W55.51XA — Bitten by raccoon, initial encounter
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 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.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
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).
2 Active Policies
A58873 — Billing and Coding: Tetanus Immunization
J09
A58872 — Billing and Coding: Tetanus Immunization
J12
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