evekhm/cms_iom_500 huggingface dataset:
Article - Billing and Coding: Chiropractor Services (A57913)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1862(a)(1)(A). Allows coverage and payment for only those services that are considered to be medically reasonable and necessary.Title XVIII of the Social Security Act, 1833(e). Prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.CMS Manual System, Pub. 100-02,Medicare Benefit Policy Manual,Chapter 15, 30.5 and 240, 240.1, 240.1.1, 240.1.2, 240.1.3, 240.1.4. 240.1.5. Addresses Chiropractor's Services and Chiropractic Services - General, respectively.CMS Manual System, Pub. 100-04,Medicare Claims Processing Manual,Chapter 12, 220. Addresses Chiropractic Services.National policy limits the coverage of chiropractic services to the "hands on" manual manipulation of the spine for symptomatology associated with spinal subluxation. Accordingly, CPT code 98943, CMT, extraspinal, one or more regions, is not a Medicare benefit.Article TextAs Noridian has recently retired the Chiropractic Services LCD, this article is offered to help guide in the billing, coding and documentation of chiropractic services, as supplementary to the provisions of the Medicare Benefit Policy Manual, Chapter 15, Section 30.5, and the Medicare Claims Processing Manual, Chapter 12, Section 220.The following information must be documented in the medical record.I. History: chief complaint including the symptoms present that caused the patient to seek chiropractic treatment.II. Present Illness: This can include any of the following as appropriate: mechanism of trauma; quality and character of problem/symptoms; intensity of symptoms; frequency of symptoms occurring; location and radiation of symptoms; onset of symptoms; duration of symptoms; aggravating or relieving factors of symptoms; prior interventions, treatments, including medications; secondary complaints; and symptoms causing patient to seek treatment.III. Family History: If pertinentIV. Pertinent past health history which may include: general health statement prior illness(es) surgical history prior injuries or traumas past hospitalizations (as appropriate) medications
Article - Billing and Coding: Chiropractor Services (A57913)
III. Family History: If pertinentIV. Pertinent past health history which may include: general health statement prior illness(es) surgical history prior injuries or traumas past hospitalizations (as appropriate) medicationsV. Physical examination: Evaluation of musculoskeletal/nervous system through physical examination to identify:a. Pain/tenderness evaluated in terms of location, quality and intensity;b. Asymmetry/misalignment identified on a sectional or segmental level;c. Range of motion abnormality (changes in active, passive and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility); andd. Tissue, tone changes in the characteristics of contiguous or associated soft tissues, including skin, fascia, muscle and ligament.To demonstrate a subluxation based on physical examination, two of the four criteria mentioned under physical examination are required, one of which must be asymmetry/misalignment or range of motion abnormality.VI. Diagnosis: The primary diagnosis must be subluxation, including the level of subluxation either so stated or identified by a term descriptive of subluxation. Such terms may refer either to the condition of the spinal joint involved or to the direction of position assumed by the particular bone named.VII. Treatment Plan: The treatment plan should include the following: Therapeutic modalities to effect cure or relief (patient education and exercise training). The level of care that is recommended (the duration and frequency of visits). Specific goals that are to be achieved with treatment. Objective measures to evaluate treatment effectiveness. Date of initial treatment.VIII. Subsequent Visits:The following documentation requirements apply whether the subluxation is demonstrated by x-ray or by physical examination for subsequent visits:1. History:Review of chief complaint;Interval history, and system review if relevant.2. Physical exam:Exam of area of spine involved in diagnosis;Assessment of change in patient condition since last visit;Evaluation of treatment effectiveness.3. Documentation of treatment given on day of visit.Medical Necessity of Treatment:
Article - Billing and Coding: Chiropractor Services (A57913)
2. Physical exam:Exam of area of spine involved in diagnosis;Assessment of change in patient condition since last visit;Evaluation of treatment effectiveness.3. Documentation of treatment given on day of visit.Medical Necessity of Treatment:Failure to document that the chiropractic spinal manipulation is reasonable and necessary may result in denial of claim(s). This requirement may be fulfilled by indicating the Date of Service as a component of an ordered sequence of treatments in the treatment plan, i.e. #4 of ten planned adjustments".Reasonable and necessary requirements may be additionally fulfilled by a comparative assessment of clinical treatment goals, compared to the assessment at the initial visit, and at the conclusion of a course of treatment.The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary.
Article - Billing and Coding: Chiropractor Services (A57914)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1862(a)(1)(A). Allows coverage and payment for only those services that are considered to be medically reasonable and necessary.Title XVIII of the Social Security Act, 1833(e). Prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.CMS Manual System, Pub. 100-02,Medicare Benefit Policy Manual,Chapter 15, 30.5 and 240, 240.1, 240.1.1, 240.1.2, 240.1.3, 240.1.4. 240.1.5. Addresses Chiropractor's Services and Chiropractic Services - General, respectively.CMS Manual System, Pub. 100-04,Medicare Claims Processing Manual,Chapter 12, 220. Addresses Chiropractic Services.National policy limits the coverage of chiropractic services to the "hands on" manual manipulation of the spine for symptomatology associated with spinal subluxation. Accordingly, CPT code 98943, CMT, extraspinal, one or more regions, is not a Medicare benefit.Article TextAs Noridian has recently retired the Chiropractic Services LCD, this article is offered to help guide in the billing, coding and documentation of chiropractic services, as supplementary to the provisions of the Medicare Benefit Policy Manual, Chapter 15, Section 30.5, and the Medicare Claims Processing Manual, Chapter 12, Section 220.The following information must be documented in the medical record.I. History: chief complaint including the symptoms present that caused the patient to seek chiropractic treatment.II. Present Illness: This can include any of the following as appropriate: mechanism of trauma; quality and character of problem/symptoms; intensity of symptoms; frequency of symptoms occurring; location and radiation of symptoms; onset of symptoms; duration of symptoms; aggravating or relieving factors of symptoms; prior interventions, treatments, including medications; secondary complaints; and symptoms causing patient to seek treatment.III. Family History: If pertinentIV. Pertinent past health history which may include: general health statement prior illness(es) surgical history prior injuries or traumas past hospitalizations (as appropriate) medications
Article - Billing and Coding: Chiropractor Services (A57914)
III. Family History: If pertinentIV. Pertinent past health history which may include: general health statement prior illness(es) surgical history prior injuries or traumas past hospitalizations (as appropriate) medicationsV. Physical examination: Evaluation of musculoskeletal/nervous system through physical examination to identify:a. Pain/tenderness evaluated in terms of location, quality and intensity;b. Asymmetry/misalignment identified on a sectional or segmental level;c. Range of motion abnormality (changes in active, passive and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility); andd. Tissue, tone changes in the characteristics of contiguous or associated soft tissues, including skin, fascia, muscle and ligament.To demonstrate a subluxation based on physical examination, two of the four criteria mentioned under physical examination are required, one of which must be asymmetry/misalignment or range of motion abnormality.VI. Diagnosis: The primary diagnosis must be subluxation, including the level of subluxation either so stated or identified by a term descriptive of subluxation. Such terms may refer either to the condition of the spinal joint involved or to the direction of position assumed by the particular bone named.VII. Treatment Plan: The treatment plan should include the following: Therapeutic modalities to effect cure or relief (patient education and exercise training). The level of care that is recommended (the duration and frequency of visits). Specific goals that are to be achieved with treatment. Objective measures to evaluate treatment effectiveness. Date of initial treatment.VIII. Subsequent Visits:The following documentation requirements apply whether the subluxation is demonstrated by x-ray or by physical examination for subsequent visits:1. History:Review of chief complaint;Interval history, and system review if relevant.2. Physical exam:Exam of area of spine involved in diagnosis;Assessment of change in patient condition since last visit;Evaluation of treatment effectiveness.3. Documentation of treatment given on day of visit.Medical Necessity of Treatment:
Article - Billing and Coding: Chiropractor Services (A57914)
2. Physical exam:Exam of area of spine involved in diagnosis;Assessment of change in patient condition since last visit;Evaluation of treatment effectiveness.3. Documentation of treatment given on day of visit.Medical Necessity of Treatment:Failure to document that the chiropractic spinal manipulation is reasonable and necessary may result in denial of claim(s). This requirement may be fulfilled by indicating the Date of Service as a component of an ordered sequence of treatments in the treatment plan, i.e. #4 of ten planned adjustments".Reasonable and necessary requirements may be additionally fulfilled by a comparative assessment of clinical treatment goals, compared to the assessment at the initial visit, and at the conclusion of a course of treatment.The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary.
Article - Billing and Coding: MolDX: Pigmented Lesion Assay (A57915)
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 Manuals, Publication 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.2 Independent Laboratory Specimen Drawing, 60.2. Travel Allowance.CMS Internet Online Manual Pub. 100-04, Medicare Claims Processing Manual, Chapter 23 Section 10 Reporting ICD Diagnosis and Procedure Codes.CMS Internet-Only Manuals, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.1.2 A/B MAC (B) Contacts With Independent Clinical Laboratories.Article TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Pigmented Lesion Assay L38111.To report a 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: MolDX: Plasma-Based Genomic Profiling in Solid Tumors (A57917)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS Internet-Only Manual, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.1.2 A/B MAC (B) Contracts With Independent Clinical Laboratories.CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 23, 10 Reporting ICD Diagnosis and Procedure CodesArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Plasma-Based Genomic Profiling in Solid Tumors L38065.To report a Plasma-Based Genomic Profiling in Solid Tumors service, please submit the following claim information:Select the appropriate CPTcodeEnter 1 unit of service (UOS)Enter the appropriate DEX Z-Code identifier adjacent to the CPTcode 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 CPTcode 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 codeNOTE: When entering the DEX Z- Code on the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line.
Article - Billing and Coding: Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH) (A57926)
CMS National Coverage PolicyN/AArticle TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD)L38378-Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH).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.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: MolDX: Plasma-Based Genomic Profiling in Solid Tumors (A57936)
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, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15,  80.1.2 A/B MAC (B) Contracts With Independent Clinical Laboratories.CMS Internet Online Manual Pub. 100-04 Medicare Claims Processing Manual, Chapter 23 Section 10 "Reporting ICD Diagnosis and Procedure Codes".Article TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Plasma-Based Genomic Profiling in Solid Tumors L36168.To report a Plasma-Based Genomic Profiling in Solid Tumors 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 codeNOTE:When entering the DEX Z-Code on the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line.
Article - Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A57944)
CMS National Coverage PolicyN/AArticle TextRefer to the Proposed Local Coverage Determination (LCD) DL38528, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, 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 for correct coding guidelines and specific applicable code combinations prior to billing Medicare.CodingGuidelinesImplantationof a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA CPT code:CPT code 64582- Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode arrayRevision or replacementof HSN for treatment of OSA is reported with:CPT code 64583- Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generatorReduced services-Use modifier 52 for revision or replacement of either the hypoglossal nerve stimulator electrode array or distal respiratory sensor, and bill at a reduced rate.Removalof HSN for treatment of OSA is reported with:CPT code 64584- Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode arrayReduced services- Use modifier 52 for removal of one or two components of the hypoglossal nerve stimulator electrode array, pulse generator, or distal respiratory sensor, and bill at a reduced rate.Coding GuidanceDo not bill CPT code64582in conjunction with64583, 64584, or 61888Do not bill CPT code64583in conjunction with64582, 64584, or 61888Do not bill CPT code64584in conjunction with64582, 64583, or 61888Documentation Requirements
Article - Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A57944)
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 diagnosis code(s).
Article - Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (A57948)
CMS National Coverage PolicyN/AArticle TextRefer to the Local Coverage Determination (LCD) L38310, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, 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 for correct coding guidelines and specific applicable code combinations prior to billing Medicare.Coding GuidelinesImplantationof a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA CPT code:CPT code 64582- Open implantation of hypoglossal nerve neurostimulator array, pulse generator and distal respiratory sensor electrode or electrode array.Revision or replacementof HSN for treatment of OSA is reported with:CPT code 64583-Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator.Reduced Services -Use modifier 52 for revision or replacement of either the hypoglossal nerve stimulator electrode array or distal respiratory sensor, and bill at a reduced rate.Removalof HSN for treatment of OSA is reported with:CPT code 64584-Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array.Reduced Services -Use modifier 52 for removal of one or two components of the hypoglossal nerve stimulator electrode array, pulse generator, or distal respiratory sensor, and bill at a reduced rateCoding GuidanceDo notbill CPT code64582in conjunction with64583 or 64584Do notbill CPT code64583in conjunction with64582 or 64584Do notbill CPT code64584in conjunction with64582 or 64583Documentation Requirements
Article - Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (A57948)
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 diagnosis code(s).