ICD-10 M19.172 is officially defined as "Post-traumatic osteoarthritis, left ankle and foot." code M19.172 is referenced in 3 tracked payer policy changes from Health Net and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code M19.172 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Health Net updated multiple medical policies in Q4 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties including oxygen therapy, allergy testing, bariatric surgery, wound care, and various diagnostic procedures.
CalViva Health updated multiple medical policies for Q4 2020 affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties. Key changes include revised oxygen therapy criteria, new ambulatory surgery center redirection requirements, updated bariatric surgery protocols, and modified coverage for various diagnostic and therapeutic services.
Total ankle replacement using an FDA-approved device may be considered medically necessary in skeletally mature patients with moderate to severe ankle (tibiotalar) pain that limits daily activity and who have arthritis in adjacent joints (subtalar or midfoot), severe arthritis or arthrodesis of the contralateral ankle, or inflammatory (e.g., rheumatoid) arthritis. Total ankle replacement is considered investigational for all other indications. Absolute contraindications include extensive avascular necrosis of the talar dome, compromised bone stock or soft tissue, severe malalignment (e.g., >15 degrees) not correctable by surgery, active ankle joint infection, peripheral vascular disease, and Charcot neuroarthropathy.
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