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Breast cyst removal, male or female (1 or more cysts) [HCPCS 19120]

Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]

A flexible colonoscopy is performed with single or multiple biopsies. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Any suspect site(s) to be biopsied is identified and biopsy forceps are placed through the biopsy channel in the endoscope. The forceps are opened, the tissue is spiked, and the forceps are closed. The biopsied tissue is then removed through the endoscope. One or more tissue samples may be obtained and are sent for separately reportable laboratory analysis.

Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]

A flexible colonoscopy is performed with removal of tumors, polyps, or other lesions by hot biopsy forceps or snare technique. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The tumor, polyp, or other lesion is identified. Hot biopsy method uses insulated monopolar forceps to remove and electrocoagulate (cauterize) tissue simultaneously. Hot biopsy forceps are used primarily for removal of small polyps and treatment of vascular ectasias. A wire snare loop is placed around the lesion. The loop is heated to shave off and cauterize the lesion. Lesions may be removed en bloc with one placement of the snare or in a piecemeal fashion which requires multiple applications of the snare. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, bleeding sites, lesions, strictures, or other abnormalities.

Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]

A flexible colonoscopy is performed with or without collection of specimens by brushing or washing. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn as mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology (cell) samples may be obtained using a brush introduced through the endoscope. Alternatively, sterile water may be introduced to wash the mucosal lining and the fluid aspirated to obtain cell samples. Cytology samples are sent for separately reportable laboratory analysis.

Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]

An upper gastrointestinal (UGI) endoscopic examination, also referred to as an esophagogastroduodenoscopy (EGD), is performed on the esophagus, stomach, duodenum and/or jejunum with biopsy(s). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum where mucosal surfaces are inspected for any abnormalities. Single or multiple samples of suspect tissue are taken through the scope. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities.

Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]

A diagnostic upper gastrointestinal (UGI) endoscopic examination is performed of the esophagus, stomach, duodenum and/or jejunum with or without collection of specimens by brushing or washing. This procedure may also be referred to as an esophagogastroduodenoscopy (EGD). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum of the stomach are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum. Mucosal surfaces of the duodenum and/or jejunum are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology samples may be obtained by cell brushing or washing.

Gallbladder removal with an endoscope [HCPCS 47562]

The gallbladder is removed by laparoscopic technique. A small portal incision is made at the navel and a trocar is inserted. The scope and video camera are then inserted at this site. The abdomen is inflated with carbon dioxide. Two to three additional abdominal portal incisions are made and trocars are inserted for placing surgical instruments. The gallbladder is identified. If the gallbladder is distended, a needle may be used to drain bile from the gallbladder. Grasper clamps are applied. The Hartmann's pouch is identified and retracted, exposing the triangle of Calot. The cystic artery and cystic duct are identified. The cystic duct is dissected free and transected. The cystic artery is dissected free, ligated, and doubly divided. Electrocautery is used to dissect the gallbladder off the liver bed. The gallbladder is placed in an extraction sac and removed from the abdomen through one of the small incisions.

Groin hernia repair for patient 5 years of age or older (herniated tissue that is not trapped) [HCPCS 49505]

An initial inguinal hernia repair is performed on a patient who is five years or older. An inguinal hernia is a condition where structures protrude through a weakness in the abdominal wall in the groin area. Incarcerated hernia tissue cannot be pushed back into its normal position. Strangulated hernias are those in which circulation is compromised. An incision is made over the internal ring. The skin, fat, and subcutaneous fascia are incised down to the aponeurosis of the external oblique muscle. The external ring is identified and the external oblique aponeurosis is slit. The internal ring is opened and the inguinal canal is exposed. In males, the spermatic cord and its covering are mobilized and the covering is removed. The hernia sac is dissected free into the retroperitoneum, opened, and inspected for the presence of bowel or bladder wall. Any bowel or bladder content is reduced (pushed back into the abdominal cavity) and the hernia sac is transected and inverted into the abdominal cavity. A mesh plug may be placed to reinforce the repair. In women, the sac is inspected for the ovary. If the ovary is present, it is returned to the abdomen. The sac is then resected together with the round ligament. The internal ring is closed and the posterior wall of the inguinal canal is repaired.

Knee cartilage removal with endoscope (one knee) [HCPCS 29881]

Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]

Total Knee or Hip Replacement

Esophageal swallowing movement measurement [HCPCS 91010]

Gastroesophageal reflux test with pH electrode insertion including recording, analysis and interpretation [HCPCS 91035]

Cefazolin sodium injection [HCPCS J0690]

Injection, cefazolin sodium, 500 mg

Diphenhydramine hcl injectio [HCPCS J1200]

Injection, diphenhydramine hcl, up to 50 mg

Fentanyl citrate injection [HCPCS J3010]

Injection, fentanyl citrate, 0.1 mg

Garamycin gentamicin inj [HCPCS J1580]

Inj midazolam hydrochloride [HCPCS J2250]

Injection, midazolam hydrochloride, per 1 mg

Levofloxacin injection [HCPCS J1956]

Injection, levofloxacin, 250 mg

Metoclopramide hcl injection [HCPCS J2765]

Injection, metoclopramide hcl, up to 10 mg

Neostigmine methylslfte inj [HCPCS J2710]

Promethazine hcl injection [HCPCS J2550]

Injection, promethazine hcl, up to 50 mg

Vancomycin hcl injection [HCPCS J3370]

Injection, vancomycin hcl, 500 mg

Ocular imp, aqueous drain de [HCPCS C1783]

Abdominal or navel hernia repair with endoscope (herniated tissue that is not trapped) [HCPCS 49652]

Anesthetic agent and/or steroid injection into suprascapular nerve of shoulder [HCPCS 64418]

Anti-cancer drug injection into bladder [HCPCS 51720]

Bladder and urethra (bladder canal) examination with endoscope for diagnosis [HCPCS 52000]

Blood or fluid collection incision and drainage [HCPCS 10140]

Bone implant removal (deep) [HCPCS 20680]

Bone joints removal of bones between wrist and fingers [HCPCS 25447]

Broken lower forearm bone or growth plate separation treatment with hardware insertion (3 or more fragments, open treatment) [HCPCS 25609]

Colon (large bowel) examination and injections beneath lining of colon with flexible endoscope [HCPCS 45381]

Colorectal cancer screening; colonoscopy on invididual not meeting high risk [HCPCS G0121]

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

Colorectal scrn; hi risk ind [HCPCS G0105]

Colorectal cancer screening; colonoscopy on individual at high risk

Dialysis graft repair (open procedure) [HCPCS 36832]

Esophagus, stomach, and/or upper small bowel examination and injections with endoscope [HCPCS 43236]

Eye fluid drainage device insertion (external approach) [HCPCS 66183]

Finger tendon repair on the top side of the hand without a graft [HCPCS 26418]

Fluid accumulation removal in sperm reservoir [HCPCS 54840]

Foreign body, stone, or stent removal from urethra (bladder canal) or bladder with endoscope (simple) [HCPCS 52310]

Gallbladder and pancreatic, liver, and bile ducts examination and pancreatic or bile duct widening by balloon with endoscope [HCPCS 43277]

Groin hernia repair (herniated tissue that is not trapped) [HCPCS 49520]

Healthy skin and tissue transfer to repair adjacent wound of forehead, cheeks, chin, mouth, neck, underarms, genitalia, hands, and/or feet (10 sq cm or less) [HCPCS 14040]

Intermediate repair of wound of scalp, underarms, trunk, arms, and/or legs (12.6 to 20.0 cm) [HCPCS 12035]

Intermediate repair of wound of scalp, underarms, trunk, arms, and/or legs (2.6 to 7.5 cm) [HCPCS 12032]

Large joint or joint capsule fluid removal and/or injection with needle [HCPCS 20610]

Arthrocentesis, aspiration, and/or injection of a joint or bursa is performed. Arthrocentesis and aspiration is performed to remove fluid from a joint or bursa in order to diagnose the cause of joint effusion and/or to reduce pain caused by the excess fluid. Injection of a joint or bursa may be performed in conjunction with the arthrocentesis procedure and is typically performed using an anti-inflammatory medication such as a steroid to reduce inflammation of the joint or bursa. The skin over the joint is cleansed. A local anesthetic is injected as needed. A needle with a syringe attached is inserted into the affected joint or bursa. Fluid is removed and sent for separately reportable laboratory analysis. This may be followed by a separate injection of medication into the joint or bursa.

Median nerve of hand release and/or relocation [HCPCS 64721]

Mesh placement to repair incisional or abdominal hernia (open procedure) [HCPCS 49568]

Multiple internal and external hemorrhoid groups removal [HCPCS 46260]

Nasal cartilage reshaping [HCPCS 30520]

Palm tissue removal with release of finger (1 finger) [HCPCS 26123]

Relocation of arm vein with connection to arm artery (at any site) [HCPCS 36821]

Removal of cancerous skin lesion of trunk, arms, or legs (over 4.0 cm) [HCPCS 11606]

Side of skull (temporal) artery tying or biopsy [HCPCS 37609]

Skin and muscle removal (first 20 sq cm or less) [HCPCS 11043]

Skin and tissue removal (each additional 20 sq cm) [HCPCS 11045]

Skin and tissue removal (first 20 sq cm or less) [HCPCS 11042]

Tendon covering incision [HCPCS 26055]

Tendon incision into the tendon covering on the top side of the wrist [HCPCS 25000]

Tendon lesion removal from finger or hand [HCPCS 26160]

Tissue destruction in the bladder, urethra (bladder canal), or surrounding glands with endoscope [HCPCS 52214]

Ulnar nerve at elbow release and/or relocation [HCPCS 64718]

Underarm lymph nodes biopsy or removal (open procedure) [HCPCS 38525]

Ureter (urinary duct) catheter insertion with endoscope through the bladder area [HCPCS 52005]

Uterus polyp biopsy and/or removal with endoscope [HCPCS 58558]

Wrist cyst removal (initial or primary) [HCPCS 25111]

Wrist ligament release with endoscope [HCPCS 29848]

Abdominal x-ray (single view) [HCPCS 74018]

A radiologic examination of the abdomen images the internal organs, soft tissue (muscle, fat), and supporting skeleton. X-ray imaging uses indirect ionizing radiation to take pictures of non-uniform material, such as human tissue, because of its different density and composition, which allows some of the x-rays to be absorbed and some to pass through and be captured. This produces a 2D image of the structures. The radiographs may be taken to look for size, shape, and position of organs, pattern of air (bowel gas), obstruction, foreign objects, and calcification in the gallbladder, urinary tract, and aorta. A radiologic examination of the abdomen may be ordered to diagnose abdominal distention and pain, vomiting, diarrhea or constipation, and traumatic injury; it may also be obtained as a screening exam or scout film prior to other imagining procedures. Common views of the abdomen include front to back anteroposterior (AP) with the patient lying supine or standing erect, back to front posteroanterior (PA) with the patient lying prone, lateral with the patient lying on the side, lateral decubitus anteroposterior (side lying, front to back view), lateral dorsal decubitus (lying supine, side view), oblique (anterior or posterior rotation), and coned (small collimated) views which may be used to localize and differentiate lesions, calcifications, or herniations.

Chest x-ray (single view) [HCPCS 71045]

A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

Fluoroscopic guidance for central venous access device insertion, replacement, or removal [HCPCS 77001]

Ultrasound guidance for needle placement including imaging supervision of procedure and interpretation of results [HCPCS 76942]

Ultrasound guidance including imaging supervision and interpretation is performed for needle placement during a separately reportable biopsy, aspiration, injection, or placement of a localization device. A local anesthetic is injected at the site of the planned needle or localization device placement. A transducer is then used to locate the lesion, site of the planned injection, or site of the planned placement of the localization device. The radiologist constantly monitors needle placement with the ultrasound probe to ensure the needle is properly placed. The radiologist also uses ultrasound imaging to monitor separately reportable biopsy, aspiration, injection, or device localization procedures. Upon completion of the procedure, the needle is withdrawn and pressure applied to control bleeding. A dressing is applied as needed. The radiologist then provides a written report of the ultrasound imaging component of the procedure.

Urinary tract imaging [HCPCS 74420]

X-ray of bile and/or pancreatic ducts during surgery including radiological supervision of procedure and interpretation of results [HCPCS 74300]

Major small & large bowel procedures with complications

Major small & large bowel procedures without complications

Wnd debrid & skn grft exc hand, for musculo-conn tiss dis without complications

Hip & femur procedures except major joint with complications

Knee procedures without pdx of infection with major complications

Knee procedures without pdx of infection without complications

Lower extrem & humer proc except hip,foot,femur without complications

Revision of hip or knee replacement with complications

Total Knee or Hip Revision

Total Shoulder Replacement

Kidney & ureter procedures for neoplasm without complications

Extracranial procedures without complications