evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
ICD-10 CM Code  Code Description  F17.210  Nicotine dependence, cigarettes, uncomplicated  F17.211  Nicotine dependence, cigarettes, in remission  F17.213  Nicotine dependence, cigarettes, with withdrawal  F17.218  Nicotine dependence, cigarettes, with other nicotine -induced disorders  F17.219  Nicotine dependence, cigarettes, with unspecified nicotine -induced disorders  F17.220  Nicotine dependence, chewing tobacco, uncomplicated  F17.221  Nicotine dependence, chewing tobacco, in remission  F17.223  Nicotine dependence, chewing tobacco, with withdrawal  F17.228  Nicotine dependence, chewing tobacco, with other nicotine -induced disorders  F17.229  Nicotine dependence, chewing tobacco, with unspecified nicotine -induced disorders  F17.290  Nicotine dependence, other tobacco product, uncomplicated  F17.291  Nicotine dependence, other tobacco product, in remission  F17.293  Nicotine dependence, other tobacco product, with withdrawal  F17.298  Nicotine dependence, other tobacco product, with other nicotine -induced disorders  F17.299  Nicotine dependence, other tobacco product, with unspecified nicotine -induced disorders  T65.211A  Toxic effect of chewing tobacco, accidental (unintentional), initial encounter  T65.212A  Toxic effect of chewing tobacco, intentional self -harm, initial encounter  T65.213A  Toxic effect of chewing tobacco, assault, initial encounter  T65.214A  Toxic effect of chewing tobacco, undetermined, initial encounter  T65.221A  Toxic effect of tobacco cigarettes, accidental (unintentional), initial encounter  T65.222A  Toxic effect of tobacco cigarettes, intentional self-harm, initial encounter  T65.223A  Toxic effect of tobacco cigarettes, assault, initial encounter  T65.224A  Toxic effect of tobacco cigarettes, undetermined, initial encounter  T65.291A  Toxic effect of other tobacco and nicotine, accidental (unintentional), initial encounter  T65.292A  Toxic effect of other tobacco and nicotine, intentional self -harm, initial encounter  T65.293A  Toxic effect of other tobacco and nicotine, assault, initial encounter  T65.294A  Toxic effect of other tobacco and nicotine, undetermined, initial encounter  Z87.891  Personal history of nicotine dependence
(Medicare Claims Processing Manual)
or without above ICD -10-CM is applicable Part A/B MACs (A), (B), or (HHH) shall use the following messages:   CARC 16  Claim/service lacks information or has submission/billing error(s).   RARC M64 -  Missing/incomplete/invalid other diagnosis   A/B MACs (A), (B), or (HHH) shall use Group Code CO, assigning financial liability to the provider, if a claim is received with no signed ABN on file.   MSN 15.4: The information provided does not support the need for this service or item.   MSN Spanish Version: La informacin proporcionada no confirma la necesidad para este servicio o artculo   When denying claims for counseling to prevent tobacco use services and smoking and tobacco- use cessation counseling services that exceed a combined total of 8 sessions within a 12- month period (99406, 99407), A/B MACs (A), (B), or (HHH) shall use the following messages:   CARC 119: Benefit maximum for this time period or occurrence has been reached.   RARC N362: The number of days or units of service exceeds our acceptable maximum.   A/B MACs (A), (B), or (HHH) shall use Group Code PR, assigning financial liability to the beneficiary, if a claim is received with a signed ABN on file.   A/B MACs (A), (B), or (HHH) shall use Group Code CO, assigning financial liability to the provider, if a claim is received with no signed ABN on file.   MSN 20.5: These services cannot be paid because your benefits are exhausted at this time.   MSN Spanish Version: Estos servicios no pueden ser pagados porque sus beneficios se han agotado.   150.4 - Common Working File (CWF)  (Rev. 11021; Issued: 10- 01-21; Effective: 10 -29-21; Implementation: 10 -29-21)
(Medicare Claims Processing Manual)
150.4 - Common Working File (CWF)  (Rev. 11021; Issued: 10- 01-21; Effective: 10 -29-21; Implementation: 10 -29-21)  The Common Working File (CWF) shall edit for the frequency of service limitations of counseling to prevent tobacco use sessions and smoking and tobacco- use cessation counseling services (99406, 99407) rendered to a beneficiary for a combined total of 8 sessions within a 12- month period. The beneficia ry may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered counseling session was performed. To start the count for  the second or subsequent 12- month period, begin with the month after the month in which the first Medicare covered counseling session was performed and count until 11 full months have elapsed.   By entering the beneficiarys health insurance claim number (HICN), providers have the capability to view the number of sessions a beneficiary has received for this service via  inquiry through CWF.   160 - Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)  (Rev. 2432, Issued: 03- 23-12, Effective: 11 -08-11, Implementation: 12- 27-11 non -shared system edits, 04-02-12 shared system edits, 07- 02-12 CWF/HICR/MCS MCDST)   For services furnished on or after November 8, 2011, the Centers for Medicare & Medicaid Services (CMS) covers intensive behavioral therapy (IBT) for cardiovascular disease (CVD).  See National Coverage Determinations (NCD) Manual (Pub. 100- 03) 210.11 for  complete coverage guidelines.   160.1 - Coding Requirements for IBT for CVD Furnished on or After November 8, 2011  (Rev. 2432, Issued: 03- 23-12, Effective: 11 -08-11, Implementation: 12- 27-11 non -shared system edits, 04-02-12 shared system edits, 07- 02-12 CWF/HICR/MCS MCDST)   The following is the applicable Healthcare Procedural Coding System (HCPCS) code for IBT for CVD:   G0446: Annual, face -to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
(Medicare Claims Processing Manual)
The following is the applicable Healthcare Procedural Coding System (HCPCS) code for IBT for CVD:   G0446: Annual, face -to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes   A/B MACs (A) and (B) shall not apply deductibles or coinsurance to claim lines containing HCPCS code G0446.  160.2 - Claims Processing Requirements for IBT for CVD Furnished on or After November 8, 2011 (Rev. 2432, Issued: 03- 23-12, Effective: 11 -08-11, Implementation: 12- 27-11 non -shared system edits, 04-02-12 shared system edits, 07- 02-12 CWF/HICR/MCS MCDST)   160.2.1 - Correct Place of Service (POS) Codes for IBT for CVD on Professional Claims  (Rev. 2432, Issued: 03- 23-12, Effective: 11 -08-11, Implementation: 12- 27-11 non -shared system edits, 04-02-12 shared system edits, 07- 02-12 CWF/HICR/MCS MCDST)   A/B MACs (B) shall pay for IBT CVD, G0446 only when services are provided at the following POS:   11- Physicians Office  22-Outpatient Hospital 49- Independent Clinic  72-Rural Health Clinic   Claims not submitted with one of the POS codes above will be denied.   The following messages shall be used when A/B MACs (B) deny professional claims for incorrect POS:   Claim Adjustment Reason Code (CARC) 58: Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.  NOTE:  Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) , if present.   Remittance Advice Remark Code (RARC) N428:  Not covered when performed in this place of service.   Medicare Summary Notice (MSN) 21.25:  This service was denied because Medicare only covers this service in certain settings.   Spanish Version:  El servicio fue denegado porque Medicare solamente lo cubre en ciertas situaciones."
(Medicare Claims Processing Manual)
Spanish Version:  El servicio fue denegado porque Medicare solamente lo cubre en ciertas situaciones."   Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.   Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.  160.2.2 - Provider Specialty Edits for IBT for CVD on Professional Claims  (Rev. 2432, Issued: 03- 23-12, Effective: 11 -08-11, Implementation: 12- 27-11 non -shared system edits, 04-02-12 shared system edits, 07- 02-12 CWF/HICR/MCS MCDST)   A/B MACs (B) shall pay claims for HCPCS code G0446 only when services are submitted by the following provider specialty types found on the providers enrollment record:   01= General Practice  08 = Family Practice  11= Internal Medicine  16 = Obstetrics/Gynecology 37= Pediatric Medicine  38 = Geriatric Medicine  42= Certified Nurse Midwife  50 = Nurse Practitioner  89 = Certified Clinical Nurse Specialist 97= Physician Assistant   A/B MACs (B) shall deny claim lines for HCPCS code G0446 performed by any other provider specialty type other than those listed above.  The following messages shall be used when A/B MACs (B) deny IBT for CVD claims billed with invalid provider specialty types:   CARC 185:  The rendering provider is not eligible to perform the service billed.  NOTE: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.    RARC N95:  This provider type/provider specialty may not bill this service.   MSN 21.18:  This item or service is not covered when performed or ordered by this provider.   Spanish version:  Este servicio no esta cubierto cuando es ordenado o rendido por este proveedor.   Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.
(Medicare Claims Processing Manual)
Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.  160.3 - Correct Types of Bill (TOB) for IBT for CVD on Institutional Claims  (Rev. 2432, Issued: 03- 23-12, Effective: 11 -08-11, Implementation: 12- 27-11 non -shared system edits, 04-02-12 shared system edits, 07- 02-12 CWF/HICR/MCS MCDST)   Effective for claims with dates of service on and after November 8, 2011, the following types of bill (TOB) may be used for IBT for CVD: 13X, 71X, 77X, or 85X.  All other TOB codes shall be denied.   The following messages shall be used when A/B MACs (A) deny claims for G0446 when submitted on a TOB other than those listed above:   CARC 170:  Payment is denied when performed/billed by this type of provider.  Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.   RARC N428:  Not covered when performed in this place of service.   MSN 21.25:  This service was denied because Medicare only covers this service in certain settings.   Spanish Version:  El servicio fue denegado porque Medicare solamente lo cubre en ciertas situaciones."   Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.   Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.  160.4 - Frequency Edits for IBT for CVD Claims  (Rev. 2432, Issued: 03- 23-12, Effective: 11 -08-11, Implementation: 12- 27-11 non -shared system edits, 04-02-12 shared system edits, 07- 02-12 CWF/HICR/MCS MCDST)   A/B MACs (A) and (B) shall allow claims for G0446 no more than once in a 12- month period.
(Medicare Claims Processing Manual)
A/B MACs (A) and (B) shall allow claims for G0446 no more than once in a 12- month period.   NOTE:  11 full months must elapse following the month in which the last G0446 IBT for CVD took place.   MACs shall deny claims IBT for CVD claims that exceed one (1) visit every 12 months.  A/B MACs (A) and (B) shall allow one professional service and one facility fee claim for each visit.   The following messages shall be used when A/B MACs (A) and (B) deny IBT for CVD claims that exceed the frequency limit:  CARC 119:  Benefit maximum for this time period or occurrence has been reached.   RARC N362:  The number of days or units of service exceeds our acceptable maximum.   MSN 20.5:  These services cannot be paid because your benefits are exhausted at this time.   Spanish Version:  Estos servicios no pueden ser pagados porque sus beneficios se han agotado.   Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.   Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.  160.5 - Common Working File (CWF) Edits for IBT for CVD Claims  (Rev. 2432, Issued: 03- 23-12, Effective: 11 -08-11, Implementation: 12- 27-11 non -shared system edits, 04-02-12 shared system edits, 07- 02-12 CWF/HICR/MCS MCDST)
(Medicare Claims Processing Manual)
When applying frequency, CWF shall count 11 full months following the month of the last IBT for CVD, G0446 before allowing subsequent payment of another G0446 screening.   When applying frequency limitations to G0446, CWF shall allow both a claim for the professional service and a claim for the facility fee.  CWF shall identify the following institutional claims as facility fee claims for screening services:  TOB 13X, TOB85X  when the revenue code is not 096X, 097X, or 098X.  CWF shall identify all other claims as professional service claims for screening services.   NOTE:  This does not apply to RHCs and FQHCs.  170 - Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs  (Rev. 2476, Issued: 05- 23-12, Effective: 11 -08-11, Implementation: 02- 27-12)  170.1 - Healthcare Common Procedure Coding System (HCPCS) Codes for Screening for STIs and HIBC to Prevent STIs  (Rev. 11759, Issued:12- 21-2022, Effective:01 -23-2023, Implementation:01- 23-2023)   Effective for claims with dates of service on and after November 8, 2011, the claims processing instructions for payment of screening tests for STI will apply to the following HCPCS/CPT codes:    Chlamydia:    86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, 87800,    0353U - effective 10/01/22 (used for combined chlamydia and gonorrhea testing)    Gonorrhea:   87590, 87591, 87850, 87800,  0353U -  effective 10/01/22 (used for combined chlamydia and gonorrhea testing)    Syphilis: 86592, 86593, 86780   Hepatitis B: (hepatitis B surface antigen): 87340, 87341  Effective for claims with dates of service on and after November 8, 2011, implemented with the January 2, 2012, IOCE, the following HCPCS code is to be billed for HIBC to prevent STIs :
(Medicare Claims Processing Manual)
Effective for claims with dates of service on and after November 8, 2011, implemented with the January 2, 2012, IOCE, the following HCPCS code is to be billed for HIBC to prevent STIs :   G0445 -  high- intensity behavioral counseling to prevent sexually transmitted infections, face -to-face, individual, includes: education, skills training, and guidance on how to change sexual behavior, performed semi -annually, 30 minutes.   170.2 - Diagnosis Code Reporting  (Rev. 11021; Issued: 10- 01-21; Effective: 10 -29-21; Implementation: 10 -29-21)  A claim that is submitted for screening chlamydia, gonorrhea, syphilis, and/or hepatitis B shall be submitted with one or more of the following diagnosis codes in the header and pointed to the line item:   a. For claims for screening for chlamydia, gonorrhea, and syphilis in women at increased risk who are not pregnant use the following ICD -10-CM diagnosis codes:     Z11.3 -  Encounter for screening for infections with a predominantly sexual mode of transmission;   And any of   o Z72.89 -  Other problems related to lifestyle, or  o Z72.51 -  High risk heterosexual behavior, or  o Z72.52 -  High risk homosexual behavior, or  o Z72.53 - High risk bisexual behavior (These diagnosis codes are used to indicate high/increased risk for STIs).   b. For claims for screening for syphilis in men at increased risk use the following ICD -10-CM diagnosis codes:    Z11.3 -  Encounter for screening for infections with a predominantly sexual mode of transmission; and   And any of   o Z72.89 -  Other problems related to lifestyle, or  o Z72.51 -  High risk heterosexual behavior, or  o Z72.52 -  High risk homosexual behavior, or  o Z72.53 - High risk bisexual behavior (These diagnosis codes are used to indicate high/increased risk for STIs).    c. For claims for screening for chlamydia and gonorrhea in pregnant women at increased risk for STIs use the following ICD -10-CM diagnosis codes, if applicable:    Z11.3 -  Encounter for screening for infections with a predominantly sexual mode of transmission; and  one of:
(Medicare Claims Processing Manual)
 Z11.3 -  Encounter for screening for infections with a predominantly sexual mode of transmission; and  one of:  o Z72.89 -  Other problems related to lifestyle, or  o Z72.51 -  High risk heterosexual behavior, or  o Z72.52 -  High risk homosexual behavior, or  o Z72.53 - High risk bisexual behavior (These diagnosis codes are used to indicate high/increased risk for STIs).   and also one of the following.  Code  Description  Z34.00  Encounter for supervision of normal first pregnancy, unspecified trimester  Z34.01  Encounter for supervision of normal first pregnancy, first trimester  Z34.02  Encounter for supervision of normal first pregnancy, second trimester  Z34.03  Encounter for supervision of normal first pregnancy, third trimester  Z34.80  Encounter for supervision of other normal pregnancy, unspecified trimester  Z34.81  Encounter for supervision of other normal pregnancy, first trimester  Z34.82  Encounter for supervision of other normal pregnancy, second trimester  Z34.83  Encounter for supervision of other normal pregnancy, third trimester  Code  Description  Z34.90  Encounter for supervision of normal pregnancy, unspecified, unspecified trimester  Z34.91  Encounter for supervision of normal pregnancy, unspecified, first trimester  Z34.92  Encounter for supervision of normal pregnancy, unspecified, second trimester  Z34.93  Encounter for supervision of normal pregnancy, unspecified, third trimester  O09.90  Supervision of high risk pregnancy, unspecified, unspecified trimester  O09.91  Supervision of high risk pregnancy, unspecified, first trimester  O09.92  Supervision of high risk pregnancy, unspecified, second trimester  O09.93  Supervision of high risk pregnancy, unspecified, third trimester     d. For claims for screening for syphilis in pregnant women use the following ICD -10-CM diagnosis codes:     Z11.3 -  Encounter for screening for infections with a predominantly sexual mode of transmission;  and one of
(Medicare Claims Processing Manual)
d. For claims for screening for syphilis in pregnant women use the following ICD -10-CM diagnosis codes:     Z11.3 -  Encounter for screening for infections with a predominantly sexual mode of transmission;  and one of   Code  Description  Z34.00  Encounter for supervision of normal first pregnancy, unspecified trimester  Z34.01  Encounter for supervision of normal first pregnancy, first trimester  Z34.02  Encounter for supervision of normal first pregnancy, second trimester  Z34.03  Encounter for supervision of normal first pregnancy, third trimester  Z34.80  Encounter for supervision of other normal pregnancy, unspecified trimester  Z34.81  Encounter for supervision of other normal pregnancy, first trimester  Z34.82  Encounter for supervision of other normal pregnancy, second trimester  Z34.83  Encounter for supervision of other normal pregnancy, third trimester  Z34.90  Encounter for supervision of normal pregnancy, unspecified, unspecified trimester  Z34.91  Encounter for supervision of normal pregnancy, unspecified, first trimester  Z34.92  Encounter for supervision of normal pregnancy, unspecified, second trimester  Z34.93  Encounter for supervision of normal pregnancy, unspecified, third trimester  O09.90  Supervision of high risk pregnancy, unspecified, unspecified trimester  O09.91  Supervision of high risk pregnancy, unspecified, first trimester  Code  Description  O09.92  Supervision of high risk pregnancy, unspecified, second trimester  O09.93  Supervision of high risk pregnancy, unspecified, third trimester   e. For claims for screening for syphilis in pregnant women at increased risk for STIs use the following ICD -10-CM diagnosis codes:    Z11.3 -  Encounter for screening for infections with a predominantly sexual mode of transmission;  and any of:   o Z72.89 -  Other problems related to lifestyle, or  o Z72.51 -  High risk heterosexual behavior, or  o Z72.52 -  High risk homosexual behavior, or  o Z72.53 - High risk bisexual behavior (These diagnosis codes are used to indicate high/increased risk for STIs).    and also one of the following:
(Medicare Claims Processing Manual)
and also one of the following:   Code  Description  Z34.00  Encounter for supervision of normal first pregnancy, unspecified trimester  Z34.01  Encounter for supervision of normal first pregnancy, first trimester  Z34.02  Encounter for supervision of normal first pregnancy, second trimester  Z34.03  Encounter for supervision of normal first pregnancy, third trimester  Z34.80  Encounter for supervision of other normal pregnancy, unspecified trimester  Z34.81  Encounter for supervision of other normal pregnancy, first trimester  Z34.82  Encounter for supervision of other normal pregnancy, second trimester  Z34.83  Encounter for supervision of other normal pregnancy, third trimester  Z34.90  Encounter for supervision of normal pregnancy, unspecified, unspecified trimester  Z34.91  Encounter for supervision of normal pregnancy, unspecified, first trimester  Z34.92  Encounter for supervision of normal pregnancy, unspecified, second trimester  Z34.93  Encounter for supervision of normal pregnancy, unspecified, third trimester  O09.90  Supervision of high risk pregnancy, unspecified, unspecified trimester  O09.91  Supervision of high risk pregnancy, unspecified, first trimester  O09.92  Supervision of high risk pregnancy, unspecified, second trimester  O09.93  Supervision of high risk pregnancy, unspecified, third trimester   f. For claims for screening for hepatitis B in pregnant women use the following ICD -10-CM diagnosis codes:     Z11.59 -  Encounter for screening for other viral diseases, and  any of   Z34.00 -  Encounter for supervision of normal first pregnancy, unspecified trimester, or   Z34.80 -  Encounter for supervision of other normal pregnancy, unspecified trimester, or   Z34.90 -  Encounter for supervision of normal pregnancy, unspecified, unspecified trimester, or   O09.90 -  Supervision of high risk pregnancy, unspecified, unspecified trimester.   g. For claims for screening for hepatitis B in pregnant women at increased risk for STIs use the following ICD-10 -CM diagnosis codes:     Z11.59 -  Encounter for screening for other viral diseases, and   Z72.89 -  Other problems related to lifestyle, and    any of  o Z72.51 -  High risk heterosexual behavior, or  o Z72.52 -  High risk homosexual behavior, or  o Z72.53 -  High risk bisexual behavior;   and also one of the following: