S52.691C — Other fracture of lower end of right ulna, initial encounter for open fracture type IIIA, IIIB, or IIIC
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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).
- All documentation must be maintained in the patient medical record and made available to the contractor upon request, with every page legible and containing appropriate patient identification (e.g., full name, dates of service).
- The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- 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).
- When the patient has not been previously immunized for rabies, coverage includes RIG (half IM and half wound on day 0) plus HDCV on days 0, 3, 7, 14, and 28.
- Vaccinations are covered only when directly related to treatment of an injury or direct exposure to a disease/condition listed in this policy.
- Preventive immunizations are covered for pneumococcal, hepatitis B, and influenza vaccines.
- Tdap or Td vaccines are covered when given for an acute injury in a person who is incompletely immunized for tetanus.
4 Active Policies
A56900 — Billing and Coding: Immunizations
J05
L34596 — Immunizations
J05
A58873 — Billing and Coding: Tetanus Immunization
J09
A58872 — Billing and Coding: Tetanus Immunization
J12
Related Codes
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