1989 procedure codes for preventive care services : year 1 report

42 Pages·1994·1.3 MB·English

by  Herz, Lisa

1^4
1989PROCEDURECODES
FORPREVENTIVECARESERVICES
YEAR1REPORT
HCFAContract500-92-066
Preparedfor:
FeatherDavis,ProjectOfficer
OfficeofResearchandDemonstrations
HealthCareFinancingAdministration
6325SecurityBoulevard
OakMeadowsBuilding
Baltimore,MD21207
Preparedby:
LisaHerz
NormaGavin
MarilynEllwood
KateSredl
SysteMetrics
ADivisionofTheMEDSTAT*Group
4401ConnecticutAvenue,N.W.
Suite400
Washington.DC20008
REPORTS
RA
445 May3,1994
A13
1994
TABLEOFCONTENTS
Page
I. CPT4,NATIONALHCPCSANDUB82 1
II. GEORGIASTATE-SPECIFICCODES 12
III. TENNESSEESTATE-SPECIFICCODES 15
IV. CAUFORNIASTATE-SPECIFICCODES 21
V. MICHIGANSTATE-SPECIFICCODES 33
ATTACHMENTA 40
1989PROCEDURECODESFORPREVENTIVECARESERVICES
CPT4,NATIONALHCPCSANDUB82
9/14/93
A, PREVENTIVECAREVISITS
1. StandaloneCPT-4procedurecodes(donotrequireanaccompanyingpreventivecarediagnosis
code)
90750 initial historyand examination relatedtothe healthyindividual, includinganticipatory
guidance;adult(age18+)
90751 initial historyand examination relatedtothe healthyindividual, includinganticipatory
guidance;adolescent(age12through17years)
90752 initial historyand examination relatedtothe healthy individual, includinganticipatory
guidance;latechildhood(age5though11>c-:.-/
90753 initial historyand examination related tothe healthyindividual, including anticipatory
guidance;earlychildhood(age1through4years)
90754 initial historyand examination relatedtothe healthy individual, including anticipatory
guidance;infant(ageunder1year)
90755 infantcaretooneyearofage,withamaximumof12officevisitsduringregularoffice
hours,includingtuberculinskintestingandimmunizationofDTPandoralpolio
90757 newborncare,inotherthanhospitalsetting,includingphysicalexaminationofbabyand
conference(s)withparent(s)
90760 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory
guidance,periodictypeofexamination;adult(age18+)
90761 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory
guidance,periodictypeofexamination;adolescent(age12through17years)
90762 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory
guidance,periodictypeofexamination;latechildhood(age5through11years)
90763 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory
guidance,periodictypeofexamination;earlychildhood(age1through4years)
90764 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory
guidance,periodictypeofexamination;infant(ageunder1year)
1
3
PREVENTIVECAREVISITS(Continued)
CPT-4 procedure codesforgeneral office visitsthat must be present in combinationwith
diagnosiscodesfromprimaryDXlook-uptableinordertobeflaggedasapreventivecarevisit.
90000 officemedicalservice,newpatient;briefservice
90010 officemedicalservice,newpatient;limitedservice
90015 officemedicalservice,newpatient;intermediateservice
90017 officemedicalservice,newpatient;extendedservice
90020 officemedicalservice,newpatient;comprehensiveservice
90030 officemedicalservice,establishedpatient;minimalservice
90040 officemedicalservice,establishedpatient;briefservice
90050 officemedicalservice,establishedpatient;Imitedservice
90060 officemedicalservice,establishedpatient;intermediateservice
90070 officemedicalservice,establishedpatient;extendedservice
90080 officemedicalservice,establishedpatient;comprehensiveservice
NationalHCPCScodesforofficevisits(codebooksaysthesearepreventivecarevisitcodes.
However,werequirethesecodestoappearincombinationwithpreventivecareICD-9-CMdiagnosis
codesfromtheprimaryDXlook-uptable)
M0005 officevisitswithtwoormoremodalitiesofthesamearea
M0006 office visitswithoneoftheabovementionedtreatmentmodalities, eachadditional 15
minutes
M0007 officevisitincludingcombinationofanymodality(s)andprocedure(s),initial30minutes
M0008 officevisitincludingcombinationofanymodality(s)andprocedure(s),eachadditional15
minutes
M0009 nototherwiseclassified,officevisits
A, PREVENTIVECAREVISITS(Continued)
4. UB82revenuecodesforgeneralvisitsthatmustbepresentincombinationwithdiagnosiscodes
fromtheprimaryDXlook-uptable.
510 clinic-generalclassification
oiy clinic-otherclinic
520 freestandingclinic-generalclassification
521 freestandingclinic-ruralhealthclinic
523 freestandingclinic-familypractice
529 freestandingclinic-other
982 professionalfees-outpatientservices
983 professionalfees-clinic
JL DEVELOPMENTALASSESSMENTSCREENING
1. CPT-4procedurecodesthatmustappearwithapreventivediagnosiscodefromtheprimaryDX
look-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateofservice.
90774 Administrationandmedicalinterpretationofdevelopmentaltests
2. NationalHCPCScodes
Noindividualcodeshere
Q IMMUNIZATIONS-CLASSIC
1. cStoadnedfarloomnteheCPpTr-im4arpyroDcXedluoroke-ucpodtaebsle(NdoORnotacnceoemdpaannyacaccolmapiamnfyoirnagpprreevveennttiivveecacraerevidsiitagonnostihse
samedateofservice.)
90701 DTP
90702 DT
90703 Tetanustoxoid
90704 mumps
90705 measles
90706 rubella
90707 MMR
3
C IMMUNIZATIONS-CLASSIC(Continued)
1. StandaloneCPT-4procedurecodes(donotneedanaccompanyingpreventivecarediagnosis
codefromtheprimaryDXlook-uptableNORaccompanyaclaimforapreventivecarevisitonthe
samedateofservice.)
90708 measlesandrubella
90709 rubellaandmumps
90712 oralpolio
90718 Td
90719 diphtheriatoxoid
90731 hepatitisB
90737 HemophilusinfluenzaB
2. StandaloneNationalHCPCScodesforimmunizations(donotneedtoappearincombinationwith
diagnosiscodesfromtheprimaryDXlook-uptableNORaccompanyaclaimfcrapreventivecare
visitonthesamedateofservice.)
J1670 tetanusimmuneglobulin,human
D, IMMUNIZATIONS-OTHER
1. cStoadnedfarloomnteheCPpTr-im4arpyroDcXedluoroke-ucpodtaebsle(NdoORnotacnceoemdpaannyacaccolmapiamnfyoirnagprperveevnetnitvievecacraerevidsiitagonnostihse
samedateofservice.)
90713 poliomyelitis
90714 typhoid
90717 yellowfever
90724 influenzavirus
90725 cholera
90726 rabies
90727 plague
90728 BCG
90732 pneumococcal
90733 meningococcal
4
C
JL IMMUNIZATIONS-OTHER(Continued)
1. cStoadnedfarloomnteheCPpTr-im4arpyroDcXedluoroke-ucpodtaebsle(NdoORnotacnceoemdpaannyacaccolmapiamnfyoirnagpprreevveennttiivevecacraerevidsiitagonnostihse
samedateofservice.)
90741 ISG
90742 specifichyperimmuneserumglobin
90749 unlistedimmunizationprocedure
2. StandaloneNationalHCPCScodesforimmunizations(donotneedtoappearincombinationwith
diagnosiscodesfromtheprimaryDXlook-uptableNORaccompanyaclaimforapreventivecare
visitonthesamedateofservice.)
J2750 rabies
J6015 typhus
J6025 cholera
J6045 smallpox
E HEARINGEXAM/SCREENING
1. CDPXTl-o4okp-ruopcteadbulreeOcRodaecscotmhaptamnuysatcalpapiemafrorinacoprmebviennattiivoencwairtehvdisiiatgonnostihsecsoadmesefdraotmetohfeseprrviimcae.ry
92506 medicalevaluationspeech,languageand/orhearingproblems
92551 screeningtest,puretone,aironly
92552 puretoneaudiometry(threshold);aironly
92553 puretoneaudiometry(threshold);airandbone
92557 basiccomprehensiveaudiometry
92560 Bekesyaudiometry;screening
2. NationalHCPCScodesthatmustappearincombinationwithdiagnosiscodesfromtheprimary
DXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateofservice.
V5000 audiometricexam-hearingexamincludingthemeasuringofhearingacuityandtests
relatingtoairconduction, boneconduction, speech reception,thresholdandspeech
discrimination
5
9
F. VISIONEXAM/SCREENING
1. CPT-4procedurecodes
NoIndividualcodeshere-theseservicesaresupposedtobebundledintopreventivecarevisits
2. NationalHCPCScodes
Noindividualcodeshere
G HEMOGLOBIN/HEMATOCRIT
1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe
primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof
service.
85014 hematocrit
85018 hemoglobin,colorimeu.~
85021 hemogram,automated(RBC,WBC,Hgb,Hctandindicesonly)
85025 hemogram,andplateletcount,automated,andautomatedcompletedifferentialWBCcount
(CBC)
85031 Bloodcount;hemogram,manual,completeCBC(RBC,WBC,Hgb,Hct,differentialand
indices)
2. NationalHCPCScodes
Noindividualcodeshere
H. URINALYSIS
1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe
primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof
service.
81000 urinalysis; routine(pH,specificgravity, protein,testsforreducingsubstancessuchas
glucose),withmicroscopy
81002 urinalysis;routine,withoutmicroscopy
NationalHCPCScodes
Noindividualcodeshere
6
L TBTEST
1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe
primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof
service.
86580 skintest;tuberculosis,intradermal
86585 skintest;tuberculosis,tinetest
2. NationalHCPCScodes
Noindividualcodeshere
J, SICKLECELL
1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe
primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof
service.
83020 hemoglobin;electrophoresis(includesA2,S,C,etc)
83052 hemoglobin;sickle,turbidmetric
2. NationalHCPCScodes
Noindividualcodeshere
jC CHLAMYDIA/GCCULTURE
1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe
primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof
service.
87072 cultureordirectbacterialidentificationmethod,eachorganism,bycommercialkit,any
sourceexcepturine
87110 chlamydiaculture
2. NationalHCPCScodes
Noindividualcodeshere
7
L PKU
1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe
primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof
service.
84030 Phenylalanine(PKU),blood;Guthrie
84031 Phenylalanine(PKU),blood;fluorometric
2. NationalHCPCScodes
Noindividualcodeshere
NL PAPSMEAR
1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe
primaryDXlook-uptableORaccompanyaclaimforapreveimvecarevisitonthesamedateof
service.
88150 cytopat'ology, smears, cervical orvaginal (e.g., Papanicolaou), uptothreesmears;
screeningbytechnicianunderphysiciansupervision
88151 cytopathology, smears, cervical orvaginal (e.g., Papanicolaou), uptothree smears;
requiringinterpretationbyphysician
2. NationalHCPCScodes
Noindividualcodeshere
3. UB82revenuecodeswhichmustbepresentincombinationwithdiagnosiscodesfromtheprimary
DXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateofservice.
923 papsmear
N, VDRL
1. CprPiTm-a4rypDrXocleodoukr-eupctoadbelseOwhRicahccmoumsptabneyparecsleanitmfionrcaompbrienvaetntiiovnewciatrhedviiasigtnoosnisthceosdeasmefrdoamtethoef
service.
86592 Syphilistest;qualitative(EG.,VDRL,RPR,ART)
2. NationalHCPCScodes
Noindividualcodeshere
8