Question

A claim is submitted for a patient who suffered a fractured femur. The diagnosis code that was submitted is S82.401A, with the CPT® fracture care code 27230. Does the diagnosis code support medical necessity for the service provided?

1) Yes, the diagnosis code supports the CPT® code billed.
2) Yes, the procedure code is supported by the ICD-10-CM code.
3) No, the diagnosis code does not support the CPT® fracture care code.
4) A diagnosis code is not necessary when reporting CPT® codes.

Answer 1

The diagnosis code S82.401A does support medical necessity for the service provided with the CPT code 27230 as it corresponds to the treatment of a closed proximal femoral fracture.

Step-by-step explanation:

Yes, the diagnosis code S82.401A supports the medical necessity for the service provided when billed with the CPT® fracture care code 27230. The ICD-10-CM code S82.401A represents a closed fracture of the shaft of the right femur, initial encounter for a closed fracture, which correlates with the procedure described by CPT® code 27230 for closed treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement. Thus, the provided diagnosis supports the CPT® code, which is necessary for billing and insurance purposes to demonstrate the medical necessity of the procedure performed.