Spinal x-ray of lower and sacral spine (minimum of 4 views) [HCPCS 72110]

A radiologic exam is done of the lumbosacral spine. Frontal, posteroanterior, and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

Total Knee or Hip Replacement

Abdominal and pelvic CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74177]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

Abdominal ultrasound (complete) [HCPCS 76700]

A real time abdominal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained. The ultrasonic wave pulses directed at the abdomen are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the abdomen and provides a written interpretation.

Anesthetic agent and/or steroid injection into lower or sacral spine nerve root with imaging guidance (single level) [HCPCS 64483]

Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion [HCPCS 66984]

Cervical spinal fusion without complications

Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]

A flexible colonoscopy is performed with single or multiple biopsies. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Any suspect site(s) to be biopsied is identified and biopsy forceps are placed through the biopsy channel in the endoscope. The forceps are opened, the tissue is spiked, and the forceps are closed. The biopsied tissue is then removed through the endoscope. One or more tissue samples may be obtained and are sent for separately reportable laboratory analysis.

Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]

A flexible colonoscopy is performed with removal of tumors, polyps, or other lesions by hot biopsy forceps or snare technique. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The tumor, polyp, or other lesion is identified. Hot biopsy method uses insulated monopolar forceps to remove and electrocoagulate (cauterize) tissue simultaneously. Hot biopsy forceps are used primarily for removal of small polyps and treatment of vascular ectasias. A wire snare loop is placed around the lesion. The loop is heated to shave off and cauterize the lesion. Lesions may be removed en bloc with one placement of the snare or in a piecemeal fashion which requires multiple applications of the snare. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, bleeding sites, lesions, strictures, or other abnormalities.

Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]

A flexible colonoscopy is performed with or without collection of specimens by brushing or washing. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn as mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology (cell) samples may be obtained using a brush introduced through the endoscope. Alternatively, sterile water may be introduced to wash the mucosal lining and the fluid aspirated to obtain cell samples. Cytology samples are sent for separately reportable laboratory analysis.

Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]

An upper gastrointestinal (UGI) endoscopic examination, also referred to as an esophagogastroduodenoscopy (EGD), is performed on the esophagus, stomach, duodenum and/or jejunum with biopsy(s). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum where mucosal surfaces are inspected for any abnormalities. Single or multiple samples of suspect tissue are taken through the scope. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities.

Gallbladder removal with an endoscope [HCPCS 47562]

The gallbladder is removed by laparoscopic technique. A small portal incision is made at the navel and a trocar is inserted. The scope and video camera are then inserted at this site. The abdomen is inflated with carbon dioxide. Two to three additional abdominal portal incisions are made and trocars are inserted for placing surgical instruments. The gallbladder is identified. If the gallbladder is distended, a needle may be used to drain bile from the gallbladder. Grasper clamps are applied. The Hartmann's pouch is identified and retracted, exposing the triangle of Calot. The cystic artery and cystic duct are identified. The cystic duct is dissected free and transected. The cystic artery is dissected free, ligated, and doubly divided. Electrocautery is used to dissect the gallbladder off the liver bed. The gallbladder is placed in an extraction sac and removed from the abdomen through one of the small incisions.

Groin hernia repair for patient 5 years of age or older (herniated tissue that is not trapped) [HCPCS 49505]

An initial inguinal hernia repair is performed on a patient who is five years or older. An inguinal hernia is a condition where structures protrude through a weakness in the abdominal wall in the groin area. Incarcerated hernia tissue cannot be pushed back into its normal position. Strangulated hernias are those in which circulation is compromised. An incision is made over the internal ring. The skin, fat, and subcutaneous fascia are incised down to the aponeurosis of the external oblique muscle. The external ring is identified and the external oblique aponeurosis is slit. The internal ring is opened and the inguinal canal is exposed. In males, the spermatic cord and its covering are mobilized and the covering is removed. The hernia sac is dissected free into the retroperitoneum, opened, and inspected for the presence of bowel or bladder wall. Any bowel or bladder content is reduced (pushed back into the abdominal cavity) and the hernia sac is transected and inverted into the abdominal cavity. A mesh plug may be placed to reinforce the repair. In women, the sac is inspected for the ovary. If the ovary is present, it is returned to the abdomen. The sac is then resected together with the round ligament. The internal ring is closed and the posterior wall of the inguinal canal is repaired.

Head or brain CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70450]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the head or brain is performed. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

Imaging of brain by MRI without contrast, followed by contrast [HCPCS 70553]

Magnetic resonance imaging is done on the brain. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. MRI of the brain provides reliable information for diagnosing the presence, location, and extent of tumors, cysts, or other masses; swelling and infection; vascular disorders or malformations, such as aneurysms and intracranial hemorrhage; disease of the pituitary gland; stroke; developmental and structural anomalies of the brain; hydrocephalus; and chronic conditions and diseases affecting the central nervous system such as headaches and multiple sclerosis.

Imaging of leg joint by MRI without contrast [HCPCS 73721]

Magnetic resonance imaging is done on a joint of the upper or lower leg. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the joint. MRI scans on joints of the lower extremity are often done for injury, trauma, unexplained pain, redness, or swelling, and freezing of a joint with loss of motion. MRI scans provide clear images of areas that may be difficult to see on CT. The physician reviews the images to look for information that may correlate to the patient's signs or symptoms. MRI provides reliable information on the presence and extent of tumors, masses, or lesions within the joint; infection, inflammation, and swelling of soft tissue; muscle atrophy and other anomalous muscular development; and joint effusion and vascular necrosis.

Imaging of lower spinal canal by MRI without contrast [HCPCS 72148]

Magnetic resonance imaging (MRI) is done on the lumbar spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and coverts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back pain is unsuccessful and more aggressive treatments are considered or following surgery. The physician reviews the images to look for specific information that may correlate to the patient's symptoms, such as abnormal spinal alignment; disease or injury of vertebral bodies; intervertebral disc herniation, degeneration, or dehydration; the size of the spinal canal to accommodate the cord and nerve roots; pinched or inflamed nerves; or any changes since surgery.

Imaging of pelvis by ultrasound through vagina [HCPCS 76830]

A transvaginal ultrasound is performed to evaluate the non-pregnant uterus and other pelvic structures. Conditions that may be evaluated by transvaginal ultrasound include infertility, abnormal bleeding, unexplained pain, congenital anomalies of the ovaries and uterus, ovarian cysts and tumors, pelvic inflammatory disease, bladder abnormalities, and intrauterine device (IUD) location. The patient is asked to empty the bladder and then lies back with the feet in stirrups. A protective cover is placed over the transducer and acoustic coupling gel is applied. The transducer is inserted into the vagina. Images of the uterus, ovaries, and surrounding pelvic structures are obtained from different orientations of the transducer. The ultrasonic wave pulses directed at the pelvic structures are imaged by recording the ultrasound echoes. The uterus is examined and endometrial thickness is determined. The ovaries are examined and any ovarian masses are carefully evaluated. The bladder and other pelvic structures are examined and any abnormalities are noted. The physician reviews the transvaginal ultrasound images and provides a written interpretation.

Knee cartilage removal with endoscope (one knee) [HCPCS 29881]

Lab analysis of urine specimen by dipstick with microscope (automated) [HCPCS 81001]

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Lab analysis of urine specimen by dipstick without microscope (automated) [HCPCS 81003]

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Lab analysis to evaluate kidney function via a blood test panel [HCPCS 80069]

A renal panel is obtained for routine health screening and to monitor conditions such as diabetes, renal disease, liver disease, nutritional disorders, thyroid and parathyroid function, and interventional drug therapies. Tests in a renal panel include glucose or blood sugar; electrolytes and minerals as sodium, potassium, chloride, total calcium, and phosphorus; the waste products blood urea nitrogen (BUN) and creatinine; a protein called albumin; and bicarbonate (carbon dioxide, CO2) responsible for acid base balance. Glucose is the main source of energy for the body and is regulated by insulin. High levels may indicate diabetes or impaired kidney function. Sodium is found primarily outside cells and maintains water balance in the tissues, as well as nerve and muscle function. Potassium is primarily found inside cells and affects heart rhythm, cell metabolism, and muscle function. Chloride moves freely in and out of cells to regulate fluid levels and help maintain electrical neutrality. Calcium is needed to support metabolic processes, heart and nerve function, muscle contraction, and blood clotting. Phosphorus is essential for energy production, nerve and muscle function, and bone growth. Blood urea nitrogen (BUN) and creatinine are waste products from tissue breakdown that circulate in the blood and are filtered out by the kidneys. Albumin, a protein made by the liver, helps to nourish tissue and transport hormones, vitamins, drugs, and calcium throughout the body. Bicarbonate (HCO3) may also be referred to as carbon dioxide (CO2) maintains body pH or the acid/base balance. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative chemiluminescent immunoassay or quantitative enzyme-linked immunosorbent assay.

Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]

Prothrombin time (PT) measures how long it takes for blood to clot. Prothrombin, also called factor II, is one of the clotting factors made by the liver and adequate levels of vitamin K are needed for the liver to produce sufficient prothrombin. Prothrombin time is used to help identify the cause of abnormal bleeding or bruising; to check whether blood thinning medication, such as warfarin (Coumadin), is working; to check for low levels of blood clotting factors I, II, V, VII, and X; to check for low levels of vitamin K; to check liver function, to see how quickly the body is using up its clotting factors. The test is performed using electromagnetic mechanical clot detection. If prothrombin time is elevated and the patient is not on a blood thinning medication, a second prothrombin time using substitution plasma fractions, also referred to as a prothrombin time mixing study, may be performed. This is performed by mixing patient plasma with normal plasma using a 1:1 mix. The mixture is incubated and the clotting time is again measured. If the result does not correct, it may be indicative that the patient has an inhibitor, such as lupus anticoagulant. If the result does correct, the patient may have a coagulation factor deficiency.

Lab analysis to identify the thyroid stimulating hormone (tsh) in blood specimen [HCPCS 84443]

A blood test is performed to determine levels of thyroid stimulating hormone (TSH). TSH is produced in the pituitary and helps to regulate two other thyroid hormones, triiodothyronine (T3) and thyroxin (T4), which in turn help regulate the body's metabolic processes. TSH levels are tested to determine whether the thyroid is functioning properly. Patients with symptoms of weight gain, tiredness, dry skin, constipation, or menstrual irregularities may have an underactive thyroid (hypothyroidism). Patients with symptoms of weight loss, rapid heart rate, nervousness, diarrhea, feeling of being too hot, or menstrual irregularities may have an overactive thyroid (hypothyroidism). TSH levels are also periodically tested in individuals on thyroid medications. The test is performed by electrochemiluminescent immunoassay.

Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]

This test may also be referred to as an activated PTT or aPTT. PTT may be performed to diagnose the cause of bleeding or as a screening test prior to surgery to rule-out coagulation defects. A silica and synthetic phospholipid PTT reagent is mixed with the patient plasma. The silica provides a negatively-charged particulate surface that activates the contact pathway for coagulation. Clot formation is initiated by adding calcium chloride to the mixture. Clotting time is measured photo-optically.

Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test [HCPCS 85027]

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test and automated differential white blood cell count [HCPCS 85025]

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Lab analysis to measure the amount of albumin, total and direct bilirubin, alkaline phosphatase, total protein, alanine amino transferase, and asparate amino transferase in blood specimen to evaluate liver function [HCPCS 800

A hepatic function panel is obtained to diagnose acute and chronic liver disease, inflammation, or scarring and to monitor hepatic function while taking certain medications. Tests in a hepatic function panel should include albumin (ALB), total and direct bilirubin, alkaline phosphatase (ALP), total protein (TP), alanine aminotransferase (ALT, SGPT), and aspartate aminotransferase (AST, SGOT). Albumin (ALB) is a protein made by the liver that helps to nourish tissue and transport hormones, vitamins, drugs, and calcium throughout the body. Bilirubin, a waste product from the breakdown of red blood cells, is removed by the liver in a conjugated state. Bilirubin is measured as total (all the bilirubin circulating in the blood) and direct (the conjugated amount only) to determine how well the liver is performing. Alkaline phosphatase (ALP) is an enzyme produced by the liver and other organs of the body. In the liver, cells along the bile duct produce ALP. Blockage of these ducts can cause elevated levels of ALP, whereas cirrhosis, cancer, and toxic drugs will decrease ALP levels. Circulating blood proteins include albumin (60% of total) and globulins (40% of total). By measuring total protein (TP) and albumin (ALB), the albumin/globulin (A/G) ratio can be determined and monitored. TP may decrease with malnutrition, congestive heart failure, hepatic disease, and renal disease and increase with inflammation and dehydration. Alanine aminotransferase (ALT, SGPT) is an enzyme produced primarily in the liver and kidneys. In healthy individuals ALT is normally low. ALT is released when the liver is damaged, especially with exposure to toxic substances such as drugs and alcohol. Aspartate aminotransferase (AST, SGOT) is an enzyme produced by the liver, heart, kidneys, and muscles. In healthy individuals AST is normally low. An AST/ALT ratio is often performed to determine if elevated levels are due to liver injury or damage to the heart or skeletal muscles. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method or quantitative spectrophotometry.

Lab analysis to measure the amount of free PSA (prostate specific antigen) in serum specimen [HCPCS 84154]

Prostate specific antigen (PSA) is measured. PSA is a protein produced by normal prostate cells found in serum and exists in both free form and complexed with other proteins. In 84154, free PSA is measured, often in conjunction with total PSA, to provide an indirect measurement of complexed PSA.

Lab analysis to measure the amount of lipids (cholesterol and triglycerides) in blood specimen [HCPCS 80061]

"A lipid panel is obtained to assess the risk for cardiovascular disease and to monitor appropriate treatment. Lipids are comprised of cholesterol, protein, and triglycerides. They are stored in cells and circulate in the blood. Lipids are important for cell health and as an energy source. A lipid panel should include a measurement of triglycerides and total serum cholesterol and then calculate to find the measurement of high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and very low density lipoprotein (VLDL-C). HDL contains the highest ratio of cholesterol and is often referred to as ""good cholesterol"" because it is capable of transporting excess cholesterol in the blood to the liver for removal. LDL contains the highest ratio of protein and is considered ""bad cholesterol"" because it transports and deposits cholesterol in the walls of blood vessels. VLDL contains the highest ratio of triglycerides and high levels are also considered ""bad"" because it converts to LDL after depositing triglyceride molecules in the walls of blood vessels. A blood sample is obtained by separately reportable venipuncture or finger stick. Serum/plasma is tested using quantitative enzymatic method."

Lab analysis to measure the amount of total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN) in blood specimen [HCPCS 80048]

A basic metabolic blood panel is obtained that includes ionized calcium levels along with carbon dioxide (bicarbonate) (CO2), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN). A basic metabolic panel with measurement of ionized calcium may be used to screen for or monitor overall metabolic function or identify imbalances. Ionized or free calcium flows freely in the blood, is not attached to any proteins, and represents the amount of calcium available to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Total carbon dioxide (bicarbonate) (CO2) level is composed of CO2, bicarbonate (HCO3-), and carbonic acid (H2CO3) with the primary constituent being bicarbonate, a negatively charged electrolyte that works in conjunction with other electrolytes, such as potassium, sodium, and chloride, to maintain proper acid-base balance and electrical neutrality at the cellular level. Chloride is also a negatively charged electrolyte that helps regulate body fluid and maintain proper acid-base balance. Creatinine is a waste product excreted by the kidneys that is produced in the muscles while breaking down creatine, a compound used by the muscles to create energy. Blood levels of creatinine provide a good measurement of renal function. Glucose is a simple sugar and the main source of energy for the body, regulated by insulin. When more glucose is available than is required, it is stored in the liver as glycogen or stored in adipose tissue as fat. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly. Both potassium and sodium are positively charged electrolytes that work in conjunction with other electrolytes to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance and both are essential for maintaining normal metabolic processes. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea is taken up by the kidneys and excreted in the urine. Blood urea nitrogen, BUN, is a measure of renal function, and helps monitor renal disease and the effectiveness of dialysis.

Lab analysis to measure the amount of total PSA (prostate specific antigen) in serum specimen [HCPCS 84153]

Prostate specific antigen (PSA) is measured. PSA is a protein produced by normal prostate cells found in serum and exists in both free form and complexed with other proteins. Total PSA is measured ad the total amount of both free and complexed forms. Total PSA levels are higher in men with benign prostatic hyperplasia (BPH), acute bacterial prostatitis, or prostate cancer. Total PSA is used to screen for prostate cancer and evaluate the response to treatment in those with prostate cancer, but cannot be used by itself to definitively diagnose prostate cancer.

Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]

A comprehensive metabolic panel is obtained that includes albumin, bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, alanine amino transferase (ALT) (SGPT), aspartate amino transferase (AST) (SGOT), and urea nitrogen (BUN). This test is used to evaluate electrolytes and fluid balance as well as liver and kidney function. It is also used to help rule out conditions such as diabetes. Tests related to electrolytes and fluid balance include: carbon dioxide, chloride, potassium, and sodium. Tests specific to liver function include: albumin, bilirubin, alkaline phosphatase, ALT, AST, and total protein. Tests specific to kidney function include: BUN and creatinine. Calcium is needed to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Glucose is the main source of energy for the body and is regulated by insulin. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly.

Mammography of both breasts (screening exam) [HCPCS 77067]

Bilateral screening mammography is done with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength than those typically used for bone imaging. A screening mammogram is done on asymptomatic women for early breast cancer detection when there are no known palpable masses. This is done on both breasts with two views taken on each side. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Mammography of both breasts for diagnosis [HCPCS 77066]

These codes report diagnostic mammography of one breast or both breasts with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength that those typically used for bone imaging. The test is done to detect tumors or cysts in women who have symptoms of breast disease or a palpable mass. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Mammography of one breast for diagnosis [HCPCS 77065]

These codes report diagnostic mammography of one breast or both breasts with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength that those typically used for bone imaging. The test is done to detect tumors or cysts in women who have symptoms of breast disease or a palpable mass. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Pelvis CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 72193]

Diagnostic computed tomography (CT) is done on the pelvis to provide detailed visualization of the organs and structures within or near the pelvis, such as kidneys, bladder, prostate, uterus, cervix, vagina, lymph nodes, and pelvic bones. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of organs within the pelvis can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the pelvis area. The physician reviews the images to gather information for specified purposes such as diagnosing or monitoring cancer, evaluating the pelvic bones for fractures or other injury following trauma, locating abscesses or masses found during physical exam, finding the cause of pelvic pain, providing more detailed information before surgery, and evaluating the patient after surgery.

Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]

Therapeutic exercise is the application of careful, graduated force to the body to increase strength, endurance, range of motion, and flexibility. Increased muscle strength is achieved by the deliberate overloading of a targeted muscle or muscle group and improved endurance is achieved by raising the intensity of the strengthening exercise to the targeted area(s) over a prolonged period of time. To maintain range of motion (ROM) and flexibility requires the careful movement and stretching of contractile and non-contractile tissue that may tighten with injury or neurological disease, causing weakness and/or spasticity. Therapeutic exercise can increase blood flow to the targeted area, reduce pain and inflammation, reduce the risk of blood clots from venous stasis, decrease muscle atrophy and improve coordination and motor control. Therapeutic exercise may be prescribed following acute illness or injury and for chronic conditions that affect physical activity or function.

Prostate gland biopsy [HCPCS 55700]

Spinal fusion other than the neck without major complications

Private Room

Semi-Private Room

Swing Bed

Established patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 10-19 minutes) [HCPCS 99212]

Hospital outpatient clinic visit for assessment and management of a patient [HCPCS G0463]

Hospital outpatient clinic visit for assessment and management of a patient

Critical care delivery to critically ill or injured patient (each additional 30 minutes) [HCPCS 99292]

Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes

Emergency department visit for minor problem [HCPCS 99281]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

Emergency department visit for problem of high severity [HCPCS 99284]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.

Emergency department visit for problem of low to moderate severity [HCPCS 99282]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.

Emergency department visit for problem of moderate severity [HCPCS 99283]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

Emergency department visit for problem with significant threat to life [HCPCS 99285]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.

Drug test def 1-7 classes [HCPCS G0480]

Lab analysis by immunoassay (ELISA) to identify clostridium difficile toxins (stool pathogen) [HCPCS 87324]

Lab analysis by immunoassay (ELISA) to identify cryptosporidium (parasite) [HCPCS 87328]

Lab analysis by immunoassay (ELISA) to identify Hepatitis B surface antigen [HCPCS 87340]

A laboratory test is performed to detect Hepatitis B surface antigen (HBsAg) or Hepatitis Be antigen (HBeAg) in serum/plasma by any immunoassay technique such as enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), and immunochemiluminometric assay (IMCA). The Hepatitis B surface antigen (HBsAg) neutralization test (87341) is used to confirm a positive HBsAg test. The Hepatitis Be antigen (HBeAg) test  is used to monitor an active HBV infection and response to therapy. The presence of HBeAg in a sample indicates active HBV replication. Viral infectivity is based on both HBeAg and HBsAg activity. Hepatitis B is a virus that infects the liver. An individual with chronic HBV infection has an increased risk of developing cirrhosis and hepatocellular carcinoma. HBV may be transmitted in blood and body fluids between sexual partners, from mother to infant, and through contaminated objects such as needles, razors, and toothbrushes. The virus may cause fever, fatigue, abdominal pain, weight loss, nausea/vomiting, and joint pain, or it may be asymptomatic. A serum or plasma sample is obtained and placed in a fixative or sent fresh to the laboratory for processing. Both EIA and ELISA detect very small quantities of the antigen when bound to its specific antibody in a sample by adding a secondary, enzyme-labeled antibody to detect its presence. A chromogenic reaction of the enzyme produces a visible color change or fluorescence. Qualitative and semi-quantitative measures are assessed by the colorimetric reading. Immunochemiluminometric assay uses the reaction of antibodies labeled with a chemiluminescent substance to identify and quantify the bound antigen-antibody complex by light emission.

Lab analysis by immunoassay (ELISA) to identify HIV-1 and HIV-2 [HCPCS 87389]

Lab analysis by immunoassay to identify influenza virus [HCPCS 87804]

A quick test to detect influenza (Type A or B) by immunoassay with direct optical observation is performed. It is a rapid, qualitative test performed using lateral flow immunoassay. Influenza is an acute, highly contagious, viral upper respiratory infection. There are three types of influenza viruses delineated as Type A, B, or C with Type A being the most severe and prevalent type. Type B is generally less severe. Type C is the least common and is not associated with large human epidemics. Type A and B can both be detected by a rapid test. A nasal or nasopharyngeal swab is obtained. Alternatively nasal wash or aspirate may be used. The specimen is placed in a tube containting an extraction reagent that disrupts the virus particles in the specimen and exposes viral nucleoproteins. A test strip is then inserted into the tube. If the influenza virus being tested (Type A or B) is present, a line on the test strip will change color along with a control line.

Lab analysis by immunoassay to identify Strep (streptococcus) [HCPCS 87880]

A direct optical test to detect Streptococcus Group A (Strep A) by immunoassay is a rapid, qualitative test performed using lateral flow immunoassay. Strep A causes acute upper respiratory infection with the most common symptoms being pharyngitis (sore throat) and fever. If left untreated serious complications can occur including rheumatic fever and glomerulonephritis. This type of test is a rapid, qualitative test performed using lateral flow immunoassay. A throat swab is obtained. Two reagents are added to extract Strep A antigen from the specimen. A dipstick is added to the extracted sample. If Strep A antigen is present the test line and a control line will change color indicating a positive test. Another method uses a throat swab specimen inserted into a test cassette. Antigen extraction solutions are then mixed in a separate chamber of the tube and added to the swab chamber. If Strep A is present, a test line will change color as will a second control line.

Lab analysis by nucleic acid (DNA or RNA) to identify chlamydia trachomatis by amplified probe technique [HCPCS 87491]

Infectious agent antibody detection by nucleic acid technique (DNA or RNA) is used to identify Chlamydia trachomatis infection using direct probe, amplified probe, or quantification of the amplified probe. C. trachomatis infection is a sexually transmitted disease (STD) that often produces no symptoms, but can cause irreversible damage to the female reproductive tract, resulting in infertility. In men, symptoms include burning and itching of the urethra, but men rarely suffer reproductive damage from the infection. Some types of nucleic acid tests are rapid tests that may be performed in the physician office using a test kit. A swab is used to obtain a specimen from the cervix, male urethra, or eye. The exact methodology is dependent on the test kit used as there are several manufacturers. One test kit uses a nucleic acid hybridization method. A single stranded chemiluminescent DNA probe is used that is complementary to the ribosomal RNA of the Chlamydia organism. Lysate is used to rupture cells and release nucleic acids. The ribosomal RNA from the Chlamydia organism then combines with the labeled DNA probe to form a stable DNA:RNA hybrid. The presence of DNA:RNA hybrids is then detected using a luminometer. In an amplification technique, such as polymerase chain reaction (PCR), is used to create copies of the Chlamydia nucleic acids. Amplification is used when it is suspected that there are low levels of the targeted microorganism in the specimen that would not be detected using a direct probe. The Chlamydia nucleic acid is then detected using a variety of techniques.

Lab analysis by nucleic acid (DNA or RNA) to identify Neisseria gonorrhoeae (gonorrhoeae bacteria) by amplified probe technique [HCPCS 87591]

Neisseria gonorrhoeae (N. gonorrhoeae) causes gonorrhea, a sexually transmitted disease (STD), that is spread through direct contact and can infect the reproductive tract, mouth, throat, eyes, and anus. N. gonorrhoeae often causes no symptoms in women, but can cause irreversible damage to the reproductive tract of women which can result in infertility. In men, symptoms include burning, itching, and discharge of the urethra, but men rarely suffer reproductive damage from the infection. Some types of nucleic acid tests are rapid tests that may be performed in the physician office using a test kit. A swab is used to obtain a specimen from the cervix, male urethra, mouth, throat, or eye. An amplification technique, such as polymerase chain reaction (PCR) or transcription mediated amplification (TMA) is used to create copies of the N. gonorrhoeae nucleic acids. Amplification is used when there may be low levels of the suspected microorganism in the specimen that would not be detected using a direct probe. The N. gonorrhoeae nucleic acid is then detected using a variety of techniques.

Lab analysis of any culture (except blood) to identify aerobic isolates (each isolate) [HCPCS 87077]

Used if further testing is required from an anaerobic bacterial tissue culture in order to verify the results.

Lab analysis of any culture (except blood) to identify anaerobic bacteria [HCPCS 87075]

A tissue sample is collected and placed in a medium conducive to the growth of bacteria. The culture is examined for the growth of bacteria that can survive without oxygen.

Lab analysis of blood culture to identify bacteria [HCPCS 87040]

A blood sample is drawn and placed in a medium conducive to the growth of bacteria. Any bacteria present in the blood sample will then reveal themselves.

Lab analysis of rheumatoid factor [HCPCS 86430]

Lab analysis of skin, hair, or nail to identify fungus (mold or yeast) [HCPCS 87101]

Lab analysis of special gram or Giemsa stain to idenitfy microorganisms [HCPCS 87205]

A laboratory test is performed to identify bacteria, fungi, or cell types in pus, normally sterile body fluid(s), or aspirated material using Gram or Giemsa stain technique. Gram staining is a differential technique used to classify bacteria into gram positive (Gram +) or gram negative (Gram -) groups. Gram + bacteria have a thick layer of peptidoglycan in the cell wall which stains purple. Giemsa technique is used in cytogenetics for chromosome staining; in histopathology to detect trichomonas, some spirochetes, protozoans, malaria, and other parasites; and as a stain for peripheral blood and bone marrow to differentiate cells types such as erythrocytes, platelets, lymphocyte cytoplasm, monocyte cytoplasm, and leukocyte nuclear chromatin. A drop of suspended culture or cell material is applied in a thin layer to a slide using an inoculation hook and fixed with heat. The material is stained and the slide is examined under a microscope. The bacteria, fungi, or cells are identified, counted, and a written report of the findings is made.

Lab analysis of stool culture to identify bacteria [HCPCS 87045]

A stool sample is collected and placed in a medium conducive to the growth of bacteria. The culture is examined for the growth of Salmonella and Shigella bacteria.

Lab analysis of urine culture to measure the amount of bacteria [HCPCS 87086]

"A laboratory test is performed to determine the presence or absence of bacterial colonies in urine and provide a colony count. Bacteria in urine may indicate an acute or chronic urinary tract infection (UTI) including pyelonephritis, cystitis, urethritis, or acute urethral syndrome. A urine sample is obtained by clean catch, mid-stream void or catheterization. Using a calibrated loop, the urine specimen is inoculated onto agar plates and incubated. Quantitative colony counts are determined and potential pathogens are identified. A colony count 10,000 cfu/mL is reported as ""organism present"" and may indicate an infection. Comingled flora of the urethra and mixed organisms in the colony counts are reported as ""mixed flora"" and most often represent contamination."

Lab analysis of urine specimen by dipstick to detect the hormone found in women in early pregnancy [HCPCS 81025]

Pregnancy tests detect the presence of human chorionic gonadotropin (hCG) in the urine. HCG is produced by the placenta and can be detected in urine shortly after the embryo attaches to the uterine lining. The test may be performed by collecting a urine specimen and dipping a stick treated to detect the presence of hCG in the urine. The presence of hCG is indicated by a color change in the treated section of the dipstick indicating a positive pregnancy test. If no color change occurs, the test is negative.

Lab analysis of urine specimen with microscope [HCPCS 81015]

Microscopic analysis is performed to determine if sediment in the urine specimen is normal or indicative of an abnormality such as infection. Microscopy can be performed using a standard glass counting chamber and coverslips or a disposable system. Most laboratories use disposable systems. Urine from the sample is centrifuged to concentrate the sediment in a button at the bottom of the tube. The specimen is decanted leaving only 0.2-0.5 ml liquid. The sediment is resuspended. The sediment is placed in a test well and examined under a microscope at low power to identify crystals, casts, squamous cells, and other debris. The test well is 0.1 mm deep and contains a grid that measures 3x3 mm with 90 small squares in the grid. Each of the 90 small squares are grouped together in 1x1 mm squares which are the medium squares and each contains 9 small squares. Casts are usually counted at low power. The urine is then examined under high power for the presence of red blood cells (RBCs), white blood cells (WBCs), epithelial cells, bacteria, yeast, and crystals and each of the constituents is characterized and counted. Counts may be performed on a single small cell or all 90 cells may be counted depending on the concentration of each of the constituents in the specimen. For example, WBCs may be counted in only a single small square when high numbers of cells are present, 9 medium squares when moderate levels of cells are present, or the entire 90 cells when low cell counts are present. If a single small square is counted the results are multiplied by 90 to obtain the WBC count. If a medium square is counted (9 small cells) the results are multiplied by 10. If all 90 cells are counted, the total count is reported.

Lab analysis of vaginal or cervical cells (pap test) with automated screening and manual re-screening under physician supervision [HCPCS 88175]

Lab analysis to evaluate the clotting factor X time in blood specimen (diluted) [HCPCS 85613]

Lab analysis to idenitfy tuberculosis (TB) by gamma interferon release assay [HCPCS 86480]

This test is performed on individuals suspected of having or being at high risk for Mycobacterium tuberculosis (TB) infection. This test measures cell mediated immunity (CMI) antigen response to stimulation with TB-specific proteins. Two proteins, early-secreted antigenic target 6-kDa protein (ESAT-6) and culture filtrate protein (CFP-10), are used in CMI antigen response tests for TB. Individuals with TB infection have lymphocytes in their blood that recognize these proteins. A blood sample is obtained by separately reportable venipuncture. The blood sample is stimulated with ESAT-6 and CFP-10. If the blood sample reacts to these proteins, which is indicated by the secretion of cytokine interferon gamma, the test is positive for TB. Cytokines are hormone-like proteins secreted by cells that regulate the intensity and duration of immune response. Both the presence and amount of cytokine interferon gamma present in the blood sample are used for diagnosis of TB.

Lab analysis to identify antibodies for autoimmune disorder assessment (any method) [HCPCS 86235]

A blood test is performed to measure extractable nuclear antigen or antibody to it. One or more of these antibodies are typically elevated in autoimmune diseases such as Sjogren Syndrome, polymyositis, systemic lupus erythematosus, and progressive systemic sclerosis. Many are included in comprehensive panels that screen for multiple antibodies at one time. A blood sample is obtained by separately reportable venipuncture and tested by any method, particularly semiquantitative multi-analyte fluorescent detection. Report once for each antibody, such as: SSA (Ro) (ENA) Antibody, IgG; Jo-1 Antibody, IgG; scleroderma (Scl-70) (ENA) Antibody, IgG; Smith (ENA) Antibody, IgG; SSB (La) (ENA) Antibody, IgG; and RNP (U1) (Ribonucleic Protein) (ENA) Antibody, IgG.

Lab analysis to identify antibodies for rheumatoid arthritis assessment [HCPCS 86200]

Lab analysis to identify antibodies to Borrelia burgdorferi (Lyme disease bacteria) with confirmation test [HCPCS 86617]

Lab analysis to identify antibodies to Epstein-Barr virus (mononucleosis virus), nuclear antigen [HCPCS 86664]

Lab analysis to identify antibodies to HIV -1 virus [HCPCS 86701]

Lab analysis to identify antibodies to native or double stranded DNA [HCPCS 86225]

Lab analysis to identify gonadotropin (reproductive hormone) in serum or urine specimen [HCPCS 84703]

A specimen is tested for chorionic gonadotropin (hCG). A qualitative test is performed to test for the presence of absence of hCG only. This test may be performed on blood or urine. Qualitative hCG testing is performed to confirm pregnancy.

Lab analysis to identify Hepatitis A antibodies [HCPCS 86708]

Lab analysis to identify Hepatitis B core antibodies (IgG and IgM) [HCPCS 86704]

A blood sample is tested for hepatitis B core antibody (HBcAB). Hepatitis B is an inflammation of the liver caused by the hepatitis B virus (HBV) and has an acute and chronic phase. The core antibody is produced during and after an acute HBV infection, even in individuals who have cleared the virus without developing a chronic infection, and also during the chronic phase. In 86704, total HBcAB is tested using chemiluminescent assay. Both IgG and IgM antibodies are identified in a single test that does not differentiate between the two. Since IgM antibody is found in the initial phase of the infection and IgG in the later phase, this test is not specific to the acute or chronic phase of the infection.

Lab analysis to identify Hepatitis B surface antibodies [HCPCS 86706]

A blood sample is tested for hepatitis B surface antibody (HBsAB). Hepatitis B is an inflammation of the liver caused by the hepatitis B virus (HBV). HBsAB testing is performed to identify previous exposure to HBV without current acute or chronic infection, to determine the need for vaccination, and whether or not a previously administered vaccination has been successful. Individuals with a positive HBsAB test have been exposed to the virus but no longer carry an active form of the virus, cannot pass it on to others, and are immune from future HBV infection. HBsAB is tested using chemiluminescent assay.

Lab analysis to identify Hepatitis C antibodies [HCPCS 86803]

A laboratory test is performed to measure Hepatitis C virus (HCV) antibodies. Hepatitis C causes acute or chronic liver inflammation and may be transmitted via blood transfusion, needle sticks or sharing of needles in occupational situations or recreational drug use, unprotected sex, placental transfer during pregnancy, or sharing personal items such as a razor or toothbrush. The test is used to screen individuals at risk for infection with HCV. A blood sample is obtained by separately reportable venipuncture. Serum is tested using qualitative chemiluminescent immunoassay. Antibodies toward HCV may not start to elevate until 2 months after exposure, so a negative test screening should be repeated if there is a strong suspicion of HCV infection.

Lab analysis to identify phenotype alpha-1-antitrypsin (protein) in blood specimen [HCPCS 82104]

Lab analysis to identify tissue antibody cardiolipin [HCPCS 86147]

Lab analysis to identify total thyroxine (thyroid chemical) function in serum specimen for screening [HCPCS 84436]

A blood sample is obtained and levels of total thyroxin (84436), thyroxine requiring elution as for testing in neonates (84437), or free thyroxine (84439) are evaluated. Thyroxine, also referred to as T4, is tested to determine whether the thyroid is functioning properly and is used to aid in the diagnosis of overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function. In 84436, total thyroxine levels are evaluated. Total thyroxine measures the total amount of both bound and unbound (free) thyroxine in the blood. All thyroxine tests use electrochemiluminescent immunoassay methodology. *

Lab analysis to identify tumor antigens by immunoassay (quantitative, CA 125) [HCPCS 86304]

A quantitative immunoassay for tumor antigen CA 125 is performed. Tumor antigens, also referred to as tumor markers, are indicators that a malignant neoplasm may be present. Significant circulating levels found in serum are often associated with malignancy. Tumor antigen CA 125 is used in patients with a documented ovarian mass to help determine whether the mass is benign or malignant. It is also used to monitor response to treatment in patients with an established diagnosis of ovarian, fallopian tube, or endometrial cancer. CA 125 uses an electrochemiluminescent immunoassay test kit. Periodic tumor antigen testing is used in conjunction with other clinical methods to monitor progression or regression of the malignancy.

Lab analysis to identify tumor antigens by immunoassay (quantitative, CA 15-3) [HCPCS 86300]

Lab analysis to identify white blood cells (manual) with microscope [HCPCS 85007]

A blood smear is performed with microscopic examination with or without a manual differential WBC count. A blood smear is typically performed following an automated test that indicates the presence of abnormal or immature blood cells. It may also be performed when the physician suspects a condition that affects blood cell production, such as anemia. A blood sample is obtained by separately reportable venipuncture. A blood smear is prepared and examined under a microscope by a technician for immature or abnormal cells. The test is performed with a manual differential white blood cell (WBC) count. The technician examines and counts each of the five types of WBCs separately. Neutrophils comprise the majority of WBCs in healthy adults and are differentiated by cytoplasm with pink or purple granules. Eosinophils normally comprise 1-3% of total WBCs and are differentiated in stained smears by their large, red-orange granules. Elevated levels of eosinophils may indicate allergy or parasitic infection. Basophils normally comprise only 1% of total WBCs and are differentiated by their large black granules. Elevated levels of basophils may be indicative of certain leukemias, varicella (chicken pox) infection, or ulcerative colitis. Monocytes are the largest WBCs and act as scavengers to ingest (phagocytize) cellular debris, bacteria, and other particles. Lymphocytes produce antibodies (immunoglobulins) and are differentiated by their homogenous cytoplasm and smooth, round nucleus.

Lab analysis to measure the amount of vanillylmandelic acid in urine specimen [HCPCS 84585]

Lab analysis to measure blood count (hemoglobin) [HCPCS 85018]

A blood test is performed to determine hemoglobin (Hgb) which is a measurement of the amount of oxygen-carrying protein in the blood. Hgb is measured to determine the severity of anemia or polycythemia, monitor response to treatment for these conditions, or determine the need for blood transfusion. A blood sample is collected by separately reportable venipuncture or finger, heel, or ear stick. The sample may be sent to the lab or a rapid testing system may be used in the physician's office. Systems consist of a portable photometer and pipettes that contain reagent. The pipette is used to collect the blood sample from a capillary stick and the blood is automatically mixed with the reagent in the pipette. The photometer is then used to read the result which is displayed on the photometer device.

Lab analysis to measure the amylase (enzyme) level in serum specimen [HCPCS 82150]

Laboratory testing for amylase may be performed on blood, urine, and other body fluids. Amylase is an enzyme responsible for the break down of starches into sugar molecules (disaccharides and trisaccharides) and eventually into glucose for energy use by the cells. Amylase is produced in saliva and the pancreas. Abnormal amylase levels may result from pancreatic inflammation or trauma, perforated peptic ulcer, ovarian cyst (torsion), strangulation ileus, macroamylasemia, mumps, and cystic fibrosis. A blood or body fluid sample is obtained. The sample is then tested using quantitative enzymatic methodology.

Lab analysis to measure coagulation function measurement of D-dimer (quantitative) [HCPCS 85379]

D-dimer testing for fibrin degradation products is performed to help rule out the presence of a thrombus. D-dimer tests are also used to rule-out hypercoagulability. D-dimer has a negative predictive value for these conditions which means that a negative result indicates that there is not an elevated level of fibrin degradation products present in the specimen. A positive result indicates an abnormally high level of fibrin degradation products which may be indicative of a thrombus. It is used to help diagnosis deep vein thrombophlebitis, pulmonary embolus, and stroke. The test is also used to evaluate for hypercoagulability which predisposes the patient to blood clots and to help diagnose disseminated intravascular coagulation (DIC) and monitor the effectiveness of DIC treatment.

Lab analysis to measure the antithrombin III antigen (clotting inhibitor) activity [HCPCS 85300]

Lab analysis to measure free thyroxine (thyroid chemical) in serum specimen [HCPCS 84439]

A blood sample is obtained and levels of total thyroxin, thyroxine requiring elution as for testing in neonates or free thyroxine are evaluated. Thyroxine, also referred to as T4, is tested to determine whether the thyroid is functioning properly and is used to aid in the diagnosis of overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function. In free thyroxine levels are tested. Free thyroxine is the amount of active thyroxine in the blood. Free thyroxine levels are considered to be a more accurate indicator of thyroid function. All thyroxine tests use electrochemiluminescent immunoassay methodology.

Lab analysis to measure the blood potassium level in blood specimen [HCPCS 84132]

A blood sample is obtained to measure potassium level. Potassium is a positively charged electrolyte that works in conjunction with other electrolytes, such as sodium, chloride, and carbon dioxide (CO2), to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance. Potassium is found in all body fluids but mostly stored within cells, not in extracellular fluids, blood serum, or plasma. Small fluctuations in blood potassium, either too high (hyperkalemia) or too low (hypokalemia), can have serious, even life-threatening, consequences. Potassium level is used to screen for and monitor renal disease; monitor patients on certain medications, such as diuretics, as well as patients with acute and chronic conditions, such as dehydration or endocrine disorders. Because blood potassium affects heart rhythm and respiratory rate, it is routinely checked prior to major surgical procedures. Potassium is measured by ion-selective electrode (ISE) methodology.

Lab analysis to measure the calcium level in urine specimen [HCPCS 82340]

Lab analysis to measure the carcinoembryonic antigen (cea) protein level [HCPCS 82378]

A laboratory test is obtained to measure carcinoembryonic antigen (CEA) levels in blood and body fluids. CEA is a protein normally present at high levels during fetal development but is low or absent after birth. Elevated levels of CEA may occur with colorectal, breast, lung, pancreatic, prostate, ovarian, and medullary thyroid cancers. CEA testing can help determine tumor size, stage, and metastasis. A baseline level is usually obtained following a cancer diagnosis. Serial testing is done to monitor treatment and response to therapy. Elevated levels of CEA have also been noted in smokers and in patients diagnosed with inflammatory disorders, cirrhosis, peptic ulcer, ulcerative colitis, rectal polyps, emphysema, and benign breast disease. CEA testing should not be used for screening in the general population. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid (CSF) is obtained by separately reportable lumbar puncture. Pleural and peritoneal fluids are obtained by needle aspiration. Serum/plasma and body fluids are tested using quantitative electrochemiluminescent immunoassay.

Lab analysis to measure osmolality (concentration) in blood specimen [HCPCS 83930]

Osmolality of blood or urine is tested. Osmolality refers to the number of solutes present in blood (plasma or serum) or urine. Osmotically active particles include sodium, chloride, potassium, urea, and glucose. Osmolality is tested using freezing point methodology or vapor pressure osmometer. The higher the concentration of solutes, the lower the freezing point as compared to water.

Lab analysis to measure the creatinine level in blood specimen to test for kidney function or muscle injury [HCPCS 82565]

A blood sample is taken to measure creatinine levels. Creatinine is a waste product produced by the muscles in the breakdown of creatine, which is a compound used by the muscles to create energy for contraction. The waste product, creatinine, is excreted by the kidneys and blood levels provide a good measurement of renal function. Creatinine may be checked to screen for or monitor treatment of renal disease. Creatinine levels may also be monitored in patients with acute or chronic illnesses that may impair renal function and in patients on medications that affect renal function. Creatinine is measured using spectrophotometry.

Lab analysis to measure the cyanocobalamin (vitamin b-12) level [HCPCS 82607]

Cyanocobalamin is a vitamer of the B-12 vitamin family and plays an important role in metabolism, red blood cell production and nervous system function. Blood levels of cyanocobalamin are measured. Blood levels may be reduced with pernicious and other forms of anemia, and in individuals who follow a strict vegan diet, have chronic infections (such as HIV) and during pregnancy. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Lab analysis to measure the dihydroxyvitamin D, 1, 25 level in serum or plasma specimen [HCPCS 82652]

Lab analysis to measure red blood cell concentration [HCPCS 85014]

A blood test is performed to determine hematocrit (Hct). Hematocrit refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. A blood sample is obtained by separately reportable venipuncture or finger, heel, or ear stick. Hct is calculated using an electronic cell counter.

Lab analysis to measure the direct bilirubin level [HCPCS 82248]

A laboratory test is performed to measure total or direct bilirubin. Bilirubin is a pigmented waste product normally produced when red blood cells (RBCs) break down. Non-water soluble (unconjugated) bilirubin is carried on albumin to the liver where it attaches to sugar molecules to become conjugated. Conjugated (direct) bilirubin is water soluble and able to pass from the liver to the small intestine. Further breakdown of bilirubin occurs in the small intestine and it is eventually eliminated in the feces in the form of stercobilin. Total bilirubin is the sum of conjugated (direct) and unconjugated bilirubin. A test for either conjugated or direct bilirubin or total bilirubin may be ordered to diagnose and monitor liver disorders, hemolytic anemia, and newborn (physiologic) jaundice. A blood sample is obtained by separately reportable venipuncture or heel stick. Other body fluids, including cerebral spinal fluid, may be collected and tested for total bilirubin. Serum/plasma is tested using quantitative spectrophotometry.

Lab analysis to measure red blood cell sedimentation rate to detect inflammation (automated) [HCPCS 85652]

Lab analysis to measure the ferritin (blood protein) level [HCPCS 82728]

A blood test is performed to measure ferritin levels. Ferritin is an intracellular protein that stores iron and releases it into circulation in a controlled manner to protect the body against iron overload and iron deficiency. Ferritin levels may be obtained to evaluate for elevated levels caused by excess storage diseases such as hemochromatosis and following multiple transfusions. Levels may also be obtained to evaluate for decreased levels due to iron deficiency. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Lab analysis to measure red blood count (automated test) [HCPCS 85045]

An automated reticulocyte count is performed. Reticulocytes are new red blood cells (RBCs) that circulate in the peripheral blood for 1-2 days before losing sufficient RNA to become mature RBCs. A reticulocyte count may be performed when a blood test shows decreased RBCs and/or decreased hemoglobin or hematocrit measurements. The test can help determine if the bone marrow is responding to the body's need for RBCs. Indications for monitoring reticulocytes include vitamin B12 or folate deficiency, kidney disease, chemotherapy, bone marrow transplant, and treatment with erythropoietin or darbepoetin. A blood sample is obtained. A reticulocyte count is performed with an automated blood cell counting instrument. Automated reticulocyte count performed alone is reported. When automated reticulocyte count is performed with direct measurement of one or more cellular parameters, such as reticulocyte hemoglobin content (CHr), immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), or RNA content is reported. CHr measures the amount of hemoglobin in reticulocytes, which is an indicator of iron utilization for RBC production, and is used to diagnosis iron deficiency. IRF is used to determine whether reticulocytes are being released prematurely and to quantify the proportion of immature reticulocytes. Premature release occurs during periods of high demand for RBCs in chronic kidney disease, following chemotherapy or bone marrow transplant, or in patients with AIDs or malignant disease, as well as other conditions. IRF is calculated as a ratio of immature reticulocytes to the total number of reticulocytes (both immature and mature). MRV looks at the total volume of reticulocytes compared to total red blood cells and is used to evaluate iron utilization. RNA content is evaluated to determine the maturity of circulating reticulocytes.

Lab analysis to measure the folic acid level in serum specimen [HCPCS 82746]

A blood test is performed to measure folic acid (folate) levels in serum or red blood cells (RBC). Folic acid (folate) may also be referred to as Vitamin B9 and is essential for the growth, division and repair of cells, especially fetal growth during pregnancy and in early infancy. It is also necessary for the production of healthy red blood cells and to prevent anemia at all ages. The test may be used to diagnose anemia or certain neuropathies and to monitor the effectiveness of treatment for these conditions. A blood sample is obtained by separately reportable venipuncture.

Lab analysis to measure the adrenocorticotropic hormone (ACTH) level [HCPCS 82024]

Lab analysis to measure the glucose (sugar) level in blood [HCPCS 82947]

A blood sample is obtained to measure total (quantitative) blood glucose level. Glucose is a simple sugar that is the main source of energy for the body. Carbohydrates are broken down into simple sugars, primarily glucose, absorbed by the intestine, and circulated in the blood. Insulin, a hormone produced by the pancreas, regulates glucose level in the blood and transports glucose to cells in other tissues and organs. When more glucose is available in the blood than is required, it is converted to glycogen and stored in the liver or converted to fat and stored in adipose (fat) tissue. If the glucose/insulin metabolic process is working properly, blood glucose will remain at a fairly constant, healthy level. Glucose is measured to determine whether the glucose/insulin metabolic process is functioning properly. It is used to monitor glucose levels and determine whether they are too low (hypoglycemia) or too high (hyperglycemia) as well as test for diabetes and monitor blood sugar control in diabetics.

Lab analysis to measure the albumin (protein) level in blood, serum, or plasma specimen [HCPCS 82040]

A blood test is performed to measure albumin levels in serum, plasma, or whole blood. Albumin is a plasma protein responsible for regulating the colloidal osmotic pressure of blood. It is capable of binding water, electrolytes (sodium, potassium, calcium), fatty acids, hormones, bilirubin, and drugs/medications. Albumin levels are used to assess nutritional status. A blood sample is obtained by separately reportable venipuncture. The plasma, serum or whole blood is tested using spectrophotometry or quantitative nephelometry.

Lab analysis to measure the glutamyltransferase (liver enzyme) level [HCPCS 82977]

A blood test is performed to measure gamma glutamyltransferase (GGT) levels. GGT is an enzyme that assists with the transfer of amino acids across cell membranes, including cells found in the liver, kidney, pancreas, heart, brain, and seminal vesicles. GGT levels are used as a diagnostic marker for certain diseases of the liver, bile ducts, and pancreas. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative enzymatic methodology.

Lab analysis to measure the aldolase (enzyme) level [HCPCS 82085]

Lab analysis to measure the gonadotropin, follicle stimulating (reproductive hormone) level [HCPCS 83001]

Lab analysis to measure the amount of blood gases [HCPCS 82803]

A laboratory test is performed to measure one or more components of blood gases. The homeostatic acid-base balance is measured as blood pHùthe number of hydrogen ions (H+) dissolved in the blood. Partial pressure of carbon dioxide (pCO2) is the amount of carbon dioxide dissolved in the blood and reflects how well the lungs can move CO2 out of the body. Partial pressure of oxygen (pO2) is the level of oxygen dissolved in the blood and reflects the exchange of oxygen molecules in the alveoli. Bicarbonate (HCO3) is calculated from pH and pCO2 and is the metabolic component of acid-base balance reflecting the kidney's response to changes in pH. Oxygen saturation (O2 Sat) is the percent of hemoglobin that is carrying oxygen. Calculated O2 saturation uses a mathematical model to determine the percentage of hemoglobin that is carrying oxygen based on the level of pO2. Blood gas monitoring may be performed to evaluate lung function; detect an acid-base imbalance; monitor metabolic, respiratory, and kidney disorders; and evaluate the effectiveness of treatment. A blood sample is obtained by separately reportable venipuncture, heelstick, arterial, or umbilical cord draw.

Lab analysis to measure the gonadotropin, luteinizing (reproductive hormone) level [HCPCS 83002]

Lab analysis to measure the haptoglobin (serum protein) level in serum specimen [HCPCS 83010]

Lab analysis to measure the hemoglobin A1C level in blood specimen [HCPCS 83036]

A blood test is performed to measure glycosylated hemoglobin (HbA1C) levels. Plasma glucose binds to hemoglobin and the HbA1C test measures the average plasma glucose concentration over the life of red blood cells (approximately 90-120 days). HbA1C levels may be used as a diagnostic reference for patients with suspected diabetes mellitus (DM) and to monitor blood glucose control in patients with known DM. HbA1C levels should be monitored at least every 6 months in patients with DM and more frequently when the level is >7.0%. A blood sample is obtained by separately reportable venipuncture. Whole blood is tested using quantitative high performance liquid chromatography/boronate affinity.

Lab analysis to measure the amount of blood in stool specimen by fecal hemoglobin determination and immunoassay [HCPCS 82274]

Lab analysis to measure the IgE (immune system protein) level [HCPCS 82785]

Lab test for Gammaglobulin IgE

Lab analysis to measure the ionized calcium level in blood specimen [HCPCS 82330]

A blood sample is taken to measure the amount of ionized or free calcium. Ionized or free calcium is calcium that flows freely in the blood and is not attached to any proteins. Ionized calcium is metabolically active and available to support and regulate heart function, muscle contraction, central nervous system function, and blood clotting. Ionized calcium measurements may be obtained prior to major surgery, in critically ill patients, or when protein levels are abnormal. Ionized calcium is measured by ion selective electrode (ISE) or pH electrode methodology.

Lab analysis to measure the iron binding capacity [HCPCS 83550]

A blood test is performed to measure the iron binding capacity of transferrin. Transferrin, a protein found in circulating blood is responsible for carrying iron molecules. This test measures the ability of transferrin to carry iron. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative spectrophotometry/calculation.

Lab analysis to measure the amount of carbamazepine (total) in blood specimen [HCPCS 80156]

A laboratory test is performed to determine total or free carbamazepine levels. Carbamazepine, also referred to as Tegretol, is an anticonvulsant used to treat epilepsy and may also be used as an analgesic to treat trigeminal neuralgia. Carbamazepine, carbamazepine metabolite (10,11-epoxide), and free carbamazepine are routinely measured to determine optimal doses in patients with epilepsy as well as to monitor for carbamazepine toxicity. A blood sample is obtained by separately reportable venipuncture. Blood serum is then tested using one of several techniques including high performance liquid chromatography or fluorescent polarization immunoassay. Total carbamazepine tests the total amount present in the blood. Under normal circumstances, circulating carbamazepine is 75% protein bound. In some patients carbamazepine may be displaced from protein resulting in higher levels of free carbamazepine circulating in the blood. In these patients, lower levels of the drug may result in toxicity, so the unbound (free) levels must be monitored.

Lab analysis to measure the iron level [HCPCS 83540]

A blood, urine or liver test is performed to measure iron levels. Iron (Fe) is an essential element that circulates in the blood attached to the protein transferrin. Iron is necessary component of hemoglobin, found in red blood cells (RBCs) and myoglobin found in muscle cells. Low iron levels may cause a decrease in red blood cells and iron deficiency anemia. High iron levels may be caused by excessive intake of iron supplements or a hereditary genetic condition such as hemochromatosis from a mutation of the RGMc gene or HAMP gene. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative spectrophotometry. A random voided or 24 hour urine specimen is obtained and tested using quantitative inductively coupled plasma/emission spectrometry. Patient should wait 2-4 days after receiving iodine or gadolinium contrast media to collect a urine specimen. A liver sample is obtained by a separately reportable procedure. Liver tissue is tested using quantitative inductively coupled plasma-mass spectrometry.

Lab analysis to measure the amount of carbon dioxide, chloride, potassium, and sodium in blood specimen [HCPCS 80051]

"An electrolyte panel is obtained to detect problems with fluid and electrolyte balance and monitor the health status of persons with acute or chronic medical conditions including high blood pressure, heart failure, and kidney or liver disease. The test measures electrically charged minerals such as sodium, potassium, and chloride found in body tissues and blood. Sodium is primarily found outside cells and maintains water balance in the tissues, as well as nerve and muscle function. Potassium is primarily found inside cells and affects heart rhythm, cell metabolism, and muscle function. Chloride moves freely in and out of cells to regulate fluid levels and help maintain electrical neutrality. Carbon dioxide, or bicarbonate, maintains body pH and the acid/base balance of the blood. A test called an ""anion gap"" may be included in the electrolyte panel. Anion gap is a calculated value of the test components that measures the difference between the negatively charged ions (anions) and the positivity charged ions (cations). Anion gap values can be affected by many conditions such as metabolic disorders, starvation, and diabetes, or exposure to toxins. A blood sample is obtained by separately reportable venipuncture, heel or finger stick. Serum/plasma is tested using quantitative ion-selective electrode/enzymatic method."

Lab analysis to measure the lactate dehydrogenase (enzyme) level [HCPCS 83615]

A blood or body fluid test is performed to measure lactate dehydrogenase (LD) (LDH) levels. LDH is an enzyme present in red blood cells (RBCs) and in the tissue of heart, liver, pancreas, kidney, skeletal muscle, brain and lungs. LDH levels are used as a marker for tissue and RBC damage. Elevated blood levels can be caused by stroke, myocardial infarction, liver disease, pancreatitis, muscular dystrophy, infectious mononucleosis, hemolytic anemia and tumors/cancers such as lymphoma. Elevated cerebral spinal fluid (CSF) levels are usually indicative of bacterial meningitis. LDH levels in pleural and/or pericardial fluid can indicate if the effusion is an exudate, caused by an infection or a transudate caused by fluid pressure problem. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid is obtained by separately reportable lumbar puncture (spinal tap). Pericardial fluid is obtained by separately reportable pericardiocentesis. Fluid from a pleural effusion is obtained by separately reportable thoracentesis. Serum or plasma and all body fluids are tested using quantitative enzymatic methodology.

Lab analysis to measure the amount of C-reactive protein in serum by high sensitivity assay to identify infection or inflammation [HCPCS 86141]

Lab test for High Sensitivity C-reactive protein

Lab analysis to measure the LDL cholesterol level [HCPCS 83721]

Lab test for LDL Cholesterol

Lab analysis to measure the amount of C-reactive protein in serum to identify infection or inflammation [HCPCS 86140]

A blood test is performed to measure C-reactive protein (CRP) levels. This standard test has a wide value range. CRP is an acute phase protein, synthesized by the liver and released in response to inflammation and infection. The test is not diagnostic for any specific disease or condition but can be used as a marker to monitor the body's response to treatment(s) or to evaluate the need for further testing. Elevation of CRP levels may be found during pregnancy, with the use of oral contraceptives, or hormone replacement therapy. Diseases/conditions that cause an elevation of CRP include: lymphoma, arteritis/vasculitis, osteomyelitis, inflammatory bowel disease, rheumatoid arthritis, pelvic inflammatory disease (PID), systemic lupus erythematosus (SLE), acute infections, burns, surgical procedures, and organ transplants. A blood sample is obtained by separately reportable venipuncture. Serum in neonates is tested using immunoassay. Serum/plasma in all other patients is tested using quantitative immunoturbidimetric method.

Lab analysis to measure the liver enzyme (sgot), level in serum or plasma specimen [HCPCS 84450]

A blood test is performed to measure aspartate aminotransferase (AST) levels. This enzyme was previously referred to as serum glutamic oxaloacetic transaminase (SGOT). AST is an enzyme found primarily in liver and muscle cells. Elevated levels may result from liver disease or damage such as hepatitis, cirrhosis, ischemia, drug toxicity, and/or muscle damage, especially cardiac muscle (myocardial infarction). This test is often ordered in conjunction with alanine transferase, ALT or other liver function tests (LFTs) to diagnose disease and monitor individuals taking cholesterol lowering medications. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method.

Lab analysis to measure the amount of cyclosporine in blood specimen [HCPCS 80158]

Lab analysis to measure the liver enzyme (sgpt), level in serum or plasma specimen [HCPCS 84460]

A blood test is performed to measure alanine aminotransferase (ALT) levels. This enzyme was previously referred to as serum glutamic pyruvic transaminase (SGPT). ALT is an enzyme found primarily in liver and muscle cells. Elevated levels may result from liver disease or damage such as hepatitis, cirrhosis, ischemia, drug toxicity, and/or muscle damage, especially cardiac muscle (myocardial infarction). This test is often ordered in conjunction with aspartate transferase, AST or other liver function tests (LFTs) to diagnose disease and monitor individuals taking cholesterol lowering medications. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method.

Lab analysis to measure the amount of gammaglobulin (immune system protein) [HCPCS 82784]

A test is performed to measure immunoglobin levels in the blood or other body fluids, such as saliva or cerebral spinal fluid. Immunoglobins, also referred to as antibodies, are evaluated to help diagnose a variety of conditions including autoimmune diseases, allergies, or malignant neoplasms such as multiple myeloma or macroglobulinemia. In addition, immunoglobulin levels may be evaluated in patients with frequent infections to determine if there is a low level of immunoglobulin IgG. Immunoglobulins are also evaluated in patients with cancer or H. pylori infection to determine the effectiveness of treatment. There are five major types of antibodies. IgA antibodies are found in the nose, respiratory and digestive tracts, ears, eyes, and vagina. IgA protects the body surfaces from outside foreign substances. IgD is found in tissues lining the abdominal and thoracic cavity. IgE is found in the lungs, skin, and mucous membranes and reacts to substances commonly associated with allergies, such as food, pollen, dander, dust, fungus spores, etc. High levels of IgE are associated with allergies. IgG is found in all body fluids and is important in fighting bacterial and viral infections. There are four subclasses of IgG, designated as IgG1, IgG2, IgG3, and IgG4. These different subclasses protect against different types of infection. For example IgG1 is particularly effective in protecting the body from viral proteins, whereas IgG2 is more effective against certain types of bacterial infections. Individuals may have selective IgG subclass deficiencies characterized by low levels of one or two IgG subclasses with normal total IgG. IgM is found in blood and lymph and is important in fighting infection. A blood specimen is obtained by separately reportable venipuncture, a CSF sample is obtained by separately reportable spinal puncture, or saliva is collected. The methodology used to test immunoglobulin levels is dependent on the type of specimen and the immunoglobulin being tested.

Lab analysis to measure the microalbumin (protein) level in urine specimen [HCPCS 82043]

A test on urine is used to measure microalbumin levels and is routinely performed annually on diabetic patients with stable blood glucose levels to assess for early onset nephropathy. The quantitative test, which measures the actual amount of microalbumin present in the urine, may be performed on a random urine sample, with a notation of total volume and voiding time, or a 24-hour urine sample using immunoturbidimetric technique. The semi-quantitative test identifies the presence of elevated microalbumin levels in the urine within a general range and involves a chemical dipstick placed into the urine sample which reacts and changes color when albumin is present.

Lab analysis to measure the natriuretic peptide (heart and blood vessel protein) level in plasma specimen [HCPCS 83880]

The level of the natriuretic peptide in the blood is measured to evaluate heart failure and to differentiate symptoms that might be indicative of heart failure from other disorders that cause similar symptoms. A separately reportable venipuncture is performed and whole blood or plasma collected using EDTA as an anticoagulant. An automated immunoassay is performed using murine monoclonal and polyclonal antibodies against natriuretic peptide. The antibodies are labeled with a fluorescent dye and immobilized on the solid phase. The specimen is placed in the sample chamber and the analysis is run. The physician reviews the results and uses them to make diagnosis and treatment decisions.

Lab analysis to measure the parathormone (parathyroid hormone) level [HCPCS 83970]

A blood or tissue test is performed to measure parathormone (parathyroid hormone, parathyrin) levels. Parathyroid hormone (PTH) is produced by chief cells in the parathyroid gland. The hormone helps to regulate blood calcium levels, absorption/excretion of phosphate by the kidneys and in Vitamin D synthesis in the body. Elevated levels (hyperparathyroidism) may be caused by parathyroid gland tumors or chronic renal failure. Decreased levels (hypoparathyroidism) may result from inadvertent removal (during thyroid gland surgery), autoimmune disorders or genetic inborn errors of metabolism. A blood sample is obtained by separately reportable venipuncture. Parathyroid gland tissue is obtained by separately reportable fine needle aspirate. Serum/plasma or tissue sample are tested using quantitative electrochemiluminescent immunoassay. Plasma is tested for parathyroid hormone, CAP (Cyclase Activating Parathyroid Hormone) using immunoradiometric assay.

Lab analysis to measure the phosphatase (enzyme) level (alkaline) [HCPCS 84075]

Lab test for Alkaline Phosphatase

Lab analysis to measure the phosphate level [HCPCS 84100]

A blood or urine test is performed to measure inorganic phosphorus (phosphate) levels. Phosphate is an intracellular anion, found primarily in bone and soft tissue. It plays an important role in cellular energy (nerve and muscle function) and the building/repair of bone and teeth. Decreased levels are most often caused by malnutrition and lead to muscle and neurological dysfunction. Elevated levels may be due to kidney or parathyroid gland problems. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative spectrophotometry.

Lab analysis to measure the amount of glucose (sugar) in blood specimen with reagent strip [HCPCS 82948]

Lab analysis to measure the prolactin (milk producing hormone) level in serum specimen [HCPCS 84146]

A blood test is performed to measure prolactin levels. Prolactin is a hormone produced by the pituitary gland. Normal variations in prolactin levels occur during the day and night. Normal elevations occur during pregnancy, lactation (breast feeding), and times of physical or emotional stress. Abnormal elevations can occur with kidney and liver disease, hypothyroidism, and pituitary gland tumors (prolactinomas). Decreased levels may result from pituitary gland damage. This test may be ordered to evaluate nipple discharge, infertility, and erectile dysfunction. This code may be used to report prolactin, prolactin macroadenoma (dilution study) for patients with prolactin secreting tumors, and thyroid releasing hormone stimulation of Prolactin at 0, 30, 60, 90 minutes. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative chemiluminescent immunoassay.

Lab analysis to measure the renin (kidney enzyme) level in plasma specimen [HCPCS 84244]

Lab analysis to measure the sodium level in urine specimen [HCPCS 84300]

A urine sample is obtained to measure sodium level. Sodium is a positively charged electrolyte that works in conjunction with other electrolytes, such as potassium, chloride, and carbon dioxide (CO2), to regulate fluid in the body and maintain proper acid-base balance. Sodium is an essential mineral in the body, necessary for maintaining normal metabolic processes, fluid levels, and vascular pressure. Sodium level is used to screen for and monitor elevated blood sodium (hypernatremia), low blood sodium (hyponatremia), and electrolyte imbalances. Sodium may be monitored in patients on certain medications, such as diuretics, that can cause electrolyte imbalance. Sodium is measured by ion-selective electrode (ISE) methodology.

Lab analysis to measure the thyroid stimulating immune globulins (thyroid related protein) level in serum specimen [HCPCS 84445]

Lab analysis to measure the amount of hepatitis A antibody, hepatitis B core antibody, hepatitis B surface antigen, and hepatitis C antibody in blood specimen to evaluate acute hepatitis [HCPCS 80074]

An acute hepatitis panel is obtained to detect and diagnose acute or chronic viral liver infections. Hepatitis A virus (HAV) is highly contagious but usually causes only a mild illness. HAV is found in contaminated food and water but may also be spread person to person by close physical contact. It does not cause a chronic infection and a vaccine is available. Hepatitis B virus (HBV) is found in blood and body fluids and is the most common hepatitis virus contracted. It is a chronic infection and a vaccine is available against HBV. Hepatitis C virus is also found in blood and body fluids, and is chronic, however no vaccine is yet available to protect against this virus. Tests in an acute hepatitis panel should include Hepatitis A antibody, IgM antibody (HAAb IgM Ab), Hepatitis B core antibody, IgM antibody (HBcAb IgM Ab), Hepatitis B surface antigen (HBsAg), and Hepatitis C antibody (by CIA or Interp). Hepatitis A Virus antibody, IgM develops 2-3 weeks post exposure and remains elevated for 2-6 months. Hepatitis B Virus core antibody, IgM is produced in response to the presence of Hepatitis B core antigen. It will be elevated with acute initial infection and during flare up of disease activity in chronic infection. Hepatitis B Virus surface antigen is a protein located on the surface of HBV. Elevated levels of HBsAg may be an early sign of exposure to the virus or indicate an acute or chronic infection. When testing for Hepatitis C antibody, it is not possible to distinguish whether elevated levels are due to active acute infection or a chronic disease state unless differentiated by further testing. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative chemiluminescent immunoassay.

Lab analysis to measure the total bilirubin level [HCPCS 82247]

A laboratory test is performed to measure total or direct bilirubin. Bilirubin is a pigmented waste product normally produced when red blood cells (RBCs) break down. Non-water soluble (unconjugated) bilirubin is carried on albumin to the liver where it attaches to sugar molecules to become conjugated. Conjugated (direct) bilirubin is water soluble and able to pass from the liver to the small intestine. Further breakdown of bilirubin occurs in the small intestine and it is eventually eliminated in the feces in the form of stercobilin. Total bilirubin is the sum of conjugated (direct) and unconjugated bilirubin. A test for either conjugated or direct bilirubin or total bilirubin may be ordered to diagnose and monitor liver disorders, hemolytic anemia, and newborn (physiologic) jaundice. A blood sample is obtained by separately reportable venipuncture or heel stick. Other body fluids, including cerebral spinal fluid, may be collected and tested for total bilirubin. Serum/plasma is tested using quantitative spectrophotometry.

Lab analysis to measure the amount of lactoferrin (immune system protein) in stool specimen [HCPCS 83631]

Lab analysis to measure the total calcium level in blood specimen [HCPCS 82310]

A blood sample is taken to measure the amount of total calcium. Calcium is one of the most important minerals in the body. About 99 percent of the calcium found the body is stored in the bones. The remaining one percent circulates in the blood. Calcium may be ionized (free) or attached (bound) to proteins. Free calcium is the calcium metabolically active in the body. Bound calcium is inactive. Total calcium is a measurement of the total amount of both free calcium and bound calcium circulating in the blood. Total calcium is measured to screen for or monitor a number of conditions, including those affecting the bones, heart, nerves, kidneys and teeth. Total calcium is measured using spectrophotometry.

Lab analysis to measure the amount of levetiracetam in blood specimen [HCPCS 80177]

Lab analysis to measure the total creatine kinase (cardiac enzyme) level in blood specimen [HCPCS 82550]

Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. A blood test is performed to measure total creatine kinase (CK) levels. A blood specimen is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative enzymatic methodology.

Lab analysis to measure the amount of lithium in blood specimen [HCPCS 80178]

A blood test is performed to measure lithium levels. Lithium (carbonate), also known as Eskalith or Lithobid, is a neurotransmitter that affects the flow of sodium through nerve and muscle cells. It is used to stabilize the manic phase in patients with bipolar disorder and may also be prescribed to treat cluster headaches and bipolar depression. Lithium has a very narrow therapeutic range and blood levels are monitored frequently at the beginning of therapy, when dose is being adjusted, for suspected high or low levels and then at regular intervals when on maintenance doses. Blood should be drawn 12 hours after the last dose. A blood sample is obtained by a separately reportable venipuncture. Blood serum is then tested using reflectance spectrophotometry.

Lab analysis to measure the total protein level in body fluid specimen [HCPCS 84157]

A test is performed on body fluids other than blood or urine, such as cerebral spinal fluid or synovial fluid, in order to measure total protein levels. Elevated protein levels in cerebral spinal fluid (CSF) may be caused by tumors, bleeding, inflammation, or injury in the brain or central nervous system. A decrease in protein levels may result from a rapid turnover/replacement of cerebral spinal fluid. An elevated level of total protein in synovial fluid is most often caused by inflammation. CSF is obtained by separately reportable lumbar puncture (spinal tap), while synovial fluid is obtained by arthrocentesis from the affected joint. All body fluids are tested using reflectance spectrophotometry.

Lab analysis to measure the amount of phenobarbital in serum or plasma specimen [HCPCS 80184]

A blood test is performed to measure phenobarbital levels. Phenobarbital, also known as Luminal, is an anticonvulsant/hypnotic prescribed to treat seizures and insomnia by decreasing electrical activity in the brain. The drug may be administered orally or by injection. Blood concentration levels are monitored at regular intervals and also when breakthrough seizure activity or over sedation occurs, indicating possible high/low therapeutic blood levels. A blood sample is obtained by a separately reportable venipuncture. Blood serum is then tested using high performance liquid chromatography.

Lab analysis to measure the total protein level in urine specimen [HCPCS 84156]

A urine test is performed to measure total protein levels. Protein is not normally found in urine and usually indicates damage or disease in the kidneys. Elevated levels are often present in patients with diabetes, hypertension, and multiple myeloma. A 24-hour or random urine sample is obtained and tested using quantitative spectrophotometry.

Lab analysis to measure the amount of phosphatase (enzyme) (alkaline, isoenzymes) [HCPCS 84080]

Lab analysis to measure the uric acid level in blood specimen [HCPCS 84550]

A blood test is performed to measure uric acid levels. Uric acid forms from the natural breakdown of body cells and the food we ingest. Uric acid is normally filtered by the kidneys and excreted in urine. Elevated blood levels may result from kidney disease, certain cancers and/or cancer therapies, hemolytic or sickle cell anemia, heart failure, cirrhosis, lead poisoning, and low levels of thyroid or parathyroid hormones. Levels may be decreased in Wilson's disease, poor dietary intake of protein, and with the use of certain drugs. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative spectrophotometry.

Lab analysis to measure the amount of sirolimus in blood specimen [HCPCS 80195]

Lab analysis to measure the vitamin B-6 level in plasma specimen [HCPCS 84207]

Lab analysis to measure the vitamin D-3 level in serum or plasma specimen [HCPCS 82306]

Blood levels of 25-hydroxyvitamin D are used to primarily to determine whether a deficiency of Vitamin D or abnormal metabolism of calcium is the cause of bone weakness or malformation. Vitamin D is a fat soluble vitamin that is absorbed from the intestine like fat, and 25-hydroxyvitamin D levels are also evaluated in individuals with conditions or diseases that interfere with fat absorption, such as cystic fibrosis, Crohn's disease, or in patients who have undergone gastric bypass surgery. A blood sample is obtained. Levels of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 are evaluated using chemiluminescent immunoassay. The test results may be the sum of Vitamin D3 and D2 or the results may include fractions of D3 and D2 as well as the sum of these values.

Lab analysis to measure urea nitrogen level in serum or plasma specimen to assess kidney function (quantitative) [HCPCS 84520]

A blood sample is obtained to measure total (quantitative) urea nitrogen (BUN) level. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea then enters the bloodstream, is taken up by the kidneys and excreted in the urine. Blood BUN is measured to evaluate renal function, to monitor patients with renal disease, and to evaluate effectiveness of dialysis. BUN may also be measured in patients with acute or chronic illnesses that affect renal function. BUN is measured using spectrophotometry.

Lab analysis to screen for antibody to noninfectious agents [HCPCS 86255]

Lab analysis to screen for autoimmune disorders [HCPCS 86038]

A blood sample is obtained to screen for the presence of antinuclear antibodies (ANA) or to measure the concentration of antinuclear antibody in the blood, which is referred to as an ANA titer. Antinuclear antibodies are auto-antibodies that bind to structures within the nucleus of cells. Auto-antibodies are a type of antibody that is directed against the body's own tissues. The presence and concentration of antinuclear antibodies may indicate one of several autoimmune disorders that cause inflammation of body tissues including systemic lupus erythematosus, Sjorgren's syndrome, rheumatoid arthritis, polymyositis, scleroderma, Hashimoto's thyroiditis, juvenile diabetes mellitus, Addison disease, vitiligo, pernicious anemia, glomerulonephritis, and pulmonary fibrosis. When testing for antinuclear antibodies, the specimen is typically screened first using an enzyme-linked immunosorbent assay (ELISA) If the screening test is positive, that is if antinuclear antibodies are detected, a titer is then obtained. An antinuclear antibody titer is performed by diluting the blood sample with increasing amounts of a saline solution and retesting until antinuclear antibodies are no longer detectable. ANA titer is expressed as 1:10, 1:20, 1:40, 1:80, etc, with the 1 indicating 1 part blood and the second number indicating the parts of saline solution. A higher second number indicates a higher concentration of antinuclear antibodies in the blood.

Lab analysis to measure the amount of total cortisol (hormone) [HCPCS 82533]

Cortisol is a glucocorticoid (steroid hormone) produced by the adrenal gland in response to stress. The hormone causes an elevation in blood glucose levels, a decrease in immune system function and aids in the metabolism of fats, proteins and carbohydrates. The test may be used to diagnose Cushing syndrome (elevated cortisol levels) or Addison disease (decreased cortisol levels). A blood or saliva test is performed to measure total cortisol (hydrocortisone) levels. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative chemiluminescent immunoassay or quantitative liquid chromatography-tandom mass spectrometry. A saliva sample is obtained by separately reportable oral swab using a saliva collection device. Saliva is tested using quantitative enzyme immunoassay.

Lab analysis to screen for mononucleosis (mono) [HCPCS 86308]

Lab analysis to measure the amount of total digoxin in blood specimen [HCPCS 80162]

A laboratory test is performed to measure digoxin levels. Digoxin, also known as Lanoxin, is a cardiac glycoside that controls sodium and potassium levels in the cells. Digoxin is primarily prescribed to treat atrial fibrillation, atrial flutter, and congestive heart failure. The drug increases the strength of cardiac muscle contractions which increases cardiac output and lowers the heart rate and venous pressure. Digoxin has a narrow therapeutic window but antidotal treatment is available (Digibind, Digoxin Immune FAB). The test for total digoxin measures Fab fragment-bound (inactive) digoxin and free (active) digoxin. This test is primarily used to monitor digoxin therapy and should be drawn 8-12 hours following an oral dose. The test for free digoxin (80163) may be used to evaluate breakthrough digoxin toxicity in patients with renal failure, access the need for additional antidigoxin Fab, determine when to reintroduce digoxin therapy, and monitor patients with possible digoxin-like immune reactive factors. To measure free digoxin, a blood sample is obtained by separately reportable venipuncture 6-8 hours after the last dose. Serum is tested for total digoxin using immunoassay and for free digoxin using ultrafiltration followed by electrochemiluminescent immunoassay.

Lab analysis to screen for syphilis [HCPCS 86592]

A test for syphilis is performed. Syphilis is a sexually-transmitted disease (STD) caused by the bacterium Treponema pallidum. During the primary stage, a sore called a chancre appears at the site where the syphilis bacterium entered the body. The chancre resolves without treatment in 3-6 weeks but the patient remains infected. Without treatment, the infection will progress to a secondary stage in which a skin rash and mucous membrane lesions appear. The most common site of the rash is the palms of the hands and soles of the feet. Other symptoms during the secondary stage include fever, swollen lymph nodes, sore throat, hair loss, headaches, weight loss, muscle aches, and fatigue. Symptoms of secondary syphilis also resolve spontaneously but the patient remains infected. The patient then enters the late or latent stage of the disease. Symptoms of this stage may not appear for 10-20 years. Symptoms of late stage syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. These symptoms occur as the disease damages internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Of particular concern is undiagnosed syphilis infection during pregnancy as the infection can be passed to the baby in utero. This increases the risk of stillbirth or death shortly after birth. Untreated infants who survive often experience developmental delays or seizures. A qualitative syphilis test, such as the venereal disease research laboratory (VDRL) test, rapid plasma reagin (RPR) test, or automated reagin test (ART). The VDRL, RPR, ART are nontreponemal tests that measure antibody response to lipoidal antigen from T. pallidum and/or antibody interaction with host tissues. If a screening test is positive and the result is confirmed with a second confirmatory test, quantitative testing is then performed to determine disease activity and monitor response to treatment. Quantitative testing may be performed by enzyme linked immunosorbent assay (ELISA).

Lab analysis to measure the amount of total phenytoin in blood specimen [HCPCS 80185]

A blood test is performed to measure phenytoin total and phenytoin free levels. Phenytoin also known as Dilantin, Phenytek or Prompt, is an anticonvulsant prescribed to treat seizures and works by deceasing electrical activity in the brain. The drug may be administered orally or by injection. Phenytoin has a narrow therapeutic range and the patient should be monitored for both total and free phenytoin levels. Total phenytoin reflects the total serum concentration of the drug while free phenytoin levels reflect the unbound levels. Only the unbound levels are biologically active. Ninety (90) percent of the drug is typically highly bound and biologically inactive, but bound phenytoin is sensitive to displacement by other protein binding drugs which can elevate levels of free phenytoin in the blood. Blood concentration levels are monitored at regular intervals and also when breakthrough seizures occur, indicating possible low therapeutic levels. A blood sample is obtained by a separately reportable venipuncture. Blood serum is then tested using immunoassay.

Lab blood analysis to confirm blood unit compatibility with computer check (electronic) [HCPCS 86923]

Lab analysis to measure the amount of total thyroid hormone, T3 in serum specimen [HCPCS 84480]

A blood sample is tested to determine levels of total triiodothyronine (T3), free T3, or reverse T3. T3 is a hormone made by the thyroid gland that affects almost every metabolic process including body temperature, growth, and heart rate. T3 can either be produced by the thyroid or synthesized by the body from T4. Approximately 95% of T3 is bound to proteins in the blood and is inactive. The remaining 5% is free and active. T3 tests are used to help determine whether the thyroid is functioning properly, to diagnose hyperthyroidism, and to monitor patients with known thyroid disorders. In total T3, which reflects the amount of both bound and free T3, is measured. Total and free T3 are evaluated using electrochemiluminescent immunoassay. If the thyroid does not produce enough T3 or not enough is synthesized from T4, an inactive form of T3, referred to as reverse T3 or rT3, may be produced. Elevated levels of rT3 may be indicative of a thyroid disorder. Radioimmunoassay is used to evaluate rT3 levels.

Lab blood analysis to identify antigens on red blood cell surface and determine the patient's blood group type (ABO) [HCPCS 86900]

A blood specimen is tested to determine blood type (ABO) or Rh(D). Blood is grouped using an ABO blood typing system which identifies four blood types: type A, B, AB, or O. The blood sample is mixed with antibodies against Type A and B blood and then checked to determine if the blood cells agglutinate, or stick together. Type A blood has anti-B antibodies; type B blood has anti-A antibodies; type O blood has antibodies to both A and B; and type AB blood does not have anti-A or anti-B antibodies. Type A blood agglutinates when type B antibodies are introduced. Type B blood agglutinates when type A antibodies are introduced. Type O blood agglutinates when type A or B antibodies are introduced. Type AB blood does not agglutinate when type A or B antibodies are introduced. The blood is then back typed. Blood serum is mixed with blood that is known to be type A or B.

Lab analysis to measure the amount of total valproic acid in blood specimen [HCPCS 80164]

A laboratory test is performed to measure valproic acid (dipropylacetic acid, depakote). Valproic acid is an anticonvulsant that may be used to treat seizure disorders, manic phase of bipolar disorders, and migraine headaches. The drug works by changing certain chemicals neurotransmitters in the brain. The test for total valproic acid can be used to monitor drug therapy, assess patient compliance, and evaluate for potential toxicity. The test for free valproic acid may be used to evaluate the cause of toxicity when the total valproic acid concentration is within the normal range. Free valproic acid may be elevated in patients with an altered or unpredictable protein binding capacity. A blood sample is obtained by separately reportable venipuncture just prior to medication administration to obtain the trough level. Serum/plasma is tested for total valproic acid using fluorescence polarization immunoassay and for free valproic acid using quantitative enzyme multiplied immunoassay.

Lab blood analysis to identify antigens on red blood cell surface and determine the patient's Rh (D) type (Rh positive or Rh negative) [HCPCS 86901]

A blood specimen is tested to determine blood type (ABO) or Rh(D). In Rh(D), blood is tested for Rh factor, which is an antigen on red blood cells. Blood is Rh+ if the antigen is present or Rh- if the antigen is absent. Blood is tested by mixing the blood sample with antibodies against Rh factor and then checking for agglutination. If agglutination occurs, the blood is Rh+. If the blood does not agglutinate, it is Rh-.

Lab analysis to measure the amount of troponin (protein) in serum specimen [HCPCS 84484]

A blood test is performed to measure troponin levels. Troponins are regulatory proteins that facilitate contraction of skeletal and smooth muscle by forming calcium bonds. Troponin T binds to tropomyosin to form a complex. Troponin I binds to actin and holds the Troponin T-tropomyosin complex together. Elevation of troponins, coupled with cardiac symptoms such as chest pain are considered diagnostic for cardiac injury. This test is commonly ordered in the Emergency Department when a patient presents with possible myocardial infarction, and is then repeated at 6 hour intervals. It may be ordered with other tests that assess cardiac biomarkers such as CK, CK-MB, and myoglobin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested for Troponin T using quantitative electrochemiluminescent immunoassay. Serum is tested for Troponin I using chemiluminescent immunoassay.

Lab examination of specimen by the selective celllular enhancement technique to diagnose disease [HCPCS 88112]

Lab analysis to measure the amount of vancomycin (antibiotic) in serum specimen [HCPCS 80202]

A blood test is performed to measure vancomycin levels at random, peak and trough times. Vancomycin, also known as Vancocin is a glycopeptide antibiotic prescribed to treat severe or serious bacterial infections. For systemic infections it is administered by intravenous infusion. For intestinal infections such as colitis or clostridium difficile it is taken orally. Blood level monitoring is necessary because the drug has the potential to cause auditory toxicity. A random sample may be drawn any time, peak and trough levels are time dependant and are usually drawn 24 hours after initiating therapy and every 2-3 days thereafter. A trough level is drawn 10 minutes prior to intravenous infusion. A peak level is drawn 1-2 hours after intravenous infusion is complete. A blood sample is obtained by separately reportable venipuncture. Blood serum is then tested using fluorescence polarization immunoassay.

Lab genetic analysis to identify the variants of the hemochromatosis gene [HCPCS 81256]

Pathology lab analysis of special stained specimen slides to identify organisms with interpretation and report [HCPCS 88312]

Pathology lab analysis of tissue with microscope (intermediate complexity) [HCPCS 88305]

Tissue removed during a surgical procedure, such as a biopsy, excision, or resection, is examined macroscopically (gross or visual examination) and then under a microscope. The cells, tissues, or organ are transported from the surgical suite to the pathologist. The pathologist first visually examines the specimen and notes any defining characteristics. The specimen is then prepared for microscopic evaluation. The physician carefully analyzes the specimens to help establish a diagnosis, identify the presence or absence of malignant neoplasm, identify the exact type malignancy if present, examine the margins of the specimen to determine whether or not the entire diseased area was removed. A written report of findings is then prepared and a copy sent to the treating physician. Pathology services are reported based on the type of tissue examined, whether or not the tissue is expected to be normal or diseased, the difficulty of the pathology exam, and the time required to complete the exam.

Pathology lab analysis of tissue with microscope (moderately high complexity) [HCPCS 88307]

Tissue removed during a surgical procedure, such as a biopsy, excision, or resection, is examined macroscopically (gross or visual examination) and then under a microscope. The cells, tissues, or organ are transported from the surgical suite to the pathologist. The pathologist first visually examines the specimen and notes any defining characteristics. The specimen is then prepared for microscopic evaluation. The physician carefully analyzes the specimens to help establish a diagnosis, identify the presence or absence of malignant neoplasm, identify the exact type malignancy if present, examine the margins of the specimen to determine whether or not the entire diseased area was removed. A written report of findings is then prepared and a copy sent to the treating physician. Pathology services are reported based on the type of tissue examined, whether or not the tissue is expected to be normal or diseased, the difficulty of the pathology exam, and the time required to complete the exam.

Pathology lab analysis of tissue with microscope (moderately low complexity) [HCPCS 88304]

Tissue removed during a surgical procedure, such as a biopsy, excision, or resection, is examined macroscopically (gross or visual examination) and then under a microscope. The cells, tissues, or organ are transported from the surgical suite to the pathologist. The pathologist first visually examines the specimen and notes any defining characteristics. The specimen is then prepared for microscopic evaluation. The physician carefully analyzes the specimens to help establish a diagnosis, identify the presence or absence of malignant neoplasm, identify the exact type malignancy if present, examine the margins of the specimen to determine whether or not the entire diseased area was removed. A written report of findings is then prepared and a copy sent to the treating physician. Pathology services are reported based on the type of tissue examined, whether or not the tissue is expected to be normal or diseased, the difficulty of the pathology exam, and the time required to complete the exam.

Pathology lab analysis of tissue with microscope [HCPCS 88302]

Psa screening [HCPCS G0103]

Prostate cancer screening; prostate specific antigen test (psa)

Rbc leukocytes reduced [HCPCS P9016]

Red blood cells, leukocytes reduced, each unit

Drug administration beneath the skin or into muscle by injection for therapy, diagnosis, or prevention [HCPCS 96372]

A subcutaneous or intramuscular injection of a therapeutic, prophylactic, or diagnostic substance or drug is given. A subcutaneous injection is administered just under the skin in the fatty tissue of the abdomen, upper arm, upper leg, or buttocks. The skin is cleansed. A two-inch fold of skin is pinched between the thumb and forefinger. The needle is inserted completely under the skin at a 45 to 90 degree angle using a quick, sharp thrust. The plunger is retracted to check for blood. If blood is present, a new site is selected. If no blood is present, the medication is injected slowly into the tissue. The needle is withdrawn and mild pressure is applied. An intramuscular injection is administered in a similar fashion deep into muscle tissue, differing only in the sites of administration and the angle of needle insertion. Common sites include the gluteal muscles of the buttocks, the vastus lateralis muscle of the thigh, or the deltoid muscle of the upper arm. The angle of insertion is 90 degrees. Intramuscular administration provides rapid systemic absorption and can be used for administration of relatively large doses of medication.

Drug administration into vein by infusion for therapy, prevention, or diagnosis (each additional hour) [HCPCS 96366]

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

Drug administration into vein by infusion for therapy, prevention, or diagnosis (up to 1 hour) [HCPCS 96365]

An intravenous infusion of a specified substance or drug is administered for therapy, prophylaxis, or diagnosis. An intravenous line is placed into a vein, usually in the arm, and the specified substance or drug is administered. The physician provides direct supervision of the administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment.

Drug administration into vein by push technique for therapy, diagnosis, or prevention (each additional push of same drug) [HCPCS 96376]

A therapeutic, prophylactic, or diagnostic injection is administered by intravenous push (IVP) technique. The specified substance or drug is injected using a syringe directly into an injection site of an existing intravenous line or intermittent infusion set (saline lock). The injection is given over a short period of time, usually less than 15 minutes.

Hydration administration into vein by infusion (31 minutes to 1 hour) [HCPCS 96360]

An intravenous infusion is administered for hydration. An intravenous line is placed into a vein, usually in the arm, and fluid is administered to provide additional fluid levels and electrolytes to counteract the effects of dehydration or supplement deficient oral fluid intake. The physician provides direct supervision of the fluid administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment.

Hydration administration into vein by infusion (each additional hour) [HCPCS 96361]

An intravenous infusion is administered for hydration. An intravenous line is placed into a vein, usually in the arm, and fluid is administered to provide additional fluid levels and electrolytes to counteract the effects of dehydration or supplement deficient oral fluid intake. The physician provides direct supervision of the fluid administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment. Use 96360 for the initial 31 minutes to one hour of hydration. Use 96361 for each additional hour.

Immunization administration of vaccine into, between, or beneath the skin or into muscle (single vaccine) [HCPCS 90471]

A single vaccine or a combination vaccine/toxoid is administered by injection to a patient over age 18 with or without a face-to-face encounter with the physician or other health care professional. These codes are also used when a vaccine/toxoid is given to a patient age 18 or younger without any face-to-face counseling by the physician or other health care professional. Routes of administration include percutaneous, intradermal, subcutaneous, or intramuscular.

Therapeutic massage to 1 or more areas (each 15 minutes) [HCPCS 97124]

Airway inhalation treatment to relieve airway obstruction or for sputum collection (inhaled pressure or nonpressure treatment) [HCPCS 94640]

The patient is placed on intermittent inhalation treatment for acute airway obstruction or to induce sputum production for therapeutic and/or diagnostic purposes. To treat acute airway obstruction, pressurized or nonpressurized bronchodilator medication is delivered for short intervals several times a day using an inhaler, nebulizer, aerosol generator, or an intermittent positive pressure breathing (IPPB) device. Bronchodilator medication is suspended as fine particles within a gaseous propellant and taken into the lungs as a fine spray. The medication acts to relax the smooth muscle of the bronchioles and lung tissue, which has constricted in conditions such as an asthma attack or hypersensitivity reaction, severely restricting air flow. The patient uses the prescribed pressurized or nonpressurized inhalation device as directed by the physician typically for 10-15 minutes several times during the day. To induce sputum production for diagnostic purposes, an isotonic or hypertonic solution is delivered using a nebulizer or other device. These solutions induct secretion of sputum in the lower airways. The patient must cough to expectorate the secretions which are collected in a sterile container and sent to the laboratory for separately reportable analysis.

Oxygen saturation measurement in blood by ear or finger device (single determination) [HCPCS 94760]

Ear or pulse oximetry measures the percentage of hemoglobin (Hb) that is saturated with oxygen and is used to monitor oxygen saturation of blood and detect lower than normal levels of oxygen in the blood. Oximeters also record pulse rate and provide a graphical display of blood flow past the probe. A probe is attached to the patient's ear lobe or finger. The probe is connected to a computerized unit. A light source from the probe is emitted at two wavelengths. The light is partially absorbed by Hb in amounts that differ based on whether the Hb is saturated or desaturated with oxygen. The absorption of the two wavelengths is then computed by the oximeter processer and the percentage of oxygenated Hb is displayed. The oximeter can be programmed to sound an audible alarm when the oxygen saturation of blood falls below a certain level.

Indwelling bladder catheter insertion (simple) [HCPCS 51702]

A temporary indwelling catheter is inserted into the bladder. This may be referred to as Foley catheterization. A catheter kit is prepared. The urethra is cleansed with antiseptic solution. A sterile Foley catheter is inserted through the urethra into the bladder. The balloon is then inflated with about 10 cc of water to keep it in place. The catheter is attached to a sterile drainage bag and urine is continuously drained from the bladder.

Median nerve of hand release and/or relocation [HCPCS 64721]

Needle insertion into vein for collection of blood sample [HCPCS 36415]

An appropriate vein is selected, usually one of the larger anecubital veins such as the median cubital, basilic, or cehalic veins. A tourniquet is placed above the planned puncture site. The site is disinfected with an alcohol pad. A needle is attached to a hub and the vein is punctured. A Vacuainer tube is attached to the hub and the blood specimen is collected. The Vacutainer tube is removed. Depending on the specific blood tests required, multiple Vacutainers may be filled from the same punchture site.

Short arm splint application forearm to hand (non-moveable) [HCPCS 29125]

A static splint is applied to stabilize an injury by decreasing movement and providing support to the posterior aspect of the forearm, wrist, and hand. A stockinette is applied over the arm from the elbow to the wrist followed by padding over the stockinette. Plaster sheets cut to the appropriate length are then immersed in water and saturated. Excess water is gently squeezed out of the plaster. The plaster is applied to the posterior aspect of the forearm, wrist, and hand. The plaster is smoothed and molded. An elastic bandage is wrapped around the arm to secure the splint. The forearm may be placed in a sling.

Simple repair of wound of scalp, neck, underarms, genitalia, trunk, arms, and/or legs (2.5 cm or less) [HCPCS 12001]

Simple repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities is performed. The wound is cleansed and a local anesthetic is administered. The wound is inspected and determined to be superficial involving only the epidermis, dermis, or subcutaneous tissue without involvement of deeper tissues and without heavy contamination. A simple, one-layer closure using sutures, staples, or tissue adhesive is performed. Alternatively, chemical cautery or electrocautery may be used to treat the wound without closure.

Post chmbr intraocular lens [HCPCS V2632]

Abdominal and pelvic CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 74176]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

Abdominal aorta ultrasound for screening of abdominal aortic aneurysm [HCPCS 76706]

Abdominal ultrasound (limited) [HCPCS 76705]

A real time abdominal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained. The ultrasonic wave pulses directed at the abdomen are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the abdomen and provides a written interpretation.

Abdominal x-ray (single view) [HCPCS 74018]

A radiologic examination of the abdomen images the internal organs, soft tissue (muscle, fat), and supporting skeleton. X-ray imaging uses indirect ionizing radiation to take pictures of non-uniform material, such as human tissue, because of its different density and composition, which allows some of the x-rays to be absorbed and some to pass through and be captured. This produces a 2D image of the structures. The radiographs may be taken to look for size, shape, and position of organs, pattern of air (bowel gas), obstruction, foreign objects, and calcification in the gallbladder, urinary tract, and aorta. A radiologic examination of the abdomen may be ordered to diagnose abdominal distention and pain, vomiting, diarrhea or constipation, and traumatic injury; it may also be obtained as a screening exam or scout film prior to other imagining procedures. Common views of the abdomen include front to back anteroposterior (AP) with the patient lying supine or standing erect, back to front posteroanterior (PA) with the patient lying prone, lateral with the patient lying on the side, lateral decubitus anteroposterior (side lying, front to back view), lateral dorsal decubitus (lying supine, side view), oblique (anterior or posterior rotation), and coned (small collimated) views which may be used to localize and differentiate lesions, calcifications, or herniations.

Ankle x-ray (2 views) [HCPCS 73600]

A radiologic examination of the ankle images the bones of the distal lower extremities including the tibia, fibula, and talus. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Ankle x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the ankle include front to back anteroposterior (AP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

Ankle x-ray (minimum of 3 views) [HCPCS 73610]

A radiologic examination of the ankle images the bones of the distal lower extremities including the tibia, fibula, and talus. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Ankle x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the ankle include front to back anteroposterior (AP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

Arm or leg ultrasound (complete) [HCPCS 76881]

Ultrasound, also referred to as sonography and echography, is a non-invasive imaging technique that uses high-frequency sound waves to evaluate tissues and structures. Nonvascular structures of the extremities that may be evaluated by ultrasound include periarticular soft tissue masses, muscles, tendons, nerves, ligaments, and joints. Common conditions that can be detected or evaluated by ultrasound include cystic lesions, solid tumors, abscesses, joint effusion, tendon tears, tendonitis, tenosynovitis, nerve compression, and stress fractures. Acoustic coupling gel is applied to the extremity to be examined. An ultrasound probe is placed against the skin and moved over the target joint area to be examined as sound waves pass through and bounce off extremity tissues and structures. The sound waves are reflected back to the receiving unit at varying speeds and converted into images. Longitudinal, transverse, and oblique images are obtained. The physician reviews the images and provides a written interpretation.

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (complete, both arms or legs) [HCPCS 93970]

A vascular ultrasound study is performed to evaluate veins in the extremities. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin of the extremity over the region to be studied. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied. The Doppler probe produces sound waves that bounce off blood cells moving within the veins. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The duplex scan may include a baseline evaluation followed by additional scans obtained with compression or using other maneuvers that alter blood flow. The physician reviews the duplex scan and provides a written interpretation of findings.

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (limited, one arm or leg) [HCPCS 93971]

A vascular ultrasound study is performed to evaluate veins in the extremities. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin of the extremity over the region to be studied. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied. The Doppler probe produces sound waves that bounce off blood cells moving within the veins. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The duplex scan may include a baseline evaluation followed by additional scans obtained with compression or using other maneuvers that alter blood flow. The physician reviews the duplex scan and provides a written interpretation of findings.

Blood flow (outside of the brain) ultrasound on both sides of head and neck [HCPCS 93880]

A vascular ultrasound study is performed to evaluate the extracranial arteries which include the common carotid and external carotid arteries. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin over the arteries to be studied. A B-mode transducer is placed on the skin and real-time images of the artery are obtained. A Doppler probe within the B-mode transducer provides information on pattern and direction of blood flow in the artery. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the arteries when the probe is placed over the arteries at various locations and angles. The Doppler probe produces sound waves that bounce off blood cells moving within the artery. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function, including information on the presence of narrowing and plaque formation within the arteries. The physician reviews the duplex scan and provides a written interpretation of findings.

Bone density measurement of the axial skeleton (hips, pelvis, spine) [HCPCS 77080]

These codes report dual-energy x-ray absorptiometry (DXA) for bone density study. Measuring bone mass or bone mineral density (BMD) is done to diagnose for bone disease, evaluate bone disease progression, or monitor the results of treatment, particularly for osteoporosis, which puts a bone at higher risk of fracture. The radiation dose of DXA is around 1/30th of that in a standard chest x-ray. DXA involves aiming two x-ray beams of different energy levels at the bones in alternate pulses. Soft tissue absorption is subtracted out, and the BMD is determined by the bone's absorption of each beam in the projected area. The DXA scan measurement is then compared to a same sex standard of bone density at age 30, since the maximum BMD occurs at age 30 in both males and females. The difference between the measured BMD and the sex-matched, average 30-year-old standard is known as the T score. A T score between -1.0 and -2.4 diagnoses osteopenia, while a T score of -2.5 or less indicates osteoporosis.

Breast ultrasound (one breast, complete) [HCPCS 76641]

A real time ultrasound of the right or left breast is performed with image documentation, including the axillary area, when performed. Breast ultrasound is used to help diagnose breast abnormalities detected during a physical exam or on mammography. Ultrasound imaging can identify masses as solid or fluid-filled and can show additional structural features of the abnormal area and surrounding tissues. The patient is placed supine with the arm raised above the head on the side being examined. Acoustic coupling gel is applied to the breast and the transducer is pressed firmly against the skin of the breast. The transducer is then swept back and forth over the area of the abnormality and images are obtained. The ultrasonic wave pulses directed at the breast are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the breast and provides a written interpretation.

Chest CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 71260]

Diagnostic computed tomography (CT) is done on the thorax. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and reconstructs a 3D image. Thin, cross-sectional 2D and 3D slices are then produced of the targeted organ or area. The patient is placed inside the CT scanner on the table and images are obtained of the thorax to look for problems or disease in the lungs, heart, esophagus, soft tissue, or major blood vessels of the chest, such as the aorta. The physician reviews the images to look for suspected disease such as infection, lung cancer, pulmonary embolism, aneurysms, and metastatic cancer to the chest from other areas.

Chest CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 71250]

Diagnostic computed tomography (CT) is done on the thorax. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and reconstructs a 3D image. Thin, cross-sectional 2D and 3D slices are then produced of the targeted organ or area. The patient is placed inside the CT scanner on the table and images are obtained of the thorax to look for problems or disease in the lungs, heart, esophagus, soft tissue, or major blood vessels of the chest, such as the aorta. The physician reviews the images to look for suspected disease such as infection, lung cancer, pulmonary embolism, aneurysms, and metastatic cancer to the chest from other areas.

Chest x-ray (2 views) [HCPCS 71046]

A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

Chest x-ray (single view) [HCPCS 71045]

A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

Color-directed heart blood flow doppler ultrasound to evaluate heart rate and valve function [HCPCS 93325]

Doppler color flow

CTA scan of chest blood vessels with contrast to examine injury, foreign bodies, or tumors [HCPCS 71275]

A computed tomographic angiography (CTA) of the noncoronary vessels of the chest is performed with contrast material including image postprocessing. Noncontrast images may also be obtained and are included when performed. CTA provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images may be obtained. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the noncoronary vessels of the chest.

Digital tomography of both breasts (screening exam) [HCPCS 77063]

Digital screening mammogram

Elbow x-ray, complete study (minimum of 3 views) [HCPCS 73080]

A radiologic examination of the elbow is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. X-rays of the elbow are usually considered necessary to assess for fractures or dislocations when the normal range of motion for extension, flexion, supination, and pronation cannot be carried out. Most acute disruptions of the elbow joint can be diagnosed by conventional x-ray examination, with the minimum number of views including the front to back anteroposterior projection with the elbow in as full extension as possible, and the side, or lateral image taken in flexion. A complete series of images also includes an oblique view of the radial head-capitellar image to help diagnose suspected subtle fractures involving the radial head or in cases of acute pain and trauma. The patient needs to be able to hold the elbow in full extension for the front view and in 90 degree flexion for the oblique and lateral views as much as possible.

Esophagus x-ray with barium swallow (single contrast material swallowed) [HCPCS 74220]

Oral contrast material is swallowed and the passage of the contrast is observed fluoroscopically as it passes through the pharynx and/or esophagus. Once the lumen of the pharynx and/or esophagus is completely coated with contrast material, still radiographic images are obtained. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

Facial CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70486]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the maxillofacial area is obtained. The maxillofacial area includes the forehead (frontal bone), sinuses, nose and nasal bones, jaw (maxilla and mandible). The only facial region not included in this study is the orbit. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

Fluoroscopy imaging guidance for procedure (up to 1 hour) [HCPCS 76000]

Foot x-ray (2 views) [HCPCS 73620]

A radiologic examination of the foot images the bones of the distal lower extremity and may include the tibia, fibula, talus, calcaneus, cuboid, navicular, cuneiform, metatarsals, and phalanges. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Foot x-rays may also be used to determine whether there is satisfactory alignment of foot bones following fracture treatment. Standard views of the foot include top to bottom dorsal planter (DP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

Foot x-ray, complete study (minimum of 3 views) [HCPCS 73630]

A radiologic examination of the foot images the bones of the distal lower extremity and may include the tibia, fibula, talus, calcaneus, cuboid, navicular, cuneiform, metatarsals, and phalanges. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Foot x-rays may also be used to determine whether there is satisfactory alignment of foot bones following fracture treatment. Standard views of the foot include top to bottom dorsal planter (DP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

Hand x-ray (minimum of 2 views) [HCPCS 73130]

A radiologic examination of the hand is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, or tumors. Hand x-rays are also used to help determine the 'bone age' of children and assess whether any nutritional or metabolic disorders may be interfering with proper development. The posteroanterior projection is taken with the palm down flat and may show not only the metacarpals, phalanges, and interphalangeal joints, but the carpal bones, radius, and ulna as well. Lateral views may be taken with the hand placed upright, resting upon the ulnar side of the palm and little finger with the thumb on top, ideally with the fingers supported by a sponge and splayed to avoid overlap. Oblique views can be obtained with the hand placed palm down and rolled slightly to the outside with the fingertips still touching the film surface. The beam is angled perpendicular to the cassette for oblique projections and aimed at the middle finger metacarpophalangeal joint.

Head and neck ultrasound [HCPCS 76536]

An ultrasound examination of soft tissues of the head and neck is performed with image documentation. The thyroid, parathyroid, or parotid glands and surrounding soft tissue may be examined. Ultrasound visualizes the body internally using sound waves far above human perception bounce off interior anatomical structures. As the sound waves pass through different densities of tissue, they are reflected back to the receiving unit at varying speeds and converted into pictures displayed on screen. A linear scanner or mechanical sector scanner is used to evaluate the shape, size, border, internal architecture, distal enhancement, color flow, and echogenicity of the soft tissue structures of the head and neck as well as any lesions or masses. The echogenicity is compared to that of the surrounding muscle tissue. The physician reviews the images and provides a written interpretation.

Heart ultrasound and continuous monitoring performed during rest, exercise, and/or drug-induced stress with interpretation and report [HCPCS 93351]

Cardiac stress test with echocardiogram real-time imaging

Heart ultrasound including color-depicted blood flow rate, direction, and valve function [HCPCS 93306]

The physician performs complete transthoracic real-time echocardiography with image documentation (2-D) including M-mode recording, if performed, with spectral Doppler and color flow Doppler echocardiography. Cardiac structure and dynamics are evaluated using a series of real-time tomographic images with multiple views recorded digitally or on videotape. Time-motion (M-mode) recordings are made as needed to allow dimensional measurement. Blood flow and velocity patterns within the heart, across valves and within the great vessels are evaluated by color flow Doppler. Normal blood flow patterns through these regions have a characteristic pattern defined by direction, velocity, duration, and timing throughout the cardiac cycle. Spectral Doppler by pulsed or continuous wave technique is used to evaluate antegrade flow through inflow and outflow tracts and cardiac valves. Multiple transducer positions or orientations may be required. The physician reviews the echocardiography images and orders additional images as needed to allow evaluation of any abnormalities. Digital or videotaped images are then reviewed by the physician. Abnormalities of cardiac structure or dynamics are noted. The extent of the abnormalities is evaluated and quantified. Any previous cardiac studies are compared to the current study and any quantitative or qualitative changes are identified. The physician provides an interpretation of the echocardiography with a written report of findings.

Hip x-ray of hip with pelvis (2 to 3 views) [HCPCS 73502]

A radiologic examination of the hip is done on either the left or the right side, which may also include the pelvis. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, infection, or tumor. Hip standard views that are taken most frequently include the front to back anteroposterior view taken with the patient lying supine and the legs straight, rotated slightly inward; the lateral ‘frog-leg’ view, taken with the hips flexed and abducted and the knees flexed with the soles of the feet placed together; a cross table view with the unaffected hip and knee flexed at a 90 degree angle out of the way and the beam aimed perpendicular to the long axis of the femur on the affected side. Another type of lateral view is taken with the hip flexed 45 degrees and abducted 45 degrees and the beam aimed perpendicular to the table.

Imaging of arm joint by MRI without contrast [HCPCS 73221]

Magnetic resonance imaging is done on a joint of the upper or lower arm. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the joint. MRI scans on joints of the upper extremity are often done for injury, trauma, unexplained pain, redness, or swelling, and freezing of a joint with loss of motion. MRI scans provide clear images of areas that may be difficult to see on CT.

Imaging of brain by MRI without contrast [HCPCS 70551]

Magnetic resonance imaging is done on the brain. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. MRI of the brain provides reliable information for diagnosing the presence, location, and extent of tumors, cysts, or other masses; swelling and infection; vascular disorders or malformations, such as aneurysms and intracranial hemorrhage; disease of the pituitary gland; stroke; developmental and structural anomalies of the brain; hydrocephalus; and chronic conditions and diseases affecting the central nervous system such as headaches and multiple sclerosis.

Imaging of heart vessels with SPECT tomography and drugs or exercise (multiple studies) [HCPCS 78452]

Myocardial perfusion imaging is a nuclear medicine procedure used to evaluate the heart muscle and blood flow to the heart. An intravenous line is inserted into a vein in the hand or arm. ECG leads are placed and a blood pressure cuff is placed on the arm. The patient lies flat on a table in the procedure room for myocardial perfusion imaging performed at rest. For a stress study, the patient is either on a treadmill or bike or an injection of a pharmacologic agent is administered to stress the heart. A radionuclide, also called a tracer, is injected into the intravenous line and allowed to circulate. The radionuclide localizes in healthy heart tissue. Ischemic heart tissue does not absorb the radionuclide. Images of the heart and great vessels are obtained using single photon emission computed tomography (SPECT). When SPECT images are obtained, the scanner rotates around the body to obtain images in multiple planes. The physician evaluates heart wall motion to determine how effective the heart muscle is in pumping blood through the heart and to the peripheral vascular system. Ejection fraction, which is the percentage of blood pumped out of the heart to the peripheral vascular system, is measured using either a first pass or gated technique. In a first pass technique, images are obtained as the blood circulates through the heart during the first pass of the radionuclide. In a gated technique, a series of images are obtained between heart beats. Using electrical signals from the heart, the camera captures a series of images as the heart rests, creating very sharp, high resolution images. Additional images are obtained as needed. The physician reviews the images, calculates the ejection fraction and quantifies other parameters of heart function based on the distribution of the radionuclide. The physician then provides a written report of findings.

Imaging of lower spinal canal by MRI without contrast, followed by contrast [HCPCS 72158]

Magnetic resonance imaging (MRI) is done on the cervical, thoracic, or lumbar spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and coverts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery. Images are taken first without contrast and again after the administration of contrast to see the spinal area better. The physician reviews the images to look for specific information that may correlate to the patient's symptoms, such as abnormal spinal alignment; disease or injury of vertebral bodies; intervertebral disc herniation, degeneration, or dehydration; the size of the spinal canal to accommodate the cord and nerve roots; pinched or inflamed nerves; or any changes since surgery.

Imaging of upper spinal canal by MRI without contrast [HCPCS 72141]

Magnetic resonance imaging (MRI) is done on the cervical spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and converts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery.

Knee x-ray (3 views) [HCPCS 73562]

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

Knee x-ray (4 or more views) [HCPCS 73564]

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

Lower leg x-ray (2 views) [HCPCS 73590]

A radiologic examination of the tibia and fibula images the bones of the distal lower extremities and may include the knee and ankle joints. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Tibia and fibula x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the tibia and fibula include front to back anteroposterior (AP) and lateral (side).

Neck CT scan of the soft tissue of the neck with contrast to examine injury, foreign bodies, or tumors [HCPCS 70491]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In a CT scan of the soft tissues of the neck, the patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

Pelvis CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 72192]

Diagnostic computed tomography (CT) is done on the pelvis to provide detailed visualization of the organs and structures within or near the pelvis, such as kidneys, bladder, prostate, uterus, cervix, vagina, lymph nodes, and pelvic bones. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of organs within the pelvis can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the pelvis area. The physician reviews the images to gather information for specified purposes such as diagnosing or monitoring cancer, evaluating the pelvic bones for fractures or other injury following trauma, locating abscesses or masses found during physical exam, finding the cause of pelvic pain, providing more detailed information before surgery, and evaluating the patient after surgery.

Pelvis ultrasound, not pregrnancy related (complete) [HCPCS 76856]

A real time pelvic (non-obstetric) ultrasound is performed with image documentation to evaluate the uterus and cervix, ovaries, fallopian tubes, and bladder. Conditions evaluated include pelvic pain, abnormal bleeding, and palpable masses, such as ovarian cysts, uterine fibroids, or other pelvic masses. The patient presents with a full bladder. Acoustic coupling gel is applied to the skin of the lower abdomen. The transducer is pressed firmly against the skin and swept back and forth over the lower abdomen and images obtained of the uterus, ovaries, and surrounding pelvic structures. The ultrasonic wave pulses directed at the pelvic structures are imaged by recording the ultrasound echoes. Any abnormalities are evaluated. The physician reviews the ultrasound images and provides a written interpretation.

Pelvis x-ray (1 or 2 views) [HCPCS 72170]

A diagnostic x-ray examination of the pelvis is done. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Bones appear white while soft tissue and fluids appear shades of grey. Pelvic x-rays are taken when the patient complains of pain and/or injury in the area of the pelvis or hip joints to assess for fractures and detect arthritis or bone disease. The patient is placed on a table and different views of the pelvis are taken by having the patient position the legs and feet differently, such as turning the feet inward to point at each other, or bending the knees outward with the soles of the feet together in a 'frog-leg' position.

Rib cage x-ray of ribs on one side of body including chest (minimum of 3 views) [HCPCS 71101]

Rib radiographs (x-rays) are typically obtained following trauma to the rib cage to determine if fractures or other internal injuries are present. The most common views of the ribs are anteroposterior (AP) (frontal) and oblique. There are four positions used for oblique views: right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area that is being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views.

Shoulder x-ray, complete study (minimum of 2 views) [HCPCS 73030]

A radiologic examination of the shoulder is done. The shoulder is the junction of the humeral head and the glenoid of the scapula. Standard views include the anteroposterior (AP) view and the lateral 'Y' view, named because of the Y shape formed by the scapula when looking at it from the side. An axial view can also be obtained for further assessment when the patient is able to hold the arm in abduction. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

Spinal CT scan of lower spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72131]

Diagnostic computed tomography (CT) is done on the lumbar spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the lumbar spine. The physician reviews the images to look for suspected problems with the spine such as bone disease, and evaluate for fractures or other injuries as well as birth defects of the spine in children.

Spinal CT scan of upper spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72125]

Diagnostic computed tomography (CT) is done on the cervical spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the cervical spine.

Spinal x-ray of lower and sacral spine (2 or 3 views) [HCPCS 72100]

A radiologic exam is done of the lumbosacral spine. Frontal, posteroanterior, and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

Thighbone x-ray (minimum of 2 views) [HCPCS 73552]

A radiologic examination of the femur is done between the hip and the knee. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, and cysts or tumors. X-rays may also be used to determine whether the femur is in satisfactory alignment following fracture treatment. Femur standard views that are taken most frequently include the front to back anteroposterior view and the lateral view from the side.

Ultrasound of area behind abdominal cavity (complete) [HCPCS 76770]

A real time retroperitoneal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained of the retroperitoneal area. The ultrasonic wave pulses directed at the retroperitoneum are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the retroperitoneum and provides a written interpretation.

Wrist x-ray, complete study (minimum of 3 views) [HCPCS 73110]

A radiologic examination of the wrist is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, arthritis, foreign body, infection, or tumor. Wrist standard views include the front to back anteroposterior (AP) or back to front posteroanterior (PA) projection; the lateral view with the elbow flexed and the hand and wrist placed thumb up; and oblique views. Oblique views are obtained with the hand and wrist either supinated or pronated with the hand slightly flexed so the carpal target area lies flat, and then rotating the wrist 45 degrees externally or internally. A more specialized image may be obtained for assessing carpal tunnel. For the carpal tunnel view, the forearm is pronated with the palm down, and the wrist is hyperextended as far as possible by grasping the fingers with the opposite hand and gently hyperextending the joint until the metacarpals and fingers are in a near vertical position.

Tomosynthesis, mammo [HCPCS G0279]

Admin influenza virus vac [HCPCS G0008]

Administration of influenza virus vaccine

Drug administration into vein by push technique for therapy, diagnosis, or prevention (each additional push of new drug) [HCPCS 96375]

A therapeutic, prophylactic, or diagnostic injection is administered by intravenous push (IVP) technique. The specified substance or drug is injected using a syringe directly into an injection site of an existing intravenous line or intermittent infusion set (saline lock). The injection is given over a short period of time, usually less than 15 minutes.

Drug administration into vein by push technique for therapy, diagnosis, or prevention (initial drug) [HCPCS 96374]

A therapeutic, prophylactic, or diagnostic injection is administered by intravenous push (IVP) technique. The specified substance or drug is injected using a syringe directly into an injection site of an existing intravenous line or intermittent infusion set (saline lock). The injection is given over a short period of time, usually less than 15 minutes.

Tc99m medronate [HCPCS A9503]

Tc99m sestamibi [HCPCS A9500]

Function improvement activities with one-on-one contact between patient and provider (each 15 minutes) [HCPCS 97530]

In a one-on-one physical therapy session, the provider instructs and assists the patient in therapeutic activities designed to address specific functional limitations. The therapeutic activities are specifically developed and modified for the patient. Dynamic/movement activities, also called kinetic activities, that are designed to improve functional performance such as lifting, bending, pushing, pulling, jumping and reaching are included in this service. For example, the patient may be given therapeutic activities to perform to improve the ability to sit, stand, and get out of bed after an injury without straining or risking reinjury. This code is reported for each 15 minutes of one-on-one therapeutic activity provided.

Occupational therapy evaluation (typically 30 minutes) [HCPCS 97165]

An occupational therapy evaluation or re-evaluation is performed. Occupational therapy assists the patient in developing or regaining skills that allow independent functioning and enhance health and personal well-being. A patient history is taken that includes an occupational profile and medical and therapy history with review of records as well as an extensive review of physical, cognitive, or psychosocial elements related to current performance of daily activities. The occupational therapist evaluates the patient's physical functioning, mental, and/or neurobehavioral impairment and performs tests to identify functional limitations or performance deficits. Physical functioning is evaluated, including an evaluation of any musculoskeletal conditions that may impair function. The ability to perform basic activities of daily living such as dressing, bathing, mobility, and other activities for living independently, such as shopping, cooking, driving, or accessing public transportation are all assessed. Barriers in the home, school, work, and community environments are identified. The need for adaptive equipment is assessed. The occupational therapist develops a treatment plan using clinical decision making from the patient analysis, assessment data, comorbidities, and possible treatment options. During a re-evaluation, an interim history is taken; the patient's response to treatment is evaluated; and the plan of care is revised based on the patient's response to treatment, functional and medical status, and any changes in condition or environment that affect future interventions or goals.

Physcial therapy exercise of walking training to 1 or more areas (each 15 minutes) [HCPCS 97116]

Gait training is a therapeutic procedure that observes and educates an individual in the manner of walking including the rhythm, cadence, step, stride, and speed. The objective of gait training is to strengthen muscles and joints, improve balance and posture, and develop muscle memory. As the lower extremities are retrained for repetitive motion, the body also benefits from the exercise with increased endurance, improved heart/lung function, and reduced or improved osteoporosis. Gait training is an appropriate therapeutic procedure following brain and/or spinal cord injury, stroke, fracture of the pelvis and/or lower extremity, joint injury or replacement of the knee, hip, or ankle, amputation, and for certain musculoskeletal and/or neurological diseases. A treadmill fitted with a safety harness is initially used to ensure safe walking. As the patient gains strength and balance, step training and stair climbing is added to the treatment modality.

Physical therapy evaluation (typically 20 minutes) [HCPCS 97161]

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Physical therapy evaluation (typically 30 minutes) [HCPCS 97162]

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Physical therapy procedure to re-educate brain-to-nerve-to-muscle function (each 15 minutes) [HCPCS 97112]

Therapeutic procedures for neuromuscular reeducation are used to develop conscious control of a single muscle or muscle group and heighten the awareness of the body's position in space, especially the position of the extremities when sitting or standing. Neuromuscular reeducation is employed during the recovery or regeneration stage following severe injury or trauma, cerebral vascular accident, or systemic neurological disease. The goal of therapy is improved range of motion (ROM), balance, coordination, posture, and spatial awareness. Techniques may include proprioceptive neuromuscular facilitation which uses diagonal contract-relax patterns of skeletal muscles to stimulate receptors in the joints that communicate body position to the brain via motor and sensory nerves. Feldenkrais is a method which observes the patient's habitual movement patterns and teaches new patterns based on efficient active or passive repetitive conditioning. Additional techniques that may be useful for neuromuscular reeducation are Bobath concept, which promotes motor learning and efficient motor control, and biomechanical ankle platform system (BAPS) boards.

Physical therapy techniques to 1 or more regions (each 15 minutes) [HCPCS 97140]

Manual therapies are skilled, specific, hands-on techniques usually performed by physical therapists, occupational therapists, chiropractors, osteopaths, and/or physiatrists to diagnose and treat soft tissue and joint problems. The goal of manual therapy is to modulate pain and induce relaxation, increase range of motion (ROM), facilitate movement, function, and stability, decrease inflammation, and improve muscle tone and extensibility. Tissue mobilization involves slow, controlled myofascial stretching using deep pressure to break up fibrous muscle tissue and/or connective tissue adhesions. Manipulation is a more forceful stretching of the myofascial tissue that takes the joint just beyond its restricted barrier. Manual lymphatic drainage is a type of light massage employed to reduce swelling by gentle movement of the skin in the direction of lymphatic flow. Manual traction involves the controlled counterforce of the therapist to induce asymptomatic strain by gently stretching muscle and/or connective tissue.

Heart and blood vessel stress test with EKG tracing and monitoring (exercise or drug-induced) [HCPCS 93017]

An ECG is used to evaluate the electrical activity of the heart using treadmill, bicycle exercise, and/or pharmacologically induced stress. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the stress ECG device are then attached to the patches. A baseline ECG is obtained. The exercise portion of the study is then initiated. Heart rate and blood pressure are monitored. Staged stress protocol is used and the patient's response to stress is monitored as the stress ECG is recorded. Unless contraindicated, exercise or pharmacological stress continues until the patient is unable to continue or until the target heart rate is achieved. Upon completion of the study, the stress ECG is reviewed and a written interpretation of findings is provided.

Routine EKG (electrocardiogram) tracing using at least 12 wires [HCPCS 93005]

An ECG is used to evaluate the electrical activity of the heart. The test is performed with the patient lying prone on the exam table. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the ECG tracing device are then attached to the patches. A tracing is obtained of the electrical signals from the heart. Electrical activity begins in the sinoatrial node which generates an electrical stimulus at regular intervals, usually 60 to 100 times per minute. This stimulus travels through the conduction pathways to the sinoatrial node causing the atria to contract. The stimulus then travels along the bundle of His which divides into right and left pathways providing electrical stimulation of the ventricles causing them to contract. Each contraction of the ventricles represents one heart beat. The ECG tracing includes the following elements: P wave, QRS complex, ST segment, and T wave. The P wave, a small upward notch in the tracing, indicates electrical stimulation of the atria. This is followed by the QRS complex which indicates the ventricles are electrically stimulated to contract. The short flat ST segment follows and indicates the time between the end of the ventricular contraction and the T wave. The T wave represents the recovery period of the ventricles. The physician reviews, interprets, and provides a written report of the ECG recording taking care to note any abnormalities.

Heart Failure with major complications

Blood Infection with major complications

Blood infection without major complications

Nutritional or Metabolic Disorders without major complications

Total Shoulder Replacement

Chronic Lung Disease with complications

Chronic Lung Disease with major complications

Pneumonia with complications

Pneumonia with major complications