DRAFT LCD Reference Article Billing and Coding Article

Billing and Coding: Lower Esophageal Magnetic Sphincter Augmentation

DA59654

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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

Draft Article Information

General Information

Source Article ID
A59654
Draft Article ID
DA59654
Original ICD-9 Article ID
Not Applicable
Draft Article Title
Billing and Coding: Lower Esophageal Magnetic Sphincter Augmentation
Article Type
Billing and Coding
Original Effective Date
N/A
Revision Effective Date
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Revision Ending Date
N/A
Retirement Date
ANTICIPATED 04/18/2025

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Lower Esophageal Magnetic Sphincter Augmentation DL39780.

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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(2 Codes)
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Group 1 Codes
Code Description
K21.00 Gastro-esophageal reflux disease with esophagitis, without bleeding
K21.9 Gastro-esophageal reflux disease without esophagitis
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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.

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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
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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
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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 Archived Date Status
02/09/2024 N/A N/A You are here

Keywords

  • lower esophageal magnetic sphincter augmentation
  • MSA
  • LINX
  • gastroesophageal reflux disease
  • GERD
  • reflux