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ICD-10-CM S12.111S — Posterior displaced Type II dens fracture, sequela | No Prior Auth

Ask Verity/S12.111S

`S12.111S` — Posterior displaced Type II dens fracture, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Title XVIII of the Social Security Act, Section 1833(e) prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.
Documentation must support that the scan is reasonable and necessary.
Accurate coding information must be provided with claims to differentiate CT and/or MRI scans from other radiology services and to make coverage determinations.
Sufficient documentation such as, history and physical notes, laboratory results, signs and symptoms of the disease to warrant the diagnostic test and to support the claim of reasonable and necessary must be included in the medical records.

Key Coverage Criteria

G71.21 | Nemaline myopathy
G83.0 | Diplegia of upper limbs
H44.19 | Other endophthalmitis
H44.532 | Leucocoria, left eye
H44.533 | Leucocoria, bilateral
H53.11 | Day blindness

20 Active Policies

L39788 — Cervical Fusion

J05

A59664 — Billing and Coding: Cervical Fusion

J05

L39770 — Cervical Fusion

J06

A59632 — Billing and Coding: Cervical Fusion

J06

L39799 — Cervical Fusion

J09

Related Codes

M50.022(20 policies)M50.121(20 policies)M48.52XS(20 policies)M50.021(20 policies)M50.023

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Ask Verity about documentation requirements, denial risks, or coverage in your state.

This information must be available to Medicare upon request.

Diagnoses used must be supported by appropriate documentation of medical necessity in the medical record.

A59674 — Billing and Coding: Cervical Fusion

J09

A59668 — Billing and Coding: Cervical Fusion

J12

L39793 — Cervical Fusion

J12

A59624 — Billing and Coding: Cervical Fusion

A59634 — Billing and Coding: Cervical Fusion

L34427 — Outpatient Occupational Therapy

L34428 — Outpatient Physical Therapy

L34560 — Home Health Occupational Therapy

L34564 — Home Health Physical Therapy

L39758 — Cervical Fusion

L39773 — Cervical Fusion

L39741 — Cervical Fusion

L35175 — MRI and CT Scans of the Head and Neck

L37373 — MRI and CT Scans of the Head and Neck

A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck

(20 policies)

M50.11(20 policies)

M48.51XS(20 policies)

M50.122(20 policies)