Persius/hicric huggingface dataset:
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)

This article gives guidance for billing, coding, and other guidelines in
relation to local coverage policy for L37578-Micro-Invasive Glaucoma Surgery
(MIGS).



The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding
System (HCPCS) code(s) may be subject to National Correct Coding Initiative
(NCCI) edits. This information does not take precedence over NCCI edits.
Please refer to NCCI for correct coding guidelines and specific applicable
code combinations prior to billing Medicare.  
  

**Coding Guidance  
**

For noncomplex cataract removal with insertion of aqueous drainage system, use
CPT 66991.

For complex cataract removal with intraocular lens implant and concomitant
intraocular aqueous drainage device, use CPT code 66989.

Please refer to the "Limitations" section in the related LCD for additional
information.  
  

**For Part A claims:**

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

**For Part B claims:**

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

**Frequency Limitations  
  
**

Medicare may cover only 1 unit per eye, per date of service of CPT code 66991
and 66989 for insertion of glaucoma drainage device(s) into the trabecular
meshwork (e.g., iStent, or iStent _inject_ ), when performed in conjunction
with cataract surgery and when the medically reasonable and necessary criteria
as stated in the LCD are met. Although more than one drainage device into the
trabecular meshwork of a single eye on a single day of service, using an
insertion tool loaded with more than one device, (e.g., iStent _inject_ ),
may be performed, once the insertion tool is deployed within the eye, there is
negligible increase in work or expense. Therefore only one unit of 66991 and
66989 per eye, per day may be billed, regardless of the number of devices
inserted into a single eye on the date of service.  
  

Medicare may cover only **1 unit per eye, per date of service of CPT code
0449T** for insertion of glaucoma drainage device(s) into the subconjunctival
space (e.g., XEN45), when the medically reasonable and necessary criteria as
stated in the LCD are met.  
  

**Documentation Requirements**  
  

  1. All documentation must be maintained in the patient's medical record and must support the medical necessity of the services as directed in this article and be 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: MolDX DecisionDx-Melanoma

CGS Administrators, LLC received comments on proposed policy DL38016-MolDX
DecisionDx-Melanoma from February 13, 2019 through March 29, 2019. Comments
were received from the provider community. The notice period begins May 9,
2019 through June 23, 2019. The LCD becomes final on June 24, 2019.
Billing and Coding: Hospice - Neurological Conditions

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Hospice -
Neurological Conditions L34547.
Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Blepharoplasty,
Eyelid Surgery, and Brow Lift L34411.
Billing and Coding: Transesophageal Echocardiography (TEE)

  
This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35016, Transesophageal Echocardiography (TEE).
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.  
  
CPT code 93355 is used to report TEE services during transcatheter
intracardiac therapies. CPT code 93355 is reported once per intervention and
only by an individual who is not performing the interventional procedure. CPT
code 93355 includes the work of passing the endoscopic ultrasound transducer
through the mouth into the esophagus, when performed by the individual
performing the TEE, diagnostic transesophageal echocardiography and ongoing
manipulation of the transducer to guide sizing and/or placement of implants,
determination of adequacy of the intervention, and assessment for potential
complications. Real-time image acquisition, measurements, and interpretation
of image(s), documentation of completion of the intervention, and final
written report are included in this code.  
  
CPT code 93312 (HCPCS code C8925 for Outpatient Prospective Payment System
[OPPS]) should be billed when contrast is used or CPT code 93315 (HCPCS code
C8926 for OPPS billing when contrast is used) for the complete procedure,
including probe placement, image acquisition, interpretation and report. CPT
code 93315 (HCPCS code C8926 for OPPS billing when contrast is used) should be
used for congenital anomalies only.  
  
Hospitals should use guidelines and descriptors associated with the applicable
Level 1 CPT code(s) to bill for echocardiograms without contrast.  
  
All services/procedures performed on the same day for the same beneficiary by
the physician/provider should be billed on the same claim.  
  
 **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: Corneal Hysteresis

As an important part of Medicare Local Coverage Determination (LCD)
development, National Government 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 Corneal Hysteresis LCD. The official notice period for the
final LCD begins on June 16, 2019, and the final determination will become
effective on August 1, 2019.
Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin
LAR Depot)

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Octreotide Acetate
for Injectable Suspension (Sandostatin LAR Depot) L33438. ** **

When ICD-10-CM codes T38.895A, T38.895D, T38.895S, T43.215A, T43.215D,
T43.215S, T43.225A, T43.225D, T43.225S, T50.995A, T50.995D or T50.995S is
submitted for chemotherapy induced diarrhea (CID); the medical record must
document the covered chemotherapy agent(s) causing the CID and the previous
antidiarrheal treatments that have become ineffective.

  * If ICD-10-CM codes C25.4, C26.0, D13.7, D13.91 and D13.99 are submitted on the claim, the medical record must document that the patient's diagnosis is VIPoma.

  * If ICD-10-CM code R79.89 is submitted on the claim, the patient's record must document abnormal findings leading to suspicion of VIPoma.

  * If ICD-10-CM code R94.7 is submitted on the claim, the patient's record must document an abnormal octreotide scan leading to suspicion of VIPoma.
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging
(SCODI)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Scanning Computerized Ophthalmic Imaging
(L34380).

**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.

**Documentation Requirements:**

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the LCD. (See "Indications
and Limitations of Coverage.") This documentation includes, but is not limited
to, relevant medical history, physical examination, and results of pertinent
diagnostic tests or procedures.
Billing and Coding: Allergen Immunotherapy

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L36240 (Allergen Immunotherapy). 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.  
  
Please refer to the CMS IOM Publication 100-04, _Medicare Claims Processing
Manual,_ Chapter 12, Section 200 Allergy Testing and Immunotherapy for
instructions on billing for allergy services.  
  
 **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 should support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code should describe the service performed.
  4. Documentation of any therapeutic expectations, level of antigens, time frame for administration, and any adjustments to the expectation based on local reactions, systemic reactions, missed dosing will need to be very clear in the medical records.
  5. Documentation for all references to the therapeutic effective dose in the medical record should be referenced to the maintenance concentrate and should be noted as a volume-to-volume dilution (e.g., 1:100 vol/vol dilution of maintenance concentrate).
  6. In the event that allergen immunotherapy is administered to a patient in a home setting, medical record documentation must clearly demonstrate that the benefits of immunotherapy outweigh the risks, include a copy of the patient's informed consent, and include validation regarding the training and ability of the individual administering the injection to recognize and manage immunotherapy reactions, particularly anaphylaxis.
Billing and Coding: Prostate Rectal Spacers

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Prostate Rectal Spacers.



**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.
Billing and Coding: Biomarkers Overview

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L35062 Biomarkers Overview. 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.

It is the expectation, that when reporting ICD-10 codes the code representing
the highest level of specificity documented in the medical record should be
reported and unspecified codes should only be used when they are the code that
most accurately reflects what is known about the patient's condition at the
time of the encounter.  
  
**Utilization Parameters**

CPT code 81490, Autoimmune (rheumatoid arthritis), is limited to two services
per rolling year per beneficiary.

**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: BRCA1 and BRCA2 Genetic Testing

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L36715, BRCA1 and BRCA2 Genetic Testing. 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.
Billing and Coding: Hospice - Renal Care

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Hospice -Renal Care
L34559.
Billing and Coding: Panretinal (Scatter) Laser Photocoagulation

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Panretinal (Scatter) Laser Photocoagulation
(PRP).  
  
 **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.  
  
 __ Use modifiers LT/RT to indicate operative site. Claims submitted without
modifier -RT, -LT, or -50 (in the rare event both eyes are treated on the same
day/session) will be returned as unprocessable under 1833[e]).

Panretinal laser photocoagulation is usually performed in two or more sessions
(staged surgery). Payment may be made only once during the global period of
the initial procedure. Reimbursement for subsequent sessions in the
postoperative period of the initial procedure is included in the allowance of
the initial procedure.  
  
Medicare allowance generally includes reimbursement for related procedures
performed on the same eye during the global surgery period of the first
procedure. Therefore, procedure codes 67208, 67210 or 67227 would be covered
only if they represented clearly distinct and different procedures with
different indications and were not re-operations or treatment of
complications. Such services, and other totally unrelated services, should be
billed with a modifier -79 (unilateral procedure or service by the same
physician during the post-operative period).

**Documentation Requirements:  
  
** The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the 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: Visual Fields Testing

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

  
**Coding Information:**  
  
Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.  
  
For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.  
  
A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.  
  
The diagnosis code(s) must best describe the patient's condition for which the
service was performed.  
 __

**Documentation Requirements:  
  
** The patient's medical record must contain documentation that fully supports
the medical necessity for services included within this LCD. (See "Indications
and Limitations of Coverage.") This documentation includes, but is not limited
to, relevant medical history, physical examination, and results of pertinent
diagnostic tests or procedures.
Billing and Coding: Allergy Testing

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L36241, Allergy Testing. 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.  
  
Consistent with the related LCD, CPT code 82785 Gammaglobulin
[immunoglobulin]; IgE is not appropriate in most general allergy testing.
Please refer to the LCD for details on medically reasonable and necessary
guidelines.  
  
It is not usually necessary to report CPT code 86003 Allergen specific IgE;
quantitative or semiquantitative, crude allergen extract (in vitro testing) in
addition to skin testing. Please see the related LCD for medically 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 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. Prior to performance of allergy testing, there must be evidence in the medical record that a history has been obtained, indicating the possible presence of allergy.
    * This history should support that attempts to narrow the area of investigation were taken so that the minimal number of necessary skin tests might deliver a diagnosis.
    * The history should support that the selection of antigens was based on the patient specific history and physician examination.
  5. The medical record must indicate which allergy test(s) were used, the interpretation(s), and measurement (in mm) of reaction size of both wheal and erythema response or a standardized grading system in vivo testing (as applicable).
Billing and Coding: Allergy Skin Testing

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Allergy Skin
Testing L33417.
Billing and Coding: Health and Behavior Assessment/Intervention

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Health and Behavior
Assessment/Intervention L37638.

CPT code 90901 Biofeedback is also not covered as a health and behavioral
intervention.
Billing and Coding: Brain Natriuretic Peptide (BNP) Level

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Brain Natriuretic
Peptide (BNP) Level L33422.
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Osteoporotic
Vertebral Compression Fracture (VCF)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Percutaneous Vertebral Augmentation (PVA) for
Osteoporotic Vertebral Compression Fracture (VCF).

Provisions in this article and the LCD only address Vertebral Augmentation for
Osteoporotic Vertebral Compression Fracture (VCF). Coverage will remain
available for medically necessary procedures for other conditions not included
in this article/LCD.

**Coding Guidelines**

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

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

All services/procedures performed on the same day for the same beneficiary by
the physician/provider should be billed on the same claim.

**Specific Coding Guidelines**

No separate payment for venography performed during the operative session may
be allowed and it should not be separately billed.

This LCD will not affect the use of this treatment for cancer related
diagnoses.

Exclusion for total number of levels involved will not apply for a diagnosis
of multiple myeloma.

**Documentation Requirements**

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the related LCD. (See
"Indications and Limitations of Coverage.") This documentation includes, but
is not limited to, relevant medical history, physical examination, and results
of pertinent diagnostic tests or procedures.
Billing and Coding: Computerized Axial Tomography (CT), Thorax

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Computerized Axial
Tomography (CT), Thorax L33459.

**Reordering Identical Type of Imaging Examination:** No imaging examination
(pertaining to an identical CPT code only) should be ordered more frequently
than 6 times per calendar year. Furthermore, this frequency limit shall only
apply to the following outpatient Places of Service (POS): office (11),
outpatient hospital (22), independent clinic (49), rural health clinic (72)
and independent diagnostic testing facility (IDTF).
Billing and Coding: Surface Electrical Stimulation in the Treatment of
Dysphagia

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Surface Electrical
Stimulation in the Treatment of Dysphagia L34578.