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ICD-10-CM D68.312, Antiphospholipid antibody with hemorrhagic disorder | No Prior Auth

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`D68.312`, Antiphospholipid antibody with hemorrhagic disorder

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Clinical records must clearly document the diagnosis, specific foot findings, and the clinical rationale that treatment was medically necessary and that withholding care would be hazardous to the beneficiary.
For the policy’s asterisked/complicating conditions, include the name of the primary physician (MD or DO) who made the diagnosis and the approximate date of the last visit; this information must be included in the medical record and entered on the appropriate claim forms or electronic equivalent when billing Medicare.
Follow CMS website instructions for billing Part A and Part B claims and Noridian guidance for JE Part B claims; include required claim form entries/electronic equivalents.
Document provider licensure and ensure services are rendered by a certified physician, podiatrist, or non-physician practitioner within scope of State licensure when billing for routine foot care.

Key Coverage Criteria

Routine foot care is covered only when clinical documentation demonstrates the patient’s condition warrants the provider to render the services and that failure to provide the services would be hazardous to the beneficiary due to underlying medical condition(s), per CMS Pub 100-02, Ch.15, §290.

1 Active Policy

A57954, Billing and Coding: Routine Foot Care

Related Codes

11056(1 policies)11057(1 policies)11719(1 policies)11720(1 policies)11721(1 policies)A30.4(1 policies)A30.5(1 policies)11055(1 policies)

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