South Carolina North Carolina Louisiana. Norplant implant removal. Diaphragm fitting with instructions

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Marcus McBride
5 years ago
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1 P a g e Anesthesia, intraperitoneal procedure, lower abdomen, Including laparoscopy; tubal ligation/transection Anesthesia for vaginal procedure (including biopsy of labia, vagina, cervix, or endometrium); hysteroscopy and/or hysterosalpingography Insertion, implantable contraceptive capsules Removal, implantable contraceptive capsules Removal with reinsertion, implantable contraceptive capsules Insertion, non-biodegradable drug delivery implant Removal, non biodegradable drug delivery implant Removal, with reinsertion, nonbiodegradable drug delivery implant Collection of venous blood by venipuncture Collection of capillary blood specimen Anesthesia intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified. Anesthesia intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection. Anesthesia for procedure on male genitalia (including open urethral procedures); vasectomy, unilateral or bilateral. Norplant implant removal Vasectomy, unilateral or bilateral (including postop semen examination(s)) Ligation of vas deferens, unilateral or bilateral Diaphragm or cervical cap fitting w/ instructions Diaphragm fitting with instructions Anes; tubal ligation/transection Insertion or reinsertion, implantabl Removal without reinsertion, implant Removal with reinsertion, implantabl Venipuncture multiple patients Diaphragm fitting with instructions

2 P a g e Insertion of intrauterine device IUD insertion Insert intrauterine device Removal of intrauterine device IUD removal Remove intrauterine device Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (sis) or hysterosalpingography Laparoscopy/hysteroscopy with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants Ligation or transaction of fallopian tube(s), Tubal ligation by abdominal incision Division of fallopian tube abd or vaginal, unilateral or bilateral Occlusion of fallopian tube(s) by device (e.g., band, clip) vaginal or suprapubic approach Tubal ligation by suprapubic approach Occlusion of fallopian tube, device Laparoscopy with fulguration of oviducts Laparoscopy, tubal Tubal ligation by laparoscopic surgery (with or without transection) cautery Laparoscopy with occlusion of oviducts by device (e.g., band, clip) Tubal ligation by laparoscopic surgery Laparoscopy, tubal block Inject spine l/s (cd) Inject spine w/cath l/s (cd) Radiologic examination, chest; single view, frontal Radiology examination; chest; single view, frontal X-ray chest; single view X-ray chest; two views Hysterosalpingography, radiological supervision and interpretation Echography, pelvic, real time Echography, transvaginal Basic metabolic panel Basic metabolic panel General health screen panel

3 P a g e Electrolyte panel Lipid profile Urinalysis by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these Urinalysis by dip stick or tablet reagent Urinalysis w/ microscopy constituents; non-automated, with microscopy Urinalysis by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific Urinalysis; automated with microscopy Urinalysis, auto, w/scope gravity, urobilinogen, any number of these constituents; automated, with microscopy Urinalysis by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy Urinalysis; non-automated without microscopy Routine urine analysis Urinalysis by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, Urinalysis, by dip stick or leukocytes, nitrite, ph, protein, specific Urinalysis; automated without microscopy tablet r gravity, urobilinogen, any number of these constituents; automated, with microscopy Urinalysis; qualitative or semiquantitative, except immunoassaysal kit Urinalysis Urinalysis; bacteriuria screen, by nonculture, commercial kit Urinalysis microscopic only Urinalysis; two or three glass test Urine pregnancy test by visual color comparison methods Urine pregnancy test Urine pregnancy test, by visual colo Stick assay of blood glucose

4 P a g e Glucose, blood, by glucose monitorin Assay hemoglobin Assay bun Assay blood uric acid Gonadotropin, chorionic; quantitative HCG quantitative Gonadotropin, chorionic; qualitative HCG qualitative quintana, direct probe ; candida species Blood count; manual differential wbc count (includes rbc morphology) and platelet estimation Blood count, manual blood smear examination without differential parameters Blood count; differential wbc count, buffy coat Gonadotropin, chorionic; quantitative Gonadotropin, chorionic; qualitative Blood smear, spun microhematocrit Blood count; spun microhematocrit Blood count; Blood smear, hematocrit Blood count; other than spun hematocrit Blood count other than spun hematocr Hemoglobin Blood count; hemoglobin Hemoglobin, colorimetric Blood count, complete cbc with automated differential wbc count Blood count; automated differential wbc count, complete cbc, automated (hgb, hct, rbc, wbc, and platelet count) Manual cell count (erythrocyte, leukocyte or platelet) each Fluorescent noninfectious agent antibody, screen, each Blood count; rbc only Blood count; hemo; plat count

5 P a g e Syphilis test, qualitative Syphilis Syphilis test(s),qualitative Syphilis; qualitative Syphilis Syphilis test, quantitative Chlamydia Antibody Chlamydia, igm Antibody HTLVI, antibody detection; immunoassa Antibody HTLV or HIV antibody HTLV or HIV antibody Confirmatory test Herpes simplex; non-specific type test Herpes simplex, non-specific type test Herpes simplex; type 1 Herpes simples, type Antibody; herpes simplex type 2 Herpes simplex, type Immunoassay performed by multiple step method for the detection of antibodies to HIV 1 Antibody infectious agents-hiv Antibody HIV 2 Antibody HIV-2 Antibody HIV-1&2 HIV 1&2 Antibody Treponema pallidum, confirmatory test (e.g., fta-abs) Treponema pallidum, confirmatory test Culture specimen, bacteria Culture specimen, bacteria Culture, bacterial, screening only, for Culture, bacterial, screening only, for single single organisms organisms Bacteria culture screen Culture, chlamydia Culture, chlamydia Culture, chlamydia Dark field examination, any source; includes specimen collection Smear, primary source, with interpretation, fluorescent and/or acid fast stain for bacteria, fungi, or cell types Smear, primary source with interpretation; gram or giemsa stain for bacteria, fungi, or cell types

6 P a g e Smear, primary source with interpretation fluorescent and /or acid fast stain for bacteria, fungi, or cell types Smear, primary source with interpretation, special stain for inclusion bodies or intracellular parasites (e.g., malaria, kala azar, herpes) Smear, primary source with interpretation, complex special stain (e.g., trichrome, iron hemotoxylin) for ova and parasites Smear, primary source with interpretation; wet mount for infections agents (e.g., saline, india ink, koh preps) Smear, primary source, with interpretation, special stain for inclusion bodies or intracellular parasites (e.g., malaria, kala azar, herpes) Smear, primary source, with interpretation, wet mount with simple stain, for bacteria, fungi, ova, and/or parasites Smear, stain & interpret Tissue examination for fungi Chlamydia trachomatis Infectious agent antigen detection by enzyme immunoflourescent ; adenovirus; Chylmd trach ag, dfa chlamydia trachomatis Herpes symplex virus, type Herpes simplex virus, type Treponema pallidum Infectious agent antigen detection by enzyme immunoassay ; adenovirus; chlamydia Chylmd trach ag, eia trachomatis HIV-1 HIV-1 ag, eia HIV-2 HIV-2 ag, eia Candida species, direct probe Candida, DNA, dir probe Candida species, amplified probe Candida, DNA, amp probe Candida species, quantification Infectious agent detection by nucleic acid (DNA Chylmd trach, DNA, dir or RNA); chlamydia trachomatis. Direct probe quintana, direct probe ; probe. chlamydia trachomatis

7 P a g e quintana, direct probe ; chlamydia trachomatis, amplified probe quintana, direct probe ; gardnerella vaginalis Gardnerella vaginalis, amplified probe Infectious agent detection by nucleic acid (DNA or RNA); chlamydia trachomatis. Amplified probe. Infectious agent detection by nucleic acid (DNA or RNA); chlamydia trachomatis, quantification Gardnerella vaginalis, quantification Herpes simplex, direct probe Herpes simplex virus, direct probe Herpes simplex, amplified probe Herpes simplex virus, amplified probe Herpes simplex, quantification Herpes simplex virus, quantification Herpes virus-6, direct probe Herpes virus-6, amplified probe Herpes virus-6, quantification HIV-1, direct probe HIV-1, direct probe HIV-1, amplified probe HIV-1, amplified probe HIV-1, quantification HIV-1, quantification HIV-2, direct probe HIV-2, direct probe HIV-2, amplified probe HIV-2, amplified probe HIV-2, quantification HIV-2, quantification quintana, direct probe ; neisseria gonorrhoeae, direct probe quintana, direct probe ; neisseria gonorrhoeae, amplified probe Neisseria gonorrhea, direct probe Neisseria gonorrhea, amplified probe Chylmd trach, DNA, amp probe N.gonorrhoeae, DNA, dir prob N.gonorrhoeae, DNA, amp prob

8 P a g e Neisseria gonorrhea, amplified probe Neisseria gonorrhea, quantification Papillomavirus, human quantification HPV, DNA, dir probe quintana, direct probe ; HPV, DNA, amp probe papillomavirus, human, amplified probe Papillomavirus, human, direct probe Trichomonas vaginalis, direct probe not otherwise specified; direct probe, each organism Neisseria gonorrhea Neisseria gonorrhea Cytopathology, concentration, smears and interpretation Cytopathology, cervical or vaginal; requires interpretation by a physician Cytopathology, cervical or vaginal; collected in preservative fluid; automated thin layer preparation, manual screening under physician supervision Cytopathology, manual screening & rescreening under physician supervision Cytopathology smears, screening by automated system under physician supervision Infectious agent detection by immunoassay with direct optical observation; chlamydia trachomatis Cytopathology, cervical or vaginal; requiring interpretation by physician (use in conjunction with , ) Cytopathology, cervical or vaginal, automated thin layer preparation Cytopathology, manual screening & rescreening under physician supervision Cytopathology smears, screening by automated system under physician supervision Chylmd trach assay w/optic N. Gonorrhoeae assay w/optic Cytopathology, fluids, washings or b Cytopath cerv/vag interpret Cytopath cerv/vag thin layer Cytpath c/vag tilayer redo Cytpath c/vag automated

9 P a g e Cytopathology, screening by automated Cytopathology, screening by automated system Cytpath c/vag auto system with manual rescreening with manual rescreening rescreen ; Cytopathology, manual screening under Cytopathology, pap manual screening under physician physician supervision smear supervision Cytopath cerv/vag auto Cytopathology, slides, manual screening & Cytopathology, slides, manual screening & rescreening under physician supervision rescreening under physician supervision (use in (use in conjunction with , conjunction with , ) ) Cytpath c/vag redo Cytopathology, slides, computer assisted Cytopathology, slides, computer assisted Cytpath c/vag select Cytopath,(pap);w/ def.hormonal eval Cytopathology, smears, any other source Cytopathology Cytopathology, preparation, screening and Cytopath;prep, screen, interpretation Cytopathology, extended study involving over 5 slides and/or multiple stains (the bethesda system); manual screening under physician supervision (the bethesda system); with manual screening and rescreening under physician supervision (the bethesda system); with manual screening and computer-assisted Rescreening under physician supervision (the bethesda system); with manual screening and computer assisted rescreening using cell selection and review under physician supervision Cytopathology, slides, computer assisted rescreening interp. Cytopath;ext.study,+5 slides,multi Cytpath tbs c/vag manual Cytpath tbs c/vag redo Cytpath tbs c/vag auto redo Cytpath tbs c/vag select

10 P a g e Cytopathology evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s) Cytopathology; interpretation and report Fine needle aspirate; interp/report Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated system, under physician supervision, collected in preservative fluid; automated thin layer preservative, screening, manual re-screening under physician supervision Level l surgical pathology, gross examination only Level II - surgical pathology, gross and Surgical pathology, gross and microscopic microscopic examination examination Level lv surgical pathology, gross and microscopic examination Special stains Cytopathology, cervial or vaginal col Cytopathology with screening Surgical pathology, gross Surgical pathology, complete Special stains Semen analysis; motility and count (not including huhner test) Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only Routine ECG w/at least 12 leads

11 P a g e Educational supplies, such as books, tapes, and pamphlets, provided by the physician for the patient's education at cost to the physician evaluation and management of a new patient evaluation and management of a new patient evaluation and management of a new patient evaluation and management of a new patient evaluation and management of a new patient evaluation and management of an established patient, that may not require the presence of a physician. Usually the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. evaluation and management of an established patient evaluation and management of an established patient Services requested after posted office hours in addition to basic service Office/outpatient visit; new patient physician time approximately 10 minutes Office/outpatient visit; new patient moderate, physician time approximately 20 minutes Office/outpatient visit; new patient moderate, physician time approximately 30 minutes Office/outpatient visit; new patient complex, physician time approximately 40 minutes Office/outpatient visit; new patient complex, physician time approximately 60 minutes Office/outpatient visit; established patient minimal, physician time approximately 5 minutes Office/outpatient visit; established patient minor, physician time approximately 10 minutes Office/outpatient visit; established patient severe, physician time approximately 15 minutes Office, new, problem, straightforward Office, new pt, expanded, straightfowd Office, new pt, detailed, low complex Office, new pt, comprehen, mod complx Office, new pt, comprehen, high compx Office, est pt, minimal problems Office, est pt, problem, straitforwd Office, est pt, expanded, low complex

12 P a g e evaluation and management of an established patient evaluation and management of an established patient Hospital discharge day management 30 minutes or less More than 30 minutes Office or other outpatient consultation: new or established patient: level Office or other outpatient consultation; new or established patient; level 2 Office/outpatient visit; established patient severe, physician time approximately 25 minutes Office/outpatient visit; established patient severe, physician time approximately 40 minutes Office consultation; new or established patient minor, physician time approximately 15 minutes Office consultation; new or established patient low, physician time approximately 30 minutes Office consultation; new or established patient Office or other outpatient consultation; new moderate, physician time approximately 40 or established patient; level 3 minutes Office consultation for a new or Office consultation; new or established patient established patient severe, physician time approximately 60 minutes Office consultation for new or established patient, which requires these 3 components: comprehensive history; comprehensive examination, and decision making of high complexity. Counseling Office consultation; new or established patient and/or coordination of care with other complex, physician time approximately 80 providers or agencies are provided minutes consistent with the nature of the problem(s) and of moderate severity. Physician usually spends 80 minutes face to face with the patient/family Emergency department visit Initial comprehensive preventive medicine, new patient, years Initial comprehensive preventive medicine, new patient, years Office, est pt, detailed, mod complx Office, est pt, comprehen, high complx Off consult, nre pt, prblm, strtfwd Off conslt, nre pt, xpnd pblm, strtfwd Off cnslt, nre pt, dtld, lo cmplxy Off cnslt, nre pt,cmphsv, mod cmplxy Off cnslt, nre pt, cmphsv, hi cmplxy

13 P a g e J1055 J1056 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes Injection medroxyprogesterone acetate (depo-provera) Injection medroxyprogesterone acetate/estradiol cypionate 25 mg/5mg (lunelle) Periodic comprehensive preventive medicine, established patient, years Periodic comprehensive preventive medicine, established patient, years Depo-Provera 150mg/ml Limited to one injection every 70 days J7300 Intrauterine copper contraceptive Mechanical (Paragard) IUD J7302 Levonorgestrel - release iu contraceptive 52 mg Mirena IUD Depo-provera inj 150mg Lunelle monthly contraception inj Intrauterine copper contraceptive Mirena

PROCEDURE/DIAGNOSIS/REVENUE CODES

PROCEDURE/DIAGNOSIS/REVENUE CODES TAKE CHARGE offers a limited benefit package of services which includes professional services, outpatient services, and laboratory/radiology and pharmaceutical services.