S96.221D — Laceration of intrinsic muscle and tendon at ankle and foot level, right foot, 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.
- Injection therapy for Morton's neuroma (focal injection of tissue surrounding a localized plantar digital inflammatory focus) should be billed using CPT 64455 or 64632.
- Injection therapy for plantar fasciitis is addressed and billed with CPT 20550 and corresponds to ICD-10-CM M72.2.
- Injection to tendons at their origin or insertion sites should be reported using CPT 20551.
- A single CPT 20551 should be reported when injections include both the plantar fascia and the area around a calcaneal spur.
6 Active Policies
A56459 — Billing and Coding: Debridement Services
A57079 — Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
A57311 — Billing and Coding: Physical Therapy - Home Health
L34218 — Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
L34032 — Debridement Services
Related Codes
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