Persius/hicric huggingface dataset:
Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis
Diagnostic Test

The following coding and billing guidance is to be used with its associated
Local coverage determination.

To report an EnvisiaTM Genomic Classifier service, please submit the following
claim information:

  * Select 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
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative
Myeloproliferative Disease

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Genetic
Testing for BCR-ABL Negative Myeloproliferative Disease L36180. For single
genes performed by NGS, these tests must demonstrate compliance with L38123
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies
and Suspected Myeloid Malignancies and its accompanying billing and coding
article, A55624 Billing and Coding: MolDX: Targeted and Comprehensive Genomic
Profile Next-Generation Sequencing Testing in Cancer.

To report Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
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
  *  Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative
Myeloproliferative Disease

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Genetic
Testing for BCR-ABL Negative Myeloproliferative Disease L36186. For single
genes performed by NGS, these tests must demonstrate compliance with L38125
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies
and Suspected Myeloid Malignancies and its accompanying billing and coding
article, A56518 Billing and Coding: MolDX: Targeted and Comprehensive Genomic
Profile Next-Generation Sequencing Testing in Cancer.

To report Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
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
  *  Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Genetic Testing for Hypercoagulability /
Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)

The following coding and billing guidance is to be used with its associated
Local coverage determination.

To report a Genetic Testing for Hypercoagulability/Thrombophilia 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 SV010-7 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
Billing and Coding: MolDX: Genetic Testing for Hypercoagulability /
Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)

The following coding and billing guidance is to be used with its associated
Local coverage determination.

To report a Genetic Testing for Hypercoagulability / Thrombophilia (Factor V
Leiden, Factor II Prothrombin, and MTHFR) 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
  * Select the appropriate ICD-10-CM code
Billing and Coding: Transrectal Ultrasound

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Transrectal Ultrasound.

**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. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

**Documentation Requirements:**  
  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the related 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.  
  
Documentation must be available to Medicare upon request.  
  
 **Utilization Guidelines:**  
  
CPT code 76872 will be covered only 2 (two) times in a year. Services
exceeding this parameter will be considered not medically necessary.
Billing and Coding: Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac
(SI) Joint

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Minimally-invasive Surgical (MIS) Fusion of
the Sacroiliac (SI) Joint.

**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. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

**Documentation Requirements**  
  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the related LCD. (See
Indications and Limitations of Coverage section) This documentation includes,
but is not limited to, relevant medical history, physical examination, and
results of pertinent diagnostic tests or procedures.  
  
Medical record documentation must be available to Medicare upon request.
Billing and Coding: MolDX: MGMT Promoter Methylation Analysis

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: MGMT
Promoter Methylation Analysis

To report a MGMT Promoter Methylation Analysis service, please submit the
following claim information:

  * 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
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: MGMT Promoter Methylation Analysis

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: MGMT
Promoter Methylation Analysis.

To report a MGMT Promoter Methylation Analysis service, please submit the
following claim information:

  * Select Bill Type Code 022x - Skilled Nursing - Inpatient (Medicare Part B only)
  * Select CPT code 81287
  * 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
Billing and Coding: Vestibular and Audiologic Function Studies

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35007 Vestibular and Audiologic Function
Studies. Please refer to the LCD for reasonable and necessary requirements.  
  
**Coding Guidance**  
  
**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.  
  
Consistent with the LCD, CPT codes 92553, 92557 and 92568 may be performed
when there is current long-term use of ototoxic antibiotics.  
  
The professional component of the services represented by CPT codes 92537,
92538, 92541, 92542, 92544, 92545, 92546, 92587, 92588, 92651, 92652, and
92653 may be reported for services performed in inpatient, outpatient, nursing
facilities (when Part A benefits have been exhausted), rehabilitation
facilities, hearing and speech centers, independent clinics, and independent
diagnostic testing facilities (IDTF).  
  
CPT codes 92547, 92552, 92553, 92555, 92556, 92562, 92563, 92565, 92571,
92572, 92575, 92576, 92577, 92582, 92583, and 92584 are considered technical
services only codes and may be reported for services performed in the office
setting, clinics, hearing and speech centers, and nursing facilities.  
  
**Note:** Payment for technical components of Technical Component
(TC)/Professional Component (PC) services (when the PC is performed by an
appropriate professional) and for technical-only services are allowed to
hospitals.  
  
**Utilization Parameters**

Consistent with the utilization outlined in the related LCD:

  * CPT codes 92553, 92557, 92567 and 92568 may be reported once a month when a beneficiary is receiving ototoxic medications
  * The following may only be reported once during a session (same date of service) 
    * CPT codes 92541, 92542, 92544,92545 and 92546
  * CPT code 92542 should not be billed two times for two positions or any multiple increments.
  * Payment may be made for two of the following services per patient per year: 
    * CPT codes 92541, 92542, 92544, 92545 and 92546

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
Billing and Coding: Magnetic Resonance Image Guided High Intensity Focused
Ultrasound (MRgFUS) for Tremor

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Magnetic Resonance Image Guided High
Intensity Focused Ultrasound (MRgFUS) For Tremor.

**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. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

CPT 0398T is inclusive of all radiological services performed. Thus billing
for radiological services associated with the performance of 0398T is not
appropriate and thus not allowed.

Per the Medicare Physician Fee Schedule Relative Value File, co-surgery is not
allowed.

Coverage is limited to a place of service of a hospital or a hospital
outpatient department.
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for
Osteoporotic Vertebral Compression Fracture (VCF)

As an important part of Medicare Local Coverage Determination (LCD)
development, National Government 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 for Percutaneous
Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture
(VCF). The official notice period for the final LCD begins on October 10, 2019
and the final determination will become effective for services rendered on or
after December 1, 2019.
Billing and Coding: MolDX: HLA-DQB1*06:02 Testing for Narcolepsy

The following coding and billing guidance is to be used with its associated
Local Coverage Determination.
Billing and Coding: BRCA1 and BRCA2 Genetic Testing

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L36499, BRCA1 and BRCA2 Genetic Testing. Please
refer to the LCD for reasonable and necessary requirements.

**Coding Guidelines**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

**Documentation Requirements**

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

**Utilization Guidelines**

In accordance with CMS Ruling 95-1 (V), utilization of these services should
be consistent with locally acceptable standards of practice.
Billing and Coding: Genetic Testing for Lynch Syndrome

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34912 Genetic Testing for Lynch Syndrome. Please
refer to the LCD for reasonable and necessary requirements.  
  
**Coding Guidance**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

It has been recognized that there is some variation in the order of testing
based on tissue availability, prevalence, patient history, test availability,
testing turn-around time and patient treatment schedule. However, routine MMR
germ-line mutation testing is not expected prior to appropriate screening
(IHC/MSI). When MSI/IHC testing cannot be performed or is contradictory,
claims for MMR germ-line testing exemptions will require the addition of the
-KX modifier with the reported Current Procedural Terminology (CPT) code. The
-KX modifier specifies that the "Requirements specified in the medical policy
have been met. Documentation on file." Documentation is expected to be
available upon request.

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
Billing and Coding: Posterior Tibial Nerve Stimulation for Voiding Dysfunction

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Posterior Tibial Nerve Stimulation for
Voiding Dysfunction.

**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. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

**Documentation Requirements:**  
  
The medical record must document the patient has OBS and not stress or
neurogenic incontinence. The International Continence Society (ICS) defines
OAB as the presence of "urinary urgency, usually accompanied by frequency and
nocturia, with or without urgency urinary incontinence, in the absence of
urinary tract infection or other obvious pathology."  
  
Compliance and voiding diaries for a minimum of three days must be kept and
provided to document the patient has been compliant with first- and second-
line therapies without sufficient improvement prior to receiving PTNS.  
  
Compliance and voiding diaries for a minimum of three days must be kept and
provided during PTNS treatment and to document any symptoms of relapse.  
  
 **Utilization Guidelines:**  
  
The initial 12-week PTNS treatment should be periodically evaluated to assure
beneficiary improvement and record-keeping compliance.  
  
Treatments for relapse would not be expected to occur more often than one to
two sessions every one to two months.
Billing and Coding: Urodynamics

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Urodynamics.

**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. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

If a penile pressure cuff is used when providing a voiding pressure study, CPT
Code 55899 should be reported with non-invasive urodynamic studies noted in
the narrative portion of the claim.

**Documentation Requirements:**  
  
Each claim must be submitted with ICD-10-CM codes that reflect the condition
of the patient, and indicate the reason(s) for which the service was
performed. Claims submitted without ICD-10-CM codes will be returned.  
  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the related 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.  
  
Documentation must be available to Medicare upon request.