HIP RADIOLOGY PROGRAM CODE LISTS

Transcription

1 EFFECTIVE OCTOBER 1, MAGNETIC RESONANCE IMAGING TMJ COMPUTED TOMOGRAPHY HEAD/BRAIN WITHOUT COMPUTED TOMOGRAPHY HEAD/BRAIN WITH COMPUTED TOMOGRAPHY HEAD/BRAIN WITHOUT AND WITH COMPUTED TOMOGRAPHY ORBIT WITHOUT COMPUTED TOMOGRAPHY ORBIT WITH COMPUTED TOMOGRAPHY ORBIT WITHOUT AND WITH COMPUTED TOMOGRAPHY MAXILLOFACIAL WITHOUT COMPUTED TOMOGRAPHY MAXILLOFACIAL WITH COMPUTED TOMOGRAPHY MAXILLOFACIAL WITHOUT AND WITH COMPUTED TOMOGRAPHY SOFT TISSUE NECK WITHOUT COMPUTED TOMOGRAPHY SOFT TISSUE NECK WITH COMPUTED TOMOGRAPHY SOFT TISSUE NECK WITHOUT AND WITH COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK MAGNETIC RESONANCE IMAGING FACE, ORBIT, NECK WITHOUT MAGNETIC RESONANCE IMAGING FACE, ORBIT, NECK WITH MAGNETIC RESONANCE IMAGING FACE, ORBIT, NECK WITHAND WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY HEAD WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY HEAD WITH MAGNETIC RESONANCE ANGIOGRAPHY HEAD WITHAND WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY NECK WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY NECK WITH MAGNETIC RESONANCE ANGIOGRAPHY NECK WITHAND WITHOUT MAGNETIC RESONANCE IMAGING HEAD WITHOUT MAGNETIC RESONANCE IMAGING HEAD WITH MAGNETIC RESONANCE IMAGING HEAD WITH AND WITHOUT MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MAGNETIC RESONANCE IMAGING; INCLUDING TEST SELECTION AND ADMINISTRATION OF REPETITIVE BODY PART MOVEMENT AND/OR VISUAL STIMULATION, NOT REQUIRING PHYSICIAN OR PSYCHOLOGIST ADMINISTRATION MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MAGNETIC RESONANCE IMAGING; REQUIRING PHYSICIAN OR PSYCHOLOGIST ADMINISTRATION OF ENTIRE NEUROFUNCTIONAL TESTING COMPUTED TOMOGRAPHY THORAX WITHOUT COMPUTED TOMOGRAPHY THORAX WITH COMPUTED TOMOGRAPHY THORAX WITHOUT AND WITH COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST, NON- CORONARY MAGNETIC RESONANCE IMAGING CHEST WITHOUT MAGNETIC RESONANCE IMAGING CHEST WITH MAGNETIC RESONANCE IMAGING CHEST WITHAND WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY CHEST (EXC MYOCARDIUM) WITH OR WITHOUT COMPUTED TOMOGRAPHY CERVICAL SPINE WITHOUT COMPUTED TOMOGRAPHY CERVICAL SPINE WITH COMPUTED TOMOGRAPHY CERVICAL SPINE WITHOUT AND WITH COMPUTED TOMOGRAPHY THORACIC SPINE WITHOUT COMPUTED TOMOGRAPHY THORACIC SPINE WITH COMPUTED TOMOGRAPHY THORACIC SPINE WITHOUT AND WITH COMPUTED TOMOGRAPHY LUMBAR SPINE WITHOUT COMPUTED TOMOGRAPHY LUMBAR SPINE WITH COMPUTED TOMOGRAPHY LUMBAR SPINE WITHOUT AND WITH Group Health Incorporated (GHI), GHI HMO Select, Inc. (GHI HMO), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies. EMB_PR_FLY_11590_HIPRADIOLOGYCODELIST_color 9/12 Page 1 of 5

2 72141 MAGNETIC RESONANCE IMAGING CERVICAL SPINE WITHOUT MAGNETIC RESONANCE IMAGING CERVICAL SPINE WITH MAGNETIC RESONANCE IMAGING THORACIC SPINE WITHOUT MAGNETIC RESONANCE IMAGING THORACIC SPINE WITH MAGNETIC RESONANCE IMAGING LUMBAR SPINE WITHOUT MAGNETIC RESONANCE IMAGING LUMBAR SPINE WITH MAGNETIC RESONANCE IMAGING C SPINE WITH AND WITHOUT MAGNETIC RESONANCE IMAGING T SPINE WITH AND WITHOUT MAGNETIC RESONANCE IMAGING L SPINE WITH AND WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY SPINAL CANAL WITH OR WITHOUT COMPUTED TOMOGRAPHIC ANGIOGRAPHY PELVIS COMPUTED TOMOGRAPHY PELVIS WITHOUT COMPUTED TOMOGRAPHY PELVIS WITH COMPUTED TOMOGRAPHY PELVIS WITHOUT AND WITH MAGNETIC RESONANCE IMAGING PELVIS WITHOUT MAGNETIC RESONANCE IMAGING PELVIS WITH MAGNETIC RESONANCE IMAGING PELVIS WITHAND WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY PELVIS WITH OR WITHOUT COMPUTED TOMOGRAPHY UPPER EXTREMITY WITHOUT COMPUTED TOMOGRAPHY UPPER EXTREMITY WITH COMPUTED TOMOGRAPHY UPPER EXTREMITY WITHOUT AND WITH COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY MAGNETIC RESONANCE IMAGING UPPER EXTREMITY WITHOUT MAGNETIC RESONANCE IMAGING UPPER EXTREMITY WITH MAGNETIC RESONANCE IMAGING UPPER EXTREMITY WITHAND WITHOUT MAGNETIC RESONANCE IMAGING UPPER EXTREMITY JOINT WITHOUT MAGNETIC RESONANCE IMAGING UPPER EXTREMITY JOINT WITH MAGNETIC RESONANCE IMAGING UPPER EXTREMITY JOINT WITHAND WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY UPPER EXTREMITY WITH OR WITHOUT COMPUTED TOMOGRAPHY LOWER EXTREMITY WITHOUT COMPUTED TOMOGRAPHY LOWER EXTREMITY WITH COMPUTED TOMOGRAPHY LOWER EXTREMITY WITHOUT AND WITH COMPUTED TOMOGRAPHIC ANGIOGRAPHY LOWER EXTREMITY MAGNETIC RESONANCE IMAGING LOWER EXTREMITY WITHOUT MAGNETIC RESONANCE IMAGING LOWER EXTREMITY WITH MAGNETIC RESONANCE IMAGING LOWER EXTREMITY WITHAND WITHOUT MAGNETIC RESONANCE IMAGING LOWER EXTREMITY JOINT WITHOUT MAGNETIC RESONANCE IMAGING LOWER EXTREMITY JOINT WITH MAGNETIC RESONANCE IMAGING LOWER EXTREMITY JOINT WITHAND WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY LOWER EXTREMITY WITH OR WITHOUT COMPUTED TOMOGRAPHY ABDOMEN WITHOUT COMPUTED TOMOGRAPHY ABDOMEN WITH COMPUTED TOMOGRAPHY ABDOMEN WITHOUT AND WITH COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN AND PELVIS, WITH MATERIAL(S), INCLUDING NON IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING COMPUTED TOMOGRAPHIC ANGIOGRAPHY ABDOMEN COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT MATERIAL COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH MATERIAL(S) COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT MATERIAL IN ONE OR BOTH BODY REGIONS, FOLLOWED BY MATERIAL(S) AND FURTHER SECTIONS IN ONE OR BOTH BODY REGIONS MAGNETIC RESONANCE IMAGING ABDOMEN WITHOUT MAGNETIC RESONANCE IMAGING ABDOMEN WITH MAGNETIC RESONANCE IMAGING ABDOMEN WITHAND WITHOUT MAGNETIC RESONANCE ANGIOGRAPHY ABDOMEN WITH OR WITHOUT COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT MATERIAL Page 2 of 5

3 74262 COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITH MATERIAL (S) INCLUDING NON- IMAGES, IF PERFORMED COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, SCREENING, INCLUDING IMAGE POSTPROCESSING COMPUTED TOMOGRAPHIC ANGIOGRAPHY ABDOMINAL AORTA D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY; NOT REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY; REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION COMPUTED TOMOGRAPHY LIMITED OR LOCALIZED FOLLOW-UP STUDY MAGNETIC RESONANCE IMAGING SPECTROSCOPY ULTRASOUND OBSTETRICAL PELVIS, PREGNANT UTERUS, FIRST TRIMESTER <14 WEEKS SINGLE OR FIRST GESTATION ULTRASOUND OBSTETRICAL PELVIS, PREGNANT UTERUS, FIRST TRIMESTER <14 WEEKS EACH ADDITIONAL GESTATION ULTRASOUND OBSTETRICAL PELVIS, PREGNANT UTERUS, B-SCAN (ALLOWED ONCE PER GESTATION) ULTRASOUND OBSTETRICAL PELVIS COMPLETE, MULTIPLE GESTATION AFTER 1ST TRIMESTER (ALLOWED ONCE FOR EACH ADDITIONAL FETUS PER GESTATION; MUST BE BILLED WITH 76805) ULTRASOUND PREGNANT UTERUS FETAL AND MATERNAL EVAL PLULTRASOUND FETAL ANATOMIC EVAL TRANSABDOMINAL SINGLE OR FIRST GESTATION (ALLOWED ONCE PER GESTATION; SECOND STUDY ALLOWED IF PERFORMED BY A DIFFERENT PHYSICIAN) ULTRASOUND PREGNANT UTERUS FETAL AND MATERNAL EVAL PLULTRASOUND FETAL ANATOMIC EVAL TRANSABDOMINAL EACH ADDITIONAL GESTATION (ALLOWED ONCE FOR EACH ADDITIONAL FETULTRASOUND PER GESTATION; MUST BE BILLED WITH 76811; SECOND STUDY ALLOWED IF PERFORMED BY A DIFFERENT PHYSICIAN) ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR TRANSVAGINAL APPROACH; SINGLE OR FIRST GESTATION. (ALLOWED ONCE PER GESTATION) ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR TRANSVAGINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ALLOWED ONCE FOR EACH ADDITIONAL FETUS PER GESTATION) ULTRASOUND PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, LIMITED (E.G., FETAL HEART BEAT, PLACENTAL LOCATION, FETAL POSITION AND/OR QUALITATIVE AMNIOTIC FLUID VOLUME), 1 OR MORE FETUSES ULTRASOUND OBSTETRICAL PELVIS FOLLOW UP OR REPEAT ULTRASOUND PREGNANT UTERUS TRANSVAGINAL FETAL BIOPHYSICAL PROFILE FETAL BIOPHYSICAL PROFILE WITHOUT STRESS NON STRESS DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY ULTRASOUND OBSTETRICAL ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM FOLLOW UP OR REPEAT STUDY DOPPLER ECHOCARDIOGRAPHY FETAL COMPLETE FOLLOW UP OR REPEAT STUDY ULTRASOUND GASTROINTESTINAL, ENDOSCOPIC MAGNETIC RESONANCE IMAGING GUIDANCE FOR NEEDLE PLACEMENT MAGNETIC RESONANCE IMAGING GUIDANCE FOR AND MONITORING OF TISSUE ABLATION MAGNETIC RESONANCE IMAGING BREAST WITH AND/OR WITHOUT ; UNILATERAL MAGNETIC RESONANCE IMAGING BREAST BILATERAL MAGNETIC RESONANCE IMAGING BONE MARROWITHBLOOD SUPPLY THYROID RAI UPTAKE THYROID MULTIPLE UPTAKE THYROID SUPPRESS OR STIMULATION THYROID UPTAKE AND SCAN THYROID IMAGE, MULTIPLE UPTAKES THYROID SCAN ONLY THYROID IMAGING WITHFLOW THYROID MET IMAGING THYROID MET IMAGING WITH ADDITIONAL STUDIES THYROID SCAN WHOLE BODY THYROID CARCINOMA METASTASES UPTAKE PARATHYROID NUCLEAR IMAGING ADRENAL NUCLEAR IMAGING BONE MARROW IMAGING, LIMITED BONE MARROW IMAGING, MULTIPLE BONE MARROW IMAGING, WHOLE BODY SPLEEN IMAGING WITH WITHOUT VASCULAR FLOW LYMPH SYSTEM IMAGING LIVER IMAGING LIVER IMAGING WITHFLOW LIVER IMAGING SPECT LIVER IMAGING SPECT WITH V ASCULAR FLOW LIVER AND SPLEEN IMAGING LIVER AND SPLEEN IMAGING WITHFLOW Page 3 of 5

4 78226 LIVER FUNCTION STUDY HIDA SCAN SALIVARY GLAND IMAGING SERIAL SALIVARY GLAND SALIVARY GLAND FUNCTION TEST ESOPHAGUS MOTILITY STUDY GASTRIC MUCOSA IMAGING GASTROESOPHAGAEL REFLUX EXAM GASTRIC EMPTYING STUDY GI BLEEDER SCAN GI PROTEIN LOSS EXAM MECKEL S DIVERTICULUM IMAGING LEVEEN SHUNT PATENCY EXAM BONE OR JOINT IMAGING LIMITED BONE OR JOINT IMAGING MULTIPLE BONE SCAN WHOLE BODY BONE AND/OR JOINT IMAGING; 3 PHASE STUDY BONE JOINT IMAGING TOMO TEST SPECT NON-IMAGING HEART FUNCTION CARDIAC SHUNT IMAGING RADIONUCLIDE VENOGRAM NON-CARDIAC ACUTE VENOUS THROMBOSIS IMAGING VENOUS THROMBOSIS IMAGING UNILATERAL VENOUS THROMBOSIS IMAGING BILATERAL MYOCARDIAL INFARCTION SCAN HEART INFARCT IMAGE EF HEART INFARCT IMAGE SPECT GATED HEART, REST OR STRESS CARDIAC BLOOD POOL MUGA SCAN HEART FIRST PASS SINGLE CARDIAC BLOOD POOL IMAGING, MULTIPLE CARDIAC BLOOD POOL IMAGING, SPECT CARDIAC BLOOD POOL IMAGING, SINGLE AT REST PULMONARY VENTILATION IMAGING (E.G., AEROSOL OR GAS) PULMONARY PERFUSION IMAGING PULMONARY VENTILATION (E.G., AEROSOL OR GAS) AND PERFUSION IMAGING QUANTITATIVE DIFFERENTIAL PULMONARY PERFUSION, INCLUDING IMAGING, WHEN PERFORMED QUANTITATIVE DIFFERENTIAL PULMONARY PERFUSION AND VENTILATION (E.G., AEROSOL OR GAS), INCLUDING IMAGING, WHEN PERFORMED BRAIN IMAGING LIMITED STATIC BRAIN LIMITED IMAGING AND FLOW BRAIN IMAGING COMPLETE BRAIN IMAGING COMPLETE WITH FLOW BRAIN IMAGING SPECT BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) METABOLIC EVALUATION BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION EVALUATION BRAIN FLOW IMAGING ONLY CISTERNOGRAM (CEREBROSPINAL FLUID FLOW) CEREBROSPINAL VENTRICULOGRAPHY CEREBROSPINAL FLUID FLOW SHUNT EVALUATION CEREBROSPINAL FLUID SCAN SPECT CEREBROSPINAL FLUID FLOW LEAKAGE DETECTION AND LOCALIZATION RADIOPHARMACEUTICAL DACRYOCYSTORGRAPHY KIDNEY IMAGING MORPHOLOGY KIDNEY IMAGING MORPHOLOGY WITH VASCULAR FLOW KIDNEY IMAGING MORPHOLOGY WITH VASCULAR FLOW AND FUNCTION STUDY KIDNEY IMAGING MORPHOLOGY WITH VASCULAR FLOW AND FUNCTION, SINGLE WITH PHARM INTERVENTION KIDNEY IMAGING MORPHOLOGY WITH VASCULAR FLOW, MULTIPLE, WITHOUT AND WITH PHARM INTERVENTION KIDNEY IMAGING, SPECT KIDNEY FUNCTION STUDY, NON-IMAGE RADIOISOTROPIC URINARY BLADDER RESIDUAL STUDY URETERAL REFLUX STUDY TESTICULAR IMAGING WITH VASCULAR FLOW RADIOPHARM LOCALIZATION OF TUMOR, LIMITED AREA RADIOPHARM LOCALIZATION OF TUMOR, MULTIPLE AREAS RADIOPHARM LOCALIZATION OF TUMOR, WHOLE BODY RADIOPHARM LOCALIZATION OF TUMOR, SPECT RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF RADIOPHARMACEUTICAL AGENT(S); WHOLE BODY, REQUIRING 2 OR MORE DAYS IMAGING RADIOPHARM LOCALIZATION OF ABSCESS, LIMITED AREA RADIOPHARM LOCALIZATION OF ABSCESS, WHOLE BODY RADIOPHARM LOCALIZATION OF ABSCESS, SPECT POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; LIMITED AREA (E.G., CHEST, HEAD/NECK) POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; SKULL BASE TO MID-THIGH POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; WHOLE BODY Page 4 of 5

5 78814 POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY CORRECTION AND ANATOMICAL LOCALIZATION IMAGING; LIMITED AREA (E.G., CHEST, HEAD/NECK) POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY CORRECTION AND ANATOMICAL LOCALIZATION IMAGING; SKULL BASE TO MID-THIGH POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY CORRECTION AND ANATOMICAL LOCALIZATION IMAGING; WHOLE BODY C8900 C8901 C8902 C8903 C8904 C8905 C8906 C8907 C8908 MAGNETIC RESONANCE ANGIOGRAPHY WITH, ABDOMEN MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT, ABDOMEN, ABDOMEN MAGNETIC RESONANCE IMAGING WITH, BREAST; UNILATERAL MAGNETIC RESONANCE IMAGING WITHOUT, BREAST; UNILATERAL MAGNETIC RESONANCE IMAGING WITH AND WITHOUT, BREAST; UNILATERAL MAGNETIC RESONANCE IMAGING WITH, BREAST; BILATERAL MAGNETIC RESONANCE IMAGING WITHOUT, BREAST; BILATERAL MAGNETIC RESONANCE IMAGING WITH AND WITHOUT, BREAST; BILATERAL C8909 C8910 C8911 C8912 C8913 C8914 C8918 C8919 C8920 C8931 C8932 C8933 C8934 C8935 C8936 MAGNETIC RESONANCE ANGIOGRAPHY WITH, CHEST (EXCLUDING MYOCARDIUM) MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT, CHEST (EXCLUDING MYOCARDIUM), CHEST (EXCLUDING MYOCARDIUM) MAGNETIC RESONANCE ANGIOGRAPHY WITH, LOWER EXTREMITY MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT, LOWER EXTREMITY, LOWER EXTREMITY MAGNETIC RESONANCE ANGIOGRAPHY WITH, PELVIS MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT, PELVIS, PELVIS MAGNETIC RESONANCE ANGIOGRAPHY WITH, SPINAL CANAL AND CONTENTS MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT, SPINAL CANAL AND CONTENTS MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT FOLLOWED BY WITH, SPINAL CANAL AND CONTENTS MAGNETIC RESONANCE ANGIOGRAPHY WITH, UPPER EXTREMITY MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT, UPPER EXTREMITY MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT FOLLOWED BY WITH, UPPER EXTREMITY Page 5 of 5