Persius/hicric huggingface dataset:
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) for MolDX: Prostate
Cancer Genomic Classifier Assay for Men with Localized Disease .

To report a Prostate Cancer 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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select ICD-10-CM code C61
Billing and Coding: GlycoMark Testing for Glycemic Control

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

To receive a GlycoMark test denial, please submit the following claim
information:

  * CPT code 84378 or 84999
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier
Billing and Coding: GlycoMark Testing for Glycemic Control

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for GlycoMark Testing
for Glycemic Control L36864.

To receive a GlycoMark test denial, please submit the following claim
information:

  * CPT code 84378 or 84999
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier
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 L37750 .

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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral
Compression Fracture (VCF)

The information in this article contains coding guidelines that complement the
Local Coverage Determination (LCD) for Percutaneous Vertebral Augmentation
(PVA) for Vertebral Compression Fracture (VCF) (L38201).

**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.

No separate payment for venography performed during the operative session may
be allowed and it should not be separately billed.
Response to Comments: Micro Invasive Glaucome Surgery (MIGS)

This article summarizes the comments CGS Administrators received during open
comment period, June 26, 2019 thru August 9, 2019, for DL37578 Micro Invasive
Glaucoma Surgery (MIGS). The policy will be made final with the notice period
beginning  November 14, 2019 and ending December 29, 2019. the policy will
become effective on December 30, 2019.
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 L37748.

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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within this LCD. (Please 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.  
  
The patient's medical record must document the following:  
  
  
history and physical findings supporting a diagnosis of symptomatic varicose
veins;  
  
failure of an adequate trial of conservative treatment as described in the
"Indications" section of this LCD;  
  
exclusion of other causes of edema, ulceration and pain in the limbs;  
  
performance of appropriate tests to confirm the presence and location of
incompetent perforating veins;  
  
location and number of varicosities, level of incompetence of the vein and
the veins involved; and  
  
necessity of utilizing ultrasound guidance, if used.  
The medical record must also include pre-treatment photographs of the varicose
veins for which claims for sclerotherapy are submitted to Medicare. These
photographs must be made available to the carrier upon request for review.  
  
Not applicable  
  
Coverage for podiatrists is limited by scope of practice specific to the state
in which the service is provided.  
  
Medicare recognizes that multiple injections are needed to perform
sclerotherapy and that responses differ due to the anatomical site being
treated. Medicare would not expect to see the following when performing
sclerotherapy:  
  
  
More than three sclerotherapy sessions for each leg.  
  
Only one sclerotherapy service per treatment session should be reported for
either leg, regardless of how many veins are treated per session.  
Patients are not expected to require ablation of the saphenous vein by
radiofrequency or laser more than once for either leg.  
  
A duplex ultrasound examination will be allowed when performed within 1 week
(preferably within 72 hours) of EFRA to check for any evidence of thrombus
extension from the saphenofemoral junction into the deep system.
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 L38327

The following test 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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * 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 L38329.

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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
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 L38351.
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 L38353
Billing and Coding: Diagnostic and Therapeutic Colonoscopy

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

**Coding Guidelines**

Do not report a colonoscopy procedure code for an endoscopy performed with a
sigmoidoscope on a patient with a normal length colon, even if the
sigmoidoscope reaches proximal to the splenic flexure. A sigmoidoscope (an
endoscope typically 65 centimeters in length) may be used for a colonoscopy
only if the bowel is sufficiently short so that the entire colon may be
examined, and such should be clearly documented in the clinical record.

Payment for a colonoscopy performed in the office is subject to recovery when
colonoscope information is not available to the contractor.

An incomplete colonoscopy is defined by CMS in the IOM at 100-4, Chapter 12,
Section 30.1.B; _Incomplete Colonoscopies (Codes 44388, 45378, G0105 and
G0121)._

_An incomplete colonoscopy, e.g., the inability to advance the colonoscope to
the cecum or colon-small intestine anastomosis due to unforeseen
circumstances, is billed and paid using colonoscopy through stoma code 44388,
colonoscopy code 45378, and screening colonoscopy codes G0105 and G0121 with
modifier "-53." (Code 44388 is valid with modifier 53 beginning January 1,
2016.) The Medicare physician fee schedule database has specific values for
codes 44388-53, 45378-53, G0105-53 and G0121-53. An incomplete colonoscopy
performed prior to January 1, 2016, is paid at the same rate as a
sigmoidoscopy. Beginning January 1, 2016, Medicare will pay for the
interrupted colonoscopy at a rate that is calculated using one-half the value
of the inputs for the codes._

When the colonoscopy procedure is unusual or difficult, modifier 22 (unusual
procedural services) may be reported.

The most specific ICD-10-CM code must be chosen and billed to its highest
level of specificity. Submit this as the line diagnosis (linked to the
procedure) on the claim.

**Limitations**

The requirements for coverage have **not** been met if:

  * Only a sigmoidoscope is used.
  * An office-based colonoscopy is not validated with the appropriate equipment information.
  * Chronic abdominal pain unresponsive to medical therapy is used to justify the service but lacks appropriate clinical documentation.

****Documentation Requirement **  
******

Supportive clinical documentation evidencing the condition and treatment is
expected to be documented in the clinical notes or procedure note and be made
available upon request from the MAC or other authorized CMS auditor.  
  
Medical records need not be submitted with the claim unless modifier 22 is
used; however, they must be furnished to Medicare upon request.  
  
The medical records must support the medical reasonableness, necessity, and
frequency of each diagnostic service supplied.  
  
The medical record must substantiate the diagnosis listed on the claim form.  
  
The colonoscopy report must describe the following:

  * The maximum depth of penetration;
  * A description of any abnormal findings; and
  * Any procedures performed as the result of such findings (e.g., biopsy).
Billing and Coding: Diagnostic and Therapeutic Colonoscopy

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

**Coding Guidelines**

Do not report a colonoscopy procedure code for an endoscopy performed with a
sigmoidoscope on a patient with a normal length colon, even if the
sigmoidoscope reaches proximal to the splenic flexure. A sigmoidoscope (an
endoscope typically 65 centimeters in length) may be used for a colonoscopy
only if the bowel is sufficiently short so that the entire colon may be
examined, and such should be clearly documented in the clinical record.

Payment for a colonoscopy performed in the office is subject to recovery when
colonoscope information is not available to the contractor.

An incomplete colonoscopy is defined by CMS in the IOM at 100-4, Chapter 12,
Section 30.1.B; _Incomplete Colonoscopies (Codes 44388, 45378, G0105 and
G0121)._

_An incomplete colonoscopy, e.g., the inability to advance the colonoscope to
the cecum or colon-small intestine anastomosis due to unforeseen
circumstances, is billed and paid using colonoscopy through stoma code 44388,
colonoscopy code 45378, and screening colonoscopy codes G0105 and G0121 with
modifier "-53." (Code 44388 is valid with modifier 53 beginning January 1,
2016.) The Medicare physician fee schedule database has specific values for
codes 44388-53, 45378-53, G0105-53 and G0121-53. An incomplete colonoscopy
performed prior to January 1, 2016, is paid at the same rate as a
sigmoidoscopy. Beginning January 1, 2016, Medicare will pay for the
interrupted colonoscopy at a rate that is calculated using one-half the value
of the inputs for the codes._

When the colonoscopy procedure is unusual or difficult, modifier 22 (unusual
procedural services) may be reported.

The most specific ICD-10-CM code must be chosen and billed to its highest
level of specificity. Submit this as the line diagnosis (linked to the
procedure) on the claim.

**Limitations**

The requirements for coverage have **not** been met if:

  * Only a sigmoidoscope is used.
  * An office-based colonoscopy is not validated with the appropriate equipment information.
  * Chronic abdominal pain unresponsive to medical therapy is used to justify the service but lacks appropriate clinical documentation.

**Documentation Requirement**

Supportive clinical documentation evidencing the condition and treatment is
expected to be documented in the clinical notes or procedure note and be made
available upon request from the MAC or other authorized CMS auditor.  
  
Medical records need not be submitted with the claim unless modifier 22 is
used; however, they must be furnished to Medicare upon request.  
  
The medical records must support the medical reasonableness, necessity, and
frequency of each diagnostic service supplied.  
  
The medical record must substantiate the diagnosis listed on the claim form.  
  
The colonoscopy report must describe the following:

  * The maximum depth of penetration;
  * A description of any abnormal findings; and
  * Any procedures performed as the result of such findings (e.g., biopsy).
Billing and Coding: BDX-XL2

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for BDX-XL2 L37054.
Billing and Coding: BDX-XL2

The following coding and billing guidance is to be used with its associated
Local Coverage Determination BDX-XL2 L37062.
Billing and Coding: MolDX: Breast Cancer Assay: Prosigna

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

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: 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) for MolDX: Prostate
Cancer Genomic Classifier Assay for Men with Localized Disease.

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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * 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.

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: 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 L36139.
Billing and Coding: Implantable Miniature Telescope (IMT)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Implantable Miniature Telescope (IMT).

**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 related LCD. This
documentation includes, but is not limited to, relevant medical history,
physical examination, and results of pertinent diagnostic tests or procedures.
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and
Therapeutic)

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35350, Upper Gastrointestinal Endoscopy
(Diagnostic and Therapeutic). 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: MolDX: DecisionDx-Melanoma

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

To report a DecisionDX-Melanoma service, please submit the following claim
information:

  * 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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: DecisionDx-Melanoma

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

To report a DecisionDx-Melanoma service, please submit the following claim
information:

  * 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
    * Item 19 for paper claim

  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code