Appendix A ICD-9-CM Diagnosis and CPT Code Tables

Transcription

1 Appendix A ICD-9-CM Diagnosis and CPT Code Tables OP Table 1.0: E/M Codes for Emergency Department Encounters Code E/M Emergency department visit, new or established patient Emergency department visit, new or established patient Emergency department visit, new or established patient Emergency department visit, new or established patient Emergency department visit, new or established patient Critical care, evaluation and management OP Table 1.1: Acute Myocardial Infarction (AMI) Diagnosis Codes Code ICD-9-CM Description Shortened Description Anterolateral wall, acute myocardial infarction AMI ANTEROLATERAL,UNSPEC Anterolateral wall, acute myocardial infarctioninitial AMI ANTEROLATERAL, INIT Other anterior wall, acute myocardial infarction AMI ANTERIOR WALL,UNSPEC Other anterior wall, acute myocardial infarctioninitial AMI ANTERIOR WALL, INIT Inferolateral wall, acute myocardial infarction AMI INFEROLATERAL,UNSPEC Inferolateral wall, acute myocardial infarctioninitial AMI INFEROLATERAL, INIT Inferoposterior wall, acute myocardial infarction AMI INFEROPOST, UNSPEC Inferoposterior wall, acute myocardial infarctioninitial AMI INFEROPOST, INITIAL Other inferior wall, acute myocardial infarction AMI INFERIOR WALL,UNSPEC Other inferior wall, acute myocardial infarctioninitial AMI INFERIOR WALL, INIT Other lateral wall, acute myocardial infarction AMI LATERAL NEC, UNSPEC Other lateral wall, acute myocardial infarctioninitial AMI LATERAL NEC, INITIAL True posterior wall, acute myocardial infarction TRUE POST INFARCT,UNSPEC True posterior wall, acute myocardial infarctioninitial TRUE POST INFARCT, INIT Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-1

2 OP Table 1.1: Acute Myocardial Infarction (AMI) Diagnosis Codes Code ICD-9-CM Description Shortened Description Subendocardial, acute myocardial infarction SUBENDO INFARCT, UNSPEC Subendocardial, acute myocardial infarction-initial SUBENDO INFARCT, INITIAL Other specified sites, acute myocardial infarction AMI NEC, UNSPECIFIED Other specified sites, acute myocardial infarctioninitial AMI NEC, INITIAL Unspecified site, acute myocardial infarction AMI NOS, UNSPECIFIED Unspecified site, acute myocardial infarctioninitial AMI NOS, INITIAL OP Table 1.1a: Chest Pain, Angina, Acute Coronary Syndrome Codes Code ICD-9-CM Description Shortened Description Intermediate coronary syndrome INTERMED CORONARY SYND Acute ischemic heart disease other AC ISCHEMIC HRT DIS NEC Other and unspecified angina pectoris ANGINA PECTORIS NEC/NOS Chest pain, unspecified CHEST PAIN NOS Precordial Chest Pain PRECORDIAL PAIN Painful Respiration PAINFUL RESPIRATION Chest pain, other CHEST PAIN NEC OP Table 6.0: Surgery Procedure Codes Open treatment of mandibular fracture with external fixation Open treatment of mandibular fracture; without interdental fixation With interdental fixation Open treatment of mandibular condylar fracture Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); thoracic Lumbar Each additional vertebral segment Percutaneous skeletal fixation of femoral fracture, proximal end, neck Open treatment of femoral fracture, proximal end, head, includes internal fixation, when Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-2

3 OP Table 6.0: Surgery Procedure Codes Arthroplasty, knee, tibial plateau; With debridement and partial synovectomy Arthroplasty, femoral condyles or tibial plateau(s), knee; With debridement and partial synovectomy Arthroplasty, knee, condyle and plateau; medial OR lateral compartment With implant (total ankle) Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage Resection of joint with implant Open treatment of calcaneal fracture, includes internal fixation, when With primary iliac or other autogenous bone graft (includes obtaining graft) Open treatment of talus fracture, includes internal fixation, when Open treatment of tarsal bone fracture (except talus and calcaneus) includes internal fixation, when, each Open treatment of metatarsal fracture, includes internal fixation, when, each Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when, each Open treatment of sesamoid fracture, with or without internal fixation Open treatment of tarsal bone dislocation, includes internal fixation, when Open treatment of talotarsal joint dislocation, includes internal fixation, when Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when Open treatment of interphalangeal joint dislocation, includes internal fixation, when Arthrodesis; pantalar Triple Subtalar Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse With osteotomy (e.g., flatfoot correction) Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicularcuneiform (e.g., Miller type procedure) Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial Ventricular Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-3

4 OP Table 6.0: Surgery Procedure Codes Atrial and ventricular Insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular Dual chamber Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator (right atrial or right ventricular) electrode Insertion of a single transvenous electrode, permanent pacemaker or cardioverterdefibrillator Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverterdefibrillator Repair of single transvenous electrode for a single chamber, permanent pacemaker or single chamber pacing cardioverter-defibrillator Repair of 2 transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator Revision or relocation of skin pocket for pacemaker Revision of skin pocket for cardioverter-defibrillator Removal of permanent pacemaker pulse generator Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular Dual lead system Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator By transvenous extraction Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator Nonautogenous graft (eg, biological collagen, thermoplastic graft) Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach Upper gastrointestinal endoscopy with directed placement of percutaneous gastrostomy tube With construction of gastric tube (eg, Janeway procedure) Insertion of penile prosthesis; non-inflatable (semi-rigid) Inflatable (self-contained) Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders and reservoir Removal of all components of a multi-component inflatable penile prosthesis without replacement of prosthesis Repair of component(s) of a multi-component, inflatable penile prosthesis Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-4

5 OP Table 6.0: Surgery Procedure Codes Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session Biopsy, prostate; needle or punch, single or multiple, any approach Incisional, any approach Sling operation for stress incontinence (e.g., fascia or synthetic) Paravaginal defect repair (including repair of cystocele, if ), laparoscopic approach Vaginal hysterectomy, for uterus 250 g or less; With removal of tube(s) and/or ovary(s) With removal of tube(s), and/or ovary(s), with repair of enterocele With repair of enterocele Vaginal hysterectomy, for uterus greater than 250 g; With removal of tube(s) and/or ovary(s) With removal of tube(s) and/or ovary(s), with repair of enterocele With colpo-urethrocystopexy (Marshall-Marchetti-Kranz type, Pereyro type) with or without endoscopic control With repair of enterocele Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; With removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; With removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy for uterus 250 g or less With removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g With removal of tube(s) and/or ovary(s) Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir Non-programmable pump Programmable pump, including preparation of pump, with or without programming Laminectomy with exploration and/or decompression of spinal cord and/or cauda equine, without facetectomy, foraminotomy or discectomy, (e.g., spinal stenosis), 1 or 2 vertebral segments; cervical Thoracic Lumbar, except for spondylolisthesis Sacral Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-5

6 OP Table 6.0: Surgery Procedure Codes Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equine and nerve roots for spondylolisthesis, lumbar (Gill type procedure) Laminectomy with exploration and/or decompression of spinal cord and/or cauda equine, without facetectomy, foraminotomy or discectomy, (e.g., spinal stenosis), more than 2 vertebral segments; cervical Thoracic Lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; including open and endoscopically-assisted approaches; 1 interspace, cervical interspace, lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; cervical Lumbar Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equine and/or nerve root(s), (e.g., spinal or lateral recess stenosis)), single vertebral segment; cervical Thoracic Lumbar Lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc) Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace OP Table 6.1: Cardiac Codes Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial Ventricular Atrial and ventricular Insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular Dual chamber Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator (right atrial or right ventricular) electrode Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-6

7 OP Table 6.1: Cardiac Codes Insertion of a single transvenous electrode, permanent pacemaker or cardioverterdefibrillator Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverterdefibrillator Repair of single transvenous electrode for a single chamber, permanent pacemaker or single chamber pacing cardioverter-defibrillator Repair of 2 transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator Revision or relocation of skin pocket for pacemaker Revision of skin pocket for cardioverter-defibrillator Removal of permanent pacemaker pulse generator Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular Dual lead system Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator By transvenous extraction Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator Nonautogenous graft (eg, biological collagen, thermoplastic graft) OP Table 6.2: Orthopedic Codes Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); thoracic Lumbar Each additional vertebral segment Percutaneous skeletal fixation of femoral fracture, proximal end, neck Open treatment of femoral fracture, proximal end, head, includes internal fixation, when Arthroplasty, knee, tibial plateau; With debridement and partial synovectomy Arthroplasty, femoral condyles or tibial plateau(s), knee; With debridement and partial synovectomy Arthroplasty, knee, condyle and plateau; medial OR lateral compartment With implant (total ankle) Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws, and/or cerclage Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-7

8 OP Table 6.2: Orthopedic Codes Resection of joint with implant Open treatment of calcaneal fracture, includes internal fixation, when With primary iliac or other autogenous bone graft (includes obtaining graft) Open treatment of talus fracture, includes internal fixation, when Open treatment of tarsal bone fracture (except talus and calcaneus) includes internal fixation, when, each Open treatment of metatarsal fracture, includes internal fixation, when, each Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when, each Open treatment of sesamoid fracture, with or without internal fixation Open treatment of tarsal bone dislocation, includes internal fixation, when Open treatment of talotarsal joint dislocation, includes internal fixation, when Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when Open treatment of interphalangeal joint dislocation, includes internal fixation, when Arthrodesis; pantalar Triple Subtalar Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse With osteotomy (eg, flatfoot correction) Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicularcuneiform (eg, Miller type procedure) OP Table 6.3: Genitourinary Transrectal biopsy, prostate Biopsy, prostate; needle or punch, single or multiple, any approach Incisional, any approach OP Table 6.3a: Genitourinary Penile prosthesis insertion, removal, revision Insertion of penile prosthesis; non-inflatable (semi-rigid) Inflatable (self-contained) Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-8

9 OP Table 6.3a: Genitourinary Penile prosthesis insertion, removal, revision Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders and reservoir Removal of all components of a multi-component inflatable penile prosthesis without replacement of prosthesis Repair of component(s) of a multi-component, inflatable penile prosthesis Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session OP Table 6.4: Gastric/biliary PEG placement Upper gastrointestinal endoscopy with directed placement of percutaneous gastrostomy tube With construction of gastric tube (eg, Janeway procedure) OP Table 6.5: Gynecological LAVH, Vaginal Hysterectomy Vaginal hysterectomy, for uterus 250 g or less; With removal of tube(s) and/or ovary(s) With removal of tube(s), and/or ovary(s), with repair of enterocele With repair of enterocele Vaginal hysterectomy, for uterus greater than 250 g; With removal of tube(s) and/or ovary(s) With removal of tube(s) and/or ovary(s), with repair of enterocele With colpo-urethrocystopexy (Marshall-Marchetti-Kranz type, Pereyro type) with or without endoscopic control With repair of enterocele Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; With removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; With removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy for uterus 250 g or less With removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g With removal of tube(s) and/or ovary(s) Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-9

10 OP Table 6.5a: Gynecological Pubovaginal sling Sling operation for stress incontinence (e.g., fascia or synthetic) Paravaginal defect repair (including repair of cystocele, if ), laparoscopic approach OP Table 6.6: Head and Neck Open treatment of mandibular fracture with external fixation Open treatment of mandibular fracture; without interdental fixation With interdental fixation Open treatment of mandibular condylar fracture Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach OP Table 6.7: Neurological Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir Non-programmable pump Programmable pump, including preparation of pump, with or without programming Laminectomy with exploration and/or decompression of spinal cord and/or cauda equine, without facetectomy, foraminotomy or discectomy, (e.g., spinal stenosis), 1 or 2 vertebral segments; cervical Thoracic Lumbar, except for spondylolisthesis Sacral Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equine and nerve roots for spondylolisthesis, lumbar (Gill type procedure) Laminectomy with exploration and/or decompression of spinal cord and/or cauda equine, without facetectomy, foraminotomy or discectomy, (e.g., spinal stenosis), more than 2 vertebral segments; cervical Thoracic Lumbar Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-10

11 OP Table 6.7: Neurological Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; including open and endoscopically-assisted approaches; 1 interspace, cervical interspace, lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; cervical Lumbar Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equine and/or nerve root(s), (e.g., spinal or lateral recess stenosis)), single vertebral segment; cervical Thoracic Lumbar Lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc) Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical single interspace Specifications Manual for Hospital Outpatient Department Quality Measures Appendix A-11