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

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: EnvisiaTM,
VeracyteTM, Idiopathic Pulmonary Fibrosis Diagnostic Test L37905.

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

  * Select CPT code 
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    *  Loop 2400 or SV101-7 for the 5010A1 837P
    *  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: Cystatin C Measurement

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for Cystatin C
Measurement L37598.

**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 the medical necessity of the services as directed in the related LCD.
  5. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition (ICD-10-CM code) that warrants the test(s).
  6. Examples of documentation requirements of the ordering physician/non-physician practitioner (NPP) include, but are not limited to, history and physical or exam findings that support the decision making, problems/diagnoses, relevant data (e.g., lab testing).
  7. Medical record documentation must support cystatin C test was performed on an adult patient with creatinine based eGFR 45-59 ml/min/1.73 m2 who does not have markers of kidney damage.
  8. Medical record documentation must clearly indicate the rationale which supports the medical necessity for performing eGFR by measurement of cystatin C (i.e., support GFR estimates based on serum creatinine are thought to be inaccurate and what decisions depend on more accurate knowledge of the GFR) and must reflect how the test results were used in the patient's plan of care.

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

  *  Select CPT code 82610
  *  Enter 1 unit of service (UOS)
  *  Select the appropriate ICD-10-CM code

  
Note: The contractor has identified the Bill Type and Revenue Codes applicable
for use with the CPT/HCPCS codes included in this article. Providers are
reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type
and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with
specific Bill Type and Revenue Codes. Providers are encouraged to refer to the
CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for
further guidance.
Billing and Coding: MolDX: Breast Cancer Assay: Prosigna

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Breast
Cancer Assay: Prosigna L36425.

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

  
 Select CPT code 81520

 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: Polysomnography

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Polysomnography
L36593.

HCPCS codes G0398, G0399, and G0400 and CPT codes 95800, 95801 and 95806
(unattended sleep study) by definition involve the absence of a technologist.
Unattended sleep studies must meet the narrative definition of the codes.
G0400, Home sleep test (HST) with type IV portable monitor, unattended;
minimum of 3 channels, must measure respiratory movement, airflow, and oxygen
saturation. **Effective for dates of service on or after 01/01/2011, CPT 
codes 95800 and 95801 have been added.**
Billing and Coding: MolDX: EndoPredict Breast Cancer Gene Expression Test

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: EndoPredict
Breast Cancer Gene Expression Test L37356.

To report an EndoPredict service, please submit the following claim
information:

  * Select CPT code 81522 
  * 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: NRAS Genetic Testing

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: NRAS Genetic
Testing L35442.

  
To report a NRAS Genetic 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: Genetic Testing for BCR-ABL Negative
Myeloproliferative Disease

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Genetic
Testing for BCR-ABL Negative Myeloproliferative Disease L36117. For single
genes performed by NGS, these tests must demonstrate compliance with L38047
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies
and Suspected Myeloid Malignancies and its accompanying billing and coding
article, A54901 Billing and Coding: MolDX: Targeted and Comprehensive Genomic
Profile Next-Generation Sequencing Testing in Cancer.

  
To report Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
service, please submit the following claim information:

  
 Select appropriate CPT code

 Enter 1 unit of service (UOS)

 Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in
the comment/narrative field for the following Part B claim field/types:

  * Loop 2400 or SV101-7 for the 5010A1 837P
  * 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
Response to Comments: Cervical Disc Replacement

The comment period for the Cervical Disc Replacement L38033 Local Coverage
Determination (LCD) began on 5/6/19 and ended on 6/20/19. The comments below
were received from the provider community. The notice period for L38033 begins
on 9/12/19 and will become effective on 10/28/19.
Billing and Coding: Multimarker Serum Tests Related to Ovarian Cancer Testing

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Multimarker Serum Tests Related to Ovarian
Cancer Testing.

**Coding Guidelines:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

**CPT coding:**

CPT code 81500 should be reported when billing for ROMATM.

CPT 81503 should be reported when billing for OVA1.

CPT 0003U should be reported when billing for OVERA.
Billing and Coding: Cervical Disc Replacement

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Cervical Disc
Replacement L38033.
Billing and Coding: Autonomic Function Testing

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Autonomic Function 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. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

Do not report 95922 in conjunction with 95921

**Documentation Requirements:**

  1. Medical record documentation maintained by the performing provider must clearly support the medical necessity for ANS testing as well as the test reports and interpretation. Supportive documentation showing medically reasonable and necessary indications as outlined in this LCD are expected to be documented in the medical record and be available upon request. This documentation includes, but is not limited to, relevant medical history, physical examination and results of pertinent diagnostic tests or procedures used to rule out more common causes of autonomic signs or symptoms.
  2. General professional standards with FDA clearance apply for all equipment used in ANS testing.

**Utilization Guidelines:**

  1. Diagnostic testing may be allowed once to confirm or exclude specific autonomic disease.
  2. For patients with diagnosed autonomic disorders, repeat testing is governed by a change in clinical status or response to a therapeutic intervention. If a repeat test is needed, it is not expected to exceed once per year.
  3. Providers who perform these tests on an unusually high proportion of their patients, or at frequencies exceeding once per year may be subject to medical review.
  4. Providers who do not have tilt tables and are using the code range 95921-95924 may be subject to medical review.
Billing and Coding: Computed Tomographic (CT) Colonography for Diagnostic Uses

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Computed Tomographic (CT) Colonography for
Diagnostic Uses.

**Coding Information:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

**Documentation Requirements:**  
  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within 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.  
  
 **Utilization Guidelines:**  
  
CT colonography is reimbursable only when performed following an instrument
colonoscopy which was incomplete or when a board certified or board eligible
gastroenterologist or surgeon trained in endoscopy determined from an
evaluation of the patient that optical colonoscopy can not be safely
attempted. Tests performed without a prior incomplete instrument colonoscopy
in history or documentation by a board certified or eligible
gastroenterologist, a surgeon trained in endoscopy or a physician with
equivalent endoscopic training indicating why an optical colonoscopy cannot be
safely attempted will be denied.
Billing and Coding: Ultrasound, Soft Tissues of Head and Neck

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34027, Ultrasound, Soft Tissues of Head and
Neck. 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.
Billing and Coding: EEG  Ambulatory Monitoring

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for EEG - Ambulatory Monitoring.

**Coding Information:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.

**Documentation Requirements:**  
  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the 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.  
  
Monitoring beyond 72 hours must be supported by written documentation for each
additional 24 hours of monitoring and be made available to Medicare upon
request.  
  
 **Utilization Guidelines:**  
  
The following represent the number of 24-hour segments of recordings for
testing:

  * For diagnostic testing - Two or three days is usually sufficient when looking for seizures or interictal activity
  * For pre-surgical evaluation - Seven to ten days may be required to capture at least three or four seizures in order to be sure of seizure onset location reliability. Two to three days is usually sufficient for follow-up.
Billing and Coding: MolDX: ConfirmMDx Epigenetic Molecular Assay

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: ConfirmMDx
Epigenetic Molecular Assay L35632.

  
To report a ConfirmMDx epigenetic assay service, please submit the following
claim information:

  
 Select CPT code 81551.

 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: ProMark Risk Score

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: ProMark
Risk Score L36675.

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

  
 Select CPT code 81479

 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: Biomarkers in Cardiovascular Risk Assessment

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Biomarkers
in Cardiovascular Risk Assessment L36358.
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Biomarkers
in Cardiovascular Risk Assessment L36362.
Billing and Coding: Aortography and Peripheral Angiography

  
This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L36767 Aortography and Peripheral Angiography.
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.  
  
CMS issued HCPCS code G0278 for femoral or iliac angiography when done at the
time of coronary angiography. Medicare would not expect to see a high
percentage of femoral or iliac angiography done at the same time of coronary
studies, and such billing could be subject to review.  
  
 **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 operating physician should retain in the patient's medical records the history and physical examination and notes documenting the evaluation and management of one of the Medicare covered conditions/diagnoses, including relevant clinical signs/symptoms or abnormal diagnostic test results.
  5. The treating physician order for the renal angiography performed at the time of cardiac catheterization must specifically request this extra angiographic service with documentation supporting medical necessity and made available upon request.
Billing and Coding: Diagnostic Aerosol or Vapor Inhalation

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33969 Diagnostic Aerosol or Vapor Inhalation.
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. Documentation that the service was performed for sputum induction/mobilization or bronchodilation for diagnostic purposes must be included in the patient's medical record. This information is normally found in the office/progress notes, hospital notes, and/or procedure report.
Billing and Coding: Biomarker Testing for Neuroendocrine Tumors/Neoplasms

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Biomarker Testing for Neuroendocrine
Tumors/Neoplasms.

CPT code 0007M is considered not medically necessary and will be automatically
denied as a non-covered procedure.
Billing and Coding: Visual Electrophysiology Testing

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