Private Room

Intensive Care Unit

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 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.

Paraffin Wax Bath

A paraffin bath may be used on small, irregular surfaces such as the wrists, hands, and feet to treat acute or chronic pain and stiffness. Paraffin is a mineral wax derived from petroleum with a low melting point, which allows extended contact with the skin without the risk of thermal injury. Paraffin is melted in a small tub and the extremity is immersed in the liquid. The moist heat from the wax increases blood flow to the area and relaxes muscle tissue. Paraffin bath treatments may be used prior to exercise to reduce joint stiffness and increase range of motion. This treatment modality is helpful for patients with osteoarthritis, rheumatoid conditions, fibromyalgia, and scleroderma. Paraffin baths may also be prescribed for bursitis, tendonitis, and muscle sprains or strains.

CPAP Initiation & Management

Continuous positive airway pressure (CPAP) ventilation is used primarily to treat sleep apnea. It may also be prescribed to treat preterm infants whose lungs have not fully developed. CPAP uses a mask or other breathing device that fits over the nose and mouth which is connected via a tube to a CPAP device. The CPAP machine delivers an air mixture at a continuous low level of pressure. The continuous positive airway pressure keeps the airways open and prevents mechanical obstruction of the flow of air caused by relaxation and collapse of airway structures during sleep. This code is used for initial set-up and management. A durable medical device provider delivers the CPAP device and other required equipment to the home or a residential facility. The device is set up and programmed to the settings indicated by the written prescription obtained from the physician or other qualified health care professional. The patient or caregiver is instructed on correct use of the CPAP and then is asked to demonstrate understanding by placing the mask over the mouth and nose and turning on the machine.

Holter Testing - 48-Hour EKG

Electrocardiographic (ECG) rhythm-derived data is gathered for up to 48 hours of monitoring as the patient goes about regular daily activity while wearing an external ECG recording device, also called a Holter monitor. Electrodes or leads are placed on the patient's chest, and the patient is instructed on the use of the monitor. The recording device makes continuous, original ECG wave recordings for a 12 to 48 hour period. The recordings are captured on magnetic tape or digitized medium to be reviewed later. At the end of the recording period, the patient returns to the office with the device. Stored data derived from the continuous recordings of the electrical activity of the heart include heart rhythm and rate, ST analysis, variability in heart rate and T-wave alternans. Visual superimposition scanning is done to give a 'page review' of the entire recording, identifying different ECG waveforms with selective samples of rhythm strips. A report is made after analysis of the scanning, and the physician or other qualified health care professional reviews and interprets the data for heart arrhythmias.

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-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.

Amikacin (antibiotic) level

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 Gastrointestinal Bacteria

A laboratory test is performed to measure Helicobacter pylori antibodies. H. pylori is a bacterium found in contaminated food and water and may be spread person to person. The organism causes chronic inflammation of the gastrointestinal mucosa, primarily in the stomach and duodenum, which leads to erosion or ulcer formation. The seroconversion of IgA and IgG antibodies will occur together within about 60 days of exposure. Elevated titers to both IgA and IgG antibodies in the presence of symptoms may represent an active H. pylori infection. The antibody test should be confirmed with bacterial isolation or other diagnostic tests such as H. pylori breath test, or fecal antigen by EIA. It is also possible to test for IgM antibodies, however the clinical usefulness of this measurement has not been clearly established. A blood sample is obtained by separately reportable venipuncture. Serum is tested for IgA/IgG antibodies using semi-quantitative enzyme immunoassay and for IgM antibodies using semi-quantitative enzyme-linked immunosorbent assay.

Analysis for antibody bacteria

Analysis for antibody to Diphtheria (bacteria)

Analysis for antibody to HIV-1 and HIV-2 virus

Lab test for HIV-1/HIV-2

Analysis for antibody to tetanus bacteria (Clostridium tetanus)

Analysis of Substance Using Immunoassay Technique

An immunoassay is performed to detect a chemical substance (analyte) other than an antigen or antibody produced by the body in response to an infectious agent. There are dozens of immunoassays for non-infectious antigens and antibodies that are reported with these codes. Examples of non-infectious diseases and disorders that may be worked up using these tests include: celiac disease, motor and sensory neuropathy, Crohn's disease or other inflammatory bowel disease, liver disease, thyroid disease. Examples of specific antigens and antibodies reported with these codes include: Asialo IgG and IgM, ganglioside IgG and IgM, gliadin IgA and IgG. Codes are reported for each immunoglobulin class or subclass tested using this technique, so for example when testing for gliadin IgA and IgG by immunoassay, the code would be reported twice. Qualitative or semiquantitative testing is performed. Qualitative tests detect only the presence or absence of the specific substance. Semiquantitative tests provide a rough estimate of the amount of the substance being tested.

Antithrombin III antigen (clotting inhibitor) level

Apolipoprotein level

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 urine culture; quantitative colony count

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

Bacterial culture for anaerobic isolates

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.

Blood Creatinine

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

Blood Glucose Level Test

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

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.

Calcitonin (hormone) level

Calcium Level

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

Carbamazepine Level

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

Catecholamines (organic nitrogen) level

Russell viper venom time (includes venom); diluted

Complete Blood Count/Differential

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.

Copper level

Cortisol Measurement

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

Crystal identification from tissue or body fluid

Cyclosporine level

Detection Test for Chlamydia; Amplified Probe Technique

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

Detection Test for Neisseria Gonorrhoeae

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

Detection test for HIV-1 and HIV-2

Detection test for bacteria toxin (shiga-like toxin)

Detection test for cryptosporidium (parasite); immunoassay technique

Detection test for cytomegalovirus, quantification

Detection test for giardia; immunoassay technique

Detection test for organism; amplified probe technique

Dihydroxyvitamin D, 1, 25 level

Drug Test(s) by Chemistry Analyzer

A laboratory test is performed to detect the presence or absence of drugs classes in a patient’s system during a specific encounter. Presumptive screening is commonly done first, followed by test(s) for definitive drug identification as presumptive testing will not provide qualitative identification of individual drugs, nor quantitative levels present. A sample of blood or urine is obtained by separately reported procedure. Methods used include immunoassays, chromatography, and mass spectrometry.

Estriol (hormone) level

Fat stain of stool, urine, or respiratory secretions

Folic acid level

Fungal culture (mold or yeast)

GENERAL HEALTH PANEL

Gammaglobulin (immune system protein) measurement

Gastrin (GI tract hormone) level

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

Gentamicin (antibiotic) level

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.

Gonadotropin, chorionic (reproductive hormone) level

Lab test for Chorionic Gonadotropin

Gonadotropin, follicle stimulating (reproductive hormone) level

Gonadotropin, luteinizing (reproductive hormone) level

Haptoglobin (serum protein) level

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 Surface Antibody Measurement

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

Hepatitis B core antibody (IgM) measurement

Homocysteine (amino acid) level

Hydroxyindolacetic acid (product of metabolism) level

Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum

HLA typing; A, B, or C (eg, A10, B7, B27), single antigen

Infrared analysis of stone

Inhibin A (reproductive organ hormone) measurement

Intrinsic factor (stomach protein) antibody measurement

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.

LDL cholesterol level

Lab test for LDL Cholesterol

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.

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.

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 Antibody for Assessment of Autoimmune Disorder

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

Measurement of Complement (Immune System Proteins)

A blood test is performed to measure complement antigen levels. Complement factors help to clear immune complexes from the blood. Proteins are activated in response to the immune complex and generate peptides that bind the complexes and complement receptors. The cell membrane breaks apart and an attack complex is formed. A blood sample is obtained by separately reportable venipuncture. Complements are tested in serum or plasma samples, using specified methods, particularly quantitative radial immunodiffusion. Report for each complement component tested: 2-9 (2 being the most common inherited complement deficiency), 3A (the most abundant of all complement components), 4A, and 1Q; complement factor B and Bb; and C1-esterase inhibitor.

Deoxyribonucleic acid (DNA) antibody; native or double stranded

Measurement of antibody (IgE) to allergic substance

Lab test for Allergen-specific antibodies

Measurement of antibody (IgG) to allergic substance

Measurement of antibody to noninfectious agent

Measurement of complement (immune system proteins)

Nephelometry, test method using light

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.

Phosphatase (enzyme) level; alkaline

Lab test for Alkaline Phosphatase

Phosphatase, alkaline; isoenzymes

Prealbumin Level

A blood test is performed to measure prealbumin levels. Prealbumin, also referred to as transthyretin (TTR) is found in serum and cerebral spinal fluid (CSF). It is responsible for transporting thyroxin and retinol binding protein carried on retinol. The test may be ordered to detect protein-calorie malnutrition in chronically or critically ill individuals. Levels may be elevated with the use of high dose corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs), adrenal gland disorders, Hodgkin's disease, and kidney failure. Decreased levels may be caused by hyperthyroidism, liver disease, severe infection, inflammatory diseases, and certain digestive disorders. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using immunoturbidimetric method.

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.

Red blood cell sedimentation rate, to detect inflammation; non-automated

Lab test for Sedimentation rate

Renin (kidney enzyme) level

Rheumatoid factor analysis

Screening test for Pathogenic Organisms

This test is performed when a specific pathogen is suspected. A blood sample is taken and placed in a medium conducive to the growth of the suspected pathogen. Any colonies that grow in the medium are then examined.

Screening test for antibody to noninfectious agent

Screening test for mononucleosis (mono)

Serotonin (hormone) level

Sirolimus level

Somatostatin (growth hormone inhibitor) level

Special stained specimen slides to examine tissue

Stool Culture

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

Stool lactoferrin (immune system protein) analysis

Strep Test

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

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.

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.

Thyroid hormone, T3 measurement

Tissue or Cell Analysis by Immunologic Technique

Immunohistochemistry or immunocytochemistry identifies a certain antigen by using an antibody specific to that antigen when examining cells contained in a specimen such as a tissue block, brushed cell samples, blood smear, or fine needle biopsy (FNB). The specimen is prepped for histological or cytological examination on a glass slide that has been fixed with a commercially available antibody. Enzymes and/or special stains are then applied to the specimen slide. The characteristic changes to the cells in the sample can help determine the antigenic profile of morphologically undifferentiated cells, and aid in the diagnosis of malignant neoplasms. The prepped slide specimen may be used to identify a single antibody or multiple antibodies.

Tobramycin (antibiotic) level

Total Protein Level, Urine

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

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.

Urine Osmolality Measurement

Osmolality of blood or urine is tested. Osmolality refers to the number of solutes present in blood (plasma or serum) or urine. Osmotically active particles include sodium, chloride, potassium, urea, and glucose. Osmolality is tested using freezing point methodology or vapor pressure osmometer. The higher the concentration of solutes, the lower the freezing point as compared to water. A random urine specimen is obtained. Urine osmolality is tested to help evaluate fluid balance or to assess kidney function as demonstrated by the ability to produce and concentrate urine. Often both urine and blood osmolality is measured to determine the ratio of urine osmolality to serum osmolality.

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.

Vitamin A level

Vitamin B-6 level

Vitamin E level

Vitamin K level

White blood cell enzyme activity measurement

Application of blood vessel compression or decompression device to 1 or more areas

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.

Demonstration and/or evaluation of manual maneuvers to chest wall to assist movement of lung secreti

External shock to heart to regulate heart beat

Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days

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)

Manual maneuvers to chest wall to assist movement of lung secretions

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

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

Standardized thought processing testing, interpretation, and report per hour

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 tetanus and diphtheria toxoids injection into muscle, patient 7 years or older

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, initial day

Catheter, balloon dilatation, non-vascular

Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)

Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen

Direct admission of patient for hospital observation care

Hospital Observation per Hour

Hospital observation service, per hour

Injection of anesthetic agent, greater occipital nerve

Injection, gadobenate dimeglumine (multihance), per ml

Injection, gadoxetate disodium, 1 ml

Injection, perflutren lipid microspheres, per ml

Injection, phenylephrine and ketorolac, 4 ml vial

Low Osmolar Contrast Material, 300-399 mg/ml Iodine Concentration

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

Magnetic resonance angiography without contrast, abdomen

Mesh (implantable)

Repair of hernia at navel patient age 5 years or older

Repair initial femoral hernia, any age; reducible

Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf

Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries

Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries

Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries

Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries

Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries

Technetium tc-99m tetrofosmin, diagnostic, per study dose

Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries

Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using

Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf

Xenon xe-133 gas, diagnostic, per 10 millicuries

Tetanus Vaccine

Toxoids provide long lasting immunity by stimulating the body's own defense system to make antibodies that destroy specific toxins produced by bacteria. Vaccines also provide 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 these same agents again. The toxoid vaccine is an inactivated poison, called a toxin, produced by culturing the bacteria in a liquid medium, then purifying and inactivating the poison produced by the bacteria. Since toxoids are not a live vaccine, booster doses are recommended because immunity will decline over time. These tetanus toxoid combinations are formulations for adults and those over 7 years of age, given by intramuscular injection.

5% dextrose/normal saline (500 ml = 1 unit)

5% dextrose/water (500 ml = 1 unit)

Infusion, d5w, 1000 cc

Infusion, normal saline solution , 1000 cc

Infusion, normal saline solution, sterile (500 ml = 1 unit)

Injection, Adrenalin, Epinephrine, 0.1 mg

Injection, adrenalin, epinephrine, 0.1 mg

Injection, Ceftriaxone Sodium, per 250 mg

Injection, ceftriaxone sodium, per 250 mg

Injection, Dexamethasone Sodium Phosphate, 1 mg

Injection, dexamethasone sodium phosphate, 1mg

Injection, Diphenhydramine HCL, up to 50 mg

Injection, diphenhydramine hcl, up to 50 mg

Injection, Fentanyl Citrate, 0.1 mg

Injection, fentanyl citrate, 0.1 mg

Injection, Furosemide, up to 20 mg

Injection, furosemide, up to 20 mg

Injection, Heparin Sodium, per 1000 Units

Injection, heparin sodium, per 1000 units

Injection, Hydralazine hcl, Up to 20 mg

Injection, hydralazine hcl, up to 20 mg

Injection, Hydromorphone, Up to 4 mg

Injection, hydromorphone, up to 4 mg

Injection, Ketorolac Tromethamine, per 15 mg

Injection, ketorolac tromethamine, per 15 mg

Injection, Lorazepam, 2 mg

Injection, lorazepam, 2 mg

Injection, Magnesium Sulfate, per 500 mg

Injection, magnesium sulfate, per 500 mg

Injection, Methylprednisolone Sodium Succinate, up to 125 mg

Injection, methylprednisolone sodium succinate, up to 125 mg

Injection, Metoclopramide HCL, Up to 10mg

Injection, metoclopramide hcl, up to 10 mg

Injection, Midazolam Hydrochloride, per 1 mg

Injection, midazolam hydrochloride, per 1 mg

Injection, Morphine Sulfate, up to 10 mg

Injection, morphine sulfate, up to 10 mg

Injection, Ondansetron Hydrochloride, per 1 mg

Injection, ondansetron hydrochloride, per 1 mg

Injection, Promethazine HCL, up to 50 mg

Injection, promethazine hcl, up to 50 mg

Injection, Vancomycin HCL, 500 mg

Injection, vancomycin hcl, 500 mg

Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)

Injection, alteplase recombinant, 1 mg

Injection, amiodarone hydrochloride, 30 mg

Injection, calcium gluconate, per 10 ml

Injection, chlorpromazine hcl, up to 50 mg

Injection, diazepam, up to 5 mg

Injection, dicyclomine hcl, up to 20 mg

Injection, dobutamine hydrochloride, per 250 mg

Injection, dopamine hcl, 40 mg

Injection, epoetin alfa, (for non-esrd use), 1000 units

Injection, ertapenem sodium, 500 mg

Injection, glucagon hydrochloride, per 1 mg

Injection, haloperidol, up to 5 mg

Injection, hydrocortisone sodium succinate, up to 100 mg

Injection, hydroxyzine hcl, up to 25 mg

Injection, hyoscyamine sulfate, up to 0.25 mg

Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg

Injection, meropenem, 100 mg

Injection, methylnaltrexone, 0.1 mg

Injection, methylprednisolone acetate, 80 mg

Injection, methylprednisolone sodium succinate, up to 40 mg

Injection, naloxone hydrochloride, per 1 mg

Injection, neostigmine methylsulfate, up to 0.5 mg

Injection, omalizumab, 5 mg

Injection, orphenadrine citrate, up to 60 mg

Injection, phenylephrine hcl, up to 1 ml

Injection, potassium chloride, per 2 meq

Injection, prochlorperazine, up to 10 mg

Injection, propofol, 10 mg

Injection, regadenoson, 0.1 mg

Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg

Injection, succinylcholine chloride, up to 20 mg

Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

Injection, thiamine hcl, 100 mg

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

Injection, ziprasidone mesylate, 10 mg

Injection, zoledronic acid, 1 mg

Ringers lactate infusion, up to 1000 cc

Pulse Oximetry

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

Repair of groin hernia patient age 5 years or older

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

ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED

Anterior (front) eye procedure

Application of chemical agent to excessive wound tissue

Application of uniplane external bone fixation on one arm or leg

Arthrocentesis, aspiration and/or injection, major joint or bursa with ultrasound guidance

Balloon dilation of large bowel using an endoscope

Biopsy and/or removal of polyp of the uterus using an endoscope

Biopsy of bone, open procedure, deep

Biopsy of breast accessed throught the skin with MRI guidance, first lesion

Biopsy of breast, open procedure

Biopsy of large bowel using an endoscope

Biopsy or removal of lymph nodes of under the arm, open procedure

Change of stomach feeding, accessed through the skin

Closed treatment of ankle dislocation

Closed treatment of dislocated hip prosthesis

Closed treatment of dislocated hip prosthesis under anesthesia

Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel,

Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope

D&C for diagnosis and/or therapy (non-obstetrical)

Donor bone graft for spine surgery

Drainage of abscess or blood accumulation in shoulder

Drainage of finger abscess; simple

Extensive removal of shoulder joint tissue using an endoscope

Female genital system (nonobstetric) procedure

Arthrodesis, great toe; metatarsophalangeal joint

Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2

Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2

Fusion of spine bones with removal of disc, anterior approach

Harvest of bone fragments for spine surgery graft

Incision of tendon covering

Insertion of Central Venous Catheter

A tunneled centrally inserted central venous catheter (CVC) with a subcutaneous port is placed. A CVC must terminate in the subclavian, brachiocephalic, or iliac veins, the superior or inferior vena cava, or right atrium. A tunneled CVC is placed through a subcutaneous tunnel into the jugular, subclavian, or femoral vein or the inferior vena cava with the most common venous access site for tunneled devices being the jugular vein. Separately reportable imaging guidance may be used to access the venous entry site and/or to manipulate the catheter tip to the final central position. Local anesthesia is administered at the planned puncture site. Using a Seldinger technique to access the jugular vein, the skin and vein are punctured with a needle. A guidewire is inserted through the needle and advanced several centimeters. A subcutaneous pocket is then created for placement of the port. A subcutaneous tunnel is created from the venous access site to the subcutaneous pocket. An introducer sheath and dilator are advanced over the guidewire and the guidewire and dilator removed. The catheter is then advanced through the tunnel to the introducer sheath in the jugular vein and into the brachiocephalic vein, subclavian vein, superior vena cava or right atrium. Placement is checked by separately reportable radiographs. The catheter and port are connected and the port is placed in the subcutaneous pocket. The incision over the venous access site is closed. The port is sutured into place and the pocket is closed.

Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with int

Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body re

Insertion of temporary bladder catheter

Lymph node imaging during surgery

Manipulation of shoulder joint under anesthesia

Needle biopsy of liver

Open treatment of distal fibular fracture

Open treatment of metacarpal fracture, single

Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine

Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine

Partial removal of breast

Partial removal of collar bone

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar

Partial removal of spine bone with release of spinal cord and/or nerves

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inc

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inc

Plastic repair of vagina and tissue separating vagina, rectum, and bladder

Re-amputation of leg

Release and/or relocation of median nerve of hand

Release and/or relocation of ulnar nerve at elbow

Release of shoulder biceps tendon using an endoscope

Release or removal of shoulder scar tissue using an endoscope

Removal of both knee cartilages using an endoscope

Extracapsular cataract removal with insertion of intraocular lens prosthesis

Removal of cyst at wrist (dorsal or volar); primary

Removal of deep bone implant

Removal of fluid-filled sac of elbow

Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals

Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals

Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals

Removal of loose or foreign body of shoulder using an endoscope

Removal of nail

Removal of peripheral venous catheter for infusion

Removal or repair of collar bone and shoulder blade joint

Removal or revision of neurostimulator pulse generator or receiver

Removal or scraping of cyst or growth of either bone of lower leg

Removal or scraping of cyst or growth of either bone of lower leg with donor bone graft

Repair of Wound (7.6 to 12.5 cm)

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

Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site

Repair of herniated bladder into vaginal wall

Repair of shoulder socket cartilage using an endoscope

Repair of tendon, finger and/or hand

Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals

Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes

Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed throu

Avulsion of nail plate, partial or complete, simple; single

Small bone graft harvest

Tissue transfer repair of wound (10 sq centimeters or less) of the trunk

Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the trunk

Simple wound repair of scalp, neck, external genitalia; 2.5 cm or less

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

Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with

CT Leg without Contrast

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

CT Scan of Abdominal Aorta and Both Leg Arteries with Contrast

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

CT scan of heart with evaluation of blood vessel calcium

CT scan of lower spine before and after contrast

Fluoroscopic guidance for insertion of needle

MRI Brain with Contrast

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

MRI Orbit, Face, Neck without Contrast

Magnetic resonance imaging is done on the orbit, the face, and/or the neck. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. Orbital MRI provides reliable information for diagnosing tumors of the eye; infection or inflammation of the lacrimal glands and other soft tissues around the eye as well as osteomyelitis of nearby bone; damage or deterioration of the optic nerve; vascular edema or hemangioma of the eye area; and orbital muscular disorders. It is often performed in cases of trauma. MRI of the face and neck region is used to detect problems and abnormalities occurring outside the skull in the mouth, tongue, pharynx, nasal and sinus cavities, salivary glands, and vocal cords. MRI provides information on the presence and extent of tumors, masses, or lesions; infection, inflammation, and swelling of soft tissue; vascular edema or lesions; muscular abnormalities; and vocal cord paralysis.

MRI scan of middle spinal canal with contrast

Nuclear Medicine Study of Heart Wall Motion at Rest or with Stress

Cardiac blood pool imaging using scintigraphy and a radiolabeled isotope tracer is performed to evaluate how effective the heart is at pumping blood; to assess cardiac wall motion; measure the size and shape of the heart chambers; and monitor ventricular systolic and diastolic function and ejection fraction. A comparison of the heart muscle at rest and during stress allows for quantitative information to be obtained in a single study. The patient is positioned on the imaging table and cardiac electrodes are placed for continuous electrocardiogram (ECG) tracing. The gamma camera is positioned over the chest and the ECG and camera are interfaced. An intravenous line is established and the radiolabeled isotope tracer is injected and allowed to circulate. Scanning captures the radioactive energy emitted and converts it into an image. Planar views of the heart and great vessels are typically obtained in up to three directions to assess different areas of the heart. In a gated equilibrium test, images are taken only at specific phases of the cardiac cycle, such as between heartbeats, with the image recording set, or gated, by the ECG waveforms. When assessing a patient at rest, no additional steps are necessary. To obtain a study during stress, the patient may be placed on a treadmill or exercise bicycle or injected with an appropriate pharmacological compound to stress the heart. The physician reviews the images, calculates the ejection fraction, and may quantify other parameters of heart function based on the distribution of the radionuclide. The physician then provides a written report of findings.

Kidney imaging with assessment of blood flow and function; single study with pharmacological intervention

The size, shape, and structure (morphology) of the kidney and its function, including vascular flow, is assessed using scintigraphy and a radiolabeled isotope tracer. The kidneys filter waste from the blood; maintain a balance of certain chemicals; and produce erythropoietin for red blood cell growth, renin for blood pressure control, and calcitriol for calcium uptake by the bones. This procedure may be used to evaluate renal blood flow, renovascular hypertension, renal cysts, tumors, abscesses, and kidney disease, as well as monitor kidney transplants. An intravenous line is established and the radiolabeled isotope tracer is injected directly into the circulatory system. The patient is positioned on the imaging table with the gamma camera focused on the kidneys. Scanning is performed at specific intervals and the radioactive energy emitted is converted into an image. A diuretic may be administered during the procedure for more detailed images of kidney obstruction. An angiotensin converting enzyme (ACE-inhibitor) medication may be administered to help determine if hypertension is associated with renal vascular flow.

Nuclear medicine imaging for thyroid uptake measurements

Kidney imaging with assessment of blood flow and function; single study without pharmacological intervention

Radiologic exam, spine, entire thoracic and lumbar, including skull, cervical and sacral spine; 2 or 3 views

Radiologic examination, femur; 1 view

Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view

Stomach emptying study

Ultrasonic guidance during surgery

X-Ray Colon with Air Contrast and High Density Barium

A radiologic examination of the colon (large intestine) images the right ascending, transverse, left descending, and sigmoid colon, as well as the rectum; it may also include the appendix and a portion of the distal small intestine. X-ray imaging uses indirect ionizing radiation to take pictures of non-uniform material, such as human tissue, because of its different density and composition, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. A radiologic examination of the colon may be used to diagnose tumors, inflammatory bowel disease such as Crohn's disease and ulcerative colitis, irritable bowel syndrome, obstruction, abnormal position or configuration of the organ including Hirschsprung disease in children. Patients may present with symptoms such as weight loss, blood in the stool, abdominal pain, a change in bowel habits, diarrhea, and/or constipation. A radiologic examination of the colon will often begin with a front to back anteroposterior (AP) scout film obtained in erect or supine position to verify adequate colonic preparation for the study. A small tube is inserted into the rectum and high density barium contrast is instilled via gravity. The patient may be turned in varying positions to facilitate the passage of contract throughout the large intestine. The radiologist visualizes the colon and directly observes function using fluoroscopy and obtains spot films as indicated. The barium is then drained and air is used to insufflate the colon to complete the study. Glucagon may be administered intravenously to induce colonic hypotonia and reduce pain and spasms associated with colon distension during the procedure.

X-Ray Foot, 2 Views

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

X-Ray Hip and Pelvis, 1 View

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

X-Ray Shoulder, 1 View

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

X-Ray Upper Digestive Tract without Contrast

A radiologic examination of the upper gastrointestinal (GI) tract images the esophagus, stomach, and duodenum, the first portion of the small intestine. X-ray imaging uses indirect ionizing radiation to take pictures of non-uniform material, such as human tissue, because of its different density and composition, which allows some of the X-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. A radiologic examination of the upper GI tract may be used to diagnose ulcers, tumors, inflammation, hiatal hernia, scarring, obstruction, and abnormal position or configuration of the organs. Patients may present with symptoms such as difficulty swallowing, chest or abdominal pain, vomiting, reflux, indigestion, or blood in the stool. A radiologic examination of the GI tract will often begin with a single, front to back anteroposterior (AP) scout film obtained in an erect or supine position that includes imaging of the kidneys, ureter, and bladder known as a KUB. Under fluoroscopy, the patient orally ingests contrast media and the liquid is watched as it passes down the esophagus into the stomach and duodenum. Spot films are taken as indicated. Medication may be administered to speed up or delay GI motility and movement of the contrast. Delayed images may be required if movement is very slow or to verify emptying of the contrast from the upper GI tract.

X-ray lower and sacral spine including bending views minimum 6 views

X-ray of eye

X-ray of paranasal sinus, complete, minimum of 3 views

X-ray of upper spine, 6 or more views

Abnormal or Irregular Heartbeat with complications

Acute myocardial infarction, discharged alive with complications

Acute myocardial infarction, expired with complications

Angina pectoris

Appendectomy w complicated principal diag with major complications

Extensive O.R. procedure unrelated to principal diagnosis with major complications

Hernia procedures except inguinal & femoral with complications

Non-extensive O.R. procedure unrelated to principal diagnosis with major complications

Other skin, subcutaneous tissue & breast procedure with complications

Pancreas, liver & shunt procedures with complications

Skin debridement with complications

Cellulitis with major complications

Diabetes with major complications

G.I. hemorrhage without complications

G.I. obstruction with major complications

Major esophageal disorders with complications

Other disorders of the eye without major complications

Postoperative & post-traumatic infections without major complications

Red blood cell disorders with major complications

Septicemia or severe sepsis w MV 96+ hours

Skin ulcers with major complications

Seizures with major complications

Stroke with major complications

Traumatic stupor & coma, coma >1 hr with major complications

Digestive malignancy with complications

Kidney & urinary tract neoplasms with major complications

Amputation of lower limb for endocrine, nutritional, & metabolic disorder with complications

Amputation for musculoskeletal system & connective tissue with complications

Other musculoskelet system & connective tissue O.R. procedure with major complications

Aftercare for muscle and connective tissue injuries with complications

Osteomyelitis w major complications

Other musculoskeletal system & connective tissue diagnoses with major complications

Septic arthritis with complications

Mental Illness

Mental disturbances and retardation

Interstitial lung disease with complications

Pneumothorax with major complications

Pulmonary embolism with major complications