Private Room

Semi-Private Room

Emergency Department Visit - Level 1

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

Emergency Department Visit - Level 2

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.

Emergency Department Visit - Level 3

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

Emergency Department Visit - Level 4

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.

Emergency Department Visit - Level 5

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.

Emergency Critical Care, First 30 Minutes

Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

Application of Electrical Stimulation - 15 Minutes

Electrical stimulation involves the use of a transcutaneous electrical nerve stimulation device (TENS), functional electrical stimulation device (FES), or a neuromuscular electrical stimulation device (NMES). The physical therapist or other physical therapy aid places the electrodes of the selected device over the region to be stimulated. The electrical impulse is set to the desired strength and the control unit is turned on. Electrical impulses are transmitted to the skin. The electrical stimulation device causes the muscles to contract. The muscle contraction stimulates both muscle and nerve tissues to relieve pain and promote healing. Electrical stimulation may be provided as a supervised modality that does not require direct (one-on-one) patient contact or it may be provided under constant attendance with direct (one-on-one) patient contact.

Electric Stimulation for Therapy

Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care

PT Evaluation - Moderate Complexity

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Physical Therapy 1 or More Regions (15 min)

Manual therapies are skilled, specific, hands-on techniques usually performed by physical therapists, occupational therapists, chiropractors, osteopaths, and/or physiatrists to diagnose and treat soft tissue and joint problems. The goal of manual therapy is to modulate pain and induce relaxation, increase range of motion (ROM), facilitate movement, function, and stability, decrease inflammation, and improve muscle tone and extensibility. Tissue mobilization involves slow, controlled myofascial stretching using deep pressure to break up fibrous muscle tissue and/or connective tissue adhesions. Manipulation is a more forceful stretching of the myofascial tissue that takes the joint just beyond its restricted barrier. Manual lymphatic drainage is a type of light massage employed to reduce swelling by gentle movement of the skin in the direction of lymphatic flow. Manual traction involves the controlled counterforce of the therapist to induce asymptomatic strain by gently stretching muscle and/or connective tissue.

Physical Therapy Exercise, 15 Minutes

Therapeutic exercise is the application of careful, graduated force to the body to increase strength, endurance, range of motion, and flexibility. Increased muscle strength is achieved by the deliberate overloading of a targeted muscle or muscle group and improved endurance is achieved by raising the intensity of the strengthening exercise to the targeted area(s) over a prolonged period of time. To maintain range of motion (ROM) and flexibility requires the careful movement and stretching of contractile and non-contractile tissue that may tighten with injury or neurological disease, causing weakness and/or spasticity. Therapeutic exercise can increase blood flow to the targeted area, reduce pain and inflammation, reduce the risk of blood clots from venous stasis, decrease muscle atrophy and improve coordination and motor control. Therapeutic exercise may be prescribed following acute illness or injury and for chronic conditions that affect physical activity or function.

Physical Therapy, standard evaluation - 20 minutes

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Therapeutic Activities Involving Functional Activities (15 min)

In a one-on-one physical therapy session, the provider instructs and assists the patient in therapeutic activities designed to address specific functional limitations. The therapeutic activities are specifically developed and modified for the patient. Dynamic/movement activities, also called kinetic activities, that are designed to improve functional performance such as lifting, bending, pushing, pulling, jumping and reaching are included in this service. For example, the patient may be given therapeutic activities to perform to improve the ability to sit, stand, and get out of bed after an injury without straining or risking reinjury. This code is reported for each 15 minutes of one-on-one therapeutic activity provided.

Holter Testing - 48-Hour EKG

Electrocardiographic (ECG) rhythm-derived data is gathered for up to 48 hours of monitoring as the patient goes about regular daily activity while wearing an external ECG recording device, also called a Holter monitor. Electrodes or leads are placed on the patient's chest, and the patient is instructed on the use of the monitor. The recording device makes continuous, original ECG wave recordings for a 12 to 48 hour period. The recordings are captured on magnetic tape or digitized medium to be reviewed later. At the end of the recording period, the patient returns to the office with the device. Stored data derived from the continuous recordings of the electrical activity of the heart include heart rhythm and rate, ST analysis, variability in heart rate and T-wave alternans. Visual superimposition scanning is done to give a 'page review' of the entire recording, identifying different ECG waveforms with selective samples of rhythm strips. A report is made after analysis of the scanning, and the physician or other qualified health care professional reviews and interprets the data for heart arrhythmias.

Routine EKG - Minimum 12 Leads

An ECG is used to evaluate the electrical activity of the heart. The test is performed with the patient lying prone on the exam table. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the ECG tracing device are then attached to the patches. A tracing is obtained of the electrical signals from the heart. Electrical activity begins in the sinoatrial node which generates an electrical stimulus at regular intervals, usually 60 to 100 times per minute. This stimulus travels through the conduction pathways to the sinoatrial node causing the atria to contract. The stimulus then travels along the bundle of His which divides into right and left pathways providing electrical stimulation of the ventricles causing them to contract. Each contraction of the ventricles represents one heart beat. The ECG tracing includes the following elements: P wave, QRS complex, ST segment, and T wave. The P wave, a small upward notch in the tracing, indicates electrical stimulation of the atria. This is followed by the QRS complex which indicates the ventricles are electrically stimulated to contract. The short flat ST segment follows and indicates the time between the end of the ventricular contraction and the T wave. The T wave represents the recovery period of the ventricles. The physician reviews, interprets, and provides a written report of the ECG recording taking care to note any abnormalities.

Spirometry - medicated breathing procedure

Spirometry with bronchodilation responsiveness is a pulmonary function test that is used to help diagnose the cause of shortness of breath and to monitor existing pulmonary disease, such as chronic bronchitis, emphysema, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and asthma. The test is first performed without administration of a bronchodilator. A spirometry device consisting of a mouthpiece and tubing connected to a machine that records and displays results is used to perform the test. The patient inhales deeply and then exhales through the mouthpiece. Inhalation and exhalation measurements are first taken with the patient breathing normally. The patient is then instructed to perform rapid, forceful inhalation and exhalation. The spirometer records the volume of air inhaled, exhaled, and the length of time each breath takes. A bronchodilator medication is administered and the test is repeated. The test results are displayed on a graph that the physician reviews and interprets in a written report.

Speech Therapy

A speech-language pathologist treats a speech, language, voice, communication, and/or auditory processing disorder. Using the information obtained from a separately reportable screening and in-depth evaluation of a speech or language disorder, the clinician develops an individualized treatment plan for the patient. The clinician defines specific treatment goals and sets baseline measures with which to assess the patient's progress. These goals are continuously monitored and fine-tuned throughout the treatment period. Once the goals and baseline measures have been established the clinician uses a number of intervention activities to correct the specific speech or language disorder identified. These can include games, stories, rhymes, drills, and other tasks. If the patient has a speech disorder, the clinician may demonstrate the sounds and have the patient copy the way the clinician moves the lips, mouth, and tongue to make the right sound. A mirror may be used so that the patient can practice making the sound while observing himself or herself in the mirror. Treatment of a language disorder might include help with grammar. If the patient is having difficulty with auditory processing, a game like Simon Says might be used to help improve understanding of verbal instructions.

Swallow Treatment

Swallowing dysfunction and/or oral function are treated in an individual with difficulty passing food or liquid from the mouth or throat into the stomach. A swallowing or oral function disorder can occur in any age group or at any point in the swallowing process as food or liquid passes from the mouth, through the pharynx and esophagus, into the stomach. Swallowing disorders are common in individuals with degenerative neurological disorders such as cerebral palsy, amyotrophic lateral sclerosis (ALS), postpolio syndrome, myasthenia gravis, multiple sclerosis, and Parkinson's disease. A swallowing disorder may also result from neurological damage such as a stroke or head or spinal cord injury, or from a congenital or acquired deformity of the mouth, pharynx, esophagus, or stomach. Medical treatment is provided for a patient with a swallowing or oral function disorder. The diet is modified. Swallowing posture is assessed and modified as needed. Swallowing technique is modified to strengthen oropharyngeal muscle groups and improve the mechanics of swallowing so that food and liquid can pass into the esophagus and then into the stomach without aspiration into the lungs.

Ammonia level

A blood test is performed to measure ammonia levels. Ammonia is a by product of protein metabolism and is normally converted to urea by the liver and excreted via the kidney. Elevated ammonia levels may result from cirrhosis or hepatitis. Symptoms of elevated ammonia levels are confusion, tremors, excessive sleepiness, or coma. Testing may be performed in disease states such as Reyes syndrome or liver failure. A blood sample is obtained by a separately reportable venipuncture or arterial access line. The specimen is then tested using colorimetry.

Amylase (enzyme) level

Laboratory testing for amylase may be performed on blood, urine, and other body fluids. Amylase is an enzyme responsible for the break down of starches into sugar molecules (disaccharides and trisaccharides) and eventually into glucose for energy use by the cells. Amylase is produced in saliva and the pancreas. Abnormal amylase levels may result from pancreatic inflammation or trauma, perforated peptic ulcer, ovarian cyst (torsion), strangulation ileus, macroamylasemia, mumps, and cystic fibrosis. A blood or body fluid sample is obtained. The sample is then tested using quantitative enzymatic methodology.

Analysis for antibody to Rickettsia (bacteria)

Analysis of Substance Using Immunoassay Technique

An immunoassay is performed to detect a chemical substance (analyte) other than an antigen or antibody produced by the body in response to an infectious agent. There are dozens of immunoassays for non-infectious antigens and antibodies that are reported with these codes. Examples of non-infectious diseases and disorders that may be worked up using these tests include: celiac disease, motor and sensory neuropathy, Crohn's disease or other inflammatory bowel disease, liver disease, thyroid disease. Examples of specific antigens and antibodies reported with these codes include: Asialo IgG and IgM, ganglioside IgG and IgM, gliadin IgA and IgG. Codes are reported for each immunoglobulin class or subclass tested using this technique, so for example when testing for gliadin IgA and IgG by immunoassay, the code would be reported twice. Qualitative or semiquantitative testing is performed. Qualitative tests detect only the presence or absence of the specific substance. Semiquantitative tests provide a rough estimate of the amount of the substance being tested.

Bacterial Culture for Aerobic Isolates

Used if further testing is required from an anaerobic bacterial tissue culture in order to verify the results.

Bacterial Culture, Any Source Except Urine, Blood, or Stool

A tissue sample besides blood, urine, or stool is collected and placed in a medium conducive to the growth of bacteria. The culture is examined for the growth of bacteria.

Bacterial culture and colony count

Bilirubin level (Direct)

A laboratory test is performed to measure total or direct bilirubin. Bilirubin is a pigmented waste product normally produced when red blood cells (RBCs) break down. Non-water soluble (unconjugated) bilirubin is carried on albumin to the liver where it attaches to sugar molecules to become conjugated. Conjugated (direct) bilirubin is water soluble and able to pass from the liver to the small intestine. Further breakdown of bilirubin occurs in the small intestine and it is eventually eliminated in the feces in the form of stercobilin. Total bilirubin is the sum of conjugated (direct) and unconjugated bilirubin. A test for either conjugated or direct bilirubin or total bilirubin may be ordered to diagnose and monitor liver disorders, hemolytic anemia, and newborn (physiologic) jaundice. A blood sample is obtained by separately reportable venipuncture or heel stick. Other body fluids, including cerebral spinal fluid, may be collected and tested for total bilirubin. Serum/plasma is tested using quantitative spectrophotometry.

Blood Typing, Rh (D)

A blood specimen is tested to determine blood type (ABO) or Rh(D). In Rh(D), blood is tested for Rh factor, which is an antigen on red blood cells. Blood is Rh+ if the antigen is present or Rh- if the antigen is absent. Blood is tested by mixing the blood sample with antibodies against Rh factor and then checking for agglutination. If agglutination occurs, the blood is Rh+. If the blood does not agglutinate, it is Rh-.

Blood creatinine level

A blood sample is taken to measure creatinine levels. Creatinine is a waste product produced by the muscles in the breakdown of creatine, which is a compound used by the muscles to create energy for contraction. The waste product, creatinine, is excreted by the kidneys and blood levels provide a good measurement of renal function. Creatinine may be checked to screen for or monitor treatment of renal disease. Creatinine levels may also be monitored in patients with acute or chronic illnesses that may impair renal function and in patients on medications that affect renal function. Creatinine is measured using spectrophotometry.

Blood glucose (sugar) level

A blood sample is obtained to measure total (quantitative) blood glucose level. Glucose is a simple sugar that is the main source of energy for the body. Carbohydrates are broken down into simple sugars, primarily glucose, absorbed by the intestine, and circulated in the blood. Insulin, a hormone produced by the pancreas, regulates glucose level in the blood and transports glucose to cells in other tissues and organs. When more glucose is available in the blood than is required, it is converted to glycogen and stored in the liver or converted to fat and stored in adipose (fat) tissue. If the glucose/insulin metabolic process is working properly, blood glucose will remain at a fairly constant, healthy level. Glucose is measured to determine whether the glucose/insulin metabolic process is functioning properly. It is used to monitor glucose levels and determine whether they are too low (hypoglycemia) or too high (hyperglycemia) as well as test for diabetes and monitor blood sugar control in diabetics.

Blood potassium level

A blood sample is obtained to measure potassium level. Potassium is a positively charged electrolyte that works in conjunction with other electrolytes, such as sodium, chloride, and carbon dioxide (CO2), to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance. Potassium is found in all body fluids but mostly stored within cells, not in extracellular fluids, blood serum, or plasma. Small fluctuations in blood potassium, either too high (hyperkalemia) or too low (hypokalemia), can have serious, even life-threatening, consequences. Potassium level is used to screen for and monitor renal disease; monitor patients on certain medications, such as diuretics, as well as patients with acute and chronic conditions, such as dehydration or endocrine disorders. Because blood potassium affects heart rhythm and respiratory rate, it is routinely checked prior to major surgical procedures. Potassium is measured by ion-selective electrode (ISE) methodology.

Blood test, basic group of blood chemicals

Blood test, basic group of blood chemicals

A basic metabolic blood panel is obtained that includes ionized calcium levels along with carbon dioxide (bicarbonate) (CO2), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN). A basic metabolic panel with measurement of ionized calcium may be used to screen for or monitor overall metabolic function or identify imbalances. Ionized or free calcium flows freely in the blood, is not attached to any proteins, and represents the amount of calcium available to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Total carbon dioxide (bicarbonate) (CO2) level is composed of CO2, bicarbonate (HCO3-), and carbonic acid (H2CO3) with the primary constituent being bicarbonate, a negatively charged electrolyte that works in conjunction with other electrolytes, such as potassium, sodium, and chloride, to maintain proper acid-base balance and electrical neutrality at the cellular level. Chloride is also a negatively charged electrolyte that helps regulate body fluid and maintain proper acid-base balance. Creatinine is a waste product excreted by the kidneys that is produced in the muscles while breaking down creatine, a compound used by the muscles to create energy. Blood levels of creatinine provide a good measurement of renal function. Glucose is a simple sugar and the main source of energy for the body, regulated by insulin. When more glucose is available than is required, it is stored in the liver as glycogen or stored in adipose tissue as fat. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly. Both potassium and sodium are positively charged electrolytes that work in conjunction with other electrolytes to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance and both are essential for maintaining normal metabolic processes. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea is taken up by the kidneys and excreted in the urine. Blood urea nitrogen, BUN, is a measure of renal function, and helps monitor renal disease and the effectiveness of dialysis.

Blood test, clotting time

Prothrombin time (PT) measures how long it takes for blood to clot. Prothrombin, also called factor II, is one of the clotting factors made by the liver and adequate levels of vitamin K are needed for the liver to produce sufficient prothrombin. Prothrombin time is used to help identify the cause of abnormal bleeding or bruising; to check whether blood thinning medication, such as warfarin (Coumadin), is working; to check for low levels of blood clotting factors I, II, V, VII, and X; to check for low levels of vitamin K; to check liver function, to see how quickly the body is using up its clotting factors. The test is performed using electromagnetic mechanical clot detection. If prothrombin time is elevated and the patient is not on a blood thinning medication, a second prothrombin time using substitution plasma fractions, also referred to as a prothrombin time mixing study, may be performed. This is performed by mixing patient plasma with normal plasma using a 1:1 mix. The mixture is incubated and the clotting time is again measured. If the result does not correct, it may be indicative that the patient has an inhibitor, such as lupus anticoagulant. If the result does correct, the patient may have a coagulation factor deficiency.

Blood test, comprehensive group of blood chemicals

A comprehensive metabolic panel is obtained that includes albumin, bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, alanine amino transferase (ALT) (SGPT), aspartate amino transferase (AST) (SGOT), and urea nitrogen (BUN). This test is used to evaluate electrolytes and fluid balance as well as liver and kidney function. It is also used to help rule out conditions such as diabetes. Tests related to electrolytes and fluid balance include: carbon dioxide, chloride, potassium, and sodium. Tests specific to liver function include: albumin, bilirubin, alkaline phosphatase, ALT, AST, and total protein. Tests specific to kidney function include: BUN and creatinine. Calcium is needed to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Glucose is the main source of energy for the body and is regulated by insulin. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly.

Blood test, lipids (cholesterol and triglycerides)

"A lipid panel is obtained to assess the risk for cardiovascular disease and to monitor appropriate treatment. Lipids are comprised of cholesterol, protein, and triglycerides. They are stored in cells and circulate in the blood. Lipids are important for cell health and as an energy source. A lipid panel should include a measurement of triglycerides and total serum cholesterol and then calculate to find the measurement of high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and very low density lipoprotein (VLDL-C). HDL contains the highest ratio of cholesterol and is often referred to as ""good cholesterol"" because it is capable of transporting excess cholesterol in the blood to the liver for removal. LDL contains the highest ratio of protein and is considered ""bad cholesterol"" because it transports and deposits cholesterol in the walls of blood vessels. VLDL contains the highest ratio of triglycerides and high levels are also considered ""bad"" because it converts to LDL after depositing triglyceride molecules in the walls of blood vessels. A blood sample is obtained by separately reportable venipuncture or finger stick. Serum/plasma is tested using quantitative enzymatic method."

Blood test, thyroid stimulating hormone (TSH)

A blood test is performed to determine levels of thyroid stimulating hormone (TSH). TSH is produced in the pituitary and helps to regulate two other thyroid hormones, triiodothyronine (T3) and thyroxin (T4), which in turn help regulate the body's metabolic processes. TSH levels are tested to determine whether the thyroid is functioning properly. Patients with symptoms of weight gain, tiredness, dry skin, constipation, or menstrual irregularities may have an underactive thyroid (hypothyroidism). Patients with symptoms of weight loss, rapid heart rate, nervousness, diarrhea, feeling of being too hot, or menstrual irregularities may have an overactive thyroid (hypothyroidism). TSH levels are also periodically tested in individuals on thyroid medications. The test is performed by electrochemiluminescent immunoassay.

Body fluid cell count with cell identification

Carbamazepine level

A laboratory test is performed to determine total or free carbamazepine levels. Carbamazepine, also referred to as Tegretol, is an anticonvulsant used to treat epilepsy and may also be used as an analgesic to treat trigeminal neuralgia. Carbamazepine, carbamazepine metabolite (10,11-epoxide), and free carbamazepine are routinely measured to determine optimal doses in patients with epilepsy as well as to monitor for carbamazepine toxicity. A blood sample is obtained by separately reportable venipuncture. Blood serum is then tested using one of several techniques including high performance liquid chromatography or fluorescent polarization immunoassay. Total carbamazepine tests the total amount present in the blood. Under normal circumstances, circulating carbamazepine is 75% protein bound. In some patients carbamazepine may be displaced from protein resulting in higher levels of free carbamazepine circulating in the blood. In these patients, lower levels of the drug may result in toxicity, so the unbound (free) levels must be monitored.

Carcinoembryonic antigen (CEA) protein level

A laboratory test is obtained to measure carcinoembryonic antigen (CEA) levels in blood and body fluids. CEA is a protein normally present at high levels during fetal development but is low or absent after birth. Elevated levels of CEA may occur with colorectal, breast, lung, pancreatic, prostate, ovarian, and medullary thyroid cancers. CEA testing can help determine tumor size, stage, and metastasis. A baseline level is usually obtained following a cancer diagnosis. Serial testing is done to monitor treatment and response to therapy. Elevated levels of CEA have also been noted in smokers and in patients diagnosed with inflammatory disorders, cirrhosis, peptic ulcer, ulcerative colitis, rectal polyps, emphysema, and benign breast disease. CEA testing should not be used for screening in the general population. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid (CSF) is obtained by separately reportable lumbar puncture. Pleural and peritoneal fluids are obtained by needle aspiration. Serum/plasma and body fluids are tested using quantitative electrochemiluminescent immunoassay.

Coagulation Function Measurement; D-dimer; quantitative

D-dimer testing for fibrin degradation products is performed to help rule out the presence of a thrombus. D-dimer tests are also used to rule-out hypercoagulability. D-dimer has a negative predictive value for these conditions which means that a negative result indicates that there is not an elevated level of fibrin degradation products present in the specimen. A positive result indicates an abnormally high level of fibrin degradation products which may be indicative of a thrombus. It is used to help diagnosis deep vein thrombophlebitis, pulmonary embolus, and stroke. The test is also used to evaluate for hypercoagulability which predisposes the patient to blood clots and to help diagnose disseminated intravascular coagulation (DIC) and monitor the effectiveness of DIC treatment.

Complete blood cell count - automated differential WBC count

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Complete blood cell count - automated test with out Differential

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Creatine kinase Level (cardiac enzyme) - Total

Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. A blood test is performed to measure total creatine kinase (CK) levels. A blood specimen is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative enzymatic methodology.

Creatine kinase level (cardiac enzyme) - Muscle/Brain

Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. Only creatine kinase (CK) MB fraction is measured. Testing for this isoenzyme can help identify heart muscle damage following a heart attack (myocardial infarction). A blood test is obtained by separately reportable venipuncture. Serum is tested using chemiluminescent immunoassay.

Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum

Detection Test for Hepatitis B

A laboratory test is performed to detect Hepatitis B surface antigen (HBsAg) or Hepatitis Be antigen (HBeAg) in serum/plasma by any immunoassay technique such as enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), and immunochemiluminometric assay (IMCA). The Hepatitis B surface antigen (HBsAg) neutralization test (87341) is used to confirm a positive HBsAg test. The Hepatitis Be antigen (HBeAg) test  is used to monitor an active HBV infection and response to therapy. The presence of HBeAg in a sample indicates active HBV replication. Viral infectivity is based on both HBeAg and HBsAg activity. Hepatitis B is a virus that infects the liver. An individual with chronic HBV infection has an increased risk of developing cirrhosis and hepatocellular carcinoma. HBV may be transmitted in blood and body fluids between sexual partners, from mother to infant, and through contaminated objects such as needles, razors, and toothbrushes. The virus may cause fever, fatigue, abdominal pain, weight loss, nausea/vomiting, and joint pain, or it may be asymptomatic. A serum or plasma sample is obtained and placed in a fixative or sent fresh to the laboratory for processing. Both EIA and ELISA detect very small quantities of the antigen when bound to its specific antibody in a sample by adding a secondary, enzyme-labeled antibody to detect its presence. A chromogenic reaction of the enzyme produces a visible color change or fluorescence. Qualitative and semi-quantitative measures are assessed by the colorimetric reading. Immunochemiluminometric assay uses the reaction of antibodies labeled with a chemiluminescent substance to identify and quantify the bound antigen-antibody complex by light emission.

Detection test for Influenza virus, A or B

Detection test for bacteria toxin (shiga-like toxin)

Digoxin level

A laboratory test is performed to measure digoxin levels. Digoxin, also known as Lanoxin, is a cardiac glycoside that controls sodium and potassium levels in the cells. Digoxin is primarily prescribed to treat atrial fibrillation, atrial flutter, and congestive heart failure. The drug increases the strength of cardiac muscle contractions which increases cardiac output and lowers the heart rate and venous pressure. Digoxin has a narrow therapeutic window but antidotal treatment is available (Digibind, Digoxin Immune FAB). The test for total digoxin measures Fab fragment-bound (inactive) digoxin and free (active) digoxin. This test is primarily used to monitor digoxin therapy and should be drawn 8-12 hours following an oral dose. The test for free digoxin (80163) may be used to evaluate breakthrough digoxin toxicity in patients with renal failure, access the need for additional antidigoxin Fab, determine when to reintroduce digoxin therapy, and monitor patients with possible digoxin-like immune reactive factors. To measure free digoxin, a blood sample is obtained by separately reportable venipuncture 6-8 hours after the last dose. Serum is tested for total digoxin using immunoassay and for free digoxin using ultrafiltration followed by electrochemiluminescent immunoassay.

Drug test(s); includes specimen validity testing, per day; 8-14 drug class(es)

Ferritin (blood protein) level

A blood test is performed to measure ferritin levels. Ferritin is an intracellular protein that stores iron and releases it into circulation in a controlled manner to protect the body against iron overload and iron deficiency. Ferritin levels may be obtained to evaluate for elevated levels caused by excess storage diseases such as hemochromatosis and following multiple transfusions. Levels may also be obtained to evaluate for decreased levels due to iron deficiency. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Gammaglobulin Measurement

A test is performed to measure immunoglobin levels in the blood or other body fluids, such as saliva or cerebral spinal fluid. Immunoglobins, also referred to as antibodies, are evaluated to help diagnose a variety of conditions including autoimmune diseases, allergies, or malignant neoplasms such as multiple myeloma or macroglobulinemia. In addition, immunoglobulin levels may be evaluated in patients with frequent infections to determine if there is a low level of immunoglobulin IgG. Immunoglobulins are also evaluated in patients with cancer or H. pylori infection to determine the effectiveness of treatment. There are five major types of antibodies. IgA antibodies are found in the nose, respiratory and digestive tracts, ears, eyes, and vagina. IgA protects the body surfaces from outside foreign substances. IgD is found in tissues lining the abdominal and thoracic cavity. IgE is found in the lungs, skin, and mucous membranes and reacts to substances commonly associated with allergies, such as food, pollen, dander, dust, fungus spores, etc. High levels of IgE are associated with allergies. IgG is found in all body fluids and is important in fighting bacterial and viral infections. There are four subclasses of IgG, designated as IgG1, IgG2, IgG3, and IgG4. These different subclasses protect against different types of infection. For example IgG1 is particularly effective in protecting the body from viral proteins, whereas IgG2 is more effective against certain types of bacterial infections. Individuals may have selective IgG subclass deficiencies characterized by low levels of one or two IgG subclasses with normal total IgG. IgM is found in blood and lymph and is important in fighting infection. A blood specimen is obtained by separately reportable venipuncture, a CSF sample is obtained by separately reportable spinal puncture, or saliva is collected. The methodology used to test immunoglobulin levels is dependent on the type of specimen and the immunoglobulin being tested.

Gonadotropin (reproductive hormone) analysis

A specimen is tested for chorionic gonadotropin (hCG). A qualitative test is performed to test for the presence of absence of hCG only. This test may be performed on blood or urine. Qualitative hCG testing is performed to confirm pregnancy.

Hemoglobin A1C level

A blood test is performed to measure glycosylated hemoglobin (HbA1C) levels. Plasma glucose binds to hemoglobin and the HbA1C test measures the average plasma glucose concentration over the life of red blood cells (approximately 90-120 days). HbA1C levels may be used as a diagnostic reference for patients with suspected diabetes mellitus (DM) and to monitor blood glucose control in patients with known DM. HbA1C levels should be monitored at least every 6 months in patients with DM and more frequently when the level is >7.0%. A blood sample is obtained by separately reportable venipuncture. Whole blood is tested using quantitative high performance liquid chromatography/boronate affinity.

Hepatitis C Antibody Measurement

A laboratory test is performed to measure Hepatitis C virus (HCV) antibodies. Hepatitis C causes acute or chronic liver inflammation and may be transmitted via blood transfusion, needle sticks or sharing of needles in occupational situations or recreational drug use, unprotected sex, placental transfer during pregnancy, or sharing personal items such as a razor or toothbrush. The test is used to screen individuals at risk for infection with HCV. A blood sample is obtained by separately reportable venipuncture. Serum is tested using qualitative chemiluminescent immunoassay. Antibodies toward HCV may not start to elevate until 2 months after exposure, so a negative test screening should be repeated if there is a strong suspicion of HCV infection.

Immunologic analysis for detection of tumor antigen (CA 125)

A quantitative immunoassay for tumor antigen CA 125 is performed. Tumor antigens, also referred to as tumor markers, are indicators that a malignant neoplasm may be present. Significant circulating levels found in serum are often associated with malignancy. Tumor antigen CA 125 is used in patients with a documented ovarian mass to help determine whether the mass is benign or malignant. It is also used to monitor response to treatment in patients with an established diagnosis of ovarian, fallopian tube, or endometrial cancer. CA 125 uses an electrochemiluminescent immunoassay test kit. Periodic tumor antigen testing is used in conjunction with other clinical methods to monitor progression or regression of the malignancy.

Ionized Calcium

A blood sample is taken to measure the amount of ionized or free calcium. Ionized or free calcium is calcium that flows freely in the blood and is not attached to any proteins. Ionized calcium is metabolically active and available to support and regulate heart function, muscle contraction, central nervous system function, and blood clotting. Ionized calcium measurements may be obtained prior to major surgery, in critically ill patients, or when protein levels are abnormal. Ionized calcium is measured by ion selective electrode (ISE) or pH electrode methodology.

Iron Binding Capacity

A blood test is performed to measure the iron binding capacity of transferrin. Transferrin, a protein found in circulating blood is responsible for carrying iron molecules. This test measures the ability of transferrin to carry iron. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative spectrophotometry/calculation.

Iron level

A blood, urine or liver test is performed to measure iron levels. Iron (Fe) is an essential element that circulates in the blood attached to the protein transferrin. Iron is necessary component of hemoglobin, found in red blood cells (RBCs) and myoglobin found in muscle cells. Low iron levels may cause a decrease in red blood cells and iron deficiency anemia. High iron levels may be caused by excessive intake of iron supplements or a hereditary genetic condition such as hemochromatosis from a mutation of the RGMc gene or HAMP gene. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative spectrophotometry. A random voided or 24 hour urine specimen is obtained and tested using quantitative inductively coupled plasma/emission spectrometry. Patient should wait 2-4 days after receiving iodine or gadolinium contrast media to collect a urine specimen. A liver sample is obtained by a separately reportable procedure. Liver tissue is tested using quantitative inductively coupled plasma-mass spectrometry.

Kidney Function Blood Test Panel

A renal panel is obtained for routine health screening and to monitor conditions such as diabetes, renal disease, liver disease, nutritional disorders, thyroid and parathyroid function, and interventional drug therapies. Tests in a renal panel include glucose or blood sugar; electrolytes and minerals as sodium, potassium, chloride, total calcium, and phosphorus; the waste products blood urea nitrogen (BUN) and creatinine; a protein called albumin; and bicarbonate (carbon dioxide, CO2) responsible for acid base balance. Glucose is the main source of energy for the body and is regulated by insulin. High levels may indicate diabetes or impaired kidney function. Sodium is found primarily outside cells and maintains water balance in the tissues, as well as nerve and muscle function. Potassium is primarily found inside cells and affects heart rhythm, cell metabolism, and muscle function. Chloride moves freely in and out of cells to regulate fluid levels and help maintain electrical neutrality. Calcium is needed to support metabolic processes, heart and nerve function, muscle contraction, and blood clotting. Phosphorus is essential for energy production, nerve and muscle function, and bone growth. Blood urea nitrogen (BUN) and creatinine are waste products from tissue breakdown that circulate in the blood and are filtered out by the kidneys. Albumin, a protein made by the liver, helps to nourish tissue and transport hormones, vitamins, drugs, and calcium throughout the body. Bicarbonate (HCO3) may also be referred to as carbon dioxide (CO2) maintains body pH or the acid/base balance. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative chemiluminescent immunoassay or quantitative enzyme-linked immunosorbent assay.

LDL cholesterol level

Lab test for LDL Cholesterol

Lactate dehydrogenase (enzyme) level

A blood or body fluid test is performed to measure lactate dehydrogenase (LD) (LDH) levels. LDH is an enzyme present in red blood cells (RBCs) and in the tissue of heart, liver, pancreas, kidney, skeletal muscle, brain and lungs. LDH levels are used as a marker for tissue and RBC damage. Elevated blood levels can be caused by stroke, myocardial infarction, liver disease, pancreatitis, muscular dystrophy, infectious mononucleosis, hemolytic anemia and tumors/cancers such as lymphoma. Elevated cerebral spinal fluid (CSF) levels are usually indicative of bacterial meningitis. LDH levels in pleural and/or pericardial fluid can indicate if the effusion is an exudate, caused by an infection or a transudate caused by fluid pressure problem. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid is obtained by separately reportable lumbar puncture (spinal tap). Pericardial fluid is obtained by separately reportable pericardiocentesis. Fluid from a pleural effusion is obtained by separately reportable thoracentesis. Serum or plasma and all body fluids are tested using quantitative enzymatic methodology.

Lipase (fat enzyme) level

A test is performed on blood and body fluids to measure lipase levels. Lipase is an enzyme released by the pancreas into the small intestine and is essential for the digestion of dietary fats. Elevated levels may result from small bowel obstruction, celiac disease, cholecystitis, duodenal ulcer, severe gastroenteritis, macrolipasemia, pancreatitis, and pancreatic tumors. The test may be ordered when there is a family history of lipoprotein lipase deficiency. A blood sample is obtained by separately reportable venipuncture. Other body fluids collected by other methods. Blood and other body fluids are tested using quantitative enzymatic methodology.

Liver enzyme (SGOT), level

A blood test is performed to measure aspartate aminotransferase (AST) levels. This enzyme was previously referred to as serum glutamic oxaloacetic transaminase (SGOT). AST is an enzyme found primarily in liver and muscle cells. Elevated levels may result from liver disease or damage such as hepatitis, cirrhosis, ischemia, drug toxicity, and/or muscle damage, especially cardiac muscle (myocardial infarction). This test is often ordered in conjunction with alanine transferase, ALT or other liver function tests (LFTs) to diagnose disease and monitor individuals taking cholesterol lowering medications. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method.

Liver enzyme (SGPT), level

A blood test is performed to measure alanine aminotransferase (ALT) levels. This enzyme was previously referred to as serum glutamic pyruvic transaminase (SGPT). ALT is an enzyme found primarily in liver and muscle cells. Elevated levels may result from liver disease or damage such as hepatitis, cirrhosis, ischemia, drug toxicity, and/or muscle damage, especially cardiac muscle (myocardial infarction). This test is often ordered in conjunction with aspartate transferase, AST or other liver function tests (LFTs) to diagnose disease and monitor individuals taking cholesterol lowering medications. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method.

Liver function blood test panel

A hepatic function panel is obtained to diagnose acute and chronic liver disease, inflammation, or scarring and to monitor hepatic function while taking certain medications. Tests in a hepatic function panel should include albumin (ALB), total and direct bilirubin, alkaline phosphatase (ALP), total protein (TP), alanine aminotransferase (ALT, SGPT), and aspartate aminotransferase (AST, SGOT). Albumin (ALB) is a protein made by the liver that helps to nourish tissue and transport hormones, vitamins, drugs, and calcium throughout the body. Bilirubin, a waste product from the breakdown of red blood cells, is removed by the liver in a conjugated state. Bilirubin is measured as total (all the bilirubin circulating in the blood) and direct (the conjugated amount only) to determine how well the liver is performing. Alkaline phosphatase (ALP) is an enzyme produced by the liver and other organs of the body. In the liver, cells along the bile duct produce ALP. Blockage of these ducts can cause elevated levels of ALP, whereas cirrhosis, cancer, and toxic drugs will decrease ALP levels. Circulating blood proteins include albumin (60% of total) and globulins (40% of total). By measuring total protein (TP) and albumin (ALB), the albumin/globulin (A/G) ratio can be determined and monitored. TP may decrease with malnutrition, congestive heart failure, hepatic disease, and renal disease and increase with inflammation and dehydration. Alanine aminotransferase (ALT, SGPT) is an enzyme produced primarily in the liver and kidneys. In healthy individuals ALT is normally low. ALT is released when the liver is damaged, especially with exposure to toxic substances such as drugs and alcohol. Aspartate aminotransferase (AST, SGOT) is an enzyme produced by the liver, heart, kidneys, and muscles. In healthy individuals AST is normally low. An AST/ALT ratio is often performed to determine if elevated levels are due to liver injury or damage to the heart or skeletal muscles. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method or quantitative spectrophotometry.

Magnesium Level

A blood, urine, or fecal test is performed to measure magnesium levels. Magnesium is an essential dietary mineral responsible for enzyme function, energy production, and contraction and relaxation of muscle fibers. Decreased levels may result from severe burns, metabolic disorders, certain medications, and low blood calcium levels. A blood sample is obtained by separately reportable venipuncture. Red blood cells (RBCs) are tested using quantitative inductively coupled plasma-mass spectrometry. Serum/plasma is tested using quantitative spectrophotometry. A 24-hour voided urine specimen is tested using quantitative spectrophotometry. A random or 24-hour fecal sample is tested using quantitative spectrophotometry.

Measurement C-reactive protein

A blood test is performed to measure C-reactive protein (CRP) levels. This standard test has a wide value range. CRP is an acute phase protein, synthesized by the liver and released in response to inflammation and infection. The test is not diagnostic for any specific disease or condition but can be used as a marker to monitor the body's response to treatment(s) or to evaluate the need for further testing. Elevation of CRP levels may be found during pregnancy, with the use of oral contraceptives, or hormone replacement therapy. Diseases/conditions that cause an elevation of CRP include: lymphoma, arteritis/vasculitis, osteomyelitis, inflammatory bowel disease, rheumatoid arthritis, pelvic inflammatory disease (PID), systemic lupus erythematosus (SLE), acute infections, burns, surgical procedures, and organ transplants. A blood sample is obtained by separately reportable venipuncture. Serum in neonates is tested using immunoassay. Serum/plasma in all other patients is tested using quantitative immunoturbidimetric method.

Measurement of Complement (Immune System Proteins)

A blood test is performed to measure complement antigen levels. Complement factors help to clear immune complexes from the blood. Proteins are activated in response to the immune complex and generate peptides that bind the complexes and complement receptors. The cell membrane breaks apart and an attack complex is formed. A blood sample is obtained by separately reportable venipuncture. Complements are tested in serum or plasma samples, using specified methods, particularly quantitative radial immunodiffusion. Report for each complement component tested: 2-9 (2 being the most common inherited complement deficiency), 3A (the most abundant of all complement components), 4A, and 1Q; complement factor B and Bb; and C1-esterase inhibitor.

Other closed skull fracture without mention of intracranial injury, with loss of consciousness of unspecified duration

PSA (prostate specific antigen) measurement

Prostate specific antigen (PSA) is measured. PSA is a protein produced by normal prostate cells found in serum and exists in both free form and complexed with other proteins. Total PSA is measured ad the total amount of both free and complexed forms. Total PSA levels are higher in men with benign prostatic hyperplasia (BPH), acute bacterial prostatitis, or prostate cancer. Total PSA is used to screen for prostate cancer and evaluate the response to treatment in those with prostate cancer, but cannot be used by itself to definitively diagnose prostate cancer.

Coagulation assessment blood test

This test may also be referred to as an activated PTT or aPTT. PTT may be performed to diagnose the cause of bleeding or as a screening test prior to surgery to rule-out coagulation defects. A silica and synthetic phospholipid PTT reagent is mixed with the patient plasma. The silica provides a negatively-charged particulate surface that activates the contact pathway for coagulation. Clot formation is initiated by adding calcium chloride to the mixture. Clotting time is measured photo-optically.

Phenytoin level

A blood test is performed to measure phenytoin total and phenytoin free levels. Phenytoin also known as Dilantin, Phenytek or Prompt, is an anticonvulsant prescribed to treat seizures and works by deceasing electrical activity in the brain. The drug may be administered orally or by injection. Phenytoin has a narrow therapeutic range and the patient should be monitored for both total and free phenytoin levels. Total phenytoin reflects the total serum concentration of the drug while free phenytoin levels reflect the unbound levels. Only the unbound levels are biologically active. Ninety (90) percent of the drug is typically highly bound and biologically inactive, but bound phenytoin is sensitive to displacement by other protein binding drugs which can elevate levels of free phenytoin in the blood. Blood concentration levels are monitored at regular intervals and also when breakthrough seizures occur, indicating possible low therapeutic levels. A blood sample is obtained by a separately reportable venipuncture. Blood serum is then tested using immunoassay.

Phosphate level

A blood or urine test is performed to measure inorganic phosphorus (phosphate) levels. Phosphate is an intracellular anion, found primarily in bone and soft tissue. It plays an important role in cellular energy (nerve and muscle function) and the building/repair of bone and teeth. Decreased levels are most often caused by malnutrition and lead to muscle and neurological dysfunction. Elevated levels may be due to kidney or parathyroid gland problems. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative spectrophotometry.

Procalcitonin (hormone) level

Prostate Cancer Screening Test

Prostate cancer screening; prostate specific antigen test (psa)

Protein Measurement, Serum

A blood test is performed to measure protein levels in serum. This test is often performed in conjunction with total protein to detect pathophysiologic states such as inflammation, gammopathies, and dysproteinemias. There are more sensitive tests available to detect these and similar disorders. A blood sample is obtained by separately reportable venipuncture. Serum is tested using electrophoretic fractionation and quantitation.

Red Blood Cells, Leukocytes Reduced, Each Unit

Red blood cells, leukocytes reduced, each unit

Red blood cell sedimentation rate, to detect inflammation

Rheumatoid factor analysis

Rheumatoid factor level

Lab test for Rheumatoid Arthritis factor

Screening Test for Red Blood Cell Antibodies

A blood sample is tested for antibodies directed against red blood cell (RBC) antigens other than A and B antigens. This test may also be referred to as an indirect antiglobulin test (IAT). This test is performed as part of a blood typing and screening test when it is anticipated that a blood transfusion might be required. If an antibody is detected, then separately reportable antibody identification is performed to identify the specific antibodies present. The test may be performed using IAT methodology or another serum technique such as solid phase. If multiple serum techniques are used, each reported separately.

Screening test for Pathogenic Organisms

This test is performed when a specific pathogen is suspected. A blood sample is taken and placed in a medium conducive to the growth of the suspected pathogen. Any colonies that grow in the medium are then examined.

Smear for Parasites

A stool sample is collected and observed under a microscope for signs of parasite or parasite eggs.

Special Stain for Microorganism; Gram or Glemsa Stain

A laboratory test is performed to identify bacteria, fungi, or cell types in pus, normally sterile body fluid(s), or aspirated material using Gram or Giemsa stain technique. Gram staining is a differential technique used to classify bacteria into gram positive (Gram +) or gram negative (Gram -) groups. Gram + bacteria have a thick layer of peptidoglycan in the cell wall which stains purple. Giemsa technique is used in cytogenetics for chromosome staining; in histopathology to detect trichomonas, some spirochetes, protozoans, malaria, and other parasites; and as a stain for peripheral blood and bone marrow to differentiate cells types such as erythrocytes, platelets, lymphocyte cytoplasm, monocyte cytoplasm, and leukocyte nuclear chromatin. A drop of suspended culture or cell material is applied in a thin layer to a slide using an inoculation hook and fixed with heat. The material is stained and the slide is examined under a microscope. The bacteria, fungi, or cells are identified, counted, and a written report of the findings is made.

Special stained specimen slides to examine tissue including interpretation and report

Stool Analysis for Blood

A fecal (stool) sample is obtained for colorectal neoplasm screening and tested for the presence of occult (hidden) blood by peroxidase activity. This test is also referred to as a fecal occult blood test (FOBT). Occult blood in a stool specimen is present in amounts too small to see with the naked eye, but becomes visible when chemical tests are performed. Guaiac is one type of chemical (reagent) test that can be performed to identify the presence of blood in the stool. If the test is performed in an office or hospital, the physician may obtain the sample during a rectal exam. If the test is performed at home, the patient is provided with a stool collection kit consisting of three cards or a single triple card. The patient obtains three consecutive stool specimens per the kit instructions. The stool specimens are then returned to the physician office or mailed to a laboratory. All three specimens are then tested using a chemical reagent for the presence of occult blood. A few drops of the chemical reagent are applied to each stool specimen. If blood is present, a color change will be detected on the card.

Stool culture - salmonella and shigella species

A stool sample is collected and placed in a medium conducive to the growth of bacteria. The culture is examined for the growth of Salmonella and Shigella bacteria.

Stool culture - additional pathogens

Strep Test

A direct optical test to detect Streptococcus Group A (Strep A) by immunoassay is a rapid, qualitative test performed using lateral flow immunoassay. Strep A causes acute upper respiratory infection with the most common symptoms being pharyngitis (sore throat) and fever. If left untreated serious complications can occur including rheumatic fever and glomerulonephritis. This type of test is a rapid, qualitative test performed using lateral flow immunoassay. A throat swab is obtained. Two reagents are added to extract Strep A antigen from the specimen. A dipstick is added to the extracted sample. If Strep A antigen is present the test line and a control line will change color indicating a positive test. Another method uses a throat swab specimen inserted into a test cassette. Antigen extraction solutions are then mixed in a separate chamber of the tube and added to the swab chamber. If Strep A is present, a test line will change color as will a second control line.

Syphilis Detection Test

A test for syphilis is performed. Syphilis is a sexually-transmitted disease (STD) caused by the bacterium Treponema pallidum. During the primary stage, a sore called a chancre appears at the site where the syphilis bacterium entered the body. The chancre resolves without treatment in 3-6 weeks but the patient remains infected. Without treatment, the infection will progress to a secondary stage in which a skin rash and mucous membrane lesions appear. The most common site of the rash is the palms of the hands and soles of the feet. Other symptoms during the secondary stage include fever, swollen lymph nodes, sore throat, hair loss, headaches, weight loss, muscle aches, and fatigue. Symptoms of secondary syphilis also resolve spontaneously but the patient remains infected. The patient then enters the late or latent stage of the disease. Symptoms of this stage may not appear for 10-20 years. Symptoms of late stage syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. These symptoms occur as the disease damages internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Of particular concern is undiagnosed syphilis infection during pregnancy as the infection can be passed to the baby in utero. This increases the risk of stillbirth or death shortly after birth. Untreated infants who survive often experience developmental delays or seizures. A qualitative syphilis test, such as the venereal disease research laboratory (VDRL) test, rapid plasma reagin (RPR) test, or automated reagin test (ART). The VDRL, RPR, ART are nontreponemal tests that measure antibody response to lipoidal antigen from T. pallidum and/or antibody interaction with host tissues. If a screening test is positive and the result is confirmed with a second confirmatory test, quantitative testing is then performed to determine disease activity and monitor response to treatment. Quantitative testing may be performed by enzyme linked immunosorbent assay (ELISA).

Tacrolimus Level

A blood test is performed to measure tacrolimus levels. Tacrolimus, also known as Prograf is an immunosuppressant drug that affects the ability of certain white blood cells in the body to recognize and respond to transplanted body organs such as kidney, liver, heart and lung. The drug is administered intravenously, either alone or in combination with other immunosuppressant drugs. Tacrolimus has a narrow therapeutic range and blood levels may be assessed daily at the start of therapy, taper to 1-2 times per week and finally to once every 1-2 months. For routine monitoring the specimen is collected as a trough level, immediately prior to a scheduled dose and at least 12 hours after the previous dose. A blood sample is obtained by a separately reportable venipuncture. Whole blood is then tested using liquid chromatography-tandem mass spectrometry. Prograf may be tested with chromatographic or immunoassay technique and the results will be somewhat different. Make note of the technique used when comparing results with previous levels.

Test for Influenza Virus

A quick test to detect influenza (Type A or B) by immunoassay with direct optical observation is performed. It is a rapid, qualitative test performed using lateral flow immunoassay. Influenza is an acute, highly contagious, viral upper respiratory infection. There are three types of influenza viruses delineated as Type A, B, or C with Type A being the most severe and prevalent type. Type B is generally less severe. Type C is the least common and is not associated with large human epidemics. Type A and B can both be detected by a rapid test. A nasal or nasopharyngeal swab is obtained. Alternatively nasal wash or aspirate may be used. The specimen is placed in a tube containting an extraction reagent that disrupts the virus particles in the specimen and exposes viral nucleoproteins. A test strip is then inserted into the tube. If the influenza virus being tested (Type A or B) is present, a line on the test strip will change color along with a control line.

Testosterone (hormone) level

A urine test is performed to measure total testosterone level. Testosterone is an androgen hormone secreted in the testes of men, ovaries of women, and the adrenal glands of both sexes. Testosterone helps promote protein synthesis and supports the growth of cells and tissue. This test is often performed in conjunction with sex hormone binding globulin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma of adult males is tested using quantitative electrochemiluminescent immunoassay with the value derived from a mathematical expression using sex hormone binding globulin (SHBG). Serum/plasma of adult males may also be tested using quantitative equilibrium dialysis/high performance liquid chromatography-tandem mass spectrometry. Serum/plasma of children and adult females is tested using quantitative high performance liquid chromatography-tandem mass spectrometry/electrochemiluminescent immunoassay with the value also derived from a mathematical expression using sex hormone binding globulin (SHBG).

Testosterone Level; Free

A blood test is performed to measure free testosterone levels. Testosterone is an androgen hormone secreted in the testes of men, ovaries of women, and the adrenal glands of both sexes. Testosterone helps promote protein synthesis and supports the growth of cells and tissue. This test is often performed in conjunction with sex hormone binding globulin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma of adult males is tested using quantitative electrochemiluminescent immunoassay with the value derived from a mathematical expression using sex hormone binding globulin (SHBG). Serum/plasma of adult males may also be tested using quantitative equilibrium dialysis/high performance liquid chromatography-tandem mass spectrometry. Serum/plasma of children and adult females is tested using quantitative high performance liquid chromatography-tandem mass spectrometry/electrochemiluminescent immunoassay with the value also derived from a mathematical expression using sex hormone binding globulin (SHBG).

Thyroxine (thyroid chemical) measurement - Free Thyroxine

A blood sample is obtained and levels of total thyroxin, thyroxine requiring elution as for testing in neonates or free thyroxine are evaluated. Thyroxine, also referred to as T4, is tested to determine whether the thyroid is functioning properly and is used to aid in the diagnosis of overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function. In free thyroxine levels are tested. Free thyroxine is the amount of active thyroxine in the blood. Free thyroxine levels are considered to be a more accurate indicator of thyroid function. All thyroxine tests use electrochemiluminescent immunoassay methodology.

Urea nitrogen level to assess kidney function

A blood sample is obtained to measure total (quantitative) urea nitrogen (BUN) level. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea then enters the bloodstream, is taken up by the kidneys and excreted in the urine. Blood BUN is measured to evaluate renal function, to monitor patients with renal disease, and to evaluate effectiveness of dialysis. BUN may also be measured in patients with acute or chronic illnesses that affect renal function. BUN is measured using spectrophotometry.

Uric acid level, blood

A blood test is performed to measure uric acid levels. Uric acid forms from the natural breakdown of body cells and the food we ingest. Uric acid is normally filtered by the kidneys and excreted in urine. Elevated blood levels may result from kidney disease, certain cancers and/or cancer therapies, hemolytic or sickle cell anemia, heart failure, cirrhosis, lead poisoning, and low levels of thyroid or parathyroid hormones. Levels may be decreased in Wilson's disease, poor dietary intake of protein, and with the use of certain drugs. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative spectrophotometry.

Urinalysis with Examination, using Microscope

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Urinalysis, Automated Test

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Urinalysis, Manual Test

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Urine Pregnancy Test

Pregnancy tests detect the presence of human chorionic gonadotropin (hCG) in the urine. HCG is produced by the placenta and can be detected in urine shortly after the embryo attaches to the uterine lining. The test may be performed by collecting a urine specimen and dipping a stick treated to detect the presence of hCG in the urine. The presence of hCG is indicated by a color change in the treated section of the dipstick indicating a positive pregnancy test. If no color change occurs, the test is negative.

Urine microalbumin (protein) level

A test on urine is used to measure microalbumin levels and is routinely performed annually on diabetic patients with stable blood glucose levels to assess for early onset nephropathy. The quantitative test, which measures the actual amount of microalbumin present in the urine, may be performed on a random urine sample, with a notation of total volume and voiding time, or a 24-hour urine sample using immunoturbidimetric technique. The semi-quantitative test identifies the presence of elevated microalbumin levels in the urine within a general range and involves a chemical dipstick placed into the urine sample which reacts and changes color when albumin is present.

Valproic acid level

A laboratory test is performed to measure valproic acid (dipropylacetic acid, depakote). Valproic acid is an anticonvulsant that may be used to treat seizure disorders, manic phase of bipolar disorders, and migraine headaches. The drug works by changing certain chemicals neurotransmitters in the brain. The test for total valproic acid can be used to monitor drug therapy, assess patient compliance, and evaluate for potential toxicity. The test for free valproic acid may be used to evaluate the cause of toxicity when the total valproic acid concentration is within the normal range. Free valproic acid may be elevated in patients with an altered or unpredictable protein binding capacity. A blood sample is obtained by separately reportable venipuncture just prior to medication administration to obtain the trough level. Serum/plasma is tested for total valproic acid using fluorescence polarization immunoassay and for free valproic acid using quantitative enzyme multiplied immunoassay.

Vancomycin (antibiotic) level

A blood test is performed to measure vancomycin levels at random, peak and trough times. Vancomycin, also known as Vancocin is a glycopeptide antibiotic prescribed to treat severe or serious bacterial infections. For systemic infections it is administered by intravenous infusion. For intestinal infections such as colitis or clostridium difficile it is taken orally. Blood level monitoring is necessary because the drug has the potential to cause auditory toxicity. A random sample may be drawn any time, peak and trough levels are time dependant and are usually drawn 24 hours after initiating therapy and every 2-3 days thereafter. A trough level is drawn 10 minutes prior to intravenous infusion. A peak level is drawn 1-2 hours after intravenous infusion is complete. A blood sample is obtained by separately reportable venipuncture. Blood serum is then tested using fluorescence polarization immunoassay.

Vitamin D-3 Level

Blood levels of 25-hydroxyvitamin D are used to primarily to determine whether a deficiency of Vitamin D or abnormal metabolism of calcium is the cause of bone weakness or malformation. Vitamin D is a fat soluble vitamin that is absorbed from the intestine like fat, and 25-hydroxyvitamin D levels are also evaluated in individuals with conditions or diseases that interfere with fat absorption, such as cystic fibrosis, Crohn's disease, or in patients who have undergone gastric bypass surgery. A blood sample is obtained. Levels of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 are evaluated using chemiluminescent immunoassay. The test results may be the sum of Vitamin D3 and D2 or the results may include fractions of D3 and D2 as well as the sum of these values.

White blood cell measure, stool specimen

Application of mechanical traction to 1 or more areas

Heart rhythm analysis, interpretation and report of 48-hour EKG

Hydration Infusion into a Vein

An intravenous infusion is administered for hydration. An intravenous line is placed into a vein, usually in the arm, and fluid is administered to provide additional fluid levels and electrolytes to counteract the effects of dehydration or supplement deficient oral fluid intake. The physician provides direct supervision of the fluid administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment. Use 96360 for the initial 31 minutes to one hour of hydration. Use 96361 for each additional hour.

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

An intravenous infusion is administered for hydration. An intravenous line is placed into a vein, usually in the arm, and fluid is administered to provide additional fluid levels and electrolytes to counteract the effects of dehydration or supplement deficient oral fluid intake. The physician provides direct supervision of the fluid administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment.

Infusion (Additional) for Therapy, Diagnosis or Prevention

An intravenous infusion of a specified substance or drug is administered for therapy, prophylaxis, or diagnosis. An intravenous line is placed into a vein, usually in the arm, and the specified substance or drug is administered. The physician provides direct supervision of the administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment.

Infusion into a Vein for Therapy, Diagnosis, or Prevention

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

An intravenous infusion of a specified substance or drug is administered for therapy, prophylaxis, or diagnosis. An intravenous line is placed into a vein, usually in the arm, and the specified substance or drug is administered. The physician provides direct supervision of the administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment.

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

A subcutaneous or intramuscular injection of a therapeutic, prophylactic, or diagnostic substance or drug is given. A subcutaneous injection is administered just under the skin in the fatty tissue of the abdomen, upper arm, upper leg, or buttocks. The skin is cleansed. A two-inch fold of skin is pinched between the thumb and forefinger. The needle is inserted completely under the skin at a 45 to 90 degree angle using a quick, sharp thrust. The plunger is retracted to check for blood. If blood is present, a new site is selected. If no blood is present, the medication is injected slowly into the tissue. The needle is withdrawn and mild pressure is applied. An intramuscular injection is administered in a similar fashion deep into muscle tissue, differing only in the sites of administration and the angle of needle insertion. Common sites include the gluteal muscles of the buttocks, the vastus lateralis muscle of the thigh, or the deltoid muscle of the upper arm. The angle of insertion is 90 degrees. Intramuscular administration provides rapid systemic absorption and can be used for administration of relatively large doses of medication.

Injection of Same Drug into Vein for Therapy or Diagnosis

A therapeutic, prophylactic, or diagnostic injection is administered by intravenous push (IVP) technique. The specified substance or drug is injected using a syringe directly into an injection site of an existing intravenous line or intermittent infusion set (saline lock). The injection is given over a short period of time, usually less than 15 minutes.

Irrigation of implanted venous access drug delivery device

Multiple measurements of oxygen saturation in blood using ear or finger device

Sleep monitoring of patient (6 years or older) in sleep lab

Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk each 15 minu

Vein Infusion for Therapy, Prevention or Diagnosis, Concurrent with Another Infusion

An intravenous infusion of a specified substance or drug is administered for therapy, prophylaxis, or diagnosis. An intravenous line is placed into a vein, usually in the arm, and the specified substance or drug is administered. The physician provides direct supervision of the administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment.

Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

Diabetes outpatient self-management training services, individual, per 30 minutes

Injection, gadobenate dimeglumine (multihance), per ml

Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries

Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries

Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf

Administration of 1 Vaccine

A single vaccine or a combination vaccine/toxoid is administered by injection to a patient over age 18 with or without a face-to-face encounter with the physician or other health care professional. These codes are also used when a vaccine/toxoid is given to a patient age 18 or younger without any face-to-face counseling by the physician or other health care professional. Routes of administration include percutaneous, intradermal, subcutaneous, or intramuscular.

Injection of Drug or Substance into Vein for Therapy or Diagnosis

A therapeutic, prophylactic, or diagnostic injection is administered by intravenous push (IVP) technique. The specified substance or drug is injected using a syringe directly into an injection site of an existing intravenous line or intermittent infusion set (saline lock). The injection is given over a short period of time, usually less than 15 minutes.

Injection of New Drug into Vein for Therapy or Diagnosis

A therapeutic, prophylactic, or diagnostic injection is administered by intravenous push (IVP) technique. The specified substance or drug is injected using a syringe directly into an injection site of an existing intravenous line or intermittent infusion set (saline lock). The injection is given over a short period of time, usually less than 15 minutes.

Injection, Cefazolin Sodium, 500 mg

Injection, cefazolin sodium, 500 mg

Injection, Ceftriaxone Sodium, per 250 mg

Injection, ceftriaxone sodium, per 250 mg

Injection, Diphenhydramine HCL, up to 50 mg

Injection, diphenhydramine hcl, up to 50 mg

Injection, Fentanyl Citrate, 0.1 mg

Injection, fentanyl citrate, 0.1 mg

Injection, Furosemide, up to 20 mg

Injection, furosemide, up to 20 mg

Injection, Heparin Sodium, per 1000 Units

Injection, heparin sodium, per 1000 units

Injection, Hydromorphone, Up to 4 mg

Injection, hydromorphone, up to 4 mg

Injection, Lorazepam, 2 mg

Injection, lorazepam, 2 mg

Injection, Methylprednisolone Sodium Succinate, up to 125 mg

Injection, methylprednisolone sodium succinate, up to 125 mg

Injection, Metoclopramide HCL, Up to 10mg

Injection, metoclopramide hcl, up to 10 mg

Injection, Midazolam Hydrochloride, per 1 mg

Injection, midazolam hydrochloride, per 1 mg

Injection, Morphine Sulfate, up to 10 mg

Injection, morphine sulfate, up to 10 mg

Injection, Vancomycin HCL, 500 mg

Injection, vancomycin hcl, 500 mg

Injection, epoetin alfa, (for non-esrd use), 1000 units

Injection, ertapenem sodium, 500 mg

Injection, lidocaine hcl for intravenous infusion, 10 mg

Injection, methylprednisolone acetate, 40 mg

Injection, methylprednisolone acetate, 80 mg

Injection, perflutren lipid microspheres, per ml

Injection, zoledronic acid, 1 mg

Tetanus Vaccine

Toxoids provide long lasting immunity by stimulating the body's own defense system to make antibodies that destroy specific toxins produced by bacteria. Vaccines also provide active, long-term immunity by exposing the recipient's immune system to altered versions of specific viruses or bacteria that induce the immune system to produce its own antibodies against the invading micro-organism. The body then remembers how to make antibodies when exposed to these same agents again. The toxoid vaccine is an inactivated poison, called a toxin, produced by culturing the bacteria in a liquid medium, then purifying and inactivating the poison produced by the bacteria. Since toxoids are not a live vaccine, booster doses are recommended because immunity will decline over time. These tetanus toxoid combinations are formulations for adults and those over 7 years of age, given by intramuscular injection.

Arterial Puncture

The radial artery is the most common site for arterial puncture with alternative sites being the axillary and femoral arteries. The arterial puncture site is selected. The skin is prepped for sterile entry. The selected artery is punctured and the necessary blood samples obtained for separately reportable laboratory studies. The needle is withdrawn and pressure applied to the puncture site.

CO Diffusion Capacity

The diffusing capacity of the lungs using carbon monoxide (CO) measures the ability of the lungs to transfer gas from inhaled air across the alveolar-capillary membrane to the red blood cells. This test is performed in conjunction with other separately reportable pulmonary function tests to determine whether lung restriction is due to parenchymal (intrapulmonary, interstitial) disease or to decreased cardiac output (extrapulmonary). The patient breathes all the way out. The patient then breathes in through the mouthpiece of the diffusion capacity testing device which delivers a gas mixture containing 0.3 percent CO, 10 percent Helium, 21 percent oxygen and 68.7 percent nitrogen. When total lung capacity is reached, the patient holds his/her breath for 10 seconds. The patient then breathes out, expelling the gas that has been in the dead space (mouth, trachea, and two main bronchi), which is discarded. The remainder of the gas is exhaled and collected. The amount of the various exhaled gases in the sample is then analyzed and diffusing capacity is evaluated. The physician reviews the test results and provides a written report of findings.

Nebulizer Treatment

The patient is placed on intermittent inhalation treatment for acute airway obstruction or to induce sputum production for therapeutic and/or diagnostic purposes. To treat acute airway obstruction, pressurized or nonpressurized bronchodilator medication is delivered for short intervals several times a day using an inhaler, nebulizer, aerosol generator, or an intermittent positive pressure breathing (IPPB) device. Bronchodilator medication is suspended as fine particles within a gaseous propellant and taken into the lungs as a fine spray. The medication acts to relax the smooth muscle of the bronchioles and lung tissue, which has constricted in conditions such as an asthma attack or hypersensitivity reaction, severely restricting air flow. The patient uses the prescribed pressurized or nonpressurized inhalation device as directed by the physician typically for 10-15 minutes several times during the day. To induce sputum production for diagnostic purposes, an isotonic or hypertonic solution is delivered using a nebulizer or other device. These solutions induct secretion of sputum in the lower airways. The patient must cough to expectorate the secretions which are collected in a sterile container and sent to the laboratory for separately reportable analysis.

Pulse Oximetry

Ear or pulse oximetry measures the percentage of hemoglobin (Hb) that is saturated with oxygen and is used to monitor oxygen saturation of blood and detect lower than normal levels of oxygen in the blood. Oximeters also record pulse rate and provide a graphical display of blood flow past the probe. A probe is attached to the patient's ear lobe or finger. The probe is connected to a computerized unit. A light source from the probe is emitted at two wavelengths. The light is partially absorbed by Hb in amounts that differ based on whether the Hb is saturated or desaturated with oxygen. The absorption of the two wavelengths is then computed by the oximeter processer and the percentage of oxygenated Hb is displayed. The oximeter can be programmed to sound an audible alarm when the oxygen saturation of blood falls below a certain level.

Thoracic Gas Volume

Lung volume plethysmography is performed to determine the maximum volume of air that the lungs can hold. The test is performed in a small airtight room called a body box. Clips are placed on the nose to prevent air from entering the nostrils. The patient then breathes and/or pants into a mouthpiece that is in an open position. If airway resistance is measured, the patient then breathes and/or pants into a closed mouthpiece. As the chest moves during breathing or panting, the pressure and amount of air in the room and against the mouthpiece is measured. Changes in these variables allow the physician to measure lung volume with an open mouthpiece and airway resistance with a closed mouthpiece. The physician analyzes the test results and provides a written report of findings.

Technetium tc-99m sestamibi, diagnostic, per study dose

Application of Short Arm Splint

A static splint is applied to stabilize an injury by decreasing movement and providing support to the posterior aspect of the forearm, wrist, and hand. A stockinette is applied over the arm from the elbow to the wrist followed by padding over the stockinette. Plaster sheets cut to the appropriate length are then immersed in water and saturated. Excess water is gently squeezed out of the plaster. The plaster is applied to the posterior aspect of the forearm, wrist, and hand. The plaster is smoothed and molded. An elastic bandage is wrapped around the arm to secure the splint. The forearm may be placed in a sling.

Biopsy of Large Bowel, Using an Endoscope

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.

Biopsy of prostate gland

Biopsy of the Esophagus, Stomach, Using an Endoscope

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.

Colonscopy

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.

Colorectal Cancer Screening; Colonoscopy on Non-High Risk Patient

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

Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope

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.

Epidural Injection Thoracic

Removal of cataract with insertion of lens

Gallbladder Removal Using an Endoscope

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.

Injection of anesthetic and/or steroid into lower spine nerve root using imaging

Injection of substance into spinal canal or lower back using imaging

Insertion of Indwelling Bladder Catheter

A temporary indwelling catheter is inserted into the bladder. This may be referred to as Foley catheterization. A catheter kit is prepared. The urethra is cleansed with antiseptic solution. A sterile Foley catheter is inserted through the urethra into the bladder. The balloon is then inflated with about 10 cc of water to keep it in place. The catheter is attached to a sterile drainage bag and urine is continuously drained from the bladder.

Insertion of Needle into Vein to Collect Blood

An appropriate vein is selected, usually one of the larger anecubital veins such as the median cubital, basilic, or cehalic veins. A tourniquet is placed above the planned puncture site. The site is disinfected with an alcohol pad. A needle is attached to a hub and the vein is punctured. A Vacuainer tube is attached to the hub and the blood specimen is collected. The Vacutainer tube is removed. Depending on the specific blood tests required, multiple Vacutainers may be filled from the same punchture site.

Removal of one knee cartilage using an endoscope

Colonoscopy with removal of polyp(s)

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.

Removal of skin and tissue

Removal of skin and tissue first 20 sq cm or less

Repair of groin hernia patient age 5 years or older

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.

Ultrasound measurement of bladder capacity after voiding

Bone Density Scan (DEXA Scan)

These codes report dual-energy x-ray absorptiometry (DXA) for bone density study. Measuring bone mass or bone mineral density (BMD) is done to diagnose for bone disease, evaluate bone disease progression, or monitor the results of treatment, particularly for osteoporosis, which puts a bone at higher risk of fracture. The radiation dose of DXA is around 1/30th of that in a standard chest x-ray. DXA involves aiming two x-ray beams of different energy levels at the bones in alternate pulses. Soft tissue absorption is subtracted out, and the BMD is determined by the bone's absorption of each beam in the projected area. The DXA scan measurement is then compared to a same sex standard of bone density at age 30, since the maximum BMD occurs at age 30 in both males and females. The difference between the measured BMD and the sex-matched, average 30-year-old standard is known as the T score. A T score between -1.0 and -2.4 diagnoses osteopenia, while a T score of -2.5 or less indicates osteoporosis.

Breast Ultrasound - Limited

A real time ultrasound of the right or left breast is performed with image documentation, including the axillary area, when performed. Breast ultrasound is used to help diagnose breast abnormalities detected during a physical exam or on mammography. Ultrasound imaging can identify masses as solid or fluid-filled and can show additional structural features of the abnormal area and surrounding tissues. The patient is placed supine with the arm raised above the head on the side being examined. Acoustic coupling gel is applied to the breast and the transducer is pressed firmly against the skin of the breast. The transducer is then swept back and forth over the area of the abnormality and images are obtained. The ultrasonic wave pulses directed at the breast are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the breast and provides a written interpretation.

CT Abdomen & Pelvis with Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

CT Abdomen & Pelvis with and without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

CT Abdomen & Pelvis without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

CT Angiogram Abdomen & Pelvis with and without Contrast

Computed tomographic angiography (CTA) provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images of the abdomen and pelvis are obtained as needed. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA of the abdomen and pelvis is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the blood vessels of the abdomen and pelvis.

CT Angiogram Chest with and without Contrast

A computed tomographic angiography (CTA) of the noncoronary vessels of the chest is performed with contrast material including image postprocessing. Noncontrast images may also be obtained and are included when performed. CTA provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images may be obtained. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the noncoronary vessels of the chest.

CT Head Brain without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the head or brain is performed. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

CT Pelvis with Contrast

Diagnostic computed tomography (CT) is done on the pelvis to provide detailed visualization of the organs and structures within or near the pelvis, such as kidneys, bladder, prostate, uterus, cervix, vagina, lymph nodes, and pelvic bones. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of organs within the pelvis can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the pelvis area. The physician reviews the images to gather information for specified purposes such as diagnosing or monitoring cancer, evaluating the pelvic bones for fractures or other injury following trauma, locating abscesses or masses found during physical exam, finding the cause of pelvic pain, providing more detailed information before surgery, and evaluating the patient after surgery.

CT Pelvis without Contrast

Diagnostic computed tomography (CT) is done on the pelvis to provide detailed visualization of the organs and structures within or near the pelvis, such as kidneys, bladder, prostate, uterus, cervix, vagina, lymph nodes, and pelvic bones. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of organs within the pelvis can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the pelvis area. The physician reviews the images to gather information for specified purposes such as diagnosing or monitoring cancer, evaluating the pelvic bones for fractures or other injury following trauma, locating abscesses or masses found during physical exam, finding the cause of pelvic pain, providing more detailed information before surgery, and evaluating the patient after surgery.

CT Spine Cervical without Contrast

Diagnostic computed tomography (CT) is done on the cervical spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the cervical spine.

CT Spine Lumbar without Contrast

Diagnostic computed tomography (CT) is done on the lumbar spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the lumbar spine. The physician reviews the images to look for suspected problems with the spine such as bone disease, and evaluate for fractures or other injuries as well as birth defects of the spine in children.

Chest X-Ray; 2 Views

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.

Chest X-Ray; Single View

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.

Diagnostic mammography, bilateral

These codes report diagnostic mammography of one breast or both breasts with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength that those typically used for bone imaging. The test is done to detect tumors or cysts in women who have symptoms of breast disease or a palpable mass. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Diagnostic mammography, unilateral

These codes report diagnostic mammography of one breast or both breasts with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength that those typically used for bone imaging. The test is done to detect tumors or cysts in women who have symptoms of breast disease or a palpable mass. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Imaging of Abdomen and Chest

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.

Imaging of Abdomen; 2 Views

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.

Imaging of Abdomen; Single View

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.

Imaging of Liver and Bile Duct System with Use of Drugs

Hepatobiliary system nuclear imaging tracks the production and flow of bile from the liver to the small intestine using a radioactive tracer that highlights the liver, bile ducts, and gallbladder if the gallbladder has not been surgically removed. This procedure may also be referred to as a HIDA scan which stands for hepatobiliary iminodiacetic acid scan. The procedure is performed to evaluate liver function, specifically bile production and excretion, and to evaluate the drainage system (bile ducts) and gallbladder for obstruction, inflammation, or other abnormalities. An intravenous catheter is placed. The radioactive tracer is injected. A gamma camera travels back and forth over the abdomen and multiple images are obtained as the radioactive tracer flows through the bloodstream and is taken up by the bile-producing cells in the liver. Images are obtained continuously as the radioactive tracer, which is now contained in the bile, travels from the liver through the biliary ducts into the gallbladder, and then from the gallbladder through the common bile duct into the duodenum. The patient is monitored throughout the procedure. Upon completion, the physician reviews the images and provides a written report of findings. The procedure is performed as described above except that during the procedure additional medications are administered. These medications may be given to enhance the gallbladder images or to trigger the gallbladder to empty. The physician may also perform a test called gallbladder ejection fraction which is a measurement of the rate at which bile is released from the gallbladder.

MRI Abdomen with and without Contrast

Magnetic resonance imaging is done on the abdomen. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the abdomen. MRI is often done for trauma and suspected internal injury, and unexplained abdominal pain, swelling, and fever. MRI scans provide clear images of areas that may be difficult to see on CT. The physician reviews the images to look for information that may correlate to the patient's signs or symptoms, such as the location of tumors, abscesses, or masses; the presence of kidney stones, hernias, appendicitis or other infections, and internal injury.

MRI Arm Joint without Contrast

Magnetic resonance imaging is done on a joint of the upper or lower arm. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the joint. MRI scans on joints of the upper extremity are often done for injury, trauma, unexplained pain, redness, or swelling, and freezing of a joint with loss of motion. MRI scans provide clear images of areas that may be difficult to see on CT.

MRI Brain with and without Conrast

Magnetic resonance imaging is done on the brain. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. MRI of the brain provides reliable information for diagnosing the presence, location, and extent of tumors, cysts, or other masses; swelling and infection; vascular disorders or malformations, such as aneurysms and intracranial hemorrhage; disease of the pituitary gland; stroke; developmental and structural anomalies of the brain; hydrocephalus; and chronic conditions and diseases affecting the central nervous system such as headaches and multiple sclerosis.

MRI Brain without Contrast

Magnetic resonance imaging is done on the brain. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. MRI of the brain provides reliable information for diagnosing the presence, location, and extent of tumors, cysts, or other masses; swelling and infection; vascular disorders or malformations, such as aneurysms and intracranial hemorrhage; disease of the pituitary gland; stroke; developmental and structural anomalies of the brain; hydrocephalus; and chronic conditions and diseases affecting the central nervous system such as headaches and multiple sclerosis.

MRI Leg Joint without Contrast

Magnetic resonance imaging is done on a joint of the upper or lower leg. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the joint. MRI scans on joints of the lower extremity are often done for injury, trauma, unexplained pain, redness, or swelling, and freezing of a joint with loss of motion. MRI scans provide clear images of areas that may be difficult to see on CT. The physician reviews the images to look for information that may correlate to the patient's signs or symptoms. MRI provides reliable information on the presence and extent of tumors, masses, or lesions within the joint; infection, inflammation, and swelling of soft tissue; muscle atrophy and other anomalous muscular development; and joint effusion and vascular necrosis.

MRI Spine Cervical without Contrast

Magnetic resonance imaging (MRI) is done on the cervical spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and converts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery.

MRI Spine Lumbar without Contrast

Magnetic resonance imaging (MRI) is done on the lumbar spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and coverts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back pain is unsuccessful and more aggressive treatments are considered or following surgery. The physician reviews the images to look for specific information that may correlate to the patient's symptoms, such as abnormal spinal alignment; disease or injury of vertebral bodies; intervertebral disc herniation, degeneration, or dehydration; the size of the spinal canal to accommodate the cord and nerve roots; pinched or inflamed nerves; or any changes since surgery.

MRI Spine Thoracic without Contrast

Magnetic resonance imaging (MRI) is done on the thoracic spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and converts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery.

Myocardial Perfusion, Tomographic

Myocardial perfusion imaging is a nuclear medicine procedure used to evaluate the heart muscle and blood flow to the heart. An intravenous line is inserted into a vein in the hand or arm. ECG leads are placed and a blood pressure cuff is placed on the arm. The patient lies flat on a table in the procedure room for myocardial perfusion imaging performed at rest. For a stress study, the patient is either on a treadmill or bike or an injection of a pharmacologic agent is administered to stress the heart. A radionuclide, also called a tracer, is injected into the intravenous line and allowed to circulate. The radionuclide localizes in healthy heart tissue. Ischemic heart tissue does not absorb the radionuclide. Images of the heart and great vessels are obtained using single photon emission computed tomography (SPECT). When SPECT images are obtained, the scanner rotates around the body to obtain images in multiple planes. The physician evaluates heart wall motion to determine how effective the heart muscle is in pumping blood through the heart and to the peripheral vascular system. Ejection fraction, which is the percentage of blood pumped out of the heart to the peripheral vascular system, is measured using either a first pass or gated technique. In a first pass technique, images are obtained as the blood circulates through the heart during the first pass of the radionuclide. In a gated technique, a series of images are obtained between heart beats. Using electrical signals from the heart, the camera captures a series of images as the heart rests, creating very sharp, high resolution images. Additional images are obtained as needed. The physician reviews the images, calculates the ejection fraction and quantifies other parameters of heart function based on the distribution of the radionuclide. The physician then provides a written report of findings.

Screening Mammography, Bilateral, with CAD

Bilateral screening mammography is done with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength than those typically used for bone imaging. A screening mammogram is done on asymptomatic women for early breast cancer detection when there are no known palpable masses. This is done on both breasts with two views taken on each side. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography

Ultrasound Abdomen - Complete

A real time abdominal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained. The ultrasonic wave pulses directed at the abdomen are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the abdomen and provides a written interpretation.

Ultrasound Abdomen - Limited

A real time abdominal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained. The ultrasonic wave pulses directed at the abdomen are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the abdomen and provides a written interpretation.

Ultrasound Behind Abdominal Cavity - Complete

A real time retroperitoneal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained of the retroperitoneal area. The ultrasonic wave pulses directed at the retroperitoneum are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the retroperitoneum and provides a written interpretation.

Ultrasound Blood Flow Outside the Brain

A vascular ultrasound study is performed to evaluate the extracranial arteries which include the common carotid and external carotid arteries. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin over the arteries to be studied. A B-mode transducer is placed on the skin and real-time images of the artery are obtained. A Doppler probe within the B-mode transducer provides information on pattern and direction of blood flow in the artery. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the arteries when the probe is placed over the arteries at various locations and angles. The Doppler probe produces sound waves that bounce off blood cells moving within the artery. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function, including information on the presence of narrowing and plaque formation within the arteries. The physician reviews the duplex scan and provides a written interpretation of findings.

Ultrasound Head Neck

An ultrasound examination of soft tissues of the head and neck is performed with image documentation. The thyroid, parathyroid, or parotid glands and surrounding soft tissue may be examined. Ultrasound visualizes the body internally using sound waves far above human perception bounce off interior anatomical structures. As the sound waves pass through different densities of tissue, they are reflected back to the receiving unit at varying speeds and converted into pictures displayed on screen. A linear scanner or mechanical sector scanner is used to evaluate the shape, size, border, internal architecture, distal enhancement, color flow, and echogenicity of the soft tissue structures of the head and neck as well as any lesions or masses. The echogenicity is compared to that of the surrounding muscle tissue. The physician reviews the images and provides a written interpretation.

Ultrasound Heart

The physician performs complete transthoracic real-time echocardiography with image documentation (2-D) including M-mode recording, if performed, with spectral Doppler and color flow Doppler echocardiography. Cardiac structure and dynamics are evaluated using a series of real-time tomographic images with multiple views recorded digitally or on videotape. Time-motion (M-mode) recordings are made as needed to allow dimensional measurement. Blood flow and velocity patterns within the heart, across valves and within the great vessels are evaluated by color flow Doppler. Normal blood flow patterns through these regions have a characteristic pattern defined by direction, velocity, duration, and timing throughout the cardiac cycle. Spectral Doppler by pulsed or continuous wave technique is used to evaluate antegrade flow through inflow and outflow tracts and cardiac valves. Multiple transducer positions or orientations may be required. The physician reviews the echocardiography images and orders additional images as needed to allow evaluation of any abnormalities. Digital or videotaped images are then reviewed by the physician. Abnormalities of cardiac structure or dynamics are noted. The extent of the abnormalities is evaluated and quantified. Any previous cardiac studies are compared to the current study and any quantitative or qualitative changes are identified. The physician provides an interpretation of the echocardiography with a written report of findings.

Ultrasound Pelvis NonOB

A real time pelvic (non-obstetric) ultrasound is performed with image documentation to evaluate the uterus and cervix, ovaries, fallopian tubes, and bladder. Conditions evaluated include pelvic pain, abnormal bleeding, and palpable masses, such as ovarian cysts, uterine fibroids, or other pelvic masses. The patient presents with a full bladder. Acoustic coupling gel is applied to the skin of the lower abdomen. The transducer is pressed firmly against the skin and swept back and forth over the lower abdomen and images obtained of the uterus, ovaries, and surrounding pelvic structures. The ultrasonic wave pulses directed at the pelvic structures are imaged by recording the ultrasound echoes. Any abnormalities are evaluated. The physician reviews the ultrasound images and provides a written interpretation.

Ultrasound Pelvis through Vagina

A transvaginal ultrasound is performed to evaluate the non-pregnant uterus and other pelvic structures. Conditions that may be evaluated by transvaginal ultrasound include infertility, abnormal bleeding, unexplained pain, congenital anomalies of the ovaries and uterus, ovarian cysts and tumors, pelvic inflammatory disease, bladder abnormalities, and intrauterine device (IUD) location. The patient is asked to empty the bladder and then lies back with the feet in stirrups. A protective cover is placed over the transducer and acoustic coupling gel is applied. The transducer is inserted into the vagina. Images of the uterus, ovaries, and surrounding pelvic structures are obtained from different orientations of the transducer. The ultrasonic wave pulses directed at the pelvic structures are imaged by recording the ultrasound echoes. The uterus is examined and endometrial thickness is determined. The ovaries are examined and any ovarian masses are carefully evaluated. The bladder and other pelvic structures are examined and any abnormalities are noted. The physician reviews the transvaginal ultrasound images and provides a written interpretation.

Ultrasound Veins of Both Arms or Legs

A vascular ultrasound study is performed to evaluate veins in the extremities. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin of the extremity over the region to be studied. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied. The Doppler probe produces sound waves that bounce off blood cells moving within the veins. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The duplex scan may include a baseline evaluation followed by additional scans obtained with compression or using other maneuvers that alter blood flow. The physician reviews the duplex scan and provides a written interpretation of findings.

Ultrasound Veins of One Arm or Leg

A vascular ultrasound study is performed to evaluate veins in the extremities. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin of the extremity over the region to be studied. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied. The Doppler probe produces sound waves that bounce off blood cells moving within the veins. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The duplex scan may include a baseline evaluation followed by additional scans obtained with compression or using other maneuvers that alter blood flow. The physician reviews the duplex scan and provides a written interpretation of findings.

Whole Body Bone Scan

Bone and/or joint imaging using scintigraphy and a radiolabeled isotope tracer may be performed on patients who have unexplained skeletal pain suggestive of bone loss, infection, inflammation, or injury and traditional radiographics (planar x-rays) have failed to provide a diagnosis. An intravenous line is established and the radiolabeled isotope tracer is injected directly into the circulatory system. When inflammation is suspected, a blood sample is drawn and centrifuged to separate white blood cells (WBCs), which are then tagged with radioactive calcium and injected back into the patient. After a prescribed period of time, the patient is positioned on the imaging table with the gamma camera over the body. Scanning is performed at specific intervals and the radioactive energy emitted is converted into an image. The physician interprets the bone and/or joint imaging study and provides a written report of the findings.

X-Ray Ankle, 3 Views

A radiologic examination of the ankle images the bones of the distal lower extremities including the tibia, fibula, and talus. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Ankle x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the ankle include front to back anteroposterior (AP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

X-Ray Both Hips and Pelvis, 2 Views

A radiologic examination is done on both the left and the right hip, which may also include the pelvis. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, infection, or tumor. Hip standard views that are taken most frequently include the front to back anteroposterior view taken with the patient lying supine and the legs straight, rotated slightly inward; the lateral ‘frog-leg’ view, taken with the hips flexed and abducted and the knees flexed with the soles of the feet placed together; a cross table view with the unaffected hip and knee flexed at a 90 degree angle out of the way and the beam aimed perpendicular to the long axis of the femur on the affected side. Another type of lateral view is taken with the hip flexed 45 degrees and abducted 45 degrees and the beam aimed perpendicular to the table. A front to back view of the hips in a pelvic view is often taken with the patient supine and both legs rotated slightly inward about 15 degrees.

X-Ray Elbow, 3 Views

A radiologic examination of the elbow is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. X-rays of the elbow are usually considered necessary to assess for fractures or dislocations when the normal range of motion for extension, flexion, supination, and pronation cannot be carried out. Most acute disruptions of the elbow joint can be diagnosed by conventional x-ray examination, with the minimum number of views including the front to back anteroposterior projection with the elbow in as full extension as possible, and the side, or lateral image taken in flexion. A complete series of images also includes an oblique view of the radial head-capitellar image to help diagnose suspected subtle fractures involving the radial head or in cases of acute pain and trauma. The patient needs to be able to hold the elbow in full extension for the front view and in 90 degree flexion for the oblique and lateral views as much as possible.

X-Ray Femus, 2 Views

A radiologic examination of the femur is done between the hip and the knee. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, and cysts or tumors. X-rays may also be used to determine whether the femur is in satisfactory alignment following fracture treatment. Femur standard views that are taken most frequently include the front to back anteroposterior view and the lateral view from the side.

X-Ray Fingers, 2 Views

A radiologic examination of the finger(s) is done with at least 2 different projections taken. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, interphalangeal (IP) joint dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, or tumors. The posteroanterior projection is taken with the palm down flat, fingers extended, and slightly apart to show the metacarpals, phalanges, and IP joints of the target finger(s). Anteroposterior views are taken with the back of the hand placed on the film and the x-ray beam going from palmar to dorsal direction. Lateral views are taken with the ulnar side of the hand on the film cassette and the fingers spread apart to avoid overlap, sometimes supported from underneath. Oblique views can be obtained with the hand placed palm down and the radial side rotated 45 degrees up away from the surface, with the fingers extended and spread apart.

X-Ray Foot, 3 Views

A radiologic examination of the foot images the bones of the distal lower extremity and may include the tibia, fibula, talus, calcaneus, cuboid, navicular, cuneiform, metatarsals, and phalanges. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Foot x-rays may also be used to determine whether there is satisfactory alignment of foot bones following fracture treatment. Standard views of the foot include top to bottom dorsal planter (DP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

X-Ray Forearm, 2 Views

A radiologic examination of the forearm is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Frontal views, or back to front (PA) views and lateral views are necessary to show the radius and ulna and assess the extent and direction of injury. Since the radius and ulna are anatomically connected at both ends of the bones with ligaments, the two bones function in a manner that makes the forearm considered as a single unit when assessing injury. The two standard views taken for x-ray examination of the forearm include the anteroposterior (AP) view, and the lateral view.

X-Ray Hand, 3 Views

A radiologic examination of the hand is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, or tumors. Hand x-rays are also used to help determine the 'bone age' of children and assess whether any nutritional or metabolic disorders may be interfering with proper development. The posteroanterior projection is taken with the palm down flat and may show not only the metacarpals, phalanges, and interphalangeal joints, but the carpal bones, radius, and ulna as well. Lateral views may be taken with the hand placed upright, resting upon the ulnar side of the palm and little finger with the thumb on top, ideally with the fingers supported by a sponge and splayed to avoid overlap. Oblique views can be obtained with the hand placed palm down and rolled slightly to the outside with the fingertips still touching the film surface. The beam is angled perpendicular to the cassette for oblique projections and aimed at the middle finger metacarpophalangeal joint.

X-Ray Hip and Pelvis, 2 Views

A radiologic examination of the hip is done on either the left or the right side, which may also include the pelvis. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, infection, or tumor. Hip standard views that are taken most frequently include the front to back anteroposterior view taken with the patient lying supine and the legs straight, rotated slightly inward; the lateral ‘frog-leg’ view, taken with the hips flexed and abducted and the knees flexed with the soles of the feet placed together; a cross table view with the unaffected hip and knee flexed at a 90 degree angle out of the way and the beam aimed perpendicular to the long axis of the femur on the affected side. Another type of lateral view is taken with the hip flexed 45 degrees and abducted 45 degrees and the beam aimed perpendicular to the table.

X-Ray Knee, 3 Views

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

X-Ray Knee, 4 or More Views

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

X-Ray Lower Leg, 2 Views

A radiologic examination of the tibia and fibula images the bones of the distal lower extremities and may include the knee and ankle joints. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Tibia and fibula x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the tibia and fibula include front to back anteroposterior (AP) and lateral (side).

X-Ray Lower Sacral Spine, 2-3 Views

A radiologic exam is done of the lumbosacral spine. Frontal, posteroanterior, and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

X-Ray Lower Sacral Spine, 4 or More Views

A radiologic exam is done of the lumbosacral spine. Frontal, posteroanterior, and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

X-Ray Pelvis, 1-2 Views

A diagnostic x-ray examination of the pelvis is done. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Bones appear white while soft tissue and fluids appear shades of grey. Pelvic x-rays are taken when the patient complains of pain and/or injury in the area of the pelvis or hip joints to assess for fractures and detect arthritis or bone disease. The patient is placed on a table and different views of the pelvis are taken by having the patient position the legs and feet differently, such as turning the feet inward to point at each other, or bending the knees outward with the soles of the feet together in a 'frog-leg' position.

X-Ray Pelvis, 2 Views

A radiologic examination of the sacrum and coccyx is done with at least 2 views obtained. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Routine views include an anteroposterior (AP) or posteroanterior (PA) view of the sacrum, an AP or PA view of the coccyx, and lateral sacrum/coccyx views. For the sacral view, the patient's pelvis needs to be positioned correctly so the sacrum and sacroiliac joints are symmetrical. Because the coccyx has a forward curvature in relation to the sacrum, it is not automatically visualized when taking an AP view of the sacrum, and so another positioning is done for the coccyx. For lateral views, the patient stands sideways with feet shoulder width apart and arms crossed at the shoulders. Lateral imaging shows the entire 5th lumbar vertebra, the sacrum, and the coccyx. Good sacrum and coccyx imaging requires patient preparation with an empty bladder, clean colon, and removal of clothing in favor of wearing a gown. This is due to the difficulty these obstructions can cause in achieving a good radiographic image. Shielding is done for males, but is not possible for female patients.

X-Ray Shoulder, 2 Views

A radiologic examination of the shoulder is done. The shoulder is the junction of the humeral head and the glenoid of the scapula. Standard views include the anteroposterior (AP) view and the lateral 'Y' view, named because of the Y shape formed by the scapula when looking at it from the side. An axial view can also be obtained for further assessment when the patient is able to hold the arm in abduction. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

X-Ray Toes, 2 Views

A radiologic examination of the calcaneus images the bones of the distal lower extremity and usually includes the tibia, fibula, and talus. A radiologic examination of the toe(s) (phalanges) will usually include the metatarsals. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Calcaneus and toe(s) x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views to image the calcaneus include lateral (side) and axial (supine with foot dorsiflexed). Common views to image the toe(s) include top to bottom dorsal planter (DP) and oblique (supine with leg rotated medially to image the 1st, 2nd, and 3rd digits and laterally to image the 4th and 5th digits).

X-Ray Upper Arm, 2 Views

A radiologic examination of the humerus is done with a minimum of 2 views taken. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The surgical neck of the humerus is the most common site of fracture. Shaft fractures are often associated with some kind of pathological lesion. X-rays of the humerus can be taken to detect deformities or lesions in the upper arm, such as cysts, tumors, late stage infection, or other diseases as well as a broken bone. The standard views of the humerus include the front to back anteroposterior view and the side, or lateral view.

X-Ray Upper Spine, 4-5 Views

A radiologic exam is done of the cervical spine. Anteroposterior and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

X-Ray Wrist, 3 Views

A radiologic examination of the wrist is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, arthritis, foreign body, infection, or tumor. Wrist standard views include the front to back anteroposterior (AP) or back to front posteroanterior (PA) projection; the lateral view with the elbow flexed and the hand and wrist placed thumb up; and oblique views. Oblique views are obtained with the hand and wrist either supinated or pronated with the hand slightly flexed so the carpal target area lies flat, and then rotating the wrist 45 degrees externally or internally. A more specialized image may be obtained for assessing carpal tunnel. For the carpal tunnel view, the forearm is pronated with the palm down, and the wrist is hyperextended as far as possible by grasping the fingers with the opposite hand and gently hyperextending the joint until the metacarpals and fingers are in a near vertical position.

X-Ray of Middle Spine; 3 Views

A radiologic exam is done of the thoracic spine. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. X-rays are taken of the thoracic spine to evaluate for back pain or suspected disease or injury. Films are taken from differing views that commonly include anteroposterior, lateral, posteroanterior, and a swimmer's view for the upper thoracic spine in which the patient reaches up with one arm and down with the other as if taking a swimming stroke.

X-ray Ribs One Side, Minimum 3 Views

Rib radiographs (x-rays) are typically obtained following trauma to the rib cage to determine if fractures or other internal injuries are present. The most common views of the ribs are anteroposterior (AP) (frontal) and oblique. There are four positions used for oblique views: right anterior oblique, left anterior oblique, right posterior oblique, 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 that is being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views.

Infection of the skin

Stomach Disorder without complications

Total Knee or Hip Replacement

Pneumonia with complications

Pneumonia without complications

Respiratory Failure

Kidney & urinary Infection without complications