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ICD-10-CM T84.020A, Dislocation of internal right hip prosthesis, initial encounter | No Prior Auth

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`T84.020A`, Dislocation of internal right hip prosthesis, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims and coding must follow and reference the Local Coverage Determination L33456; consult L33456 for specific clinical coverage criteria and required documentation.
All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information such as complete name and dates of service.

The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient’s care.

The submitted medical record must support the use of the selected ICD-10-CM code(s).

The submitted CPT/HCPCS code must accurately describe the service performed.

Key Coverage Criteria

Coverage for lower extremity major joint replacement (hip and knee) is subject to the reasonable and necessary requirements of Local Coverage Determination L36007; services meeting LCD L36007 criteria are covered.
Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
Beneficiary is under the care of a physician.

15 Active Policies

CGS-J15-L40232, Total Joint Arthroplasty

J15

CGS-J18-L40232, Total Joint Arthroplasty

J18

WPS-J5-L39911, Total Joint Arthroplasty

J5

A59811, Billing and Coding: Total Joint Arthroplasty

J5

WPS-J8-L39911, Total Joint Arthroplasty

J8

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

J9

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

J9

NOVITAS-JH-L36007, Lower Extremity Major Joint Replacement (Hip and Knee)

JH

A56796, Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)

JL

NOVITAS-JL-L36007, Lower Extremity Major Joint Replacement (Hip and Knee)

JL

A60250, Billing and Coding: Total Joint Arthroplasty

A56777, Billing and Coding: Total Joint Arthroplasty

A57206, Billing and Coding: Lumbar MRI

A57311, Billing and Coding: Physical Therapy - Home Health

A57683, Billing and Coding: Total Hip Arthroplasty

Related Codes

M16.31(15 policies)M16.4(15 policies)M16.12(15 policies)M16.2(15 policies)M16.0(15 policies)M16.32(15 policies)M16.11(15 policies)M16.51(15 policies)

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