Showing posts with label Medical billing update. Show all posts
Showing posts with label Medical billing update. Show all posts

Saturday, August 18, 2012

E” Code is Reported as the First Diagnosis and Procedure 88305 - correct way

procedure code description 

88305 Tissue exam by pathologist - $76


procedure  code 88305 describes level IV surgical pathology, gross and microscopic examination. When the operating provider or pathologist examines multiple, separate tissue samples on the same date of service for the same patient, the procedure code is reported using either multiple units or line items and may include any appropriate modifier(s). When the tissue samples are for prostate tissue, HCPCS lists procedure codes G0416-G0419 for 10 or more specimens in various increments for prostate needle biopsy. Therefore, the Health Plan will apply a frequency limit of nine units per date of service for procedure  code 88305 when reported with a prostate diagnosis. When procedure  code 88305 is reported in excess of nine units on the same date of service with a prostate diagnosis, the code will not be eligible for reimbursement.


Proper billing of procedure code 88305

Providers are incorrectly coding claims when billing for multiple specimens of procedure code 88305. Multiple specimens for the same date of service, billed on the same claim, should be submitted on one detail line by adjusting the “number billed field” (Units) to reflect the number of specimens. Billing these services on separate details is inappropriate.

Handling Form CMS-1500 Claims Where an ICD-9-CM “E” Code is Reported as  the First Diagnosis on the Claim

Provider Action Needed

This Change Request (CR) 7700 provides new instructions to return as unprocessable claims  submitted on the Form CMS-1500 where an ICD-9-CM "E" Code (external causes of injury  and poisoning) is reported as the first/principal diagnosis on the claim.

CR7700 will bring the policy for handling form CMS-1500 claims into alignment with the policy  for handling claims initially submitted in electronic format. The ICD-9-CM code set prohibits an  E” code from being reported as principal diagnosis (first-listed) on a claim. This guidance also  applies to V00-Y99 (external causes of morbidity) equivalent ICD-10 CM diagnosis codes. 

Therefore, if an “E” code or V00-Y99 range ICD-10 CM diagnosis code is the first listed  diagnosis code on the CMS-1500, the claim would not conform to the ICD-9-CM code set and electronic transmission of the electronic claim to a Coordination of Benefits Agreement  (COBA) trading partner would not be Health Insurance Portability and  Accountability Act (HIPAA) compliant.  

Claims initially submitted as electronic claims will, effective April 1, 2012, be rejected in  accordance with an edit established by CMS CR7596 when the principal (first) diagnosis code  presented in the diagnosis code field is an “E” code or, effective with the implementation of  ICD-10, when the principal (first) diagnosis is a code within the code range V00-Y99 of the  ICD-10- CM code set. This procedure will prevent those non-HIPAA compliant claims from  being adjudicated and then transmitted to the Coordination of Benefits Contractor (COBC) for  COBA crossover purposes. CR7700 applies this reasoning to claims submitted on CMS-1500  on or after January 1, 2013.

Be aware of the following:

• For claims received via form CMS-1500 on or after April January 1, 2013, Medicare  contractors will return as unprocessable claims for items or services where a  diagnosis code is required and the diagnosis code reported in the Number 1 field of  Item 21 of the Form CMS-1500 is an ICD-9-CM “E” code (external causes of injury  and poisoning) or, upon ICD-10 implementation, an ICD-10 CM code within the code  range of V00-Y99

• Reprocessed/adjustment claims failing these edits will be denied.

• Claims returned or denied as a result of these edits will show remittance advice  remarks code message MA63 (Missing/incomplete/invalid principal diagnosis) and  claim adjustment reason code 16 (Claim/service lacks information which is needed  for adjudication).

Billing Guide

Anthem Central Region bundles 88302, 88304, 88305, 88307 and 88309 as redundant/mutually exclusive with 88321, 88323 and 88325. Based on the Correct Coding Edits for Comprehensive Code 80000-89999; codes 88302, 88304, 88305, 88307 and 88309 are listed as component codes to codes 88321,88323, 88325. Based on procedure  Assistant article:

“Also included in codes 88311 through 88365 are three codes for consultation and report on material referred from another source (i.e., referred from another pathologist or facility). These codes are appropriate for use in reporting consultation provided to another pathologist in a different practice site or facility or in reporting consultations to another physician in the same facility/site on material referred from an outside source (e.g., review of slides from another restitution  prior to surgery or therapy at your facility 

• Code 88321 is used to report a consultation on a referred slide(s) from a specimen

• Code 88323 is used to report a consultation on a specimen when the consultant prepares a slide(s) for routine histologic staining 

• Code 88325 is used for a more comprehensive consultation on referred material that involves review of records and specimens


Therefore, when a pathologist is reviewing a specimen they are providing either the initial surgical pathology or acting as a consultant at the request of someone else. They cannot perform both services on the same specimen on the same date of service. If 88302, 883204, 88305, 88307 or 88309 is submitted with 88321, 88323 or 88325—only the consultation (88321, 88323 or 88325) reimburses.


The Identified Coding Problems 

During an audit of the procedure  codes associated with MMS across several states in a region, Medicare Recovery Auditors found instances in which the preparation and/or interpretation of the slides of tissue removed during the procedures was performed by someone other than the surgeon (or his/ her employee). Examples of findings from this audit follow:

• Example 1: A physician billed procedure  Code 17311 (Mohs Micrographic Surgery), while on the same date of service procedure  Code 88305 (Surgical Pathology, gross and microscopic examination) for the preparation and interpretation of the slides taken during the procedure, was separately billed for a specimen examination by a different practitioner without a modifier.procedure  Code 17311 was, therefore, an overpaid claim.


• Example 2: A physician billed procedure  Code 17313 (Mohs Micrographic Surgery) while on the same date of service procedure  Code 88305 (Surgical Pathology, gross and microscopic examination) for the preparation and interpretation of the slides during the procedure was separately billed for a specimen examination by a different practitioner without a modifier. procedure  Code 17313 was, therefore an overpaid claim.

Thursday, January 19, 2012

V code list - DX 2012 revised one

FY 2012 New Diagnosis Codes


Diagnosis Code   Description
649.82 Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39
completed weeks gestation, with delivery by (planned) cesarean section, delivered, with mention of postpartum complication
704.41 Pilar cyst
704.42 Trichilemmal cyst
726.13*  Partial tear of rotator cuff
747.31 Pulmonary artery coarctation and atresia
747.32 Pulmonary arteriovenous malformation
747.39 Other anomalies of pulmonary artery and pulmonary circulation
793.11*  Solitary pulmonary nodule
793.19*   Other nonspecific abnormal finding of lung field
795.51*    Nonspecific reaction to tuberculin skin test without active tuberculosis
795.52*    Nonspecific reaction to cell mediated immunity measurement of gamma interferon
antigen response without active tuberculosis
808.44 Multiple closed pelvic fractures without disruption of pelvic circle
808.54 Multiple open pelvic fractures without disruption of pelvic circle
996.88 Complications of transplanted organ, stem cell
997.32 Postprocedural aspiration pneumonia
997.41 Retained cholelithiasis following cholecystectomy
997.49 Other digestive system complications
998.00*  Postoperative shock, unspecified
998.01*   Postoperative shock, cardiogenic
998.02*   Postoperative shock, septic
998.09*   Postoperative shock, other
999.32*   Bloodstream infection due to central venous catheter
999.33*   Local infection due to central venous catheter
999.34*   Acute infection following transfusion, infusion, or injection of blood and blood products
999.41 Anaphylactic reaction due to administration of blood and blood products
999.42 Anaphylactic reaction due to vaccination
999.49 Anaphylactic reaction due to other serum
999.51 Other serum reaction due to administration of blood and blood products
999.52 Other serum reaction due to vaccination
999.59 Other serum reaction
V12.21 Personal history of gestational diabetes
V12.29 Personal history of other endocrine, metabolic, and immunity disorders
V12.55 Personal history of pulmonary embolism
V13.81 Personal history of anaphylaxis
V13.89 Personal history of other specified diseases
V19.11 Family history of glaucoma
V19.19 Family history of other specified eye disorder
V23.42 Pregnancy with history of ectopic pregnancy
V23.87 Pregnancy with inconclusive fetal viability
V40.31* Wandering in diseases classified elsewhere
V40.39* Other specified behavioral problem
V54.82 Aftercare following explantation of joint prosthesis
V58.68* Long term (current) use of bisphosphonates
V87.02 Contact with and (suspected) exposure to uranium
V88.21 Acquired absence of hip joint
V88.22 Acquired absence of knee joint
V88.29 Acquired absence of other joint

Sunday, January 15, 2012

Dx code list - FY 2012 New Diagnosis Codes



Diagnosis Code    Description
488.89*   Influenza due to identified novel influenza A virus with other manifestations
508.2*   Respiratory conditions due to smoke inhalation
512.2*    Postoperative air leak
512.81*  Primary spontaneous pneumothorax
512.82*  Secondary spontaneous pneumothorax
512.83*  Chronic pneumothorax
512.84*  Other air leak
512.89*  Other pneumothorax
516.30 Idiopathic interstitial pneumonia, not otherwise specified
516.31 Idiopathic pulmonary fibrosis
516.32 Idiopathic non-specific interstitial pneumonitis
516.33*  Acute interstitial pneumonitis
516.34 Respiratory bronchiolitis interstitial lung disease
516.35 Idiopathic lymphoid interstitial pneumonia
516.36 Cryptogenic organizing pneumonia
516.37 Desquamative interstitial pneumonia
516.4 Lymphangioleiomyomatosis
516.5 Adult pulmonary Langerhans cell histiocytosis
516.61 Neuroendocrine cell hyperplasia of infancy
516.62 Pulmonary interstitial glycogenosis
516.63 Surfactant mutations of the lung
516.64 Alveolar capillary dysplasia with vein misalignment
516.69 Other interstitial lung diseases of childhood
518.51*  Acute respiratory failure following trauma and surgery
518.52*  Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery
518.53*  Acute and chronic respiratory failure following trauma and surgery
539.01 Infection due to gastric band procedure
539.09 Other complications of gastric band procedure
539.81 Infection due to other bariatric procedure
539.89 Other complications of other bariatric procedure
573.5*  Hepatopulmonary syndrome
596.81 Infection of cystostomy
596.82 Mechanical complication of cystostomy
596.83 Other complication of cystostomy
596.89 Other specified disorders of bladder
629.31 Erosion of implanted vaginal mesh and other prosthetic materials to surrounding organ or tissue
629.32 Exposure of implanted vaginal mesh and other prosthetic materials into vagina
631.0 Inappropriate change in quantitative human chorionic gonadotropin (hCG) in early pregnancy
631.8 Other abnormal products of conception
649.81 Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section, delivered, with or without mention of antepartum condition

Wednesday, January 11, 2012

List 2 - 2012 Revised DX CODE

FY 2012 New Diagnosis Codes

Diagnosis Code    Description
41.41 Shiga toxin-producing Escherichia coli [E. coli] (STEC) O157
41.42 Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC)
41.43 Shiga toxin-producing Escherichia coli [E. coli] (STEC), unspecified
41.49 Other and unspecified Escherichia coli [E. coli]
173.00 Unspecified malignant neoplasm of skin of lip
173.01 Basal cell carcinoma of skin of lip
173.02 Squamous cell carcinoma of skin of lip
173.09 Other specified malignant neoplasm of skin of lip
173.10 Unspecified malignant neoplasm of eyelid, including canthus
173.11 Basal cell carcinoma of eyelid, including canthus
173.12 Squamous cell carcinoma of eyelid, including canthus
173.19 Other specified malignant neoplasm of eyelid, including canthus
173.20 Unspecified malignant neoplasm of skin of ear and external auditory canal
173.21 Basal cell carcinoma of skin of ear and external auditory canal
173.22 Squamous cell carcinoma of skin of ear and external auditory canal
173.29 Other specified malignant neoplasm of skin of ear and external auditory canal
173.30 Unspecified malignant neoplasm of skin of other and unspecified parts of face
173.31 Basal cell carcinoma of skin of other and unspecified parts of face
173.32 Squamous cell carcinoma of skin of other and unspecified parts of face
173.39 Other specified malignant neoplasm of skin of other and unspecified parts of face
173.40 Unspecified malignant neoplasm of scalp and skin of neck
173.41 Basal cell carcinoma of scalp and skin of neck
173.42 Squamous cell carcinoma of scalp and skin of neck
173.49 Other specified malignant neoplasm of scalp and skin of neck
173.50 Unspecified malignant neoplasm of skin of trunk, except scrotum
173.51 Basal cell carcinoma of skin of trunk, except scrotum
173.52 Squamous cell carcinoma of skin of trunk, except scrotum
173.59 Other specified malignant neoplasm of skin of trunk, except scrotum
173.60 Unspecified malignant neoplasm of skin of upper limb, including shoulder
173.61 Basal cell carcinoma of skin of upper limb, including shoulder
173.62 Squamous cell carcinoma of skin of upper limb, including shoulder
173.69 Other specified malignant neoplasm of skin of upper limb, including shoulder
173.70 Unspecified malignant neoplasm of skin of lower limb, including hip
173.71 Basal cell carcinoma of skin of lower limb, including hip
173.72 Squamous cell carcinoma of skin of lower limb, including hip
173.79 Other specified malignant neoplasm of skin of lower limb, including hip
173.80 Unspecified malignant neoplasm of other specified sites of skin
173.81 Basal cell carcinoma of other specified sites of skin
173.82 Squamous cell carcinoma of other specified sites of skin
173.89 Other specified malignant neoplasm of other specified sites of skin

Sunday, January 8, 2012

FY 2012 Revised Diagnosis Codes - List 2



Diagnosis Code   Description
317*  Mild intellectual disabilities
318.0*  Moderate intellectual disabilities
318.1*  Severe intellectual disabilities
318.2*  Profound intellectual disabilities
319*     Unspecified intellectual disabilities
323.41 Other encephalitis and encephalomyelitis due to other infections classified elsewhere
323.42 Other myelitis due to other infections classified elsewhere
346.01 Migraine with aura, with intractable migraine, so stated, without mention of status migrainosus
346.11 Migraine without aura, with intractable migraine, so stated, without mention of status migrainosus
346.21 Variants of migraine, not elsewhere classified, with intractable migraine, so stated, without mention of status migrainosus
346.31 Hemiplegic migraine, with intractable migraine, so stated, without mention of status migrainosus
346.41 Menstrual migraine, with intractable migraine, so stated, without mention of status migrainosus
346.51 Persistent migraine aura without cerebral infarction, with intractable migraine, so stated, without mention of status migrainosus
346.61 Persistent migraine aura with cerebral infarction, with intractable migraine, so stated, without mention of status migrainosus
346.71 Chronic migraine without aura, with intractable migraine, so stated, without mention of status migrainosus
346.81 Other forms of migraine, with intractable migraine, so stated, without mention of status migrainosus
346.91 Migraine, unspecified, with intractable migraine, so stated, without mention of status migrainosus
365.01 Open angle with borderline findings, low risk
488.11* Influenza due to identified 2009 H1N1 influenza virus with pneumonia
488.12* Influenza due to identified 2009 H1N1 influenza virus with other respiratory manifestations
488.19* Influenza due to identified 2009 H1N1 influenza virus with other manifestations
646.70 Liver and biliary tract disorders in pregnancy, unspecified as to episode of care or not applicable
646.71 Liver and biliary tract disorders in pregnancy, delivered, with or without mention of antepartum condition
646.73 Liver and biliary tract disorders in pregnancy, antepartum condition or complication
808.43 Multiple closed pelvic fractures with disruption of pelvic circle
808.53 Multiple open pelvic fractures with disruption of pelvic circle
968.5 Surface (topical) and infiltration anesthetics
995.0 Other anaphylactic reaction
995.60 Anaphylactic reaction due to unspecified food
995.61 Anaphylactic reaction due to peanuts
995.62 Anaphylactic reaction due to crustaceans
995.63 Anaphylactic reaction due to fruits and vegetables
995.64 Anaphylactic reaction due to tree nuts and seeds
995.65 Anaphylactic reaction due to fish
995.66 Anaphylactic reaction due to food additives
995.67 Anaphylactic reaction due to milk products
995.68 Anaphylactic reaction due to eggs
995.69 Anaphylactic reaction due to other specified food
999.31* Other and unspecified infection due to central venous catheter
V18.4* Family history of intellectual disabilities
V79.2* Special screening for intellectual disabilities

Friday, January 6, 2012

VITAMIN B-12 CHEMISTRY TEST - CPT CODE: 82607

CPT CODE: 82607 - (cyanocobalamin) Chemistry test - quantitative analysis of serum vitamin B12 levels.

COVERED DIAGNOSIS:

123.4 Diphyllobothriasis, intestinal, fish tapeworm infection

151.0-151.9 Malignant neoplasm of stomach

238.7 Myelodysplastic syndrome

266.2 Other B-complex deficiencies

269.9 Unspecified nutritional deficiency

281.0-281.1 Pernicious anemia; other vitamin B12 deficiency anemia

281.3 Other specified megaloblastic anemias not elsewhere classified

281.9 Unspecified deficiency anemia

288.0 Agranulocytosis

289.8 Macrocytosis

290.0-290.9 Senile and pre-senile organic psychotic conditions

294.10-294.11 Dementia in conditions classified elsewhere

294.8-294.9 Other specified and unspecified organic brain syndromes (chronic)

310.1 Organic personality syndrome

333.99 Restless legs

336.2 Subacute combined degeneration of spinal cord

356.4-356.9 Idiopathic progressive, peripheral neuropathy, specified,unspecified

357.4 Polyneuropathy in other diseases classified elsewhere

529.0 Glossitis

529.6 Glossodynia (painful tongue)

535.10-535.11 Atrophic gastritis

555.0-555.9 Regional enteritis

564.2 Post-gastric surgery syndromes

577.1 Chronic pancreatitis

579.0-579.9 Intestinal malabsorption

751.1 Atresia and stenosis of small intestine

780.71-780.79 Chronic fatique syndrome; other malaise and fatigue

781.1 Disturbance of sensation of smell and taste

781.2 Abnormal gait

781.3 Lack of coordination

782.0 Disturbance of skin sensation

E934.1 Adverse effect of antianemic agents

V44.2 Ileostomy

V44.4 Other artificial opening of gastrointestinal tract

V45.3 Intestinal bypass or anastomosis status

V45.75 Acquired absence, stomach

V45.89 Other post-surgical status

V58.83 Encounter for therapeutic drug monitoring

Thursday, December 29, 2011

FLUORIDE VARNISH CPT D1206 AND VALID DX

CPT CODE:

D1206 Topical fluoride varnish; therapeutic application for moderate to high caries risk patients



CRITERIA:

• Patient must be – age 6 months to 21 years

• Recommend the fluoride varnish be applied at the time of a well child visit /

Health Tracks screening

• Allow a maximum of two (2) applications per year, per patient

• Only the following professionals may perform the procedure after receiving appropriate board approved training

a. Physicians

b. Nurse Practitioners

c. Physician Assistants

d. Registered Nurses and Licensed Practical Nurses under the direct supervision of a physician (claim must be submitted with under the physician’s PIN)

e. Registered Dental Hygienist or Registered Dental Assistant under the direct or general supervision of a licensed dentist.

NOTE: This service is currently covered when rendered by a dentist.



COVERED DIAGNOSIS:

V07.31 Prophylactic fluoride administration

►This guideline supersedes previous Fluoride Varnish guideline(s).

Saturday, December 24, 2011

EKG CPT 93000, 93010, 93005 - covered ICDs

EKG - ECG CPT codes and related ICDs


CPT CODES:

93000 Electrocardiogram, routine ECG with at least 12 leads: with interpretation and report

93005 tracing only, without interpretation and report

93010 interpretation and report only


Fee schedule Of EKG Codes

Its varies insurance to insurance however the below table would give you the basic idea of reimbursement.

Payment for ECG or EKG cpt codes 93000, 93010



Billing and Coding Guidelines

BCBSNC will reimburse for interpretation of the ECG once, except under unusual consultative circumstances. The interpretation or the fee for the interpretation should be submitted based on place of service where the ECG was performed.

BCBSNC reimbursement for the professional component (CPT 93010) is for "interpretation and report" of an ECG procedure, not "review" of the procedure. A review of the findings of these procedures, without a written report, does not meet the conditions for separate payment of the service since the review is already included in the emergency room visit payment.

“Global only” codes represent a routine ECG with at least 12 leads and include the physician’s interpretation and report. Other CPT codes are established to specify the “technical” component, (the ECG tracing only), and the “professional” component (for interpretation and report only). It is not appropriate to use modifiers -26 or –TC with these latter codes. ..

Anthem Central Region bundles 93000, 93010, 93018, 93040, 93042 and 0180T as redundant/mutually exclusive to 99281-99285. Anthem considers interpretations of tests to be a component of performing the evaluation and management service. An ECG is performed while the patient is in the emergency department. The emergency physician performing his evaluation and management service interprets this ECG and makes a decision as to the type of treatment that is required for this patient. This interpretation is a component or part of the decision making portion of the evaluation and management services

BCBS Guidelines
In the Pathologist section added code 85060 to the list of codes eligible for clinical interpretation. Changed the wording from “Pathology interpretation of all other codes in the 80002-87999 range is considered an integral service.” to “Pathology interpretation of all other codes in the 80002-87999 range is considered an integral to the laboratory test.” Changed the words “mutually exclusive” to “incidental” in the Cardiac Stress Test section.

Removed code 93000 and 93040 because the incidental logic no longer applies to 99291 and 99292 in the Critical Care section. Code 93798 removed from the Electrocardiograms section. Removed code 82800, 82805, 82810, 93000, 93040 and 94640 because the incidental logic no longer applies to codes 99296, 99294, 99295, 99296 and 99298 in the Neonatal Intensive Care Services. Changed the word from “incidental” to “mutually exclusive” in the Transvaginal Ultrasound section. Removed the Maldistribution of Inspired Gas, Chlamydia Testing by Direct or Amplified Probe Technique, Fluoroscopic Guidance and Voiding Pressure Studies section. Removed any deleted codes. Policy reviewed 10/26/07 by Senior Medical Director of Provider Partnerships, Medical and Reimbursement Policy.




Electrical Stimulation Electrodes

The supply of electrodes is considered incidental to electrical stimulation. Separate reimbursement for incidental supplies is not allowed.

Electrocardiograms Electrocardiograms (ECG) (e.g., CPT codes 93000, 93005, 93010) will not be separately reimbursed when submitted with a cardiac stress test (CPT code 93015), a cardiac test that includes an ECG as part of the test, or with initial hospital care. A three-lead ECG is considered incidental to a 12-lead ECG. Separate reimbursement for ECGs that are considered incidental is not allowed. An ECG is considered mutually exclusive to physician services for cardiac rehabilitation (CPT code 93797). Separate reimbursement for ECGs that are considered mutually exclusive is not allowed.

Separate reimbursement for the interpretation of an ECG report (CPT code 93010) will be allowed once for the report officially attached to the EKG. Separate reimbursement is not allowed for 93010 when submitted with the following services: emergency room E/M (CPT codes 99281-99285); or critical care E/M (CPT codes 99291-99292). Interpretation of the ECG report by the attending physician is considered part of the E/M visit. Fetal Non-Stress Test 59025

Effective October 17, 2011, we will consider more than one fetal non-stress test performed on the same date of service when the test is being performed on more than one fetus in a multiple gestation situation. The diagnosis on the claim must reflect the multiple gestation. See the list of eligible diagnoses below: 651.00 651.03 651.10 651.13 651.20 651.23 651.30 651.33 651.40 651.43 651.50 651.53 651.60 651.63 651.80 651.83 651.90 651.93


Categories of CV Codes


• Cardiography (CPT 93000 – 93042)
– Electrocardiogram (EKG)
– Cardiovascular Stress Tests (Treadmills)

• Cardiovascular Monitoring Services (93224 – 93278)

• Implantable & Wearable Cardiac Device Evaluations (CPT 93279 – 93299)
– Attended Surveillance
– Devices
• Pacemaker

– Single Lead
– Dual Lead
– Multiple Lead

• Implantable CV Monitor (ICM)
• Implantable Cardioverter-defibrillator (ICD)
• Implantable Loop Recorder (ILR)

• Echocardiography (93303 – 93464)

– Complete (initial )Studies
– Follow-Up or Limited Studies
– TEE (Transesophageal)
– Doppler – sometimes reported in addition
– Color Flow Mapping – sometimes reported in addition

• Cardiac Catheterization (CPT 93451 – 93581)


Electrical Stimulation Electrodes

The supply of electrodes is considered incidental to electrical stimulation. Separate reimbursement for incidental supplies is not allowed.

Electrocardiograms Electrocardiograms (ECG) (e.g., CPT codes 93000, 93005, 93010) will not be separately reimbursed when submitted with a cardiac stress test (CPT code 93015), a cardiac test that includes an ECG as part of the test, or with initial hospital care. A three-lead ECG is considered incidental to a 12-lead ECG. Separate reimbursement for ECGs that are considered incidental is not allowed. An ECG is considered mutually exclusive to physician services for cardiac rehabilitation (CPT code 93797). Separate reimbursement for ECGs that are considered mutually exclusive is not allowed.

Separate reimbursement for the interpretation of an ECG report (CPT code 93010) will be allowed once for the report officially attached to the EKG. Separate reimbursement is not allowed for 93010 when submitted with the following services: emergency room E/M (CPT codes 99281-99285); or critical care E/M (CPT codes 99291-99292). Interpretation of the ECG report by the attending physician is considered part of the E/M visit. Fetal Non-Stress Test 59025

Effective October 17, 2011, we will consider more than one fetal non-stress test performed on the same date of service when the test is being performed on more than one fetus in a multiple gestation situation. The diagnosis on the claim must reflect the multiple gestation. See the list of eligible diagnoses below: 651.00 651.03 651.10 651.13 651.20 651.23 651.30 651.33 651.40 651.43 651.50 651.53 651.60 651.63 651.80 651.83 651.90 651.93


20 Professional Component (PC)/Technical Component (TC) Indicator payment guidelines

0 = Physician service codes: This indicator identifies codes that describe physician services. Examples include visits, consultations, and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 & TC cannot be used with these codes. The total Relative Value Units (RVUs) include values for physician work, practice expense and malpractice expense. There are some codes with no work RVUs.

1 = Diagnostic tests or radiology services: This indicator identifies codes that describe diagnostic tests, e.g., pulmonary function tests, or therapeutic radiology procedures, e.g., radiation therapy. These codes generally have both a professional and technical component. Modifiers 26 and TC can be used with these codes. The total RVUs for codes reported with a 26 modifier include values for physician work, practice expense, and malpractice expense. The total RVUs for codes reported with a TC modifier include values for practice expense and malpractice expense only. The total RVUs for codes reported without a modifier equals the sum of RVUs for both the professional and technical component.

2 = Professional component only codes: This indicator identifies stand alone codes that describe the physician work portion of selected diagnostic tests for which there is an associated code that describes the technical component of the diagnostic test only and another associated code that describes the global test. An example of a professional component only code is 93010, Electrocardiogram; interpretation and report. Modifiers 26 and TC cannot be used with these codes. The total RVUs for professional component only codes include values for physician work, practice expense, and malpractice expense.

3 = Technical component only codes: This indicator identifies stand alone codes that describe the technical component (i.e., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the professional component of the diagnostic tests only.

An example of a technical component code is 93005,  Electrocardiogram, tracing only, without interpretation and report. It also identifies codes that are covered only as diagnostic tests and therefore do not have a related professional code. Modifiers 26 and TC cannot be used with these codes. The total RVUs for technical component only codes include values for practice expense and malpractice expense only.

4 = Global test only codes: This indicator identifies stand alone  codes for which there are associated codes that describe: a) the professional component of the test only and b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes. The total RVUs for global procedure only codes include values for physician work, practice expense, and malpractice expense. The total RVUs for global procedure only codes equals the sum of the total RVUs for the professional and technical components only codes combined.



EKG (ECG) Interpretation

For EKGs, the interpretation must include appropriate comments on any three of the following six elements: (1) the rhythm or rate (2) axis, (3) intervals, (4) segments, (5) notation of a comparison with a prior EKG if one was available to the physician, and (6) summary of clinical condition.

An EKG with interpretation must have the full graphic tracings with formal written or printed interpretation on file for review. The interpretation should appear on the designated sections of a page formatted EKG or written in the clinical records. Interpretations should include appropriate comments on rhythm, axis intervals, acute or chronic changes and a comparison with the most recent tracing. While every single parameter is not required for each tracing, the appropriate measurements must be mentioned if the purpose of repeated EKGs is to monitor the effects of a given parameter (e.g., the QT interval).

Example:

* EKG reveals normal sinus rhythm, no axis deviation, no acute changes.
* EKG reveals atrial fibrillation, rapid ventricular response, non-specific ST-T wave changes.
* EKG reveals normal sinus rhythm, normal axis, T-wave inversion in V3 and V4 and Twave flattening and high laterally. No EKG was available for comparison. Common Question Regarding Electrocardiogram (EKG) and Computer Generated Reports

Question:

The EKG equipment we use not only provides the strip showing the rhythm, but also generates a report on the findings. Can I bill for the interpretation (whether as a global service or the professional component only) for this computer-generated report?

Answer:

A provider may use the computer-generated report as the basis of his/her interpretation and report of the test. However, a provider may only submit a claim for the professional component of this service when the situation meets certain qualifications.

1) There must be a notation of the physician's opinion of the computer decision - whether he/she agrees or disagrees.
2) If the physician disagrees with the computer decision or has additional information to supply, he/she must notate the disagreement or additional information. He/she can mark out or cross through the part he/she disagrees with, indicating the correct information. A common error seen in the computer-generated decision is that it indicates "RBBB" but the rhythm is actually a completely paced rhythm. Medicare would expect to see something similar to "Disagree with RBBB. Completely paced rhythm with ventricular rate of 72; agree with rest."
3) The physician must sign his or her notation.


COVERED DIAGNOSIS:

002.0 Typhoid fever

005.1 Botulism

017.90-017.96 Tuberculosis of specified organs

018.00-018.96 Miliary tuberculosis

020.2 Septicemic plaque

022.3 Anthrax septicemia

032.82 Diptheritic myocarditis

036.2 Meningococcemia

036.40-036.43 Meningococcal carditis

038.0-038.9 Septicemia

040.0 Gas gangrene

042 Human immunodeficiency virus (HIV) disease

054.5 Herpetic septicemia

074.1 Epidemic pleurodynia

074.20-074.23 Coxsackie carditis

086.0 Chagas’ disease with heart involvement

088.81 Lyme disease

093.0-093.9 Cardiovascular syphilis

098.83-098.85 Gonococcal heart disease

112.5 Disseminated candidiasis

112.81 Candidial endocarditis

115.03-115.04 Infection by histoplasma capsulatum

115.13-115.14 Infection by histoplasma duboisii

115.93-115.94 Histoplasmosis, unspecified

124 Trichinosis

130.3 Myocarditis due to toxoplasmosis

130.8 Multisystemic disseminated toxoplasmosis

135 Sarcoidosis

163.0-163.9 Malignant neoplasm of pleura

164.0-164.9 Malignant neoplasm of thymus, heart, and mediastinum

165.0-165.9 Malignant neoplasm of other and ill-defined sites within the respiratory system and intrathoracic organs

212.4-212.7 Benign neoplasm of respiratory and intrathoracic organs

242.00-242.91 Thyrotoxiosis with or without goiter

243 Congential hypothyroidism

244.0-244.9 Acquired hypothroidism

245.0-245.9 Thyroiditis

252.0-252.9 Disorders of parathroid gland

255.0-255.9 Disorders of adrenal glands

265.0-265.2 Thiamine and niacin deficiency states

270.0 Disturbances of amino-acid transport

272.0-272.9 Disorders of lipoid metabolism

274.82 Gouty tophi of other sites

275.2-275.3 Disorders of mineral metabolism; magnesium/phosphorus

275.40-275.49 Disorders of calcium metabolism

276.0-276.9 Disorders of fluid, electrolyte, and acid-base balance

277.3 Amyloidosis

277.5 Mucopolysaccharidosis

282.60-282.69 Sickle-cell anemia

305.50-305.53 Opioid abuse

305.60-305.63 Cocaine abuse

305.70-305.73 Amphetamine or related acting sympathomimetic

306.2 Physiological malfunction arising from mental factors; cardiovascular

337.0 Idiopathic peripheral autonomic neuropathy

357.6 Polyneuropathy due to drugs

362.30-362.37 Retinal vascular occlusion

390 Rheumatic fever without mention of heart involvement

391.0-391.9 Rheumatic fever with heart involvement

392.0-392.9 Rheumatic chorea

393 Chronic rheumatic pericarditis

394.0-394.9 Diseases of mitral valve

395.0-395.9 Diseases of aortic valve

396.0-396.9 Diseases of mitral and aortic valves

397.0-397.9 Diseases of other endocardial structures

398.0-398.99 Other rheumatic heart disease

401.0-401.9 Essential hypertension

402.00-402.91 Hypertensive heart disease

403.00-403.91 Hypertensive renal disease

404.00-404.93 Hypertensive heart and renal disease

405.01-405.99 Secondary hypertension

410.00-410.92 Acute myocardial infarction

411.0-411.89 Other acute and subacute forms of ischemic heart disease

412 Old myocardial infarction

413.0-413.9 Angina pectoris

414.00-414.9 Other forms of chronic ischemic heart disease

415.0-415.19 Acute pulmonary heart disease

416.0-416.9 Chronic pulmonary circulation

420.0-420.99 Acute pericarditis

421.0-421.9 Acute and subacute endocarditis

422.0-422.99 Acute myocarditis

423.0-423.9 Other diseases of pericardium

424.0-424.99 Other diseases of endocardium

425.0-425.9 Cardiomyopathy

426.0-426.9 Conduction disorders

427.0-427.9 Cardiac dysrhythmias

428.0-428.9 Heart failure

429.0-429.9 Ill-defined descriptions and complications of heart disease

430 Subarachnoid hemorrhage

431 Intra-cerebral hemorrhage

432.0-432.9 Other and unspecified intra-cranial hemorrhage

433.00-433.91 Occlusion and stenosis of precerebral arteries, with or without cerebral infarction

434.00-434.01 Occlusion of cerebral arteries: cerebral thrombosis

434.10-434.11 Occlusion of cerebral arteries: cerebral embolism

434.90-434.91 Occlusion of cerebral arteries: cerebral artery occlusion unspecified

435.0-435.9 Transient cerebral ischemia

435 Acute, but ill-defined cerebrovascular disease

437.0-437.9 Other and ill-defined cerebrovascular disease

440.9 Generalized and unspecified atherosclerosis

441.00-441.9 Aortic aneurysm and dissection

442.89 Of other specified artery: other

443.0-443.9 Other peripheral vascular disease

444.0-444.9 Arterial embolism and thrombosis

446.0-446.7 Polyarteritis nodosa and allied conditions

458.0-458.9 Hypotension

491.20-491.21 Obstructive chronic bronchitis: with or without mention of acute exacerbation

492.0-492.8 Emphysema

493.00-493.92 Asthma

496 Chronic airway obstruction; not elsewhere classified

506.1 Acute pulmonary edema due to fumes and vapors

511.0-511.9 Pleurisy

514 Pulmonary congestion and hypostasis

518.2 Compensatory emphysema

518.4 Acute edema of lung, unspecified

518.5 Pulmonary insufficiency following trauma and surgery

518.81-518.84 Acute respiratory failure

519.3 Other diseases of mediastinum, not elsewhere classified

530.0-530.5 Diseases of esophagus

530.81 Esophageal reflux

552.3 Diaphragmatic hernia with obstruction

575.0 Acute cholecystitis

575.10-575.12 Other cholecystitis

580.0-580.4 Acute glomerulonephritis

585 Chronic renal failure

511.71 Mastodynia

634.50-634.62 Spontaneous abortion

635.50-635.62 Legally induced abortion

636.50-636.62 Illegally induced abortion

637.50-637.62 Unspecified abortion

638.5-638.6 Failed attempt4ed abortion

639.5-639.8 Complications following abortion and ectopic and molar pregnancies

642.00-642.94 Hypertension complicating pregnancy, childbirth, and puerperium

648.50-648.54 Other current conditions in the mother classifiable elsewhere, but complication pregnancy, childbirth, or the puerperium: congenital cardiovascular disorders

668.00-668.04 Complications of the administration of anesthetic or other sedation in labor and delivery; pulmonary complications

668.10-668.14 Complication of the administration of anesthetic or other sedation in labor and delivery; cardiac complications

669.10-669.14 Other complications of labor and delivery, not elsewhere classified; shock during or following and delivery

669.20-669.24 Other complications of labor and delivery, not elsewhere classified; maternal hypotension syndrome

669.40-669.44 Other complications of labor and delivery, not elsewhere classified; other complication of obstetrical surgery and procedures

673.00-673.84 Obstetrical pulmonary embolism

674.80 Other and unspecified complications of the puerperium, unspecified as to episode of care or not applicable

674.84 Other and unspecified complications of the puerperium, postpartum condition of complication

710.0 Systemic lupus erythematosus

714.0-714.9 Rheumatoid arthritis and other inflammatory polyarthropathies

719.41 Pain in joint

724.1 Pain in thoracic spine

729.5 Pain in limb

729.81-729.89 Other musculoskeletal symptoms referable to limbs

733.6 Tietz’s disease

738.3 Acquired deformity of chest and rib

745.0-745.9 Bulbus cordis anomalies and anomalies of cardiac septal closure

746.00-746.9 Other congenital anomalies of heart

747.00-747.49 Other congenital anomalies of circulatory system

754.81-754.82 Other specified nonteratogenic anomalies

780.01-780.09 Alteration of consciousness

780.1 Hallucination

780.2 Syncope and collapse

780.31-780.39 Convulsions

780.4 Dizziness and giddiness

780.50-780.59 Sleep disturbances

780.71-780.79 Malaise and fatique

782.0 Disturbance of skin sensation

782.3 Edema

782.5 Cyanosis

782.61-782.62 Pallor and flushing

784.1 Throat pain

785.0-785.9 Symptoms involving cardiovascular system

786.00-786.09 Dyspnea and respiratory abnormalities

786.5-786.59 Chest pain

787.01-787.03 Nausea and vomiting

787.1 Heartburn

789.00-789.09 Abdominal pain

789.1 Hepatomegaly

790.4 Nonspecific elevation of levels of transaminase of lactic acid dehydrogenase (LDH)

793.1-793.2 Nonspecific abnormal findings on radiological and other examination by body structure

794.30-794.39 Nonspecific abnormal results of function studies; cardiovascular

799.1 Respiratory arrest

807.0-807.09 Fracture of rib(s), closed

807.10-807.19 Fracture of rib(s), open

807.2-807.4 Fracture of rib(s) and sternum

860.0-860.5 Traumatic pneumothorax and hemothorax

861.00-861.32 Injury to heart and lung

862.0 Injury to diaphragm without mention of open would into cavity

862.21-862.39 Injury to other and unspecified intrathoracic organs

862.8-862.9 Injury to multiple and unspecified intrathoracic organs

875.0-875.1 Open wound of chest (wall)

901.0-901.89 Injury to blood vessels of thorax

922.1 Contusion of chest wall

926.8-926.9 Crushing injury of multiple sites of trunk or unspecified site

958.0-958.1 Certain early complications of trauma; air or fat embolism

958.4 Traumatic shock

959.1 Injury, other and unspecified; trunk

963.1 Poisoning by antineoplastic and immunosuppressive drugs

972.0-972.9 Poisoning by agents primarily affecting the cardiovascular system

986 Toxic effect of carbon monoxide

989.3 Toxic effect of organophosphate and carbamate

989.4 Toxic effect of other pesticides, not elsewhere classified

991.6 Hypothermia

992.0 Heat stroke and sunstroke

992.1 Heat syncope

992.3 Heat exhaustion, anhydrotic

993.2 Other and unspecified effects of high altitude

993.3 Caisson disease

993.4 Effects of air pressure caused by explosion

994.0 Effects of lightning

994.1 Drowning and nonfatal submersion

994.4 Exhaustion due to exposure

994.5 Exhaustion due to excessive exertion

994.7 Asphyxiation and strangulation

994.8 Electrocution and nonfatal effects of electrical current

995.0 Other anaphylactic shock

995.4 Shock due to anesthesia

995.60-995.69 Anaphylactic shock due to adverse food reaction

995.89 Other specified adverse effects, not elsewhere classified; other

996.00-996.09 Mechanical complication of cardiac device implant, and graft

996.61 Infection and inflammatory reaction due to cardiac device, implant, and graft

996.71-996.72 Other complications of internal (biological) (synthetic) prosthetic device, implant, and graft

996.83-996.84 Complications of transplanted heart and lung

997.1 Cardiac complications

997.4 Digestive system complications

998.0 Postoperative shock

999.1 Complications of medical care, not elsewhere classified; air embolism

999.4 Complications of medical care, not elsewhere classified; anaphylactic shock due to serum

999.5 Complications of medical care, not elsewhere classified; other serum reaction

999.9 Other and unspecified complications of medical care; not elsewhere classified

V15.1 Other personal history presenting hazards to health; surgery to heart and great vessels

V42.1-V42.2 Organ or tissue replaced by transplant

V43.2-V43.4 Organ or tissue replaced by other means

V45.00-V45.09 Cardiac device in situ

V45.81-V45.82 Other post-surgical status

V47.2 Other cardiorespiratory problems; cardiovascular exercise intolerance with pain (with); at rest, less than ordinary activity, ordinary activity

V53.31-V53.39 Fitting or adjustment of other cardiac device

V58.69 Long-term (current) use of other medications

V67.51 Following completed treatment with high-risk medications, not elsewhere classified

E925.0-E925.9 Accident caused by electric current

Sunday, December 18, 2011

Non covered CPT for assistant surgeon

Examples of HCPCS procedure codes that are "Nevers" for assistant surgeon

The below table identified procedure codes that are not eligible for reimbursement when reported by an Assistant Surgeon.

C9724 G0105 G0247 G0341 S0601 S2080 S2202 S2267 S2344
C9725 G0121 G0259 G0364 S0630 S2112 S2230 S2270 S2348
C9726 G0127 G0269 G0392 S0800 S2120 S2235 S2300 S9090
C9727 G0166 G0289 G0393 S0810 S2140 S2260 S2340
C9728 G0168 G0290 P9615 S0812 S2142 S2265 S2341
G0104 G0186 G0291 S0390 S2070 S2150 S2266 S2342

Thursday, December 15, 2011

Screening Pap Test - g0270,g0271, g0123, g0124, g0141 - Medicare non covered

Non covered CPT - Screening Pap Test

Service CPT/ HCPCS Code Long Descriptor USPSTF Rating¹ CY 2011
Coins. / Deductible
G0270 Medical nutrition therapy;
reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including
additional hours needed for renal disease), individual, face to face with the
patient, each 15 minutes
B WAIVED
G0271 Medical nutrition therapy,
reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including
additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
WAIVED
Screening
Pap Test
G0123 Screening cytopathology,
cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
A WAIVED
G0124 Screening cytopathology,
cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring
interpretation by physician
WAIVED
G0141 Screening cytopathology
smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
WAIVED

Wednesday, November 23, 2011

HIPAA 4010 deadline date.

HIPAA 4010 Cutoff Date Coming Soon

All HIPAA-covered entities must be fully compliant with 5010 on January 1, 2012. Medicare, Wisconsin Physicians Service Insurance Corp. (WPS), TriWest Healthcare Alliance, and TRICARE® are in compliance with HIPAA 5010. If you fail to prepare, it will be your business and cash flow that will be affected. If you rely on a vendor or clearinghouse to maintain your billing system, ask them about their plans for transitioning to the new 5010 format.

The HIPAA 4010 format cutoff date is December 30, 2011, 4:30 p.m. CST. Any 4010 files received after this time will be rejected.

If you currently receive your 835 Electronic Remittance Advice (ERA) in the X12 835 format, and have not converted to the 5010 format, these files will automatically be converted to the 835 5010A1 format on January 1, 2012. 

Friday, October 21, 2011

Flu shot update from Tricare - CPT Q2035,Q2036,Q2038 & 90655, 90656,90660

2011-2012 Billing for Flu Shots

Upon direction from TRICARE Management Activity (TMA), TriWest Healthcare Alliance (TriWest) will be following the latest Centers for Medicare & Medicaid Services' billing guidelines for the 2011-2012 flu season. The change is retroactive to January 1, 2011.

The following Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are recommended for billing. There is currently CHAMPUS Maximum Allowable Charge (CMAC) pricing for these codes:
  • 90655 - Influenza virus vaccine, split virus, preservative free, when administered to children 6-o35 mnths of age for intramuscular use 
  • 90656 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older for intramuscular use 
  • 90657 - Influenza virus vaccine, split virus, when administered to children 6-35 months of age for intramuscular use 
  • 90660 - Influenza virus vaccine, live, for intranasal use 
  • Q2035 - Influenza virus, spit virus, when administered to individuals 3 years of age and older for intramuscular use (Afluria) 
  • Q2036 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older for intramuscular use (Fluaval) 
  • Q2038 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older for intramuscular use (Fluzone)
CPT code 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older for intramuscular use) is currently not priced by TRICARE®. If this code is used for billing, the claim must be billed with the National Drug Code (NDC) number and it will be reimbursed at the NDC rate. If there is no NDC on the claim, it will be denied. If the 90658 is denied and an Q-code is appropriate, a corrected claim can be submitted.
Note: 90662 - Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content for intramuscular use is on the No Government Pay Procedure Code List and is not reimbursable. 

Friday, July 9, 2010

Newly added modifiers and CPTs

HCPCS 2010 Additions

Codes/Modifiers  Short Description

AI Principal physician of rec
J4 DMEPOS comp bid furn by hosp
PA Surgery, wrong body part
PB Surgery, wrong patient
PC Wrong surgery on patient
PI PET tumor init tx strat
PS PET tumor subsq tx strategy
V5 Vascular catheter
V6 Arteriovenous graft
V7 Arteriovenous fistula
V8 Infection present
V9 No infection present
A4264 Intratubal occlusion device
A4336 Urethral insert
A4360 Disposable ext urethral dev
A4456 Adhesive remover, wipes
A4466 Elastic garment/covering
A9581 Gadoxetate disodium inj
A9582 Iodine I-123 iobenguane
A9583 Gadofosveset trisodium inj
A9604 Sm 153 lexidronam
C9250 Artiss fibrin sealant
C9254 Injection, lacosamide
C9255 Paliperidone palmitate inj
C9256 Dexamethasone intravitreal
C9257 Bevacizumab injection
C9360 SurgiMend, neonatal
C9361 NeuroMend nerve wrap
C9362 Implnt,bon void filler-strip
C9363 Integra Meshed Bil Wound Mat
C9364 Porcine implant, Permacol
E0433 Portable liquid oxygen sys
E1036 Patient transfer system >300
G0420 Ed svc CKD ind per session
G0421 Ed svc CKD grp per session
G0422 Intens cardiac rehab w/exerc
G0423 Intens cardiac rehab no exer
G0424 Pulmonary rehab w exer
G0425 Inpt telehealth consult 30m
G0426 Inpt telehealth consult 50m
G0427 Inpt telehealth con 70/>m
G0430 Drug screen multi class
G0431 Drug screen single class
G8545 HepC measures grp
G8546 CAP measures grp
G8547 IVD measures grp
G8548 HF measures grp
G8549 HepC MG qual act perform
G8550 CAP MG qual act perform
G8551 HF MG qual act perform
G8552 IVD MG qual act perform
G8553 1 Rx via qualified eRx sys
G8556 Ref to doc otolog eval
G8557 Pt inelig ref otolog eval
G8558 No ref to doc otolog eval
G8559 Pt ref doc oto eval
G8560 Pt hx act drain prev 90 days
G8561 Pt inelig for ref oto eval
G8562 Pt no hx act drain 90 d
G8563 Pt no ref oto reas no spec
G8564 Pt ref oto eval
G8565 Ver doc hear loss
G8566 Pt inelig ref oto eval
G8567 Pt no doc hear loss
G8568 Pt no ref otolo no spec
G8569 Prol intubation req
G8570 No prol intub req
G8571 Ster wd ifx 30 d postop
G8572 No ster wd ifx
G8573 Stk/CVA CABG
G8574 No strk/CVA CABG
G8575 Postop ren insuf
G8576 No postop ren insuf
G8577 Reop req bld grft oth
G8578 No reop req bld grft oth
G8579 Antplt med disch
G8580 Antplt med contraind
G8581 no antplt med disch
G8582 Bblock disch
G8583 Bblock contraind
G8584 No bblock disch
G8585 Antilipid treat disch
G8586 Antlip disch contra
G8587 No antlipid treat disch
G8588 Sys BP <140
G8589 Sys BP >= 140
G8590 Dia BP < 90
G8591 Dia BP >= 90
G8592 No BP measure
G8593 Lipid pn results
G8594 No lipid prof perf
G8595 Ldl < 100
G8596 No LDL perf
G8597 Ldl >= 100
G8598 Asp therp used
G8599 No asp therp used
G8600 tPA initi w/in 3 hrs
G8601 No elig tPA init w/in 3 hrs
G8602 No tPA init w/in 3 hrs
G8603 Spok lang comp score
G8604 No high score spok lang
G8605 No spok lang comp score
G8606 Attention score
G8607 No high score attention
G8608 No attention score
G8609 Memory score
G8610 No high score memory
G8611 No memory score
G8612 Moto speech score
G8613 No high score moto speech
G8614 No moto speech score
G8615 Reading score
G8616 No high score reading
G8617 No reading score
G8618 Spok lang exp score
G8619 No high score spok lang exp
G8620 No spok lang exp score
G8621 Writing score
G8622 No high score writing
G8623 No writing score
G8624 Swallowing score
G8625 No high score swallowing
G8626 No swallowing score
G8627 Surg proc w/in 30 days
G8628 No surg proc w/in 30 days
G9141 Influenza A H1N1,admin w cou
G9142 Influenza A H1N1, vaccine
G9143 Warfarin respon genetic test
J0461 Atropine sulfate injection
J0559 PenG benzathine/procaine inj
J0586 AbobotulinumtoxinA
J0598 C1 esterase inhibitor inj
J0718 Certolizumab pegol inj
J0833 Cosyntropin injection NOS
J0834 Cosyntropin cortrosyn inj
J1680 Human fibrinogen conc inj
J2562 Plerixafor injection
J2793 Rilonacept injection
J2796 Romiplostim injection
J7185 Xyntha inj
J7325 Synvisc or Synvisc-One
J9155 Degarelix injection
J9171 Docetaxel injection
J9328 Temozolomide injection
K0739 Repair/svc DME non-oxygen eq
K0740 Repair/svc oxygen equipment
L2861 Torsion mechanism knee/ankle
L3891 Torsion mechanism wrist/elbo
L5973 Ank-foot sys dors-plant flex
L8031 Breast prosthesis w adhesive
L8032 Reusable nipple prosthesis
L8627 CID ext speech process repl
L8628 CID ext controller repl
L8629 CID transmit coil and cable
L8692 Non-osseointegrated snd proc
Q0138 Ferumoxytol, non-esrd
Q0139 Ferumoxytol, esrd use
Q0506 Lith-ion batt elec/pneum VAD
Q4074 Iloprost non-comp unit dose
Q4115 Alloskin skin sub
Q4116 Alloderm skin sub
Q9968 Visualization adjunct
S0280 Medical home, initial plan
S0281 Medical home, maintenance
S3713 KRAS mutation analysis
S3865 Comp genet test hyp cardiomy
S3866 Spec gene test hyp cardiomy
S3870 CGH test developmental delay
14301 Skin tissue rearrangement
14302 Skin tissue rearrange add-on
21011 Exc face les sc < 2 cm
21012 Exc face les sc = 2 cm
21013 Exc face tum deep < 2 cm
21014 Exc face tum deep = 2 cm
21016 Resect face tum = 2 cm
21552 Exc neck les sc = 3 cm
21554 Exc neck tum deep = 5 cm
21558 Resect neck tum = 5 cm
21931 Exc back les sc = 3 cm
21932 Exc back tum deep < 5 cm
21933 Exc back tum deep = 5 cm
21936 Resect back tum = 5 cm
22901 Exc back tum deep = 5 cm
22902 Exc abd les sc < 3 cm
22903 Exc abd les sc > 3 cm
22904 Resect abd tum < 5 cm
22905 Resect abd tum > 5 cm
23071 Exc shoulder les sc > 3 cm
23073 Exc shoulder tum deep > 5 cm
23078 Resect shoulder tum > 5 cm
24071 Exc arm/elbow les sc = 3 cm
24073 Ex arm/elbow tum deep > 5 cm
24079 Resect arm/elbow tum > 5 cm
25071 Exc forearm les sc > 3 cm
25073 Exc forearm tum deep = 3 cm
25078 Resect forearm/wrist tum=3cm
26111 Exc hand les sc > 1.5 cm
26113 Exc hand tum deep > 1.5 cm
26118 Exc hand tum ra > 3 cm
27043 Exc hip pelvis les sc > 3 cm
27045 Exc hip/pelv tum deep > 5 cm
27059 Resect hip/pelv tum > 5 cm
27337 Exc thigh/knee les sc > 3 cm
27339 Exc thigh/knee tum deep >5cm
27364 Resect thigh/knee tum >5 cm
27616 Resect leg/ankle tum > 5 cm
27632 Exc leg/ankle les sc > 3 cm
27634 Exc leg/ankle tum deep >5 cm
28039 Exc foot/toe tum sc > 1.5 cm
28041 Exc foot/toe tum deep >1.5cm
28047 Resect foot/toe tumor > 3 cm
29581 Apply multlay comprs lwr leg
31626 Bronchoscopy w/markers
31627 Navigational bronchoscopy
32552 Remove lung catheter
32553 Ins mark thor for rt perq
32561 Lyse chest fibrin init day
32562 Lyse chest fibrin subq day
33782 Nikaidoh proc
33783 Nikaidoh proc w/ostia implt
33981 Replace vad pump ext
33982 Replace vad intra w/o bp
33983 Replace vad intra w/bp
36147 Access av dial grft for eval
36148 Access av dial grft for proc
37761 Ligate leg veins open
43281 Lap paraesophag hern repair
43282 Lap paraesoph her rpr w/mesh
43775 Lap sleeve gastrectomy

45171 Exc rect tum transanal part
45172 Exc rect tum transanal full
46707 Repair anorectal fist w/plug
49411 Ins mark abd/pel for rt perq
51727 Cystometrogram w/up
51728 Cystometrogram w/vp
51729 Cystometrogram w/vp&up
53855 Insert prost urethral stent
57426 Revise prosth vag graft lap
63661 Remove spine eltrd perq aray
63662 Remove spine eltrd plate
63663 Revise spine eltrd perq aray
63664 Revise spine eltrd plate
64490 Inj paravert f jnt c/t 1 lev
64491 Inj paravert f jnt c/t 2 lev
64492 Inj paravert f jnt c/t 3 lev
64493 Inj paravert f jnt l/s 1 lev
64494 Inj paravert f jnt l/s 2 lev
64495 Inj paravert f jnt l/s 3 lev
74261 Ct colonography, w/o dye
74262 Ct colonography, w/dye
74263 Ct colonography, screen
75565 Card mri vel flw map add-on
75571 Ct hrt w/o dye w/ca test
75572 Ct hrt w/3d image
75573 Ct hrt w/3d image, congen
75574 Ct angio hrt w/3d image
75791 Av dialysis shunt imaging
77338 Design mlc device for imrt
78451 Ht muscle image spect, sing
78452 Ht muscle image spect, mult
78453 Ht muscle image,planar,sing
78454 Ht musc image, planar, mult
83987 Exhaled breath condensate
84145 Procalcitonin (pct)
84431 Thromboxane, urine
86305 Human epididymis protein 4
86352 Cell function assay w/stim
86780 Treponema pallidum
86825 Hla x-match, non-cytotoxic
86826 Hla x-match, non-cyt add-on
87150 Dna/rna, amplified probe
87153 Dna/rna sequencing
87493 C diff amplified probe
88387 Tiss exam molecular study
88388 Tiss ex molecul study add-on
88738 Hgb quant transcutaneous
89398 Unlisted reprod med lab proc
90470 Immune admin H1N1 im/nasal
90644 HIB/men/tt vaccine, im
90670 Pneumococcal vacc, 13 val im
92540 Basic vestibular evaluation
92550 Tympanometry & reflex thresh
92570 Acoustic immittance testing
93750 Interrogation vad, in person
94011 Up to 2 yrs old, spirometry
94012 = 2 yrs, spiromtry w/dilator
94013 = 2 yrs, lung volumes
95905 Motor/sens nrve conduct test
0545F Follow up care plan mdd docd
1200F Seizure type(s)+ frq docd
1205F EPI etiol synd rvwd and docd
2060F Pt talk eval hlthwkr re mdd
3008F Body mass index docd
3015F Cerv cancer screen docd
3038F Pulm fx w/in 12 mon b/4 surg
3293F Abo rh blood typing docd
3294F Grp b strep screening docd
3323F Clin node stgng docdb/4 surg
3324F Mri ct scan ord rvwd rqstd
3328F Prfrmnc docd 2 wks b/4 surg
3650F Eeg ordered rvwd reqstd
4004F Pt tobacco use done rcvd tlk
4063F Antidepres rxthxpy not rxd
4255F Anesth >= 60 min as docd
4256F Anesth < 60 min as docd
4330F Cnslng epi spec sfty issues
4340F Cnslng chldbrng+ women epi
5200F Eval appros surg thxpy epi
6070F Pt asked/cnsld aed effects
0199T Physiologic tremor record
0200T Perq sacral augmt unilat inj
0201T Perq sacral augmt bilat inj
0202T Post vert arthrplst 1 lumbar
0203T Unattend sleep study w/time
0204T Unattended sleep study
0205T Inirs each vessel add-on
0206T Remote algorithm analys ecg
0207T Clear eyelid gland w/heat
0208T Automated audiometry air
0209T Auto audiometry air/bone
0210T Auto audiometry sp thresh
0211T Auto audiometry sp thresh
0212T Comprehen auto audiometry
0213T Us facet jt inj cerv/t 1 lev
0214T Us facet jt inj cerv/t 2 lev
0215T Us facet jt inj cerv/t 3 lev
0216T Us facet jt inj ls 1 level
0217T Us facet jt inj ls 2 level
0218T Us facet jt inj ls 3 level
0219T Fuse spine facet jt cerv
0220T Fuse spine facet jt thor
0221T Fuse spine facet jt lumbar
0222T Fuse spine facet jt add seg

Most read cpt modifiers