Persius/hicric huggingface dataset:
Billing and Coding: Noninvasive Ear or Pulse Oximetry For Oxygen Saturation

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33923, Noninvasive Ear or Pulse Oximetry For
Oxygen Saturation. 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.

Procedure codes 94760 and 94761 represent services that have a T-status
indicator. Therefore, if any other services payable under the physician fee
schedule are billed on the same date by the same provider, this service is
bundled into the physician services for which payment is made.

**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 (e.g., office/progress notes) must indicate the medical necessity for performing ear or pulse oximetry studies. Additionally, a copy of the study results should be maintained in the medical records.
  5. If the provider of oximetry studies 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 study. The ordering/referring physician must state the clinical indication/medical necessity for the oximetry study in the order for the test.
Billing and Coding: Ionized Calcium

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34011 Ionized Calcium. 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.

Renal dialysis facilities should report a diagnosis code of N18.6 for
submission of claims.

**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 records maintained in the patient's file must document the medical necessity of the test including the test results. This information is usually found in the office/progress notes, hospital notes, and/or laboratory results.
Billing and Coding: Parathormone (Parathyroid Hormone)

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34018 Parathormone (Parathyroid Hormone). 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.

Renal dialysis facilities should report a diagnosis code of N18.6 for
submission of claims.

CPT 83970 should not be billed with more than one (1) unit of service per day.

**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, 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 his order for the test.
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.

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 and 0222U and codes 81105-81112 are
also germline tests. These will be noncovered 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
    * Item 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: Noninvasive Physiologic Studies of Upper or Lower
Extremity Arteries

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33696 Noninvasive Physiologic Studies of Upper
or 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 non-invasive physiologic studies of the upper or 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 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. If performing procedure code 93924, documentation must include results of resting studies and after treadmill stress testing studies. This information is normally found in the office/progress notes and test results.
  5. If the provider of non-invasive physiologic studies of arteries of the upper or lower extremity 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 arterial studies from another provider, the ordering/referring physician/nonphysician practitioner must state the reason for the studies in his/her order for the test. 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.
  6. 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: Psychiatric Codes

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35101, Psychiatric Codes. 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.  
  
Although the diagnostic interview is indicated for the initial evaluation of a
beneficiary, a second provider seeing the beneficiary for the first time may
report the diagnostic interview codes.  
  
CPT code 96105 represents formal evaluation of aphasia with an instrument such
as the Boston Diagnostic Aphasia Examination.  
  
Psychological/neuropsychological testing codes should not be reported by the
treating physician for only reading the results of the testing.  
  
Psychotherapy codes should not be used when an Evaluation and Management (E/M)
code would be more appropriate.  
  
 **Utilization Parameters  
  
** CPT code 96105 is typically only performed once during treatment. Refer to
the related LCD for information regarding the reasonable and necessary
guidelines for this service.  
  
Consistent with the related LCD, more than three CPT code(s) 90791, 90792 or a
combination of both should not be reported per year, per beneficiary by the
same provider.
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) for MolDX: Repeat
Germline Testing L38288.
Billing and Coding: MolDX: Decipher Biopsy Prostate Cancer Classifier Assay
for Men with Favorable Intermediate Risk Disease

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Decipher
Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate
Risk Disease(DL38303).

To report a Decipher Biopsy Prostate Cancer Classifier for Men with Favorable
Intermediate Risk Disease Testing 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
    * 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: Surgical Management of Morbid Obesity

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33411 Surgical Management of Morbid Obesity.
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 codes 43886, 43887 and 43888 are for open port replacement. The open port
replacement procedures are associated with the non-covered open gastric
restrictive procedures: adjustable gastric banding and vertical banded
gastroplasty and per the National Coverage Determination (NCD) 100.1 Bariatric
Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity, open
port replacement procedures are also noncovered.

For billing covered laparoscopic restrictive procedures that require port
replacements report CPT code 43771, 43772, or 43773.

CPT code 43842 is for vertical banded gastroplasty and is non-covered per NCD
100.1 Bariatric Surgery for Treatment of Co-Morbid Conditions Related to
Morbid Obesity.

CPT code 43843 for other than vertical-banded gastroplasty is non-covered
since it is associated with the NCD 100.1 non-covered open adjustable gastric
banding and open sleeve gastrectomy.  
  
 **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 must include the following: history and physical containing evidence of comorbid conditions, operative report containing a detailed procedure note, and office/progress notes documenting unsuccessful medical treatment for obesity.
    * The medical record must substantiate presence and severity of associated organic diseases requiring the treatment of obesity documented through appropriate physiologic testing and/or imaging.
    * The patient's medical record must include documentation of all required preoperative and postoperative evaluations and interventions and all other applicable coverage provisions required as outlined in this LCD.
    * Patients who have a history of psychiatric or psychological disorder must undergo preoperative psychological evaluation and clearance and the patient's record must include documentation of the evaluation and assessment.
    * Documentation of smoking history, and that the patient has received counseling on the effects of smoking on surgical outcomes and treatment for smoking cessation, if applicable.
Billing and Coding: MolDX: Signatera and Minimal Residual Disease Testing for
Colorectal Cancer

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Signatera
and Minimal Residual Disease Testing for Colorectal Cancer(DL38305).

To report a Signatera and Minimal Residual Disease Testing for Colorectal
Cancer 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
    * 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: Hypoglossal Nerve Stimulation for Treatment of Obstructive
Sleep Apnea

Refer to the Local Coverage Determination (LCD) L38307, Hypoglossal Nerve
Stimulation for the Treatment of Obstructive Sleep Apnea, 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.

**Coding Guidelines**

**Implantation** of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA
utilizes 2 CPT codes:

**Beginning 01/01/2022** use single code:

  * **CPT 64582** Open implantation of hypoglossal nerve stimulator array, pulse generator, and distal respiratory sensor electrode or electrode array ****



**Coding Information**

  * **Effective 1/1/22 CPT code 64568 is no longer used for hypoglossal nerve stimulator due to development of specific CPT codes for this technology 64582-64584**

**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 diagnosis code(s).

**Informational Only:**

Removal, revisions and replacements related to implantable devices are
addressed in **** Medicare Benefit Policy Manual, Chapter 16, Section 180,
"Services Related to and Required as a Result of Services Which Are Not
Covered Under Medicare"

**Effective 1/1/22 0466T, 0467T and 0468T are deleted codes. Services for
revision, replacement or removal of hypoglossal nerve stimulator components
should be billed with:**

  * **CPT 64583** Revision or replacement of hypoglossal nerve stimulator array and distal respiratory sensor electrode or electrode array, including connections to existing pulse generator
  * **CPT 64584** removal of hypoglossal nerve rose stimulator array pulse generator, and distal respiratory sensor electrode or electrode array

**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: MolDX: SelectMDx for Prostate Cancer

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: SelectMDx
for Prostate Cancer(DL38247).

To report a SelectMDX for Prostate Testing 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
    * 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: 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 L38249.

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 and 0222U and codes 81105-81112 are
also germline tests. These will be noncovered 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: Benign Skin Lesion Removal (Excludes Actinic Keratosis,
and Mohs)

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

1) CPT codes 17106, 17107 and 17108 describe treatment of lesions that are
usually cosmetic. When using these CPT codes the clinical records should
clearly document the medical necessity of such treatment and why the procedure
is not cosmetic.  
  
2) CPT codes 11055, 11056 and 11057 describe treatment of hyperkeratotic
lesions (e.g., corns and calluses). Coverage for these three codes is
described in the Medicare Internet Only Manual.
Billing and Coding: MolDX: Melanoma Risk Stratification Molecular Testing

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Melanoma
Risk Stratification Molecular Testing DL38016.

To report a molecular diagnostic 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: MolDX: Razor 14-Gene Lung Cancer Assay

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Razor
14-Gene Lung Cancer Assay(DL38284).

To report a Razor 14-Gene Lung Cancer Assay 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
    * 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