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49255
Quick jump to procedure code: Printer Friendly Version
49321

CPT® 49320: LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

Short Description: Diag laparo separate proc

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Fee $337.50

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $4001.15
2016 Unadjusted ASC Payment $2010.99


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5361
Level 1 Laparoscopy

2016 OPPS Status Indicator: J1

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
4.8% V64.41    Laparoscopic surgical procedure converted to open procedure

No related ICD-10 codes.
4.5% 560.9    Unspecified intestinal obstruction K56.60   Unspecified intestinal obstruction
4.2% 568.0    Peritoneal adhesions, postoperative, postinfective K66.0   Peritoneal adhesions (postprocedural) (postinfection)
3.8% 625.9    Unspecified symptom associated with female genital organs N94.89   Other specified conditions associated with female genital organs and menstrual cycle
OR:
R10.2   Pelvic and perineal pain
2.7% 789.00    Abdominal pain, unspecified site R10.9   Unspecified abdominal pain
1.7% 789.07    Abdominal pain, generalized R10.84   Generalized abdominal pain
1.5% 614.6    Pelvic peritoneal adhesions, female (postoperative) (postinfective) N73.6   Female pelvic peritoneal adhesions (postinfective)
1.5% 789.04    Abdominal pain, left lower quadrant R10.32   Left lower quadrant pain
1.4% 789.03    Abdominal pain, right lower quadrant R10.31   Right lower quadrant pain
1.3% 553.21    Ventral hernia, Incisional K43.2   Incisional hernia without obstruction or gangrene

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

49320 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

CCI Edits for 49320
Denied Codes (1)
Effective
Modifier
Accepted (2)
0312T Laps impltj nstim vagus
01/01/2013 No
0313T Laps rmvl nstim array vagus
01/01/2013 No
0314T Laps rmvl vgl arry&pls gen
01/01/2013 No
0336T Lap ablat uterine fibroids
01/01/2014 No
0392T Lap es sph augment dev place
10/01/2015 No
0393T Es sph augmnt device removal
10/01/2015 No
36260 Insertion of infusion pump
10/01/2010 Yes
36261 Revision of infusion pump
10/01/2010 Yes
36262 Removal of infusion pump
10/01/2010 Yes
38100 Removal of spleen total
10/01/2010 Yes
38101 Removal of spleen partial
10/01/2010 Yes
38102 Removal of spleen total
10/01/2010 Yes
38115 Repair of ruptured spleen
10/01/2010 Yes
38120 Laparoscopy splenectomy
06/05/2000 No
38382 Thoracic duct procedure
10/01/2010 Yes
38562 Removal pelvic lymph nodes
10/01/2010 Yes
38564 Removal abdomen lymph nodes
10/01/2010 Yes
38570 Laparoscopy lymph node biop
06/05/2000 No
38571 Laparoscopy lymphadenectomy
06/05/2000 No
38572 Laparoscopy lymphadenectomy
06/05/2000 No
38770 Remove pelvis lymph nodes
10/01/2010 Yes
38780 Remove abdomen lymph nodes
10/01/2010 Yes
38794 Access thoracic lymph duct
10/01/2010 Yes
39501 Repair diaphragm laceration
10/01/2010 Yes
39503 Repair of diaphragm hernia
10/01/2010 Yes
39540 Repair of diaphragm hernia
10/01/2010 Yes
39541 Repair of diaphragm hernia
10/01/2010 Yes
39545 Revision of diaphragm
10/01/2010 Yes
39560 Resect diaphragm simple
10/01/2010 Yes
39561 Resect diaphragm complex
10/01/2010 Yes
43101 Excision of esophagus lesion
10/01/2010 Yes
43108 Removal of esophagus
10/01/2010 Yes
43113 Removal of esophagus
10/01/2010 Yes
43116 Partial removal of esophagus
10/01/2010 Yes
43117 Partial removal of esophagus
10/01/2010 Yes
43118 Partial removal of esophagus
10/01/2010 Yes
43122 Partial removal of esophagus
10/01/2010 Yes
43123 Partial removal of esophagus
10/01/2010 Yes
43279 Lap myotomy heller
01/01/2009 No
43280 Laparoscopy fundoplasty
06/05/2000 No
43281 Lap paraesophag hern repair
01/01/2010 No
43282 Lap paraesoph her rpr w/mesh
01/01/2010 No
43320 Fuse esophagus & stomach
10/01/2010 Yes
43325 Revise esophagus & stomach
10/01/2010 Yes
43330 Esophagomyotomy abdominal
10/01/2010 Yes
43340 Fuse esophagus & intestine
10/01/2010 Yes
43360 Gastrointestinal repair
10/01/2010 Yes
43361 Gastrointestinal repair
10/01/2010 Yes
43405 Ligate/staple esophagus
10/01/2010 Yes
43415 Repair esophagus wound
10/01/2010 Yes
43425 Repair esophagus opening
10/01/2010 Yes
43500 Surgical opening of stomach
10/01/2010 Yes
43501 Surgical repair of stomach
10/01/2010 Yes
43502 Surgical repair of stomach
10/01/2010 Yes
43510 Surgical opening of stomach
10/01/2010 Yes
43520 Incision of pyloric muscle
10/01/2010 Yes
43605 Biopsy of stomach
10/01/2010 Yes
43610 Excision of stomach lesion
10/01/2010 Yes
43611 Excision of stomach lesion
10/01/2010 Yes
43620 Removal of stomach
10/01/2010 Yes
43621 Removal of stomach
10/01/2010 Yes
43622 Removal of stomach
10/01/2010 Yes
43631 Removal of stomach partial
10/01/2010 Yes
43632 Removal of stomach partial
10/01/2010 Yes
43633 Removal of stomach partial
10/01/2010 Yes
43634 Removal of stomach partial
10/01/2010 Yes
43640 Vagotomy & pylorus repair
10/01/2010 Yes
43641 Vagotomy & pylorus repair
10/01/2010 Yes
43644 Lap gastric bypass/roux-en-y
01/01/2005 No
43645 Lap gastr bypass incl smll i
01/01/2005 No
43647 Lap impl electrode antrum
01/01/2007 No
43648 Lap revise/remv eltrd antrum
01/01/2007 No
43651 Laparoscopy vagus nerve
06/05/2000 No
43652 Laparoscopy vagus nerve
06/05/2000 No
43653 Laparoscopy gastrostomy
06/05/2000 No
43770 Lap place gastr adj device
01/01/2006 No
43771 Lap revise gastr adj device
01/01/2006 No
43772 Lap rmvl gastr adj device
01/01/2006 No
43773 Lap replace gastr adj device
01/01/2006 No
43774 Lap rmvl gastr adj all parts
01/01/2006 No
43775 Lap sleeve gastrectomy
01/01/2010 No
43800 Reconstruction of pylorus
10/01/2010 Yes
43810 Fusion of stomach and bowel
10/01/2010 Yes
43820 Fusion of stomach and bowel
10/01/2010 Yes
43825 Fusion of stomach and bowel
10/01/2010 Yes
43830 Place gastrostomy tube
10/01/2010 Yes
43831 Place gastrostomy tube
10/01/2010 Yes
43832 Place gastrostomy tube
10/01/2010 Yes
43840 Repair of stomach lesion
10/01/2010 Yes
43843 Gastroplasty w/o v-band
10/01/2010 Yes
43845 Gastroplasty duodenal switch
10/01/2010 Yes
43846 Gastric bypass for obesity
10/01/2010 Yes
43847 Gastric bypass incl small i
10/01/2010 Yes
43848 Revision gastroplasty
10/01/2010 Yes
43850 Revise stomach-bowel fusion
10/01/2010 Yes
43855 Revise stomach-bowel fusion
10/01/2010 Yes
43860 Revise stomach-bowel fusion
10/01/2010 Yes
43865 Revise stomach-bowel fusion
10/01/2010 Yes
43870 Repair stomach opening
10/01/2010 Yes
43880 Repair stomach-bowel fistula
10/01/2010 Yes
43881 Impl/redo electrd antrum
01/01/2007 Yes
43882 Revise/remove electrd antrum
01/01/2007 Yes
44010 Incision of small bowel
10/01/2010 Yes
44020 Explore small intestine
10/01/2010 Yes
44021 Decompress small bowel
10/01/2010 Yes
44025 Incision of large bowel
10/01/2010 Yes
44055 Correct malrotation of bowel
10/01/2010 Yes
44110 Excise intestine lesion(s)
10/01/2010 Yes
44111 Excision of bowel lesion(s)
10/01/2010 Yes
44120 Removal of small intestine
10/01/2010 Yes
44125 Removal of small intestine
10/01/2010 Yes
44126 Enterectomy w/o taper cong
10/01/2010 Yes
44127 Enterectomy w/taper cong
10/01/2010 Yes
44130 Bowel to bowel fusion
10/01/2010 Yes
44137 Remove intestinal allograft
10/01/2010 Yes
44140 Partial removal of colon
10/01/2010 Yes
44141 Partial removal of colon
10/01/2010 Yes
44143 Partial removal of colon
10/01/2010 Yes
44144 Partial removal of colon
10/01/2010 Yes
44145 Partial removal of colon
10/01/2010 Yes
44146 Partial removal of colon
10/01/2010 Yes
44147 Partial removal of colon
10/01/2010 Yes
44150 Removal of colon
10/01/2010 Yes
44151 Removal of colon/ileostomy
10/01/2010 Yes
44155 Removal of colon/ileostomy
10/01/2010 Yes
44156 Removal of colon/ileostomy
10/01/2010 Yes
44157 Colectomy w/ileoanal anast
01/01/2007 Yes
44158 Colectomy w/neo-rectum pouch
01/01/2007 Yes
44160 Removal of colon
10/01/2010 Yes
44180 Lap enterolysis
01/01/2006 No
44186 Lap jejunostomy
01/01/2006 No
44187 Lap ileo/jejuno-stomy
01/01/2006 No
44188 Lap colostomy
01/01/2006 No
44202 Lap enterectomy
06/05/2000 No
44204 Laparo partial colectomy
01/01/2002 No
44205 Lap colectomy part w/ileum
01/01/2002 No
44206 Lap part colectomy w/stoma
01/01/2003 No
44207 L colectomy/coloproctostomy
01/01/2003 No
44208 L colectomy/coloproctostomy
01/01/2003 No
44210 Laparo total proctocolectomy
01/01/2003 No
44211 Lap colectomy w/proctectomy
01/01/2003 No
44212 Laparo total proctocolectomy
01/01/2003 No
44227 Lap close enterostomy
01/01/2006 No
44300 Open bowel to skin
10/01/2010 Yes
44310 Ileostomy/jejunostomy
10/01/2010 Yes
44312 Revision of ileostomy
10/01/2010 Yes
44314 Revision of ileostomy
10/01/2010 Yes
44316 Devise bowel pouch
10/01/2010 Yes
44320 Colostomy
10/01/2010 Yes
44322 Colostomy with biopsies
10/01/2010 Yes
44340 Revision of colostomy
10/01/2010 Yes
44345 Revision of colostomy
10/01/2010 Yes
44346 Revision of colostomy
10/01/2010 Yes
44602 Suture small intestine
10/01/2010 Yes
44603 Suture small intestine
10/01/2010 Yes
44604 Suture large intestine
10/01/2010 Yes
44605 Repair of bowel lesion
10/01/2010 Yes
44615 Intestinal stricturoplasty
10/01/2010 Yes
44620 Repair bowel opening
10/01/2010 Yes
44625 Repair bowel opening
10/01/2010 Yes
44626 Repair bowel opening
10/01/2010 Yes
44640 Repair bowel-skin fistula
10/01/2010 Yes
44650 Repair bowel fistula
10/01/2010 Yes
44660 Repair bowel-bladder fistula
10/01/2010 Yes
44661 Repair bowel-bladder fistula
10/01/2010 Yes
44680 Surgical revision intestine
10/01/2010 Yes
44700 Suspend bowel w/prosthesis
06/05/2000 No
44800 Excision of bowel pouch
10/01/2010 Yes
44820 Excision of mesentery lesion
10/01/2010 Yes
44850 Repair of mesentery
10/01/2010 Yes
44900 Drain appendix abscess open
10/01/2010 Yes
44960 Appendectomy
10/01/2010 Yes
44970 Laparoscopy appendectomy
06/05/2000 No
45110 Removal of rectum
10/01/2010 Yes
45111 Partial removal of rectum
10/01/2010 Yes
45112 Removal of rectum
10/01/2010 Yes
45113 Partial proctectomy
10/01/2010 Yes
45114 Partial removal of rectum
10/01/2010 Yes
45116 Partial removal of rectum
10/01/2010 Yes
45120 Removal of rectum
10/01/2010 Yes
45121 Removal of rectum and colon
10/01/2010 Yes
45123 Partial proctectomy
10/01/2010 Yes
45126 Pelvic exenteration
10/01/2010 Yes
45135 Excision of rectal prolapse
10/01/2010 Yes
45136 Excise ileoanal reservior
10/01/2010 Yes
45395 Lap removal of rectum
01/01/2006 No
45397 Lap remove rectum w/pouch
01/01/2006 No
45400 Laparoscopic proc
01/01/2006 No
45402 Lap proctopexy w/sig resect
01/01/2006 No
45540 Correct rectal prolapse
10/01/2010 Yes
45550 Repair rectum/remove sigmoid
10/01/2010 Yes
45560 Repair of rectocele
10/01/2010 Yes
45563 Exploration/repair of rectum
10/01/2010 Yes
45800 Repair rect/bladder fistula
10/01/2010 Yes
45805 Repair fistula w/colostomy
10/01/2010 Yes
45820 Repair rectourethral fistula
10/01/2010 Yes
45825 Repair fistula w/colostomy
10/01/2010 Yes
46712 Repr per/vag pouch dbl proc
10/01/2010 Yes
47010 Open drainage liver lesion
10/01/2010 Yes
47015 Inject/aspirate liver cyst
10/01/2010 Yes
47100 Wedge biopsy of liver
10/01/2010 Yes
47120 Partial removal of liver
10/01/2010 Yes
47122 Extensive removal of liver
10/01/2010 Yes
47125 Partial removal of liver
10/01/2010 Yes
47130 Partial removal of liver
10/01/2010 Yes
47133 Removal of donor liver
10/01/2010 Yes
47135 Transplantation of liver
10/01/2010 Yes
47140 Partial removal donor liver
10/01/2010 Yes
47141 Partial removal donor liver
10/01/2010 Yes
47142 Partial removal donor liver
10/01/2010 Yes
47300 Surgery for liver lesion
10/01/2010 Yes
47350 Repair liver wound
10/01/2010 Yes
47360 Repair liver wound
10/01/2010 Yes
47370 Laparo ablate liver tumor rf
01/01/2002 No
47371 Laparo ablate liver cryosurg
01/01/2002 No
47380 Open ablate liver tumor rf
10/01/2010 Yes
47381 Open ablate liver tumor cryo
10/01/2010 Yes
47400 Incision of liver duct
10/01/2010 Yes
47420 Incision of bile duct
10/01/2010 Yes
47425 Incision of bile duct
10/01/2010 Yes
47460 Incise bile duct sphincter
10/01/2010 Yes
47480 Incision of gallbladder
10/01/2010 Yes
47562 Laparoscopic cholecystectomy
06/05/2000 No
47563 Laparo cholecystectomy/graph
06/05/2000 No
47564 Laparo cholecystectomy/explr
06/05/2000 No
47570 Laparo cholecystoenterostomy
06/05/2000 No
47600 Removal of gallbladder
07/01/2006 No
47605 Removal of gallbladder
06/05/2000 No
47610 Removal of gallbladder
07/01/2006 No
47612 Removal of gallbladder
10/01/2010 Yes
47620 Removal of gallbladder
10/01/2010 Yes
47700 Exploration of bile ducts
10/01/2010 Yes
47701 Bile duct revision
10/01/2010 Yes
47711 Excision of bile duct tumor
10/01/2010 Yes
47712 Excision of bile duct tumor
10/01/2010 Yes
47715 Excision of bile duct cyst
10/01/2010 Yes
47720 Fuse gallbladder & bowel
10/01/2010 Yes
47721 Fuse upper gi structures
10/01/2010 Yes
47740 Fuse gallbladder & bowel
10/01/2010 Yes
47741 Fuse gallbladder & bowel
10/01/2010 Yes
47760 Fuse bile ducts and bowel
10/01/2010 Yes
47765 Fuse liver ducts & bowel
10/01/2010 Yes
47780 Fuse bile ducts and bowel
10/01/2010 Yes
47785 Fuse bile ducts and bowel
10/01/2010 Yes
47800 Reconstruction of bile ducts
10/01/2010 Yes
47801 Placement bile duct support
10/01/2010 Yes
47802 Fuse liver duct & intestine
10/01/2010 Yes
47900 Suture bile duct injury
10/01/2010 Yes
48000 Drainage of abdomen
10/01/2010 Yes
48001 Placement of drain pancreas
10/01/2010 Yes
48020 Removal of pancreatic stone
10/01/2010 Yes
48100 Biopsy of pancreas open
10/01/2010 Yes
48105 Resect/debride pancreas
10/01/2010 Yes
48120 Removal of pancreas lesion
10/01/2010 Yes
48140 Partial removal of pancreas
10/01/2010 Yes
48145 Partial removal of pancreas
10/01/2010 Yes
48146 Pancreatectomy
10/01/2010 Yes
48148 Removal of pancreatic duct
10/01/2010 Yes
48150 Partial removal of pancreas
10/01/2010 Yes
48152 Pancreatectomy
10/01/2010 Yes
48153 Pancreatectomy
10/01/2010 Yes
48154 Pancreatectomy
10/01/2010 Yes
48155 Removal of pancreas
10/01/2010 Yes
48500 Surgery of pancreatic cyst
10/01/2010 Yes
48510 Drain pancreatic pseudocyst
10/01/2010 Yes
48520 Fuse pancreas cyst and bowel
10/01/2010 Yes
48540 Fuse pancreas cyst and bowel
10/01/2010 Yes
48545 Pancreatorrhaphy
10/01/2010 Yes
48547 Duodenal exclusion
10/01/2010 Yes
48548 Fuse pancreas and bowel
10/01/2010 Yes
48550 Donor pancreatectomy
10/01/2010 No
48554 Transpl allograft pancreas
10/01/2010 No
48556 Removal allograft pancreas
10/01/2010 No
49010 Exploration behind abdomen
10/01/2010 Yes
49020 Drainage abdom abscess open
10/01/2010 Yes
49040 Drain open abdom abscess
10/01/2010 Yes
49060 Drain open retroperi abscess
10/01/2010 Yes
49062 Drain to peritoneal cavity
06/05/2000 No
49185 Sclerotx fluid collection
01/01/2016 Yes
49203 Exc abd tum 5 cm or less
10/01/2010 Yes
49204 Exc abd tum over 5 cm
10/01/2010 Yes
49205 Exc abd tum over 10 cm
10/01/2010 Yes
49215 Excise sacral spine tumor
10/01/2010 Yes
49250 Excision of umbilicus
10/01/2010 Yes
0213T Njx paravert w/us cer/thor
07/01/2010 No
0216T Njx paravert w/us lumb/sac
07/01/2010 No
0228T Njx tfrml eprl w/us cer/thor
10/01/2010 No
0230T Njx tfrml eprl w/us lumb/sac
10/01/2010 No
12001 Rpr s/n/ax/gen/trnk 2.5cm/<
10/01/2012 Yes
12002 Rpr s/n/ax/gen/trnk2.6-7.5cm
10/01/2012 Yes
12004 Rpr s/n/ax/gen/trk7.6-12.5cm
10/01/2012 Yes
12005 Rpr s/n/a/gen/trk12.6-20.0cm
10/01/2012 Yes
12006 Rpr s/n/a/gen/trk20.1-30.0cm
10/01/2012 Yes
12007 Rpr s/n/ax/gen/trnk >30.0 cm
10/01/2012 Yes
12011 Rpr f/e/e/n/l/m 2.5 cm/<
10/01/2012 Yes
12013 Rpr f/e/e/n/l/m 2.6-5.0 cm
10/01/2012 Yes
12014 Rpr f/e/e/n/l/m 5.1-7.5 cm
10/01/2012 Yes
12015 Rpr f/e/e/n/l/m 7.6-12.5 cm
10/01/2012 Yes
12016 Rpr fe/e/en/l/m 12.6-20.0 cm
10/01/2012 Yes
12017 Rpr fe/e/en/l/m 20.1-30.0 cm
10/01/2012 Yes
12018 Rpr f/e/e/n/l/m >30.0 cm
10/01/2012 Yes
12020 Closure of split wound
10/01/2012 Yes
12021 Closure of split wound
10/01/2012 Yes
12031 Intmd rpr s/a/t/ext 2.5 cm/<
10/01/2012 Yes
12032 Intmd rpr s/a/t/ext 2.6-7.5
10/01/2012 Yes
12034 Intmd rpr s/tr/ext 7.6-12.5
10/01/2012 Yes
12035 Intmd rpr s/a/t/ext 12.6-20
10/01/2012 Yes
12036 Intmd rpr s/a/t/ext 20.1-30
10/01/2012 Yes
12037 Intmd rpr s/tr/ext >30.0 cm
10/01/2012 Yes
12041 Intmd rpr n-hf/genit 2.5cm/<
10/01/2012 Yes
12042 Intmd rpr n-hf/genit2.6-7.5
10/01/2012 Yes
12044 Intmd rpr n-hf/genit7.6-12.5
10/01/2012 Yes
12045 Intmd rpr n-hf/genit12.6-20
10/01/2012 Yes
12046 Intmd rpr n-hf/genit20.1-30
10/01/2012 Yes
12047 Intmd rpr n-hf/genit >30.0cm
10/01/2012 Yes
12051 Intmd rpr face/mm 2.5 cm/<
10/01/2012 Yes
12052 Intmd rpr face/mm 2.6-5.0 cm
10/01/2012 Yes
12053 Intmd rpr face/mm 5.1-7.5 cm
10/01/2012 Yes
12054 Intmd rpr face/mm 7.6-12.5cm
10/01/2012 Yes
12055 Intmd rpr face/mm 12.6-20 cm
10/01/2012 Yes
12056 Intmd rpr face/mm 20.1-30.0
10/01/2012 Yes
12057 Intmd rpr face/mm >30.0 cm
10/01/2012 Yes
13100 Cmplx rpr trunk 1.1-2.5 cm
10/01/2012 Yes
13101 Cmplx rpr trunk 2.6-7.5 cm
10/01/2012 Yes
13102 Cmplx rpr trunk addl 5cm/<
10/01/2012 Yes
13120 Cmplx rpr s/a/l 1.1-2.5 cm
10/01/2012 Yes
13121 Cmplx rpr s/a/l 2.6-7.5 cm
10/01/2012 Yes
13122 Cmplx rpr s/a/l addl 5 cm/>
10/01/2012 Yes
13131 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13132 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13133 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13151 Cmplx rpr e/n/e/l 1.1-2.5 cm
10/01/2012 Yes
13152 Cmplx rpr e/n/e/l 2.6-7.5 cm
10/01/2012 Yes
13153 Cmplx rpr e/n/e/l addl 5cm/<
10/01/2012 Yes
36000 Place needle in vein
10/01/2002 Yes
36400 Bl draw < 3 yrs fem/jugular
04/01/2009 Yes
36405 Bl draw <3 yrs scalp vein
04/01/2009 Yes
36406 Bl draw <3 yrs other vein
04/01/2009 Yes
36410 Non-routine bl draw 3/> yrs
10/01/2002 Yes
36420 Vein access cutdown < 1 yr
04/01/2009 Yes
36425 Vein access cutdown > 1 yr
04/01/2009 Yes
36430 Blood transfusion service
04/01/2009 Yes
36440 Bl push transfuse 2 yr/<
04/01/2009 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
36600 Withdrawal of arterial blood
04/01/2009 Yes
36640 Insertion catheter artery
04/01/2009 Yes
43752 Nasal/orogastric w/tube plmt
01/01/2004 Yes
44005 Freeing of bowel adhesion
07/01/2007 No
47001 Needle biopsy liver add-on
01/01/2003 Yes
49082 Abd paracentesis
04/01/2013 Yes
49083 Abd paracentesis w/imaging
04/01/2013 Yes
49084 Peritoneal lavage
04/01/2013 Yes
49400 Air injection into abdomen
10/01/2014 No
50715 Release of ureter
10/01/2004 Yes
51701 Insert bladder catheter
10/01/2007 Yes
51702 Insert temp bladder cath
10/01/2007 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
51703 Insert bladder cath complex
10/01/2007 Yes
57410 Pelvic examination
06/05/2000 Yes
62310 Inject spine cerv/thoracic
04/01/2009 No
62311 Inject spine lumbar/sacral
04/01/2009 No
62318 Inject spine w/cath crv/thrc
10/01/2002 No
62319 Inject spine w/cath lmb/scrl
10/01/2002 No
64400 N block inj trigeminal
04/01/2009 No
64402 N block inj facial
04/01/2009 No
64405 N block inj occipital
04/01/2009 No
64408 N block inj vagus
04/01/2009 No
64410 N block inj phrenic
04/01/2009 No
64413 N block inj cervical plexus
04/01/2009 No
64415 N block inj brachial plexus
10/01/2002 No
64416 N block cont infuse b plex
01/01/2003 No
64417 N block inj axillary
10/01/2002 No
64418 N block inj suprascapular
04/01/2009 No
64420 N block inj intercost sng
04/01/2009 No
64421 N block inj intercost mlt
04/01/2009 No
64425 N block inj ilio-ing/hypogi
04/01/2009 No
64430 N block inj pudendal
04/01/2009 No
64435 N block inj paracervical
04/01/2009 No
64445 N block inj sciatic sng
04/01/2009 No
64446 N blk inj sciatic cont inf
04/01/2009 No
64447 N block inj fem single
04/01/2009 No
64448 N block inj fem cont inf
04/01/2009 No
64449 N block inj lumbar plexus
04/01/2009 No
64450 N block other peripheral
10/01/2002 No
64461 Pvb thoracic single inj site
01/01/2016 No
64463 Pvb thoracic cont infusion
01/01/2016 No
64479 Inj foramen epidural c/t
04/01/2009 No
64483 Inj foramen epidural l/s
04/01/2009 No
64486 Tap block unil by injection
01/01/2015 No
64487 Tap block uni by infusion
01/01/2015 No
64488 Tap block bi injection
01/01/2015 No
64489 Tap block bi by infusion
01/01/2015 No
64490 Inj paravert f jnt c/t 1 lev
01/01/2010 No
64493 Inj paravert f jnt l/s 1 lev
01/01/2010 No
64505 N block spenopalatine gangl
04/01/2009 No
64508 N block carotid sinus s/p
04/01/2009 No
64510 N block stellate ganglion
04/01/2009 No
64517 N block inj hypogas plxs
04/01/2009 No
64520 N block lumbar/thoracic
04/01/2009 No
64530 N block inj celiac pelus
04/01/2009 No
69990 Microsurgery add-on
06/05/2000 No
76000 Fluoroscope examination
10/01/2009 Yes
76001 Fluoroscope exam extensive
10/01/2009 Yes
77001 Fluoroguide for vein device
01/01/2011 Yes
77002 Needle localization by xray
01/01/2011 Yes
92012 Eye exam establish patient
04/01/2014 Yes
92014 Eye exam&tx estab pt 1/>vst
04/01/2014 Yes
93000 Electrocardiogram complete
04/01/2009 Yes
93005 Electrocardiogram tracing
04/01/2009 Yes
93010 Electrocardiogram report
04/01/2009 Yes
93040 Rhythm ecg with report
04/01/2009 Yes
93041 Rhythm ecg tracing
04/01/2009 Yes
93042 Rhythm ecg report
04/01/2009 Yes
93318 Echo transesophageal intraop
04/01/2009 Yes
93355 Echo transesophageal (tee)
01/01/2015 Yes
94002 Vent mgmt inpat init day
04/01/2009 Yes
94200 Lung function test (mbc/mvv)
04/01/2009 Yes
94250 Expired gas collection
04/01/2009 Yes
94680 Exhaled air analysis o2
04/01/2009 Yes
94681 Exhaled air analysis o2/co2
04/01/2009 Yes
94690 Exhaled air analysis
04/01/2009 Yes
94770 Exhaled carbon dioxide test
04/01/2009 Yes
95812 Eeg 41-60 minutes
04/01/2009 Yes
95813 Eeg over 1 hour
04/01/2009 Yes
95816 Eeg awake and drowsy
04/01/2009 Yes
95819 Eeg awake and asleep
04/01/2009 Yes
95822 Eeg coma or sleep only
04/01/2009 Yes
95829 Surgery electrocorticogram
04/01/2009 Yes
95955 Eeg during surgery
04/01/2009 Yes
96360 Hydration iv infusion init
01/01/2009 Yes
96361 Hydrate iv infusion add-on
04/01/2016 Yes
96365 Ther/proph/diag iv inf init
01/01/2009 Yes
96366 Ther/proph/diag iv inf addon
04/01/2016 Yes
96367 Tx/proph/dg addl seq iv inf
04/01/2016 Yes
96368 Ther/diag concurrent inf
04/01/2016 Yes
96372 Ther/proph/diag inj sc/im
01/01/2009 Yes
96374 Ther/proph/diag inj iv push
01/01/2009 Yes
96375 Tx/pro/dx inj new drug addon
01/01/2009 Yes
96376 Tx/pro/dx inj same drug adon
04/01/2009 Yes
99148 Mod sed diff phys/qhp<5 yrs
10/01/2009 No
99149 Mod sed diff phys/qhp 5/>yrs
10/01/2009 No
99150 Mod sed diff phys/qhp add on
10/01/2009 No
99211 Office/outpatient visit est
07/01/2013 Yes
99212 Office/outpatient visit est
07/01/2013 Yes
99213 Office/outpatient visit est
07/01/2013 Yes
99214 Office/outpatient visit est
07/01/2013 Yes
99215 Office/outpatient visit est
07/01/2013 Yes
99217 Observation care discharge
07/01/2013 Yes
99218 Initial observation care
07/01/2013 Yes
99219 Initial observation care
07/01/2013 Yes
99220 Initial observation care
07/01/2013 Yes
99221 Initial hospital care
07/01/2013 Yes
99222 Initial hospital care
07/01/2013 Yes
99223 Initial hospital care
07/01/2013 Yes
99231 Subsequent hospital care
07/01/2013 Yes
99232 Subsequent hospital care
07/01/2013 Yes
99233 Subsequent hospital care
07/01/2013 Yes
99234 Observ/hosp same date
07/01/2013 Yes
99235 Observ/hosp same date
07/01/2013 Yes
99236 Observ/hosp same date
07/01/2013 Yes
99238 Hospital discharge day
07/01/2013 Yes
99239 Hospital discharge day
07/01/2013 Yes
99241 Office consultation
07/01/2013 Yes
99242 Office consultation
07/01/2013 Yes
99243 Office consultation
07/01/2013 Yes
99244 Office consultation
07/01/2013 Yes
99245 Office consultation
07/01/2013 Yes
99251 Inpatient consultation
07/01/2013 Yes
99252 Inpatient consultation
07/01/2013 Yes
99253 Inpatient consultation
07/01/2013 Yes
99254 Inpatient consultation
07/01/2013 Yes
99255 Inpatient consultation
07/01/2013 Yes
99291 Critical care first hour
07/01/2013 Yes
99292 Critical care addl 30 min
07/01/2013 Yes
99304 Nursing facility care init
07/01/2013 Yes
99305 Nursing facility care init
07/01/2013 Yes
99306 Nursing facility care init
07/01/2013 Yes
99307 Nursing fac care subseq
07/01/2013 Yes
99308 Nursing fac care subseq
07/01/2013 Yes
99309 Nursing fac care subseq
07/01/2013 Yes
99310 Nursing fac care subseq
07/01/2013 Yes
99315 Nursing fac discharge day
07/01/2013 Yes
99316 Nursing fac discharge day
07/01/2013 Yes
99334 Domicil/r-home visit est pat
07/01/2013 Yes
99335 Domicil/r-home visit est pat
07/01/2013 Yes
99336 Domicil/r-home visit est pat
07/01/2013 Yes
99337 Domicil/r-home visit est pat
07/01/2013 Yes
99347 Home visit est patient
07/01/2013 Yes
99348 Home visit est patient
07/01/2013 Yes
99349 Home visit est patient
07/01/2013 Yes
99350 Home visit est patient
07/01/2013 Yes
99374 Home health care supervision
07/01/2013 Yes
99375 Home health care supervision
07/01/2013 Yes
99377 Hospice care supervision
07/01/2013 Yes
99378 Hospice care supervision
07/01/2013 Yes
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
99495 Trans care mgmt 14 day disch
01/01/2014 No
99496 Trans care mgmt 7 day disch
01/01/2014 No
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G0471 Ven blood coll snf/hha
07/01/2015 Yes
49321 Laparoscopy biopsy
06/05/2000 No
49322 Laparoscopy aspiration
06/05/2000 No
49323 Laparo drain lymphocele
06/05/2000 No
49324 Lap insert tunnel ip cath
01/01/2007 No
49325 Lap revision perm ip cath
01/01/2007 No
49327 Lap ins device for rt
01/01/2011 Yes
49402 Remove foreign body adbomen
10/01/2010 Yes
49405 Image cath fluid colxn visc
01/01/2014 Yes
49406 Image cath fluid peri/retro
01/01/2014 Yes
49411 Ins mark abd/pel for rt perq
10/01/2010 No
49419 Insert tun ip cath w/port
10/01/2010 Yes
49421 Ins tun ip cath for dial opn
07/01/2006 No
49422 Remove tunneled ip cath
10/01/2010 Yes
49423 Exchange drainage catheter
10/01/2010 Yes
49424 Assess cyst contrast inject
10/01/2010 Yes
49425 Insert abdomen-venous drain
10/01/2010 Yes
49426 Revise abdomen-venous shunt
10/01/2010 Yes
49427 Injection abdominal shunt
10/01/2010 Yes
49428 Ligation of shunt
10/01/2010 Yes
49429 Removal of shunt
10/01/2010 Yes
49560 Rpr ventral hern init reduc
10/01/2010 Yes
49561 Rpr ventral hern init block
10/01/2010 Yes
49565 Rerepair ventrl hern reduce
10/01/2010 Yes
49566 Rerepair ventrl hern block
10/01/2010 Yes
49570 Rpr epigastric hern reduce
10/01/2010 Yes
49572 Rpr epigastric hern blocked
10/01/2010 Yes
49580 Rpr umbil hern reduc < 5 yr
10/01/2010 Yes
49582 Rpr umbil hern block < 5 yr
10/01/2010 Yes
49585 Rpr umbil hern reduc > 5 yr
10/01/2010 Yes
49587 Rpr umbil hern block > 5 yr
10/01/2010 Yes
49590 Repair spigelian hernia
10/01/2010 Yes
49600 Repair umbilical lesion
10/01/2010 Yes
49605 Repair umbilical lesion
10/01/2010 Yes
49606 Repair umbilical lesion
10/01/2010 Yes
49610 Repair umbilical lesion
10/01/2010 Yes
49611 Repair umbilical lesion
10/01/2010 Yes
49650 Lap ing hernia repair init
06/05/2000 No
49651 Lap ing hernia repair recur
06/05/2000 No
49652 Lap vent/abd hernia repair
01/01/2009 No
49653 Lap vent/abd hern proc comp
01/01/2009 No
49654 Lap inc hernia repair
01/01/2009 No
49655 Lap inc hern repair comp
01/01/2009 No
49656 Lap inc hernia repair recur
01/01/2009 No
49657 Lap inc hern recur comp
01/01/2009 No
49904 Omental flap extra-abdom
10/01/2010 Yes
49905 Omental flap intra-abdom
10/01/2010 Yes
50525 Close nephrovisceral fistula
10/01/2010 Yes
50541 Laparo ablate renal cyst
07/01/2001 No
50542 Laparo ablate renal mass
01/01/2003 No
50543 Laparo partial nephrectomy
01/01/2003 No
50544 Laparoscopy pyeloplasty
07/01/2001 No
50545 Laparo radical nephrectomy
04/01/2002 No
50546 Laparoscopic nephrectomy
07/01/2001 No
50547 Laparo removal donor kidney
07/01/2001 No
50548 Laparo remove w/ureter
07/01/2001 No
50785 Reimplant ureter in bladder
10/01/2010 Yes
50800 Implant ureter in bowel
10/01/2010 Yes
50810 Fusion of ureter & bowel
10/01/2010 Yes
50815 Urine shunt to intestine
10/01/2010 Yes
50820 Construct bowel bladder
10/01/2010 Yes
50825 Construct bowel bladder
10/01/2010 Yes
50840 Replace ureter by bowel
10/01/2010 Yes
50945 Laparoscopy ureterolithotomy
07/01/2001 No
50947 Laparo new ureter/bladder
04/01/2002 No
50948 Laparo new ureter/bladder
04/01/2002 No
51020 Incise & treat bladder
10/01/2010 Yes
51030 Incise & treat bladder
10/01/2010 Yes
51040 Incise & drain bladder
10/01/2010 Yes
51045 Incise bladder/drain ureter
10/01/2010 Yes
51050 Removal of bladder stone
10/01/2010 Yes
51060 Removal of ureter stone
10/01/2010 Yes
51065 Remove ureter calculus
10/01/2010 Yes
51080 Drainage of bladder abscess
10/01/2010 Yes
51500 Removal of bladder cyst
10/01/2010 Yes
51520 Removal of bladder lesion
10/01/2010 Yes
51525 Removal of bladder lesion
10/01/2010 Yes
51530 Removal of bladder lesion
10/01/2010 Yes
51535 Repair of ureter lesion
10/01/2010 Yes
51550 Partial removal of bladder
10/01/2010 Yes
51555 Partial removal of bladder
10/01/2010 Yes
51565 Revise bladder & ureter(s)
10/01/2010 Yes
51570 Removal of bladder
10/01/2010 Yes
51575 Removal of bladder & nodes
10/01/2010 Yes
51580 Remove bladder/revise tract
10/01/2010 Yes
51585 Removal of bladder & nodes
10/01/2010 Yes
51590 Remove bladder/revise tract
10/01/2010 Yes
51595 Remove bladder/revise tract
10/01/2010 Yes
51596 Remove bladder/create pouch
10/01/2010 Yes
51597 Removal of pelvic structures
10/01/2010 Yes
51800 Revision of bladder/urethra
10/01/2010 Yes
51820 Revision of urinary tract
10/01/2010 Yes
51840 Attach bladder/urethra
10/01/2010 Yes
51841 Attach bladder/urethra
10/01/2010 Yes
51845 Repair bladder neck
10/01/2010 Yes
51860 Repair of bladder wound
10/01/2010 Yes
51865 Repair of bladder wound
10/01/2010 Yes
51900 Repair bladder/vagina lesion
10/01/2010 Yes
51920 Close bladder-uterus fistula
10/01/2010 Yes
51925 Hysterectomy/bladder repair
10/01/2010 Yes
51960 Revision of bladder & bowel
10/01/2010 Yes
51980 Construct bladder opening
10/01/2010 Yes
51990 Laparo urethral suspension
07/01/2001 No
51992 Laparo sling operation
07/01/2001 No
54560 Exploration for testis
10/01/2010 Yes
54650 Orchiopexy (fowler-stephens)
10/01/2010 Yes
54690 Laparoscopy orchiectomy
06/05/2000 No
54692 Laparoscopy orchiopexy
07/01/2001 No
55535 Revise spermatic cord veins
10/01/2010 Yes
55550 Laparo ligate spermatic vein
06/05/2000 No
55600 Incise sperm duct pouch
10/01/2010 Yes
55605 Incise sperm duct pouch
10/01/2010 Yes
55650 Remove sperm duct pouch
10/01/2010 Yes
55680 Remove sperm pouch lesion
10/01/2010 Yes
55815 Extensive prostate surgery
10/01/2010 Yes
55842 Extensive prostate surgery
10/01/2010 Yes
55845 Extensive prostate surgery
10/01/2010 Yes
55860 Surgical exposure prostate
10/01/2010 Yes
55862 Extensive prostate surgery
10/01/2010 Yes
55865 Extensive prostate surgery
10/01/2010 Yes
55866 Laparo radical prostatectomy
01/01/2003 No
57270 Repair of bowel pouch
10/01/2010 Yes
57280 Suspension of vagina
10/01/2010 Yes
57284 Repair paravag defect open
04/01/2009 No
57296 Revise vag graft open abd
01/01/2007 Yes
57305 Repair rectum-vagina fistula
10/01/2010 Yes
57307 Fistula repair & colostomy
10/01/2010 Yes
57423 Repair paravag defect lap
01/01/2008 No
57425 Laparoscopy surg colpopexy
07/01/2004 No
57426 Revise prosth vag graft lap
01/01/2010 No
57540 Removal of residual cervix
10/01/2010 Yes
57545 Remove cervix/repair pelvis
10/01/2010 Yes
58140 Myomectomy abdom method
10/01/2010 Yes
58146 Myomectomy abdom complex
10/01/2010 Yes
58150 Total hysterectomy
10/01/2010 Yes
58152 Total hysterectomy
10/01/2010 Yes
58180 Partial hysterectomy
10/01/2010 Yes
58200 Extensive hysterectomy
10/01/2010 Yes
58210 Extensive hysterectomy
10/01/2010 Yes
58240 Removal of pelvis contents
10/01/2010 Yes
58400 Suspension of uterus
10/01/2010 Yes
58410 Suspension of uterus
10/01/2010 Yes
58520 Repair of ruptured uterus
10/01/2010 Yes
58540 Revision of uterus
10/01/2010 Yes
58541 Lsh uterus 250 g or less
01/01/2007 No
58542 Lsh w/t/o ut 250 g or less
01/01/2007 No
58543 Lsh uterus above 250 g
01/01/2007 No
58544 Lsh w/t/o uterus above 250 g
01/01/2007 No
58545 Laparoscopic myomectomy
01/01/2003 No
58546 Laparo-myomectomy complex
01/01/2003 No
58548 Lap radical hyst
01/01/2007 No
58550 Laparo-asst vag hysterectomy
06/05/2000 No
58552 Laparo-vag hyst incl t/o
01/01/2003 No
58553 Laparo-vag hyst complex
01/01/2008 No
58554 Laparo-vag hyst w/t/o compl
01/01/2003 No
58570 Tlh uterus 250 g or less
01/01/2008 No
58571 Tlh w/t/o 250 g or less
01/01/2008 No
58572 Tlh uterus over 250 g
01/01/2008 No
58573 Tlh w/t/o uterus over 250 g
01/01/2008 No
58600 Division of fallopian tube
10/01/2010 Yes
58605 Division of fallopian tube
10/01/2010 Yes
58660 Laparoscopy lysis
06/05/2000 No
58661 Laparoscopy remove adnexa
06/05/2000 No
58662 Laparoscopy excise lesions
06/05/2000 No
58670 Laparoscopy tubal cautery
06/05/2000 No
58671 Laparoscopy tubal block
06/05/2000 No
58672 Laparoscopy fimbrioplasty
06/05/2000 No
58673 Laparoscopy salpingostomy
06/05/2000 No
58700 Removal of fallopian tube
10/01/2010 Yes
58720 Removal of ovary/tube(s)
10/01/2010 Yes
58740 Adhesiolysis tube ovary
10/01/2010 Yes
58750 Repair oviduct
10/01/2010 Yes
58752 Revise ovarian tube(s)
10/01/2010 Yes
58760 Fimbrioplasty
10/01/2010 Yes
58770 Create new tubal opening
10/01/2010 Yes
58805 Drainage of ovarian cyst(s)
10/01/2010 Yes
58822 Drain ovary abscess percut
10/01/2010 Yes
58825 Transposition ovary(s)
10/01/2010 Yes
58900 Biopsy of ovary(s)
10/01/2010 Yes
58920 Partial removal of ovary(s)
10/01/2010 Yes
58925 Removal of ovarian cyst(s)
10/01/2010 Yes
58940 Removal of ovary(s)
10/01/2010 Yes
58943 Removal of ovary(s)
10/01/2010 Yes
58950 Resect ovarian malignancy
10/01/2010 Yes
58951 Resect ovarian malignancy
10/01/2010 Yes
58952 Resect ovarian malignancy
10/01/2010 Yes
58953 Tah rad dissect for debulk
10/01/2010 Yes
58954 Tah rad debulk/lymph remove
10/01/2010 Yes
58956 Bso omentectomy w/tah
10/01/2010 Yes
58957 Resect recurrent gyn mal
04/01/2008 Yes
58958 Resect recur gyn mal w/lym
04/01/2008 Yes
58960 Exploration of abdomen
10/01/2010 Yes
58970 Retrieval of oocyte
10/01/2014 No
59100 Remove uterus lesion
10/01/2010 Yes
59120 Treat ectopic pregnancy
10/01/2010 Yes
59121 Treat ectopic pregnancy
10/01/2010 Yes
59130 Treat ectopic pregnancy
10/01/2010 Yes
59135 Treat ectopic pregnancy
10/01/2010 Yes
59136 Treat ectopic pregnancy
10/01/2010 Yes
59140 Treat ectopic pregnancy
10/01/2010 Yes
59150 Treat ectopic pregnancy
10/01/2014 No
59151 Treat ectopic pregnancy
10/01/2014 No
59325 Revision of cervix
10/01/2010 Yes
59350 Repair of uterus
10/01/2010 Yes
59852 Abortion
10/01/2010 Yes
59857 Abortion
10/01/2010 Yes
60650 Laparoscopy adrenalectomy
06/05/2000 No
64755 Incision of stomach nerves
10/01/2010 Yes
64760 Incision of vagus nerve
10/01/2010 Yes
64766 Incise hip/thigh nerve
10/01/2010 Yes
G0342 Laparoscopy islet cell trans
04/01/2005 No
G0343 Laparotomy islet cell transp
10/01/2010 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 49320.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 49320


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Anatomic Consideration Anatomic Consideration Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   49320 Top 5 Ordering Providers National*
CHRISTOPHER DUMA -NEWPORT BEACH,CA 32
LISA RUTSTEIN -PORTLAND,ME 29
SUHAIL SHARIF -FORT WORTH,TX 24
EMMANUEL ANEKWE -EL PASO,TX 17
RONALD CHAMBERLAIN -LIVINGSTON,NJ 15

*Based on 2013 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 49320*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 12,486
Total Services Denied 2014: 3,163 (25.3%)
National Charges Submitted 2014: $ 16,280,450.00
National Charges Allowed 2014: $ 2,500,156.00
National Average (No Modifier) Fee Submitted 2014: $1413.94
National Average (No Modifier) Fee Allowed 2014: $369.10


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
General surgery 7,992 64.0% $1261.33 2,209 27.6%
Obstetrics/gynecology 1,814 14.5% $1124.33 318 17.5%
Physician assistant
(eff 5/92)
510 4.1% $671.12 102 20.0%
Surgical oncology
(eff 5/92)
426 3.4% $1325.78 74 17.4%
Colorectal surgery
(formerly proctology)
342 2.7% $1729.21 61 17.8%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Inpatient hospital 7,529 60.3% $1244.30 2,153 28.6%
Outpatient hospital 4,358 34.9% $1185.04 792 18.2%
Ambulatory surgical center 494 4.0% $3210.11 166 33.6%
Office 72 0.6% $1048.02 39 54.2%
Emergency room - hospital 32 0.3% $2688.56 12 37.5%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 5,414 43.4% $1413.95 1,282 23.7%
59 - Distinct Procedural Service 2,635 21.1% $1379.61 747 28.3%
51 - Multiple Procedures 1,076 8.6% $1123.51 382 35.5%
80 - Assistant Surgeon 723 5.8% $903.71 200 27.7%
AS 597 4.8% $667.80 161 27.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
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