(Medicare Claims Processing Manual)

 ICD-10-CM G20.A1 -  Parkinson's disease without dyskinesia, without mention of fluctuations    ICD-10-CM G20.A2 -  Parkinson's disease without dyskinesia, with fluctuations    ICD-10-CM G20.B1 -  Parkinson's disease with dyskinesia, without mention of fluctuations    ICD-10 CM G20.B2 -  Parkinson's disease with dyskinesia, with fluctuations    ICD-10-CM G20.C -  Parkinsonism, unspecified   ICD-10-CM G25.0 - Essential  tremor   ICD-10-CM G25.2 - Other specified form of  tremor   50.4.2  Allowable Covered Procedure Codes  (Rev. 11021; Issued: 10-01- 21; Effective: 10 -29-21; Implementation: 10-29-21)   The following procedure codes may be present:     If ICD -10-PCS is applicable:    ICD-10-PCS Code  Code Description  00H00MZ  Insertion of Neurostimulator Lead into Brain, Open Approach  00H03MZ     Insertion of Neurostimulator Lead into Brain, Percutaneous Approach  00H04MZ  Insertion of Neurostimulator Lead into Brain, Endoscopic Approach  00H60MZ  Insertion of Neurostimulator Lead into Cerebral Ventricle, Open Approach  00H63MZ  Insertion of Neurostimulator Lead into Cerebral Ventricle, Percutaneous Approach  00H64MZ  Insertion of Neurostimulator Lead into Cerebral Ventricle, Percutaneous Endoscopic Approach  00P00MZ  Removal of Neurostimulator Lead from Brain, Open Approach  00P03MZ  Removal of Neurostimulator Lead from Brain, Percutaneous Approach  00P04MZ  Removal of Neurostimulator Lead from Brain, Percutaneous Endoscopic Approach  00P60MZ  Removal of Neurostimulator Lead from Cerebral Ventricle, Open Approach  00P63MZ  Removal of Neurostimulator Lead from Cerebral Ventricle, Percutaneous Approach  00P64MZ  Removal of Neurostimulator Lead from Brain, Open Approach  0H80XZZ  Division of Scalp Skin, External Approach  0HSSXZZ  Reposition Hair, External Approach   Coverage policy may be found in the National Coverage Determinations Manual in Chapter 1, section 160.24: Deep Brain Stimulation, using the following link: (http://www.cms.hhs.gov/manuals/103_cov_determ/ncd103index.asp).  50.4.3  Healthcare Common Procedure Coding System (HCPCS)  (Rev. 11021; Issued: 10-01- 21; Effective: 10 -29-21; Implementation: 10-29-21)  The following HCPCS codes are available for use when billing for covered deep brain stimulation:    61880   Revision or removal of intracranial neurostimulator electrodes    61885   Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array   61886   Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays   61888   Revision or removal of cranial neurostimulator pulse generator or receiver   95961    Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance   95962     Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of physician attendance (List separat ely in addition to code for primary procedure) (Use 95962 in conjunction with code 95961)   95970    Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (i.e., cranial nerve, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming    95971     Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance m easurements); simple brain, spinal cord, or peripheral (i.e., peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming.  95983     Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group(s), interleaving, amplitude, pulse width, frequency (Hz), on/off cycling, burst, magnet mode, doe lockout, patient selectable parameters, responsive n eurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/ transmitter programming, first 15 minutes face -to-face time with physician or other qualified health care professional.  95984     Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group(s), interleaving, amplitude, pulse width, frequency (Hz), on/off cycling, burst, magnet mode, doe lockout, patient selectable parameters, responsive n eurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face -to-face time with physician or other qualified health care professional.   50.5  Ambulatory Surgical Centers  (Rev. 128, 03- 26-04)  The following HCPCS codes are approved for billing in Ambulatory Surgical Centers:   61885 Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array - ASC Payment Group 02  61888 Revision or removal of cranial neurostimulator pulse generator or receiver - ASC Payment Group 01   NOTE:   Pulse generator is payable in an ASC; implantation of electrodes are not.  50.6  Claims Editing for Intermediaries  (Rev. 128, 03- 26-04)  We do not require nationwide standard system claims processing edits for pre and post payment review of claim(s) at this time.  However, carriers and intermediaries may create local claims processing edits for the requirements listed above.  50.7  Remittance Advice Notice for Intermediaries  (Rev.  2998, Issued: 07- 25-14, Effective: Upon implementation of ICD -10; 01- 01-12 - ASC X12, Implementation: 08- 25-2014 -  ASC X12; Upon Implementation of ICD -10)  Use appropriate existing remittance advice reason and remark codes at the line level to express the specific reason if you deny payment for DBS.  If denying services as furnished before April 1, 2003, use existing ASC X 12- 835 claim adjustment reason code 26 "Expenses incurred prior to coverage" at the line level.   50.8 - Medicare Summary Notice (MSN) Messages for Intermediaries (Rev. 128, 03- 26-04)  Use the following MSN messages where appropriate:   If a claim for DBS is denied because the service was performed prior to April 1, 2003, use the MSN message:    "This service was not covered by Medicare at the time you received it."  (MSN Message 21.11)   The Spanish version of the MSN message should read:    "Este servicio no estaba cubierto por Medicare cuando usted lo recibi."  (MSN Message 21.11)   50.9  Provider Notification  (Rev. 128, 03- 26-04)  Contractors should notify providers of this new national coverage in their next regularly scheduled bulletin, on their Web site within 2 weeks, and in routinely scheduled training sessions.   60  Coverage and Billing for Home Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management  (Rev. 1562, Issued: 07- 25-08, Effective: 03 -19-08, Implementation: 08- 25-08)  The prothrombin time (PT) test is an in -vitro test to assess coagulation.  PT testing and its normalized correlate, the International Normalized Ratio (INR), are the standard measurements for therapeutic effectiveness of warfarin therapy.  Warfarin, Coumad in, and others, are self -administered, oral anticoagulant, or blood thinner, medications that affect a persons Vitamin K -dependent clotting factors.   Use of the INR allows physicians to determine the level of anticoagulation in a patient independent of the laboratory reagents used.  The INR is the ratio of the patient's prothrombin time compared to the mean prothrombin time for a group of normal individuals.   60.1  Coverage Requirements  (Rev. 1562, Issued: 07- 25-08, Effective: 03 -19-08, Implementation: 08- 25-08)  For services furnished on or after July 1, 2002, Medicare will cover the use of home INR monitoring for anticoagulation management for patients with mechanical heart valves on warfarin.  The monitor and the home testing must be prescribed by a physician and the following patient requirements must be met:   Must have been anticoagulated for at least 3 months prior to use of the home INR device;    Must undergo an educational program on anticoagulation management and the use of the device prior to its use in the home; and   Self testing with the device is limited to a frequency of once per week.   For services furnished on or after March 19, 2008, the Centers for Medicare & Medicaid Services revised its national coverage determination (NCD) on PT/INR Monitoring for Home Anticoagulation Management as follows:   Medicare will cover the use of home PT/INR monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism ) on warfarin.  The monitor and the home testing must be prescribed by a treating physician as provided at 42 CFR 410.32(a), and all of the following requirements must be met:   1. The patient must have been anticoagulated for at least 3 months prior to use of the home INR device; and,   2. The patient must undergo a face -to-face educational program on anticoagulation management and must have demonstrated the correct use of the device prior to its use in the home; and,  3. The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following the initiation of home monitoring; and,  4. Self-testing with the device should not occur more frequently than once a week.   NOTE:   Porcine valves are not included in this NCD, so Medicare will not make payment on home INR monitoring for patients with porcine valves unless covered by local Medicare contractors.   60.2  Intermediary Payment Requirements  (Rev. 216, 06- 25-04)  60.2.1  Part A Payment Methods  (Rev. 216, 06- 25-04)  Payment is as follows:   Hospital outpatient departments -  Outpatient Prospective Payment System (OPPS)    Critical Access Hospital (CAH) -  Reasonable cost or Medicare Physician Fee Schedule (MPFS)   Deductible and coinsurance apply.   60.3  Intermediary Billing Procedures  (Rev. 216, 06- 25-04)  60.3.1  Bill Types (Rev. 216, 06- 25-04)  The applicable bill types are 13X and 85X.   60.3.2  Revenue Codes (Rev. 216, 06- 25-04)  Hospitals may report these services under revenue code 920 or they may report HCPCS codes G0248 and G0249 under the revenue center where they are performed.   60.4  Intermediary Allowable Codes (Rev. 216, 06- 25-04)  60.4.1  Allowable Covered Diagnosis Codes  (Rev.10881; Issued: 08- 06-2021; Effective: 09- 07-2021; Implementation: 09- 07- 2021)   For services furnished on or after the implementation of ICD -10 the applicable ICD -10-CM diagnosis codes for this benefit are: