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ICD-10-CM S10.83XD, Contusion of other specified part of neck, subsequent encounter | No Prior Auth

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`S10.83XD`, Contusion of other specified part of neck, 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.
Incision and drainage (I&D) is covered when medical record documents an abscess, hematoma, seroma or other collection of the skin/subcutaneous/accessory structures requiring drainage with signs/symptoms that justify the procedure (e.g., evidence of infection, frank pus, severe pain, or failure of conservative measures).
For podiatry (specialty 48), CPT codes 10060, 10061 or 10160 are payable when billed with ICD-10-CM codes L02.611, L02.612 or L98.8 only.
CPT code 10140 is payable only when billed with the specified ICD-10-CM codes listed in the policy (multiple S- and L- codes for traumatic or specific skin conditions as enumerated).

4 Active Policies

NGS-J6-L33563, Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures

J6

A56766, Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures

J6

NGS-JK-L33563, Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures

JK

A53058, Billing and Coding: Home Health Physical Therapy

Related Codes

L03.012(4 policies)L03.031(4 policies)K68.11(4 policies)L03.011(4 policies)L03.021(4 policies)L03.022(4 policies)K12.2(4 policies)L03.032(4 policies)

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