Semi-Private Room

Intensive Care Unit

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

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

Abdominal ultrasound (complete) [HCPCS 76700]

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

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

Breast cyst removal, male or female (1 or more cysts) [HCPCS 19120]

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

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

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 The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities.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

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

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

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

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

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

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

Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]

A diagnostic upper gastrointestinal (UGI) endoscopic examination is performed of the esophagus, stomach, duodenum and/or jejunum with or without collection of specimens by brushing or washing. This procedure may also be referred to as an esophagogastroduodenoscopy (EGD). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum of the stomach are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum. Mucosal surfaces of the duodenum and/or jejunum are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology samples may be obtained by cell brushing or washing.

Family psychotherapy treatment without patient (50 minutes) [HCPCS 90846]

Gallbladder removal with an endoscope [HCPCS 47562]

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

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

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

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

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

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

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

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

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

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

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

Imaging of pelvis by ultrasound through vagina [HCPCS 76830]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mammography of both breasts for diagnosis [HCPCS 77066]

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

Mammography of one breast for diagnosis [HCPCS 77065]

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

New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 30-44 minutes) [HCPCS 99203]

New patient visit requiring a detailed history and examination, for a low complexity medical issue of moderate severity

New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 45-59 minutes) [HCPCS 99204]

New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 60-74 minutes) [HCPCS 99205]

New patient visit requiring a comprehensive history and examination, for a high complexity medical issue of moderate to high severity

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

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

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

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

Prostate gland biopsy [HCPCS 55700]

Recurring cataract removal in lens capsule by laser [HCPCS 66821]

Spinal canal injection of substance into lower back or sacrum with imaging guidance [HCPCS 62323]

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

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

Established patient office or outpatient visit with physician or other healthcare professional to diagnose and treat illness or injury (presenting problem is minimal) [HCPCS 99211]

Established patient visit for a minor complaint

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

Established patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 20-29 minutes) [HCPCS 99213]

Established patient visit requiring an expanded problem-focused history and examination, for a low complexity medical issue of low to moderate severity

Established patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 30-39 minutes) [HCPCS 99214]

Established patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 40-54 minutes) [HCPCS 99215]

Established patient visit requiring a comprehensive history and examination, for a high complexity medical issue of moderate to high severity

New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 15-29 minutes) [HCPCS 99202]

Smoking and tobacco use cessation counseling visit, intensive (more than 10 minutes) [HCPCS 99407]

Smoking and tobacco use cessation counseling visit, intermediate (more than 3 minutes up to 10 minutes) [HCPCS 99406]

Telephone evaluation and management visit with physician to diagnose and treat illness or injury (11-20 minutes of medical discussion) [HCPCS 99442]

Telephone evaluation and management visit with physician to diagnose and treat illness or injury (21-30 minutes of medical discussion) [HCPCS 99443]

Telephone evaluation and management visit with physician to diagnose and treat illness or injury (5-10 minutes of medical discussion) [HCPCS 99441]

Transitional care management services with face-to-face visits within 14 days of discharge (moderate complexity) [HCPCS 99495]

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

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

Critical care delivery to critically ill or injured patient (first 30-74 minutes) [HCPCS 99291]

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

Emergency department visit for minor problem [HCPCS 99281]

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

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

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

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

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

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

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

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

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