S72.009B — Fracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type I or II
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's 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.
- The ordering/referring physician/nonphysician practitioner must state the reason for the duplex scan in the order and provide relevant diagnostic information to the performing provider.
Key Coverage Criteria
- Duplex scan of lower extremity arteries is covered when medically necessary per LCD L33667, with the ordering/referring provider documenting signs and symptoms, relevant history (including known diagnoses and/or prior imaging) supporting evaluation of lower extremity arterial disease.
- Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
- Beneficiary is under the care of a physician.
- Beneficiary is receiving services under a plan of care that is established and periodically reviewed by a physician.
- Beneficiary needs skilled nursing care on an intermittent basis, or physical therapy, or speech-language pathology, or has a continued need for occupational therapy.
- Physical therapy services ordered by a physician and provided by a qualified physical therapist or under the general supervision of a qualified physical therapist are covered when reasonable and necessary to treat illness/injury or to restore or maintain function.
6 Active Policies
A57064 — Billing and Coding: Duplex Scan of Lower Extremity Arteries
J09
A57765 — Billing and Coding: Major Joint Replacement (Hip and Knee)
J09
L33618 — Major Joint Replacement (Hip and Knee)
J09
L33667 — Duplex Scan Of Lower Extremity Arteries
J09
A57311
Related Codes
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