Persius/hicric huggingface dataset:
Billing and Coding: Transcranial Magnetic Stimulation (TMS)

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD L37086 Transcranial Magnetic Stimulation (TMS).

**Documentation Requirements**  
  
All documentation must be maintained in the patient's medical record and
available to the contractor upon request. The medical record documentation
must support the medical necessity of the services as directed in this policy
as well as include sufficient detail to determine services rendered.  
  
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.  
  
The attending physician must monitor and document the patient's clinical
progress during treatment. The attending physician must use evidence-based
validated depression monitoring scales such as the Geriatric Depression Scale
(GDS), the Personal Health Questionnaire Depression Scale (PHQ-9), the Beck
Depression Scale (BDI), Hamilton Rating Scale for Depression (HAM-D), the
Montgomery Asberg Depression Rating Scale (MADRS), the Quick Inventory of
Depressive Symptomatology (QIDS) or the Inventory for Depressive
Symptomatology Systems Review (IDS-SR) to monitor treatment response and the
achievement of remission of symptoms.  
  
 **Utilization Guidelines**  
  
The treatment must be provided by use of a device approved by the FDA for the
purpose of supplying Transcranial Magnetic Stimulation.  
  
It is expected that the services would be performed as indicated by current
medical literature and standards of practice. Services performed in excess of
established parameters may be subject to review for medical necessity.  
  
TMS is reasonable and necessary for up to 20 visits over a 4-week period
followed by five visits for tapering for those in remission. For those who
show at least 25% improvement by means of the standard tests for depression,
the therapy may be continued for an additional 2 weeks (an additional 10
visits) with an additional 6 visits for tapering.  
  
Retreatment may be considered for patients who met the guidelines for initial
treatment and subsequently developed relapse of depressive symptoms if the
patient responded to prior treatments as evidenced by a greater than 50%
improvement in standard rating scale measurements for depressive symptoms or
if there was a relapse after remission (e.g., (GDS), PHQ-9, BDI, HAM-D, MADRS,
QIDS or IDS-SR score). A repeat treatment program is allowed as above.  
  
Maintenance therapy is considered experimental/investigational and therefore
non-covered as not medically reasonable and necessary.
Billing and Coding: Transcranial Magnetic Stimulation (TMS)

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD L37088 Transcranial Magnetic Stimulation (TMS).

**Documentation Requirements**  
  
All documentation must be maintained in the patient's medical record and
available to the contractor upon request. The medical record documentation
must support the medical necessity of the services as directed in this policy
as well as include sufficient detail to determine services rendered.  
  
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.  
  
The attending physician must monitor and document the patient's clinical
progress during treatment. The attending physician must use evidence-based
validated depression monitoring scales such as the Geriatric Depression Scale
(GDS), the Personal Health Questionnaire Depression Scale (PHQ-9), the Beck
Depression Scale (BDI), Hamilton Rating Scale for Depression (HAM-D), the
Montgomery Asberg Depression Rating Scale (MADRS), the Quick Inventory of
Depressive Symptomatology (QIDS) or the Inventory for Depressive
Symptomatology Systems Review (IDS-SR) to monitor treatment response and the
achievement of remission of symptoms.  
  
 **Utilization Guidelines**  
  
The treatment must be provided by use of a device approved by the FDA for the
purpose of supplying Transcranial Magnetic Stimulation.  
  
It is expected that the services would be performed as indicated by current
medical literature and standards of practice. Services performed in excess of
established parameters may be subject to review for medical necessity.  
  
TMS is reasonable and necessary for up to 20 visits over a 4-week period
followed by five visits for tapering for those in remission. For those who
show at least 25% improvement by means of the standard tests for depression,
the therapy may be continued for an additional 2 weeks (an additional 10
visits) with an additional 6 visits for tapering.  
  
Retreatment may be considered for patients who met the guidelines for initial
treatment and subsequently developed relapse of depressive symptoms if the
patient responded to prior treatments as evidenced by a greater than 50%
improvement in standard rating scale measurements for depressive symptoms or
if there was a relapse after remission (e.g., (GDS), PHQ-9, BDI, HAM-D, MADRS,
QIDS or IDS-SR score). A repeat treatment program is allowed as above.  
  
Maintenance therapy is considered experimental/investigational and therefore
non-covered as not medically reasonable and necessary.
Billing and Coding: Computerized Corneal Topography

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33810 Computerized Corneal Topography. Please
refer to the LCD for reasonable and necessary requirements and limitations.

**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.

**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: Trigger Point Injections

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

It is expected that trigger point injections would not usually be performed
more often than three sessions in a three month period. If trigger point
injections are performed more than three sessions in a three month period, the
reason for repeated performance and the substances injected should be evident
in the medical record and available to the Contractor upon request.  
  
This contractor may request records when it is apparent that patients are
requiring a significant number of injections to manage their pain.
Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

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

1\. Each claim must be submitted with an ICD-10-CM code(s) that reflects the
condition of the patient and indicates the     reason(s) for which the service
was performed.  
  
2\. The patient's medical record must contain a history and physical
examination supporting the diagnosis of symptomatic varicose veins, and the
failure of an adequate (at least 3 months) trial of conservative management.  
  
3\. The medical record must document the performance of appropriate tests, if
medically necessary, to confirm the pathology of the vascular anatomy.  
  
4\. This documentation must be made available to Medicare upon request.  
  
5\. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI)
edits. This policy does not take precedence over CCI edits. Please refer to
the CCI for correct coding guidelines and specific applicable code
combinations prior to billing Medicare.  
  
6\. When the documentation does not meet the criteria for the service rendered
or the documentation does not establish the medical necessity for the
services, such services will be denied as not reasonable and necessary under
Section 1862(a)(1) of the Social Security Act.
Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

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

1\. Each claim must be submitted with an ICD-10-CM code(s) that reflects the
condition of the patient and indicates the reason(s) for which the service was
performed.  
  
2\. The patient's medical record must contain a history and physical
examination supporting the diagnosis of symptomatic varicose veins, and the
failure of an adequate (at least 3 months) trial of conservative management.  
  
3\. The medical record must document the performance of appropriate tests, if
medically necessary, to confirm the pathology of the vascular anatomy.  
  
4\. This documentation must be made available to Medicare upon request.  
  
5\. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI)
edits. This policy does not take precedence over CCI edits. Please refer to
the CCI for correct coding guidelines and specific applicable code
combinations prior to billing Medicare.  
  
6\. When the documentation does not meet the criteria for the service rendered
or the documentation does not establish the medical necessity for the
services, such services will be denied as not reasonable and necessary under
Section 1862(a)(1) of the Social Security Act.
Billing and Coding: Vitamin D Assay Testing

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

Documentation must clearly indicate the necessity for the test(s), any and all
repeat testing and frequency of testing.  
  
The medical record must be made available to Medicare upon request.  
  
The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits.
This policy does not take precedence over CCI edits. Please refer to the CCI
for correct coding guidelines and specific applicable code combinations prior
to billing Medicare.  
  
When the documentation does not meet the criteria for the service rendered or
the documentation does not establish the medical necessity for the services,
such services will be denied as not reasonable and necessary under Section
1862(a)(1) of the Social Security Act.
Response to Comments: Endovenous Stenting

First Coast Service Options, Inc. (First Coast) received no comments for the
Proposed Local Coverage Determination (LCD) DL38231 and related Article:
Billing and Coding: Endovenous Stenting (A56644).
Response to Comments: Gastrointestinal Pathogen (GIP) Panels Utilizing
Multiplex Nucleic Acid Amplification Techniques (NAATs)

The following are the comment summaries and contractor responses for Novitas
Solutions Proposed Local Coverage Determination (LCD) DL38229 Gastrointestinal
Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification
Techniques (NAATs) which was posted for comment on 06/27/2019, and presented
at the Open Meeting on July 11, 2019. All comments were reviewed and
incorporated into the final LCD where applicable.
Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical
Stains

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Lab: Special
Histochemical Stains and Immunohistochemical Stains L36805.

To report special histochemical stains and/or immunohistochemical stains
services, please submit the following claim information:

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
Response to Comments: Micro-Invasive Glaucoma Surgery (MIGS)

The following are the comment summaries and contractor responses for Novitas
Solutions Proposed Local Coverage Determination (LCD) DL38223, Micro-Invasive
Glaucoma Surgery (MIGS) which was posted for comment on June 27, 2019, and
presented at the July 2019 Contractor Advisory Committee (CAC) Meeting. All
comments were reviewed and incorporated into the final LCD where applicable.
Billing and Coding: Vitamin D Assay Testing

**This article contains coding or other guidelines that complement the local
coverage determination (LCD) for Vitamin D Assay Testing.  
  
 **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.  
**

**Documentation**  

  * Documentation must justify the test(s) chosen for a particular disease entity. Various component sources of 25-OH Vitamin D, such as stored D or diet-derived D, should not be billed separately.

  * If Vitamin D level is between 20 and 50 ng/ml and patient is clinically stable, documentation in the patient's medical record for repeat testing must clearly indicate the necessity of the test.
Response to Comments: Gastrointestinal Pathogen (GIP) Panels Utilizing
Multiplex Nucleic Acid Amplification Techniques (NAATs)

First Coast Service Options, Inc. (First Coast) received comments from Florida
Gastroenterologic Society as well as American Gastroenterological Association
(AGA), American Society for Microbiology (ASM), Association for Molecular
Pathology (AMP), Association of Public Health Laboratories (APHL), College of
American Pathologists (CAP), Infectious Diseases Society of America (ISDA),
Pan American Society for Clinical Virology (PASCV) and interested parties
outside of the Medicare Administrative Contractor (MAC) Jurisdiction N (JN)
for Florida, Puerto Rico and the United States Virgin Islands, for the
Proposed Local Coverage Determination (LCD) DL38227 Gastrointestinal Pathogen
(GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques
(NAATs). All comments were reviewed and incorporated into the final LCD where
applicable.
Response to Comments: Micro-Invasive Glaucoma Surgery (MIGS)

First Coast Service Options, Inc. (First Coast) received comments from the
American Society of Cataract and Refractive Surgery (ASCRS) and numerous
comments from interested parties from within and outside the Medicare
Administrative Contractor (MAC) Jurisdiction N (JN) for Florida, Puerto Rico
and the United States Virgin Islands, for the Proposed Local Coverage
Determination (LCD) DL38233/A56647 Micro-Invasive Glaucoma Surgery (MIGS). All
comments were reviewed and incorporated into the final LCD where applicable.
Billing and Coding: Trigger Point Injections

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35010, Trigger Point Injections. 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.

Only one code from **20552** or **20553** should be reported on any particular
day, no matter how many sites or regions are injected.
Billing and Coding: Wireless Capsule Endoscopy

Refer to Local Coverage Determination (LCD) L35089, Wireless Capsule
Endoscopy, for reasonable and necessary requirements.  
  
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.
Please refer to NCCI for correct coding guidelines and specific applicable
code combinations prior to billing Medicare.
Billing and Coding: Vitamin B12 Injections

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33967 Vitamin B12 Injections. 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.
  4. Progress notes and laboratory test results indicating present or past values of serum B12 as well as supporting the treatment for the identified diagnosis(es) need to be maintained and made available upon request in the event a review is required.
  5. A serum B12 level is not required if vitamin B12 is administered in conjunction with pemetrexed or pralatrexate. The medical record should reflect the patient is being treated with pemetrexed or pralatrexate.
Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Molecular
Diagnostic Tests (MDT) L36807.

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-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
Billing and Coding: MolDX: Breast Cancer Index (BCI) Gene Expression Test

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Breast
Cancer Index (BCI) Gene Expression Test.

Effective 1/01/2019, MolDX will provide limited coverage for the BCI gene
expression test.

The BCI test is covered for postmenopausal women with invasive breast cancer
when the following criteria are met:

  * Pathology reveals invasive carcinoma of the breast that is ER+ and/or PR+ and HER2 -; and
  * Patient has early-stage disease (T1-3, pN0-N1, M0); and
  * Patient has no evidence of distant breast cancer metastasis (i.e., non-relapsed); and
  * Test results will be used in determining treatment management of the patient for chemotherapy and/or endocrine therapy.

MolDX expects this test will be performed once per patient lifetime on
formalin-fixed, paraffin-embedded (FFPE) tissue from the primary tumor
specimen obtained prior to adjuvant treatment.

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

  * Select CPT code 81518
  * Enter 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: MolDX: Breast Cancer Index (BCI) Gene Expression Test

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Breast
Cancer Index (BCI) Gene Expression Test.

Effective 1/01/2019, MolDX will provide limited coverage for the BCI gene
expression test.

The BCI test is covered for postmenopausal women with invasive breast cancer
when the following criteria are met:

  * Pathology reveals invasive carcinoma of the breast that is ER+ and/or PR+ and HER2 -; and
  * Patient has early-stage disease (T1-3, pN0-N1, M0); and
  * Patient has no evidence of distant breast cancer metastasis (i.e., non-relapsed); and
  * Test results will be used in determining treatment management of the patient for chemotherapy and/or endocrine therapy.

MolDX expects this test will be performed once per patient lifetime on
formalin-fixed, paraffin-embedded (FFPE) tissue from the primary tumor
specimen obtained prior to adjuvant treatment.

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

  * Select CPT code 81518
  * Enter unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following 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