Persius/hicric huggingface dataset:
Billing and Coding: Magnetic Resonance Angiography (MRA)

This First Coast Billing and Coding Article for Local Coverage Determination
(LCD) L34372 Magnetic Resonance Angiography (MRA) 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. If the provider of the magnetic resonance angiography study 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. The physician must state the reason for the MRA in his order for the test. (CFR, Title 42, Volume 2,Chapter IV, Part 410.32(a) Ordering diagnostic tests.) 

**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 L34372, Magnetic Resonance Angiography
(MRA) may be monitored and addressed through post payment data analysis and
subsequent medical review audits.
Billing and Coding: Psychological and Neuropsychological Tests

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34520 Psychological and Neuropsychological
Tests. 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.

Codes 96132, 96133, 96136, 96137, 96138, and 96139 describe testing which is
intended to diagnose and characterize the neurocognitive effects of medical
disorders that impinge directly or indirectly on the brain.

Neuropsychological testing does not rely on self-report questionnaires such as
the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), rating scales such
as the Hamilton Depression Rating Scale, or projective techniques such as the
Rorschach or Thematic Apperception Test (TAT). In circumstances when
additional time is necessary to integrate other sources of clinical data
including previously completed and reported technician- and/or computer-
administered tests, the neuropsychological testing may include time spent
integrating self-report questionnaires.

Typically, psychological testing/neuropsychological testing may require four
(4) to six (6) hours to perform (including administration, scoring, and
interpretation.) If the testing is done over several days, the testing time
should be combined and reported all on the last date of service.

**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 must indicate testing is necessary as an aid in the diagnosis and therapeutic planning. The record must show the tests performed, scoring and interpretation, as well as the time involved for services that are time- based. 
    * The medical record should include all of the following information:
      * Reason for referral.
      * Tests administered, scoring/interpretation, and time involved.
      * Present evaluation.
      * Diagnosis (or suspected diagnosis that was the basis for the testing if no mental/ neurocognitive illness was found).
      * Recommendations for interventions, if necessary.
      * Identity of person performing service.
Billing and Coding: Peripheral Nerve Blocks

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33933 Peripheral Nerve Blocks. 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.

Refer to the National Correct Coding Initiative Policy Manual for Medicare
Services, Chapter 2 and Chapter 8 for CPT codes 64400-64530 coding
instructions.

Refer to LCD L33930 Facet Joint Interventions for Pain Management for
information regarding billing paravertebral facet joint blocks on the same
date of service.

Use of physical medicine and rehabilitation CPT/HCPCS codes (97032, 97139,
G0282, G0283) for treatment of neuropathies or peripheral neuropathies caused
by underlying systemic diseases is inappropriate.

**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. Assessment of the outcome of this procedure depends on the patient's responses, therefore documentation should include: 
    * Whether the block was a diagnostic or therapeutic injection 
    * Pre- and post-procedure evaluation of the patient
    * Patient education
  5. When preemptive analgesia is performed by a provider other than the surgeon or the anesthesia professional who provides anesthesia/analgesia for the procedure, there must be a compelling patient care reason for the involvement of the additional provider. The rationale for this approach must be clearly documented in the medical record.
Billing and Coding: Spinal Cord Stimulators for Chronic Pain

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

Physicians with a low trial to permanent implant ratio (less than 50%) will be
subject to post-payment review and may be asked to submit documentation as to
the patient selection criteria, the radiologic imaging demonstrating proper
lead placement, and the medical necessity of the trials. Failure to provide
this documentation will be cause for post-payment denial and recoupment of
reimbursement. It is understood that all patients may not have a favorable
result of the trial implant; but careful selection should find the most
appropriate patients.  

If a trial fails, a repeat trial is not appropriate unless there are
extenuating circumstances that lead to trial failure. Appropriate medical
documentation to support a repeat trial can be sent on appeal.

**Documentation Requirements**  
  
The clinical record should include the elements leading to the diagnosis and
the therapies tried before the decision to use spinal cord stimulators (SCS).  
  
The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits.
This policy does not take precedence over CCI edits. Please refer to the CCI
for correct coding guidelines and specific applicable code combinations prior
to billing Medicare.  
  
When the documentation does not meet the criteria for the service rendered or
the documentation does not establish the medical necessity for the services,
such services will be denied as not reasonable and necessary.  
  
 **Utilization Guidelines**  
  
63650 - Two temporary spinal cord stimulator trials per anatomic spinal region
(two per DOS) or (four units) per patient per lifetime (with exceptions
allowed for technical limitations for the initial trials or for use of
different modalities of stimulation, including new technology), in place of
service office, ASC, out-patient hospital, or hospital. Since permanent
neurostimulator arrays can also be placed percutaneously, code 63650 can be
covered more often in place of service ASC, out-patient hospital, or hospital.  
  
63655 - One permanent spinal cord stimulator per patient per lifetime and must
be performed in an ASC, out-patient hospital or hospital.  
  
63663 - Will not be reimbursed in the office setting since they are included
in 63650.
Billing and Coding: Hepatic (Liver) Function Panel

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33907 Hepatic (Liver) Function Panel. 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 the 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 each test billed.
Billing and Coding: High Sensitivity C-Reactive Protein (hsCRP)

This First Coast Billing and Coding Article for Local Coverage Determination
(LCD) L33908 High Sensitivity C-Reactive Protein (hsCRP) 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. Medical record documentation maintained by the ordering/referring physician/qualified nonphysician practitioner must indicate the medical necessity for performing the test and the test results. In addition, if the service exceeds the frequency parameter listed in the LCD, documentation of medical necessity must be submitted upon request.
  5. If the provider of the service is other than the ordering/referring physician/nonphysician practitioner, that provider must maintain a copy of test results, along with copies of the ordering/referring physician/nonphysician practitioner's order for the test. The clinical indication/medical necessity for the test must be indicated in the 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 L33908, High Sensitivity C-Reactive
Protein (hsCRP) may be monitored and addressed through post payment data
analysis and subsequent medical review audits.
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging
(SCODI)

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33751 Scanning Computerized Ophthalmic
Diagnostic Imaging (SCODI). 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.  
  
 **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.
Response to Comments: Repetitive Transcranial Magnetic Stimulation (rTMS) in
Adults with Treatment Resistant Major Depressive Disorder

The comment period for the Repetitive Transcranial Magnetic Stimulation (rTMS)
in Adults with Treatment Resistant Major Depressive Disorder DL34869 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 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with
Treatment Resistant Major Depressive Disorder L34869 begins on 11/28/19 and
will become effective on 1/13/20.
Billing and Coding: Repetitive Transcranial Magnetic Stimulation (rTMS) in
Adults

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Repetitive
Transcranial Magnetic Stimulation (rTMS) in Adults L34869.

 **Documentation Requirements**  

  1. All documentation must be maintained in the patients 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 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.
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for
Osteoporotic Vertebral Compression Fracture (VCF)

As an important part of Medicare Local Coverage Determination (LCD)
development, Noridian Healthcare Solutions 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 January 3, 2020
and the final determination will become effective for services rendered on or
after February 19, 2020.
Response to Comments: MolDX: Next-Generation Sequencing for Solid Tumors

The comment period for the MolDX: Next Generation Sequencing for Solid Tumors
DL38045 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 MolDX: Next Generation Sequencing for Solid Tumors L38045
begins on 12/6/19 and will become effective on 2/10/20.
Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Next
Generation Sequencing for Solid Tumors L38045.

Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57503:

To report a Next Generation Sequencing for Solid Tumors service, please submit
the following claim information:

  * Select the appropriate CPT code 
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 

  *     * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim

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

  *     * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form

  * Select the appropriate ICD-10-CM code

**NOTE:** When entering the DEX Z-Code on the SV101-7 documentation field for
Part B claims please do not add additional characters and/or information on
the line.
Response to Comments: MolDX: Next Generation Sequencing Lab-Developed Tests
for Myeloid Malignancies and Suspected Myeloid Malignancies

The comment period for the MolDX: Next Generation Sequencing Lab-Developed
Tests for Myeloid Malignancies and Suspected Myeloid Malignancies DL38047
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 MolDX: Next Generation Sequencing Lab-Developed Tests for Myeloid
Malignancies and Suspected Myeloid Malignancies DL38047 begins on 12/26/19 and
will become effective on 2/10/20.
Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for
Myeloid Malignancies and Suspected Myeloid Malignancies

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Next
Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and
Suspected Myeloid Malignancies L38047.

Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57503:

To report a Next Generation Sequencing Lab-Developed Tests for Myeloid
Malignancies and Suspected Myeloid Malignancies service, please submit the
following claim information:

  * Select the appropriate CPT code 
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 

  *     * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 

  *     * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code

**NOTE:** When entering the DEX Z-Code on the SV101-7 documentation field for
Part B claims please do not add additional characters and/or information on
the line.
Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery
(MRgFUS) for Essential Tremor

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38495 Magnetic-Resonance-Guided Focused
Ultrasound Surgery (MRgFUS) for Essential Tremor. 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.