evekhm/cms_iom_500 huggingface dataset:
Article - Billing and Coding: Nerve Conduction Studies and Electromyography (A56619)
Limitations:Nerve Conduction StudiesEach descriptor (code) from CPTcodes 95907, 95908, 95909, 95910, 95911, 95912, and 95913, can be reimbursed only once per nerve, or named branch of a nerve, regardless of the number of sites tested or the number of methods used on that nerve. For instance, testing the ulnar nerve at wrist, forearm, below elbow, above elbow, axilla and supraclavicular regions will all be considered as a single nerve. Motor and sensory nerve testing are considered separate tests. CPTcode 95905 is payable only once per limb studied and cannot be used in conjunction with any other nerve conduction codes.Psychophysical measurements(current, vibration, thermal perceptions), even though they may involve delivery of a stimulus, are considered to be part of the physical exam and may not be billed as a separate service.Examination using portable hand-held devices, or devices which are incapable of real-time wave-form display and analysis, and incapable of both NCS and EMG testing, will be included in the E/M service. They will not be paid separately. Examples include The Axon II or delta fiber analysis testing and/or machines with other names.NCS must provide a number of response parameters in a real-time fashion to facilitate provider interpretation. Those parameters include amplitude, latency, configuration and conduction velocity. Medicare does not accept diagnostic studies that do not provide this information or those that provide delayed interpretation as substitutes for NCS. Raw measurement data obtained and transmitted trans-telephonically or over the Internet, therefore, does not qualify for the payment of the ED service codes included in this article.Medicare does not expect to receive claims for nerve conduction testing accomplished with discriminatory devices that use fixed anatomic templates and computer-generated reports used as an adjunct to physical examination routinely on all patients.ElectromyographyIt is expected that providers will use CPTcode 95870 for sampling muscles other than the paraspinals associated with the extremities, which have been tested. Medicare would not expect to see this code billed when the paraspinal muscles corresponding to an extremity are tested and when the extremity EMG CPTcode 95860, 95861, 95863 or 95864 is also billed.
Article - Billing and Coding: Nerve Conduction Studies and Electromyography (A56619)
It is not necessary to include documentation with each claim submission. Data gathered during NCS, however, should be available.
Article - Billing and Coding: Swallowing Studies for Dysphagia (A56621)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, 3.4.1.3 Diagnosis Code RequirementsArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Swallowing Studies for Dysphagia L33449.Utilization GuidelinesCPTcodes 70370, 70371 and 74230 describe the complete procedure and should not be billed more than 1 time per patient on the same date of service.Only 1 of the above codes should be billed per patient on the same date of service.
Article - Billing and Coding: Echocardiography (A56625)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claimCMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, 3.4.1.3 Diagnosis Code RequirementsArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Echocardiography L37379.Follow-up Studies or Limited StudiesWhen a less than complete examination is performed for the purpose of evaluation of 1 specific cardiac problem, or region of the heart, the service is described by CPTcodes 93308 and 93321, follow-up or limited studies. When a limited service is performed, or the patients condition requires only a limited examination, these codes must be used to indicate the appropriate service.Examples of appropriate use of CPTcode 93308:a follow-up study of a patient with pericardial effusion following heart surgery, to evaluate progression or resolution of the effusion; ora serial evaluation of left ventricular (LV) function during antineoplastic chemotherapyExamples of appropriate use of CPTcode 93321:recording tricuspid regurgitant velocity in order to estimate pulmonary artery systolic pressure; orsequential evaluation of the transmitral velocity profile in a patient with mitral stenosis, in order to evaluate for a change in gradient or valve area
Article - Billing and Coding: Echocardiography (A56625)
recording tricuspid regurgitant velocity in order to estimate pulmonary artery systolic pressure; orsequential evaluation of the transmitral velocity profile in a patient with mitral stenosis, in order to evaluate for a change in gradient or valve areaDoppler Color Flow Velocity MappingWhen the test is performed without a specific indication, it is considered routine screening, and must be billed with a screening ICD-10 code to indicate the reason for the test.LimitationsWhen ultrasound (US) contrast enhancement is used for visualizing the ventricular chambers and endocardial border, the supply is considered separate from the procedure for reimbursement from Medicare.NoncoveredWhen a screening test is performed, use the appropriate screening ICD-10 code to indicate the test is being done for screening purposes. When the result of the test is abnormal, subsequent services may be billed with the test-result diagnosis; however, the initial screening test must be listed as screening, even though the result of the screening test may be a covered condition.Diagnostic injection services are an integral part of a contrast procedure and are not separately payable.Transesophageal Echocardiography (TEE)Use of intraoperative TEE for monitoring purposes (CPTcode 93318) performed by the anesthesiologist during cardiopulmonary surgery (e.g., cardiopulmonary bypass and valvular surgery) is included in the reimbursement for the anesthesia service and not separately reportable.Note:When 2 (or more) imaging studies are routinely billed (i.e., without a supporting clinical indication), only1 of the services will be allowed and the other(s) will be denied as not medically necessary.
Article - Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (A56631)
CMS National Coverage PolicyN/AArticle TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35035, Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography. Please refer to the LCD for reasonable and necessary requirements.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 Coding Policy Manual for Medicare Services, Chapters V and IX, for information on proper coding for these services.Coding GuidanceNotice: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.Do not report CPT Codes 36222, 36223, or 36224 together for ipsilateral angiography. Instead, select the code that represents the most comprehensive service.Do not report CPT Codes 36225 and 36226 together for ipsilateral angiography. Select the code that represents the more comprehensive service.CPT codes 75600 and 75605 typically should not be reported with CPT codes 36221 - 36227. Refer to the related LCD for full information on reporting these services together.
Article - Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy (A56632)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.Article TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L34454.Covered Indications:For surveillance of colonic neoplasia (when the patient has a history of colorectal cancer or polyps and is being followed for this indication, use the appropriate CPT/HCPCS code with the appropriate ICD-10-CM code and 1 of the following ICD-10-CM codes as the secondary diagnosis: Z85.038, Z85.048 or Z86.010):For follow-up 1 year after surgery for treatment of colorectal cancer when the patient is identified as being at high-risk for colon cancer and is eligible for continued screenings at 24-month intervals (HCPCS code G0105 should be reported).Limitations:**Marking of a neoplasm for localization (tattooing) is covered, but is not separately payable.Infectious colitis is an acceptable indication in its general form. Specificity in ICD-10 coding is not needed but should be maintained in the patient's chart.
Article - Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
CMS National Coverage PolicySocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38223, Micro-Invasive Glaucoma Surgery (MIGS). Please refer to the LCD for reasonable and necessary requirements.Coding GuidanceNotice: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 ParametersMedicare may cover only1 unit per eye, per date of service of CPT code 66989 or 66991for insertion of glaucoma drainage device(s) into the trabecular meshwork (e.g., iStent, or iStentinject), 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, may be performed using an insertion tool loaded with more than one device, (e.g., iStentinject), once the insertion tool is deployed within the eye, the work and clinical skill required to place additional device(s) is equivalent to placement of other U.S. Food and Drug Administration (FDA) cleared devices described by the same codes. Therefore, only one unit of 66989 or 66991 per eye per day may be billed, regardless of the number of devices inserted into a single eye on the same date of service.Medicare may cover only1 unit per eye, per date of service of CPT code 0449Tfor 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.Note: CPT Code 0450T for additional device insertion is not covered.
Article - Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
Note: CPT Code 0450T for additional device insertion is not covered.Note: CPT code 0671T does not need to be reported with any of the following codes: 66982, 66983, 66984, 66987, and 66988.Documentation RequirementsAll 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.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.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.
Article - Billing and Coding: MolDX: Melanoma Risk Stratification Molecular Testing (A56636)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS Internet Only Manual Pub. 100-04 Medicare Claims Processing Manual, Chapter 23, 10 Reporting ICD Diagnosis and Procedure CodesCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.2 Independent Laboratory Specimen Drawing, 60.2. Travel AllowanceArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Melanoma Risk Stratification Molecular Testing DL38018.To report a molecular diagnostic service, please submit the following claim information:Select the appropriate CPT codeEnter 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 837PBox 19 for paper claimEnter 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 claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM code
Article - Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56638)
CMS National Coverage PolicyInternet Only Manual (IOM) Citations:CMS IOM Publication 100-04,Medicare Claims Processing Manual,Chapter 23, Section 10 Reporting ICD Diagnosis and Procedure Codes and Section 20.9 National Correct Coding Initiative (NCCI)National Correct Coding Initiative (NCCI) Citation:NCCI Policy Manual for Medicare ServicesChapter 1 General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare ServicesChapter 10 Pathology/Laboratory Services CPT codes 80000-89999 For National Correct Coding Initiative Policy Manual for Medicare ServicesSocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38227 Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs). Please refer to the LCD for reasonable and necessary requirements.Coding GuidanceNotice: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.A GIP test panel is a single service with a single unit of service (UOS=1). A GIP testpanel must not be unbundled and billed as individual componentsregardless of the fact that the GIP test panel reports multiple individual pathogens and/or targets.Utilization ParametersMedicare will allow reporting only one GIP multiplex panel (CPT codes 0369U, 87505, 87506, and 87507) summing the testing for all targets per day per beneficiary by the same or different provider consistent with the related LCD.Consistent with the LCD, repeat NAAT testing within seven days during the same episode of diarrhea will be denied (any combination of CPT codes 0369U, 87505, 87506, and 87507).Documentation Requirements
Article - Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56638)
Documentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.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.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.
Article - Billing and Coding: Hospice Alzheimer's Disease & Related Disorders (A56639)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 11, 30.2 Payment Rates, 30.2.2 Service Intensity Add-on (SIA) Payments, and 30.3 Data Required on the Institutional Claim to A/B MAC (HHH)Article TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for HospiceAlzheimers Disease & Related Disorders L34567.
Article - Billing and Coding: Debridement of Mycotic Nails (A56640)
CMS National Coverage PolicyPlease refer to the related LCD, L35013.Article TextRefer to the Novitas Local Coverage Determination (LCD) L35013, Debridement of Mycotic Nails, for reasonable and necessary requirements and frequency limitations.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.CPT codes 11720 and 11721 will not be reimbursed more often than once every 60 days.CPT codes 11720 and 11721 may be limited to 6 sessions per beneficiary, per 12 months. Refer to the Utilization Guidelines in the related LCD for information related to this limitation.
Article - Billing and Coding: Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's Disease and Behavioral Disturbances (A56641)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.Federal Register Final Rule/Vol. 74, No 216, dated November 10, 2009, pp 58111-58112CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 10, 40.2 HH PPS ClaimsArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) forHome Health Skilled Nursing Care-Teaching and Training: Alzheimers Disease and Behavioral Disturbances L34562.
Article - Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
CMS National Coverage PolicyInternet Only Manual (IOM) Citations:CMS IOM Publication 100-04,Medicare Claims Processing Manual,Chapter 23, Section 10 Reporting ICD Diagnosis and Procedure Codes and Section 20.9 National Correct Coding Initiative (NCCI)National Correct Coding Initiative (NCCI) Citation:NCCI Policy Manual for Medicare Services,Chapter 1 General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare ServicesChapter 10 Pathology/Laboratory Services CPT codes 80000-89999 For National Correct Coding Initiative Policy Manual for Medicare ServicesSocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38229 Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs). Please refer to the LCD for reasonable and necessary requirements.Coding GuidanceNotice: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.A GIP test panel is a single service with a single unit of service (UOS=1). A GIP testpanel must not be unbundled and billed as individual componentsregardless of the fact that the GIP test panel reports multiple individual pathogens and/or targets.Utilization ParametersMedicare will allow reporting only one GIP multiplex panel (CPT codes 0369U, 87505, 87506, and 87507) summing the testing for all targets per day per beneficiary by the same or different provider consistent with the related LCD.Consistent with the LCD, repeat NAAT testing within seven days during the same episode of diarrhea will be denied (any combination of CPT codes 0369U, 87505, 87506, and 87507).Documentation Requirements
Article - Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
Documentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.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.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.
Article - Billing and Coding: C-Reactive Protein High Sensitivity Testing (hsCRP) (A56643)
CMS National Coverage PolicyPlease refer to the Local Coverage Determination (LCD) L34856, C-Reactive Protein High Sensitivity Testing (hsCRP).Article TextRefer to the Novitas Local Coverage Determination (LCD) L34856, C-Reactive Protein High Sensitivity Testing (hsCRP), for reasonable and necessary requirements and frequency limitations.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 GuidanceCPT code 86140 is not to be used in place of CPT code 86141, which represents high sensitivity C-reactive protein (hsCRP) testing.Frequency LimitationsConsistent with the related LCD, no more than 3 services of CPT code 86141 may be reported per patients lifetime.