Persius/hicric huggingface dataset:
Billing and Coding: MolDX: Oncotype DX Genomic Prostate Score

The Oncotype DX Genomic Prostate Score (Genomic Health) is covered for use
in very low risk, low risk, and favorable intermediate risk prostate cancer.

To bill for Oncotype DX Genomic Prostate Score services, please provide the
following claim information:

  * CPT code 0047U for services on or after 01/01/2019.
  * Enter "1" in the Days/Unit field
  * For CPT non-NOC codes, Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information. 
    * 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: MolDX: Inivata, InVisionFirst, Liquid Biopsy for
Patients with Lung Cancer

The comment period for the Response to Comments: MolDX: Inivata,
InVisionFirst, Liquid Biopsy for Patients with Lung Cancer DL37903 began on
11/15/2018 and ended on 12/29/2018. Comments were received from the provider
community. The notice period begins on 03/28/2019 and ends 05/12/2019. The LCD
becomes final on 05/13/2019.
Response to Comments: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis
Diagnostic Test

The comment period for the Response to Comments: MolDX: Envisia, Veracyte,
Idiopathic Pulmonary Fibrosis Diagnostic Test DL37887 began on 10/04/2018 and  
ended on 12/14/2018. Comments were received from the provider community. The
notice period begins on 04/11/2019 and ends 05/26/2019. The LCD becomes final
on 05/27/2019.
Response to Comments: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis
Diagnostic Test

The comment period for the Response to Comments: MolDX: Envisia, Veracyte,
Idiopathic Pulmonary Fibrosis Diagnostic Test DL37891 began on 10/04/2018 and  
ended on 12/14/2018. Comments were received from the provider community. The
notice period begins on 04/11/2019 and ends 05/26/2019. The LCD becomes final
on 05/27/2019.
Billing and Coding: Rituximab

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Rituximab L35026.
Response to Comments: Helicobacter Pylori Infection Testing

Noridian's Response to Provider Recommendations for Helicobacter Pylori
Infection Testing for comment period ending 04/13/2018.
Billing and Coding: Supervised Exercise Therapy for the Treatment of
Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent
Claudication

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Supervised Exercise
Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic
Lower Extremity Intermittent Claudication.

After the initial 36 treatment sessions or 12 weeks (whichever comes first)
beneficiaries may be eligible for another 36 treatment sessions with another
referral from a physician. The requirements of this second referral are the
same as for the initial referral. All claims submitted for additional sessions
after the first 36 sessions or the initial 12 week period must append modifier
-KX to the CPT code for this service in order to attest that those
requirements have been fulfilled.

ICD-10-CM diagnosis codes supporting medical necessity must be submitted with
each claim. Claims submitted without such evidence will be denied as not
medically necessary.

Any diagnosis submitted must have documentation in the patient's record to
support coverage and medical necessity.

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: Upper Gastrointestinal Endoscopy and Visualization

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Upper
Gastrointestinal Endoscopy and Visualization L34434.

All unlisted procedure codes billed for services are subject to development
and medical review.
Billing and Coding: Lumbar Artificial Disc Replacement

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Lumbar Artificial
Disc Replacement L37826.
Response to Comments: Topical Oxygen Therapy

The comment period for the Topical Oxygen Therapy L37873 Local Coverage
Determination (LCD) began on October 1, 2018 and ended on November 15, 2018.
The comment below was received from the provider community. The notice period
for L37873 begins on March 21, 2019 and ends on May 5, 2019. This LCD will
become effective on May 6, 2019.
Response to Comments: Lumbar Artificial Disc Replacement

The comment period for the **_Lumbar Artificial Disc Replacement_** **
_L37826_** Local Coverage Determination (LCD) began on 10/1/18 and ended on
11/15/18. The comments below were received from the provider community. The
notice period for L37826 begins on 3/21/19 and will become effective on
5/6/19.
Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic

This article only applies to **diagnostic** colonoscopies and sigmoidoscopies.
Sigmoidoscopy and colonoscopy testing allows for the direct visualization of
the lower gastrointestinal tract. Inspection is performed with an illuminated
tube. These procedures are performed to detect polyps, tumors and other
lesions of the intestines. The site of pathology can be identified during a
colonoscopy and a biopsy can be obtained. Refer to associated LCD L34614.

Refer to the Medicare Internet Only Manuals (IOM) for coverage of colorectal
cancer screening procedures.

**Documentation Requirements**  
The medical record should support the medical reasonableness, necessity and
frequency of the diagnostic test performed. This documentation should be made
available to the Contractor upon request.

Documentation must indicate the precise areas scoped and the depth reached
during colonoscopy.

**Utilization Guidelines**  
It is expected that these services would be performed as indicated by current
medical literature and/or standards of practice.
Billing and Coding: Endoscopic Treatment of GERD

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD L34659.

Benefits are not available for endoluminal treatment for Gastroesophageal
Reflux Disease (GERD) using the Stretta procedure, the Bard EndoCinchTM
Suturing System, PlicatorTM, or similar treatments as these procedures are not
considered reasonable and necessary for the diagnosis or treatment of an
injury or disease.

Currently, these procedures are considered non-covered due to the fact that
current peer-reviewed literature does not support the efficacy of the
services. Claims will be denied as "not proven effective."

Coverage is appropriate for the TIF (Transoral Incisionless Fundoplication)
procedure, example EsophyXTM, documentation must support the indications listed
in L34659.

**Documentation Requirements**  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within this LCD. (See the Coverage
Indications, Limitations and/or Medical Necessity). This documentation
includes, but is not limited to, relevant medical history, physical
examination, and results of pertinent diagnostic tests or procedures, and any
other records that describe or support the evaluation and treatment of the
patient. Documentation should be available to the Contractor upon request.
Billing and Coding: Lumbar Spinal Fusion

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Lumbar Spinal
Fusion L37848.
Response to Comments: Lumbar Spinal Fusion

The comment period for the **_Lumbar Spinal Fusion L37848_** Local Coverage
Determination (LCD) began on 10/1/18 and ended on 11/15/18. The comments
below were received from the provider community. The notice period for L37848
begins on 3/21/19 and will become effective on 5/6/19.
Response to Comments: MolDX: MDS FISH (DL37772)

NA
Response to Comments: Voretigene Neparvovec-rzyl (Luxturna)

The comment period for the Voretigene Neparvovec-rzyl (LuxturnaTM) L37863
Local Coverage Determination (LCD) began on October 1, 2018 and ended on
November 15, 2018. The comments below were received from the provider
community. The notice period for L37873 begins on March 21, 2019 and ends on
May 5, 2019. This LCD will become effective on May 6, 2019.
Response to Comments: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis
Diagnostic Test (DL37919)

NA
Response to Comments: MolDX: Inivata, InVisionFirst, Liquid Biopsy for
Patients with Lung Cancer

The comment period for the Response to Comments: MolDX: Inivata,
InVisionFirst, Liquid Biopsy for Patients with Lung Cancer DL37899 began on
10/04/2018 and ended on 12/14/2018. Comments were received from the provider
community. The notice period begins on 04/18/2019 and ends 06/02/2019. The LCD
becomes final on 06/03/2019.
Response to Comments: MolDX: Inivata, InVisionFirst, Liquid Biopsy for
Patients with Lung Cancer

The comment period for the Response to Comments: MolDX: Inivata,
InVisionFirst, Liquid Biopsy for Patients with Lung Cancer DL37897 began on
10/04/2018 and ended on 12/14/2018. Comments were received from the provider
community. The notice period begins on 04/18/2019 and ends 06/02/2019. The LCD
becomes final on 06/03/2019.
Response to Comments: Hyaluronan Acid Therapies for Osteoarthritis of the Knee

The following are the comment summaries and contractor responses for Novitas
Solutions Proposed Local Coverage Determination (LCD) DL35427 Hyaluronan Acid
Therapies for Osteoarthritis of the Knee which was posted for comment on
September 20, 2018, and presented at the October 2018 Contractor Advisory
Committee (CAC) Meeting. All comments were reviewed and incorporated into the
final LCD where applicable.
Billing and Coding: Endovenous Stenting

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L37893 Endovenous Stenting. Please refer to the
LCD for reasonable and necessary requirements.  
  
Medicare reimbursement for endovenous stenting is limited to the treatment of
severely symptomatic venous obstructions as outlined in the related LCD.  
  
 **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.

Claims must be submitted with an ICD-10-CM code that represents the reason the
procedure was done. The ICD-10-CM code must be billed to the highest level of
specificity for that code set. The ICD-10-CM code must be linked to the
appropriate procedure code.  
  
 **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.
  4. Medical record documentation should list type and length of conservative treatment as applicable per the LCD.
  5. Pre- and post-deployment intervention images should be obtained and made available upon request. Intermediate stages pertinent to the endovascular procedure may also be documented with images. Details should include the position of the device, and when appropriate, the nature of the obstruction (if a determination can be made regarding the etiology), and effect of the device on target or nontarget vessels.
  6. Medical record documentation should list guide catheter used, as well as stent type, diameter and length.
Billing and Coding: Assays for Vitamins and Metabolic Function

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34914, Assays for Vitamins and Metabolic
Function. 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.

The following tests currently do not have specific codes assigned for the
test.

  * CPT code 84999 should be used to bill the following tests and a note should be added to identify which test was performed in the Remarks area of the claim for Part A and the Narrative area of the claim for Part B:
    * Functional intracellular analysis
    * Total antioxidant function

**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: Frequency of Laboratory Tests

Refer to the Novitas Local Coverage Determination (LCD) L35099, Frequency of
Laboratory Tests, for reasonable and necessary requirements and frequency
limitations.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding
System (HCPCS) code(s) may be subject to National Correct Coding Initiative
(NCCI) edits. This information does not take precedence over NCCI edits. Per
CMS Medicare Learning Network (MLN) Medicare Matters number MM8863, the use of
NCCI-associated modifiers should NOT be used to bypass a procedure-to-
procedure (PTP) edit unless the proper criteria for use of the modifier are
met. Documentation in the medical record must satisfy the criteria required by
any NCCI-associated modifier that is used. Please refer to NCCI for correct
coding guidelines and specific applicable code combinations prior to billing
Medicare.

Refer to the NCDs for the procedure code list of ICD-10-CM codes that are
considered covered by Medicare at:

https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html
Billing and Coding: CT of the Abdomen and Pelvis

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for CT of the Abdomen
and Pelvis L34415.
Billing and Coding: Bariatric Surgical Management of Morbid Obesity

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35022 (Bariatric Surgical Management). 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.

CPT code 43659 should be used when BOTH the gastric band and subcutaneous port
components were removed AND replaced.

CPT code 43843 should be used to bill the following test and a note should be
added to identify the specific test performed in the Remarks area of the claim
for Part A and the Narrative area of the claim for Part B:

  * Open-sleeve gastrectomy

Not otherwise classified (NOC) CPT code 43999 should be used to bill the
following tests and a note should be added to identify the specific test
performed in the Remarks area of the claim for Part A and the Narrative area
of the claim for Part B:

  * Laparoscopic vertical-banded gastroplasty
  * Open adjustable gastric banding

Coverage for selected bariatric surgery procedures on patients who meet
national and local coverage criteria set forth in the LCD requires reporting
three appropriate diagnoses. Report the primary diagnosis as E66.01 (morbid
obesity). Report a secondary diagnosis from ICD-10 Code group 1 and a tertiary
diagnosis from ICD-10 Code group 2.
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing

  
This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35083 Cardiology Non-Emergent Outpatient Stress
Testing. 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.  
  
Current Procedural Terminology (CPT) code 78434 should be reported in
conjunction with CPT code 78431 or 78492.  
  
Evaluation of the individual's left ventricular wall motion and ejection
fractions are routinely performed during SPECT MPI and are included in the
code's definition.  
  
Attenuation correction, when performed, is included in the MPI service.  
  
 **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.
  4. If the provider of the service is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician's order for the studies.
  5. The ordering physician must state the clinical indication/medical necessity for the study in the order for the test.
  6. Documentation must be maintained by the referring physician in the beneficiary's medical record that the required conditions (as indicated in the "Coverage Indications, Limitations and/or Medical Necessity" section of the LCD) for the stress test performed have been met.
  7. The rationale for selecting pharmacologic stress testing rather than exercise stress testing must be documented in the medical record.
  8. In the instance where regional wall motion abnormalities and ejection fraction have been assessed during the same episode of care by other testing modalities (e.g., echocardiography), the medical necessity of repeating this assessment through the use of nuclear imaging modalities must be clearly documented in the medical record.
  9. All segments of the service must have a formal interpretation and report.
Billing and Coding: Topical Oxygen Therapy

The information in this article contains billing, coding or other guidelines
that complement the Topical Oxygen Therapy L37873 Local Coverage Determination
(LCD).
Billing and Coding: Infliximab

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Infliximab L35677.
Billing and Coding: eVox System and Other Electroencephalograph Testing for
Memory Loss

  
eVox, BrainView NeuralScan and VoxNeuro are Class II medical devices cleared
by the [U.S. Food & Drug Administration
(FDA)](https://www.fda.gov/MedicalDevices/default.htm) that acquire, display,
and store the electrical activity of a patient's brain, including
electroencephalograph (EEG) and event-related potentials (ERPs), by placing
two or more electrodes on the head. These devices map areas of the brain and
measure brain activity. Using analytical software the test findings are placed
into interpretable results assisting the physician in making a diagnosis and
decision about a patient's brain function.  
  
Novitas has seen the eVox System billed to Medicare using the following
Current Procedural Terminology (CPT) codes 92650, 92653, 95816, 95930, 95957
and 96146.  
  
 **Coding Guidance  
  
** CPT codes 92650, 92653, 95816, 95930, 95957 and 96146 represent separate
services for digital analysis of EEG, EEG recording, and visual and auditory
evoked potential testing. The eVox System and similar tests describe a panel
of tests that should be billed using the unlisted neurological or
neuromuscular diagnostic procedure code. The panel of tests does not
accurately reflect the testing, the work units nor the inherent training
described by the CPT codes listed above. Therefore, it is incorrect coding to
bill the individual CPT codes listed above when performing the eVox System or
other electroencephalograph testing for memory loss.  
  
When billing for eVox System, BrainView NeuralScan, VoxNeuro or similar
systems CPT code 95999 should be reported on the claim with one unit of
service. The term for the device (e.g., eVox System, BrainView Neural Scan
System, VoxNeuro, etc.) should be reported in the Remarks area of the claim
for Part A and the Narrative area of the claim for Part B.  
  
 **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.
Response to Comments: MolDX: MDS FISH

The comment period for the MolDX: MDS FISH DL37620 began on 02/01/2018 and
ended on 04/13/2018. Comments were received from the provider community. The
notice period begins on 04/18/2019 and ends 06/02/2019. The LCD becomes final
on 06/03/2019.
Billing and Coding: Cardiac Radionuclide Imaging

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Cardiac
Radionuclide Imaging L33457.

Claims submitted for stress tests performed as preoperative evaluation of
patients without symptoms of coronary artery disease (CAD) who are deemed to
be at moderate risk must document 1 of the following at-risk conditions in the
medical record: diabetes mellitus (DM) with complications, peripheral vascular
disease (PVD), aortic aneurysm or cerebrovascular disease.