Skip to main content

ICD-10-CM T87.9, Unspecified complications of amputation stump | No Prior Auth

Backwork Sign up free

Ask Backwork/T87.9

`T87.9`, Unspecified complications of amputation stump

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The patient’s medical record must include the ordering provider’s assessment as it relates to the patient’s complaint for that visit.
Medical records must contain relevant medical history and results of pertinent tests or procedures performed.
For diagnostic tests, report the result of the test if known; otherwise report the symptoms that prompted performing the test.
All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.

Key Coverage Criteria

A valid ICD-10-CM diagnosis code that best describes the patient’s condition for which the debridement service was performed must be reported on the claim.
When a service requires a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
O00.00 - O00.91 — Ectopic pregnancy
O08.1 — Delayed or excessive hemorrhage following ectopic and molar pregnancy
O44.10 - O44.13 — Placenta previa with hemorrhage
O45.001 - O45.099 — Premature separation of placenta with coagulation defect

6 Active Policies

CGS-J15-L34032, Debridement Services

J15

CGS-J18-L34032, Debridement Services

J18

AETNA-CPB-0475, Coblation

AETNA-CPB-0630, Prosthetic Limb Vacuum Systems

AETNA-CPB-0639, Autotransfusers and Red Blood Cell Genotyping

Related Codes

11001(3 policies)11042(3 policies)11043(3 policies)11044(3 policies)11045(3 policies)11046(3 policies)11047(3 policies)11000(3 policies)

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about T87.9 Sign up free

An Advance Beneficiary Notice of Non-coverage (ABN) should use Form CMS-R-131 and must be signed by the beneficiary when applicable; for Part A MAC claims include occurrence code 32 and the ABN date.

Providers should check NCCI edits and OPPS packaging edits prior to billing Medicare as procedure codes may be subject to these edits.

A56459, Billing and Coding: Debridement Services