The 2017 No Authorization Required. Out-Patient List of Surgical CPT Codes

Transcription

1 The 2017 No Authorization Required Out-Patient List of Surgical CPT s Please note: All Medicare members must have a referral issued by their PCP to see most Specialists. Out of Network Providers: Please verify Member benefits prior to rendering service by calling The Provider Service Center at AvMed

2 Effective January 1, 2017 Description Note Fine needle aspiration; without imaging guidance Fine needle aspiration; with imaging guidance Image guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple Incision and drainage of pilonidal cyst; simple Incision and drainage of hematoma, seroma or fluid collection Incision and drainage of hematoma, seroma or fluid collection Puncture aspiration of abscess, hematoma, bulla or cyst Biopsy of skin, subcutaneous tissue and/or mucous membrane; (including simple closure), unless otherwise listed; single lesion Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm Excision of pilonidal cyst or sinus; simple Excision of pilonidal cyst or sinus; extensive Excision of pilonidal cyst or sinus; complicated Removal of tissue expander(s) without insertion of prosthesis Repair, complex, scalp, arms, and/or legs; 1.1cm 2.5cm Repair, complex, scalp, arms, and/or legs; cm Puncture aspiration of cyst of breast Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure) Mastectomy with exploration or drainage of abscess; deep Injection procedure only for mammary ductogram or galactogram Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)

3 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) Biopsy of breast, open, incisional Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure) Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) Placement of radiotherapy after loading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy * Placement of radiotherapy after loading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy (List separately in addition to code for primary procedure) * Placement of radiotherapy after loading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance * Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy) Mastectomy partial (e.g., lumpectomy, tylectomy, quadrantectomy, with axillary lymphadenectomy Mastectomy, simple, complete Biopsy, muscle, percutaneous needle

4 20225 Biopsy, bone, trocar, or needle; deep (e.g., vertebral body, femur) Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx) Biopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft) Removal of foreign body in muscle or tendon sheath; deep or complicated Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting Aspiration and/or injection of ganglion cyst(s) any location Aspiration and injection for treatment of bone cyst Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate) Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; Biopsy, soft tissue of neck or thorax Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm Biopsy, soft tissue of back or flank; superficial Biopsy, soft tissue of back or flank; deep Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm Incision and drainage, shoulder area; deep abscess or hematoma Incision and drainage, shoulder area; infected bursa Biopsy, soft tissue of shoulder area; superficial Biopsy, soft tissue of shoulder area; deep Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greater Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cm Excision, tumor, soft tissue of shoulder area, subfascial less than 5 cm Removal of foreign body, shoulder; subcutaneous Removal of foreign body, shoulder; deep (subfascial or intramuscular) Incision and drainage, upper arm or elbow area; deep abscess or hematoma Incision and drainage, upper arm or elbow area; bursa Biopsy, soft tissue of upper arm or elbow; superficial Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular) Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm Excision, tumor, soft tissue of upper arm or elbow area, subfascial less than 5 cm Removal of foreign body, upper arm or elbow area; subcutaneous Removal of foreign body, upper arm or elbow area; deep (subfascial or intramuscular) Biopsy, soft tissue of forearm and/or wrist; superficial Biopsy, soft tissue forearm and/or wrist; deep (subfascial or intramuscular) Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm

5 25076 Excision, tumor, soft tissue of forearm and/or wrist area, subfascial less than 3 cm Biopsy, soft tissue of pelvis and hip area; superficial Biopsy, soft tissue thigh or knee; superficial Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular) Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm Biopsy, soft tissue of leg or ankle; superficial Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular) Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (eg, Silver type procedure) Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method Application, cast; elbow to finger (short arm) Removal or bivalving; full arm or full leg cast Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s]) Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty) ** Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral ** Arthroscopy, knee, diagnostic, with or without synovial biopsy Arthroscopy, knee, surgical; for infection, lavage, and drainage Arthroscopy, knee, surgical; with lateral release Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation) Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection) (separate procedure) Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (e.g., medial or lateral Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral) Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure) Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion) Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation Drainage abscess or hematoma, nasal, internal approach Drainage abscess or hematoma, nasal septum

6 30100 Biopsy, intranasal Excision, nasal polyp(s), simple Excision, nasal polyp(s), extensive Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture) Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium) Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure) Laryngoscopy, indirect; diagnostic (separate procedure) Laryngoscopy, indirect; with biopsy Laryngoscopy, indirect; with removal of foreign body Laryngoscopy, indirect; with removal of lesion Laryngoscopy, indirect; with vocal cord injection Laryngoscopy, direct, operative, with biopsy Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral Laryngoscopy, flexible fiberoptic; diagnostic Laryngoscopy, flexible fiberoptic; with biopsy Laryngoscopy, flexible fiberoptic; with removal of foreign body Laryngoscopy, flexible fiberoptic; with removal of lesion Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy Laryngoplasty, medialization, unilateral Tracheobronchoscopy through established tracheostomy incision Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)

7 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial samp Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic Biopsy, pleura; percutaneous needle Biopsy, lung or mediastinum, percutaneous needle Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) Insertion of pacemaker pulse generator only; with existing single lead Insertion of pacemaker pulse generator only; with existing dual leads Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator) Removal of permanent pacemaker pulse generator Transfusion, blood or blood components Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; younger than 5 years of age Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site Removal of tunneled central venous catheter, without subcutaneous port or pump Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion Declotting by thrombolytic agent of implanted vascular access device or catheter Bone marrow; aspiration only Bone marrow; biopsy, needle or trocar Drainage of lymph node abscess or lymphadenitis; simple Biopsy or excision of lymph node(s); open, superficial Biopsy or excision of lymph node(s); by needle, superficial (e.g., cervical, inguinal, axillary) Biopsy or excision of lymph node(s); open, deep cervical node(s) Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad Biopsy or excision of lymph node(s); open, deep axillary node(s) Axillary lymphadenectomy; superficial Axillary lymphadenectomy; complete Injection procedure; radioactive tracer for identification of sentinel node

8 38900 Intraoperative identification of sentinel lymph node(s Biopsy of lip Biopsy of tongue; anterior 2/ Biopsy of tongue; posterior 1/ Biopsy of floor of mouth Excision of lesion of tongue without closure Drainage of abscess of palate, uvula Biopsy of palate, uvula Biopsy of salivary gland; needle Biopsy of salivary gland; incisional Incision and drainage abscess; peitonsillar Biopsy; oropharynx Biopsy; hypopharynx Biopsy; nasopharynx, visible lesion, simple Biopsy; nasopharynx, survey for unknown primary lesion Excision or destruction of lesion of pharynx, any method Removal of foreign body from pharynx Tonsillectomy and adenoidectomy; younger than age Tonsillectomy and adenoidectomy; age 12 or over Tonnsillectomy, primary or secondary; younger than age Tonsillectomy, primary or secondary, age 12 or over Adenoidectomy, primary; younger than age Adenoidectomy, primary; age 12 or over Adenoidectomy, secondary; age 12 or over Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure) Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance Esophagoscopy, rigid, transoral; with biopsy, single or multiple Esophagoscopy, rigid, transoral; with removal of foreign body Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter) Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire Esophagoscopy, flexible, transnasal; diagnostic, includes collection of specimen(s) by brushing or washing when performed (separate procedure) Esophagoscopy, flexible, transnasal; with biopsy, single or multiple Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) Esophagoscopy, rigid or flexible; with directed submucosal injection(s), any substance Esophagoscopy, rigid or flexible; with injection sclerosis of esophageal varices Esophagoscopy, rigid or flexible; with band ligation of esophageal varices Esophagoscopy, flexible, transoral; with endoscopic mucosal resection Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre and post dilation and guide wire passage, when performed

9 Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed) Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) Esophagoscopy, rigid or flexible; with removal of foreign body Esophagoscopy, rigid or flexible; with removal of tumor(s), poly(s) or other lesion(s) by hot biopsy forceps or bipolar cautery Esophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Esophagoscopy, rigid or flexible; with balloon dilation (less than 30 mm diameter) Esophagoscopy, rigid or flexible; with insertion of guide wire followed by dilation over guide wire Esophagoscopy, rigid or flexible; with control of bleeding Esophagoscopy, flexible, transoral; with ablation of tumor(s), (s), polyp(s), or other lesion(s) (includes pre and post dilation and guide wire passage, when performed) Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination Esophagoscopy, rigid or flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) appropriate; with directed submucosal injection(s), any appropriate; with endoscopic ultrasound examination limited to the esophagus appropriate; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), esophagus ultrasound examination limited to the esophagus) appropriate; with biopsy, single or multiple appropriate; with transmural drainage of pseudocyst appropriate; with transendoscopic intraluminal tube or catheter placement appropriate; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum and/or jejunum as appropriate) appropriate; with injection sclerosis of esophageal and/or gastric varices appropriate; with band ligation of esophageal and/or gastric varices appropriate; with dilation of gastric outlet for obstruction (e.g., balloon, guide wire, bougie) appropriate; with directed placement of percutaneousgastrostomy tube appropriate; with removal of foreign body

10 43248 dilation of esophagus over guide wire appropriate; with balloon dilation of esophagus (less than 30 mm diameter) appropriate; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery appropriate; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound guided transmural injection Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection appropriate; with control of bleeding appropriate; with endoscopic ultrasound examination, Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi (pancreatic duct or common bile duct) Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde removal of calculus/calculi from biliary and/or pancreatic ducts Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde destruction, lithotripsy of calculus/calculi, any method Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre and post dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) Endoscopic retrograde cholangiopancreatography (ERCP); with removal and exchange of stent(s), biliary or pancreatic duct, including pre and post dilation and guide wire passage. Endoscopic retrograde cholangiopancreatography (ERCP); with trans endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty) Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s) Dilation of esophagus, by unguided sound or bougie, single or multiple passes Dilation of esophagus, over guide wire Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance Repositioning of a naso or oro gastric feeding tube, through the duodenum for enteric nutrition Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without collection of specimen(s) Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

11 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with transendoscopic stent placement (includes predilation) Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with placement of percutaneous jejunostomy tube Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen(s) Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with transendoscopic stent placement (includes predilation) Ileoscopy, through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) Ileoscopy, through stoma; with transendoscopic balloon dilation Ileoscopy, through stoma; with biopsy, single or multiple Ileoscopy, through stoma; with placement of endoscopic stent Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; with biopsy, single or multiple Colonoscopy through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) Colonoscopy through stoma; with biopsy, single or multiple Colonoscopy through stoma; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) Colonoscopy through stoma; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) Colonoscopy through stoma; with ablation of tumor(s), polyp(s) Colonoscopy through stoma; with endoscopic stent placement Colonoscopy through stoma; with endoscopic mucosal resection Colonoscopy through stoma; with directed submucosal injection(s) Colonoscopy through stoma; with transendoscopic balloon dilation Colonoscopy through stoma; with endoscopic ultrasound examination Colonoscopy through stoma; with transendoscopic ultrasound guided Colonoscopy through stoma; with decompression Biopsy of anorectal wall, anal approach (e.g., congenital megacolon)

12 45300 Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) Proctosigmoidoscopy, rigid; with dilation (e.g., balloon, guide wire, bougie) Proctosigmoidoscopy, rigid; with biopsy, single or multiple Proctosigmoidoscopy, rigid; with removal of foreign body Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique Proctosigmoidoscopy, rigid; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation) Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) Sigmoidoscopy, flexible; with biopsy, single or multiple Sigmoidoscopy, flexible; with removal of foreign body Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery Sigmoidoscopy, flexible; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance Sigmoidoscopy, flexible; with decompression of volvulus, any method Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Sigmoidoscopy, flexible; with dilation by balloon, 1 or more strictures Sigmoidoscopy, flexible; with endoscopic ultrasound examination Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other Sigmoidoscopy, flexible; with placement of endoscopic stent (includes Sigmoidoscopy, flexible; with endoscopic mucosal resection Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) 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) Colonoscopy, flexible, proximal to splenic flexure; with removal of foreign body Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

13 45386 Colonoscopy, flexible, proximal to splenic flexure; with dilation by balloon, 1 or more strictures Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other Colonoscopy, flexible; with endoscopic stent placement (includes pre Colonoscopy, flexible; with endoscopic mucosal resection Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) aspiration/biopsy Colonoscopy, flexible; with decompression (for pathologic distention) Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic Placement of seton Removal of anal seton, other marker Incision of drainage of ischiorectal and/or perirectal abscess (separate procedure) Incision and drainage of intramural, intramuscular, or submucosalabscess, transanal, under anesthesia Incision and drainage of perianal abscess, superficial Incision of drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular with or without placement of seton Incision and septum (infant) Sphincterectomy, anal division of sphincter (separate procedure) Incision of thrombosed hemorrhoid, external Hemorrhoidectomy, internal, by rubber band ligation(s) Excision of multiple external papillae or tags, anus Hemorrhoidectomy, external, 2 or more columns/groups Hemorrhoidectomy, internal and external single columns/groups Hemorrhoidectomy, internal and external, single column/group; with fissurectomy Hemorrhoidectomy, internal and external, single column/group; with fistulectomy, including fissurectomy, when performed Hemorrhoidectomy, internal and external, 2 or more columns/groups; Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed Excision of thrombosed hemorrhoid, external Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing Anoscopy; diagnostic, with high resolution magnification (hra) (eg, Anoscopy; with dilation (e.g., balloon, guide wire, bougie) Anoscopy; with biopsy, single or multiple Anoscopy; with high resolution magnification (hra) (eg, colposcope, Anoscopy; with removal of foreign body Anoscopy; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery Anoscopy; with removal of single tumor, polyp, or other lesion by snare technique Anoscopy; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique Anoscopy; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

14 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery) Destruction of internal hemorrhoid(s) by thermal energy (e.g., infrared coagulation, cautery, radiofrequency) Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups Biopsy of liver, needle; percutaneous Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure) Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance Peritoneal lavage, including imaging guidance, when performed Biopsy, abdominal or retroperitoneal mass, percutaneous needle Image guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); visceral (e.g., kidney, liver, spleen, lung/mediastinum), percutaneous Image guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous Image guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, transvaginal or transrectal Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure) Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible Repair initial inguinal hernia, age 5 years or older; reducible Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated Repair recurrent inguinal hernia, any age; reducible Repair recurrent inguinal hernia, any age; incarcerated or strangulated Repair inguinal hernia, sliding, any age Repair initial femoral hernia, any age; reducible Repair initial femoral hernia, any age; incarcerated or strangulated Repair recurrent femoral hernia; reducible Repair recurrent incisional or ventral hernia; reducible Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Repair epigastric hernia (e.g., preperitoneal fat); reducible (separate procedure)

15 49585 Repair umbilical hernia, age 5 years or older; reducible Laparoscopy, surgical; repair initial inguinal hernia Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated Lithotripsy, extracorporeal shock wave Injection procedure for cystography or voiding urethrocystography Injection procedure and placement of chain for contrast and/or chain urethrocystography Injection procedure for retrograde urethrocystography Bladder irrigation, simple, lavage and/or instillation Simple cystometrogram (CMG) (e.g., spinal manometer) Complex cystometrogram (i.e., calibrated electronic equipment); Complex cystometrogram (i.e., calibrated electronic equipment); with voiding pressure studies (i.e., bladder voiding pressure), any technique Complex cystometrogram (i.e., calibrated electronic equipment); with voiding pressure studies (i.e., bladder voiding pressure) and urethral pressure profile studies (i.e., urethral closure pressure profile), any technique Simple uroflowmetry (UFR) (e.g., stop watch flow rate, mechanical uroflowmeter) Complex uroflowmetry (eg, calibrated electronic equipment) Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique Needle electromyography studies (EMG) of anal or urethral sphincter, any technique Stimulus evoked response (e.g., measurement of bulbocavernosus reflex latency time) Voiding pressure studies, intra abdominal (i.e., rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure) Measurement of post voiding residual urine and/or bladder capacity by ultrasound, non imaging Cystourethroscopy (separate procedure) Cystourethroscopy with irrigation and evacuation of multiple obstructing clots Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct radiography, exclusive of radiologic service Cystourethroscopy, with biopsy(s) Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm) Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm) Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double J type) Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) Cystourethroscopy, with ureteroscopy and/or pyeloscopy Biopsy of urethra Dilation of urethral stricture by passage of sound or urethral dilator, male; initial Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent Transurethral destruction of prostate tissue; by microwave thermotherapy

16 53852 Transurethral destruction of prostate tissue; by radiofrequency thermotherapy Biopsy of penis; (separate procedure) Biopsy of penis; deep structures Circumcision, using clamp or other device with regional dorsal penile or ring block Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less) Foreskin manipulation including lysis of preputial adhesions and stretching Biopsy of testis, needle (separate procedure) Biopsy of testis, incisional (separate procedure) Biopsy of epididymis, needle Excision of local lesion of epididymis Exploration of epididymis, with or without biopsy Drainage of scrotal wall abscess Scrotal exploration Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure) Biopsy, prostate; needle or punch, single or multiple, any approach Biopsy, prostate; incisional, any approach Incision and drainage of vulva or perineal abscess Incision and drainage of Bartholin s gland abscess Marsupialization of Bartholin's gland cyst Lysis of labial adhesions Biopsy of vulva or perineum (separate procedure); 1 lesion Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) Excision of Bartholin's gland or cyst Colposcopy of vulva Colposcopy of vulva; with biopsy(s) Colposcopy of cervix including upper/adjacent vagina Colposcopy of cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocerical curettage Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) Endocervical curettage (not done as part of a dilation and curettage) Cautery of cervix, electro or thermal Cautery of cervix, cryocautery, initial or repeat Cautery of the cervix, laser ablation Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision Dilation and curettage, diagnostic and/or therapeutic (non obstetrical)