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ICD-10-CM W53.11XA, Bitten by rat, initial encounter | No Prior Auth

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`W53.11XA`, Bitten by rat, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All documentation must be maintained in the patient medical record and made available to the contractor upon request, with every page legible and containing appropriate patient identification (e.g., full name, dates of service).
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Key Coverage Criteria

Tetanus immunization is covered when given for a wound or documented direct exposure to Clostridium tetani (injury-related or exposure-related prophylaxis).
Tetanus immunization is covered when given for an injury or direct exposure to tetanus (i.e., wound management or exposure prophylaxis).

2 Active Policies

A58873, Billing and Coding: Tetanus Immunization

J9

A58872, Billing and Coding: Tetanus Immunization

JL

Related Codes

90715(2 policies)S00.01XA(2 policies)S00.01XD(2 policies)S00.05XA(2 policies)S00.05XD(2 policies)S00.07XA(2 policies)S00.07XD(2 policies)90714(2 policies)

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Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).

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