Drive down coding related denials
S.no | CPT code | Description |
---|---|---|
1 | 33370 | Transcatheter placement and subsequent removal of cerebral embolic protection device(s), including arterial access, catheterization, imaging, and radiological supervision and interpretation, percutaneous (List separately in addition to code for primary procedure) |
2 | 33894 | Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches |
3 | 33895 | Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; not crossing major side branches |
4 | 33897 | Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta |
5 | 93319 | 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echocardiographic imaging) |
6 | 93593 | Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections |
7 | 93594 | Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; abnormal native connections |
8 | 93595 | Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections |
9 | 93596 | Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections |
10 | 93597 | Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); abnormal native connections |
11 | 93598 | Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure) |
12 | 93653 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; 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 |
13 | 93654 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of ventricular tachycardia or focus of ventricular ectopy including left ventricular pacing and recording, when performed |
14 | 93656 | Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, right ventricular pacing/ recording, and His bundle recording, when performed |
15 | 0623T | Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; data preparation and transmission, computerized analysis of data, with review of computerized analysis output to reconcile discordant data, interpretation and report |
16 | 0545T | Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach |
17 | 0643T | Transcatheter left ventricular restoration device implantation including right and left heart catheterization and left ventriculography when performed, arterial approach |
18 | 0645T | Transcatheter implantation of coronary sinus reduction device including vascular access and closure, right heart catheterization, venous angiography, coronary sinus angiography, imaging guidance, and supervision and interpretation, when performed |
19 | 0646T | Transcatheter tricuspid valve implantation (TTVI)/replacement (TTVI) with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, when performed |
20 | 0650T | Programming device evaluation (remote) of subcutaneous cardiac rhythm monitor system, with iterative adjustment of the implantable device to test the function of the device and select optimal permanently programmed values with analysis, review and report by a physician or other qualified health care professional |
21 | 0692T | Therapeutic ultrafiltration |
22 | 0695T | Body surface–activation mapping of pacemaker or pacing cardioverter-defibrillator lead(s) to optimize electrical synchrony, cardiac resynchronization therapy device, including connection, recording, disconnection, review, and report; at time of implant or replacement |
23 | 0696T | Body surface–activation mapping of pacemaker or pacing cardioverter-defibrillator lead(s) to optimize electrical synchrony, cardiac resynchronization therapy device, including connection, recording, disconnection, review, and report; at time of follow-up interrogation or programming device evaluation |
24 | 0710T | Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; including data preparation and transmission, quantification of the structure and composition of the vessel wall and assessment for lipid-rich necrotic core plaque to assess atherosclerotic plaque stability, data review, interpretation and report |
25 | 0711T | Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; data preparation and transmission |
26 | 0712T | Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; quantification of the structure and composition of the vessel wall and assessment for lipid-rich necrotic core plaque to assess atherosclerotic plaque stability |
27 | 0713T | Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; data review, interpretation and report |
S.no | CPT code | Anatomical Area |
---|---|---|
1 | 00100-00222 | Head |
2 | 00300-00352 | Neck |
3 | 00400-00474 | Thorax (chest wall and shoulder girdle) |
4 | 00500-00580 | Intrathoracic |
5 | 00600-00670 | Spine and Spinal Cord |
6 | 00700-00797 | Upper Abdomen |
7 | 00800-00882 | Lower Abdomen |
8 | 00902-00952 | Perineum |
9 | 01112-01173 | Pelvis (except hip) |
10 | 01200-01274 | Upper Leg (except knee) |
11 | 01320-01444 | Knee and Popliteal Area |
12 | 01462-01522 | Lower Leg (below knee, including ankle and foot) |
13 | 01610-01680 | Shoulder and Axilla |
14 | 01710-01782 | Upper Arm and Elbow |
15 | 01810-01860 | Forearm, Wrist and Hand |
16 | 01916-01942 | Radiological Procedure |
17 | 01951-01953 | Burn Excisions or Debridement |
18 | 01958-01969 | Obstetric |
19 | 01990-01999 | Other Procedure |
S.no | CPT and HCPCS codes | Description |
---|---|---|
1 | 99446 | Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review |
2 | 99447 | 11-20 minutes of medical consultative discussion and review |
3 | 99448 | 21-30 minutes of medical consultative discussion and review |
4 | 99449 | 31 minutes or more of medical consultative discussion and review |
5 | 99451 | Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 or more minutes of medical consultative time |
6 | 99452 | Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional, 30 minutes |
7 | 11102 | Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion |
8 | 11103 | each separate/additional lesion (List separately in addition to code for primary procedure) |
9 | 11104 | Punch biopsy of skin (including simple closure, when performed) single lesion |
10 | 11105 | each separate/additional lesion (List separately in addition to code for primary procedure |
11 | 11106 | incisional biopsy of skin (e.g., wedge) (including simple closure, when performed) single lesion |
12 | 11107 | each separate/additional lesion (List separately in addition to code for primary procedure |
S.no | CPT and HCPCS codes | Description |
---|---|---|
1 | 99201 | New patient – Problem Focused |
2 | 99202 | New patient- Expanded Problem Focused |
3 | 99211 | Office or other outpatient visits for the evaluation and management of an established patient that may not require the presence of a physician |
4 | 99212 | Established patient office or other outpatient visits, 10-19 minutes. |
5 | 99203 | New patient – Detailed |
6 | 99213 | Established patient office or other outpatient visits, 20-29 minutes. |
7 | 99204 | New patient – Moderate Complexity |
8 | 99205 | New patient – High Complexity |
9 | 99214 | Established patient office or other outpatient visits, 30-39 minutes. |
10 | 99215 | Office or other outpatient visits for the evaluation and management of an established patient that may not require the presence of a physician |
S.no | CPT and HCPCS codes | Description |
---|---|---|
1 | G6001 | Ultrasonic guidance for placement of radiation therapy fields |
2 | 77014 | Computed tomography guidance for placement of radiation therapy fields |
3 | G6002 | Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy |
4 | G6017 | Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy(e.g.,3-D positional tracking, gating, 3-D surface tracking), each fraction of treatment |
5 | 76370 / 77014 (deleted/current) | Computerized axial tomography guidance for placement of radiation therapy fields |
6 | 76375/ 76376 (deleted/current) | Coronal, sagittal, multiplanar, oblique, three-dimensional and/or holographic reconstruction of computerized axial tomography, magnetic resonance imaging, or other tomography modality |
7 | 77295 | Therapeutic radiology simulation-aided field setting; Three-dimensional simulation |
8 | 77331 | Special radiation dosimetry |
9 | 77280 | Therapeutic radiology simulation-aided field setting, simple |
10 | 77285 | Therapeutic radiology simulation-aided field setting, intermediate |
11 | 77290 | Therapeutic radiology simulation-aided field setting, complex |
S.no | CPT, HCPCS and Diagnosis codes | Description |
---|---|---|
1 | 11055 | Trim skin lesion |
2 | 11056 | Trim skin lesions 2 to 4 |
3 | 11057 | Trim skin lesions over 4 |
4 | 11719 | Trim nail(s) any number |
5 | 11720 | Debride nail 1-5 |
6 | 11721 | Debride nail 6 or more |
7 | G0127 | Trim nail(s) |
8 | L03.039 | Cellulitis of unspecified toe |
9 | L03.049 | Acute lymphangitis of unspecified toe |
10 | L60.0 | Ingrowing nail |
11 | M79.609 | Pain in unspecified limb |
12 | R26.0 | Ataxic gait |
13 | R26.1 | Paralytic gait |
14 | R26.2 | Difficulty in walking, not elsewhere classified |
15 | R26.89 | Other abnormalities of gait and mobility |
16 | R26.9 | Unspecified abnormalities of gait and mobility |
S.no | CPT, HCPCS codes | Description |
---|---|---|
1 | 29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair |
2 | 29888 | Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction |
3 | 23412 | Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic |
4 | 29806 | Arthroscopy, shoulder, surgical; capsulorrhaphy |
5 | 29807 | Arthroscopy, shoulder, surgical; repair of slap lesion |
6 | 29882 | Arthroscopy, knee, surgical; with meniscus repair (medial or lateral) |
7 | 25606 | Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation |
8 | 23410 | Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute |
9 | 26615 | Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone |
10 | 25609 | Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments |
11 | 27792 | Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed |
12 | 25607 | Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation |
13 | 23515 | Open treatment of clavicular fracture, includes internal fixation, when performed |
14 | 25608 | Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments |
15 | 27814 | Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed |
16 | 27130 | Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft |
17 | 27447 | Arthroplasty, knee, condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty) |
S.no | CPT, HCPCS codes | Description |
---|---|---|
1 | 59400 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care |
2 | 59409 | Vaginal delivery only (with or without episiotomy and/or forceps) |
3 | 59410 | Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care |
4 | E/M | Antepartum care only; 1-3 visits |
5 | 59425 | Antepartum care only; 4-6 visits |
6 | 59426 | Antepartum care only; 7 or more visits |
7 | 59430 | Postpartum care only (separate procedure) |
8 | 59510 | Routine obstetric care including antepartum care, cesarean delivery, and postpartum care |
9 | 59514 | Cesarean delivery only; |
10 | 59515 | Cesarean delivery only; including postpartum care |
11 | 59610 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery |
12 | 59612 | Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); |
13 | 59614 | Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care |
14 | 59618 | Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery |
15 | 59620 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; |
16 | 59622 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care |
S.no | CPT, HCPCS codes | Description |
---|---|---|
1 | 50010-50593 | Surgical procedures on the kidney |
2 | 50600-50980 | Surgical procedures on the Ureter |
3 | 51020- 52700 | Surgical procedures on the bladder |
4 | 53000-53800 | Surgical procedures on the urethra |
5 | 54340 | repair of hypospadias complication(s) (eg, fistula, stricture, diverticula); by closure, incision, or excision, simple |
6 | 54344 | requiring mobilization of skin flaps and urethroplasty with flap or patch graft |
7 | 54348 | requiring extensive dissection and urethroplasty with flap, patch, or tubed graft, including urinary diversion, when performed |
8 | 54352 | revision of prior hypospadias repair requiring extensive dissection and excision of previously constructed structures including re-release of chordee and reconstruction of urethra and skin brought in as flaps or grafts. |
9 | 0672T | endovaginal cryogen-cooled, monopolar radiofrequency remodeling of the tissues surrounding the female bladder neck and proximal urethra for urinary incontinence |
S.no | CPT, HCPCS codes | Description |
---|---|---|
1 | 11200 - 11201 | Removal of skin tags |
2 | 11300 - 11313 | Shaving of lesions |
3 | 11400 - 11471 | Excision of lesions |
4 | 11600 - 11646 | Excision of lesions |
5 | 12001 - 12018 | Repair - simple |
6 | 12020 - 12021 | Treatment of wound dehiscence |
7 | 12031 - 12057 | Repair - intermediate |
8 | 13100 – 13160 | Repair - complex |
9 | 11719 – 11762 | Trimming, debridement and excision of nails |
10 | 11765 | Wedge excision |
11 | 11770 – 11772 | Excision of pilonidal cysts |
S.no | CPT, HCPCS codes | Description |
---|---|---|
1 | 98940 | Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions |
2 | 98941 | Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions |
3 | 98942 | Chiropractic manipulative treatment (CMT); Spinal, 5 regions |
4 | 98943 | Chiropractic manipulative treatment (CMT); Extraspinal, 1 or more regions |
5 | 99203 - 99204 | Evaluation and Management, Initial Visit |
6 | 99212 - 99214 | Evaluation and Management, Established Patient |
7 | 97140 | Manual Therapy |
8 | 97110 | Therapeutic Exercise |
9 | 97750 | Physical Performance Examination |
S.no | CPT and HCPCS codes | Description |
---|---|---|
1 | CPT 99281Type A: APC 609Type B: APC 626HCPCS: G0380 | Initial Assessment No medication or treatments Rx refill only, asymptomatic Note for Work or School Wound recheck Booster or follow up immunization, no acute injury Dressing changes (uncomplicated) Suture removal (uncomplicated) Discussion of Discharge Instructions (Straightforward) |
2 | CPT 99282 Type A: APC 613Type B: APC 627HCPCS: G0381 | Could include interventions from previous levels, plus any of: Tests by ED Staff (Urine dip, stool hemoccult, Accucheck or Dextrostix) Visual Acuity (Snellen) Obtain clean catch urine Apply ace wrap or sling Prep or assist w/ procedures such as: minor laceration repair, I&D of simple abscess, etc. Discussion of Discharge Instructions (Simple) |
3 | CPT 99283 Type A: APC 614Type B: APC 628HCPCS: G0382 | Could include interventions from previous levels, plus any of: Receipt of EMS/Ambulance patient Heparin/saline lock (1) Nebulizer treatment Preparation for lab tests described in CPT (80048-87999 codes)Preparation for EKG Preparation for plain X-rays of only 1 area (hand, shoulder, pelvis, etc.) Prescription medications administered PO Foley catheters; In & Out caths C-Spine precautions Fluorescein stain Emesis/ Incontinence care Prep or assist w/procedures such as: joint aspiration/injection, simple fracture care etc. Mental Health-anxious, simple treatment Routine psych medical clearance Limited social worker intervention Post mortem care Direct Admit via ED Discussion of Discharge Instructions (Moderate Complexity) |
4 | CPT 99284 Type A: APC 615Type B: APC 629HCPCS: G0383 | Could include interventions from previous levels, plus any of: Preparation for 2 diagnostic tests2: (Labs, EKG, X-ray) Prep for plain X-ray (multiple body areas): C-spine & foot, shoulder & pelvis Prep for special imaging study (CT, MRI, Ultrasound,VQ scans) Cardiac Monitoring (2) Nebulizer treatments Port-a-cath venous access Administration and Monitoring of infusions or parenteral medications (IV, IM, IO, SC) NG/PEG Tube Placement/Replacement Multiple reassessments Prep or assist w/procedures such as: eye irrigation with Morgan lens, bladder irrigation with 3-way foley, pelvic exam, etc. Sexual Assault Exam w/ out specimen collection Psychotic patient; not suicidal Discussion of Discharge Instructions (Complex) |
5 | CPT 99285 Type A: APC 616Type B: APC 630 HCPCS: G0384 | Could include interventions from previous levels, plus any of: Requires frequent monitoring of multiple vital signs (ie. 02 sat, BP, cardiac rhythm, respiratory rate) Preparation for ≥ 3 diagnostic tests2: (Labs, EKG, X-ray) Prep for special imaging study (CT, MRI, Ultrasound, VQ scan) combined with multiple tests or parenteral medication or oral or IV contrast. Administration of Blood Transfusion/Blood Products Oxygen via face mask or NRB Multiple Nebulizer Treatments: (3) or more (if nebulizer is continuous, each 20 minute period is considered treatment) Moderate Sedation Prep or assist with procedures such as: central line insertion, gastric lavage, LP, paracentesis,etc. Cooling or heating blanket Extended Social Worker intervention Sexual Assault Exam w/ specimen collection by ED staff Coordination of hospital admission/ transfer or change in living situation or site Physical/Chemical Restraints; Suicide Watch Critical Care less than 30 minutes |
6 | CPT 99291 Type A: APC 617 | Could include interventions from previous levels, plus any or all of: Multiple parenteral medications requiring constant monitoring Provision of any of the following: Major Trauma care/ multiple surgical consultants Chest tube insertion Major burn care Treatment of active chest pain in ACS Administration of IV vasoactive meds (see guidelines) CPR Defibrillation/ Cardioversion Pericardiocentesis Administration of ACLS Drugs in cardiac arrest Therapeutic hypothermia Bi-PAP/ CPAP Endotracheal intubation Cricothyrotomy Ventilator management Arterial line placement Control of major hemorrhage Pacemaker insertion through a Central Line Delivery of baby |
7 | CPT 99292 | As above in additional 30 minute increments. Record the TOTAL critical care time. The first 30-74 minutes equal code 99291. If used, additional 30 minute increments (beyond the first 74 minutes) are coded 99292. Medicare does not pay for code 99292 because it is considered packaged into 99291; however the services should be reported as appropriate. |
8 | Critical Care with Trauma Team ActivationAPC 618G0390 | In addition to 99291, designated trauma centers may report the Trauma Team Activation code G0390 when a trauma team was activated and all other trauma activation criteria are met. |
S.no | CPT and HCPCS codes | Description |
---|---|---|
1 | 43217 | Esphgsc rgd/flx w/rmvl tum snare tq |
2 | 43235 | Upper stomach-intestine scope for diagnosis |
3 | 43239 | Upper stomach-intestine scope for biopsy |
4 | 43244 | Upr gi ndsc band lig esophgl&/gstr varc |
5 | 43246 | Upr gi ndsc dired plmt prq gastrostomy tube |
6 | 43247 | Stomach-intestine scope for foreign body removal |
7 | 43248 | Upr gi ndsc insj gd wire dilat esoph > gd wire |
8 | 43249 | Upr gi ndsc balo dilat esoph < 30 mm diam |
9 | 43250 | Upr gi ndsc rmvl les hot bx/bipolar caut |
10 | 43251 | Upr gi ndsc rmvl tum polyp/oth les snare tq |
11 | 43255 | Upr gi ndsc ctrl bld any meth |
12 | 43256 | Upr gi ndsc tndsc stent plmt w/predilat |
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