Persius/hicric huggingface dataset:
Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT
codes 81265-81268)

Please note that CPT codes 81265 and 81266 describe services performed for
recipient/donor testing _and_ twin zygosity. Tests indicated for
recipient/donor testing will be considered for payment and tests for twin
zygosity will be denied as a statutorily excluded service. The following
instructions outline the correct reporting of recipient/donor testing for
transplant services.  
  
Chimerism analysis to identify appropriate donors and monitor engraftment
success or disease reoccurrence is a covered Medicare service.

    * Code 81265 should be reported with one unit of service (UOS). Except in rare cases, this service would only be performed once per lifetime.

    * Code 81266, when used in bone marrow transplants to report an additional double-cord blood sample, is a covered service.

    * Code 81267 should be used post transplantation to confirm successful engraftment or disease reoccurrence. Although the original donor specimen may be referenced, an additional 81265 should NOT be submitted in addition to the 81267 service. For labs that hold the pre-transplant specimen (81265 and/or 81266) until after the transplant occurs, use 81267 plus 81265 and 81266 if necessary.

  
**Note:**

Code 81267 should be reported for the findings of the pre and post-transplant
comparison

  * Code 81268 should be used to report chimerism using a buccal or other germline tissue specimen from the recipient post-transplantation. For labs that hold the pre-transplant specimen (81265 and/or 81266) until after the transplant occurs, use 81267 plus 81265 and 81266 if necessary.

MolDX would not expect to see a claim for 81265 pre-transplant and an
additional 81265 and 81267 post-transplant or a claim for 81265 pre-transplant
and an additional claim for 81268.  
  
 **EXCEPTIONS:** Although the initial chimerism testing, code 81265, for
engraftment is usually limited to once in a lifetime, MolDX recognizes special
circumstances may require an additional service and will consider approval on
a case-by-case basis through the appeal process.

To report a Molecular Diagnostic Test service, please submit the following
claim information:

  * Select appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT
codes 81265-81268)

Please note that CPT codes 81265 and 81266 describe services performed for
recipient/donor testing _and_ twin zygosity. Tests indicated for
recipient/donor testing will be considered for payment and tests for twin
zygosity will be denied as a statutorily excluded service. The following
instructions outline the correct reporting of recipient/donor testing for
transplant services.  
  
Chimerism analysis to identify appropriate donors and monitor engraftment
success or disease reoccurrence is a covered Medicare service.

    * Code 81265 should be reported with one unit of service (UOS). Except in rare cases, this service would only be performed once per lifetime.

    * Code 81266, when used in bone marrow transplants to report an additional double-cord blood sample, is a covered service.

    * Code 81267 should be used post transplantation to confirm successful engraftment or disease reoccurrence. Although the original donor specimen may be referenced, an additional 81265 should NOT be submitted in addition to the 81267 service. For labs that hold the pre-transplant specimen (81265 and/or 81266) until after the transplant occurs, use 81267 plus 81265 and 81266 if necessary.

**Note:**

Code 81267 should be reported for the findings of the pre and post-transplant
comparison.

  * Code 81268 should be used to report chimerism using a buccal or other germline tissue specimen from the recipient post-transplantation. For labs that hold the pre-transplant specimen (81265 and/or 81266) until after the transplant occurs, use 81267 plus 81265 and 81266 if necessary.

MolDX would not expect to see a claim for 81265 pre-transplant and an
additional 81265 and 81267 post-transplant or a claim for 81265 pre-transplant
and an additional claim for 81268.

**EXCEPTIONS:** Although the initial chimerism testing, code 81265, for
engraftment is usually limited to once in a lifetime, MolDX recognizes special
circumstances may require an additional service and will consider approval on
a case-by-case basis through the appeal process.

To report a Molecular Diagnostic Test service, please submit the following
claim information:

  * Select appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Response to Comments: Erythropoiesis Stimulating Agents (ESAs) (L34633)

As an important part of Medicare Local Coverage Determination (LCD)
development, Wisconsin Physician Services solicits comments from the provider
community and from members of the public who may be affected by or interested
in our LCDs. The purpose of the advice and comment process is to gain the
expertise and experience of those commenting.

We would like to thank those who suggested changes to the LCD and Billing and
Coding Article for Erythropoiesis Stimulating Agents (ESAs). The official
notice period for the final LCD begins on December 26, 2019 and the final
determination will become effective for services rendered on or after February
09, 2020.
Response to Comments: DL37228 Wound Care

As an important part of Medicare Local Coverage Determination (LCD)
development, Wisconsin Physician Services solicits comments from the provider
community and from members of the public who may be affected by or interested
in our LCDs. The purpose of the advice and comment process is to gain the
expertise and experience of those commenting.

We would like to thank those who suggested changes to the LCD L37228 Wound
Care and A55909 Billing and Coding: Wound Care. The notice period for L37228
and A55909 begins on 12/26/2019 and will become effective on 02/09/2020.
Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility

Medicare covers the following solid organ transplants: kidney, heart, lung,
heart/lung, liver, pancreas, pancreas/kidney, and intestinal/multi-visceral.
Medicare also covers stem cell transplants for certain conditions.

Claims for CPT codes used to describe Human Leukocyte Antigen (HLA) testing
used for transplant histocompatibility testing will be denied. See below for
further explanation on correct billing for these services. This does not refer
to HLA testing for non-transplant services.

HLA testing for histocompatibility testing as part of transplantation are part
of solid organ acquisition services.

Services for organ transplants must be billed as described in the Centers for
Medicare and Medicaid Services (CMS) Internet-Only Manual, Pub 100-04,
Medicare Claims Processing Manual, Inpatient Hospital Billing, Chapter 3
Section 90 and as described in the Electronic Code of Federal Regulations,
Title 42, Public Health, Part 412 Prospective Payment Systems for Inpatient
Hospital Services. The acquisition costs of hearts, kidneys, livers, lungs,
pancreas, and intestines (or multivisceral organs) incurred by approved
transplantation centers are paid on a reasonable cost basis by approved
transplant centers; they are not billed as stand-alone laboratory services.

HLA typing is a component of the acquisition services for an allogeneic stem
cell transplant as well. Payment for these acquisition services is included in
the MS-DRG payment for the allogeneic stem cell transplant when the transplant
occurs in the inpatient setting and in the OPPS APC payment for the allogeneic
stem cell transplant when the transplant occurs in the outpatient setting. The
Medicare contractor does not make separate payment for these acquisition
services, because hospitals may bill and receive payment only for services
provided to the Medicare beneficiary who is the recipient of the stem cell
transplant and whose illness is being treated with the stem cell transplant.
Unlike the acquisition costs of solid organs for transplant (e.g., hearts and
kidneys), which are paid on a reasonable cost basis, acquisition costs for
allogeneic stem cells are included in prospective payment.

Acquisition charges do not apply to autologous transplants.

HLA CPT codes unrelated to transplant testing have coverage as outlined in
the following Local Coverage Determinations (LCDs):

  * CPT 81381 - The MolDX: Pharmacogenomics Testing L38435 LCD addresses limited coverage for gene-drug interactions.
  * CPT 81383 - The MolDX: HLA-DQB1*06:02 Testing for Narcolepsy L37003 LCD addresses non-coverage of HLA-DQB1*06:02 typing for the diagnosis or management of narcolepsy.
Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Next
Generation Sequencing for Solid Tumors L38158.

Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57880:

To report a Next Generation Sequencing for Solid Tumors service, please submit
the following claim information:

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Response to Comments: Next-Generation Sequencing for Solid Tumor (DL38158)

This article summarizes the comments all of the MolDX partners received for
Draft Local Coverage Determinations (LCD) Next-Generation Sequencing for Solid
Tumor. Thank you for the comments.
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Micro-Invasive Glaucoma Surgery (MIGS).

**Coding Information:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed.

**Specific Coding Guideline:**

According to Current Procedural Terminology (CPT), in this setting a 'device'
is a 'stent'. Therefore, to comply with coverage requirements set forth in the
Local Coverage Determination the stent(s) must be inserted on the same date of
service as the cataract surgery and billed accordingly on the same claim.

Insertion of these devices not in conjunction with cataract surgery services
is considered investigational and will be denied.

For insertion of the XEN45 bill 0449T. Insertion of more than one XEN45 device
per eye in a given surgical session (each additional device represented by CPT
0450T) is considered investigational and not covered.

Since there is no specific CPT code for goniopuncture or so-called
microgoniotomy procedures, the unlisted CPT code 66999 (unlisted procedure,
anterior segment of the eye) should be reported in these instances.

Any procedures performed which consists of single or multiple small punctures
and/or injections of small amounts of viscoelastic, or other limited
interventions should be reported using unlisted CPT code 66999.

Specifically, goniotomy (CPT code 65820) should not be coded in addition to
other angle surgeries, stent insertions or Schlemm canal implants or if the
incision into the trabecular meshwork is minimal or simply incidental to
another procedure.

In order to report a goniotomy, an extensive incision of the trabecular
meshwork around the eye, at the least and generally more than 3 clock hours,
must have been performed.

Documentation regarding the reasonable and necessary premise for the work must
be present. Noridian may request additional documentation on a case-by-case
basis.

**Documentation Requirements:** The patient's medical record must contain
documentation that fully supports the medical necessity for services included
in the LCD. (See "Indications and Limitations of Coverage.") This
documentation includes, but is not limited to, relevant medical history,
physical examination, and results of pertinent diagnostic tests or procedures.
The medical record and/or test results documenting medical necessity should be
maintained and made available on request. iStent, iStent inject, and Hydrus
must be performed in conjunction with cataract surgery on the same date of
service and documented in the medical record.
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Micro-Invasive Glaucoma Surgery (MIGS).

**Coding Information:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed.

**Specific Coding Guideline:**

According to Current Procedural Terminology (CPT), in this setting a 'device'
is a 'stent'. Therefore, to comply with coverage requirements set forth in the
Local Coverage Determination, the stent(s) must be inserted on the same date
of services as the cataract surgery and billed accordingly on the same claim.

Insertion of these devices not in conjunction with cataract surgery services
is considered investigational and will be denied.

For insertion of the XEN45 bill 0449T. Insertion of more than one XEN45 device
per eye in a given surgical session (each additional device represented by CPT
0450T) is considered investigational and not covered.

Since there is no specific CPT code for goniopuncture or so-called
microgoniotomy procedures, the unlisted CPT code 66999 (unlisted procedure,
anterior segment of the eye) should be reported in these instances.

Any procedures performed which consists of single or multiple small punctures
and/or injections of small amounts of viscoelastic, or other limited
interventions should be reported using unlisted CPT code 66999.

Specifically, goniotomy (CPT code 65820) should not be coded in addition to
other angle surgeries, stent insertions or Schlemm canal implants or if the
incision into the trabecular meshwork is minimal or simply incidental to
another procedure.

In order to report a goniotomy, an extensive incision of the trabecular
meshwork around the eye, at the least and generally more than 3 clock hours,
must have been performed.

Documentation regarding the reasonable and necessary premise for the work must
be present. Noridian may request additional documentation on a case-by-case
basis.

**Documentation Requirements:** The patient's medical record must contain
documentation that fully supports the medical necessity for services included
in the LCD. (See "Indications and Limitations of Coverage.") This
documentation includes, but is not limited to, relevant medical history,
physical examination, and results of pertinent diagnostic tests or procedures.
The medical record and/or test results documenting medical necessity should be
maintained and made available on request. iStent, iStent inject, and Hydrus
must be performed in conjunction with cataract surgery on the same date of
service and documented in the medical record.
Response to Comments: MolDX: Plasma-Based Genomic Profiling in Solid Tumors

The comment period for the MolDX: Plasma-Based Genomic Profiling in Solid
Tumors DL38043 Local Coverage Determination (LCD) began on 5/6/19 and ended on
6/20/19. The comments below were received from the provider community. The
notice period for L38043 begins on 12/19/19 and will become effective on
2/3/20.
Billing and Coding: MolDX: Plasma-Based Genomic Profiling in Solid Tumors

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Plasma-Based
Genomic Profiling in Solid Tumors L38043.

To report a Plasma-Based Genomic Profiling in Solid Tumors service, please
submit the following claim information:

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Pigmented Lesion Assay

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Pigmented
Lesion Assay L38051.

To report a service, please submit the following claim information:

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Response to Comments: MolDX: Pigmented Lesion Assay

The comment period for the MolDX: Pigmented Lesion Assay DL38051 Local
Coverage Determination (LCD) began on 05/06/19 and ended on 06/20/19 _._ The
notice period for MolDX: Pigmented Lesion Assay L38051 LCD begins on 12/26/19
and will become effective on 2/10/20 _._ The comments below were received from
the provider community.
Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Next
Generation Sequencing for Solid Tumors L38067.

Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57910:

To report a Next Generation Sequencing for Solid Tumors service, please submit
the following claim information:

  * Select the appropriate CPT code 
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 

  *     * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
  *     * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code

**NOTE:** When entering the DEX Z-Code on the SV101-7 documentation field for
Part B claims please do not add additional characters and/or information on
the line.
Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for
Myeloid Malignancies and Suspected Myeloid Malignancies

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Next
Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and
Suspected Myeloid Malignancies L38070.

Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57503:

To report a Next Generation Sequencing Lab-Developed Tests for Myeloid
Malignancies and Suspected Myeloid Malignancies service, please submit the
following claim information:

  * Select the appropriate CPT code 
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 

  *     * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 

  *     * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code

NOTE: When entering the DEX Z-Code on the SV101-7 documentation field for
Part B claims please do not add additional characters and/or information on
the line.
Response to Comments: MolDX: Next-Generation Sequencing for Solid Tumors

The comment period for the MolDX: Next Generation Sequencing for Solid Tumors
DL38067 Local Coverage Determination (LCD) began on 5/7/19 and ended on
6/21/19. The comments below were received from the provider community. The
notice period for MolDX: Next Generation Sequencing for Solid Tumors L38501
begins on 12/26/19 and will become effective on 2/10/2019.
Response to Comments: MolDX: Next Generation Sequencing Lab-Developed Tests
for Myeloid Malignancies and Suspected Myeloid Malignancies

The comment period for the MolDX: Next Generation Sequencing Lab-Developed
Tests for Myeloid Malignancies and Suspected Myeloid Malignancies DL38504
Local Coverage Determination (LCD) began on 5/7/19 and ended on 6/21/19. The
comments below were received from the provider community. The notice period
for MolDX: Next Generation Sequencing Lab-Developed Tests for Myeloid
Malignancies and Suspected Myeloid Malignancies DL38504 begins on 12/26/19 and
will become effective on 2/10/20.