Does S21.309D require prior authorization?

No, S21.309D does not require prior authorization (high confidence). Covered without prior authorization.

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`S21.309D`, Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include appropriate patient identification and dates of service.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.

If the provider performing the TEE is different from the ordering/referring physician, the performing provider must retain hard copy documentation of test results and interpretation and copies of the ordering/referring physician's order.

Key Coverage Criteria

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
Coverage of transesophageal echocardiogram (TEE) is determined by the reasonable and necessary clinical criteria in Local Coverage Determination L33756; refer to LCD L33756 for specific covered indications.
An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.

7 Active Policies

FIRST_COAST-L33756, Transesophageal Echocardiogram

A57179, Billing and Coding: Transesophageal Echocardiogram

NOVITAS-JH-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

A57414, Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

NOVITAS-JL-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

A56717, Billing and Coding: Respiratory Therapy (Respiratory Care)

A57326, Billing and Coding: Electrocardiograms

`S21.309D`, Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

S21.309D, Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`S21.309D`, Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, subsequent encounter