RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Infrared Coagulation (IRC) of Hemorrhoids

A54038

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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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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A54038
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Infrared Coagulation (IRC) of Hemorrhoids
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
07/06/2023
Revision Ending Date
03/01/2024
Retirement Date
03/01/2024

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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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.

Title 42 CFR §419 Prospective Payment System for Hospital Outpatient Department Services

Title 42 CFR §419.22 Hospital services excluded from payment under the hospital outpatient prospective payment system

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 9, §100 Frequency of Billing and Same Day Billing

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §260.5.3 Rebundling of CPT Codes

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Infrared Coagulation (IRC) of Hemorrhoids L34422.

Payment for Infrared Coagulation of Hemorrhoids (IRC) will only be allowed once per beneficiary per global period (90 days), regardless of how many IRC treatment sessions occur or how many providers render the treatment within the same global period. If, during the initial treatment episode (defined as the 90-day global period commencing with the initial IRC treatment) the IRC treatment has not satisfactorily resolved symptoms, then another method of treatment should be considered. Payment for such alternative hemorrhoid treatments will not be made more than once per beneficiary during any treatment episode in addition to the payment for the initial IRC treatment. (For subsequent treatment, please see the next paragraph.)

If the hemorrhoids recur subsequent to the initial treatment episode, payment is subject to the same restrictions noted above.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is a statutory exclusion, has no Medicare benefit category or is rendered for screening purposes.

Response To Comments

Number Comment Response
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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

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(3 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
K64.0 First degree hemorrhoids
K64.1 Second degree hemorrhoids
K64.2 Third degree hemorrhoids
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 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

Group 1

Group 1 Paragraph

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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
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
03/01/2024 R6

This article is being retired because it is not up to date with 21st Century Cures requirements and no claims have been received for these services.

07/06/2023 R5

Under CMS National Coverage Policy added the following regulation: CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15 §260.5.3 Rebundling of CPT Codes. Formatting errors were corrected throughout the article.

10/17/2019 R4

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 Infrared Coagulation (IRC) of Hemorrhoids L34422 LCD and placed in this article.

05/30/2019 R3

Under Article Title changed the title to Billing and Coding: Infrared Coagulation (IRC) of Hemorrhoids. Under Article Text added the paragraphs “The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Infrared Coagulation (IRC) of Hemorrhoids L34422.” and “Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is a statutory exclusion, has no Medicare benefit category or is rendered for screening purposes.” All coding located in the Coding Information section has been removed from the related Infrared Coagulation (IRC) of Hemorrhoids L34422 LCD and added to this article. Under CPT/HCPCS Codes Group 1: Paragraph added the statement “For CPT® code 46930-Destruction of internal hemorrhoid(s) by thermal energy (e.g., infrared coagulation, cautery, radio-frequency), only one unit of service should be submitted no matter how many sites are treated per session.”

01/29/2018 R2 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
03/16/2017 R1 Revisions made to verbiage under Article Text to read, “Payment for Infrared Coagulation of Hemorrhoids (IRC) will only be allowed once per beneficiary per global period (90 days), regardless of how many IRC treatment sessions occur or how many providers render the treatment within the same global period. If, during the initial treatment episode (defined as the 90-day global period commencing with the initial IRC treatment) the IRC treatment has not satisfactorily resolved symptoms, then another method of treatment should be considered. Payment for such alternative hemorrhoid treatments will not be made more than once per beneficiary during any treatment episode in addition to the payment for the initial IRC treatment. (For subsequent treatment, please see the next paragraph.)

If the hemorrhoids recur subsequent to the initial treatment episode, payment is subject to the same restrictions noted above.”
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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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Other URLs
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Public Versions
Updated On Effective Dates Status
03/01/2024 07/06/2023 - 03/01/2024 Retired You are here
06/30/2023 07/06/2023 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Hemorrhoids
  • IRC