Persius/hicric huggingface dataset:
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.
Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical
Stains

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

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: Treatment of Males with Low Testosterone

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

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
    *  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-UM (Uveal Melanoma)

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) MolDX: DecisionDx-UM
(Uveal Melanoma) L37070.

To report a DecisionDx-UM (Uveal Melanoma) service, please submit the
following claim information:

  * Select CPT code 81552
  * 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-UM (Uveal Melanoma)

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) MolDX: DecisionDx-UM
(Uveal Melanoma) L37072.

To report a DecisionDx-UM (Uveal Melanoma) service, please submit the
following claim information:

  * Select CPT code 81552
  * 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
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for
Osteoporotic Vertebral Compression Fracture (VCF) L38213

As an important part of Medicare Local Coverage Determination (LCD)
development, Wisconsin Physician Services solicits comments from the provider
community and from members of the public who may be affected by or interested
in our LCDs. The purpose of the advice and comment process is to gain the
expertise and experience of those commenting.

We would like to thank those who suggested changes to the LCD for Percutaneous
Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture
(VCF). The official notice period for the final LCD begins on October 31, 2019
and the final determination will become effective for services rendered on or
after December 16, 2019.
Billing and Coding: Transcranial Doppler Studies

This First Coast Billing and Coding Article for Local Coverage Determination
(LCD) L33977 Transcranial Doppler Studies provides billing and coding guidance
for diagnosis limitations that support diagnosis to procedure code automated
denials. However, services performed for any given diagnosis must meet all of
the indications and limitations stated in the LCD, the general requirements
for medical necessity as stated in CMS payment policy manuals, any and all
existing CMS national coverage determinations, and all Medicare payment rules.

Refer to the LCD for reasonable and necessary requirements and limitations.

The redetermination process may be utilized for consideration of services
performed outside of the reasonable and necessary requirements in the LCD.

**Coding Guidelines**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

If the provider of transcranial doppler studies is other than the
ordering/referring physician/non-physician practitioner, the provider of the
service must maintain a copy of the test results and interpretation, along
with copies of the ordering/referring physician/non-physician practitioner's
order for the studies. The physician/non-physician practitioner must state the
clinical indication/medical necessity for the study in his/her order for the
test.

**Utilization Guidelines**

In accordance with CMS Ruling 95-1 (V), utilization of these services should
be consistent with locally acceptable standards of practice.

Compliance with the provisions in LCD L33977, Transcranial Doppler Studies may
be monitored and addressed through post payment data analysis and subsequent
medical review audits.
Billing and Coding: Duplex Scanning

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33674 Duplex Scanning. 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. If the provider of the duplex scan study(ies) is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician's order for the studies.
  5. 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: Visual Field Examination

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33766 Visual Field Examination. 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. If the provider of the service is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and 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 this order for the test.
Billing and Coding: Destruction of Malignant Skin Lesions

This First Coast Billing and Coding Article for Local Coverage Determination
(LCD) L33813 Destruction of Malignant Skin Lesions provides billing and coding
guidance for frequency limitations as well as diagnosis limitations that
support diagnosis to procedure code automated denials. However, services
performed for any given diagnosis must meet all of the indications and
limitations stated in the LCD, the general requirements for medical necessity
as stated in CMS payment policy manuals, any and all existing CMS national
coverage determinations, and all Medicare payment rules.

Refer to the LCD for reasonable and necessary requirements and limitations.

The redetermination process may be utilized for consideration of services
performed outside of the reasonable and necessary requirements in the LCD.

**Coding Guidelines**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. The medical record/progress note should indicate the removal of a malignant lesion with a corresponding pathology report or a clinical description consistent with a skin malignancy. The size and location of the lesion must be included in the documentation. 

**Utilization Guidelines**

In accordance with CMS Ruling 95-1 (V), utilization of these services should
be consistent with locally acceptable standards of practice.

Compliance with the provisions in LCD L33813, Destruction of Malignant Skin
Lesions may be monitored and addressed through post payment data analysis and
subsequent medical review audits.
Billing and Coding: Lab: Cystatin C Measurement

The information in this article contains billing, coding, or, other guidelines
that complement the Local Coverage Determination (LCD) for Lab: Cystatin C
Measurement policy L37616.

**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 this policy.
  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 result 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: Lab: Cystatin C Measurement

The information in this article contains billing, coding, or, other guidelines
that complement the Local Coverage Determination (LCD) for Lab: Cystatin C
Measurement Policy L37618.

**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 this policy.
  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 result 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: Transcranial Magnetic Stimulation (TMS) in the Treatment
of Adults with Major Depressive Disorder

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34522 Transcranial Magnetic Stimulation (TMS) in
the Treatment of Adults with Major Depressive Disorder. Please refer to the
LCD for reasonable and necessary requirements.  
  
**Coding Guidance**

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

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

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.  
  
**Utilization Parameters**

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

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

Do not report CPT code 90869 (motor threshold determination) in conjunction
with 90867 or 90868.  
  
**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. The medical record documentation must support that the attending physician has met with the patient face to face for the initial assessment and for subsequent delivery and management when there is a change in the individual's mental status and/or other significant change in clinical status.
  5. The medical record documentation must include evidence of clinical judgment of the treating physician in evaluation of the absolute and relative contraindications in the pre-procedure record for the present episode of care.
Billing and Coding: B-Type Natriuretic Peptide (BNP)

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33267, B-Type Natriuretic Peptide (BNP). 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.

BNP is allowed when performed in an office (11), inpatient hospital (21),
outpatient hospital (22), emergency room - hospital (23), independent
laboratory (81), or in an urgent care facility (20) setting given that results
are immediately available (e.g., < 2-4 hours).

**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.
  5. 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: Lumbar Spinal Fusion for Instability and Degenerative Disc
Conditions

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33382, Lumbar Spinal Fusion for Instability and
Degenerative Disc Conditions. Please refer to the LCD for reasonable and
necessary requirements.  
  
 **Coding Guidelines**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.  
  
 **Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. Medical record documentation maintained by the physician must include the following:
    * Complete operative report outlining operative approach used and all the components of the spine surgery.
    * Documentation of the history and duration of unsuccessful conservative therapy (non-surgical medical management) (for example, duration and outcomes of physiotherapy, injection therapy, anatomic factors influencing the decision for surgery, etc.) when applicable. Failure of non-surgical medical management can be historical and does not have to be under the direction of the operating surgeon.
    * Interpretation and reports for X-rays, MRI's, CT's, etc.
    * Medical clearance reports (as applicable).