Private Room

Normal vaginal delivery without complications

Cesarean Section without complications

Emergency Critical Care, Each Additional 30 Minutes

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

Emergency Critical Care, First 30 Minutes

Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

Emergency Department Visit - Level 1

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 - Level 2

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 - Level 3

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 - Level 4

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 - Level 5

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.

SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>

Gait Training - 15 Minutes

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, complex evaluation

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.

PT to Re-Educate Brain to Muscle Function (15 min)

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, re-evaluation

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.

Occupational Therapy, complex evaluation

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.

Self Care - Home Management Training - 15 Minutes

Self-care/home managemeThe patient receives one-on-one training to improve the ability to care for himself/herself and maintain independence. This may include training in activities of daily living (ADL), such as bed mobility, transfers, dressing, grooming, eating, bathing and toileting. The patient is given instruction on compensatory measures that can be taken to overcome any physical, mental or emotional disabilities. The patient receives training in how to adapt meal preparation to his/her specific needs and how to perform activities safely. The patient may also receive instruction in the use of assistive technology devices and adaptive equipment which includes any item used to improve the functional capability of the patient in the home and with ADL. This code is reported for each 15 minutes of one-on-one self-care/home management training designed to meet the specific needs of the patient.nt training, which includes instructions in the use of any assisting equipment.

Therapeutic Activities Involving Functional Activities (15 min)

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.

Evaluation of Speech Sound Production

Speech sound production disorders affect an individual's ability to communicate. There may be an organic cause for the problem (hearing impairment, cleft lip/palate, cerebral palsy, ankyloglossia) or it may be functional with no known cause. Articulation disorders are characterized by substitution, distortion, omission or addition of sounds and words. Phonological processing disorders are characterized by a set pattern of sound errors. Although small mistakes are common and normal in young children who are developing language skills, when articulation disorders persist past the age of 8 or phonological processing mistakes continue past the age of 5, an evaluation by a speech-language pathologist (SLP) that includes an audiogram to assess hearing, formal and informal observation of speech and standardized testing with tools such as the Clinical Assessment of Articulation and Phonology (CAAP) is typically performed. Verbal apraxia is a condition in which an individual who does not have a diagnosed weakness or paralysis of the speech muscles has difficulty stating what he/she wants to communicate correctly and consistently. Acquired verbal apraxia can occur at any age and is due to changes in an area of the brain. Stroke, head injury, tumor or illness/infection can cause this type of change. Developmental verbal apraxia is present from birth. It can manifest as an overall language disorder or a neurologic disorder affecting signals to and movement of the muscles involved with speech. There may be a genetic link to developmental apraxia as it is often occurs in multiple family members. Dysarthria is a speech disturbance that may be caused by a brain injury or by paralysis, spasticity or lack of coordination of the speech muscles. Evaluation by a speech-language pathologist (SLP) typically includes an audiogram to assess hearing (reported separately), formal and informal observation of speech and assessment using standardized testing tools such as Screening Test for Developmental Apraxia of Speech.

Evaluation of Speech Sound Production and Language Comprehenson

Disorders of speech sound production that relate to language comprehension and expression usually manifest before the age of 4 years. Mixed language disorder (receptive and expressive) may be due to brain injury, developmental problems such as autistic spectrum disorders, hearing loss and learning disorders. In receptive language disorders an individual will have problems understanding what has been said, following directions and organizing thoughts. Expressive language disorders can manifest with difficulty putting words together to form coherent sentences, word finding and the use of placeholder words such as ôumö, decreased vocabulary for age, leaving out words when speaking, improper use of tenses (past, present, future) and repetition (echoing) of phrases. Evaluation by a speech-language pathologist (SLP) should include an audiogram to assess hearing (reported separately), formal and informal observation and assessment using standardized testing tools such as Receptive-Expressive Emergent Language Test (REEL).

Speech Therapy

A speech-language pathologist treats a speech, language, voice, communication, and/or auditory processing disorder. Using the information obtained from a separately reportable screening and in-depth evaluation of a speech or language disorder, the clinician develops an individualized treatment plan for the patient. The clinician defines specific treatment goals and sets baseline measures with which to assess the patient's progress. These goals are continuously monitored and fine-tuned throughout the treatment period. Once the goals and baseline measures have been established the clinician uses a number of intervention activities to correct the specific speech or language disorder identified. These can include games, stories, rhymes, drills, and other tasks. If the patient has a speech disorder, the clinician may demonstrate the sounds and have the patient copy the way the clinician moves the lips, mouth, and tongue to make the right sound. A mirror may be used so that the patient can practice making the sound while observing himself or herself in the mirror. Treatment of a language disorder might include help with grammar. If the patient is having difficulty with auditory processing, a game like Simon Says might be used to help improve understanding of verbal instructions.

Swallow Evaluation

An evaluation of the oral and pharyngeal phase of the swallowing function is performed in a patient who is suspected of having oropharyngeal dysphagia. The initial evaluation is typically performed by a dysphagia specialist, usually a speech-language pathologist. This evaluation is performed to determine whether more extensive studies are warranted. Swallowing function is divided into oral, pharyngeal, and esophageal phases. The oral and pharyngeal phases are made up of oral preparation for solid foods (not required for liquids or pureed foods), oral transfer, and initiation of the swallow. Both oral and pharyngeal movements are necessary in preparing, transferring, and swallowing food. The patient is given both solids and liquids to swallow. During oral preparation of solid food the ability of the tongue to move the food from side-to-side so that the solid can be chewed and prepared for swallowing is evaluated. Once the solid food is prepared and transferred to the back of the throat, the swallowing movements are evaluated. Propelling solids or liquids requires a complex set of movements including retraction of the base of the tongue, elevation of the hyolarynx, closure of the velopharyngeus, contraction of the pharynx, opening of the upper esophageal sphincter, and closure of the airway. The speech-language pathologist observes the patient to determine whether solids and liquids are being prepared, transferred, and propelled from the pharynx into the esophagus. A written report of findings is provided.

Albumin Level

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.

Alpha-1-antitrypsin; total

Alpha-1-antitrypsin; phenotype

Alpha-Fetoprotein (AFP) Level, Serum

Alpha-fetoprotein (AFP) is measured in serum or amniotic fluid during pregnancy to screen for neural tube defects such as spina bifida and anencephaly, chromosomal abnormalities such as Down syndrome or Edwards syndrome, and omphalocele. AFP is a protein produced by the yolk sac of the fetus in early gestation and then later by the liver and gastrointestinal tract of the fetus. A blood sample is obtained by separately reportable venipuncture between 14 and 22 weeks gestation. The blood (serum) test screens for high and low levels of AFP. High levels are associated with neural tube defects while low levels are associated with chromosomal abnormalities.

Alpha-fetoprotein (AFP) analysis

Ammonia Level

A blood test is performed to measure ammonia levels. Ammonia is a by product of protein metabolism and is normally converted to urea by the liver and excreted via the kidney. Elevated ammonia levels may result from cirrhosis or hepatitis. Symptoms of elevated ammonia levels are confusion, tremors, excessive sleepiness, or coma. Testing may be performed in disease states such as Reyes syndrome or liver failure. A blood sample is obtained by a separately reportable venipuncture or arterial access line. The specimen is then tested using colorimetry.

Analysis for antibody (IgM) to Toxoplasma (parasite)

Analysis for antibody to Brucella (bacteria)

Analysis for antibody to Cryptococcus (yeast)

Analysis for antibody to Cytomegalovirus (CMV)

Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)

Analysis for antibody to Herpes simplex virus

Analysis for antibody to Herpes simplex virus, type 1

Analysis for antibody to Herpes simplex virus, type 2

Analysis for antibody to Rubeola (measles virus)

Analysis for antibody to Toxoplasma (parasite)

Analysis for antibody to helminth (intestinal worm)

Analysis for antibody to virus

Analysis for detection of tumor marker

Analysis of cell function and analysis for genetic marker

Analysis test for Hepatitis C virus

Analysis test for hepatitis b virus

Immunofluorescence, per specimen; initial single antibody stain procedure

Antibody identification; platelet antibodies

Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens

Automated white blood cell count

Bacterial Culture, Any Source Blood

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.

Bacterial culture for anaerobic isolates

Beta 2 glycoprotein 1 antibody (autoantibody) measurement

Beta-2 microglobulin (protein) level

Bilirubin Level; Total

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.

Bilirubin Level; Direct

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.

Blood Potassium Level

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.

Blood Sodium Level

A blood 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.

Blood Typing, ABO

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.

Blood Typing, Rh (D)

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-.

Blood Unit Compatibility Test; Immediate Spin Technique

A laboratory test is performed to determine the donor-recipient compatibility of a unit of blood. Compatibility testing may also be referred to as cross matching (CM). Immediate spin technique (ISCM) mixes recipient plasma or serum with donor red cells, centrifuges them immediately, and observes any hemolysis and/or agglutination. ISCM will not detect all ABO incompatibilities; however, a negative result indicates the blood of the donor and recipient are compatible and the unit may be transfused.

Blood chloride level

Blood test, clotting time

Blood typing for red blood cell antigens

Blood Unit Compatibility Test; Antiglobulin Technique

Blood viscosity measurement

Body fluid cell count with cell identification

Body fluid pH level

C-peptide (protein) level

CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon 9

CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence

Carbon dioxide (bicarbonate) level

Carcinoembryonic Antigen (CEA) Protein Level

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.

Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation

Cell examination of specimen; concentration technique

Ceruloplasmin (protein) level

Column chromatography/, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, or GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen

Chemical receptor analysis

Chemistry procedures

Cholesterol Level

A laboratory test is performed to measure total cholesterol in serum or whole blood. Cholesterol is a waxy, fat-like steroid substance present in the cell membranes of all body tissues and organs. The majority of cholesterol is produced intrinsically by the body and a small amount is ingested from food sources. Cholesterol is an important component of hormones that regulate growth, development, and reproduction. It also forms bile acids that are necessary for digestion of food and nutrient absorption. Elevated cholesterol may be a risk factor for cardiovascular disease and stroke. Certain individuals may have a genetically inherited risk for elevated cholesterol. A blood sample is obtained by separately reportable venipuncture or fingerstick. Serum/plasma and whole blood are tested using quantitative enzymatic method.

Chromosome analysis; count 5 cells, 1 karyotype, with banding

Chromosome analysis; count 15-20 cells, 2 karyotypes, with banding

Russell viper venom time (includes venom); diluted

Complete Blood Count

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.

Comprehensive Metabolic Panel

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.

Concentration of specimen for infectious agents

Confirmation test for antibody to Human T-cell lymphotrophic virus (HTLV) or HIV

Copper level

Creatine Kinase

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.

Creatine Kinase Level

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. Only creatine kinase (CK) MB fraction is measured. Testing for this isoenzyme can help identify heart muscle damage following a heart attack (myocardial infarction). A blood test is obtained by separately reportable venipuncture. Serum is tested using chemiluminescent immunoassay.

Creatinine Level to Test for Kidney Function

A sample other than blood 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 clearance, also known as urea or urea nitrogen clearance tests both blood and urine samples for a calculation of creatinine content adjusted for urine volume and physical size as a general indicator of glomerular filtration function.

Creatinine clearance measurement to test for kidney function

Cryoprecipitate, each unit

Cyclosporine level

DNA testing for genetic defects

Detection Test for Hepatitis B

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.

Detection Test for Hepatitis C Virus; Includes Reverse Transcription

The hepatitis C virus (HCV) causes inflammation of the liver. Individuals infected with HCV often develop chronic hepatitis C which can lead to cirrhosis and liver cancer. Nucleic acid detection of HCV is performed to evaluate whether a patient has an ongoing or chronic HCV infection. DNA or RNA probing detects much lower levels of the infectious agent, sometimes even the presence of a single organism. Probing involves identifying the infectious agent's nucleic acid (DNA or RNA) by releasing it from the cell and extracting it through nucleic acid hybridization using a probe. A direct probe consists of laboratory-prepared, complimentary strands of nucleic acid, often labeled with chemical fluorescence, specifically designed to align and bind with the target nucleic acid to form stable, double-stranded complexes or hybrids. Amplified probing provides greater sensitivity for more direct, qualitative detection by using techniques such as reverse transcription polymerase chain reaction (RT-PCR) to enzymatically replicate certain target sequences or positions in the nucleic acid which allows exponential amplification of the original target nucleic acid. An amplification primer is used in addition to the probe. Primers are artificial, short strands of nucleic acid complementary to the beginning or end of the nucleic acid fragment to be amplified. The primer adheres to the target nucleic acid at these points. The polymerase enzyme copies the region and builds the new nucleic acid. Following amplification, the amount of the infectious agent in the sample may be evaluated using reverse transcription and quantification. Quantification is performed to evaluate the severity of the infection and response to treatment.

Immunoassay for infectious agent antibody, quantitative, not otherwise specified

Detection test for Chlamydia pneumoniae

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification

Detection test for Hepatitis Be surface antigen

Detection test for Hepatitis C virus; amplified probe technique

Detection test for Mycoplasma pneumoniae (bacteria)

Detection test for Staphylococcus aureus (bacteria)

Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)

Detection test for Vancomycin resistance strep (VRE)

Detection test for aspergillus (fungus)

Detection test for clostridium difficile toxins (stool pathogen)

Detection test for cryptosporidium (parasite); immunofluorescent technique

Detection test for cytomegalovirus, quantification

Detection test for giardia; immunoassay technique

Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique

Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, quantification

Detection test for histoplasma capsulatum (parasite)

Infectious agent antigen detection by immunofluorescent technique; Legionella pneumophila

Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique

Detection test for multiple organisms; immunofluorescent technique

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reve

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reve

Detection test for organism; quantification, each organism

Detection test for pneumocystis carinii (respiratory parasite)

Dihydroxyvitamin D, 1, 25 level

Electrolyte Panel

"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."

Erythropoietin (protein) level

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral); disk method

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral); enzyme detection

Evaluation of fine needle aspirate

Evaluation of fine needle aspirate with interpretation and report

Fresh frozen plasma thawing, each unit

Fat stain of stool, urine, or respiratory secretions

Fibrinogen (factor 1) activity measurement

Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker

Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker

Fresh frozen plasma between 8-24 hours of collection, each unit

Fungal culture, yeast

Gammaglobulin (immune system protein) measurement

Gammaglobulin Measurement

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.

Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants

Gene analysis (Janus kinase 2) variant

Gene analysis (UDP glucuronosyltransferase 1 family, polypeptide A1) common variants

Gene analysis (coagulation factor V) Leiden variant

Gene analysis (epidermal growth factor receptor), common variants

Gene analysis (hemochromatosis) common variants

Gene analysis (mutL homolog 1, colon cancer, nonpolyposis type 2) full sequence analysis

Gene analysis (mutS homolog 2, colon cancer, nonpolyposis type 1) full sequence analysis

Gene analysis (mutS homolog 6 [E coli]) full sequence analysis

Gene analysis (postmeiotic segregation increased 2 [S cerevisiae]) full sequence analysis

Gene analysis (prothrombin, coagulation factor II) A variant

Gene analysis (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1) c

Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells

Glutamyltransferase Level

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.

Haptoglobin (serum protein) level

Hematology and coagulation procedures

Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)

Hemosiderin (hemoglobin breakdown product) analysis

Hepatitis B Antibody Measurement

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.

Hepatitis B core antibody (IgM) measurement

Hepatitis Be antibody measurement

Hepatitis C Antibody Measurement

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.

Hydroxyindolacetic acid (product of metabolism) level

IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg, glioma), common variants (eg, R132H, R132C)

IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (eg, glioma), common variants (eg, R140W, R172M)

Identification of mycobacteria (TB or TB like organism)

IgE (immune system protein) level

Lab test for Gammaglobulin IgE

Immunologic Analysis for Detection of Tumor Antigen; Immunoassay - Quantitative; CA 125

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.

Immunologic analysis for detection of antigen or antibody

Immunologic analysis for detection of organism; qualitative or semiquantitative; multiple-step method

Immunologic Analysis for Detection of Tumor Antigen; Immunoassay - Quantitative CA 15-3

Immunologic Analysis for Detection of Tumor Antigen; Immunoassay - Quantitative CA 19-9

Immunodiffusion; not elsewhere specified

Immunologic analysis technique on body fluid; Immunofixation electrophoresis

Immunofixation electrophoresis; serum

Infusion, albumin (human), 25%, 50 ml

Infusion, albumin (human), 5%, 250 ml

Insulin Measurement; Total

Lab test for Insulin

Ionized Calcium

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.

KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146)

Ketone bodies analysis, qualtitative

Lactate Dehydrogenase

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.

Lactate dehydrogenase (enzyme) measurement

Lactic Acid

A blood or body fluid test is performed to measure lactate (lactic acid) levels. Lactic acid is produced primarily by muscle tissue and red blood cells in the body. Elevated levels may be caused by strenuous exercise, heart failure, severe infection (sepsis), shock states (cardiogenic, hypovolemic) and liver disease. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid (CSF) is obtained by lumbar puncture (spinal tap). Other body fluids may also be collected and tested. Plasma, CSF, and other body fluids are tested using enzymatic methodology.

Lead level

Liver Enzyme (SGPT) Level

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.

Liver Panel

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.

Magnesium Level

A blood, urine, or fecal test is performed to measure magnesium levels. Magnesium is an essential dietary mineral responsible for enzyme function, energy production, and contraction and relaxation of muscle fibers. Decreased levels may result from severe burns, metabolic disorders, certain medications, and low blood calcium levels. A blood sample is obtained by separately reportable venipuncture. Red blood cells (RBCs) are tested using quantitative inductively coupled plasma-mass spectrometry. Serum/plasma is tested using quantitative spectrophotometry. A 24-hour voided urine specimen is tested using quantitative spectrophotometry. A random or 24-hour fecal sample is tested using quantitative spectrophotometry.

Measurement of Hepatitis A antibody (IgM)

Measurement of antibody for assessment of autoimmune disorder

Measurement of antibody for rheumatoid arthritis assessment

Measurement of complement (immune system proteins)

Measurement of complement function, each component

Microsatellite instability analysis

Microscopic genetic analysis of tumor; each single antibody stain procedure

Microscopic genetic analysis of tumor; using computer-assisted technology

Microsomal Antibodies Measurement

A blood test is performed to identify the presence of microsomal antibodies (thyroid or liver-kidney). Microsomes are located inside of cells in the thyroid, liver, and kidney. When these cells are damaged, microsomes are released, and the body produces antibodies to the microsomes in response to the damage. A blood sample is obtained by separately reportable venipuncture and tested for the presence of the microsomal antibodies. For the thyroid, the test is done to confirm thyroid problems, such as Hashimoto's thyroiditis, cancer, or nontoxic nodular goiter. For liver-kidney microsome antibody, semiquantitative indirect fluorescence or semiquantitative enzyme-linked immunosorbent assay is done to determine cell damage, such as with autoimmune hepatitis type 2 (AIH-2).

Molecular pathology procedure level 3

Morphometric analysis, in situ hybridization

Mycoplasma culture

NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61)

Nephelometry, test method using light

Oncoprotein (cancer related gene) measurement

Organic acid level

PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA

Parathormone

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.

Partial Thromblostatin Time, Activated

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.

Pathology & Lab Undefined Code

Pathology Examination of Tissue with Microscope

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.

Phenobarbital Level

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.

Phenytoin Level

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.

Phosphate Level

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.

Plasma hemoglobin level

Platelets, pheresis, leukocytes reduced, each unit

Platelets, pheresis, leukocytes reduced, irradiated, each unit

Pretreatment of serum for use in red blood cell antibody analysis and measurement

Progesterone (reproductive hormone) level

Protein Measurement, Serum

A blood test is performed to measure protein levels in serum. This test is often performed in conjunction with total protein to detect pathophysiologic states such as inflammation, gammopathies, and dysproteinemias. There are more sensitive tests available to detect these and similar disorders. A blood sample is obtained by separately reportable venipuncture. Serum is tested using electrophoretic fractionation and quantitation.

Protein measurement, body fluid

Prothrombin Time

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.

Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step metho

Quantitation of therapeutic drug

Red Blood Cells, Leukocytes Reduced, Each Unit

Red blood cells, leukocytes reduced, each unit

Red Blood Count, Automated Test

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.

Antihuman globulin test (Coombs test); direct, each antiserum

Red blood cells, leukocytes reduced, irradiated, each unit

Removal of antibodies from surface of red blood cell

Screening Test for Autoimmune Disorder

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.

Screening Test for Red Blood Cell Antibodies

A blood sample is tested for antibodies directed against red blood cell (RBC) antigens other than A and B antigens. This test may also be referred to as an indirect antiglobulin test (IAT). This test is performed as part of a blood typing and screening test when it is anticipated that a blood transfusion might be required. If an antibody is detected, then separately reportable antibody identification is performed to identify the specific antibodies present. The test may be performed using IAT methodology or another serum technique such as solid phase. If multiple serum techniques are used, each reported separately.

Screening test for mononucleosis (mono)

Screening test for presence of antibody

Serotonin (hormone) level

Sirolimus level

Special stain for parasites

Special stained specimen slides to examine tissue

Special stained specimen slides to identify organisms including interpretation and report

Specific gravity (liquid weight) measurement

Stool analysis for blood to screen for colon tumors

Lab test for Fecal Blood

Stool culture

Stool lactoferrin (immune system protein) level

Surgical Pathology, High Complexity

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.

Surgical Pathology, Intermediate Complexity

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.

T cells; absolute CD4 and CD8 count, including ratio

Tacrolimus Level

A blood test is performed to measure tacrolimus levels. Tacrolimus, also known as Prograf is an immunosuppressant drug that affects the ability of certain white blood cells in the body to recognize and respond to transplanted body organs such as kidney, liver, heart and lung. The drug is administered intravenously, either alone or in combination with other immunosuppressant drugs. Tacrolimus has a narrow therapeutic range and blood levels may be assessed daily at the start of therapy, taper to 1-2 times per week and finally to once every 1-2 months. For routine monitoring the specimen is collected as a trough level, immediately prior to a scheduled dose and at least 12 hours after the previous dose. A blood sample is obtained by a separately reportable venipuncture. Whole blood is then tested using liquid chromatography-tandem mass spectrometry. Prograf may be tested with chromatographic or immunoassay technique and the results will be somewhat different. Make note of the technique used when comparing results with previous levels.

Test for Influenza Virus

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.

Theophylline level

Thyroglobulin (thyroid protein) antibody measurement

Lab test for Thyroglobulin antibody

Thyroglobulin (thyroid related hormone) level

Thyroid hormone evaluation

Thyroxine Measurement

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. *

Tissue culture for tumor disorders

Tissue culture for tumor disorders of bone marrow and blood cells

Tissue culture inoculation for virus isolation

Total Protein Level, Blood

A blood test is performed to measure total protein levels. Total protein is often reported as a ratio of albumin to globulin (A/G ratio), and normal results will show albumin slightly greater than globulin. The test may be used to monitor nutritional status or diagnose kidney and liver disease. Elevated levels can indicate chronic inflammation, viral hepatitis, HIV infection, and multiple myeloma. Levels that are decreased may result from malnutrition or malabsorption syndromes such as celiac disease or inflammatory bowel disease. A blood sample is obtained by separately reportable venipuncture. Serum, plasma, or whole blood may be tested using quantitative spectrophotometry.

Total Protein Level, Body Fluid

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.

Translocation analysis (BCR/ABL1) major breakpoint

Triglycerides Level

A test is performed on blood or body fluids to measure triglyceride levels. Triglycerides contain glycerol and 3 fatty acid molecules and are a component of very low density lipoproteins (VLDL) found in blood and chylomicrons (cholesterol, protein, triglycerides) found in lymphatic fluid. They provide an energy source during metabolism and carry any unused dietary fats or calories to the liver and fat cells where they can be stored. Elevated levels may reflect recent carbohydrate and/or fat consumption. Blood samples should be obtained with the patient fasting for 12 hours. A blood sample is obtained by separately reportable venipuncture. Body (lymphatic) fluid is obtained by needle aspiration or incision/drainage of pooled fluid. Serum/plasma and body fluids are tested using quantitative enzymatic methods.

Tuberculosis Test

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.

Urea Nitrogren

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.

Uric Acid Level, Blood

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.

Urinalysis with Examination, using Microscope

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.

Urinalysis, Automated Test

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.

Urine Pregnancy Test

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.

Urine Sodium Level

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.

Urine albumin (protein) level

Urine chloride level

Valproic Acid Level

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.

Vancomycin Level

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.

Virus isolation; centrifuge enhanced technique, includes identification with immunofluorescence stain, each virus

Vitamin A level

Vitamin E level

White blood cell measure, stool specimen

Zinc level

Administration of vaccine

Application of on-body injector (includes cannula insertion) for timed subcutaneous injection

Attempt to Restart Heart and Lungs

Cardiopulmonary resuscitation (CPR) is a manual attempt at restarting a patient's heart and lungs when cardiopulmonary arrest occurs. Typically led by a health care provided certified in CPR, the lungs are filled with air by holding the nose and breathing through the mouth or performed with a ventilating bag. Chest compressions are also performed at intervals, alternating with the air in the lungs. A defibrillator may be used to shock the heart into starting.

Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin)

Behavioral and qualitative analysis of voice and resonance

Biopsy of the wall dividing the left and right heart

Chemotherapy procedure

Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal he

Dialysis procedure including one evaluation

Drug infusion during cardiac catheterization

Evaluation and insertion of catheters for creation of complete heart block

Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal hea

Evaluation and prescription of speech-generating and alternative communication device

Evaluation of lower heart chamber assist device with physician analysis

Evaluation of patient with prescription of speech-generating and alternative communication device

Evaluation of single or dual chamber pacing cardioverter-defibrillator with programming or reprogram

Fluoroscopic and video recorded motion evaluation of swallowing function

Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle

Hydration Infusion into a Vein

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.

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

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.

Imaging of esophagus done from the inside of the esophagus

Infusion (Additional) for Therapy, Diagnosis or Prevention

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.

Infusion into a Vein for Therapy, Diagnosis, or Prevention

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

Infusion of chemotherapy into a vein

Infusion of different chemotherapy drug or substance into a vein

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

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.

Injection for X-ray imaging of aorta above heart valve

Injection of Same Drug into Vein for Therapy or Diagnosis

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.

Insertion of catheter for diagnostic evaluation of right heart structures

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography; with bypass graft angiography

Left heart catheterization by transseptal puncture through intact septum

Insertion of catheter into right and left heart for diagnosis

Insertion of catheters for 3D mapping of electrical impulses to heart muscles

Insertion of catheters for creation of complete heart block

Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upp

Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right up

Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack

Irrigation of implanted venous access drug delivery device

Measurement and recording of brain wave (EEG) activity, awake and asleep

Measurement and recording of brain wave (EEG) activity, awake and drowsy

Measurement and recording of brain wave (EEG) activity, in coma or asleep

Measurement of esophageal swallowing movement

Measuring the stiffness in the liver via elastography

Mechanical chest wall manipulation for improvement in lung function

Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sed

Moderate sedation services provided by a physician, patient younger than 5 years old

Moderate sedation services provided by a physician, patient 5 years or older

Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent train

Multiple measurements and graphic recordings of the amount and speed of breathed air, before and fol

Multiple measurements of oxygen saturation in blood using ear or finger device

Negative pressure wound therapy, surface area greater than 50 square centimeters, per session

Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per sessi

Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle

Noninvasive vascular diagnostic study

Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes

Overnight measurement of oxygen saturation in blood using ear or finger device

PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH

PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH

Pneumococcal vaccine for injection into muscle; 13 valent (PCV13), for intramuscular use

Programmed heart rhythm stimulation after drug infusion into a vein

Cardiopulmonary exercise testing, including measurements of minute ventilation

Removal of devitalized tissue from wound(s), non-selective debridement without anesthesia

Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the sk

Repositioning maneuvers for treatment of vertigo, per day

Respiratory inhaled aerosol treatment to relieve airway obstruction, first hour

Sleep Monitoring with CPAP

Polysomnography is performed with sleep staging by a sleep technologist. Sleep studies are performed to evaluate and diagnose a variety of sleep disorders including sleep apnea, narcolepsy, insomnia, sleep walking, restless leg syndrome, and other periodic movements during sleep. The patient presents to the sleep study center in the evening. Sleep staging is accomplished using electroencephalography (EEG), electro-oculogram (EOG), and electromyogram (EMG). EEG is performed using one to four electrodes attached to the scalp. Electrodes are attached around the eyes and an EOG performed to monitor eye movement. A submental EMG is performed by placing an electrode under the chin to record muscle tone. One or more additional parameters of sleep are recorded and analyzed including: heart rate and rhythm; airflow; ventilation and respiratory effort; gas exchange by oximetry, transcutaneous monitoring, or end tidal gas analysis; extremity muscle activity or motor activity-movement; extended EEG monitoring; penile tumescence; gastroesophageal reflux; continuous blood pressure monitoring; snoring; and/or body position. The room is darkened and brain activity, eye and muscle movement are recorded. Other parameters of sleep are monitored and recorded as needed. The physician analyzes the recorded data obtained during the polysomnography and provides a written interpretation of the test results. If CPAP is performed a nasal mask is applied to the nose to keep the airway open during inhalation. If bi-level ventilation is performed, a ventilator is used to augment respiration while still allowing spontaneous unassisted respiration.

Sleep monitoring of patient (6 years or older) in sleep lab

Temporary pacemaker to regulate heart beat

VITAL CAPACITY TOTAL SEPARATE PROCEDURE

Vaccine Injection for Pneumococcal Polysaccharide

Unlike immune globulins which provide short-term, passive immunity, a vaccine provides active, long-term immunity by exposing the recipient's immune system to altered versions of specific viruses or bacteria that induce the immune system to produce its own antibodies against the invading micro-organism. The body then remembers how to make antibodies when exposed to the antigen again. The pneumococcal bacteria exist in many people's noses and throats without causing disease, but when it invades the body, it can cause pneumococcal pneumonia, bacteremia, and meningitis. Children under five, the elderly, and the immune suppressed are most susceptible. Pneumococcal disease is the leading cause of death from vaccine-preventable disease in the U.S.

Vaccine for influenza for injection into muscle; adjuvanted

Vein Infusion for Therapy, Prevention or Diagnosis, Concurrent with Another Infusion

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.

Ventilation assist and management; hospital inpatient/observation, each subsequent day

Acellular pericardial tissue matrix of non-human origin (veritas), per square centimeter

Adhesion barrier

Application of vein wound compression system thigh and lower leg

Aspiration of blood from eye

Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only

Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only

Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only

Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope

Brachytherapy source, non-stranded, high dose rate iridium-192, per source

Brachytherapy source, non-stranded, yttrium-90, per source

Cardioverter-defibrillator, dual chamber (implantable)

Cardioverter-defibrillator, other than single or dual chamber (implantable)

Cardioverter-defibrillator, single chamber (implantable)

Catheter, drainage

Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)

Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)

Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping

Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip

Catheter, extravascular tissue ablation, any modality (insertable)

Catheter, hemodialysis/peritoneal, long-term

Catheter, hemodialysis/peritoneal, short-term

Catheter, intraspinal

Catheter, intravascular ultrasound

Catheter, occlusion

Catheter, transluminal angioplasty, drug-coated, non-laser

Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Catheter, transluminal atherectomy, rotational

Catheter, ureteral

Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)

Closure device, vascular (implantable/insertable)

Colonoscopy on High Cancer Risk Patient

Colorectal cancer screening; colonoscopy on individual at high risk

Colorectal cancer screening; flexible sigmoidoscopy

Computer-aided detection and computer algorithm analysis of breast MRI image data

Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone

Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters

Destruction of lower or sacral spinal facet joint nerves using imaging guidance

Destruction of lower or sacral spinal facet joint nerves with imaging guidance

Development of cognitive skills to improve attention, memory, or problem solving, each 15 minutes

Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to g0204 or g0206)

Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney

Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral

Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral

Dialysis access system (implantable)

Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Evaluation of orthotic or prosthetic use, each 15 minutes

Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment

Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries

Generator, neurostimulator (implantable), non-rechargeable

Generator, neurostimulator (implantable), with rechargeable battery and charging system

Guide wire

Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Holster for use with electric or electric/pneumatic ventricular assist device, replacement only

Hospital Observation per Hour

Hospital observation service, per hour

Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of t

Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie

Indium in-111 pentetate, diagnostic, per 0.5 millicurie

Infusion pump, programmable (implantable)

Injection of anesthetic agent of multiple rib nerves

Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles

Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography

Injection, epoetin alfa, 100 units (for esrd on dialysis)

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis)