evekhm/cms_iom_500 huggingface dataset:
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Chapter 1 - General Billing RequirementsChapter 1 CrosswalkChapter 2 - Admission and Registration RequirementsChapter 2 CrosswalkChapter 3 - Inpatient Hospital BillingChapter 3 CrosswalkChapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS)Chapter 4 CrosswalkChapter 5 - Part B Outpatient Rehabilitation and CORF/OPT ServicesChapter 5 CrosswalkChapter 6 - Inpatient Part A Billing and SNF Consolidated BillingChapter 6 CrosswalkChapter 7 - SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule)Chapter 7 CrosswalkChapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier ClaimsChapter 8 CrosswalkChapter 9 - Rural Health Clinics/Federally Qualified Health CentersChapter 9 CrosswalkChapter 10 - Home Health Agency BillingChapter 10 CrosswalkChapter 11 - Processing Hospice ClaimsChapter 11 CrosswalkChapter 12 - Physicians/Nonphysician PractitionersChapter 12 CrosswalkChapter 13 - Radiology Services and Other Diagnostic ProceduresChapter 13 CrosswalkChapter 14 - Ambulatory Surgical CentersChapter 14 CrosswalkChapter 15 - AmbulanceChapter 15 CrosswalkChapter 16 - Laboratory ServicesChapter 16 CrosswalkChapter 17 - Drugs and BiologicalsChapter 17 CrosswalkChapter 18 - Preventive and Screening ServicesChapter 18 CrosswalkChapter 19 - Indian Health ServicesChapter 20 - Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)Chapter 20 CrosswalkChapter 21 - Medicare Summary NoticesChapter 21 - Medicare Summary Notices - English ExhibitsChapter 21 - Medicare Summary Notices - Spanish ExhibitsChapter 21 CrosswalkChapter 22 - Remittance AdviceChapter 22 CrosswalkChapter 23 - Fee Schedule Administration and Coding RequirementsChapter 23 CrosswalkChapter 24 - General EDI and EDI Support Requirements, Electronic Claims and Coordination of Benefits Requirements, Mandatory Electronic Filing of Medicare ClaimsChapter 24 CrosswalkChapter 25 - Completing and Processing the Form CMS-1450 Data SetChapter 25 CrosswalkChapter 26 - Completing and Processing Form CMS-1500 Data SetChapter 26 CrosswalkChapter 27 - Contractor Instructions for CWFChapter 28 - Coordination With Medigap, Medicaid, and Other Complementary InsurersChapter 28 CrosswalkChapter 29 - Appeals of Claims DecisionsChapter 29 CrosswalkChapter 30 - Financial Liability ProtectionsChapter 30 CrosswalkChapter 31 - ANSI X12N Formats Other Than Claims or RemittanceChapter 31 CrosswalkChapter 32 - Billing Requirements for Special ServicesChapter 33 - Miscellaneous Hold Harmless Provisions
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Chapter 29 CrosswalkChapter 30 - Financial Liability ProtectionsChapter 30 CrosswalkChapter 31 - ANSI X12N Formats Other Than Claims or RemittanceChapter 31 CrosswalkChapter 32 - Billing Requirements for Special ServicesChapter 33 - Miscellaneous Hold Harmless ProvisionsChapter 34 - Reopening and Revision of Claim Determinations and DecisionsChapter 35 - Independent Diagnostic Testing Facility (IDTF)Chapter 36 - Competitive BiddingChapter 37 - Department of Veterans Affairs (VA) Claims Adjudication Services ProjectChapter 38 - Emergency Preparedness Fee-For-Service GuidanceChapter 39  Opioid Treatment Programs (OTPs)
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Article - Billing and Coding: Endoscopic Treatment of GERD (A56395)
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 reasonable and necessary.Title XVIII of the Social Security Act, 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.Change Request 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019.IOM 100-08Medicare Program Integrity Manual, Chapter 13-Local Coverage Determinations.Article TextThe billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD L34659.Benefits are not available for endoluminal treatment for Gastroesophageal Reflux Disease (GERD) using the Stretta procedure, the Bard EndoCinch Suturing System, Plicator, or similar treatments as these procedures are not considered reasonable and necessary for the diagnosis or treatment of an injury or disease.Currently, these procedures are considered non-covered due to the fact that current peer-reviewed literature does not support the efficacy of the services. Claims will be denied as not proven effective.Coverage is appropriate for the TIF (Transoral Incisionless Fundoplication) procedure, example EsophyX, documentation must support the indications listed in L34659.Documentation RequirementsThe patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See the Coverage Indications, Limitations and/or Medical Necessity). This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures, and any other records that describe or support the evaluation and treatment of the patient. Documentation should be available to the Contractor upon request.
Article - Billing and Coding: Lumbar Spinal Fusion (A56396)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim lacking the necessary information to process that claimArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Lumbar Spinal Fusion L37848.
Article - Billing and Coding: Endovenous Stenting (A56414)
CMS National Coverage PolicySocial Security Act (Title XVIII) Standard Reference: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) L37893 Endovenous Stenting. Please refer to the LCD for reasonable and necessary requirements.Medicare reimbursement for endovenous stenting is limited to the treatment of severely symptomatic venous obstructions as outlined in the related LCD.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.Claims must be submitted with an ICD-10-CM code that represents the reason the procedure was done. The ICD-10-CM code must be billed to the highest level of specificity for that code set. The ICD-10-CM code must be linked to the appropriate procedure code.Documentation Requirements
Article - Billing and Coding: Endovenous Stenting (A56414)
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.Medical record documentation should list type and length of conservative treatment as applicable per the LCD.Pre- and post-deployment intervention images should be obtained and made available upon request. Intermediate stages pertinent to the endovascular procedure may also be documented with images. Details should include the position of the device, and when appropriate, the nature of the obstruction (if a determination can be made regarding the etiology), and effect of the device on target or nontarget vessels.Medical record documentation should list guide catheter used, as well as stent type, diameter and length.
Article - Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
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) L34914, Assays for Vitamins and Metabolic Function. 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.The following tests currently do not have specific codes assigned for the test.CPT code 84999 should be used to bill the following tests and a note should be added to identify which test was performed in the Remarks area of the claim for Part A and the Narrative area of the claim for Part B:Functional intracellular analysisTotal antioxidant functionDocumentation RequirementsAll documentation must be maintained in the patients 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.