DRAFT LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms

DA59827

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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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Draft Article ID
DA59827
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Draft Article Title
Billing and Coding: MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms
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Billing and Coding
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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.

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

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, §50.5 Jurisdiction of Laboratory Claims, §60.1.1 Independent Laboratory Specimen Drawing, §60.2. Travel Allowance

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §10 Reporting ICD Diagnosis and Procedure Codes

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §30 Correct Coding Policy

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms DL39919.

Tests performed by next generation sequencing (NGS) must demonstrate compliance with L38047 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies and its accompanying billing and coding article, A57837 Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies.

See also the following Relevant Articles: A57503 Billing and Coding: MolDX: Testing of Multiple Genes, A54795 Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer, and A53531 Billing and Coding: MolDX: BCR-ABL.

NOTES:

  • The performance of a multi-gene panel test by NGS or any other method (including multiplex PCR) must be billed as a panel test. Separately billing for the individual genes on a panel is not compliant with policy.
  • Testing of individual genes by a non-NGS method (i.e. single-gene PCR) in a sequential and reflexive manner is compliant with policy, if all LCD criteria are met.
    • As noted in the LCD, this approach may be followed by a NGS panel test in select circumstances according to the specific criteria outlined therein.
  • The unit of service for each of the CPT/PLA codes listed below is limited to once per lifetime for a given diagnosis. It is also not appropriate to bill the single gene tests sequentially and a non-NGS panel for the same intended use.
  • Billing for BCR-ABL testing must comply with A53531, Billing and Coding: MolDX: BCR-ABL.

To report a service for Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms, please submit the following claim information:

  • Select appropriate CPT® code
  • Enter 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 837P
    • Box 19 for paper claim
  • Enter 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 claim
    • Block 80 for the UB04 claim form
  • Select the appropriate ICD-10-CM code 

NOTE: 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.

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Coding Information

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ICD-10-CM Codes that Support Medical Necessity

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(13 Codes)
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Group 1 Codes
Code Description
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.41 Acute panmyelosis with myelofibrosis, in remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D45 Polycythemia vera
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.1 Secondary polycythemia
D75.81 Myelofibrosis
D75.838 Other thrombocytosis
D75.89 Other specified diseases of blood and blood-forming organs
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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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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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Keywords

  • Non-Next Generation Sequencing
  • BCR-ABL Negative Myeloproliferative Neoplasms