 Trigger Point Injections Coding and Billing (How to Bill CPT 20553 and 20552). Is this unilateral procedures?Are you Properly Coding and Billing for your Services? Coding for Trigger Point Injections (which include how to bill cpt 20553)“Trigger points are described as hyper irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that palpable nodules are small contraction knots and a common cause of pain.”keyword tags: how to bill cpt 20553, billing trigger point injection What Causes Trigger Points? It could be due to or but not limited to: Injuries (e.g. whiplash) Daily activities (especially of that are work-related) of repetitive movements (e.g. typing, data entry) Lack of exercise, stress and poor posture Lack of activity Poor back support Poor sleeping positionThe trigger point codes are very specific and here our two codes (see how to bill cpt 20553)20552 – Injection(s); single or multiple trigger point(s), one or two muscles 20553 – Single or multiple trigger points(s), three or more muscles (AMA Guidelines: If imaging guidance is performed, see 76942, 77002, 77021) Global Days: 0 *** Imaging/Radiology Crosscodes: 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) Trigger point injections must be billed one line regardless how many injections. For instance, if your pain doc performed trigger points on 2 muscles, report 20552 x 1 unit… (not 2 units for 2 muscles!) CPT 20553 is NOT an add-on code! Modifier -59 should not be used with these codes. NO Anatomical Modifier because this service is NOT billable as Unilateral/Bilateral Modifier –25 can be appended for E/M office visit if done on the same day and such is separate and identifiable medically necessary. Above and Beyond.Documentation in the patient’s medical record should include proper evaluation leading to the diagnosis of the trigger points, specific identification of the affected muscle(s). It must also be properly documented the reason why injections are the chosen as a treatment option. Is the Code for Trigger Points / Muscles Group Injections Billable for Bilateral? “Is the Code for Trigger Points / Muscles Group Injections 20552 – 20553 Billable as Bilateral?” Another interesting question on Trigger Points Injection codes 20552-20553! The answer is NO, it is not billable as bilateral. Because you are billing on the number of muscles or trigger points. There is no left and right on this procedure. You bill and code on the number of muscles or trigger points. Be careful! you do not bill for number of injections too! Again, identify the number of muscle(s) or trigger point(s). A needle placement guidance is rarely used for trigger points injection procedure, but if the medical record shows that the physician used needle placement guidance, look at 77002 for the needle placement guidance code. Here’s a part of AMA’s Question and Answer Per CPT Assistant May 2003 Question: “My physician performed two trigger point injections in two different muscles. Would it be appropriate to report code 20552 twice for the two injections?” AMA Comment: “Code 20552-20553 are reported one time per session, regardless of the number of injections or muscles injected. Therefore, it would not be appropriate to report code 20552, Injection(s); single or multiple trigger point(s), one or two muscle(s) twice for the two injections administered.” **** CPT is owned by the American Medical Association (AMA) **** For more references: Consult your CPT code books. The National Correct Coding Initiative (NCCI) and third pary payer payment policies and guidelines **** CPT Assistant September 2003 **** Always refer to your local carrier’s LCDs keyword tags: how to bill cpt 20553, billing trigger point injection Here’s a part of AMA’s Publication from CPT Assistant September 2003 (see how to bill cpt 20553)  Archives February 2018
0 Comments
Do you know that you can bill for a Smoking Cessation Face-to-face encounter? But the question that you may have is how do you bill for Smoking Cessation Counseling? Here are your codes: 99406 Intermediate Smoking and tobacco use cessation counseling visit is greater than three minutes, but not more than 10 minutes 99407 Intensive Smoking and tobacco use cessation counseling visit is greater than 10 minutes Diagnosis that Meets Medical Necessity (always refer to your payer's guidelines too!) F17.200 Nicotine dependence, unspecified, uncomplicated F17.201 Nicotine dependence, unspecified, in remission F17.210 Nicotine dependence, cigarettes, uncomplicated F17.211 Nicotine dependence, cigarettes, in remission F17.220 Nicotine dependence, chewing tobacco, uncomplicated F17.221 Nicotine dependence, chewing tobacco, in remission F17.290 Nicotine dependence, other tobacco product, uncomplicated F17.291 Nicotine dependence, other tobacco product, in remission Z87.891 Personal history of nicotine dependence How do you bill Smoking Cessation code with the EM or Evaluation and Management codes? Append your Modifier 25 to the E/M Code and not on the Smoking Counselling Code! Make sure you know the guideline of Modifier 25 and always know how to identify necessity. Modifier -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service: This modifier must be appended with an E/M service. This is the modifier you will need to use with the evaluation and management service done on the same day with other procedure done by the same physician. It has to be above and beyond the usual preoperative and postoperative encounter with the procedure. In fact, by using this modifier, it doesn't have to have a different diagnosis reported. The most important thing is that, the E/M level should meet its key components or if it is selected based on time with the patient (counseling and coordination). You have to be careful in using this modifier. It must meet medical necessity. As you know, there are procedures that already includes all other care and management. Let's describe this modifier 25: A patient came in for her monthly follow up for her chronic back pain. At the same time, patient was complaining with severe headache. The pain doctor performed bilateral occipital block on the patient at the time of service. You will append modifier 25 for the E/M code to indicate that both services were rendered on the same day. You don't use modifier 25 with E/M encounter that resulted to Decision for Surgery (we have another modifier for this!)  Categories All Insurance Payment Allowed 100% of Charged Amount is not something to celebrate!  I asked some of my readers about how they will feel if their claims has an allowed amount that is at 100% of the charged amount, wow! So, meaning, when you bill for $2000.00 and the insurance made their determination at 100% of your charges… you bill $2,000, they allowed $2,000 – would you be happy?
Honestly, if I see EOB like this, I will be very very nervous! Your provider could have been paid more than the practice submitted charges, isn’t it? Interestingly, most of my readers said they’ll be happy if they were paid at 100% of their charges… now, would you? What if the allowed amount could have been $2,500? – how much is the difference? Yep, $500! How can the payer allow $2,500 if you have only submitted a charged amount of $2,000?! Make sense? Ok, now, here’s the deal! — if you got paid at 100% based on your charged amount you should find out about your fee schedule or contracted rate or what is usual and customary if you are out of network provider. Make sure you know you are not under-charging the insurance payer. But what if you have realized that you did under-charge the insurance payer? what will you do? can you recover the money that you could have been paid for? The answer is YES! you can recover that money! Now, don’t wait too long! Take action immediately! Based on my experience, you can go back as far as 3 years from the date the claims were paid. I haven’t tried more than 3 years of claim to recover due to undercharges! After all, just like the insurance payer, they can always go back as far as more than 3 years I think to recover overpayments. Or depending on where state you are located. Pay attention on your EOBs! I think that’s the key. As soon as you discover there is an undercharging and you were paid 100% on your charged amount. Pick up the phone and call that insurance payer immediately. Connect with us today, we will show you better strategies on how to run an effective revenue cycle management! Why the CPT UNLISTED CODES IMPORTANT? Here are our Unlisted Service or Procedure Codes A service encounter or surgical procedure may be provided that is not listed in this edition of the CPT code book. When reporting such a encounter or service, the appropriate “Unlisted Procedure” code may be used to indicate the service, identifying it by “Special Report” as discussed in the section below. The “Unlisted Procedures” and accompanying codes for Surgery are as follows: 15999 Unlisted procedure, excision pressure ulcer 17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue 19499 Unlisted procedure, breast 20999 Unlisted procedure, musculoskeletal system, general 21089 Unlisted maxillofacial prosthetic procedure 21299 Unlisted craniofacial and maxillofacial procedure 21499 Unlisted musculoskeletal procedure, head 21899 Unlisted procedure, neck or thorax 22899 Unlisted procedure, spine 22999 Unlisted procedure, abdomen, musculoskeletal system 23929 Unlisted procedure, shoulder 24999 Unlisted procedure, humerus or elbow 25999 Unlisted procedure, forearm or wrist 26989 Unlisted procedure, hands or fingers 27299 Unlisted procedure, pelvis or hip joint 27599 Unlisted procedure, femur or knee 27899 Unlisted procedure, leg or ankle 28899 Unlisted procedure, foot or toes 29799 Unlisted procedure, casting or strapping 29999 Unlisted procedure, arthroscopy 30999 Unlisted procedure, nose 31299 Unlisted procedure, accessory sinuses 31599 Unlisted procedure, larynx 31899 Unlisted procedure, trachea, bronchi 32999 Unlisted procedure, lungs and pleura 33999 Unlisted procedure, cardiac surgery 36299 Unlisted procedure, vascular injection 37501 Unlisted vascular endoscopy procedure 37799 Unlisted procedure, vascular surgery 38129 Unlisted laparoscopy procedure, spleen 38589 Unlisted laparoscopy procedure, lymphatic system 38999 Unlisted procedure, hemic or lymphatic system 39499 Unlisted procedure, mediastinum 39599 Unlisted procedure, diaphragm 40799 Unlisted procedure, lips 40899 Unlisted procedure, vestibule of mouth 41599 Unlisted procedure, tongue, floor of mouth 41899 Unlisted procedure, dentoalveolar structures 42299 Unlisted procedure, palate, uvula 42699 Unlisted procedure, salivary glands or ducts 42999 Unlisted procedure, pharynx, adenoids, or tonsils 43289 Unlisted laparoscopy procedure, esophagus 43499 Unlisted procedure, esophagus 43659 Unlisted laparoscopy procedure, stomach 43999 Unlisted procedure, stomach 44238 Unlisted laparoscopy procedure, intestine (except rectum) 44799 Unlisted procedure, intestine 44899 Unlisted procedure, Meckel’s diverticulum and the mesentery 44979 Unlisted laparoscopy procedure, appendix 45399 Unlisted procedure, colon 45499 Unlisted laparoscopy procedure, rectum 45999 Unlisted procedure, rectum 46999 Unlisted procedure, anus 47379 Unlisted laparoscopic procedure, liver 47399 Unlisted procedure, liver 47579 Unlisted laparoscopy procedure, biliary tract 47999 Unlisted procedure, biliary tract 48999 Unlisted procedure, pancreas 49329 Unlisted laparoscopy procedure, abdomen, peritoneum and omentum 49659 Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy 49999 Unlisted procedure, abdomen, peritoneum and omentum 50549 Unlisted laparoscopy procedure, renal 50949 Unlisted laparoscopy procedure, ureter 51999 Unlisted laparoscopy procedure, bladder 53899 Unlisted procedure, urinary system 54699 Unlisted laparoscopy procedure, testis 55559 Unlisted laparoscopy procedure, spermatic cord 55899 Unlisted procedure, male genital system 58578 Unlisted laparoscopy procedure, uterus 58579 Unlisted hysteroscopy procedure, uterus 58679 Unlisted laparoscopy procedure, oviduct, ovary 58999 Unlisted procedure, female genital system (nonobstetrical) 59897 Unlisted fetal invasive procedure, including ultrasound guidance, when performed 59898 Unlisted laparoscopy procedure, maternity care and delivery 59899 Unlisted procedure, maternity care and delivery 60659 Unlisted laparoscopy procedure, endocrine system 60699 Unlisted procedure, endocrine system 64999 Unlisted procedure, nervous system 66999 Unlisted procedure, anterior segment of eye 67299 Unlisted procedure, posterior segment 67399 Unlisted procedure, ocular muscle 67599 Unlisted procedure, orbit 67999 Unlisted procedure, eyelids 68399 Unlisted procedure, conjunctiva 68899 Unlisted procedure, lacrimal system 69399 Unlisted procedure, external ear 69799 Unlisted procedure, middle ear 69949 Unlisted procedure, inner ear 69979 Unlisted procedure, temporal bone, middle fossa approach When you bill for unlisted code, I always recommend to submit medical documentation. Most of the payers may require additional information. So make sure you submit your documentation and operative report as well. This way, we can avoid payment delays.
Can you bill a Medicare Patient for Missed Appointment or No-Show?  When patients missed their appointments, it does cost you your time and your staff. In this article, you are wondering if you can bill Medicare when their beneficiaries missed and appointment or has no-show. Below you will find clarifications. According to Chapter 1, section 30.3.13 of the Medicare Claims Processing Manual, which is attached to CR5613, CMS policy allows physicians, providers, and suppliers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge nonMedicare patients for missed appointments and the charges for Medicare and non-Medicare patient are the same. The charge for a missed appointment is not a charge for a service itself (to which the assignment and limiting charge provisions apply), but rather is a charge for a missed business opportunity. Therefore, if a physician's or supplier's missed appointment policy applies equally to all patients (Medicare and non-Medicare), then the Medicare law and regulations do not preclude the physician or supplier from charging the Medicare patient directly. The other key points of CR5613 are:
According to Medicare guideline; "make certain that your billing staff is aware that you may bill the beneficiary directly, that Medicare itself does not make any payments for missed appointments, and that Medicare should not be billed for these charges". "The Centers for Medicare & Medicaid Services (CMS) policy is to allow physicians and suppliers to charge Medicare beneficiaries for missed appointments. However, Medicare itself does not pay for missed appointments, so such charges should not be billed to Medicare." "Providers may not charge ONLY Medicare beneficiaries for missed appointments; they must also charge non-Medicare patients. The amount the physician/supplier charges Medicare beneficiaries for missed appointments must be the same as the amount that they charge non-Medicare patients." Source: MLN: MM5613 Related Change Request Number: 5613 Need our professional consulting advise to run a more efficient Revenue Cycle Management? - call and talk to us at 609-481-3494
CMS Require Global Surgery Reporting for Post-Op Visits Effective July 01, 2017 from 9 States CMS now require providers who are part of a group practice with 10 or more providers; and are practicing in the State of Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island to report CPT Code 99024 to indicate a post-operative visit during a 10-days or 90-days global surgical periods. This is required for surgeries performed on and after July 1st 2017.
Reporting Process for Post-Operative Visits CPT Code 99024
Reference: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Global-Surgery-Data-Collection-.html Commonly Use DME Modifiers | Durable Medical Equipment Billing Keypoints:
This modifier is used for DME items that are rented, and will be used for equipment in the following categories:
KH — DMEPOS ITEM, INITIAL CLAIM, PURCHASE OR FIRST MONTH RENTAL This modifier is used for a capped rental DME item. When using the KH modifier, you are indicating you are billing for the first month of the capped rental period. KJ — DMEPOS ITEM, PARENTERAL ENTERAL NUTRITION (PEN) PUMP OR CAPPED RENTAL, Month four to fifteen. This modifier is used for capped rental DME items. When using the KJ modifier, you are indicating you are billing for months four through thirteen/fifteen of the capped rental period. KI — DMEPOS ITEM, SECOND OR THIRD MONTH RENTAL This modifier is used for capped rental DME items. When using the KI modifier, you are indicating you are billing for the second and/or third month of the capped rental period A8 — DRESSING FOR EIGHT WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A5 — DRESSING FOR FIVE WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A4 — DRESSING FOR FOUR WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A9 — DRESSING FOR NINE OR MORE WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A1 — DRESSING FOR ONE WOUND. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A7 — DRESSING FOR SEVEN WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A6 — DRESSING FOR SIX WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A3 — DRESSING FOR THREE WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A2 — DRESSING FOR TWO WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. KA — ADD ON OPTION/ACCESSORY FOR WHEELCHAIR (EFFECTIVE DATE 01/01/1994) JA — ADMINISTERED INTRAVENOUSLY (EFFECTIVE DATE 01/01/2007) N/A JB — ADMINISTERED SUBCUTANEOUSLY (EFFECTIVE DATE 01/01/2007) For all immune globulin (J1559, J1561, J1562, J1569) and associated infusion pump (E0779) claims where the route of administration is subcutaneous, a JB modifier must be added to each HCPCS code. VP — APHAKIC PATIENT (EFFECTIVE DATE 01/01/1984) N/A TW — BACK-UP EQUIPMENT (EFFECTIVE DATE 01/01/2003) N/A KB — BENEFICIARY REQUESTED UPGRADE FOR ABN, MORE THAN 4 MODIFIERS IDENTIFIED ON CLAIM. (EFFECTIVE DATE 1/1/2003) N/A KT — BENEFICIARY RESIDES IN A COMPETITIVE BIDDING AREA AND TRAVELS OUTSIDE THAT COMPETITIVE BIDDING AREA AND RECEIVES A COMPETITIVE BID ITEM (UPDATED DATE 04/01/2008 N/A KE — BID UNDER ROUND ONE OF THE DMEPOS COMPETITIVE BIDDING PROGRAM FOR USE WITH NON-COMPETITIVE BID BASE EQUIPMENT (EFFECTIVE 01/01/2009) This is a pricing modifier and it used with certain items that may be used with competitive or non-competitive bid items. Use of the KE indicates the 9.5% reduction should not affect your reimbursement. CR — CATASTROPHE/DISASTER RELATED For use by providers that have been granted a formal waiver under §1135 of the Social Security Act and then only for services affected by the emergency and while the waiver remains in effect. QQ — CLAIM SUBMITTED WITH A WRITTEN STATEMENT OF INTENT CT — COMPUTED TOMOGRAPHY SERVICES FURNISHED USING EQUIPMENT THAT DOES NOT MEET EACH OF THE ATTRIBUTES OF THE NATIONAL ELECTRICAL MANUFACTURERS ASSOCIATIONS (NEMA) XR-29-2013 STANDARD N/A PD — DIAGNOSTIC OR RELATED NON DIAGNOSTIC ITEM OR SERVICE PROVIDED IN A WHOLLY OWNED OR OPERATED ENITY TO A PATIENT WHO IS ADMITTED AS AN INPATIENT WITHIN 3 DAYS (EFFECTIVE DATE 01/01/2012) KL — DMEPOS ITEM DELIVERED VIA MAIL (EFFECTIVE DATE 07/01/2007) When using this modifier, you are indicating you have delivered your supplies via mail. This modifier must only be used with diabetic supplies. KG — DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM NUMBER 1 (EFFECTIVE DATE 07/01/2007) KK — DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM NUMBER 2 (EFFECTIVE DATE 07/01/2007) KU — DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM NUMBER 3 (EFFECTIVE DATE 07/01/2007) N/A KW — DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM NUMBER 4 (EFFECTIVE DATE 1/1/2008) N/A KY — DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM NUMBER 5 (EFFECTIVE DATE 1/1/2008) N/A KV — DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM THAT IS FURNISHED AS PART OF A PROFESSIONAL SERVICE (EFFECTIVE DATE 1/1/2008) N/A J4 — DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM THAT IS FURNISHED BY A HOSPITAL UPON DISCHARGE (EFFECTIVE 01/01/2010) JW — DRUG AMOUNT DISCARDED/NOT ADMINISTERED TO ANY PATIENT (EFFECTIVE 01/01/2003) For CGS DMEMAC claims, the JW modifier is not required for discarded drugs and biologicals. KD — DRUG OR BIOLOGICAL INFUSED THOUGH DME. (EFFECTIVE DATE 01/01/04) RD — DRUG PROVIDED TO BENEFICIARY, BUT NOT ADMINISTERED EM — EMERGENCY RESERVE SUPPLY (FOR ESRD BENEFIT ONLY). ET — EMERGENCY SERVICES EA — ERYTHROPOETIC STIMULATING AGENT (ESA) ADMINISTERED TO TREAT ANEMIA DUE TO ANTI-CANCER CHEMOTHERAPY (EFFECTIVE DATE 1/1/2008) EB — ERYTHROPOETIC STIMULATING AGENT (ESA) ADMINISTERED TO TREAT ANEMIA DUE TO ANTI-CANCER RADIOTHERAPY (EFFECTIVE DATE 1/1/2008) EC — ERYTHROPOETIC STIMULATING AGENT (ESA) ADMINISTERED TO TREAT ANEMIA NOT DUE TO ANTI-CANCER RADIOTHERAPY OR ANTI-CANCER CHEMOTHERAPY (EFFECTIVE DATE 1/1/2008) EX — EXPATRIATE BENEFICIARY Effective July 1, 2016, use this modifier to bill Medicare for purchased only DMEPOS items that are furnished to expatriate beneficiaries. By attaching the EX modifier, the supplier is attesting that the benefidicary is an expatriate beneficiary, and that the item was delivered/furnished while the beneficiary is present in the U.S., and all other billing criteria has been met. QA — FDA INVESTIGATIONAL DEVICE EXEMPTION (ENDS 12/31/2007) KP — FIRST DRUG OF A MULTIPLE DRUG UNIT DOSE FORMULATION When there is a single drug in a unit dose container, the KO modifier is added to the unit dose form code. (Exception: The KO modifier is not used with code J2545 or Q4080.) Except for code J7620, when two or more drugs are combined and dispensed to the patient in the same unit dose container, each of the drugs is billed using its unit dose form code. The KP modifier is added to only one of the unit dose form codes and the KQ modifier is added to the other unit dose code(s). Whenever a unit dose form code is billed, it must have a KO, KP or KQ modifier. (Exception: The KO, KP and KQ modifiers should not be used with code J7620.) If a unit dose code does not have one of these modifiers, it will be denied as an invalid code. The KO, KP, and KQ modifiers are not used with the concentrated form codes. The only FDA-approved unit dose preparation containing more than one drug is J7620, the combination of albuterol and ipratropium. Therefore, if the following FDA-approved unit dose codes are billed with a KP or KQ modifier, they will be rejected as invalid for claim submission: J2545, J7608, J7613, J7614, J7626, J7631, J7639, J7644, J7649, J7659, J7669, J7682, Q4080, and Q4080. RE — FURNISHED IN FULL COMPLIANCE WITH FDA-MANDATED RISK EVALUATION AND MITIGATION STRATEGY (REMS) (EFFECTIVE 01/01/2009) KS — GLUCOSE MONITOR SUPPLY FOR DIABETIC BENEFICIARY NOT TREATED WITH INSULIN If the patient is not being treated with insulin injections, the KS modifier must be added to the code for the monitor and each related supply on every claim submitted. ED — HEMATOCRIT LEVEL HAS EXCEEDED 39% (OR HEMOGLOBIN LEVEL HAS EXCEEDED 13.0 G/DL) FOR 3 OR MORE CONSECUTIVE BILLING CYCLES IMMEDIATELY PRIOR TO AND INCLUDING THE CURRENT CYCLE (EFFECTIVE DATE 1/1/2008) EE — HEMATOCRIT LEVEL HAS NOT EXCEEDED 39% (OR HEMOGLOBIN LEVEL HAS NOT EXCEEDED 13.0 G/DL) FOR 3 OR MORE CONSECUTIVE BILLING CYCLES IMMEDIATELY PRIOR TO AND INCLUDING THE CURRENT CYCLE (EFFECTIVE DATE 1/1/2008) Q0 — INVESTIGATIONAL CLINICAL SERVICE PROVIDED IN A CLINICAL RESEARCH STUDY THAT IS IN AN APPROVED CLINICAL RESEARCH STUDY (EFFECTIVE DATE 1/1/2008) KF — ITEM DESIGNATED BY FDA AS CLASS III DEVICES. (EFFECTIVE DATE 04/01/04) AV — ITEM FURNISHED IN CONJUNCTION WITH A PROSTHETIC DEVICE, PROSTHETIC OR ORTHOTIC. (EFFECTIVE DATE 1/1/2003) AW — ITEM FURNISHED IN CONJUNCTION WITH A SURGICAL DRESSING. (EFFECTIVE DATE 1/1/2003) AU — ITEM FURNISHED IN CONJUNCTION WITH A UROLOGICAL, OSTOMY, OR TRACHEOSTOMY SUPPLY. (EFFECTIVE DATE 1/1/2003) This modifier is used specifically with codes A4450, A4452, and A5120. AX — ITEM FURNISHED IN CONJUNCTION WITH DIALYSIS SERVICES. (EFFECTIVE DATE 1/1/2003) BA — ITEM FURNISHED IN CONJUNCTION WITH PARENTERAL ENTERAL NUTRITION (PEN) SERVICES. (EFFECTIVE DATE 1/1/2003) When an IV pole (E0776) is used in conjunction with parenteral nutrition, the BA modifier should be added to the code. Code E0776 is the only code with which the BA modifier may be used. GZ — ITEM OR SERVICE EXPECTED TO BE DENIED AS NOT REASONABLE OR NECESSARY. (EFFECTIVE 1/1/2002) AY — ITEM OR SERVICE FURNISHED TO AN ESRD PATIENT THAT IS NOT FOR THE TREATMENT OF ESRD (EFFECTIVE 01/01/2011) QV — ITEM OR SERVICE PROVIDED AS ROUTINE CARE IN A MEDICARE QUALIFYING CLINICAL TRAIL (ENDS 12/31/2007) GY — ITEM OR SERVICE STATUTORILY EXCLUDED, DOES NOT MEET THE DEFINITION OF ANY MEDICARE BENEFIT OR, FOR NON-MEDICARE INSURERS, IS NOT A CONTRACT BENEFIT (UPDATED 1/1/2008) FB — ITEM PROVIDED W/O COST TO PROVIDER, SUPPLIER OR PRACTITIONER, OR FULL CREDIT RECEIVED FOR REPLACED DEVICE (UPDATED 1/1/2008) QR — ITEM/SERVICE IN MEDICARE STUDY - OXYGEN (ENDS 12/31/2007) T4 — LEFT FOOT, FIFTH DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. T3 — LEFT FOOT, FOURTH DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. TA — LEFT FOOT, GREAT TOE (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. T1 — LEFT FOOT, SECOND DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. T2 — LEFT FOOT, THIRD DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. F3 — LEFT HAND, FOURTH DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. F1 — LEFT HAND, SECOND DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. F2 — LEFT HAND, THIRD DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. FA — LEFT HAND, THUMB (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. LT — LEFT SIDE. (USED TO IDENTIFY ITEM PROVIDED FOR THE LEFT SIDE OF THE BODY.) N/A K0 — LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 0 DOES NOT HAVE THE ABILITY OR POTENTIAL TO AMBULATE OR TRANSFER SAFELY WITH OR WITHOUT ASSISTANCE AND A PROSTHESIS DOES NOT ENHANCE THEIR QUALITY OF LIFE OR MOBILITY. K1 — LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 1 HAS THE ABILITY OR POTENTIAL TO USE A PROSTHESIS FOR TRANSFERS OR AMBULATION ON LEVEL SURFACES AT FIXED CADENCE. TYPICAL OF THE LIMITED AND UNLIMITED HOUSEHOLD AMBULATOR. K2 — LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 2 HAS THE ABILITY OR POTENTIAL FOR AMBULATION WITH THE ABILITY TO TRAVERSE LOW LEVEL ENVIRONMENTAL BARRIERS SUCH AS CURBS, STAIRS OR UNEVEN SURFACES. TYPICAL OF THE LIMITED COMMUNITY AMBULATOR. K3 — LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 3 HAS THE ABILITY OR POTENTIAL FOR AMBULATION WITH VARIABLE CADENCE. TYPICAL OF THE COMMUNITY AMBULATOR WHO HAS THE ABILITY TO TRANSVERSE MOST ENVIRONMENTAL BARRIERS AND MAY HAVE VOCATIONAL, THERAPEUTIC OR EXERCISE ACTIVITY THAT DEMANDS PROSTHETIC UTILIZATION BEYOND SIMPLE LOCOMOTION. K4 — LOWER PROSTHESIS FUNCTIONAL LEVEL 4 HAS THE ABILITY OR POTENTIAL FOR PROSTHETIC AMBULATION THAT EXCEEDS THE BASIC AMBULATION SKILLS, EXHIBITING HIGH IMPACT, STRESS, OR ENERGY LEVELS, TYPICAL OF THE PROSTHETIC DEMANDS OF THE CHILD, ACTIVE ADULT, OR ATHLETE. SC — MEDICALLY NECESSARY SERVICE OR SUPPLY (EFFECTIVE DATE 01/01/2001) GL — MEDICALLY UNNECESSARY UPGRADE PROVIDED INSTEAD OF NON-UPGRADED ITEM, NO CHARGE, NO ADVANCE BENEFICIARY NOTICE (ABN) (UPDATED 1/1/2008) M2 — MEDICARE SECONDARY PAYER (MSP) (EFFECTIVE DATE 01/01/2007) 99 — MODIFIER OVERFLOW. (EFFECTIVE DATE 7/1/2003) This modifier is used when you have exhausted the modifier field on the claim form. If you need additional room to add modifiers, append the 99 modifier to the last available field and include a narrative of other modifiers needed on the claim. NB — NEBULIZER SYSTEM, ANY TYPE, FDA-CLEARED FOR USE WITH SPECIFIC DRUG (EFFECTIVE 01/01/2011) NU — NEW DURABLE MEDICAL EQUIPMENT PURCHASE. This modifier is used for new DME items that are purchased. When using the NU modifier, you are indicating you have furnished the beneficiary with a new (never used) piece of equipment. NR — NEW WHEN RENTED EY — NO PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER ORDER FOR THIS ITEM OR SERVICE. (EFFECTIVE DATE 1/1/2003) If you do not have a prescription from the physician prior to billing Medicare, you must append the EY modifier to your claim GX — NOTICE OF LIABILITY ISSUED, VOLUNTARY UNDER PAYER POLICY (EFFECTIVE 04/01/2010) ZA — NOVARTIS/SANDOZ BO — ORALLY ADMINISTERED NUTRITION, NOT BY FEEDING TUBE. (EFFECTIVE DATE 1/1/2003) When enteral nutrients (B4149-B4162) are administered by mouth, the BO modifier must be added to the code. QH — OXYGEN CONSERVING DEVICE IS BEING USED WITH AN OXYGEN DELIVERY SYSTEM. FC — PARTIAL CREDIT RECEIVED FOR REPLACED DEVICE (EFFECTIVE DATE 1/1/2008) CG — POLICY CRITERIA APPLIED (EFFECTIVE DATE 07/01/2008) Effective for claims with dates of service on or after July 1, 2010, if an L3923 orthosis has a rigid plastic or metal component, the supplier must add the CG modifier (policy criteria applied) to the code. Claims for L3923 billed without a CG modifier will be rejected as incorrect coding. The CG modifier must be added to code L0450, L0454, L0455, L0621, L0625, or L0628 only if it is one made primarily of nonelastic material (e.g., canvas, cotton or nylon) or having a rigid posterior panel. QF — PRESCRIBED AMOUNT OF OXYGEN EXCEEDS 4 LPM AND PORTABLE OXYGEN IS PRESCRIBED. These modifiers may only be used with stationary gaseous (E0424) or liquid (E0439) systems or with an oxygen concentrator (E1390, E1391). They must not be used with codes for portable systems or oxygen contents. QG — PRESCRIBED AMOUNT OF OXYGEN IS GREATER THAN 4 LITERS PER MINUTE (LPM). These modifiers may only be used with stationary gaseous (E0424) or liquid (E0439) systems or with an oxygen concentrator (E1390, E1391). They must not be used with codes for portable systems or oxygen contents. QE — PRESCRIBED AMOUNT OF OXYGEN IS LESS THAN 1 LITER PER MINUTE (LPM). This modifier may only be used with stationary gaseous (E0424) or liquid (E0439) systems or with an oxygen concentrator (E1390, E1391). They must not be used with codes for portable systems or oxygen contents CC — PROCEDURE CODE CHANGE (USE 'CC' WHEN THE PROCEDURE CODE SUBMITTED WAS CHANGED EITHER FOR ADMINISTRATIVE REASONS OR BECAUSE AN INCORRECT CODE WAS FILED). (SUPPLIERS SHOULD NOT SUBMIT MODIFIER CC.) PL — PROGRESSIVE ADDITION LENSES (EFFECTIVE DATE 01/01/89) GK — REASONABLE AND NECESSARY ITEM/SERVICE ASSOCIATED WITH A GA OR GZ MODIFIER (UPDATED 1/1/2008) KR — RENTAL ITEM, BILLING FOR PARTIAL MONTH. RP — REPLACEMENT AND REPAIR. (DELETED EFFECTIVE 12/31/2008) RP MAY BE USED TO INDICATE REPLACEMENT OF DME, ORTHOTIC AND PROSTHETIC DEVICES, WHICH HAVE BEEN IN USE FOR SOMETIME. RA — REPLACEMENT OF A DME ITEM (EFFECTIVE 01/01/2009) Claims for replacement of DME items should include the RA modifer for dates of service on or after January 1, 2009. RB — REPLACEMENT OF A PART OF DME FURNISHED AS PART OF A REPAIR (EFFECTIVE 01/01/2009) KM — REPLACEMENT OF FACIAL PROSTHESIS INCLUDING NEW IMPRESSION/MOULAGE KN — REPLACEMENT OF FACIAL PROSTHESIS USING PREVIOUS MASTER MODEL KC — REPLACEMENT OF SPECIAL POWER WHEELCHAIR INTERFACE. (EFFECTIVE DATE 01/01/05) T9 — RIGHT FOOT, FIFTH DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. T8 — RIGHT FOOT, FOURTH DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. T5 — RIGHT FOOT, GREAT TOE (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. T6 — RIGHT FOOT, SECOND DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. T7 — RIGHT FOOT, THIRD DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1830 or E1831. Failure to append the modifier will result in a rejection for incorrect coding. F9 — RIGHT HAND, FIFTH DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. F8 — RIGHT HAND, FOURTH DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. F6 — RIGHT HAND, SECOND DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. F7 — RIGHT HAND, THIRD DIGIT (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. F5 — RIGHT HAND, THUMB (EFFECTIVE DATE 01/01/1995) Effective for dates of service on or after January 1, 2015, use with devices coded with HCPCS code E1825. Failure to append the modifier will result in a rejection for incorrect coding. RT — RIGHT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE RIGHT SIDE OF THE BODY). Q1 — ROUTINE CLINICAL SERVICE PROVIDED IN A CLINICAL RESEARCH STUDY THAT IS IN AN APPROVED CLINICAL RESEARCH STUDY (EFFECTIVE DATE 1/1/2008) KQ — SECOND OR SUBSEQUENT DRUG OF A MULTIPLE DRUG UNIT DOSE FORMULATION When there is a single drug in a unit dose container, the KO modifier is added to the unit dose form code. (Exception: The KO modifier is not used with code J2545 or Q4080.) Except for code J7620, when two or more drugs are combined and dispensed to the patient in the same unit dose container, each of the drugs is billed using its unit dose form code. The KP modifier is added to only one of the unit dose form codes and the KQ modifier is added to the other unit dose code(s). Whenever a unit dose form code is billed, it must have a KO, KP or KQ modifier. (Exception: The KO, KP and KQ modifiers should not be used with code J7620.) If a unit dose code does not have one of these modifiers, it will be denied as an invalid code. The KO, KP, and KQ modifiers are not used with the concentrated form codes. The only FDA-approved unit dose preparation containing more than one drug is J7620, the combination of albuterol and ipratropium. Therefore, if the following FDA-approved unit dose codes are billed with a KP or KQ modifier, they will be rejected as invalid for claim submission: J2545, J7608, J7613, J7614, J7626, J7631, J7639, J7644, J7649, J7659, J7669, J7682, Q4080, and Q4080. GW — SERVICE NOT RELATED TO THE HOSPICE PATIENT'S TERMINAL CONDITION. (USED FOR MEDICARE ADVANTAGE PLANS CLAIMS) QJ — SERVICE/ITEMS PROVIDED TO A PRISONER OR PATIENT IN STATE OR LOCAL CUSTODY, HOWEVER THE STATE OR LOCAL GOVERNMENT, AS APPLICABLE, MEETS THE REQUIREMENT IN 42 CFR 411.1(B). (EFFECTIVE DATE 1/1/2003) KO — SINGLE DRUG UNIT DOSE FORMULATION When there is a single drug in a unit dose container, the KO modifier is added to the unit dose form code. (Exception: The KO modifier is not used with code J2545 or Q4080.) Except for code J7620, when two or more drugs are combined and dispensed to the patient in the same unit dose container, each of the drugs is billed using its unit dose form code. The KP modifier is added to only one of the unit dose form codes and the KQ modifier is added to the other unit dose code(s). Whenever a unit dose form code is billed, it must have a KO, KP or KQ modifier. (Exception: The KO, KP and KQ modifiers should not be used with code J7620.) If a unit dose code does not have one of these modifiers, it will be denied as an invalid code. The KO, KP, and KQ modifiers are not used with the concentrated form codes. The only FDA-approved unit dose preparation containing more than one drug is J7620, the combination of albuterol and ipratropium. Therefore, if the following FDA-approved unit dose codes are billed with a KP or KQ modifier, they will be rejected as invalid for claim submission: J2545, J7608, J7613, J7614, J7626, J7631, J7639, J7644, J7649, J7659, J7669, J7682, Q4080, and Q4080. MS — SIX MONTH MAINTENANCE AND SERVICING FEE FOR REASONABLE AND NECESSARY PARTS AND LABOR WHICH ARE NOT COVERED UNDER ANY MANUFACTURER OR SUPPLIER WARRANTY For capped rental periods beginning prior to January 1, 2006 which have reached the 15 month rental cap, DME MACs pay claims for maintenance and servicing fees after six months have passed from the end of the final paid rental month or from the end of the period the item is no longer covered under the supplier's or manufacturer's warranty, whichever is later. A new CMN and/or physician's order is not needed for covered maintenance. KX — SPECIFIC REQUIRED DOCUMENTATION ON FILE. (EFFECTIVE DATE 7/1/2002) This modifier may be used to indicate that specific required documentation is on file in the patient's medical record. Documentation must be submitted upon request. Applicable policies include: Manual and power mobility bases and accessories, Glucose monitors & supplies, PAP devices and accessories, Respiratory Assist Devices (RAD), Commodes, Hospital beds and accessories, Therapeutic Shoes for Diabetics, Heavy duty walkers, Urological Supplies, Epoetin, Support surfaces - Groups 1, 2, and 3, Refractive Lenses - Anti reflective coating, tint, and oversize lenses, polycarbonate lenses, Cervical Traction devices - Codes E0849 and E0855, External infusion (insulin) pumps, High Frequency chest wall oscillation devices, Nebulizers (Brovana or Perforomist) - J7605 and J7606, Negative Pressure Wound Therapy, Patient lifts - E0636 and E1035, Speech generating devices, Wheelchair seating, Orthopedic Footwear, Home Dialysis supplies, Oral Antiemetic - J8502 and J8540. EJ — SUBSEQUENT CLAIMS FOR A DEFINED COURSE OF THERAPY, E.G., EPO, SODIUM HYALURONATE, INFLAXIMAB. BU — THE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND AFTER 30 DAYS HAS NOT INFORMED THE SUPPLIER OF HIS/HER DECISION. This modifier is used when you have discussed the purchase/rent option with the beneficiary, and the beneficiary has not responded within 30 days of the discussion. BP — THE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND HAS ELECTED TO PURCHASE THE ITEM. This modifier is used when you have discussed the purchase/rent option with the beneficiary, and the beneficiary has chosen to purchase the DME item. BR — THE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND HAS ELECTED TO RENT THE ITEM. This modifier is used when you have discussed the purchase/rent option with the beneficiary, and the beneficiary has chosen to rent the DME item. GD — UNITS OF SERVICE EXCEEDS MEDICALLY UNLIKELY EDIT VALUE AND REPRESENTS REASONABLE AND NECESSARY SERVICES (EFFECTIVE DATE 1/1/2008) UE — USED DURABLE MEDICAL EQUIPMENT PURCHASE. This modifier is used for used DME items that are purchased. When using the UE modifier, you are indicating you have furnished the beneficiary with a used piece of equipment. GU — WAIVER OF LIABILITY STATEMENT ISSUED AS REQUIRED BY PAYER POLICY, ROUTINE NOTICE (EFFECTIVE 01/01/2011) GA — WAIVER OF LIABILITY STATEMENT ON FILE. You must fully execute the Advanced Beneficiary Notice before appending the GA modifier to your claim. In order to have the GA modifier added to your claim after the initial determination, you must submit the ABN in paper to Written Reopenings. Sample of HCFA 1500 Claim Form when billing for DME Billing  Searched Keywords:
dme modifier list 2016 dme procedure code list medicare dme modifiers list purchase modifier for dme dme modifiers medicare dme cpt codes dme modifiers hcpcs list of D Durable Medical what is durable medical equipment durable equipment definition durable equipment providers durable medical equipment near me dme medicare modifiers dme modifier kx dme modifiers 2017 dme modifiers 2016 dme purchase modifier medicare dme modifiers 2016 medicare modifiers list what is the kx modifier used for? dme rental modifiers modifier kh dme modifiers list dme modifier kx dme modifiers 2016 medicare dme modifiers 2016 dme modifiers 2017 modifier bp According to the Centers for Disease Control and Prevention “Obesity, a common and costly health issue, affects more than one-third of adults and 17 percent of youth in the United States. “ By the numbers, 78 million adults and 12 million children are obese—figures many regard as an epidemic. Being obese increases the risk for heart disease, stroke and type 2 diabetes—the first, fourth and seventh leading causes of death, respectively—and contributes to more than one in five cancer-related deaths. Obesity-related health care spending continues to grow, with researchers estimating medical costs at $147 billion annually, including $7 billion for Medicare prescription drugs. The American Medical Association recognized obesity as a disease in 2013 and the American Academy of Pediatrics recommended obesity prevention, assessment and patient counseling in 2007. Medicare first recognized obesity as a medical condition in 2004 and began covering interventions when scientific evidence demonstrated their effectiveness. In 2011, Medicare issued a Coverage Decision memorandum outlining requirements for intensive behavioral counseling and therapy for beneficiaries affected by obesity. As of January 2012, Medicare and most private insurers cover obesity screening and behavioral counseling. In addition, as of Jan.1, 2014, the ACA requires: No consumer cost- sharing. Most insurance plans in all 50 states are required to cover certain services with no cost-sharing, including obesity screening and counseling for all adults and children. This includes no annual deductible amount, no enrollee copayments or coinsurance. Premium surcharges for being obese are prohibited in most insurance policies in all 50 states, including those sold through exchanges. Source: http://www.ncsl.org/research/health/aca-and-health-mandates-for-obesity.aspx Medicare Guideline and Policy: Make sure that …
Eligible Specialties:
Geriatric Medicine Nurse Practitioner Certified Clinical Nurse Specialist Physician Assistant 2017 MODERATE SEDATION CHANGE CODES LIST The 2017 code set revises this code by removing moderate sedation, also called conscious sedation, from this procedure. Use of moderate (conscious) sedation is no longer considered an inherent (bundled) / part of the procedure and can now be reported separately. Prior to the 2017 change, reimbursement for moderate (conscious) sedation was built into the compensation for the procedure as the anesthesia was administered by the same physician or other qualified health care professional who performed the procedure. This code included conscious sedation as an inherent part of providing the service and was not separately reportable. It has been recognized that practice patterns for some procedures have changed, with anesthesia increasingly reported separately by a provider separate from the one who performs the procedure. For this reason, CPT® 2017 unbundles moderate (conscious) sedation from hundreds of codes. To report moderate (conscious) sedation when provided by the same physician or other qualified health care professional who performs the procedure, see new CPT® 2017 codes 99151, 99152, or 99153. To report moderate (conscious) sedation services provided by a physician or other qualified health care professional other than the provider performing the procedure, see new CPT® 2017 codes 99155, 99156, or 99157. For 2017, existing CPT® codes for moderate sedation, 99143-99150, have been deleted. Here are your Code Descriptions for Moderate Sedation 2017 CPT Changes0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed
0201T Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed 0293T Insertion of left atrial hemodynamic monitor; complete system, includes implanted communication module and pressure sensor lead in left atrium including transseptal access, radiological supervision and interpretation, and associated injection procedures, when performed 0294T Insertion of left atrial hemodynamic monitor; pressure sensor lead at time of insertion of pacing cardioverter-defibrillator pulse generator including radiological supervision and interpretation and associated injection procedures, when performed (List separately in addition to code for primary procedure) 0301T Destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance 0302T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; complete system (includes device and electrode) 0303T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; electrode only 0304T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; device only 0307T Removal of intracardiac ischemia monitoring device 0308T Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular lens prosthesis 0335T Extra-osseous subtalar joint implant for talotarsal stabilization 0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance 0397T Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure) 10030 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous 20982 Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency 20983 Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablation 22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic 22511 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral 22512 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) 22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic 22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar 22515 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) 22526 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level 22527 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure) 31615 Tracheobronchoscopy through established tracheostomy incision 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) 31623 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings 31624 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage 31625 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites 31626 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple 2017 Moderate Conscious Sedation Changes 31627 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s]) 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) 31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure) 31633 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure) 31634 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (eg, fibrin glue), if performed 31635 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body 31645 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial (eg, drainage of lung abscess) 31646 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, subsequent 31647 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe 31648 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe 31649 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure) 31651 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure[s]) 31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures 31653 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures 31654 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s]) 31660 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe 31661 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes 31725 Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedside 32405 Biopsy, lung or mediastinum, percutaneous needle 32550 Insertion of indwelling tunneled pleural catheter with cuff 32551 Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure) 32553 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple 33010 Pericardiocentesis; initial 33011 Pericardiocentesis; subsequent 33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial 33207 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular 33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular 33210 Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) 33211 Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) 33212 Insertion of pacemaker pulse generator only; with existing single lead 33213 Insertion of pacemaker pulse generator only; with existing dual leads 33214 Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) 33216 Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator 33217 Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator 33218 Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator 33220 Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator 33221 Insertion of pacemaker pulse generator only; with existing multiple leads 33222 Relocation of skin pocket for pacemaker 33223 Relocation of skin pocket for implantable defibrillator 33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system 33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system 33229 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system 33230 Insertion of implantable defibrillator pulse generator only; with existing dual leads 33231 Insertion of implantable defibrillator pulse generator only; with existing multiple leads 33233 Removal of permanent pacemaker pulse generator only 33234 Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular 33235 Removal of transvenous pacemaker electrode(s); dual lead system 33240 Insertion of implantable defibrillator pulse generator only; with existing single lead 2017 Moderate Conscious Sedation Changes 33241 Removal of implantable defibrillator pulse generator only 33244 Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction 33249 Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber 33262 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system 33263 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system 33264 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system 33282 Implantation of patient-activated cardiac event recorder 33284 Removal of an implantable, patient-activated cardiac event recorder 33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only 33991 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; both arterial and venous access, with transseptal puncture 33992 Removal of percutaneous ventricular assist device at separate and distinct session from insertion 33993 Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion 36010 Introduction of catheter, superior or inferior vena cava 36140 Introduction of needle or intracatheter; extremity artery 36200 Introduction of catheter, aorta 36221 Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed 36222 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed 36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed 36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed 2017 Moderate Conscious Sedation Changes 36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed 36226 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed 36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) 36228 Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure) 36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family 36246 Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family 36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family 36248 Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate) 36251 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral 36252 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral 36253 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral 36254 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral 36481 Percutaneous portal vein catheterization by any method 36555 Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age 36557 Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age 36558 Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older 36560 Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age 36561 Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older 36563 Insertion of tunneled centrally inserted central venous access device with subcutaneous pump 36565 Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; without subcutaneous port or pump (eg, Tesio type catheter) 36566 Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; with subcutaneous port(s) 36568 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; younger than 5 years of age 2017 CPT Code Updates (New, Revised and Deleted) – Moderate Conscious Sedation Changes 36570 Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age 36571 Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older 36576 Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site 36578 Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site 36581 Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access 36582 Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access 36583 Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access 36585 Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access 36590 Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion 37183 Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recanulization/dilatation, stent placement and all associated imaging guidance and documentation) 37184 Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel 37185 Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure) 37186 Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure) 37187 Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance 37188 Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy 37191 Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed 37192 Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed 37193 Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed 37197 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed 37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day 37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day 37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed 37214 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection 37216 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection 37218 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation 37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty 37221 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed 37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) 37223 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) 37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty 37225 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed 37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed 37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed 37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty 37229 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed 37230 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed 37231 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed 2017 Moderate Conscious Sedation Changes (continue reading below) 37232 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) 37233 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) 37234 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) 37235 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) 37236 Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery 37237 Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure) 37238 Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein 37239 Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure) 37241 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) 37242 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) 37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction 37244 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation 37252 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) 37253 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure) 43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 43201 Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance 43202 Esophagoscopy, flexible, transoral; with biopsy, single or multiple 43204 Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices 43205 Esophagoscopy, flexible, transoral; with band ligation of esophageal varices 43206 Esophagoscopy, flexible, transoral; with optical endomicroscopy 43211 Esophagoscopy, flexible, transoral; with endoscopic mucosal resection 43212 Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) 43213 Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed) 43214 Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) 43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s) 43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 43217 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 43220 Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) 43226 Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire 43227 Esophagoscopy, flexible, transoral; with control of bleeding, any method 43229 Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 43231 Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination 43232 Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) 43233 Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance 43237 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures 43238 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 43240 Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed) 43241 Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter 43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 43243 Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices 43244 Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices 43245 Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) 43246 Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube 43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s) 43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire 43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) 43250 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 43252 Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy 43253 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 43254 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection 43255 Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method 43257 Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease 43259 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis 43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 43261 Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple 43262 Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy 43263 Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi 43264 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) 43265 Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy) 43266 Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) 43270 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 43273 Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (List separately in addition to code(s) for primary procedure) 43274 Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and postdilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent 43275 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) 43276 Endoscopic retrograde cholangiopancreatography (ERCP); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and postdilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged 43277 Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct 43278 Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed 43453 Dilation of esophagus, over guide wire 44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 44361 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple 44363 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body(s) 44364 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 44365 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery 44366 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) 44369 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique 44370 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with transendoscopic stent placement (includes predilation) 44372 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with placement of percutaneous jejunostomy tube 44373 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube 44376 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 44377 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple 2017 Moderate Conscious Sedation Changes 44378 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) 44379 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with transendoscopic stent placement (includes predilation) 44380 Ileoscopy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 44381 Ileoscopy, through stoma; with transendoscopic balloon dilation 44382 Ileoscopy, through stoma; with biopsy, single or multiple 44384 Ileoscopy, through stoma; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) 44385 Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 44386 Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); with biopsy, single or multiple 44388 Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 44389 Colonoscopy through stoma; with biopsy, single or multiple 44390 Colonoscopy through stoma; with removal of foreign body(s) 44391 Colonoscopy through stoma; with control of bleeding, any method 44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 44394 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 44401 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) 44402 Colonoscopy through stoma; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) 44403 Colonoscopy through stoma; with endoscopic mucosal resection 44404 Colonoscopy through stoma; with directed submucosal injection(s), any substance 44405 Colonoscopy through stoma; with transendoscopic balloon dilation 44406 Colonoscopy through stoma; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures 44407 Colonoscopy through stoma; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures 44408 Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed 44500 Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure) 45303 Proctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire, bougie) 45305 Proctosigmoidoscopy, rigid; with biopsy, single or multiple 45307 Proctosigmoidoscopy, rigid; with removal of foreign body 45308 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery 45309 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique 45315 Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique 45317 Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) 2017 Moderate Conscious Sedation Changes45320 Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser) 45321 Proctosigmoidoscopy, rigid; with decompression of volvulus 45327 Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation) 45332 Sigmoidoscopy, flexible; with removal of foreign body(s) 45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 45334 Sigmoidoscopy, flexible; with control of bleeding, any method 45335 Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance 45337 Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed 45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 45340 Sigmoidoscopy, flexible; with transendoscopic balloon dilation 45341 Sigmoidoscopy, flexible; with endoscopic ultrasound examination 45342 Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) 45346 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 45347 Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) 45349 Sigmoidoscopy, flexible; with endoscopic mucosal resection 45350 Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 45379 Colonoscopy, flexible; with removal of foreign body(s) 45380 Colonoscopy, flexible; with biopsy, single or multiple 45381 Colonoscopy, flexible; with directed submucosal injection(s), any substance 45382 Colonoscopy, flexible; with control of bleeding, any method 45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 45386 Colonoscopy, flexible; with transendoscopic balloon dilation 45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 45389 Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed) 45390 Colonoscopy, flexible; with endoscopic mucosal resection 45391 Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures 45392 Colonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures 45393 Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed 45398 Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) 2017 Moderate Conscious Sedation Changes (continue reading below) 47000 Biopsy of liver, needle; percutaneous 47382 Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency 47383 Ablation, 1 or more liver tumor(s), percutaneous, cryoablation 47532 Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; new access (eg, percutaneous transhepatic cholangiogram) 47533 Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external 47534 Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-external 47535 Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation 47536 Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation 47541 Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation, new access 47542 Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure) 47543 Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (List separately in addition to code for primary procedure) 47544 Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) 49405 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous 49406 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous 49407 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, transvaginal or transrectal 49411 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple 49418 Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous 49440 Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report 49441 Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report 49442 Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report 49446 Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report 50200 Renal biopsy; percutaneous, by trocar or needle 50382 Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation 50384 Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation 50385 Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation 50386 Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation 50387 Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation 50430 Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access 50432 Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation 50433 Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access 50434 Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, via pre-existing nephrostomy tract 50592 Ablation, 1 or more renal tumor(s), percutaneous, unilateral, radiofrequency 50593 Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy 50606 Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) 50693 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy tract 50694 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter 50695 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, with separate nephrostomy catheter 50705 Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) 50706 Balloon dilation, ureteral stricture, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) 57155 Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy 66720 Ciliary body destruction; cryotherapy 69300 Otoplasty, protruding ear, with or without size reduction 77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based 77600 Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) 77605 Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) 77610 Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators 77615 Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators 92920 Percutaneous transluminal coronary angioplasty; single major coronary artery or branch 92921 Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) 92924 Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch 92925 Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) 92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch 92929 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) 92933 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch 92934 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) 92937 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel 92938 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure) 92941 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel 92943 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel 92944 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure) 92953 Temporary transcutaneous pacing 92960 Cardioversion, elective, electrical conversion of arrhythmia; external 92961 Cardioversion, elective, electrical conversion of arrhythmia; internal (separate procedure) 92973 Percutaneous transluminal coronary thrombectomy mechanical (List separately in addition to code for primary procedure) 92974 Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (List separately in addition to code for primary procedure) 92975 Thrombolysis, coronary; by intracoronary infusion, including selective coronary angiography 92986 Percutaneous balloon valvuloplasty; aortic valve 92987 Percutaneous balloon valvuloplasty; mitral valve 93312 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report 93313 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only 93314 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only 93315 Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report 93316 Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only 93317 Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only 93318 Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis 93451 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed 93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed 93453 Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed 93454 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation 93455 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography 93456 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization 93457 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization 93458 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed 93459 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography 2017 Moderate Conscious Sedation Changes (continue reading below) 93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed 93461 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography 93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) 93463 Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure) 93464 Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure) 93505 Endomyocardial biopsy 93530 Right heart catheterization, for congenital cardiac anomalies 93561 Indicator dilution studies such as dye or thermodilution, including arterial and/or venous catheterization; with cardiac output measurement (separate procedure) 93562 Indicator dilution studies such as dye or thermodilution, including arterial and/or venous catheterization; subsequent measurement of cardiac output 93563 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (List separately in addition to code for primary procedure) 93564 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (eg, internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure) 93565 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective left ventricular or left atrial angiography (List separately in addition to code for primary procedure) 93566 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure) 93567 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure) 93568 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for pulmonary angiography (List separately in addition to code for primary procedure) 93571 Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure) 93572 Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure) 93582 Percutaneous transcatheter closure of patent ductus arteriosus 93583 Percutaneous transcatheter septal reduction therapy (eg, alcohol septal ablation) including temporary pacemaker insertion when performed 93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure) 93613 Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure) 93615 Esophageal recording of atrial electrogram with or without ventricular electrogram(s) 93616 Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing 93618 Induction of arrhythmia by electrical pacing 93619 Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia 93620 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording 93621 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure) 93622 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure) 93624 Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia 2017 Moderate Conscious Sedation Changes (continue reading below) 93640 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement 93641 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator 93642 Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) 93644 Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) 93650 Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement 93653 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary), and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry 93654 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary), and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed 93655 Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure) 93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation 93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure) 94011 Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age 94012 Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age 94013 Measurement of lung volumes (ie, functional residual capacity [FRC], forced vital capacity [FVC], and expiratory reserve volume [ERV]) in an infant or child through 2 years of age Reference: 2017 CPT Codebook. CPT is a Trademark and owned by the American Medical Association 10 Common Reasons Claims Gets Denied and Rejected  (1) Incorrect demographic information (insurance ID , date of birth, even the gender!)
Always scan a copy of your patient's primary and secondary insurance card. Make sure to get a copy of their new card (if there is a change) (2) Patient's non-coverage or terminated coverage at the time of service may also be the reason of denial. That is why, it is very important that you check on your patient's benefits and eligibility before seeing the patient (unfortunately, I have seen practices who does not check benefits and eligibility on their patients so they end up being not paid for the service they have rendered for the patient (3) Coding Issues (requires 5th digit, outdated codes)--- be careful also with your secondary/additional codes! Claims may be denied even if the problem was just because of the secondary codes!Again as I previously pointed out with my other articles on tracking your claims, with this problem, discuss solving the coding error rather than how much you want to get reimbursed. Most of the insurance companies will help you with codes (in fairness!!) and they also inform you on outdated codes, or codes that requires a 5th digit. You can also clarify by asking them more information on their reimbursement and utilization guidelines (4) Improper use of modifiers (be careful with bilateral procedures!, modifiers for professional and technical component, modifiers for multiple procedures, postoperative period, etc.) (5) No precertification or preauthorization obtained. It is so hard to file an appeal when the claim or service was non-precertified. Avoid this from happening! So be careful with your Surgical Procedures, Therapy Services and DME Services. (6) No referral on file. HMOs or the Managed Care normally requires a referral! (remember that!). Most Therapy Services would require a an order or script from the referring provider. Make sure the referring provider's NPI appears on Box 17 on your HCFA 1500 Claim Form (7) The patient has other primary insurance, the patient turn out to be a Workman's Comp case or an MVA case. Call our office, we can give you an example of our template of benefits eligibility verification. Remember, WC/MVA cases services are normally always require Prior Auth so make sure you have the claim information, connect with the Adjustor and the Nurse Case Manager (8) Claim requires documentation, require additional notes to support medical necessity. A well documented medical records is a good practice! (9) Claim requires referring physician's information (very common for Therapy Services and DME Billing requirements) (10) Untimely filing. So how can you prove that you did submit the claims in a timely manner? When unfortunately, most of the insurances does not accept your billing records on your practice management software that shows that date(s) you billed the insurance! They want a receipt from your electronic receipt or for postal mail, obviously they want a receipt too! a tracking number maybe? certified letter receipt? If you are submitting claims by electronic, make sure you generate transmission reports/receipts. Your reports must read "accepted" or "in process" and not "rejected". If you are sending claims by paper or postal mail, it is a good idea to send your claims as certified mail with tracking number, keep your transmission receipts! Need our professional consulting advise to run a more efficient Revenue Cycle Management? - call and talk to us at 609-481-3494 |
ABOUT THE AUTHOR:
Ms. Pinky Maniri-Pescasio is the CEO and Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Consultant. Archives
February 2018
Categories
All
|
RSS Feed