S20.111D — Abrasion of breast, right breast, subsequent encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The patient’s medical record must include the ordering provider’s assessment as it relates to the patient’s complaint for that visit.
- Medical records must contain relevant medical history and results of pertinent tests or procedures performed.
- For diagnostic tests, report the result of the test if known; otherwise report the symptoms that prompted performing the test.
- All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.
Key Coverage Criteria
- A valid ICD-10-CM diagnosis code that best describes the patient’s condition for which the debridement service was performed must be reported on the claim.
- When a service requires a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- Tetanus immunization is covered when given for a wound or documented direct exposure to Clostridium tetani (injury-related or exposure-related prophylaxis).
- Tetanus immunization is covered when given for an injury or direct exposure to tetanus (i.e., wound management or exposure prophylaxis).
- Debridement is covered for any wound requiring removal of deep-seated foreign material, devitalized, necrotic, or nonviable tissue at the level of skin, subcutaneous tissue, fascia, muscle, or bone to promote wound healing or prepare for surgical intervention.
- Debridement for chronic osteomyelitis and osteomyelitis associated with an open wound is covered.
4 Active Policies
A58873 — Billing and Coding: Tetanus Immunization
J09
A58872 — Billing and Coding: Tetanus Immunization
J12
A56459 — Billing and Coding: Debridement Services
L34032 — Debridement Services
Related Codes
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