S82.90XM — Unspecified fracture of unspecified lower leg, subsequent encounter for open fracture type I or II with nonunion
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation for CPT 97010, 97018, 97022, and 97026 must reflect medical necessity and be made available to the MAC upon request.
- When billing a Z-code as the diagnosis, documentation must include the orthotic/prosthetic device name, date patient received the device, and date training/teaching began.
- Documentation for CPT 97542 wheelchair propulsion training must relate the training to expected, attainable functional goals for the patient and/or caregiver.
- Physical therapists must report patient contact time in 15-minute increments and bill using G0151 for physical therapy time reporting.
Key Coverage Criteria
- CPT 97110 may be billed when treating impairments of exercise tolerance due to cardiopulmonary impairments.
- CPT 97542 (wheelchair management training) may be billed for wheelchair propulsion training when the training is tied to expected functional goals attainable by the patient or caregiver.
- Home health physical therapy services are appropriate when based on impairments of body structure/function and demonstrable functional limitations consistent with the related LCD.
- 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.
- Duplex scan is indicated for sudden pallor, numbness, and coolness of an extremity when vascular obstruction (embolism or thrombosis) is suspected.
- Duplex scanning of lower extremity arteries is medically necessary to establish the level and/or degree of arterial occlusive disease when significant signs and/or symptoms indicate a high likelihood of limb ischemia and the patient is a candidate for invasive therapeutic procedures.
4 Active Policies
A57064 — Billing and Coding: Duplex Scan of Lower Extremity Arteries
J09
L33667 — Duplex Scan Of Lower Extremity Arteries
J09
A53058 — Billing and Coding: Home Health Physical Therapy
L34564 — Home Health Physical Therapy
Related Codes
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