Pathology and Laboratory CPT code list

• CPT Divided into fourteen subsections:

Organ or Disease Oriented Panels 80048* - 80076

Drug Testing 80100 - 80103

Therapeutic Drug Assays 80150 - 80299

Evocative/Suppression Testing 80400 - 80440

Consultations (Clinical Pathology) 80500 - 80502

Urinalysis 81000 - 81099

Chemistry 82000 - 84999

Hematology and Coagulation 85002 - 85999

Immunology 86000 - 86849

Transfusion Medicine 86850 - 86999

Microbiology 87001 - 87999

Anatomic Pathology 88000 - 88099

Cytopathology 88104 - 88199

Cytogenetic Studies 88230 - 88299

Surgical Pathology 88300 - 88399

Transcutaneous Procedures 88400

Other Procedures 89050 - 89399

Getting Payment from Medicare for Clinical Laboratory Services codes

Certain clinical diagnosis procedures listed in the Pathology and Laboratory sections of the Physicians' Current Procedural Terminology (CPT) (1) are not considered a part of the laboratory fee schedule. The procedures listed below are paid from the Physician Fee Schedule at 80% of the amount listed on that fee schedule. The beneficiary is responsible for the remaining 20% once the annual deductible has been met. These procedures are not subject to national limitations:

Clinical pathology consultations

Bone marrow smears and biopsy

Blood bank physician services

Skin tests

Anatomical and surgical pathology services

Duodenal and gastric intubation

Sputum and sweat collection

Medicare tests must be billed on an assigned basis. This means that the provider must accept the Medicare reimbursement as payment in full for any covered laboratory test. Medicare patients may not be billed for any additional amounts for covered tests. (See below for policies regarding tests that are not covered by Medicare). Medicare patients may be billed for non-covered services. The mandatory assignment requirement for laboratory tests applies regardless of whether the physician is participating (accepts assignment for all Medicare services) or non-participating (does not accept assignment for all Medicare services).

Direct billing is also required for all Medicare-reimbursed laboratory tests. Tests must be billed directly to Medicare by the laboratory or physician performing the tests. If an outside laboratory performs a test on a referral from a physician, only the reference laboratory may legally bill Medicare for the procedure.

However, hospitals and reference laboratories that send specimens to other laboratories may bill  Medicare for tests performed by the other laboratories if the referring laboratory meets any one of the following three exceptions: 

(a) The referring laboratory is located in or is part of a rural hospital;

(b) The referring laboratory is wholly owned by the reference laboratory, or the referring laboratory wholly owns the reference laboratory, or both referring laboratory and reference laboratory are wholly owned by a third entity; or

(c) No more than 30% of the clinical diagnostic tests for which a laboratory receives requests annually are performed by another laboratory other than an ownership-related laboratory.

For the purpose of the 30% exception, each CPT code billed counts as one test.

For example, when CPT code 80054 is billed, it is counted as one test although 12 tests are performed.

Lab CPT codes list which can be performed by CLIA certified providers . Providers with a CLIA certificate may conduct the following laboratory tests in their offices:

Description Codes Description Codes

Urinalysis 81000- 81003

Crystal Identification 89060

Glucose 82947- 82948

ESR 85651, 85652

Prothrombin time 85610

BM Aspiration 85097

Tuberculosis Intra-Dermal Skin Test 86580

Platelet 85007

Urine Pregnancy Test 81025

Bilirubin Direct 82248

Tissue Exam (KOH) Prep 87220

Bilirubin Total 82247

Wet Mounts 87177, 87210

Hemoglobin Glycated 83036

FOBT (Hemocult) 82270

Blood Smear 85060

Strep Test Group A 87070, 87880

Molecular Cytogenetics Chromosomal 88273

CBC 85025- 85048

Molecular Cytogenetics Interphase 88274

BUN, Creatinine 82565

Special Stains Group I 88312

Potassium 84132

Special Stains Group II 88313

Hemoglobin 85018

Clinical Pathology Consultation Limited 80500

Semen Analysis 89300 - 89320

Clinical Pathology Consultation Comprehensive 80502

Sperm Evaluation 89329

Lead Testing 83655

Cervical Mucus Penetration Test 89330

Rapid Flu Test 87804

ICD 9 - DX code Mandatory Fiftt digit

Mandatory Fifth Digit

A 3-digit code is the primary classification for an illness or injury, a 4-digit code is a secondary classification of the same illness or injury, and a 5-digit code is a classification of the same illness or injury.

Notes are also used to list the fifth-digit sub classifications for subcategories – such as entries “Tuberculosis” or Diabetes mellitus.” Only the four-digit code is given for the individual entry, and you must refer to the note following the main term to locate the appropriate fifth-digit sub classification.

Not all ICD codes are valid for use on insurance claim forms. Carriers require the greatest specificity possible when using the codes. The idea is never to use a 3-digit code that has been sub-classified into 4-digit codes, and never use a 4- digit code that has been sub-classified as a 5-digit code.


Not all codes have fourth and fifth digits, but when a fourth or fifth digit is available, it must be used. It is a good idea to highlight codes with which a fifth digit is listed. This will serve as a reminder to you to always use that fifth digit. The following is a list of fifth digits that are used to identify location.

0 site unspecified
1 shoulder region
2 upper arm
3 forearm
4 hand
5 pelvic region and thigh
6 lower leg
7 ankle and foot
8 other specified sites
9 multiple sites

HERNIA REPAIR Procedures and Related CPT and ICD-9 Procedure Codes

CPT Code	CPT Description	ICD -9 Procedure
49495	Repair initial inguinal hernia, under age 6 months, with or without hydrocelectomy; reducible	5300
49496	incarcerated or strangulated	5300
49500	Repair initial inguinal hernia, age 6 months to under 5 years, with or without hydrocelectomy; reducible	5300
49501	incarcerated or strangulated	5300
49505	Repair initial inguinal hernia, age 5 years or over; reducible	5300
49507	incarcerated or strangulated	5300
49520	Repair recurrent inguinal hernia, any age; reducible	5300
49521	incarcerated or strangulated	5300
49525	Repair inguinal hernia; sliding, any age	5300
49540	Repair lumbar hernia	539
49550	Repair initial femoral hernia, any age; reducible	5329
49553	incarcerated or strangulated	5329
49555	Repair recurrent femoral hernia; reducible	5329
49557	incarcerated or strangulated	5329
49560	Repair initial incisional or ventral hernia; reducible	5351
49561	incarcerated or strangulated	5351
49565	Repair recurrent incisional or ventral hernia; reducible	5351
49566	incarcerated or strangulated	5351
49568	Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List separately in addition to code for the incisional or ventral hernia repair)	5351 (49565)
49570	Repair epigastric hernia (e.g. Preperitoneal fat); reducible (separate procedure)	5359
49572	incarcerated or strangulated	5359
49580	Repair umbilical hernia, under age 5 years; reducible	5359
49582	incarcerated or strangulated	5359
49585	Repair umbilical hernia, age 5 years or over; reducible	5349
49587	incarcerated or strangulated	5349
49590	Repair spigelian hernia	5359
49600	Repair of small omphalocele, with primary closure	5349
49605	Repair of large omphalocele or gastroschisis; with or without prosthesis	5341
49606	with removal of prosthesis, final reduction and closure, in operating room	5341
49610	Repair of omphalocele (Gross type operation); first stage	5349
49611	second stage	5349

ICD 9 - V76.2 - Pap smear

Screening Pap Smears

Effective, January 1, 1998, §4102 of the Balanced Budget Act (BBA) of 1997 (P.L. 105-33) amended §1861(nn) of the Act (42 USC 1395X(nn)) to include coverage every three years for a screening Pap smear or more frequent coverage for women:
1. At high risk for cervical or vaginal cancer; or
2. Of childbearing age who have had a Pap smear during any of the preceding three years indicating the presence of cervical or vaginal cancer or other abnormality.

Effective July 1, 2001, the Consolidated Appropriations Act of 2001 (P.L. 106-554) modifies §1861(nn) to provide Medicare coverage for biennial screening Pap smears. Specifications for frequency limitations are defined below.

For claims with dates of service from January 1, 1998, through June 30, 2001, screening Pap smears are covered when ordered and collected by a doctor of medicine or osteopathy (as defined in §1861(r)(1) of the Act), or other authorized practitioner (e.g., a certified nurse midwife, physician assistant, nurse practitioner, or clinical nurse specialist, who is authorized under State law to perform the examination) under one of the following conditions.

The beneficiary has not had a screening Pap smear test during the preceding three years (i.e., 35 months have passed following the month that the woman had the last covered Pap smear ICD-9-CM code V76.2 is used to indicate special screening for malignant neoplasm, cervix); or

There is evidence (on the basis of her medical history or other findings) that she is of childbearing age and has had an examination that indicated the presence of cervical or vaginal cancer or other abnormalities during any of the preceding three years; and at least 11 months have passed following the month that the last covered Pap smear was performed; or

She is at high risk of developing cervical or vaginal cancer ICD-9-CM code V15.89, other specified personal history presenting hazards to health) and at least 11 months have passed following the month that the last covered screening Pap smear was performed. The high risk factors for cervical and vaginal cancer are:

Cervical Cancer High Risk Factors

Early onset of sexual activity (under 16 years of age);
Multiple sexual partners (five or more in a lifetime);
History of a sexually transmitted disease (including HIV infection); and
Fewer than three negative or any Pap smears within the previous seven years.

Vaginal Cancer High Risk Factors

The DES (diethylstilbestrol) - exposed daughters of women who took DES during pregnancy

The term “woman of childbearing age” means a woman who is premenopausal, and has been determined by a physician, or qualified practitioner, to be of childbearing age, based on her medical history or other findings. Payment is not made for a screening Pap smear for women at high risk or who qualify for coverage under the childbearing provision more frequently than once every 11 months after the month that the last screening Pap smear covered by Medicare was performed.

For Claims with Dates of Service on or After July 1, 2001

When the beneficiary does not qualify for a more frequently performed screening Pap smear as noted in items 1 and 2 above, contractors pay for the screening Pap smear only after at least 23 months have passed following the month during which the beneficiary received her last covered screening Pap smear. All other coverage and payment requirements remain the same.

High Risk Medication DX Codes - V58.61

High Risk Medication Codes

V58.61 Long-term (current) use of anticoagulants
V58.62 Long-term (current) use of antibiotics
V58.64 Long-term (current) use of non-steroidal anti-inflammatories (NSAID)
V58.65 Long-term (current) use of steroids
V58.66 Long-term (current) use of aspirin
V58.67 Long-term (current) use of insulin
V58.69 Long-term (current) use of high risk medications

How costly is Medical Billing Mistakes and Fraud?

Even though working from the comfort of home as a medical billing professional may seem like the near-perfect career, offering benefits and advantages that within a doctor’s office or healthcare center are unavailable, the ramifications of possible mistakes can be very costly.

An example of how things can go wrong can be shown by MSO Washington, Inc. MSO is a medical practice management and billing service company that had to agree a settlement against claims of healthcare fraud, to the value of $565,000. 

The Dept. of Justice alleges that the company made claims to Medicare and Medicaid for settlement which failed to include the proper records and claims for procedures that were deemed medically unnecessary. The Department found that in some cases the procedures claimed for were never completed, or they were executed but charged for at rates above the industry standard.

It seems as though the healthcare providers were allegedly not aware of the questionable billing practices, and consequently, they were not a part of the investigation. The system that was under investigation was a home visitation program, in which doctors and medical professionals visited homes to inspect the residence itself.

As a professional and highly-trained medical professional, one would be able to detect anomalies and point out possible fraudulent activities. There is great value placed on such individuals, and as a result, insurance companies and government-based agencies will depend heavily on that person’s skills and training, as well as their moral character. After all, one would have medical documentation of many patients at hand.

Throughout the education and billing services classes, one is expected to learn every part of the coding systems that are used and relate to procedures, medical products and the services that their respective companies provide. Important aspects that medical offices and hospitals seek out when looking for specialists include a concern and prioritization of getting their job done; correctly and efficiently.

Where claims are concerned, most companies/offices will seek out a fair reimbursement for their services. Companies can lose vast sums of money through malpractice, accidental or intentional.

The owner of MSO Washington Inc. did not admit liability, so it can be deemed that the fraud was accidental and not intentional. This only highlights the importance of personnel who can account for their work and ensure that there are no errors. High-quality personnel are able to seek out the correct compensation while preserving a fraud-free status.

How to Prevent Medical Billing Fraud

Medical billing frauds are mostly related to medical insurances. In the US, such frauds may pertain to Medicare and Medicaid. Many people connected to health care sector may be involved in such frauds. The list of possible fraudsters includes beneficiaries, billing department personnel, recruiters, health care providers, and companies that offer medical services. 

Quite often invoices are raised for services that were not rendered to the beneficiary. Likewise, fraudulent bills may include medicines that are not prescribed for the beneficiary covered under medical insurance. Beneficiaries claim reimbursement of such bills, which might relate to somebody else's medication. Such inflated bills may also be raised to fleece the beneficiaries. 

At times cost of treating ailments that are not covered under any medical insurance, or costs of other services related to health care that do not come under Medicare are recovered by beneficiary through invoices that mention other ailments that are covered. 

This defeats the purpose of having specific coverage in medical insurance policies and Medicare. Health care facility may raise separate bills for procedures that are already covered under some main billing item. The effect of such unbundling is that the invoices get inflated. Such frauds are obviously felony. 

They happen with connivance of some medical professionals, and other personnel in billing department of the health care facility. Since legal implications of such frauds are quite serious, health care facility needs to take necessary measures for preventing medical billing frauds. 

For starters screening every employee at the time of recruitment is advisable. Background checking of the prospective candidate is a must. It is also necessary to verify the billing certificates produced by the candidate. 

In addition to this precaution, the health care facility can implement a foolproof system that requires compliance at different stages so that possibilities of medical billing fraud are remote. Somebody from administrative department should be given the responsibility of ensuring regular compliance with the system. 

This person should also have powers to deal severely with any fraud that may be detected. It is necessary to explain the entire procedure, and various checks integrated in them to every employee. The system should also ensure that an employee can report any abuse by superior without fearing any backlash. 

In addition to above measures, the health care facility can ensure that all the rules and regulations stipulated under Health Insurance Portability and Accountability Act  (HIPPA) are followed. HIPPA is a US law. It relates to health related information about a patient. It also has provisions relating to patient’s privacy and security of relevant information. 

HIPPA therefore stipulates that information about a patient such as the patient’s name, medical history, address, etc.. be protected. Passwords that guard such information should be kept a secret so that unscrupulous people do not learn about any patient’s case history. 

Placing fax machines in places that do not allow general public to access them is another way to prevent medical billing fraud. It is advisable to send encrypted mails relating to the patient rather than sending mails without any security precaution. 

A confidentiality agreement with severe consequences for breach can be entered into between the facility and the medical billing personnel. Such precautions are necessary even if a third party’s services are being availed for medical billing. Relevant clauses can then be incorporated in the contracts for such services. 

Medical Billing Fraud & abuse

Fraud, waste and abuse prevention & training

If you identify potential fraud, waste, or abuse, please report it to us immediately so that we can investigate and respond appropriately. Please see the How to Contact Us section of this guide for contact information. Please note UnitedHealthcare expressly prohibits retaliation if a report is made in good faith.

• Fraud Is a false statement, made or submitted by an individual or entity, who knows that the statement is false, and knows that the false statement could result in some otherwise unauthorized benefit to the individual or entity. These false statements could be verbal or written.

• Waste Generally means over-use of services, or other practices that result in unnecessary costs. In most cases, waste is not considered caused by reckless actions but rather the misuse of resources.

• Abuse Generally refers to provider, contractor or member practices that are inconsistent with sound business, financial or medical practices; and that cause unnecessary costs to the health care system.

Effective January 1, 2009, the Centers for Medicare & Medicaid Services (“CMS”) modified certain rules and regulations of the Medicare Advantage and the Part D programs. The rules state that a compliance plan must include training, education, and effective lines of communication between the compliance officer and the organization’s employees, managers, directors, as well as first tier, downstream and related entities. This change clarified that plan sponsors, such as UnitedHealthcare, need to apply these training and communication requirements to all entities they are partnering with to provide services in Medicare Advantage or Part D programs.

As a contracted provider for UnitedHealthcare’s Medicare Advantage programs, you are considered a first tier or downstream entity and are subject to this CMS requirement. It is our responsibility to ensure that your organization is provided with appropriate training for your employees and applicable subcontractors. To facilitate that, we will be providing your organization with training materials, which will be made available on UnitedHealthcareOnline.com.


Annually, your organization must administer the training materials to your employees and applicable subcontractors. This annual training can be done using our materials or you may use your existing training program and/or materials provided by another health plan as long as that training meets the CMS requirements. Please maintain records of the training (i.e. sign-in sheets, materials, etc). Documentation of the training may be requested by UnitedHealthcare, CMS, or an agent of CMS to verify the training was completed. 

RESPIRATORY, DIGESTIVE SYSTEM, GENITOURINARY SYSTEM - DX CODE

DISEASES OF THE RESPIRATORY SYSTEM [460-519]

[460-466] Acute respiratory infections.

[470-478] Other diseases of the upper respiratory tract.

[480-487] Pneumonia and influenza.

[490-496] Chronic obstructive pulmonary disease and allied conditions.

[500-508] Pneumoconioses and other lung diseases due to external agents.

[510-519] Other diseases of respiratory system.

DISEASES OF THE DIGESTIVE SYSTEM [520-579]

[520-529] Diseases of oral cavity, salivary glands. and jaws.

[530-537] Diseases of esophagus, stomach, and duodenum.

[540-543] Appendicitis.

[550-553] Hernia of abdominal cavity.

[555-558] Noninfectious enteritis and colitis.

[560-569] Other diseases of intestines and peritoneum.

[570-579] Other diseases of digestive system.

DISEASES OF THE GENITOURINARY SYSTEM [580-629]

[580-589] Nephritis, nephrotic syndrome, and nephrosis.

[590-599] Other diseases of urinary system.

[600-608] Diseases of male genital organs.

[610-611] Disorders of breast.

[614-616] Inflammatory disease of female pelvic organs.

[617-629] Other disorders of female genital tract.

Respiratory Therapy CPT code 31720, 94640, 94664

94640 – Pressurized or non-pressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device).

94664 Administration of bronchodilator - Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device $18

Inhaler Techniques

The following code is appropriate for inhaler techniques and can include demonstration of flow-operated inhaled devices such as flutter valves. The code may only be used once per day. This cannot be billed at the same time/ same visit as 94640. These can be billed on the same day, but must be a separate patient visit.

* 94664 – Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device can be used demonstrating (teaching) patients to use an aerosol generating device property.

Inhalation Treatment for Acute Airway Obstruction

When providing inhalation treatment for acute airway obstruction, Medicare will not pay for both 94640 and 94644 or 94645 if they are billed on the same day for the same patient. The coder must decide which of the two codes to submit for payment. Generally, it would be the code that has the greatest volume/quantity. 

The following information applies to inhalation treatments administered to Part B patients. This includes Emergency Room patients who are not admitted to the hospital. CPT code 94640 should only be reported once during a single patient encounter regardless of the number of separate inhalation treatments that are administered at that time. 

However, if there are multiple separate patient encounters for inhalation therapy on the same date of service, the additional encounters for inhalation therapy may be reported with modifier 76. Medicare defines a hospital outpatient encounter as “a direct personal contact between a patient and a physician, or other person who is authorized by State licensure law and, if applicable, by hospital or CAH staff bylaws, to order or furnish hospital services for diagnosis or treatment of the patient.”

* 94640 – Pressurized or non-pressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device).

(For more than 1 inhalation treatment performed on the same date (separate single encounter), append modifier 76) (Do not report 94640 in conjunction with 94060, 94070 or 94400)

* 94644 – Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (For services of less than 1 hour, use 94640)

* 94645 – each additional hour (List separately in addition to code for primary procedure) (Use 94645 in conjunction with 94644)

Several commenters expressed concern about our proposal to reject the Panel’s recommendation that we designate HCPCS code 94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device), as a non-surgical extended duration therapeutic service (extended duration service).

Extended duration services require an initial period of direct supervision, but the patient may be transitioned to general supervision once he or she is stable at the discretion of the supervising practitioner. One commenter believed that the physician’s presence should not be required for HCPCS code 94640 in the hospital, since this service can be performed by a patient at home.

Others commented that since the Panel’s charter does not prohibit the Panel from recommending extended duration services, it should be permitted to do so.

In the CY 2012 final rule, we indicated that the Panel may recommend only general, direct or personal supervision. HCPCS code 94640 is not performed over an extended period of time, and hospital patients receiving this service may require the supervising practitioner’s presence depending on their condition. At a future Panel meeting the Panel may reevaluate the supervision level for this service. Therefore, we continue to require direct supervision for HCPCS code 94640.

Respiratory therapy services that are provided in a facility are usually the responsibility of the facility’s nursing staff and/or respiratory therapy department.

Payment to a physician may be allowed for respiratory services only when the services are rendered as an integral although incidental part of the physician’s professional services in the course of diagnosis or treatment of an injury or illness. It is expected that respiratory therapy services will most often be used in cases of acute respiratory disease or acute exacerbation of chronic disease. 

Nevertheless, selected chronic stable conditions could require the services. Acute disease states are expected to either subside after a short period of treatment or, if no response occurs, the patient is transferred to a higher level of care. Respiratory therapy services performed in a nursing facility or office setting may be eligible for payment to a physician if one of the following conditions is met:

The service is personally performed by the physician or qualified non-physician practitioner if provision of the service is within the scope of his license.

Or,

The service is performed by ancillary personnel employed by the physician, under the direct personal supervision of the physician, and is furnished during a course of treatment in which the physician performs an initial service and subsequent service(s) which reflect his active participation in and management of the course of treatment.

CPT code 31720 is payable only if it is personally performed by the physician (or qualified non-physician practitioner).

LCD Individual Consideration

Additional payment may be allowed for respiratory therapy treatments and oximetric determinations exceeding the parameters described in the Utilization Guidelines section below on an individual consideration basis. The LCD Individual Consideration procedure is described in the related article.

Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all 

Medicare payment rules.

Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:

Safe and effective.

Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).

Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:

Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member. Furnished in a setting appropriate to the patient’s medical needs and condition. Ordered and furnished by qualified personnel. One that meets, but does not exceed, the patient’s medical need. At least as beneficial as an existing and available medically appropriate alternative.

Digestive System newly added cpt code 43283 - 43757, 49418

Digestive System – 18 New & 4 Deleted

New CPT codes

43283 - LAPS ESOPHAGEAL LENGTHENING ADDL

43327 - ESOPG/GSTR FUNDOPLASTY W/LAPT

43328 - ESOPG/GSTR FUNDOPLASTY W/THORCOM

43332 - RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH

43333 - LAPT RPR PARAESOPH HIATAL HERNIA W/ MESH

43334 - RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH

43335 - RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH

43336 - RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH

43337 - RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH

43338 - ESOPHAGUS LENGTHENING

43753 - GASTRIC TUBE PLMT W/ASPIR & LAVAGE

43754 - GASTRIC TUBE DX PLMT W/ASPIR 1 SPECIMEN

43755 - GASTRIC TUBE DX PLMT W/ASPIR MULT SPECIMENS

43756 - DUODENAL TUBE DX PLMT W/IMG GID 1 SPECIMEN

43757 - DUODENAL TUBE DX PLMT W/IMG GID MULT SPECIMEN

49327 - LAPS W/INSERTION NTRSTL DEV W/IMG GID 1+

49412 - PLMT INTRSTL DEV OPN W/IMG GID 1+

49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID

Deleted Codes

43324 - Esophagogastric fundoplasty (eg, Nissen, Belsey IV, Hill procedures)

43325 - Esophagogastric fundoplasty; with fundic patch (Thal-Nissen procedure)

43600 - Biopsy of stomach; by capsule, tube, peroral (1 or more specimens)

49420 - Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary.

DX code - V code - newly added and deleted V11.4,V15.53,V90.32

Factors Influencing Health Status (V Codes)

– New Codes –

• Personal History of:

– Combat & operational stress reaction – V11.4

– Vaginal dysplasia – V13.23

– Vulvar dysplasia – V13.24

– Other (corrected) congential malformations of:

» Genitourinary system – V13.62

» Nervous system – V13.63

» Eye, ear, face and neck – V13.64

» Heart and circulatory system – V13.65

» Respiratory system – V13.66

» Digestive system – V13.67

» Integument, limbs and musculoskeletal – V13.68

New Codes –

• Personal History of:

– Retained foreign body fully removed – V15.53

• Do not resuscitate status – V49.86

• Physical restraints status – V49.87

• Homicidal ideation – V62.85

• Acquired absence of pancreas – V88.1

– Total – V88.11 Partial – V88.12

• Retained:

– Foreign body – V90

» Radioactive fragment – V90.0

» Depleted uranium fragments – V90.01

» Other radioactive fragments – V90.09

– Metal fragments – V91

» Metal fragments, unspecified – V90.10

» Magnetic metal fragments – V90.11

» Non-magnetic metal fragments – V90.12

– Plastic fragments – V90.2

– Organic fragments – V90.3

– Animal quills or spines – V90.31

New Codes –

• Retained:

– Tooth – V90.32

– Wood fragments – V90.33

– Other organic fragments – V90.39

– Other specified foreign body – V90.8

– Glass fragments – V90.81

– Stone or crystalline fragments – V90.83

– Other specified foreign body, NEC – V90.89

– Foreign body, unspecified material – V90.9

• Multiple Gestation Placenta Status

– Codes V91.0 – V91.99

 Deleted

• Encounter for insertion of intrauterine contraceptive device (IUD) – V25.1

– Insertion of IUD – V25.11

– Removal of IUD – V25.12

– Removal and re-insertion of IUD – V25.13

• Body Mass Index (BMI) 40 and over, adult – V85.4

– BMI 40.0 – 44.9, adult – V85.41

– BMI 45.0 – 49.9, adult – V85.42

– BMI 50.0 – 59.9, adult – V85.43

– BMI 60.0 – 69.9, adult – V85.44

– BMI 70 and over, adult – V85.45

How to avoid Medical Coding Training Scams?

medicalbillingforyou.blogspot

WHAT TO KNOW BEFORE BUYING MEDICAL BILLING CODING SOFTWARE

You may be wondering why you should spend your time and money on a medical billing degree or certificate program when you see ads every day that claim you can install medical billing coding software and earn thousands of dollars per month working from home as a medical billing and coding specialist.

As you may have suspected, the vast majority of these "business opportunities" are scams. According to the Federal Trade Commission, which has filed charges against many of these companies, "few consumers who purchase a medical billing business opportunity are able to find clients, start a business and generate revenues—let alone recover their investment and earn a substantial income."

MEDICAL BILLING IS A SKILLED PROFESSION

While many companies will want to convince you that starting a medical billing business is as simple as installing some software on your computer and letting local doctors know you're open for business, you should know that medical billing involves much more than simple data entry. As a medical billing specialist you'll need to have the following knowledge and skills:

• Ability to fill out several types of complex insurance claim forms
   
• Knowledge of insurance guidelines, procedures and claims submission process
   
• Ability to analyze Explanation of Benefits (EOB) forms to ensure that insurance companies have properly assessed and paid for charges
   
• Ability to follow up with insurance companies and patients to ensure that bills are paid in a timely manner
   
• Ability to generate accounts receivable reports for clients

GET AN EDUCATION IN MEDICAL BILLING AND CODING

In addition to the above skills, you should strongly consider enrolling in a program that will educate you in both medical billing and coding. It's common for schools to combine both skill sets in one program, given that medical coding—the process of translating the information in a patient's charts into a set of coded, billable items—is essentially the first step in the billing process. Although it's possible to specialize in either medical billing or medical coding, you'll be far more marketable if you know how to do both.

MEDICAL BILLING BUSINESS REQUIREMENTS FOR SUCCESS

Medical billing specialists are responsible for getting doctors paid. This being the case, there aren't many medical practices willing to hand their accounts receivable over to an individual with minimal expertise. With a degree or certificate in medical billing and coding, a year or two of experience under your belt, and a list of personal contacts in the industry, you'll be prepared to start your medical billing business the right way.

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