FY 2017 MCRCEDP Procedure Code Reference Chart

Transcription

1 ; Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) A discontinued procedure due to extenuating circumstances or those that threatens the well being of the patient. ; with biopsy, single or multiple Flexible Colonoscopy Procedures; proximal to splenic fixture; with directed submucosal injection(s), any substance ; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) ; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery. ; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Colonoscopy Procedures; flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) (includes preand post-dilation and guide wire passage, when performed) Colonoscopy, flexible, with endoscopic mucosal resection Colonoscopy, flexible, proximal to splenic flexure; Diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) With biopsy, single or multiple Flexible Rigid Colonoscopy Procedures With directed submucosal injection(s), biopsy, single or multiple With control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) With removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery. With removal of tumor(s), polyp(s), or other lesion(s) by snare technique Colonoscopy Procedures With ablation of tumor(s), polyp(s), or other lesion(s) Colonoscopy Procedures With endoscopic mucosal resection FY /01/17

2 G0105 G FY 2017 Colorectal cancer screening; colonoscopy on individual at high risk A discontinued procedure due to extenuating circumstances or those that threatens the well-being of the patient. Colorectal cancer screening; colonoscopy on individual at average risk A discontinued procedure due to extenuating circumstances or those that threatens the well-being of the patient. Multi-test Laboratory Panels; Basic metabolic panel (Calcium, total) Colorectal cancer screening; colonoscopy on individual at increased or high risk Colorectal cancer screening; colonoscopy on individual at average risk Multi-test Laboratory Panels; QW Basic metabolic panel (Calcium, total) Multi-test Laboratory Panels; Comprehensive metabolic panel Multi-test laboratory QW Comprehensive metabolic panel Chemistry: Occult Blood; fecal hemoglobin determination by Blood, occult fecal hemoglobin determination by QW immunoassay, qualitative, feces, 1-3 simultaneous immunoassay, qualitative, feces, 1-3 simultaneous determinations ((FIT)) determinations ((FIT)) Glucose, blood by glucose monitoring device(s) cleared by the FDA Blood glucose Blood counts; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count and automated differential WBC count Blood counts; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet counts Detection Infectious Agent by Probe Techniques; Herpes virus-6, amplified probe technique Level IV Surgical pathology, gross and microscopic examination; biopsy, not requiring microscopic evaluation of surgical margins -TC Technical/Facility Component -26 Professional Component Blood counts; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet counts and automated differential WBC count Blood counts; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet counts Thromboplastin Time, partial (PTT), plasma or whole blood, each Colorectal biopsy, laboratory evaluation of tissue sample Level IV FY /01/17

3 TC -26 -TC -26 FY 2017 Level V Surgical pathology; gross and microscopic examination Technical/Facility Component Professional Component Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain -Technical component -Professional Component Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) -TC -Technical component -26 -Professional Component Electrocardiographic Services; Electrocardiograph, routine ECG with at least 12 leads; with interpretation and report Electrocardiographic Services; Electrocardiograph, routine ECG without at least 12 leads; tracing only, without interpretation and report Colorectal biopsy, laboratory evaluation of tissue sample Level V Immunohistochemistry or immunocytochemistry Immunohistochemistry or immunocytochemistry Each additional specimen or stain Electrocardiograph, routine ECG with at least 12 leads; with interpretation and report Electrocardiograph, routine ECG with at least 12 leads; tracing only; without interpretation and report Electrocardiographic Services; Electrocardiograph, routine ECG without at least 12 leads; with interpretation and report only Electrocardiograph, routine ECG with at least 12 leads; tracing only; with interpretation and report Rhythm strips; Rhythm ECG, 1-3 leads; with interpretation and report Rhythm ECG, 1-3 leads; with interpretation and report Rhythm strips; Rhythm ECG, 1-3 leads; tracing only without Rhythm ECG, 1-3 leads; tracing only without interpretation and report interpretation and report Rhythm strips; Rhythm ECG, 1-3 leads; interpretation and report Rhythm ECG, 1-3 leads; interpretation and report only Office or other outpatient visit for the evaluation and management of New patient a new patient, which requires these three key components: History, exam, and straightforward decision a problem focused history; making a problem focused examination; and 10 minutes straight forward medical decision making. FY /01/17

4 Usually, the presenting problems are self limited or minor. Providers typically spend 10 minutes face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a expanded history; a problem focused examination; and straight forward medical decision making. Usually, the presenting problems are self limited or minor. Providers typically spend 20 minutes face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity. Usually the presenting problem(s) are of moderate severity. Providers typically spend 30 minutes face-to-face with the patient and/or family Office or other outpatient visit for the 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. New patient Expanded history, exam, and straightforward decision making 20 minutes New patient Detailed history, exam, straightforward decisionmaking 30 minutes Established patient Evaluation and management, may not require presence of physician 5 minutes FY /01/17

5 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components: a problem focused history; a problem focused examination; straight forward medical decision making. Usually, the presenting problem(s) are self limited or minor. Providers typically spend 10 minutes face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually, the presenting problem(s) are of low to moderate severity. Providers typically spend 15 minutes face-to-face with the patient and/or family services provided by the same physician or other qualified health care professional performing the diagnostic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older Established patient History, exam, straightforward decision-making 10 minutes Established patient Expanded history, exam, straightforward decisionmaking 15 minutes Sedation provided by SAME physician First 15 minutes FY /01/17

6 99153 Each additional 15 minutes intraservice time (List separately in addition to code for primary service) services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older Each additional 15 minutes intraservice time (List separately in addition to code for primary service) G0500 services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with as appropriate). Each additional 15 minutes Sedation provided by ANOTHER physician First 15 minutes Each additional 15 minutes Sedation provided by SAME physician First 15 minutes FY /01/17