O71.89 — Other specified obstetric trauma
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Has documented at least a 100 pound weight loss;or
- Panniculectomy is consideredmedically necessaryfor the individual who meets the following criteria:The panniculus hangs below the level of the pubis (which is documented in photographs);andOneof the following:There are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months;orThere is documented [...]
- The panniculus hangs below the level of the pubis (which is documented in photographs);and
- Oneof the following:There are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months;orThere is documented difficulty with ambulation and interference with the activities of daily living;and
- There are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months;or
- There is documented difficulty with ambulation and interference with the activities of daily living;and
1 Active Policy
ANTHEM-CG-SURG-99 — CG-SURG-99 Panniculectomy and Abdominoplasty
Related Codes
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