Connection supplemental articles and policies - January 2008
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Connection - January 2008 (pdf, 334 KB)
supplemental articles
policies and forms
The following policy is new:
The following policies have been reviewed and have substantial changes. For more details, please see “policy changes” below.
The following policies have been reviewed and do not have substantial changes.
practice guideline: treatment of patients with major depressive disorder
by Toni P.Coughlin, R.N., B.S.N.,C.C.M.
Beacon Health Strategies, FCHP’s behavioral health partner, has adopted several clinical practice guidelines to assist providers in the assessment of treatment of behavioral health disorders among FCHP members. Prior to the adoption and dissemination of each guideline, the relevant scientific literature is reviewed by a multidisciplinary team that includes board-certified psychiatrists. Beacon reviews and approves clinical practice guidelines at least every two years and updates them as needed.
Beacon has adopted the American Psychiatric Association practice guideline for the treatment of patients with major depressive disorder. The purpose of the guideline is to assist the physician faced with the task of implementing specific antidepressant treatment(s).
This guideline summarizes the specific forms of somatic, psychotherapeutic, psychosocial and educational treatments that have been developed to deal with major depressive disorder. It begins at the point where the psychiatrist has diagnosed an adult patient who is older than 18 years as suffering from major depressive disorder, according to the criteria defined in DSM-IV, and has medically evaluated the patient to ascertain the presence of alcohol or substance use disorder or other somatic factors that may contribute to the disease process.
The five components for treating major depressive disorder included in the depression guideline are the following:
- Psychiatric management
- Acute-phase treatment
- Continuation-phase treatment
- Maintenance-phase treatment
- Discontinuation of active treatment
The APA clinical practice guideline for the treatment of patients with major depressive disorder can be found at www.guideline.gov.
If you have any questions or comments about the use of practice guidelines, or would like to recommend a particular guideline, please contact Dr. B.J. Berk, Beacon’s newly named Medical Director at bjberk@beaconhs.com or 1-781-994.7589. More information can be found on Beacon’s Web site at www.beaconhealthstrategies.com.
national asthma guidelines updated
The National Asthma Education and Prevention Program recently issued comprehensive updates to its clinical guidelines for the diagnosis and management of asthma.
The Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma—Full Report, 2007, highlights the importance of asthma control and introduces novel strategies to monitor asthma symptoms. They also feature an expanded section on childhood asthma.
pharmacotherapy
The guidelines advocate for a stepwise approach to control asthma, which involves increasing medication dosages and types as needed, and decreasing them whenever possible, based on the level of asthma control. The stepwise asthma management charts are revised and expanded to specify treatment for three age groups: 0 to 4 years, 5 to 11 years and 12 years or older. The 5-to-11 age group was added because new evidence suggests that children in this age group may respond differently than adults to asthma medications.
Recommendations on medications are updated to reflect the latest evidence on effectiveness and safety. EPR-3 reaffirms that patients with persistent asthma need both long-term medications to control asthma and prevent exacerbations, as well as quick-relief medications for symptoms as needed. For all age groups, inhaled corticosteroids are recommended as the most effective medication for long-term control.
The guidelines are available at www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.
fchp reimburses for hospice and palliative consultations
FCHP is delighted to provide reimbursement for “hospice and palliative medicine” consultations offered in our pilot program area of Worcester County. Provider reimbursement information is referenced below.
Who can provide a hospice and palliative medicine consultation?
“Hospice and palliative medicine” consultants are either physicians who are certified by the American Board of Hospice and Palliative Medicine or who are tenured as a hospice medical director, or are credentialed nurse practitioners or physician assistants working under the supervision of a physician specializing in “hospice and palliative medicine.” The American Board of Medical Specialties will grant board certification in “hospice and palliative medicine” in 2008.
What does FCHP cover for hospice and palliative medicine consultations?
As with any specialty consultation, FCHP will cover “hospice and palliative medicine” consultations provided by a credentialed “hospice and palliative medicine” physician and referred by the member’s PCP. The PCP will contact the specialist and provide his or her vendor number (National Provider Number) and name. The member may have a copayment consistent with his/her health plan option. Hospice and palliative medicine consultative services can be provided in a number of locations, including hospitals, skilled nursing facilities, a patient’s home or a physician’s office.
What are the coverage and reimbursement criteria?
Reimbursement for hospice and palliative medicine consultations will be made to the contracted hospice and palliative medicine physician on a fee-for-service basis. Reimbursement for consultations provided by the licensed and credentialed nurse practitioner or physician assistant will be conducted in accordance with the FCHP medical payment policy ADM0040, Nurse Practitioner/Physician Assistant Payment Policy.
The member is responsible for a copayment for this service.
During a hospice and palliative medicine consultation, no direct medical care is provided (such as ordering pain medication or laboratory or radiology services, etc.). FCHP will not cover related services when ordered by the hospice and palliative medicine physician. Rather, the hospice and palliative medicine physician will communicate back to the referring PCP the results of the consultation, with recommendations for pain management, symptom control and plan of care.
FCHP will credential the hospice and palliative medicine physician, as well as the nurse practitioner and physician assistant working under the supervision of a physician specializing in hospice and palliative medicine.
Are there billing/coding guidelines?
Hospice and palliative medicine consults should be billed with the appropriate CPT code, depending on the place of service (for example, office consults (99241-99245), inpatient consults (99251-99255) or home visit (99341-99345 and 99347-99350)). The ICD-9-CM code V66.7 should be billed as a secondary diagnosis in conjunction with the member’s primary diagnosis.
Services should be submitted using industry standard forms or HIPAA standard electronic formats.
policy changes
The following policies available with this issue of Connection have substantial changes.
Emergency department payment policy
- The Industry Standard for hydration, therapeutic, prophylactic and diagnostic injections and infusion services is that the physician will not be reimbursed for infusion/injection services (codes 90760-90779) when provided in an emergency room setting. Modifiers -26 and -TC cannot be used with these codes.
Global surgical payment policy
- Added to coverage and reimbursement criteria: This allows for one copayment per physician or physician practice and one copayment per outpatient facility to be taken within the global period.
- Removed from To bill for postoperative care for reporting section:
- Providers are permitted to collect applicable copayments for services within the global period.
Nurse practitioner/physician assistant payment policy
- The modifier SA should be appended to the procedure code for all NP/PA services that are billed under the supervising physician.
- Coding guidelines have been clarified.
Procedure code review policy
- Name changed from annual code review policy.
- Added under preauthorization requirements:
We recognize that new codes can be published on a quarterly basis. We will review these codes within 30 days of the effective date and notify providers of all determinations via the next published Connection newsletter
formulary updates
Fallon Community Health Plan often makes changes to its formularies, including changing prior authorization requirements and adding new medications. Please note the following changes to our commercial plan formulary.
COMMERCIAL PLAN FORMULARY
additions
| Azor® (amlodipine/olmesartan) |
Tier 3 |
| Calomist® (cyanocobalamin) Nasal Spray |
Tier 3, PA required |
| Extina® (ketoconazole) 2% Foam |
Tier 3, PA required |
| Janumet® (sitagliptin/metformin) |
Tier 3 |
changes
| Januvia® (sitagliptin) |
PA removed |
new to market policy*
Somatuline® (lanreotide)
* FCHP’s New to Market Policy was enacted to ensure patient safety and to allow for adequate time for the development, review and approval of clinical criteria. When a new medication first becomes available, it will fall under this policy and be excluded from coverage. A process is in place that allows for the quick review of provider requests for noncovered pharmaceuticals.
MEDICARE PART D FORMULARY
additions
|
Adagen |
Added as Tier 3, PA required |
|
Anadrol |
Added as Tier 3, PA required |
|
Angeliq |
Added as Tier 3 |
|
Aranesp albumin free |
Added as Tier 3, PA required |
|
Atripla |
Added as Tier 3 |
|
Attenuvax |
Added as Tier 3 |
|
Avastin |
Added as Tier 2, PA required |
|
Cardura XL |
Added as Tier 3, QLL |
|
Coreg CR |
Added as Tier 2, QLL |
|
Emsam |
Added as Tier 3, PA required |
|
Engerix-B |
Added as Tier 3, PA required |
|
Enjuvia |
Added as Tier 3 |
|
Femcon FE |
Added as Tier 3 |
|
Gammagard |
Added as Tier 2, PA required |
|
Gammar-P |
Added as Tier 3, PA required |
|
Gamunex |
Added as Tier 3, PA required |
|
Gardasil |
Added as Tier 3 |
|
Herceptin |
Added as Tier 3, PA required |
|
Hibtiter |
Added as Tier 3 |
|
Intron-a |
Added as Tier 2, PA required |
|
Iveegam |
Added as Tier 3, PA required |
|
Invega |
Added as Tier 3, PA required |
|
Janumet |
Added as Tier 3 |
|
Januvia |
Added as Tier 3 |
|
Kadian |
Added as Tier 3 |
|
Lotrel |
Added as Tier 3 |
|
Meruvax II |
Added as Tier 3 |
|
Methitest |
Added as Tier 3 |
|
M-r-vax II |
Added as Tier 3 |
|
Mumpsvax |
Added as Tier 3 |
|
Orapred ODT |
Added as Tier 3 |
|
Oxandrin |
Added as Tier 3, PA required |
|
Polygam S/D |
Added as Tier 3, PA required |
|
Prezista |
Added as Tier 3 |
|
Proleukin |
Added as Tier 3, PA required |
|
Rabavert |
Added as Tier 3 |
|
Rotateq |
Added as Tier 3 |
|
Seasonique |
Added as Tier 3 |
|
Seroquel XR |
Added as Tier 3 |
|
Sprycel |
Added as Tier 3, PA required |
|
Tekturna |
Added as Tier 3, PA required |
|
Tetanus toxoid |
Added as Tier 3 |
|
Trisenox |
Added as Tier 3, PA required |
|
Tykerb |
Added as Tier 3, PA required |
|
Tyzeka |
Added as Tier 3, PA required |
|
Velcade |
Added as Tier 3, PA required |
|
Venoglobul |
Added as Tier 3, PA required |
|
Yaz |
Added as Tier 3 |
|
Zolinza |
Added as Tier 3, PA required |
changes
|
Eth-oxydose conc |
PA removed |
|
Accuneb |
Tier change |
|
Accupril |
QLL increased |
|
Aclovate |
Tier change |
|
Acthib |
PA removed |
|
Actonel with calcium |
QLL added |
|
Actoplus met |
QLL increased |
|
Agrylin |
Tier change |
|
Ambien |
QLL increased |
|
Anexsia |
PA removed |
|
Aralast |
PA added |
|
Arava |
Tier change |
|
Axert |
QLL increased |
|
Cardura |
QLL increased |
|
Ciloxan |
Tier change |
|
Colestid |
Tier change |
|
Comvax |
PA removed |
|
Dantrium |
Tier change |
|
Daptacel |
PA removed |
|
Ddavp |
Tier change |
|
Depo-testosterone |
Tier change |
|
Didronel |
Tier change |
|
Diflucan 50, 100, 200 mg tabs |
PA removed & QLL added |
|
Dostinex |
QLL increased |
|
Faslodex soln |
Tier change |
|
Flonase |
Tier change |
|
Grifulvin V susp |
Tier change |
|
Humalog (vial) |
Tier change |
|
Ipol |
PA removed |
|
Kytril |
QLL removed |
|
Lamictal chew |
Tier change |
|
Levemir |
PA removed |
|
Lidoderm |
QLL increased |
|
Lithobid |
Tier change |
|
Lofibra |
Tier change |
|
Lorcet plus |
PA removed |
|
Lotronex |
Tier change |
|
Malarone 62.5 mg;25 mg tabs |
Tier change |
|
Marinol |
QLL removed |
|
Methergine |
Tier change |
|
Metrogel vaginal |
Tier change |
|
Metrolotion |
Tier change |
|
Miacalcin |
Tier change |
|
M-m-r II |
PA removed |
|
Naprelan |
PA removed |
|
Neupogen |
PA added |
|
Nilandron |
PA removed |
|
Nitrostat |
Tier change |
|
Norpace |
Tier change |
|
Norpace CR |
Tier change |
|
Oxyfast conc |
PA removed |
|
Pamine |
PA removed |
|
Parnate |
Tier change |
|
Prandin |
QLL increased |
|
Premarin cream |
Tier change |
|
Proscar |
Tier change |
|
Prozac 40 mg caps |
PA added |
|
Recombivax HB |
PA removed |
|
Retrovir |
Tier change |
|
Roferon-A |
PA removed |
|
Rythmol SR |
Tier change |
|
Salagen |
Tier change |
|
Sandostatin |
Tier change |
|
Sonata |
QLL increased |
|
Surmontil |
Tier change |
|
Transderm-Scop |
QLL increased |
|
Tripedia |
PA removed |
|
Twinrix |
PA removed |
|
Urocit-K |
Tier change |
|
Vaqta |
PA removed |
|
Varivax |
PA removed |
|
Verelan PM |
PA removed |
|
Wellbutrin XL |
Tier change |
|
Zavesca |
PA removed |
|
Zithromax |
Tier change |
|
Zofran |
QLL removed |
tips for medicare coding
Did you know that diagnosis codes not only impact our corporate and industry reporting, but also our reimbursement from the Centers for Medicare & Medicaid?
As a an organization that offers Medicare Advantage plans, Fallon Community Health Plan is required to submit diagnostic information to CMS on a regular basis. These submissions are based on claims data and identify ICD-9 codes present for a specific provider on any date of service. About 20% of all available ICD-9 codes are translated into a severity-adjusted level of reimbursement based on values associated with Hierarchical Condition Categories, or HCCs.
CMS has mapped in excess of 3,200 diagnosis codes to 70 categories of clinically similar diagnoses for the basis of payment within the Risk Adjustment Rating Methodology. HCC captures the severity of illness, are additive and need to be documented and coded at least once each calendar year per CMS guidelines.
improvements for better reimbursement
The Risk Adjustment Rating Methodology employed by CMS has presented several opportunities for FCHP and our partners to identify areas for quality coding improvements with the potential for increased reimbursement. This process is very detailed, and not only requires implementation of accurate coding and charting practices but also complete and detailed claims submission practices.
The risk adjustment process can be broken down into three components:
- The first step in the physician-data process is appropriate medical record documentation. This includes the recording of conditions and diseases; updating a problem list, if used; and recording of the patient’s name on each page of the medical record. Physicians should sign and date each entry in the medical record. Remember to include all active diagnosis codes.
Documentation of the medical record is both the responsibility of the clinical and non-clinical staff. Physician participation in the coding and billing process is essential. Practices may even employ physician reviewers or, at the very least, establish regular meetings with the coding and billing staff to share issues in documentation. Even if a third-party billing service is used, the responsibility for accuracy and quality of the medical record lies with the physician.
- The second step is ICD-9-CM coding based on medical record documentation.
- The third step is the physician reporting the ICD-9-CM diagnostic data to FCHP, using the CMS 1500 or UB92 claim form.
If you have any questions regarding the Risk Adjustment Payment Methodology, please contact your Provider Relations Representative at 1-866-ASK-FCHP, option #4. FCHP representatives from our Medicare Reimbursement & Analytics Department are available to conduct practice and group presentations as appropriate.
tips for bilateral services and modifier -50
One of the most frequently asked billing questions we receive is how to bill for bilateral services. In this article, we’ll address the correct use of modifier -50.
Bilateral services are services performed on both sides of the body during (a) the same operative session or (b) on the same day. The modifier -50 is not applicable to services that are bilateral by definition or the CPT code description states “bilateral’ or “unilateral.”
CPT defines modifier -50: “Bilateral Procedure—Unless otherwise identified in the listing, bilateral procedures that are performed at the same operative session should be identified by adding the -50 modifier to the appropriate five-digit code.”
When reporting bilateral diagnostic and surgical services, use modifier -50. Bilateral diagnostic and surgical services are billed on one claim line with modifier -50 and the units billed should be one. Don’t use the -50 modifier to report services already identified as bilateral by definition.
When reporting bilateral radiological services, use the -RT and -LT modifiers. Radiological services are billed on two claim lines with the -RT and -LT modifier and one unit on each line. Don’t use the -RT and -LT modifier to report services already identified as bilateral by definition.
Reimbursement for bilateral services is determined by the Medicare Physician Fee Schedule Database.
|
bilateral indicator |
definition |
fchp instructions |
|
0 |
150% payment adjustment for bilateral procedures does not apply. If the procedure is reported with modifier -50 or with -RT and -LT, the payment is based for the two sides, or the lower of the actual charges for both sides, or 100% of the fee schedule amount for a single code. |
Do not submit these codes with modifier -50. |
|
1 |
150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier -50, the payment is based on the lower of the total charges for both sides or 150% of the fee schedule for a single code. |
Submit the procedure code on a single claim line with modifier -50 with “1” unit.
See Table A below for a list of codes. |
|
2 |
150% payment adjustment does not apply. Relative Value Units (RVUs) are already based on the procedure being preformed as a bilateral procedure. If the procedure is reported with a modifier -50, or twice on the same day by any other means, the payment is based on both sides of the total actual charge by the physician for both sides or 100% of the fee schedule for a single code. |
Do not submit these codes with modifier -50. Submit the procedure code on a single claim line with “1” unit.
See Table B below for a list of codes. |
|
3 |
The usual payment adjustment for bilateral procedures does not apply. If the procedure is reported with modifier -50 or is reported for both sides on the same day, payment is based on each side or organ or site of a paired organ on the lower of the actual charge for each side, or 100% of the fee schedule amount for each side. Services in this category are generally radiology or other diagnostic tests that are not subject to the special payment rules for other bilateral surgeries. |
Submit radiology procedure code on two claim lines with the -RT and -LT modifiers with “1” unit on each claim line.
See Table C below for a list of codes. |
|
9 |
Bilateral concept does not apply. |
Do not submit these codes with modifier -50. |
Table A – 150% payment adjustment for bilateral procedures applies.
Table B – 150% payment adjustment does not apply. RVU’s are already based on the procedure being performed as a bilateral procedure.
Table C - The usual payment adjustment for bilateral procedures does not apply. Pay 100% of the fee schedule amount for each side or unit.
Table A – 150% payment adjustment for bilateral procedures applies
|
Code |
Modifier |
Description |
|
0016T |
|
Thermotx choroid vasc lesion |
|
0017T |
|
Photocoagulat macular drusen |
|
15820 |
|
Revision of lower eyelid |
|
15821 |
|
Revision of lower eyelid |
|
15822 |
|
Revision of upper eyelid |
|
15823 |
|
Revision of upper eyelid |
|
15824 |
|
Removal of forehead wrinkles |
|
15825 |
|
Removal of neck wrinkles |
|
15826 |
|
Removal of brow wrinkles |
|
15828 |
|
Removal of face wrinkles |
|
15829 |
|
Removal of skin wrinkles |
|
19020 |
|
Incision of breast lesion |
|
19030 |
|
Injection for breast x-ray |
|
19100 |
|
Bx breast percut w/o image |
|
19101 |
|
Biopsy of breast, open |
|
19102 |
|
Bx breast percut w/image |
|
19103 |
|
Bx breast percut w/device |
|
19105 |
|
Cryosurg ablate fa, each |
|
19110 |
|
Nipple exploration |
|
19112 |
|
Excise breast duct fistula |
|
19120 |
|
Removal of breast lesion |
|
19125 |
|
Excision, breast lesion |
|
19290 |
|
Place needle wire, breast |
|
19296 |
|
Place po breast cath for rad |
|
19298 |
|
Place breast rad tube/caths |
|
19300 |
|
Removal of breast tissue |
|
19301 |
|
Partical mastectomy |
|
19302 |
|
P-mastectomy w/ln removal |
|
19303 |
|
Mast, simple, complete |
|
19304 |
|
Mast, subq |
|
19305 |
|
Mast, radical |
|
19306 |
|
Mast, rad, urban type |
|
19307 |
|
Mast, mod rad |
|
19316 |
|
Suspension of breast |
|
19318 |
|
Reduction of large breast |
|
19324 |
|
Enlarge breast |
|
19325 |
|
Enlarge breast with implant |
|
19328 |
|
Removal of breast implant |
|
19330 |
|
Removal of implant material |
|
19340 |
|
Immediate breast prosthesis |
|
19342 |
|
Delayed breast prosthesis |
|
19350 |
|
Breast reconstruction |
|
19355 |
|
Correct inverted nipple(s) |
|
19357 |
|
Breast reconstruction |
|
19361 |
|
Breast reconstr w/lat flap |
|
19364 |
|
Breast reconstruction |
|
19366 |
|
Breast reconstruction |
|
19367 |
|
Breast reconstruction |
|
19368 |
|
Breast reconstruction |
|
19369 |
|
Breast reconstruction |
|
19370 |
|
Surgery of breast capsule |
|
19371 |
|
Removal of breast capsule |
|
19380 |
|
Revise breast reconstruction |
|
19396 |
|
Design custom breast implant |
|
19499 |
|
Breast surgery procedure |
|
20100 |
|
Explore wound, neck |
|
20150 |
|
Excise epiphyseal bar |
|
20526 |
|
Ther injection, carp tunnel |
|
20600 |
|
Drain/inject, joint/bursa |
|
20605 |
|
Drain/inject, joint/bursa |
|
20610 |
|
Drain/inject, joint/bursa |
|
20802 |
|
Replantation, arm, complete |
|
20805 |
|
Replant forearm, complete |
|
20808 |
|
Replantation hand, complete |
|
20824 |
|
Replantation thumb, complete |
|
20827 |
|
Replantation thumb, complete |
|
20838 |
|
Replantation foot, complete |
|
20982 |
|
Ablate, bone tumor(s) perq |
|
21010 |
|
Incision of jaw joint |
|
21050 |
|
Removal of jaw joint |
|
21060 |
|
Remove jaw joint cartilage |
|
21070 |
|
Remove coronoid process |
|
21077 |
|
Prepare face/oral prosthesis |
|
21086 |
|
Prepare face/oral prosthesis |
|
21240 |
|
Reconstruction of jaw joint |
|
21242 |
|
Reconstruction of jaw joint |
|
21243 |
|
Reconstruction of jaw joint |
|
21280 |
|
Revision of eyelid |
|
21282 |
|
Revision of eyelid |
|
21480 |
|
Reset dislocated jaw |
|
21485 |
|
Reset dislocated jaw |
|
21490 |
|
Repair dislocated jaw |
|
21615 |
|
Removal of rib |
|
21616 |
|
Removal of rib and nerves |
|
23020 |
|
Release shoulder joint |
|
23031 |
|
Drain shoulder bursa |
|
23035 |
|
Drain shoulder bone lesion |
|
23040 |
|
Exploratory shoulder surgery |
|
23044 |
|
Exploratory shoulder surgery |
|
23065 |
|
Biopsy shoulder tissues |
|
23066 |
|
Biopsy shoulder tissues |
|
23075 |
|
Removal of shoulder lesion |
|
23076 |
|
Removal of shoulder lesion |
|
23077 |
|
Remove tumor of shoulder |
|
23100 |
|
Biopsy of shoulder joint |
|
23101 |
|
Shoulder joint surgery |
|
23105 |
|
Remove shoulder joint lining |
|
23106 |
|
Incision of collarbone joint |
|
23107 |
|
Explore treat shoulder joint |
|
23125 |
|
Removal of collar bone |
|
23130 |
|
Remove shoulder bone, part |
|
23140 |
|
Removal of bone lesion |
|
23145 |
|
Removal of bone lesion |
|
23146 |
|
Removal of bone lesion |
|
23150 |
|
Removal of humerus lesion |
|
23155 |
|
Removal of humerus lesion |
|
23156 |
|
Removal of humerus lesion |
|
23170 |
|
Remove collar bone lesion |
|
23172 |
|
Remove shoulder blade lesion |
|
23174 |
|
Remove humerus lesion |
|
23180 |
|
Remove collar bone lesion |
|
23182 |
|
Remove shoulder blade lesion |
|
23184 |
|
Remove humerus lesion |
|
23190 |
|
Partial removal of scapula |
|
23195 |
|
Removal of head of humerus |
|
23200 |
|
Removal of collar bone |
|
23210 |
|
Removal of shoulder blade |
|
23220 |
|
Partial removal of humerus |
|
23221 |
|
Partial removal of humerus |
|
23222 |
|
Partial removal of humerus |
|
23330 |
|
Remove shoulder foreign body |
|
23331 |
|
Remove shoulder foreign body |
|
23332 |
|
Remove shoulder foreign body |
|
23350 |
|
Injection for shoulder x-ray |
|
23400 |
|
Fixation of shoulder blade |
|
23410 |
|
Repair rotator cuff, acute |
|
23412 |
|
Repair rotator cuff, chronic |
|
23415 |
|
Release of shoulder ligament |
|
23420 |
|
Repair of shoulder |
|
23430 |
|
Repair biceps tendon |
|
23440 |
|
Remove/transplant tendon |
|
23450 |
|
Repair shoulder capsule |
|
23455 |
|
Repair shoulder capsule |
|
23460 |
|
Repair shoulder capsule |
|
23462 |
|
Repair shoulder capsule |
|
23465 |
|
Repair shoulder capsule |
|
23466 |
|
Repair shoulder capsule |
|
23470 |
|
Reconstruct shoulder joint |
|
23472 |
|
Reconstruct shoulder joint |
|
23480 |
|
Revision of collar bone |
|
23485 |
|
Revision of collar bone |
|
23490 |
|
Reinforce clavicle |
|
23491 |
|
Reinforce shoulder bones |
|
23500 |
|
Treat clavicle fracture |
|
23505 |
|
Treat clavicle fracture |
|
23515 |
|
Treat clavicle fracture |
|
23520 |
|
Treat clavicle dislocation |
|
23525 |
|
Treat clavicle dislocation |
|
23530 |
|
Treat clavicle dislocation |
|
23532 |
|
Treat clavicle dislocation |
|
23540 |
|
Treat clavicle dislocation |
|
23545 |
|
Treat clavicle dislocation |
|
23550 |
|
Treat clavicle dislocation |
|
23552 |
|
Treat clavicle dislocation |
|
23570 |
|
Treat shoulder blade fx |
|
23575 |
|
Treat shoulder blade fx |
|
23585 |
|
Treat scapula fracture |
|
23600 |
|
Treat humerus fracture |
|
23605 |
|
Treat humerus fracture |
|
23615 |
|
Treat humerus fracture |
|
23616 |
|
Treat humerus fracture |
|
23620 |
|
Treat humerus fracture |
|
23625 |
|
Treat humerus fracture |
|
23630 |
|
Treat humerus fracture |
|
23650 |
|
Treat shoulder dislocation |
|
23655 |
|
Treat shoulder dislocation |
|
23660 |
|
Treat shoulder dislocation |
|
23665 |
|
Treat dislocation/fracture |
|
23670 |
|
Treat dislocation/fracture |
|
23675 |
|
Treat dislocation/fracture |
|
23680 |
|
Treat dislocation/fracture |
|
23800 |
|
Fusion of shoulder joint |
|
23930 |
|
Drainage of arm lesion |
|
23931 |
|
Drainage of arm bursa |
|
23935 |
|
Drain arm/elbow bone lesion |
|
24000 |
|
Exploratory elbow surgery |
|
24006 |
|
Release elbow joint |
|
24065 |
|
Biopsy arm/elbow soft tissue |
|
24066 |
|
Biopsy arm/elbow soft tissue |
|
24075 |
|
Remove arm/elbow lesion |
|
24076 |
|
Remove arm/elbow lesion |
|
24077 |
|
Remove tumor of arm/elbow |
|
24100 |
|
Biopsy elbow joint lining |
|
24101 |
|
Explore/treat elbow joint |
|
24102 |
|
Remove elbow joint lining |
|
24105 |
|
Removal of elbow bursa |
|
24110 |
|
Remove humerus lesion |
|
24115 |
|
Remove/graft bone lesion |
|
24116 |
|
Remove/graft bone lesion |
|
24120 |
|
Remove elbow lesion |
|
24125 |
|
Remove/graft bone lesion |
|
24126 |
|
Remove/graft bone lesion |
|
24130 |
|
Removal of head of radius |
|
24134 |
|
Removal of arm bone lesion |
|
24136 |
|
Remove radius bone lesion |
|
24138 |
|
Remove elbow bone lesion |
|
24140 |
|
Partial removal of arm bone |
|
24145 |
|
Partial removal of radius |
|
24147 |
|
Partial removal of elbow |
|
24149 |
|
Radical resection of elbow |
|
24150 |
|
Extensive humerus surgery |
|
24151 |
|
Extensive humerus surgery |
|
24152 |
|
Extensive radius surgery |
|
24153 |
|
Extensive radius surgery |
|
24155 |
|
Removal of elbow joint |
|
24160 |
|
Remove elbow joint implant |
|
24164 |
|
Remove radius head implant |
|
24200 |
|
Removal of arm foreign body |
|
24201 |
|
Removal of arm foreign body |
|
24220 |
|
Injection for elbow x-ray |
|
24300 |
|
Manipulate elbow w/anesth |
|
24330 |
|
Revision of arm muscles |
|
24331 |
|
Revision of arm muscles |
|
24332 |
|
Tenolysis, triceps |
|
24340 |
|
Repair of biceps tendon |
|
24341 |
|
Repair arm tendon/muscle |
|
24342 |
|
Repair of ruptured tendon |
|
24343 |
|
Repr elbow lat ligmnt w/tiss |
|
24344 |
|
Reconstruct elbow lat ligmnt |
|
24345 |
|
Repr elbw med ligmnt w/tissu |
|
24346 |
|
Reconstruct elbow med ligmnt |
|
24350 |
|
Repair of tennis elbow |
|
24351 |
|
Repair of tennis elbow |
|
24352 |
|
Repair of tennis elbow |
|
24354 |
|
Repair of tennis elbow |
|
24356 |
|
Revision of tennis elbow |
|
24360 |
|
Reconstruct elbow joint |
|
24361 |
|
Reconstruct elbow joint |
|
24362 |
|
Reconstruct elbow joint |
|
24363 |
|
Replace elbow joint |
|
24365 |
|
Reconstruct head of radius |
|
24366 |
|
Reconstruct head of radius |
|
24400 |
|
Revision of humerus |
|
24410 |
|
Revision of humerus |
|
24420 |
|
Revision of humerus |
|
24430 |
|
Repair of humerus |
|
24435 |
|
Repair humerus with graft |
|
24470 |
|
Revision of elbow joint |
|
24495 |
|
Decompression of forearm |
|
24498 |
|
Reinforce humerus |
|
24500 |
|
Treat humerus fracture |
|
24505 |
|
Treat humerus fracture |
|
24515 |
|
Treat humerus fracture |
|
24516 |
|
Treat humerus fracture |
|
24530 |
|
Treat humerus fracture |
|
24535 |
|
Treat humerus fracture |
|
24538 |
|
Treat humerus fracture |
|
24545 |
|
Treat humerus fracture |
|
24546 |
|
Treat humerus fracture |
|
24560 |
|
Treat humerus fracture |
|
24565 |
|
Treat humerus fracture |
|
24566 |
|
Treat humerus fracture |
|
24575 |
|
Treat humerus fracture |
|
24576 |
|
Treat humerus fracture |
|
24577 |
|
Treat humerus fracture |
|
24579 |
|
Treat humerus fracture |
|
24582 |
|
Treat humerus fracture |
|
24586 |
|
Treat elbow fracture |
|
24587 |
|
Treat elbow fracture |
|
24600 |
|
Treat elbow dislocation |
|
24605 |
|
Treat elbow dislocation |
|
24615 |
|
Treat elbow dislocation |
|
24620 |
|
Treat elbow fracture |
|
24635 |
|
Treat elbow fracture |
|
24640 |
|
Treat elbow dislocation |
|
24650 |
|
Treat radius fracture |
|
24655 |
|
Treat radius fracture |
|
24665 |
|
Treat radius fracture |
|
24666 |
|
Treat radius fracture |
|
24670 |
|
Treat ulnar fracture |
|
24675 |
|
Treat ulnar fracture |
|
24685 |
|
Treat ulnar fracture |
|
24800 |
|
Fusion of elbow joint |
|
24802 |
|
Fusion/graft of elbow joint |
|
24900 |
|
Amputation of upper arm |
|
24920 |
|
Amputation of upper arm |
|
24925 |
|
Amputation follow-up surgery |
|
24930 |
|
Amputation follow-up surgery |
|
24931 |
|
Amputate upper arm & implant |
|
24935 |
|
Revision of amputation |
|
24940 |
|
Revision of upper arm |
|
24999 |
|
Upper arm/elbow surgery |
|
25000 |
|
Incision of tendon sheath |
|
25001 |
|
Incise flexor carpi radialis |
|
25020 |
|
Decompress forearm 1 space |
|
25023 |
|
Decompress forearm 1 space |
|
25024 |
|
Decompress forearm 2 spaces |
|
25025 |
|
Decompress forearm 2 spaces |
|
25028 |
|
Drainage of forearm lesion |
|
25031 |
|
Drainage of forearm bursa |
|
25035 |
|
Treat forearm bone lesion |
|
25040 |
|
Explore/treat wrist joint |
|
25065 |
|
Biopsy forearm soft tissues |
|
25066 |
|
Biopsy forearm soft tissues |
|
25075 |
|
Removal forearm lesion subcu |
|
25076 |
|
Removal forearm lesion deep |
|
25077 |
|
Remove tumor, forearm/wrist |
|
25085 |
|
Incision of wrist capsule |
|
25100 |
|
Biopsy of wrist joint |
|
25101 |
|
Explore/treat wrist joint |
|
25105 |
|
Remove wrist joint lining |
|
25107 |
|
Remove wrist joint cartilage |
|
25109 |
|
Excise tendon forearm/wrist |
|
25110 |
|
Remove wrist tendon lesion |
|
25111 |
|
Remove wrist tendon lesion |
|
25112 |
|
Reremove wrist tendon lesion |
|
25115 |
|
Remove wrist/forearm lesion |
|
25116 |
|
Remove wrist/forearm lesion |
|
25118 |
|
Excise wrist tendon sheath |
|
25119 |
|
Partial removal of ulna |
|
25120 |
|
Removal of forearm lesion |
|
25125 |
|
Remove/graft forearm lesion |
|
25126 |
|
Remove/graft forearm lesion |
|
25130 |
|
Removal of wrist lesion |
|
25135 |
|
Remove & graft wrist lesion |
|
25136 |
|
Remove & graft wrist lesion |
|
25145 |
|
Remove forearm bone lesion |
|
25150 |
|
Partial removal of ulna |
|
25151 |
|
Partial removal of radius |
|
25170 |
|
Extensive forearm surgery |
|
25230 |
|
Partial removal of radius |
|
25240 |
|
Partial removal of ulna |
|
25246 |
|
Injection for wrist x-ray |
|
25248 |
|
Remove forearm foreign body |
|
25250 |
|
Removal of wrist prosthesis |
|
25259 |
|
Manipulate wrist w/anesthes |
|
25275 |
|
Repair forearm tendon sheath |
|
25300 |
|
Fusion of tendons at wrist |
|
25301 |
|
Fusion of tendons at wrist |
|
25315 |
|
Revise palsy hand tendon(s) |
|
25316 |
|
Revise palsy hand tendon(s) |
|
25320 |
|
Repair/revise wrist joint |
|
25332 |
|
Revise wrist joint |
|
25335 |
|
Realignment of hand |
|
25337 |
|
Reconstruct ulna/radioulnar |
|
25350 |
|
Revision of radius |
|
25355 |
|
Revision of radius |
|
25360 |
|
Revision of ulna |
|
25365 |
|
Revise radius & ulna |
|
25370 |
|
Revise radius or ulna |
|
25375 |
|
Revise radius & ulna |
|
25390 |
|
Shorten radius or ulna |
|
25391 |
|
Lengthen radius or ulna |
|
25392 |
|
Shorten radius & ulna |
|
25393 |
|
Lengthen radius & ulna |
|
25394 |
|
Repair carpal bone, shorten |
|
25400 |
|
Repair radius or ulna |
|
25405 |
|
Repair/graft radius or ulna |
|
25415 |
|
Repair radius & ulna |
|
25420 |
|
Repair/graft radius & ulna |
|
25425 |
|
Repair/graft radius or ulna |
|
25426 |
|
Repair/graft radius & ulna |
|
25430 |
|
Vasc graft into carpal bone |
|
25431 |
|
Repair nonunion carpal bone |
|
25440 |
|
Repair/graft wrist bone |
|
25441 |
|
Reconstruct wrist joint |
|
25442 |
|
Reconstruct wrist joint |
|
25443 |
|
Reconstruct wrist joint |
|
25444 |
|
Reconstruct wrist joint |
|
25445 |
|
Reconstruct wrist joint |
|
25446 |
|
Wrist replacement |
|
25447 |
|
Repair wrist joint(s) |
|
25449 |
|
Remove wrist joint implant |
|
25450 |
|
Revision of wrist joint |
|
25455 |
|
Revision of wrist joint |
|
25490 |
|
Reinforce radius |
|
25491 |
|
Reinforce ulna |
|
25492 |
|
Reinforce radius and ulna |
|
25500 |
|
Treat fracture of radius |
|
25505 |
|
Treat fracture of radius |
|
25515 |
|
Treat fracture of radius |
|
25520 |
|
Treat fracture of radius |
|
25525 |
|
Treat fracture of radius |
|
25526 |
|
Treat fracture of radius |
|
25530 |
|
Treat fracture of ulna |
|
25535 |
|
Treat fracture of ulna |
|
25545 |
|
Treat fracture of ulna |
|
25560 |
|
Treat fracture radius & ulna |
|
25565 |
|
Treat fracture radius & ulna |
|
25574 |
|
Treat fracture radius & ulna |
|
25575 |
|
Treat fracture radius/ulna |
|
25600 |
|
Treat fracture radius/ulna |
|
25605 |
|
Treat fracture radius/ulna |
|
25606 |
|
Treat fx distal radial |
|
25607 |
|
Treat fx rad extra-articul |
|
25608 |
|
Treat fx rad intra-articul |
|
25609 |
|
Treat fx radial 3+ frag |
|
25622 |
|
Treat wrist bone fracture |
|
25624 |
|
Treat wrist bone fracture |
|
25628 |
|
Treat wrist bone fracture |
|
25630 |
|