Persius/hicric huggingface dataset:
Billing and Coding: Sedimentation Rate, Erythrocyte

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34021, Sedimentation Rate, Erythrocyte. 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.

Erythrocyte sedimentation rates performed on rheumatoid arthritis patients to
assess for medication adjustments should be billed with the diagnosis code
which reflects the medication the patient is receiving. These diagnosis codes
are to be billed only for rheumatoid arthritis medication evaluation:

  * T39.4X5A - T39.4X5S for patients receiving antirheumatics such as gold salts.
  * T45.1X5A - T45.1X5S for patients receiving antineoplastic and immunosuppressive drugs such as methotrexate
  * T45.8X5A - T45.8X5S for patients receiving other primarily systemic and hematological agents such as heavy metal antagonists
  * T50.6X5A - T50.6X5S for patients receiving antidotes and chelating agents, such as penicillamine

**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: MDS FISH

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MDS FISH L37620.

### 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 837
    * 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
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 L37622

**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 837
    * 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
Billing and Coding: MolDX: Inivata, InVisionFirst, Liquid Biopsy for
Patients with Lung Cancer

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: InivataTM,
InVisionFirst, Liquid Biopsy for Patients with Lung Cancer L37897.

To report an InvisionFirst - Lung 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
    * 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: Inivata, InVisionFirst, Liquid Biopsy for
Patients with Lung Cancer

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: InivataTM,
InVisionFirst, Liquid Biopsy for Patients with Lung Cancer L37899.

To report an InvisionFirst - Lung 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
    * 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: Special EEG Tests

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L34521 Special EEG 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.

**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. 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: Proton Beam Radiotherapy

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33937 Proton Beam Radiotherapy. 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.

**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 L33937, Proton Beam Radiotherapy may be
monitored and addressed through post payment data analysis and subsequent
medical review audits.
Billing and Coding: Non-invasive Extracranial Arterial Studies

This First Coast Billing and Coding Article for Local Coverage Determination
(LCD) L33695 Non-invasive Extracranial Arterial Studies 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.  A hard copy, or a soft copy convertible to a hard copy provides a permanent record of the study performed and must be of a quality that meets accepted radiologic/ultrasonographic standards.

5.  If the provider of the service is other than the ordering/referring physician/nonphysician practitioner, that provider must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner's order for the studies. The physician/nonphysician practitioner must state the clinical indication/medical necessity for the study in his/her order for the test. Billing providers are encouraged to obtain additional information from referring providers and/or patients or medical records. Referring physicians are required to provide appropriate diagnostic information to the performing provider.

6.  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.

**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 L33695, Non-invasive Extracranial
Arterial Studies may be monitored and addressed through post payment data
analysis and subsequent medical review audits.
Billing and Coding: Nail Debridement

This First Coast Billing and Coding Article for Local Coverage Determination
(LCD) L33922 Nail Debridement 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**

For nail debridement not related to symptomatic mycotic nails but associated
with a systemic condition, refer to the Routine Foot Care LCD L33941.

**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 provider of the service(s) must document the affected nail(s), including the clinical evidence of mycosis, and the manner in which and to what extent the nail(s) were debrided. Use of appropriate anti-fungal treatment or the contraindication of such treatment must also be documented. In addition, a description of the qualifying symptoms for debridement of toenail(s) must be documented.

**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 L33922, Nail Debridement may be
monitored and addressed through post payment data analysis and subsequent
medical review audits.
Billing and Coding: Electroretinography (ERG)

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L37398, Electroretinography (ERG). 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. When reporting ICD-10 code Z79.899, the medical record must reflect the medication administered as well as the underlying condition for which it was given.
Billing and Coding: Allergen Immunotherapy

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L37800 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: Cystatin C Measurement

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L37561 Cystatin C Measurement. 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. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition that warrants the test(s).
Billing and Coding: Lab: Flow Cytometry

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

Flow cytometry is a complex laboratory process to examine body fluids,
including blood and cerebrospinal fluid (CSF); bone marrow; and components of
the lymphoreticular system, such as lymph nodes, tonsil, and spleen. The use
of peripheral blood and fine needle aspirate material avoids more invasive
procedures for diagnosis. LCD L34215-Flow Cytometry outlines the coverage
criteria for flow cytometry testing. When covered, testing is limited to no
more than 24 markers without additional medical necessity documentation.

Flow cytometry for the detection and/or identification or enumeration of
bacteria or viruses in patients with chronic rhinosinusitis with or without
polyps is investigational/experimental and is not a Medicare benefit.

To report a Flow Cytometry 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
Billing and Coding: Lab: Flow Cytometry

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

Flow cytometry is a complex laboratory process to examine body fluids,
including blood and cerebrospinal fluid (CSF); bone marrow; and components of
the lymphoreticular system, such as lymph nodes, tonsil, and spleen. The use
of peripheral blood and fine needle aspirate material avoids more invasive
procedures for diagnosis. LCD L36094-Flow Cytometry outlines the coverage
criteria for flow cytometry testing. When covered, testing is limited to no
more than 24 markers without additional medical necessity documentation.

Flow cytometry for the detection and/or identification or enumeration of
bacteria or viruses in patients with chronic rhinosinusitis with or without
polyps is investigational/experimental and is not a Medicare benefit.

To report a Flow Cytometry 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