Coding Tips Surgical to Anesthesia Code Crosswalk ICD-9-CM Diagnostic Codes IOM References ...

290 Pages·2014·2.55 MB·English

Coding and Payment Guide for Anesthesia Services Procedure Codes
00100 787.21 Dysphagia, oral phase
787.22 Dysphagia, oropharyngeal phase
00100 Anesthesia for procedures on salivary glands, including biopsy 787.23 Dysphagia, pharyngeal phase
787.24 Dysphagia, pharyngoesophageal phase
Coding Tips 787.29 Other dysphagia
The appropriate modifier indicating the type of provider (i.e., physician, 873.51 Open wound of cheek, complicated
CRNA) as well as the type of service being rendered (i.e., personally 873.59 Open wound of face, other and multiple sites, complicated
performed, medical direction) should be appended to the procedure 873.61 Open wound of buccal mucosa, without mention of
code. Modifiers indicating the physical status of the patient should also
complication
be appended when required by the third-party payer. Note that
873.69 Open wound of mouth, other and multiple sites, without
Medicare does not recognize physical status modifiers.
mention of complication
Surgical to Anesthesia Code Crosswalk 873.71 Open wound of buccal mucosa, complicated
873.79 Open wound of mouth, other and multiple sites,
42300, 42305, 42320, 42325, 42326, 42330, 42335, 42340, 42400,
42405, 42408, 42410, 42415, 42420, 42425, 42440, 42507, 42508, complicated
42509, 42510, 42550, 42600, 42650, 42660, 42665, 42725 906.0 Late effect of open wound of head, neck, and trunk
998.6 Persistent postoperative fistula, not elsewhere classified
ICD-9-CM Diagnostic Codes
Please note that this list of associated ICD-9-CM codes is not
142.0 Malignant neoplasm of parotid gland all-inclusive. The procedure may be performed for reasons other than
142.1 Malignant neoplasm of submandibular gland those listed that support the medical necessity of the service. Only
142.2 Malignant neoplasm of sublingual gland those conditions supported by the medical record documentation
should be reported.
142.8 Malignant neoplasm of other major salivary glands
142.9 Malignant neoplasm of salivary gland, unspecified
IOM References
144.9 Malignant neoplasm of floor of mouth, part unspecified
100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
196.0 Secondary and unspecified malignant neoplasm of lymph
100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
nodes of head, face, and neck
100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
198.89 Secondary malignant neoplasm of other specified sites
100-4,12,140.4.4
210.2 Benign neoplasm of major salivary glands
210.3 Benign neoplasm of floor of mouth CCIVersion 20.0
210.4 Benign neoplasm of other and unspecified parts of mouth 0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
230.0 Carcinoma in situ of lip, oral cavity, and pharynx 0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
235.0 Neoplasm of uncertain behavior of major salivary glands 31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
235.1 Neoplasm of uncertain behavior of lip, oral cavity, and
62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
pharynx
64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
238.9 Neoplasm of uncertain behavior, site unspecified
81000, 81002-81003, 81005, 81015, 82013, 82205, 90865,
239.0 Neoplasm of unspecified nature of digestive system 92511-92520, 92543, 92950-92961, 93000-93010, 93040-93042,
527.1 Hypertrophy of salivary gland 93303-93304, 93306-93308, 93312-93318, 93351, 93451,
527.2 Sialoadenitis 93456-93457, 93561-93562, 93701, 93922-93931, 93965-93981,
94002, 94004, 94200, 94250, 94640, 94644, 94660-94662,
527.3 Abscess of salivary gland
94680-94690, 94760-94770, 95812-95816, 95819, 95822, 95829,
527.4 Fistula of salivary gland
95955-95957, 96360, 96365, 96372-96376, 99143-99149, 99150,
527.5 Sialolithiasis 99201-99239, 99281-99285, 99304-99310, 99315, 99318,
527.6 Mucocele of salivary gland 99324-99328, 99334-99337, 99341-99343, 99347-99349,
527.7 Disturbance of salivary secretion 99354-99357, 99446-99449, 99466, 99468-99480, 99485,
C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
527.8 Other specified diseases of the salivary glands
G0425-G0427
528.3 Cellulitis and abscess of oral soft tissues
Note: These CCI edits are used for Medicare. Other payers may
710.2 Sicca syndrome
reimburse on codes listed above.
750.24 Congenital fistula of salivary gland
784.2 Swelling, mass, or lump in head and neck
785.6 Enlargement of lymph nodes
787.20 Dysphagia, unspecified
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00100................... 5.00 0.00 0.00 0.00 0.00 0.00 0.00
© 2014 OptumInsight, Inc. CPT © 2014 American Medical Association. All Rights Reserved. 97
Procedure Codes Coding and Payment Guide for Anesthesia Services
00102 CCIVersion 20.0
0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
00102 Anesthesia for procedures involving plastic repair of cleft lip 0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
Coding Tips 36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
Do not report code 00102 for procedures performed on the lip for
64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
conditions other than repair of cleft lip. For other, non-cleft-lip repairs,
81000, 81002-81003, 81005, 81015, 82013, 82205, 90865,
see code 00300. For cleft palate repairs, see 00172. The appropriate
92511-92520, 92543, 92950-92961, 93000-93010, 93040-93042,
modifier indicating the type of provider (i.e., physician, CRNA) as well
93303-93304, 93306-93308, 93312-93318, 93351, 93451,
as the type of service being rendered (i.e., personally performed,
93456-93457, 93561-93562, 93701, 93922-93931, 93965-93981,
medical direction) should be appended to the procedure code. Modifiers
94002, 94004, 94200, 94250, 94640, 94644, 94660-94662,
indicating the physical status of the patient should also be appended
94680-94690, 94760-94770, 95812-95816, 95819, 95822, 95829,
when required by the third-party payer. Note that Medicare does not
95955-95957, 96360, 96365, 96372-96376, 99143-99149, 99150,
recognize physical status modifiers.
99201-99239, 99281-99285, 99304-99310, 99315, 99318,
99324-99328, 99334-99337, 99341-99343, 99347-99349,
Terms To Know
99354-99357, 99446-99449, 99466, 99468-99480, 99485,
cleft lip.Congenital fissure or opening in the upper lip due to failure of C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
embryonic cells to fuse completely. G0425-G0427
congenital.Present at birth, occurring through heredity or an influence Note: These CCI edits are used for Medicare. Other payers may
during gestation up to the moment of birth. reimburse on codes listed above.
fissure.Deep furrow, groove, or cleft in tissue structures.
Surgical to Anesthesia Code Crosswalk
40700, 40701, 40702, 40720, 40761
ICD-9-CM Diagnostic Codes
749.10 Unspecified cleft lip
749.11 Unilateral cleft lip, complete
749.12 Unilateral cleft lip, incomplete
749.13 Bilateral cleft lip, complete
749.14 Bilateral cleft lip, incomplete
749.20 Unspecified cleft palate with cleft lip
749.21 Unilateral cleft palate with cleft lip, complete
749.22 Unilateral cleft palate with cleft lip, incomplete
749.23 Bilateral cleft palate with cleft lip, complete
749.24 Bilateral cleft palate with cleft lip, incomplete
749.25 Other combinations of cleft palate with cleft lip
V13.69 Personal history of other (corrected) congenital
malformations
V51.8 Other aftercare involving the use of plastic surgery
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
IOM References
100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
100-4,12,140.4.4
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00102................... 6.00 0.00 0.00 0.00 0.00 0.00 0.00
98 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc.
Coding and Payment Guide for Anesthesia Services Procedure Codes
00103 374.41 Eyelid retraction or lag
374.50 Unspecified degenerative disorder of eyelid
00103 Anesthesia for reconstructive procedures of eyelid (eg, 374.87 Dermatochalasis
blepharoplasty, ptosis surgery) 374.89 Other disorders of eyelid
374.9 Unspecified disorder of eyelid
Coding Tips 375.51 Eversion of lacrimal punctum
For nonreconstructive procedures on the eye, see 00140-00148. The 376.41 Hypertelorism of orbit
appropriate modifier indicating the type of provider (i.e., physician, 701.8 Other specified hypertrophic and atrophic condition of
CRNA) as well as the type of service being rendered (i.e., personally skin
performed, medical direction) should be appended to the procedure
701.9 Unspecified hypertrophic and atrophic condition of skin
code. Modifiers indicating the physical status of the patient should also
709.2 Scar condition and fibrosis of skin
be appended when required by the third-party payer. Note that
Medicare does not recognize physical status modifiers. 728.4 Laxity of ligament
743.62 Congenital deformity of eyelid
Terms To Know V50.1 Other plastic surgery for unacceptable cosmetic appearance
blepharoplasty.Plastic surgery of the eyelids to remove excess fat and V51.8 Other aftercare involving the use of plastic surgery
redundant skin weighting down the lid. The eyelid is pulled tight and sutured
Please note that this list of associated ICD-9-CM codes is not
to support sagging muscles.
all-inclusive. The procedure may be performed for reasons other than
ptosis.Drooping or displacement of the upper eyelid, caused by paralysis, those listed that support the medical necessity of the service. Only
muscle problems, or outside mechanical forces. those conditions supported by the medical record documentation
should be reported.
Surgical to Anesthesia Code Crosswalk
15820, 15821, 15822, 15823, 67700, 67710, 67715, 67825, 67830, IOM References
67835, 67880, 67882, 67901, 67902, 67903, 67904, 67906, 67908, 100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922,
100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
67923, 67924, 67930, 67935, 67938, 67950, 67961, 67966, 67971,
100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
67973, 67974, 67975
100-4,12,140.4.4
ICD-9-CM Diagnostic Codes
CCIVersion 20.0
333.81 Blepharospasm — (Use additional E code to identify drug,
0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
if drug-induced)
0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
351.8 Other facial nerve disorders 31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
370.34 Exposure keratoconjunctivitis 36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
374.00 Unspecified entropion 62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
374.01 Senile entropion 64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
81000, 81002-81003, 81005, 81015, 82013, 82205, 90865,
374.02 Mechanical entropion
92511-92520, 92543, 92950-92961, 93000-93010, 93040-93042,
374.03 Spastic entropion
93303-93304, 93306-93308, 93312-93318, 93351, 93451,
374.04 Cicatricial entropion 93456-93457, 93561-93562, 93701, 93922-93931, 93965-93981,
374.10 Unspecified ectropion 94002, 94004, 94200, 94250, 94640, 94644, 94660-94662,
374.11 Senile ectropion 94680-94690, 94760-94770, 95812-95816, 95819, 95822, 95829,
95955-95957, 96360, 96365, 96372-96376, 99143-99149, 99150,
374.12 Mechanical ectropion
99201-99239, 99281-99285, 99304-99310, 99315, 99318,
374.13 Spastic ectropion
99324-99328, 99334-99337, 99341-99343, 99347-99349,
374.14 Cicatricial ectropion 99354-99357, 99446-99449, 99466, 99468-99480, 99485,
374.20 Unspecified lagophthalmos C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
374.21 Paralytic lagophthalmos G0425-G0427
374.22 Mechanical lagophthalmos Note: These CCI edits are used for Medicare. Other payers may
374.23 Cicatricial lagophthalmos reimburse on codes listed above.
374.30 Unspecified ptosis of eyelid
374.31 Paralytic ptosis
374.32 Myogenic ptosis
374.34 Blepharochalasis
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00103................... 5.00 0.00 0.00 0.00 0.00 0.00 0.00
© 2014 OptumInsight, Inc. CPT © 2014 American Medical Association. All Rights Reserved. 99
Procedure Codes Coding and Payment Guide for Anesthesia Services
00104 100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
100-4,12,140.4.4
00104 Anesthesia for electroconvulsive therapy
CCIVersion 20.0
0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
Coding Tips
0282T-0283T, 0311T, 0333T, 31505, 31515, 31527, 31622, 31634,
Code 00104 may be denied when multiple electroconvulsive therapy
31645, 31647, 36000, 36010-36015, 36400-36410, 36420-36430,
(ECT) is provided. ECT (90870) is a noncovered service by Medicare.
36440, 36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
Therefore, when anesthesia is performed for this reason, it will be denied
62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
as noncovered. The appropriate modifier indicating the type of provider
64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
(i.e., physician, CRNA) as well as the type of service being rendered
81000, 81002-81003, 81005, 81015, 82013, 82205, 90865,
(i.e., personally performed, medical direction) should be appended to
92511-92520, 92543, 92585, 92950-92961, 93000-93010,
the procedure code. Modifiers indicating the physical status of the
93040-93042, 93303-93304, 93306-93308, 93312-93318, 93351,
patient should also be appended when required by the third-party
93451, 93456-93457, 93561-93562, 93701, 93922-93931,
payer. Note that Medicare does not recognize physical status modifiers.
93965-93981, 94002, 94004, 94200, 94250, 94640, 94644,
Schizophrenia is not diagnosed unless there is characteristic disturbance
94660-94662, 94680-94690, 94760-94770, 95812-95816, 95819,
of at least two of these areas: thought, perception, mood, conduct,
95822, 95829, 95860-95870, 95907-95913, 95925-95933,
and personality. The first axis of coding schizophrenia is to identify the
95937-95940, 95955-95957, 96360, 96365, 96372-96376,
type (i.e., simple, disordered, paranoid, latent, residual, etc.). The
99143-99149, 99150, 99201-99239, 99281-99285, 99304-99310,
second is to identify the course of illness with a fifth digit. Episodic
99315, 99318, 99324-99328, 99334-99337, 99341-99343,
mood disorders (category 296) are recurrent, severe disturbances of
99347-99349, 99354-99357, 99446-99449, 99466, 99468-99480,
mood accompanied by one or more of the following: delusions,
99485, C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
perplexity, disturbed attitude to self, disorder of perception, and
G0425-G0427, G0453
behavior. Patients with affective disorders have a strong tendency
Note: These CCI edits are used for Medicare. Other payers may
toward suicide. This category includes mild disorders of mood if the
reimburse on codes listed above.
symptoms closely match the descriptions. Subcategories identify the
type (e.g., manic or major depressive, bipolar, etc.) and episodic nature
(e.g., single, recurrent, etc.).
Terms To Know
bipolar disorder.Manic-depressive psychosis that has appeared in both the
depressive and manic form, either alternating or separated by an interval of
normality. Atypical: Episode of affective psychosis with some, but not all, of
the features of the one form of the disorder in individuals who have had a
previous episode of the other form of the disorder.
depression.Disproportionate depressive state with behavior disturbance
that is usually the result of a distressing experience and may include
preoccupation with the psychic trauma and anxiety.
schizophrenia.Fundamental disturbance of personality and characteristic
distortion of thinking, often a sense of being controlled by alien forces,
delusions, disturbed perception, abnormal affect out of keeping with the real
situation, and auditory or visual hallucinations with fear that intimate thoughts,
feelings, and acts are known by others although clear consciousness and
intellectual capacity are usually maintained.
Surgical to Anesthesia Code Crosswalk
90870, 90871
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00104................... 4.00 0.00 0.00 0.00 0.00 0.00 0.00
100 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc.
Coding and Payment Guide for Anesthesia Services Procedure Codes
00120-00126 ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
00120 Anesthesia for procedures on external, middle, and inner ear ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
including biopsy; not otherwise specified
IOM References
00124 otoscopy
100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
00126 tympanotomy
100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
Coding Tips
100-4,12,140.4.4
These are unilateral procedures. If they are performed bilaterally, some
payers require that the surgical service be reported twice with modifier CCIVersion 20.0
50 appended to the second code while others require identification of
0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
the service only once with modifier 50 appended. Modifier 50 identifies
0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
a procedure performed identically on the opposite side of the body
31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
(mirror image). Only one anesthesia service (00100-01992, 01999)
36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
should be reported per surgical session. Payers may require supporting
62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
documentation substantiating the need for anesthesia when reporting
64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
00124. Check with individual payers. The appropriate modifier
81000, 81002-81003, 81005, 81015, 82013, 82205, 90865,
indicating the type of provider (i.e., physician, CRNA) as well as the
92511-92520, 92543, 92950-92961, 93000-93010, 93040-93042,
type of service being rendered (i.e., personally performed, medical
93303-93304, 93306-93308, 93312-93318, 93351, 93451,
directions) should be appended to the procedure code. Modifiers
93456-93457, 93561-93562, 93701, 93922-93931, 93965-93981,
indicating the physical status of the patient should also be appended
94002, 94004, 94200, 94250, 94640, 94644, 94660-94662,
when required by the third-party payer. Note that Medicare does not
94680-94690, 94760-94770, 95812-95816, 95819, 95822, 95829,
recognize physical status modifiers.
95955-95957, 96360, 96365, 96372-96376, 99143-99149, 99150,
99201-99239, 99281-99285, 99304-99310, 99315, 99318,
Terms To Know
99324-99328, 99334-99337, 99341-99343, 99347-99349,
biopsy.Tissue or fluid removed for diagnostic purposes through analysis of 99354-99357, 99446-99449, 99466, 99468-99480, 99485,
the cells in the biopsy material. C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
eustachian tube.Internal channel between the tympanic cavity and the G0425-G0427
nasopharynx that equalizes internal pressure to the outside pressure and drains Also not with00124:76100
mucous production from the middle ear.
Note: These CCI edits are used for Medicare. Other payers may
oto-.Relating to the ear.
reimburse on codes listed above.
pinna.Outer portion of the ear attached to the side of the head that collects
sound by amplifying and directing the sound waves into the external auditory
canal.
tympano-.Relating to the eardrum.
vertigo.Sensation of movement, either of one's own body or the environment
rotating or spinning, due to a disturbance of the inner ear, vestibular centers,
or pathways in the central nervous system. This condition often causes nausea
and vomiting.
Surgical to Anesthesia Code Crosswalk
21230, 21235, 69000, 69005, 69020, 69100, 69105, 69110, 69120,
69140, 69145, 69150, 69200, 69205, 69210, 69220, 69222, 69300,
69310, 69320, 69405, 69410, 69420, 69421, 69424, 69433, 69436,
69440, 69450, 69501, 69502, 69505, 69511, 69530, 69535, 69540,
69550, 69552, 69554, 69601, 69602, 69603, 69604, 69605, 69610,
69620, 69631, 69632, 69633, 69635, 69636, 69637, 69641, 69642,
69643, 69644, 69645, 69646, 69650, 69660, 69661, 69662, 69666,
69667, 69670, 69676, 69700, 69710, 69711, 69720, 69725, 69740,
69745, 69801, 69802, 69805, 69806, 69820, 69840, 69905, 69910,
69915, 69930, 69955, 69960, 92502, 92584, S2230
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00120................... 5.00 0.00 0.00 0.00 0.00 0.00 0.00
00124................... 4.00 0.00 0.00 0.00 0.00 0.00 0.00
00126................... 4.00 0.00 0.00 0.00 0.00 0.00 0.00
© 2014 OptumInsight, Inc. CPT © 2014 American Medical Association. All Rights Reserved. 101
Procedure Codes Coding and Payment Guide for Anesthesia Services
00140-00148 68371, 68400, 68420, 68440, 68500, 68505, 68510, 68520, 68525,
68530, 68540, 68550, 68700, 68705, 68720, 68745, 68750, 68760,
68761, 68770, 68801, 68810, 68811, 68815, 68816, 68840, 68850,
00140 Anesthesia for procedures on eye; not otherwise specified
92018, 92019, 92070, 92071, 92072, 92132, 92133, 92134, 92135,
00142 lens surgery 92225, 92226, 92230, 92235, 92240, 92250, 92260, 92265, 92270,
00144 corneal transplant 92275, 92284, 92285, 92286, 92287, 92330, 92335, G0186, S0800,
S0810, S0812
00145 vitreoretinal surgery
00147 iridectomy ICD-9-CM Diagnostic Codes
00148 ophthalmoscopy The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Coding Tips
IOM References
Medicare coverage guidelines may consider general anesthesia in
100-3,10.1; 100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2;
cataract surgery to be reasonable and necessary for particular medical
100-4,4,250.3.3.1; 100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3;
indications if it is an accepted practice among ophthalmologists in the
local community to use general anesthesia for those indications. These 100-4,12,140.3.4; 100-4,12,140.4.1; 100-4,12,140.4.2;
are unilateral procedures. If they are performed bilaterally, some payers 100-4,12,140.4.3; 100-4,12,140.4.4
require that the surgical service be reported twice with modifier 50
appended to the second code while others require identification of the CCIVersion 20.0
service only once with modifier 50 appended. Modifier 50 identifies a 0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
procedure performed identically on the opposite side of the body 0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
(mirror image). Only one anesthesia service (00100-01992, 01999) 31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
should be reported per surgical session. Check with individual payers. 36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
The appropriate modifier indicating the type of provider (i.e., physician, 62310-62319, 64445-64450, 64479, 64483, 64490, 64493,
CRNA) as well as the type of service being rendered (i.e., personally 64505-64555, 64565, 67500, 76000-76001, 76998, 77002, 90865,
performed, medical direction) should be appended to the procedure 92511-92520, 92543, 92950-92961, 93000-93010, 93040-93042,
code. Modifiers indicating the physical status of the patient should also 93303-93304, 93306-93308, 93312-93318, 93351, 93451,
be appended when required by the third-party payer. Note that 93456-93457, 93561-93562, 93701, 93922-93931, 93965-93981,
Medicare does not recognize physical status modifiers. 94002, 94004, 94200, 94250, 94640, 94644, 94660-94662,
94680-94690, 94760-94770, 95812-95816, 95819, 95822, 95829,
Surgical to Anesthesia Code Crosswalk 95955-95957, 96360, 96365, 96372-96376, 99143-99149, 99150,
0016T, 0017T, 0099T, 0100T, 0123T, 0124T, 0176T, 0177T, 0191T, 99201-99239, 99281-99285, 99304-99310, 99315, 99318,
0192T, 0253T, 0308T, 65091, 65093, 65101, 65103, 65105, 65110, 99324-99328, 99334-99337, 99341-99343, 99347-99349,
65112, 65114, 65125, 65130, 65135, 65140, 65150, 65155, 65175, 99354-99357, 99446-99449, 99466, 99468-99480, 99485,
65205, 65210, 65220, 65222, 65235, 65260, 65265, 65270, 65272, C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
65273, 65275, 65280, 65285, 65286, 65290, 65400, 65410, 65420, G0425-G0427
65426, 65430, 65435, 65436, 65450, 65600, 65710, 65730, 65750, Also not with00140:0329T, 64400-64435, 81000, 81002-81003,
65755, 65756, 65760, 65765, 65767, 65770, 65771, 65772, 65775, 81005, 81015, 82013, 82205, 92100
65779, 65780, 65781, 65782, 65800, 65805, 65810, 65815, 65820,
Also not with00142:0329T, 64402-64435, 81000, 81002-81003,
65850, 65855, 65860, 65865, 65870, 65875, 65880, 65900, 65920,
81005, 81015, 82013, 82205, 92100
65930, 66020, 66030, 66130, 66150, 66155, 66160, 66165, 66170,
Also not with00144:64400-64435, 81000, 81002-81003, 81005,
66172, 66174, 66175, 66180, 66183, 66185, 66220, 66225, 66250,
81015, 82013, 82205
66500, 66505, 66600, 66605, 66625, 66630, 66635, 66680, 66682,
66700, 66710, 66711, 66720, 66740, 66761, 66762, 66770, 66820, Also not with00145:64400-64435
66821, 66825, 66830, 66840, 66850, 66852, 66920, 66930, 66940, Also not with00147:64400-64435
66982, 66983, 66984, 66985, 66986, 67005, 67010, 67015, 67025,
Also not with00148:64400-64435
67027, 67028, 67030, 67031, 67036, 67038, 67039, 67040, 67041,
67042, 67043, 67101, 67105, 67107, 67108, 67110, 67112, 67113, Note: These CCI edits are used for Medicare. Other payers may
67115, 67120, 67121, 67141, 67145, 67208, 67210, 67218, 67220, reimburse on codes listed above.
67221, 67227, 67228, 67229, 67250, 67255, 67311, 67312, 67314,
67316, 67318, 67343, 67345, 67346, 67350, 67400, 67405, 67412,
67413, 67414, 67415, 67500, 67515, 67550, 67560, 67570, 67901,
67902, 67903, 67904, 67906, 67909, 67911, 67914, 67915, 67921,
67922, 67930, 67935, 67950, 67961, 67966, 67971, 67973, 67974,
67975, 68020, 68040, 68100, 68110, 68115, 68130, 68135, 68200,
68320, 68325, 68326, 68328, 68330, 68335, 68340, 68360, 68362,
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00140................... 5.00 0.00 0.00 0.00 0.00 0.00 0.00
00142................... 4.00 0.00 0.00 0.00 0.00 0.00 0.00
00144................... 6.00 0.00 0.00 0.00 0.00 0.00 0.00
00145................... 6.00 0.00 0.00 0.00 0.00 0.00 0.00
00147................... 4.00 0.00 0.00 0.00 0.00 0.00 0.00
00148................... 4.00 0.00 0.00 0.00 0.00 0.00 0.00
102 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc.
Coding and Payment Guide for Anesthesia Services Procedure Codes
00160-00164 100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
100-4,12,140.4.4
00160 Anesthesia for procedures on nose and accessory sinuses; not
CCIVersion 20.0
otherwise specified
0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
00162 radical surgery
0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
00164 biopsy, soft tissue 31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
Coding Tips 62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
The appropriate modifier indicating the type of provider (i.e., physician,
90865, 92511-92520, 92543, 92950-92961, 93000-93010,
CRNA) as well as the type of service being rendered (i.e., personally
93040-93042, 93303-93304, 93306-93308, 93312-93318, 93351,
performed, medical direction) should be appended to the procedure
93451, 93456-93457, 93561-93562, 93701, 93922-93931,
code. Modifiers indicating the physical status of the patient should also
93965-93981, 94002, 94004, 94200, 94250, 94640, 94644,
be appended when required by the third-party payer. Note that
94660-94662, 94680-94690, 94760-94770, 95812-95816, 95819,
Medicare does not recognize physical status modifiers.
95822, 95829, 95955-95957, 96360, 96365, 96372-96376,
99143-99149, 99150, 99201-99239, 99281-99285, 99304-99310,
Terms To Know
99315, 99318, 99324-99328, 99334-99337, 99341-99343,
biopsy.Tissue or fluid removed for diagnostic purposes through analysis of 99347-99349, 99354-99357, 99446-99449, 99466, 99468-99480,
the cells in the biopsy material. 99485, C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
ethmoid bone.Cube-shaped bone located between the orbits. G0425-G0427
frontal sinusotomy.Surgical procedure in which the anterior wall of the Note: These CCI edits are used for Medicare. Other payers may
frontal sinus is excised, the diseased tissue removed, and a permanent opening reimburse on codes listed above.
is created between the nasal cavity and the maxillary sinus in order to facilitate
sinus drainage.
maxillary.Located between the eyes and the upper teeth.
sinus.Open space, cavity, or channel within the body or abnormal cavity,
fistula, or channel created by a localized infection to allow the escape of pus.
turbinates.Scroll or shell-shaped elevations from the wall of the nasal cavity,
the inferior turbinate being a separate bone, while the superior and middle
turbinates are of the ethmoid bone.
Surgical to Anesthesia Code Crosswalk
11044, 20912, 21210, 21230, 21235, 21310, 21315, 21320, 21325,
21330, 21335, 21336, 21337, 21338, 21339, 21340, 21343, 21344,
21345, 21346, 21347, 21348, 30000, 30020, 30100, 30110, 30115,
30117, 30118, 30120, 30124, 30125, 30130, 30140, 30150, 30160,
30200, 30210, 30220, 30310, 30320, 30400, 30410, 30420, 30430,
30435, 30450, 30460, 30462, 30465, 30520, 30540, 30545, 30560,
30580, 30600, 30620, 30630, 30801, 30802, 30901, 30903, 30905,
30906, 30915, 30920, 30930, 31000, 31002, 31020, 31030, 31032,
31040, 31050, 31051, 31070, 31075, 31080, 31081, 31084, 31085,
31086, 31087, 31090, 31200, 31201, 31205, 31225, 31230, 31231,
31233, 31235, 31237, 31238, 31239, 31240, 31254, 31255, 31256,
31267, 31276, 31287, 31288, 31290, 31291, 31292, 31293, 31294,
31295, 31296, 31297, 41019, 69400, 69401, 92511, 92512, S2342,
S2344
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00160................... 5.00 0.00 0.00 0.00 0.00 0.00 0.00
00162................... 7.00 0.00 0.00 0.00 0.00 0.00 0.00
00164................... 4.00 0.00 0.00 0.00 0.00 0.00 0.00
© 2014 OptumInsight, Inc. CPT © 2014 American Medical Association. All Rights Reserved. 103
Procedure Codes Coding and Payment Guide for Anesthesia Services
00170 100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
100-4,12,140.4.4
00170 Anesthesia for intraoral procedures, including biopsy; not otherwise
CCIVersion 20.0
specified
0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
Coding Tips
31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
Diagnosis coding is important to substantiate the coverage of code of 36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
this code. Anesthesia provided in connection with the care, treatment, 62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
filling, removal, or replacement of teeth or structures directly supporting 64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
the teeth is not covered by Medicare. The appropriate modifier 90865, 92511-92520, 92543, 92950-92961, 93000-93010,
indicating the type of provider (i.e., physician, CRNA) as well as the 93040-93042, 93303-93304, 93306-93308, 93312-93318, 93351,
type of service being rendered (i.e., personally performed, medical 93451, 93456-93457, 93561-93562, 93701, 93922-93931,
direction) should be appended to the procedure code. Modifiers 93965-93981, 94002, 94004, 94200, 94250, 94640, 94644,
indicating the physical status of the patient should also be appended 94660-94662, 94680-94690, 94760-94770, 95812-95816, 95819,
when required by the third-party payer. Note that Medicare does not 95822, 95829, 95955-95957, 96360, 96365, 96372-96376,
recognize physical status modifiers. 99143-99149, 99150, 99201-99239, 99281-99285, 99304-99310,
99315, 99318, 99324-99328, 99334-99337, 99341-99343,
Terms To Know
99347-99349, 99354-99357, 99446-99449, 99466, 99468-99480,
biopsy.Tissue or fluid removed for diagnostic purposes through analysis of 99485, C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
the cells in the biopsy material. G0425-G0427
gingiva.Soft tissues surrounding the crowns of unerupted teeth and necks Note: These CCI edits are used for Medicare. Other payers may
of erupted teeth. reimburse on codes listed above.
intra.Within.
nasopharynx.Membranous passage above the level of the soft palate.
palate.Partition that separates the nasal from the oral cavities.
periapical.Anatomical area around the terminal end of a tooth root.
vestibule of the mouth.Mucosal and submucosal tissue of the lips and
cheeks within the oral cavity, not including the dentoalveolar structures.
Surgical to Anesthesia Code Crosswalk
0088T, 20200, 20670, 21110, 21296, 21497, 40800, 40801, 40804,
40805, 40806, 40808, 40810, 40812, 40814, 40816, 40818, 40819,
40820, 40830, 40831, 40840, 40842, 40843, 40844, 40845, 41000,
41005, 41006, 41007, 41008, 41009, 41010, 41015, 41016, 41017,
41018, 41019, 41100, 41105, 41108, 41110, 41112, 41113, 41114,
41115, 41116, 41120, 41130, 41250, 41251, 41252, 41500, 41510,
41512, 41520, 41530, 41800, 41805, 41806, 41820, 41821, 41822,
41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872,
41874, 42000, 42100, 42104, 42106, 42107, 42120, 42140, 42145,
42160, 42180, 42182, 42226, 42227, 42235, 42260, 42280, 42281,
42310, 42408, 42409, 42450, 42500, 42505, 42700, 42720, 42800,
42802, 42804, 42806, 42808, 42809, 42820, 42821, 42825, 42826,
42830, 42831, 42835, 42836, 42860, 42870, 42900, 42950, 42960,
42961, 42962, 42970, 42971, 42972, 64738, 64740, S2080
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00170................... 5.00 0.00 0.00 0.00 0.00 0.00 0.00
104 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc.
Coding and Payment Guide for Anesthesia Services Procedure Codes
00172 Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
00172 Anesthesia for intraoral procedures, including biopsy; repair of
those conditions supported by the medical record documentation
cleft palate
should be reported.
Coding Tips IOM References
For cleft repair, see code 00102. Anesthesia provided in connection 100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
with the care, treatment, filling, removal, or replacement of teeth or 100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
structures directly supporting the teeth is noncovered by Medicare.
100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
The appropriate modifier indicating the type of provider (i.e., physician,
100-4,12,140.4.4
CRNA) as well as the type of service being rendered (i.e., personally
performed, medical direction) should be appended to the procedure
CCIVersion 20.0
code. Modifiers indicating the physical status of the patient should also
0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
be appended when required by the third-party payer. Note that
0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
Medicare does not recognize physical status modifiers. Cleft palate
31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
(749.0x) is the fissure or abnormal elongated opening of the palate.
36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
Cleft palate can occur either unilaterally or bilaterally and can be either
62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
partial or complete. The most common types of cleft palate are the
64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
complete left unilateral and partial midline cleft or the secondary palate.
90865, 92511-92520, 92543, 92950-92961, 93000-93010,
The dividing point between the primary and secondary palate is the
93040-93042, 93303-93304, 93306-93308, 93312-93318, 93351,
incisive foramen. Fifth-digit assignment indicates laterality.
93451, 93456-93457, 93561-93562, 93701, 93922-93931,
Terms To Know 93965-93981, 94002, 94004, 94200, 94250, 94640, 94644,
94660-94662, 94680-94690, 94760-94770, 95812-95816, 95819,
cleft lip.Congenital fissure or opening in the upper lip due to failure of
95822, 95829, 95955-95957, 96360, 96365, 96372-96376,
embryonic cells to fuse completely.
99143-99149, 99150, 99201-99239, 99281-99285, 99304-99310,
cleft palate.Congenital fissure or defect of the roof of the mouth opening 99315, 99318, 99324-99328, 99334-99337, 99341-99343,
to the nasal cavity due to failure of embryonic cells to fuse completely. 99347-99349, 99354-99357, 99446-99449, 99466, 99468-99480,
congenital.Present at birth, occurring through heredity or an influence 99485, C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
during gestation up to the moment of birth. G0425-G0427
fissure.Deep furrow, groove, or cleft in tissue structures. Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Surgical to Anesthesia Code Crosswalk
42200, 42205, 42210, 42215, 42220, 42225
ICD-9-CM Diagnostic Codes
749.00 Unspecified cleft palate
749.01 Unilateral cleft palate, complete
749.02 Unilateral cleft palate, incomplete
749.03 Bilateral cleft palate, complete
749.04 Bilateral cleft palate, incomplete
749.13 Bilateral cleft lip, complete
749.14 Bilateral cleft lip, incomplete
749.20 Unspecified cleft palate with cleft lip
749.21 Unilateral cleft palate with cleft lip, complete
749.22 Unilateral cleft palate with cleft lip, incomplete
749.23 Bilateral cleft palate with cleft lip, complete
749.24 Bilateral cleft palate with cleft lip, incomplete
749.25 Other combinations of cleft palate with cleft lip
783.3 Feeding difficulties and mismanagement
784.49 Other voice and resonance disorders
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00172................... 6.00 0.00 0.00 0.00 0.00 0.00 0.00
© 2014 OptumInsight, Inc. CPT © 2014 American Medical Association. All Rights Reserved. 105
Procedure Codes Coding and Payment Guide for Anesthesia Services
00174-00176 195.0 Malignant neoplasm of head, face, and neck
196.0 Secondary and unspecified malignant neoplasm of lymph
00174 Anesthesia for intraoral procedures, including biopsy; excision of nodes of head, face, and neck
retropharyngeal tumor 210.5 Benign neoplasm of tonsil
210.6 Benign neoplasm of other parts of oropharynx
00176 radical surgery
210.7 Benign neoplasm of nasopharynx
Coding Tips 210.8 Benign neoplasm of hypopharynx
230.0 Carcinoma in situ of lip, oral cavity, and pharynx
The appropriate modifier indicating the type of provider (i.e., physician,
CRNA) as well as the type of service being rendered (i.e., personally 235.0 Neoplasm of uncertain behavior of major salivary glands
performed, medical direction) should be appended to the procedure 235.1 Neoplasm of uncertain behavior of lip, oral cavity, and
code. Modifiers indicating the physical status of the patient should also pharynx
be appended when required by the third-party payer. Note that
238.0 Neoplasm of uncertain behavior of bone and articular
Medicare does not recognize physical status modifiers.
cartilage
238.8 Neoplasm of uncertain behavior of other specified sites
Surgical to Anesthesia Code Crosswalk
239.0 Neoplasm of unspecified nature of digestive system
41135, 41140, 41145, 41150, 41153, 41155, 42842, 42844, 42845,
472.1 Chronic pharyngitis — (Use additional code to identify
42890, 42892, 42894
infectious organism)
ICD-9-CM Diagnostic Codes 478.21 Cellulitis of pharynx or nasopharynx — (Use additional
141.0 Malignant neoplasm of base of tongue code to identify infectious organism)
141.1 Malignant neoplasm of dorsal surface of tongue Please note that this list of associated ICD-9-CM codes is not
141.2 Malignant neoplasm of tip and lateral border of tongue all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
141.3 Malignant neoplasm of ventral surface of tongue
those conditions supported by the medical record documentation
141.4 Malignant neoplasm of anterior two-thirds of tongue, part
should be reported.
unspecified
141.5 Malignant neoplasm of junctional zone of tongue IOM References
141.6 Malignant neoplasm of lingual tonsil 100-4,4,10.4; 100-4,4,10.5; 100-4,4,250.3.2; 100-4,4,250.3.3.1;
142.2 Malignant neoplasm of sublingual gland 100-4,12,140.1; 100-4,12,140.3; 100-4,12,140.3.3; 100-4,12,140.3.4;
143.1 Malignant neoplasm of lower gum 100-4,12,140.4.1; 100-4,12,140.4.2; 100-4,12,140.4.3;
144.0 Malignant neoplasm of anterior portion of floor of mouth 100-4,12,140.4.4
144.1 Malignant neoplasm of lateral portion of floor of mouth
CCIVersion 20.0
145.6 Malignant neoplasm of retromolar area
0178T-0179T, 0180T, 01996, 0213T, 0216T, 0228T, 0230T,
145.9 Malignant neoplasm of mouth, unspecified site
0282T-0283T, 0311T, 31505, 31515, 31527, 31622, 31634, 31645,
146.0 Malignant neoplasm of tonsil
31647, 36000, 36010-36015, 36400-36410, 36420-36430, 36440,
146.1 Malignant neoplasm of tonsillar fossa
36600, 36640, 43752-43754, 61026, 61055, 62280-62284,
146.2 Malignant neoplasm of tonsillar pillars (anterior) (posterior) 62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490,
146.3 Malignant neoplasm of vallecula 64493, 64505-64555, 64565, 67500, 76000-76001, 76998, 77002,
146.4 Malignant neoplasm of anterior aspect of epiglottis 90865, 92511-92520, 92543, 92950-92961, 93000-93010,
93040-93042, 93303-93304, 93306-93308, 93312-93318, 93351,
146.5 Malignant neoplasm of junctional region of oropharynx
93451, 93456-93457, 93561-93562, 93701, 93922-93931,
146.6 Malignant neoplasm of lateral wall of oropharynx
93965-93981, 94002, 94004, 94200, 94250, 94640, 94644,
146.7 Malignant neoplasm of posterior wall of oropharynx 94660-94662, 94680-94690, 94760-94770, 95812-95816, 95819,
146.8 Malignant neoplasm of other specified sites of oropharynx 95822, 95829, 95955-95957, 96360, 96365, 96372-96376,
147.1 Malignant neoplasm of posterior wall of nasopharynx 99143-99149, 99150, 99201-99239, 99281-99285, 99304-99310,
99315, 99318, 99324-99328, 99334-99337, 99341-99343,
147.2 Malignant neoplasm of lateral wall of nasopharynx
99347-99349, 99354-99357, 99446-99449, 99466, 99468-99480,
147.3 Malignant neoplasm of anterior wall of nasopharynx
99485, C8921-C8927, C8929-C8930, G0380-G0384, G0406-G0408,
148.1 Malignant neoplasm of pyriform sinus
G0425-G0427
170.1 Malignant neoplasm of mandible
Note: These CCI edits are used for Medicare. Other payers may
171.0 Malignant neoplasm of connective and other soft tissue of reimburse on codes listed above.
head, face, and neck
Base Unit Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total
00174................... 6.00 0.00 0.00 0.00 0.00 0.00 0.00
00176................... 7.00 0.00 0.00 0.00 0.00 0.00 0.00
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