evekhm/cms_iom_500 huggingface dataset:
Article - Billing and Coding: Nerve Conduction Studies and Electromyography (A57478)
The technical component (TC) of the Neuromuscular junction testing code 95937 had its Physician Supervision of Diagnostic Procedures Indicator changed to 7A This change is effective January 1, 2013.Needle electromyographic (EMG) codes 95860-95870 and 95885-95887 have the designation of 6A for the technical portion of the test. Needle electromyographic (EMG) code 95872 has the designation of 66 for the technical portion of the test. Therefore, if authorized by state law Physical Therapists are allowed the technical portion of the test according to the description of 6A which is included in this Billing and Coding Article.Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT) is not covered by Medicare. See CMS Publication 100-3, Medicare National Coverage Determinations Manual, Chapter 1, Section 160.23.
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
CMS National Coverage PolicyItalicizedfont represents CMS national language/wording copied directly from CMS Manuals or CMS transmittals. Contractors are prohibited from changing national language.CMS Pub 100-03,Medicare National Coverage Determination (NCD) Manual, Chapter 1- Coverage Determinations, Section 20.7 - Percutaneous Transluminal Angioplasty (PTA).CMS Pub 100-04Medicare Claims Processing Manual, Chapter 4  Part B Hospital (Including Inpatient Hospital Part B and OPPS), Section 61.5 - Billing for Intracoronary Stent Placement.CMS Pub 100-04Medicare Claims Processing Manual, Chapter 13  Radiology Services and Other Diagnosis Procedures, Section 20 - Payment Conditions for Radiology Services.Article Text
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
Article TextThe billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD Percutaneous Coronary Interventions L34761.GuidelinesCoronary thrombectomy performed with percutaneous transluminal coronary angioplasty (PTCA) and a stent insertion is separately reimbursable. Coronary thrombolysis (including coronary angiography) when performed by intracoronary infusion is separately reimbursable when performed preceding or subsequent to PTCA or atherectomy.Codes 92920-92944 describe percutaneous revascularization services performed for occlusive disease of the coronary vessels (major coronary arteries, coronary artery branches, or coronary artery bypass grafts). These percutaneous coronary intervention (PCI) codes are built on progressive hierarchies with more intensive services inclusive of lesser intensive services. These PCI codes all include the work of accessing and selectively catheterizing the vessel, traversing the lesion, radiological supervision and interpretation directly related to the intervention(s) performed, closure of the arteriotomy when performed through access sheath, and imaging performed to document completion of the intervention in addition to the invention(s) performed. These codes include angioplasty (e.g., balloon, cutting balloon, wired balloons, cryoplasty), atherectomy (e.g., directional, rotational, laser); and stenting (e.g., balloon expandable, self-expanding, bare metal, drug eluting, covered). Each code in this family includes the balloon angioplasty, when performed. Diagnostic coronary angiography codes 93454-93461 and injection procedure codes 93563-93564 should not be used with PCI services 92920-92944 to report:Contrast injections, angiography, roadmapping, and/or fluoroscopic guidance for the coronary intervention.Vessel measurement for the coronary intervention,orPost-coronary angioplasty/stent/atherectomy angiography, as this work is captured in the percutaneous coronary revascularization services codes (92920-92944).
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
Diagnostic angiography performed at the time of a coronary interventional procedure may be separately reportable if:No prior catheter-based coronary angiography study is available, and a full diagnostic study is performed, and a decision to intervene is based on the diagnostic angiography,orA prior study is available, but as documented in the medical record:The patients condition with respect to the clinical indications has changed since the prior study,orThere is inadequate visualization of the anatomy and/or pathology,orThere is a clinical change during the procedure that requires a new evaluation outside the target area of intervention.
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
Diagnostic coronary angiography performed at a separate session from an interventional procedure is separately reportable.If a single lesion extends from one target vessel (major coronary artery, coronary artery bypass graft, or coronary artery branch) into another target vessel, but can be revascularized with a single intervention bridging the two vessels, this PCI should be reported with a single code despite treating more than one vessel (92928).When bifurcation lesions are treated, PCI is reported for both vessels treated, use 92928 and 92929.Codes 92973 (percutaneous transluminal coronary thrombectomy, mechanical), 92974 (coronary brachytherapy), 92978 and 92979 (intravascular ultrasound/optical coherence tomography), and 93571 and 93572 (intravascular Doppler velocity and/or pressure (fractional flow reserve or coronary flow reserve) are add-on codes for reporting procedures performed in addition to coronary and bypass graft diagnostic and interventional services, unless included in the base code. Non-mechanical, aspiration thrombectomy is not reported with 92973, and is included in the PCI code for acute myocardial infarction (92941), when performed (AMA CPT 2018 Professional Edition).Angiography during the procedure, used to monitor the course of the intervention, is considered part of the PCI and is not separately billable to Medicare. Diagnostic angiography may be separately payable in situations where no previous catheter-based coronary angiography study is available, or a previous study is no longer adequate due to changes in the patients condition.The deployment of a device for distal embolic protection during an interventional procedure is considered part of the more complex procedure and is not separately billable.All interventions are within a single coronary artery. Each intervention may only be billed as a single procedure regardless of the number of lesions treated within that vessel. However, if four or more stents are placed in a single vessel, then it would be considered an "unusual procedural service" and eligible for additional reimbursement equivalent to that of an additional treated vessel.
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
Claims for PCI must include the appropriate modifiers to identify which vessel is undergoing a specific procedure. The modifiers are LD (left anterior descending coronary artery), LC (left circumflex coronary artery), RC (right coronary artery), LM (left main artery) and RI (rasmus intermedius artery).Prophylactic insertion of a temporary transvenous pacemaker, repositioning or replacement of catheters and administration of medications during the procedure are included in the procedure and are not separately billable.Intracoronary injections of drugs during diagnostic or therapeutic procedures are considered to be part of the procedure and are not separately reimbursable.Coronary thrombectomy is bundled with atherectomy on CCI (correct coding initiative) edit tables and is not separately reimbursable when performed with it.Thrombolytic infusion is bundled with stent placement on CCI tables and is not separately reimbursable when performed with intracoronary stent placement.Percutaneous vascular closure devices (PVCD) may be used to facilitate closure of an arterial puncture site after angiography, cardiac catheterization, and interventional cardiology procedures in addition to or in place of manual compression, use of a mechanical clamp or a sandbag, or a combination of these methods. These services are inherent to the invasive procedure and are not separately payable.CMS Pub 100-04Medicare Claims Processing Manual, Chapter 4  Part B Hospital (Including Inpatient Hospital Part B and OPPS), Section 61.5 - Billing for Intracoronary Stent Placement (Rev. 2611, Issued: 12-14-12, Effective: 01-01-13, Implementation, 01-07-13)
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
Since CY 2003, under the OPPS, we assign coronary stent placement procedures to separate APCs based on the use of nondrug-eluting or drug-eluting stents APC 0104 (Transcatheter Placement of Intracoronary Stents) or APC 0656 (Transcatheter Placement of Intracoronary Drug-Eluting Stents), respectively). In order to effectuate this policy, we created HCPCS G-codes G0290 (Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel) and G0291 (Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel) for drug-eluting intracoronary stent placement procedures that parallel existing CPT codes 92980 (Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel) and 92981 (Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel), which are used to describe nondrug-eluting intracoronary stent placement procedures. For CY 2012 and years prior, CPT codes 92980 and 92981 have been assigned to APC 0104, while HCPCS codes G0290 and G0291 have been assigned to APC 0656.Effective January 1, 2013, the AMAs CPT Editorial Panel is deleting CPT codes 92980 and 92981 and replacing them with the following new CPT codes:CPT code 92928 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch)
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
CPT code 92929 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure));CPT code 92933 (Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch);CPT code 92934 (Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure));CPT code 92937 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel);CPT code 92938 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure));CPT code 92941 (Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel);CPT code 92943 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel); and
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
CPT code 92944 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure)).
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
In order to maintain the existing policy of differentiating payment for intracoronary stent placement procedures involving nondrug-eluting and drug-eluting stents, we are deleting HCPCS codes G0290 and G0291 and replacing them with the following new HCPCS C-codes to parallel the new CPT codes:HCPCS code C9600 (Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch);HCPCS code C9601 (Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure));HCPCS code C9602 (Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch);HCPCS code C9603 (Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure));HCPCS code C9604 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel);HCPCS code C9605 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure));
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
HCPCS code C9606 (Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel);HCPCS code C9607 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel); andHCPCS code C9608 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure)).
Article - Billing and Coding: Percutaneous Coronary Interventions (A57479)
CPT codes 92928, 92933, 92929, 92934, 92937, 92938, 92941, 92943, and 92944 should be used to describe nondrug-eluting intracoronary stent placement procedures and are assigned to APC 0104. HCPCS codes C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, and C9608 are assigned to APC 0656.
Article - Billing and Coding: Psychiatry and Psychology Services (A57480)
CMS National Coverage PolicySocial Security Act 1861(s) Medical and Other Health Services42 CFR 410.73  410.76 describes coverage of services provided by clinical social workers, physician assistants, nurse practitioners, or clinical nurse specialists.CMS Publication 100-02:Medicare Benefit Policy Manual, Chapter 15  Covered Medical and Other Health Services:160 Clinical Psychologist Services170 Clinical Social Worker (CSW) Services180 Nurse-Midwife (CNM) Services190 Physician Assistant (PA) Services200 Nurse Practitioner (NP) Services210 Clinical Nurse Specialist (CNS) ServicesCMS Publication 100-03:Medicare National Coverage Determinations (NCD) Manual,Chapter 1  Coverage Determinations, Part 1:30.1 Biofeedback TherapyCMS Publication 100-04:Medicare Claims Processing Manual,Chapter 12  Physician/Nonphysician Practitioners:110 Physician Assistant (PA) Services Payment Methodology120 Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) Services Payment Methodology120.1 Limitations for Assistant-at-Surgery Services Furnished by Nurse Practitioners and Clinical Nurse Specialists150 Clinical Social Worker (CSW) Services160 Independent Psychologist Services170 Clinical Psychologist Services170.1 Payment210 Outpatient Mental Health Treatment LimitationArticle TextThe billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L34616 Psychiatry and Psychology Services.General CodingPsychiatry and Psychology are specialized fields for the diagnosis and treatment of various mental health disorders and/or diseases. References to providers include physicians and non-physicians, such as clinical psychologists, independent psychologists, nurse practitioners, clinical nurse specialists and physician assistances when the services performed are within the scope of their state license and clinical practice/education.Individual psychotherapy CPT codes should be used only when the focus of treatment involves individual psychotherapy. Psychiatric service CPT codes should not be used when other CPT codes such as an evaluation and management (E/M) service or pharmacological codes is more appropriate.Interactive Complexity (90785) is an add-on code specific for psychiatric services and refers to communication difficulties during the psychiatric procedure. Add-on codes may only be reported in conjunction with other codes, never alone.The specific communication difficulties are present with patients who typically:
Article - Billing and Coding: Psychiatry and Psychology Services (A57480)
Have other individuals legally responsible for their care, such as minors or adults with guardians, orRequest others to be involved in their care during the visit, such as adults accompanied by one or more participating family members or interpreter or language translator, orRequire the involvement of other third parties, such as child welfare agencies, parole or probation officers, or schools.Interactive complexity may be reported with psychiatric procedures when at least one of the following communication difficulties is present:The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.Caregiver emotions/behavior that interfere with implementation of thetreatment plan.Evidence/disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants.Use of play equipment, physical devices, interpreter, or translator to overcome significant language barriers.Do not report the CPT add-on code for Interactive Complexity code in conjunction with Psychotherapy for crisis codes or in conjunction with E/M services when no psychotherapy service is also reported.II. Service-specific Guidelines:Psychiatric Diagnostic Interview Examination (90791, 90792).A psychiatric diagnostic evaluation or a psychiatric diagnostic evaluation with medical services can be conducted once, at the onset of an illness or suspected illness. The same provider may repeat it for the same patient if an extended break in treatment occurs, if the patient requires admission to an inpatient status for a psychiatric illness, or for a significant change in mental status requiring further assessment. This contractor considers an extended break as approximately 6 months from the last time the patient was seen or treated for their psychiatric condition. A psychiatric diagnostic evaluation may also be utilized again if the patient has a previously established neurological disorder or dementia and there has been an acute and/or marked mental status change, or a second opinion or diagnostic clarification is necessary to rule out additional psychiatric or neurological processes, which may be treatable.An E/M service may be substituted for the initial interview procedure provided required elements of the E/M service billed are fulfilled. E/M services require, in addition to the interview and examination, the provision of a written opinion and/or advice. E/M CPT codes do not include a psychotherapy service.
Article - Billing and Coding: Psychiatry and Psychology Services (A57480)
CPT Codes 90832-90838 represent psychotherapy.Psychotherapy without medical evaluation and management services are reported as 90832, 90834 and 90837. Psychotherapy with medical evaluation and management services are reported with codes for E/M services plus a psychotherapy add-on code (90833; 90836; 90838). For psychotherapy sessions lasting longer than 90 minutes, reimbursement will only be made if the report is supported by the medical record documenting the face-to-face time spent with the patient and the medical necessity for the extended time.CPT Codes 90846 and 90847 represent family psychotherapy services for the treatment of mental disorders. They should not be used when the service performed is taking a family history or E/M counseling services. E/M counseling services should be coded with the appropriate E/M CPT code according to the time involved. Family counseling does not include the supervision of or therapy with professional caretakers or staff.CPT code 90853 represents group therapy. When medically indicated, the interactive complexity add-on code (+90785) may be billed in conjunction with this code.CPT Code 90839 is for psychotherapy crisis for the first 60 minutes and code 90840is for each additional 30 minutes. These codes are reported by themselves and maynot be reported with 90791, 90792, 90832-90838, 90785-90899.Medicare does not cover biofeedback for the treatment of psychosomatic disorders.III. Billing GuidelinesTo report both E/M and psychotherapy, the two services must be significant and separately identifiable.A separate diagnosis is not required for the reporting of E/M and psychotherapy on the same date of service.Site of service is not applicable to psychotherapy. Psychotherapy codes are payable in all settings.IV. Other InformationCPT codes 90885, 90887, 90889 are considered incidental services and are not separately payable.