S32.691B — Other specified fracture of right ischium, initial encounter for open fracture
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
- Billing and coding for immunizations must follow the coverage indications, limitations, and medical necessity criteria set forth in the associated Local Coverage Determination LCD L34596 (Immunizations).
- A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.
- The documentation must clearly support the ICD-10-CM code(s) reported on the claim.
Key Coverage Criteria
- Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
- A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
- Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
- T82.535S | Leakage of umbrella device, sequela
- M84.38XP | Stress fracture, other site, subsequent encounter for fracture with malunion
- M84.38XS | Stress fracture, other site, sequela
16 Active Policies
A59811 — Billing and Coding: Total Joint Arthroplasty
J05
A56900 — Billing and Coding: Immunizations
J05
L34596 — Immunizations
J05
L39911 — Total Joint Arthroplasty
J05
A58873 — Billing and Coding: Tetanus Immunization
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