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Indications for Medical Necessity

Pt requires brace:

⃝     To provide stabilization to weak or injured shoulder
⃝     To prevent shoulder flexion, extension, rotation, and deviation
⃝     To provide treatment of carpal tunnel syndrome, tendinitis or Rheumatoid arthritis
⃝     Post-surgical treatment of shoulder
⃝     Post cast healing or soft tissue injury
 

Clinical Note Requirements: Dictation must be exactly as shown above for the indication chosen

Shoulder Harness Indications for Prescribed PT:

(Must select one of the following):

Shoulder Abduction

L3960

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Most common ICD-10 codes:

M05.611 - Rheumatoid arthritis of right shoulder
M05.612 - Rheumatoid arthritis of left shoulder 
M05.619 - Rheumatoid arthritis of unspecified shoulder 

S43.421A - Sprain of right rotator cuff capsule
S43.422A  - Sprain of left rotator cuff capsule
S43.429A - Sprain of unspecified rotator cuff 

S43.80XA - Sprain of other specified parts of unspecified shoulder girdle, initial encounter
S43.81XA - Sprain of other specified parts of right shoulder girdle, initial encounter
S43.82XA - Sprain of other specified parts of left shoulder girdle, initial encounter

RX/DWO

Shoulder Harness Document Requirements: Signed/Dated RX, Clinicals with Indications. Up to date patient demographics with insurance information.

Shoulder Abduction

L3660

Shoulder Abduction Document Requirements: Signed/Dated RX, Clinicals with Indications. Signed/Dated CMN. Up to date patient demographics with insurance information.

Shoulder Abduction Indications for Prescribed PT:

(Must select one of the following):

Pt requires brace:

⃝     To provide stabilization to weak or injured shoulder
⃝     To prevent shoulder flexion, extension, rotation, and deviation
⃝     To provide treatment of carpal tunnel syndrome, tendinitis or Rheumatoid arthritis
⃝     Post-surgical treatment of shoulder
⃝     Post cast healing or soft tissue injury
 

 

Clinical Note Requirements: Dictation must be exactly as shown above for the indication chosen

Most common ICD-10 codes:

M05.611 - Rheumatoid arthritis of right shoulder
M05.612 - Rheumatoid arthritis of left shoulder 
M05.619 - Rheumatoid arthritis of unspecified shoulder 

S43.421A - Sprain of right rotator cuff capsule
S43.422A  - Sprain of left rotator cuff capsule
S43.429A - Sprain of unspecified rotator cuff 

S43.80XA - Sprain of other specified parts of unspecified shoulder girdle, initial encounter
S43.81XA - Sprain of other specified parts of right shoulder girdle, initial encounter
S43.82XA - Sprain of other specified parts of left shoulder girdle, initial encounter

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