LCD Reference Article Billing and Coding Article

Billing and Coding: Hospice - Liver Disease

A56669

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56669
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Hospice - Liver Disease
Article Type
Billing and Coding
Original Effective Date
07/11/2019
Revision Effective Date
08/01/2024
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1813(a)(4)(A)(i) addresses drugs and biologicals provided in a hospice program.

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 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 Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Hospice - Liver Disease L34544.

 

 

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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(44 Codes)
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Group 1 Codes
Code Description
C22.0 Liver cell carcinoma
C22.2 Hepatoblastoma
C22.3 Angiosarcoma of liver
C22.4 Other sarcomas of liver
C22.7 Other specified carcinomas of liver
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.30 Alcoholic cirrhosis of liver without ascites
K70.31 Alcoholic cirrhosis of liver with ascites
K70.41 Alcoholic hepatic failure with coma
K71.0 Toxic liver disease with cholestasis
K71.10 Toxic liver disease with hepatic necrosis, without coma
K71.11 Toxic liver disease with hepatic necrosis, with coma
K71.2 Toxic liver disease with acute hepatitis
K71.3 Toxic liver disease with chronic persistent hepatitis
K71.4 Toxic liver disease with chronic lobular hepatitis
K71.50 Toxic liver disease with chronic active hepatitis without ascites
K71.51 Toxic liver disease with chronic active hepatitis with ascites
K71.6 Toxic liver disease with hepatitis, not elsewhere classified
K71.7 Toxic liver disease with fibrosis and cirrhosis of liver
K71.8 Toxic liver disease with other disorders of liver
K71.9 Toxic liver disease, unspecified
K72.01 Acute and subacute hepatic failure with coma
K72.11 Chronic hepatic failure with coma
K72.91 Hepatic failure, unspecified with coma
K73.0 Chronic persistent hepatitis, not elsewhere classified
K73.1 Chronic lobular hepatitis, not elsewhere classified
K73.2 Chronic active hepatitis, not elsewhere classified
K73.8 Other chronic hepatitis, not elsewhere classified
K73.9 Chronic hepatitis, unspecified
K74.3 Primary biliary cirrhosis
K74.4 Secondary biliary cirrhosis
K74.5 Biliary cirrhosis, unspecified
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K75.2 Nonspecific reactive hepatitis
K75.3 Granulomatous hepatitis, not elsewhere classified
K75.4 Autoimmune hepatitis
K75.81 Nonalcoholic steatohepatitis (NASH)
K76.4 Peliosis hepatis
K76.7 Hepatorenal syndrome
K76.81 Hepatopulmonary syndrome
K76.82 Hepatic encephalopathy
K83.01 Primary sclerosing cholangitis
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
08/01/2024 R5

Under CMS National Coverage Policy updated section headings and added regulation: Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

10/01/2022 R4

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added K76.82. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

 

10/01/2020 R3

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted K74.0. This revision is due to the Annual ICD-10 Code Update.

10/24/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Hospice - Liver Disease L34544 LCD and placed in this article.

07/11/2019 R1

All coding located in the Coding Information section has been removed from the related Hospice - Liver Disease L34544 LCD and added to this article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
07/23/2024 08/01/2024 - N/A Currently in Effect You are here
09/01/2022 10/01/2022 - 07/31/2024 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Hospice
  • Liver Disease