A Injury of digital nerve of left ring finger, initial encounter
S64.496A Injury of digital nerve of right little finger, initial encounter
S64.497A Injury of digital nerve of left little finger, initial encounter
S64.8X1A Injury of other nerves at wrist and hand level of right arm, initial encounter
S64.8X2A Injury of other nerves at wrist and hand level of left arm, initial encounter
S64.91XA Injury of unspecified nerve at wrist and hand level of right arm, initial encounter
S64.92XA Injury of unspecified nerve at wrist and hand level of left arm, initial encounter
S74.01XA Injury of sciatic nerve at hip and thigh level, right leg, initial encounter
S74.02XA Injury of sciatic nerve at hip and thigh level, left leg, initial encounter
S74.11XA Injury of femoral nerve at hip and thigh level, right leg, initial encounter
S74.12XA Injury of femoral nerve at hip and thigh level, left leg, initial encounter
S74.21XA Injury of cutaneous sensory nerve at hip and high level, right leg, initial encounter
S74.22XA Injury of cutaneous sensory nerve at hip and thigh level, left leg, initial encounter
S74.8X1A Injury of other nerves at hip and thigh level, right leg, initial encounter
S74.8X2A Injury of other nerves at hip and thigh level, left leg, initial encounter
S74.91XA Injury of unspecified nerve at hip and thigh level, right leg, initial encounter
S74.92XA Injury of unspecified nerve at hip and thigh level, left leg, initial encounter
S84.01XA Injury of tibial nerve at lower leg level, right leg, initial encounter
S84.02XA Injury of tibial nerve at lower leg level, left leg, initial encounter
S84.11XA Injury of peroneal nerve at lower leg level, right leg, initial encounter
S84.12XA Injury of peroneal nerve at lower leg level, left leg, initial encounter
S84.21XA Injury of cutaneous sensory nerve at lower leg level, right leg, initial encounter
S84.22XA Injury of cutaneous sensory nerve at lower leg level, left leg, initial encounter
S84.801A Injury of other nerves at lower leg level, right leg, initial encounter
S84.802A Injury of other nerves at lower leg level, left leg, initial encounter
S84.91XA Injury of unspecified nerve at lower leg level, right leg, initial encounter
S84.92XA Injury of unspecified nerve at lower leg level, left leg, initial encounter
S94.01XA Injury of lateral plantar nerve, right leg, initial encounter
S94.02XA Injury of lateral plantar nerve, left leg, initial encounter
S94.11XA Injury of medial plantar nerve, right leg, initial encounter
S94.12XA Injury of medial plantar nerve, left leg, initial encounter
S94.21XA Injury of deep peroneal nerve at ankle and foot level, right leg, initial encounter
S94.22XA Injury of deep peroneal nerve at ankle and foot level, left leg, initial encounter
S94.31XA Injury of cutaneous sensory nerve at ankle and foot level, right leg, initial encounter
S94.32XA Injury of cutaneous sensory nerve at ankle and foot level, left leg, initial encounter
S94.8X1A Injury of other nerves at ankle and foot level, right leg, initial encounter
S94.8X2A Injury of other nerves at ankle and foot level, left leg, initial encounter
S94.91XA Injury of unspecified nerve at ankle and foot level, right leg, initial encounter
S94.92XA Injury of unspecified nerve at ankle and foot level, left leg, initial encounter

Group 3

(29 Codes)
Group 3 Paragraph

The following codes may be billed with any of the 7th digits that apply to this group; A-initial encounter for closed fracture, B-initial encounter for open fracture, D-subsequent encounter for fracture with routine healing, G-subsequent encounter for fracture with delayed healing, K- subsequent encounter for fracture with non-union, S- sequela.

Group 3 Codes
Code Description
S12.000A Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.001A Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.100A Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.101A Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.200A Unspecified displaced fracture of third cervical vertebra, initial encounter for closed fracture
S12.201A Unspecified nondisplaced fracture of third cervical vertebra, initial encounter for closed fracture
S12.300A Unspecified displaced fracture of fourth cervical vertebra, initial encounter for closed fracture
S12.301A Unspecified nondisplaced fracture of fourth cervical vertebra, initial encounter for closed fracture
S12.400A Unspecified displaced fracture of fifth cervical vertebra, initial encounter for closed fracture
S12.401A Unspecified nondisplaced fracture of fifth cervical vertebra, initial encounter for closed fracture
S12.500A Unspecified displaced fracture of sixth cervical vertebra, initial encounter for closed fracture
S12.501A Unspecified nondisplaced fracture of sixth cervical vertebra, initial encounter for closed fracture
S12.600A Unspecified displaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S12.601A Unspecified nondisplaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S22.019A Unspecified fracture of first thoracic vertebra, initial encounter for closed fracture
S22.029A Unspecified fracture of second thoracic vertebra, initial encounter for closed fracture
S22.039A Unspecified fracture of third thoracic vertebra, initial encounter for closed fracture
S22.049A Unspecified fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.059A Unspecified fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.069A Unspecified fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.079A Unspecified fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.089A Unspecified fracture of T11-T12 vertebra, initial encounter for closed fracture
S32.019A Unspecified fracture of first lumbar vertebra, initial encounter for closed fracture
S32.029A Unspecified fracture of second lumbar vertebra, initial encounter for closed fracture
S32.039A Unspecified fracture of third lumbar vertebra, initial encounter for closed fracture
S32.049A Unspecified fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.059A Unspecified fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.10XA Unspecified fracture of sacrum, initial encounter for closed fracture
S32.2XXA Fracture of coccyx, initial encounter for closed fracture
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

Not applicable

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R6

Posted 09/28/2023. Review completed 08/15/2023. Under ICD-10 Codes that Support Medical Necessity Group 1 Codes added R40.2A. Updated code descriptions for I71.51, I71.52, I71.61 and I71.62. These updates were made due to 2024 Annual ICD-10-CM code updates and are effective 10/01/2023.

10/01/2022 R5

Posted 10/27/2022- Under Group 1 Codes added ICD 10 codes 171.02 and 171.03. These codes were deleted in error during the ICD 10 CM code updates.

10/01/2022 R4

Posted 09/29/2022 Under Group 1 Codes deleted ICD 10 codes I71.01, I71.1-I71.6 and added I71.010-I71.012, I71.019, I71.10-I71.3, I71.20-I71.23, I71.30-I71.33, I71.40-I71.43, I71.50-I71.52 and I71.60-I71.62. These updates were made due to Annual ICD-10-CM code updates and are effective 10/01/2022.

10/28/2021 R3

10/28/2021 Under Group 1 Codes, deleted the following unspecified codes: G11.10, H71.91, H71.92, H71.93, I62.00, I63.30, I63.40, I63.50, and Q85.00. Punctuation and typographical corrections made throughout article. Review completed 9/22/2021.

10/01/2020 R2

10/01/2020 ICD-10-CM Code Updates to Group 1: Deleted G11.1 and added G11.10, G11.11, and G11.19.

11/01/2019 R1

Content has been moved to the new template.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34624 - Somatosensory Testing
Related National Coverage Documents
NCDs
160.23 - Sensory Nerve Conduction Threshold Tests (sNCTs)
SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
Description: CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c23.pdf
Description: CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 23 - Fee Schedule Administration and Coding Requirements: Section 10 - Reporting ICD Diagnosis and Procedure Codes
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Public Versions
Updated On Effective Dates Status
09/19/2023 10/01/2023 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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