Does S72.133J require prior authorization?

No, S72.133J does not require prior authorization (high confidence). Covered without prior authorization.

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`S72.133J`, Displaced apophyseal fracture of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.

Key Coverage Criteria

Duplex scan of lower extremity arteries is covered when medically necessary per LCD L33667, with the ordering/referring provider documenting signs and symptoms, relevant history (including known diagnoses and/or prior imaging) supporting evaluation of lower extremity arterial disease.
Simultaneous bilateral hip or knee replacement during the same encounter is covered when medical necessity for bilateral procedure is documented; bilateral procedures are subject to bilateral pricing.
Total hip arthroplasty (THA) or total knee arthroplasty (TKA) is covered for advanced joint disease when arthritis of the hip or knee is supported by X-ray or MRI demonstrating subchondral cysts, subchondral sclerosis, periarticular osteophytes, joint subluxation, joint space narrowing, or avascular necrosis.
THA or TKA is covered when the patient has pain or functional disability at the hip or knee, e.g., pain interfering with activities of daily living (ADLs), pain increased with initiation of activity, or pain increased with weight bearing.
THA or TKA is covered when there is documentation of unsuccessful conservative therapy appropriate to the episode of care, generally a reasonable attempt of usually 3 months or more (e.g., trial of NSAIDs or supervised physical therapy, or documented contraindication to such therapy).
THA or TKA is covered for other LCD-indicated causes when appropriate supporting evidence is documented, e.g., malignancy of the joint supported by pathology and oncology referral, or fracture supported by X-ray.

4 Active Policies

FIRST_COAST-L33618, Major Joint Replacement (Hip and Knee)

A57064, Billing and Coding: Duplex Scan of Lower Extremity Arteries

A57765, Billing and Coding: Major Joint Replacement (Hip and Knee)

A56421, Billing and Coding: CT of the Abdomen and Pelvis

`S72.133J`, Displaced apophyseal fracture of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

S72.133J, Displaced apophyseal fracture of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`S72.133J`, Displaced apophyseal fracture of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing