Persius/hicric huggingface dataset:
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 L36815. For single
genes performed by NGS, these tests must demonstrate compliance with L38176
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies
and Suspected Myeloid Malignancies and its accompanying billing and coding
article, A55197 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
Billing and Coding: MolDX: Genetic Testing for
Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and
MTHFR)

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Genetic
Testing for Hypoercoagulability / Thrombophilia (Factor V Leiden, Factor II
Prothrombin, and MTHFR) L36400.

To report a Genetic Testing for Hypercoagulability /Thrombophilia 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
Billing and Coding: MolDX: HLA-DQB1*06:02 Testing for Narcolepsy

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
associated LCD L37003, MolDX: HLA-DQB1*06:02 Testing for Narcolepsy.
Billing and Coding: MDS FISH

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MDS FISH L37772.

**Coding for FISH Testing**

There are 2 sets of codes that describe in situ hybridization (ISH). Although
the laboratory methods are similar, one distinguishes between the 2 sets of
codes based on whether the ISH test is an adjunct to a surgical or
cytopathology case, versus whether it is part of a clinical, chromosomal
analysis. Specifically, the CPT codes 88271-88291 should be used when the
laboratory performs ISH as an ancillary analysis to cytogenetic studies for
oncologic or inherited disorders.

When a pathologist performs ISH techniques as an adjunct to a surgical
pathology or cytopathology case, CPT codes 88365-88377 should be used to
distinguish qualitative versus quantitative analysis (computer assisted versus
manual). These codes must never be used by a pathologist when ISH is performed
as an ancillary analysis to cytogenetic studies.

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

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

A DEX Z-CodeTM identifier is not required for FISH testing. If submitting a DEX
Z-CodeTM identifier, please submit following the below instructions:

  * 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
Billing and Coding: MolDX: MGMT Promoter Methylation Analysis

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: MGMT
Promoter Methylation Analysis L37001.

To report a MGMT Promoter Methylation Analysis service, please submit the
following claim information:

  * Select Bill Type Code 022x - Skilled Nursing - Inpatient (Medicare Part B only)
  * Select CPT code 81287
  * 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 L36797.  
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: Oncotype DX Breast Cancer for DCIS (Genomic
Health)

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Oncotype DX
Breast Cancer for DCIS (Genomic HealthTM) L37199.

To report an Oncotype DX Breast Cancer for DCIS service, please submit the
following claim information:

  * Select PLA code 0045U
  * 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: Percepta Bronchial Genomic Classifier

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Percepta
Bronchial Genomic Classifier L37195.

To report a Percepta Bronchial Genomic Classifier 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 837
    * 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 ProMark Risk Score
L37011.

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: Prometheus IBD sgi Diagnostic Policy

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Prometheus
IBD sgi Diagnostic Policy L37539.

To receive a Prometheus IBD sgi Diagnostic denial, please submit the
following claim information:

  * Select the applicable CPT code
  * Enter 1 unit of service (UOS)
  * 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
  * If submitting a DEX Z-CodeTM identifier, 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
  * If submitting a DEX Z-CodeTM identifier, 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
Billing and Coding: Nerve Blocks for Peripheral Neuropathy

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD.

Subcutaneous injections do not involve the structures described by CPT code
64450, direct injection into other peripheral nerves, but rather the injection
of tissue surrounding a specific focus. These therapies are not to be coded
using CPT code 64450. This code addresses the additional work of an injection
of an anesthetic agent(s) (nerve block) and/or steroid by a qualified health
care professional within their scope of practice.

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and 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 record must include the physician or non-physician practitioner responsible for and providing the care to the patient. 
  3. The submitted medical record should support the use of the selected diagnosis code(s). The submitted CPT/HCPCS code should describe the service performed.
Billing and Coding: Non-Coronary Vascular Stents

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD.
Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD.

**Documentation**  
A complete history and physical containing the following minimum requirements
must be in the medical record: complete history to include the following
areas- duration and characteristics of the urinary or fecal incontinence,
frequency, timing and amount of continent voids and incontinent episodes,
precipitants of incontinence, other urinary symptoms, bowel habits, daily
fluid intake, alteration in sexual function due to urinary or fecal
incontinence, amount and type of perineal pads or protective devices, previous
treatments for urinary or fecal incontinence and the effects of that treatment
on the incontinence; neurological exam; physical exam of the patient that is
usually guided by the history and reason for being seen. This could include a
pelvic exam in women to assess for skin condition, genital atrophy, pelvic
organ prolapse, pelvic masses, paravaginal muscle tone and any other
abnormalities; abdominal exam, genital exam in men, rectal exam to assess
perineal sensation, resting and active sphincter tone, fecal impaction,
presence of masses and in men, the consistency and contour of the prostate;
past surgeries and pregnancy history in females.

**Utilization Guidelines**  
Anorectal Manometry and Pelvic Floor Electromyography are diagnostic tests and
should **not** be performed on a routine basis. Medicare would **not** expect
to see an Anorectal Manometry billed when the physician is trying to evaluate
urinary incontinence. Medicare would **not** expect these tests to be billed
more than **twice** in a lifetime.

The CPT Codes for Anorectal Manometry and Pelvic Floor Electromyography are
diagnostic. They are not a medically necessary part of physical therapy,
rehabilitation, biofeedback, or exercise program treatment plans.
Billing and Coding: Percutaneous minimally invasive fusion/stabilization of
the sacroiliac joint for the treatment of back pain

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD L36000 Percutaneous minimally invasive fusion/stabilization of the
sacroiliac joint for the treatment of back pain.

**Documentation Requirements**

All documentation must be maintained in the patient's medical record and
available to the contractor upon request.

Every page of the record must be legible and include appropriate patient
identification information (e.g., complete name, dates of service(s)). The
record must include the name of the physician or non-physician practitioner
responsible for and providing the care of the patient.
Billing and Coding: Transcranial Magnetic Stimulation (TMS)

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD L34641 Transcranial Magnetic Stimulation (TMS).

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

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD.

**Documentation Requirements**  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within this LCD. (See "Coverage
Indications, Limitations, and/or Medical Necessity") This documentation
includes, but is not limited to, relevant medical history, physical
examination, and results of pertinent diagnostic tests or procedures.  
  
Documentation supporting the medical necessity should be legible, maintained
in the patient's medical record, and must be made available to the MAC upon
request.
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35038, Scanning Computerized Ophthalmic
Diagnostic Imaging. 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.  
  
 **Utilization Parameters  
  
** One month is defined as 28 days. No more than one (1) exam per month will
be considered medically reasonable and necessary to manage the patient with
retinal conditions undergoing active treatment.  
  
CPT code 92132 and 92133 may not be reported more than two (2) times per year.
Please refer to the LCD for details on reasonable and necessary guidelines.  
  
CPT code 92134 may not be reported more than one (1) time every two (2)
months. Please refer to the LCD for details on reasonable and necessary
guidelines.  
  
 **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: Intraoperative Neurophysiological Testing

The billing and coding information in this article is dependent on the
coverage indications, limitations, and/or medical necessity described in the
related LCD L34623 Intraoperative Neurophysiological Testing.

**Documentation Requirements**  
All documentation must be maintained in the patient's medical record and
available to the contractor upon request.  
  
Every page of the medical record must be legible and include appropriate
patient identification information (e.g. complete name, dates of service). The
record must include the physician or non-physician practitioner responsible
for providing the care of the patient.  
  
The patient's medical record should document the time spent in monitoring in
correlation to the surgery performed.  
  
The submitted medical record should support the use of the selected diagnosis
code(s).  
The submitted CPT/HCPCS code should describe the service performed.  
  
**Utilization Guidelines**  
  
Intraoperative neurophysiology monitoring should not be reported by the
physician performing the operative procedure since it is included in the
global package for the surgery.
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.

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
    * 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: EndoPredict Breast Cancer Gene Expression Test

he 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.

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
    * 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: ProMark Risk Score

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

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: Lab: Special Histochemical Stains and Immunohistochemical
Stains

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Lab: Special
Histochemical Stains and Immunohistochemical Stains L36351.

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

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
Billing and Coding: Measurement of Salivary Hormones

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

If requested, chart documentation would show signs, symptoms, or clinical
reasons why Cushing's syndrome was being tested for.

No comments were received for this draft LCD for comment period ending
12/15/2016.