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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that certain conditions have both an underlying etiology and multiple body system manifestations 
due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the 
underlying condition be sequenced first, if applicable, followed by the manifestation. Wherever such a 
combination exists, there is a use additional code note at the etiology code, and a code first note at the 
manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology 
followed by manifestation. In most cases the manifestation codes will have in the code title, in diseases 
classified elsewhere. Codes with this title are a component of the etiology/ manifestation convention. The 
code title indicates that it is a manifestation code. In diseases classified elsewhere codes are never permitted 
to be used as first listed or principal diagnosis codes. They must be used in conjunction with an underlying 
condition code, and they must be listed following the underlying condition. See category F02, Dementia 
in other diseases classified elsewhere, for an example of this convention. There are manifestation codes that do 
not have in diseases classified elsewhere in the title. For such codes, there is a use additional code note at 
the etiology code and a code first note at the manifestation code, and the rules for sequencing apply. In 
addition to the notes in the Tabular List, these conditions also have a specific Alphabetic Index entry structure. 
In the Alphabetic Index both conditions are listed together with the etiology code first followed by the 
manifestation codes in brackets. The code in brackets is always to be sequenced second. An example of the 
etiology/manifestation convention is dementia in Parkinsons disease. In the Alphabetic Index, code G20 is 
listed first, followed by code F02.80 or F02.81 in brackets. Code G20 represents the underlying etiology, 
Parkinsons disease, and must be sequenced first, whereas code F02.80 and F02.81 represent the manifestation 
of dementia in diseases classified elsewhere, with or without behavioral disturbance. Code first and Use 
additional code notes are also used as sequencing rules in the classification for certain codes that are not part 
of an etiology/ manifestation combination. You can find this information in the International Classification of 
Diseases (ICD)-10-CM Official Guidelines for Coding and Reporting, Section I.A.13. 
 
The rules say for cases of septic shock, the code for the systemic infection should be sequenced first, followed by code R65.21, Severe sepsis with septic shock or code T81.12, Postprocedural septic shock. Any additional 
codes for the other acute organ dysfunctions should also be assigned. As noted in the sequencing instructions in 
the Tabular List, the code for septic shock cannot be assigned as a principal diagnosis. You can find this 
information in the ICD-10-CM Official Guidelines for Coding and Reporting, Section C. Chapter-Specific 
Coding Guidelines. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.