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ICD-10-CM S01.21XD, Laceration without foreign body of nose, subsequent encounter | No Prior Auth

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`S01.21XD`, Laceration without foreign body of nose, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

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.

Clinical notes must be written and dated entries describing signs/symptoms, treatments, patient's reaction, and changes in condition as defined in 42 CFR §484.2.

Progress notes must be dated, signed summaries of care furnished and the patient's response during the given period as defined in 42 CFR §484.2.

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.
COVID-19 vaccines are covered under Medicare Part B (see CMS guidance for vaccine pricing and coding).
Seasonal influenza vaccine is covered once per flu season (use codes 90635, 90637, 90638, 90653-90657, 90660-90662, 90672-90674, 90682, 90685-90689, 90694, 90695, 90756, Q2034-Q2039).
Pneumococcal vaccine is covered as an initial dose for Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B (use codes 90670, 90671, 90677, 90732).

10 Active Policies

CGS-J15-L34032, Debridement Services

J15

CGS-J18-L34032, Debridement Services

J18

A58873, Billing and Coding: Tetanus Immunization

J9

A58872, Billing and Coding: Tetanus Immunization

JL

A56459, Billing and Coding: Debridement Services

A56658, Billing and Coding: Cosmetic and Reconstructive Surgery

A54767, Billing and Coding: Medicare Preventive Coverage for Certain Vaccines

A58565, Billing and Coding: Wound and Ulcer Care

A53058, Billing and Coding: Home Health Physical Therapy

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

Related Codes

S01.25XD(10 policies)S01.321D(10 policies)S01.23XD(10 policies)S01.24XD(10 policies)S01.311D(10 policies)S01.312D(10 policies)S01.22XD(10 policies)S01.322D(10 policies)

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