Billing and Coding: 4Kscore Test Algorithm

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L37798, 4Kscore Test Algorithm. Please refer to the LCD for reasonable and necessary requirements. Coding Guidance Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. Documentation Requirements All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. Documentation of shared decision-making (SDM) concerning the 4Kscore testing between the ordering provider and patient must be present in the medical record, and a copy of the same shall be provided to the performing laboratory prior to the test being performed. A description of the SDM in the patient record containing the patient’s name, provider’s name, date, and legible signature of the provider responsible for providing the care to the patient is considered sufficient documentation of SDM.