Semi-Private Room

Swing Bed

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 The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities.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 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mammography of both breasts for diagnosis [HCPCS 77066]

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

Mammography of one breast for diagnosis [HCPCS 77065]

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

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

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

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

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

Psychotherapy treatment by physician face-to-face with patient (30 minutes) [HCPCS 90832]

Psychotherapy treatment by physician face-to-face with patient (45 minutes) [HCPCS 90834]

Psychotherapy treatment by physician face-to-face with patient (60 minutes) [HCPCS 90837]

Sleep pattern monitoring of patient in sleep lab, sleep staging with 4 or more parameters of sleep (6 years of age or older) [HCPCS 95810]

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.

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

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

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

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

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

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

Lab analysis to evaluate an antimicrobial drug (antibiotic, antifungal, antiviral) by microdilution or agar dilution (each multi-antimicrobial, per plate) [HCPCS 87186]

A study is performed to determine the effectiveness of a specific antibiotic agent to a specific bacteria. The test is performed in an agar solution.

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

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

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

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

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

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

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

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

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

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

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

Lab test for High Sensitivity C-reactive protein

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

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

Lab analysis to measure the creatine kinase (cardiac enzyme) level (MB fraction only) [HCPCS 82553]

Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. Only creatine kinase (CK) MB fraction is measured. Testing for this isoenzyme can help identify heart muscle damage following a heart attack (myocardial infarction). A blood test is obtained by separately reportable venipuncture. Serum is tested using chemiluminescent immunoassay.

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

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

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

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

Lab analysis to measure the lactic acid level in blood, plasma, or cerbrospinal fluid specimen [HCPCS 83605]

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.

Lab analysis to measure the lipase (fat enzyme) level [HCPCS 83690]

A test is performed on blood and body fluids to measure lipase levels. Lipase is an enzyme released by the pancreas into the small intestine and is essential for the digestion of dietary fats. Elevated levels may result from small bowel obstruction, celiac disease, cholecystitis, duodenal ulcer, severe gastroenteritis, macrolipasemia, pancreatitis, and pancreatic tumors. The test may be ordered when there is a family history of lipoprotein lipase deficiency. A blood sample is obtained by separately reportable venipuncture. Other body fluids collected by other methods. Blood and other body fluids are tested using quantitative enzymatic methodology.

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

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

Lab analysis to measure the magnesium level in body fluids and cells [HCPCS 83735]

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.

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

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

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

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

Brain wave activity measurement and recording (EEG) (awake and drowsy) [HCPCS 95816]

Physician services for outpatient heart rehab with continuous EKG monitoring (per session) [HCPCS 93798]

Sleep pattern monitoring of patient in sleep lab with continued pressured respiratory assistance by mask or breathing tube (6 years of age or older) [HCPCS 95811]

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

Therapeutic excercises and water pool therapy to 1 or more areas (each 15 minutes) [HCPCS 97113]

Electrical stimulation application to 1 or more areas (each 15 minutes) [HCPCS 97032]

Electrical stimulation involves the use of a transcutaneous electrical nerve stimulation device (TENS), functional electrical stimulation device (FES), or a neuromuscular electrical stimulation device (NMES). The physical therapist or other physical therapy aid places the electrodes of the selected device over the region to be stimulated. The electrical impulse is set to the desired strength and the control unit is turned on. Electrical impulses are transmitted to the skin. The electrical stimulation device causes the muscles to contract. The muscle contraction stimulates both muscle and nerve tissues to relieve pain and promote healing. Electrical stimulation may be provided as a supervised modality that does not require direct (one-on-one) patient contact or it may be provided under constant attendance with direct (one-on-one) patient contact.

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

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

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

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

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

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

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

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

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

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

Speech, language, voice, communication, and/or hearing processing disorder treatment [HCPCS 92507]

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

Swallowing function evaluation [HCPCS 92610]

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

Training activities for home and self-care management (each 15 minutes) [HCPCS 97535]

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

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

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

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

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

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

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

Abdominal ultrasound (limited) [HCPCS 76705]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Digital screening mammogram

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

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

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

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

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

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

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

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

Imaging of brain by MRI without contrast [HCPCS 70551]

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

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

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

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

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

PET (positron emission tomography) imaging with CT imaging (skull base to mid-thigh) [HCPCS 78815]

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

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

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

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

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

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