Persius/hicric huggingface dataset:
Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33583 Diagnostic and Therapeutic
Esophagogastroduodenoscopy. 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.

**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. The patient's medical record (e.g., history and physical, office/progress notes, procedure report) maintained by the ordering/referring physician must clearly indicate the reason for the Esophagogastroduodenoscopy (EGD). Also, the results of the EGD must be included in the patient's medical record.
Billing and Coding: Duplex Scan of Lower Extremity Arteries

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33667, Duplex Scan of Lower Extremity Arteries.
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.

**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 maintained by the ordering/referring physician/nonphysician practitioner must clearly indicate the medical necessity of duplex scan of lower extremity arteries i.e., signs and symptoms, relevant history (including known diagnoses, and/or prior imaging). This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Also, the results of the duplex scan of lower extremity arterial studies must be included in the patient's medical record. A hard copy or soft copy convertible to a hard copy provides a permanent record of the study performed and must be of a quality that meets accepted medical standards.
  5. If the provider of duplex scan of lower extremity arterial studies is other than the ordering/referring physician/nonphysician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner's order for the studies. When ordering duplex scan of lower extremity arterial studies, the ordering/referring physician/nonphysician practitioner must state the reason for the duplex scan of lower extremity arteries in his/her order for the test.
  6. The provider is responsible for ensuring the medical necessity of procedures and maintaining the medical record, which must be available upon request. Billing providers are encouraged to obtain additional information from referring providers and/or patients or medical records to determine the medical necessity of studies performed. Referring physicians are required to provide appropriate diagnostic information to the performing provider.
  7. The medical necessity for performing repeat extremity arterial studies must be clearly documented in the medical record.
  8. An order from the treating physician/nonphysician practitioner as required by CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic tests.
Billing and Coding: Electrocardiography

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33669 Electrocardiography. 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.

Outpatient hospitals, critical access hospitals and CORFS may use only code
93005 when billing for this service.

When billing subsequent electrocardiograms on the same day, use modifier 76 if
repeated by the same provider or modifier 77 when repeated by a different
provider.

When using diagnosis code Z01.810, the medical record must contain information
supporting either of the two pre-operative evaluation indications listed under
the "Indications and Limitations of Coverage and/or Medical Necessity" section
in the related LCD.

If an EKG is being performed to evaluate a patient's response to the
administration of an agent known to result in cardiac or EKG abnormalities for
patients with suspected, or at increased risk of developing cardiovascular
disease or dysfunction, then diagnosis code Z79.3, Z79.891 , Z79.899 or Z51.81
should be used. The "T" diagnoses should be used when the patient is
experiencing adverse effects to high risk medications.

**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. The EKG strip and a copy of the test results should be maintained in the medical record. In addition, the medical record must support that the physician interpreted and agrees with the test results and show that the results are being used to manage the patient.
  5. If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician's order for the studies. The physician must state the clinical indication/medical necessity for the study in the order for the test.
Billing and Coding: Transcranial Magnetic Stimulation (TMS) in the Treatment
of Adults with Major Depressive Disorder

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34998 Transcranial Magnetic Stimulation (TMS) in
the Treatment of Adults with Major Depressive Disorder. Please refer to the
LCD for reasonable and necessary requirements.  
  
**Coding Guidance**

**The ordering provider name and NPI must be included on the claim in the
following locations:**

For Part A claims: Block 78/79 of the UB-04 **OR** 2420B for EMC  
For Part B claims: Block 17 A and B for paper claims; 2310A **OR** 2420F for
EMC

**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.  
  
**Utilization Parameters**

It is expected that CPT code 90867 be reported only once per patient for the
episode (for the initial planning) and NOT in conjunction with CPT codes 90868
or 90869.

CPT code 90867 should not be reported more than once within a 6-week period of
time.

Do not report CPT code 90869 (motor threshold determination) in conjunction
with 90867 or 90868.  
  
**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. The medical record documentation must support that the attending physician has met with the patient face to face for the initial assessment and for subsequent delivery and management when there is a change in the individual's mental status and/or other significant change in clinical status.
  5. The medical record documentation must include evidence of clinical judgment of the treating physician in evaluation of the absolute and relative contraindications in the pre-procedure record for the present episode of care.
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L36393 Controlled Substance Monitoring and Drugs
of Abuse 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.

**Documentation Requirements**

Note: Refer to the LCD for documentation requirements, in the patient's
medical record, of medical necessity for testing ordered on an individual
patient basis by the clinician.

  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: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel
Syndromes and Morton's Neuroma

The following billing and coding guidance is to be used with its associated
Local Coverage Determination.

Injection therapies for Morton's neuroma do not involve the structures
described by CPT code 20550 and 20551 or direct injection into other
peripheral nerves but rather the focal injection of tissue surrounding a
specific focus of inflammation on the foot. These therapies are not to be
coded using 20550, 20551, 64450, 64640 or other assigned CPT codes. Rather,
the provider of these therapies must bill with CPT code 64455 or 64632
Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s)
(eg, Morton's neuroma) as the correct CPT code for the service.  
  
Injections for plantar fasciitis are addressed by 20550 and ICD-10-CM M72.2.
Injections for other tendon origin/insertions by 20551. Injections to include
both the plantar fascia and the area around a calcaneal spur are to be
reported using a single 20551.

The clinical record should include the elements leading to the diagnosis and
treatment decision to use injection. If the number of injections exceeds three
to the same site or local area in a six month period, the record must justify
these added injections since the presumed need for further injections should
raise the issues of correct diagnosis or correct choice of therapy as well as
concerns for adverse side effects. Records must be made available 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.  
  
The Section titled "Does the 'CPT 30% Rule' apply" needs clarification. This
rule comes from the AMA (American Medical Association), the organization that
holds the copyrights for all CPT codes. The rule states that if, in a given
section (e.g., surgery) or subsection (e.g., surgery, integumentary) of the
CPT Manual, more than 30% of the codes are listed in the LCD, then the short
descriptors must be used rather than the long descriptors found in the CPT
Manual.  
  
This policy is subject to the reasonable and necessary guidelines and the
limitation of liability provision.  
  
This medical policy consolidates and replaces all previous policies and
publications on this subject by Noridian and its predecessors for Medicare
A/B.
Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

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

Documentation supporting medical necessity should be legible, maintained in
the patient's record, and must be made available to the A/B MAC upon request.  
  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within this 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.
Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

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

Documentation supporting medical necessity must be legible, maintained in the
patient's record, and made available to the A/B MAC upon request.  
  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within this 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.
Billing and Coding: MolDX: Repeat Germline Testing

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) MolDX: Repeat Germline
Testing.
Billing and Coding: MolDX: Prostate Cancer Genomic Classifier Assay for Men
with Localized Disease

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) : MolDX: Prostate
Cancer Classifier Assay for Men with Localized Disease L38433.

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

  * Select applicable 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 ICD-10-CM code C61
Billing and Coding: MolDX: Blood Product Molecular Antigen Typing

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Blood
Product Molecular Antigen Typing L38441.

Blood product antigen typing is a germline test and the use of panels 0001U
and 0084U will be limited to once in a beneficiary lifetime.

The individual codes 0180U-0201U, 0221U, 0222U and codes 81105-81112 are also
germline tests. These will be non-covered as multiple antigens must be
utilized as part of a comprehensive antigen evaluation and will be considered
only as part of a panel.

To report a Blood Product Molecular Antigen Typing service, please submit the
following claim information:

  * Select the appropriate CPT or PLA code
  * Enter 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: Predictive Classifiers for Early Stage Non-Small
Cell Lung Cancer

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Predictive
Classifiers for Early Stage Non-Small Cell Lung Cancer L38443.

The following tests are covered in accordance with the LCD: MolDX: Predictive
Classifiers for Early Stage Non-Small Cell Lung Cancer.

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
Billing and Coding: Removal of Benign Skin Lesions

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34938, Removal of Benign Skin Lesions. 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.  
  
According to the Current Procedural Terminology (CPT) Manual, appropriate code
selection for lesion removal is determined by measuring the greatest clinical
diameter of the apparent lesion plus that margin required for complete
excision. Please refer to the current CPT manual for further information.  
  
Measurement is made prior to excision. Lesion compared to margin plus lesion
should not differ significantly.  
  
Do not report shave removal codes (11300 - 11313) when a tangential (shave)
biopsy of the lesion is performed. Shave removal codes (11300 - 11313) include
removal of tissue that may be submitted for pathological examination, biopsy
code(s) should not be reported separately with these codes. Histopathologic
examination of the lesion may be reported separately, see 88304-88305. When
shave removal is performed with the sole intent of obtaining pathologic
diagnosis, tangential biopsy CPT code(s) 11102-11103, should be reported.  
  
 **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: Injection of Trigger Points

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33912, Injection of Trigger Points. 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. The medical record must clearly indicate the number of injections given per session and the site(s) injected. Furthermore, the medical record must clearly document the medical necessity for repeated injections of trigger point(s). When frequent injections are required, the medical record must reflect the reason for repeated injections.