Medicare Data Utilities Appendices

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4821 TRANSAB PROCTOSIGMOIDOSC 4822 PROCTOSIGMOIDOSC THRU ST 4823 RIGID PROCTOSIGMOIDOSCPY 4824 CLOSED RECTAL BIOPSY 4825 OPEN RECTAL BIOPSY 4826 PERIRECTAL TISSUE BIOPSY 4829 RECT/PERIRECT DX OP NEC 483 LOCAL DESTRUC RECTAL LES* 4831 RAD ELECTROCOAG-RECT LES 4832 ELECTROCOAG RECT LES NEC 4833 LASER DESTRUC RECTAL LES 4834 CRYOSURG DESTR RECT LES 4835 LOCAL EXCIS RECTAL LES 4836 POLYPECTOMY OF RECTUM 484 PULL-THRU RECT RESECTION* 4841 SOAVE SUBMUC RECT RESECT 4849 PULL-THRU RECT RESEC NEC 485 ABD-PERINEAL RECT RESECT 486 OTHER RECTAL RESECTION* 4861 TRANSSAC RECTOSIGMOIDECT 4862 ANT RECT RESECT W COLOST 4863 ANTERIOR RECT RESECT NEC 4864 POSTERIOR RECT RESECTION 4865 DUHAMEL RECTAL RESECTION 4869 RECTAL RESECTION NEC 487 REPAIR OF RECTUM* 4871 SUTURE OF RECTAL LACER 4872 CLOSURE OF PROCTOSTOMY 4873 CLOSE RECTAL FIST NEC 4874 RECTORECTOSTOMY 4875 ABDOMINAL PROCTOPEXY 4876 PROCTOPEXY NEC 4879 REPAIR OF RECTUM NEC 488 PERIRECTAL INCIS/EXCIS* 4881 PERIRECTAL INCISION 4882 PERIRECTAL EXCISION 489 OTH RECTAL/PERIRECT OP* 4891 INCIS RECTAL STRICTURE 4892 ANORECTAL MYOMECTOMY 4893 REPAIR PERIRECT FISTULA 4899 RECTAL PERIRECT OP NEC 49 OPERATIONS ON ANUS* 490 PERIANAL INCIS & EXCIS* 4901 INCIS PERIANAL ABSCESS 4902 PERIANAL INCISION NEC 4903 EXCIS PERIANAL SKIN TAG 4904 PERIANAL EXCISION NEC 491 INCIS/EXCIS ANAL FISTULA* 4911 ANAL FISTULOTOMY 4912 ANAL FISTULECTOMY 492 ANAL & PERIANAL DX PROC* 4921 ANOSCOPY 4922 PERIANAL BIOPSY 4923 ANAL BIOPSY 4929 ANAL/PERIAN DX PROC NEC 493 LOC DESTR ANAL LES NEC* 4931 ENDOSC DESTRUC ANUS LES
4939 OTHER DESTRUC ANUS LES 494 HEMORRHOID PROCEDURES* 4941 HEMORRHOID REDUCTION 4942 HEMORRHOID INJECTION 4943 HEMORRHOID CAUTERIZAT 4944 HEMORRHOID CRYOTHERAPY 4945 HEMORRHOID LIGATION 4946 HEMORRHOIDECTOMY 4947 HEMORRHOID EVACUATION 4949 HEMORRHOID PROCEDURE NEC 495 ANAL SPHINCTER DIVISION* 4951 LEFT LAT SPHINCTEROTOMY 4952 POST SPHINCTEROTOMY 4959 ANAL SPHINCTEROTOMY NEC 496 EXCISION OF ANUS 497 REPAIR OF ANUS* 4971 SUTURE ANAL LACERATION 4972 ANAL CERCLAGE 4973 CLOSURE OF ANAL FISTULA 4974 GRACILIS MUSC TRANSPLAN 4979 ANAL SPHINCT REPAIR NEC 499 OTH OPERATIONS ON ANUS* 4991 INCISION OF ANAL SEPTUM 4992 INSERT SUBQ ANAL STIMUL 4993 ANAL INCISION NEC 4994 REDUCTION ANAL PROLAPSE 4995 CONTROL ANAL HEMORRHAGE 4999 ANAL OPERATION NEC 50 OPERATIONS ON LIVER* 500 HEPATOTOMY 501 HEPATIC DIAGNOSTIC PROC* 5011 CLOSED LIVER BIOPSY 5012 OPEN LIVER BIOPSY 5019 HEPATIC DX PROC NEC 502 LOCAL DESTRUC LIVER LES* 5021 MARSUPIALIZAT LIVER LES 5022 PARTIAL HEPATECTOMY 5029 DESTRUC HEPATIC LES NEC 503 HEPATIC LOBECTOMY 504 TOTAL HEPATECTOMY 505 LIVER TRANSPLANT* 5051 AUXILIARY LIVER TRANSPL 5059 LIVER TRANSPLANT NEC 506 REPAIR OF LIVER* 5061 CLOSURE LIVER LACERAT 5069 LIVER REPAIR NEC 509 OTHER LIVER OPERATIONS* 5091 PERCUTAN LIVER ASPIRAT 5092 EXTRACORPOR HEPAT ASSIS 5093 LOCAL PERFUSION LIVER 5094 HEPATIC INJECTION NEC 5099 LIVER OPERATION NEC 51 BILIARY TRACT OPERATION* 510 GALLBLADDER INCISION* 5101 PERCUTAN ASPIRATION GB 5102 TROCAR CHOLECYSTOSTOMY 5103 CHOLECYSTOSTOMY NEC
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Medicare Data Utilities Appendices
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Appendix C BETOS Table The Berenson
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Appendix D Carrier Claim Payment De
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Appendix G CMS Provider Specialty T
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8O = Clinical social worker (1991)
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75 = Other medical care (GPPP) (not
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Appendix I Line Place of Service Ta
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0406 = (C) MAMMOGRAPHY WITH NO HCPC
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46XB = (C) MULTIPLE COIN VALU CODES
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5500 = (U) FULL DAYS/SNF-HOSP FULL
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6911 = (C) REV CODE 274 ON OUTPAT A
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94X5 = (C) BLOOD/MSP CODE/COMPUTED
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Appendix L State Table The followin
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Appendix M Identification of variab
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48 Thyroid disorders 49 Diabetes me
Page 31 and 32:
159 Urinary tract infections 160 Ca
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Appendix O Agency for Healthcare Re
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102 Ureteral catheterization 103 Ne
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216 Respiratory intubation and mech
Page 39 and 40:
0064 AMEBIC LUNG ABSCESS 0065 AMEBI
Page 41 and 42:
01136 TB OF BRONCHUS-OTH TEST 0114
Page 43 and 44:
01326 TUBRCLOMA BRAIN-OTH TEST 0133
Page 45 and 46:
01576 TB OF BONE NEC-OTH TEST 0158
Page 47 and 48:
01726 TB PERIPH LYMPH-OTH TEST 0173
Page 49 and 50:
026 RAT-BITE FEVER* 0260 SPIRILLARY
Page 51 and 52:
04181 MYCOPLASMA 04182 BACILLUS FRA
Page 53 and 54:
05579 MEASLES COMPLICATION NEC 0558
Page 55 and 56:
0771 EPIDEM KERATOCONJUNCTIV 0772 P
Page 57 and 58:
0907 LATE CONGEN SYPH NOS 0909 CONG
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09889 GONOCOCCAL INF SITE NEC 099 O
Page 61 and 62:
1160 BLASTOMYCOSIS 1161 PARACOCCIDI
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1330 SCABIES 1338 ACARIASIS NEC 133
Page 65 and 66:
151 MALIGNANT NEO STOMACH* 1510 MAL
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1712 MAL NEO SOFT TISSUE ARM 1713 M
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1902 MAL NEO LACRIMAL GLAND 1903 MA
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20083 MIXED LYMPHOSARC ABDOM 20084
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20225 SEZARY'S DISEASE INGUIN 20226
Page 75 and 76:
20610 CHR MONO LEUK W/O RMSION 2061
Page 77 and 78:
218 UTERINE LEIOMYOMA* 2180 SUBMUCO
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234 CA IN SITU NEC/NOS* 2340 CA IN
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2469 DISORDER OF THYROID NOS 250 DI
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2592 CARCINOID SYNDROME 2593 ECTOPI
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2766 FLUID OVERLOAD 2767 HYPERPOTAS
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2882 GENETIC ANOMALY LEUKOCYT 2883
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29552 LATENT SCHIZOPHREN-CHR 29553
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2990 INFANTILE AUTISM* 29900 INFANT
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30403 OPIOID DEPENDENCE-REMISS 3041
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30721 TRANSIENT TIC, CHILDHOOD 3072
Page 97 and 98:
3150 SPECIFIC READING DIS* 31500 RE
Page 99 and 100:
33510 SPINAL MUSCL ATROPHY NOS 3351
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34600 CLSC MIGRNE WO NTRC MGRN 3460
Page 103 and 104:
3594 TOXIC MYOPATHY 3595 MYOPATHY I
Page 105 and 106:
3625 DEGENERATION OF MACULA* 36250
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36459 IRIS ATROPHY NEC 3646 ANTERIO
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36731 ANISOMETROPIA 36732 ANISEIKON
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37005 MYCOTIC CORNEAL ULCER 37006 P
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37230 CONJUNCTIVITIS NOS 37231 ROSA
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3752 EPIPHORA* 37520 EPIPHORA NOS 3
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37775 CORTICAL BLINDNESS 3779 OPTIC
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37953 VISUAL DEPRIVATN NYSTAGM 3795
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38421 CENT PERF TYMPANIC MEMB 38422
Page 123 and 124:
38900 CONDUCT HEARING LOSS NOS 3890
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41020 AMI INFEROLATERAL,UNSPEC 4102
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426 CONDUCTION DISORDERS* 4260 ATRI
Page 129 and 130:
438 LATE EFF CEREBROVASC DIS* 4380
Page 131 and 132:
4518 THROMBOPHLEBITIS NEC* 45181 IL
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4741 T & A HYPERTROPHY* 47410 HYPER
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4951 BAGASSOSIS 4952 BIRD-FANCIERS'
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5226 CHR APICAL PERIODONTITIS 5227
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53089 OTHER DSRDERS ESOPHAGUS 5309
Page 141 and 142:
535 GASTRITIS AND DUODENITIS* 5350
Page 143 and 144:
5539 HERNIA NOS 555 REGIONAL ENTERI
Page 145 and 146:
572 SEQUELA OF CHR LIVER DIS* 5720
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5838 NEPHRITIS NOS W OTH LES* 58381
Page 149 and 150:
5997 HEMATURIA 5998 URINARY TRACT D
Page 151 and 152:
6168 FEMALE GEN INFLAM NEC 6169 FEM
Page 153 and 154:
6281 INFERTIL-PITUITARY ORIG 6282 I
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63622 ILLEG AB W PEL DAMG-COMP 6363
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64120 PREM SEPAR PLACEN-UNSPEC 6412
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64613 EDEMA IN PREG-ANTEPARTUM 6461
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64821 ANEMIA-DELIVERED 64822 ANEMIA
Page 163 and 164:
65270 PROLAPSED ARM-UNSPEC 65271 PR
Page 165 and 166:
65501 FETAL CNS MALFORM-DELIV 65503
Page 167 and 168:
65901 FAIL MECH INDUCT-DELIVER 6590
Page 169 and 170:
66221 PROLONG 2ND STAGE-DELIV 66223
Page 171 and 172:
66584 OB TRAUMA NEC-POSTPARTUM 6659
Page 173 and 174:
670 MAJOR PUERPERAL INFECT* 67000 M
Page 175 and 176:
67494 PUERP COMPL NOS-POSTPART 675
Page 177 and 178:
6825 CELLULITIS OF BUTTOCK 6826 CEL
Page 179 and 180:
7038 DISEASES OF NAIL NEC 7039 DISE
Page 181 and 182:
71145 BACT ARTHRITIS-PELVIS 71146 B
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71298 CRY ARTHROP NOS-OTH SITE 7129
Page 185 and 186:
71635 CLIMACT ARTHRITIS-PELVIS 7163
Page 187 and 188:
71830 RECUR DISLOCAT-UNSPEC 71831 R
Page 189 and 190:
71951 JT STIFFNESS NEC-SHLDER 71952
Page 191 and 192:
724 BACK DISORDER NEC & NOS* 7240 S
Page 193 and 194:
72886 NECROTIZING FASCIITIS 72889 M
Page 195 and 196:
7330 OSTEOPOROSIS* 73300 OSTEOPOROS
Page 197 and 198:
7379 CURVATURE OF SPINE NOS 738 OTH
Page 199 and 200:
74405 ANOMALIES OF INNER EAR 74409
Page 201 and 202:
74904 BILAT CLEFT PALATE-INC 7491 C
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75433 CONG HIP SUBLUX, BILAT 75435
Page 205 and 206:
75681 ABSENCE OF MUSCLE/TENDON 7568
Page 207 and 208:
7641 LT-FOR-DATES W FETAL MAL* 7641
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7732 NB HEMOLYT DIS-ISOIM NEC 7733
Page 211 and 212:
7826 PALLOR & FLUSHING* 78261 PALLO
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78900 ABDMNAL PAIN UNSPCF SITE 7890
Page 215 and 216:
7951 ABN PAP SMEAR-OTH SITE 7952 AB
Page 217 and 218:
80090 OP SKL VLT FX/BR INJ NEC 8009
Page 219 and 220:
80230 MANDIBLE FX NOS-OPEN 80231 FX
Page 221 and 222:
80405 CL SKUL/OTH FX-DEEP COMA 8040
Page 223 and 224:
8060 CLOS CERV FX W CORD INJ* 80600
Page 225 and 226:
81011 FX CLAVIC, STERN END-OPN 8101
Page 227 and 228:
8141 FRACTURE CARPAL BONE-OPN* 8141
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82391 FX FIBULA NOS-OPEN 82392 FX T
Page 231 and 232:
836 DISLOCATION OF KNEE* 8360 TEAR
Page 233 and 234:
84213 SPRAIN INTERPHALANGEAL 84219
Page 235 and 236:
85155 OPN CEREBE CONT-DEEP COM 8515
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8540 BRAIN INJURY NEC* 85400 BRAIN
Page 239 and 240:
86412 LIVER LACERAT, MINOR-OPN 8641
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87333 OPEN WND NAS SINUS-COMPL 8733
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8821 OPN WOUND HAND-COMPLICAT 8822
Page 245 and 246:
90242 INJURY RENAL VEIN 90249 INJUR
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9117 FOREIGN BODY TRUNK-INFEC 9118
Page 249 and 250:
92320 CONTUSION OF HAND(S) 92321 CO
Page 251 and 252:
94111 1ST DEG BURN EAR 94112 1ST DE
Page 253 and 254:
94311 1ST DEG BURN FOREARM 94312 1S
Page 255 and 256:
9451 1ST DEGREE BURN LEG* 94510 1ST
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94888 80-89% BDY BRN/80-89% 3D 9489
Page 259 and 260:
9590 FACE AND NECK INJURY NOS* 9590
Page 261 and 262:
9697 POISON-PSYCHOSTIMULANTS 9698 P
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9840 TX EFF INORG LEAD COMPND 9841
Page 265 and 266:
99580 ADULT MALTREATMENT NOS 99581
Page 267 and 268:
9994 ANAPHYLACTIC SHOCK-SERUM 9995
Page 269 and 270:
E8147 MV COLL W PEDEST-PEDEST E8148
Page 271 and 272:
E8250 MV N-TRAFF ACC NEC-DRIV E8251
Page 273 and 274:
E8378 WATERCRAFT EXPL-PERS NEC E837
Page 275 and 276:
E8551 ACC POISN-CNS DEPRES NEC E855
Page 277 and 278:
E8714 POSTENDOSCOPY FORGN BODY E871
Page 279 and 280:
E893 CLOTHING FIRE ACCIDENT* E8930
Page 281 and 282:
E9203 KNIFE/SWORD/DAGGER ACC E9204
Page 283 and 284: E935 ADV EFF ANALGESICS* E9350 ADV
Page 285 and 286: E9473 ADV EFF ALCOHOL DETER E9474 A
Page 287 and 288: E9682 ASSAULT-STRIKING W OBJ E9683
Page 289 and 290: V0261 HEPATITIS B CARRIER V0262 HEP
Page 291 and 292: V1062 HX OF MYELOID LEUKEMIA V1063
Page 293 and 294: V169 FAMILY HX-MALIGNANCY NOS V17 F
Page 295 and 296: V291 NB OBSRV SUSPCT NEURLGCL V292
Page 297 and 298: V440 TRACHEOSTOMY STATUS V441 GASTR
Page 299 and 300: V533 ADJUST CARDIAC PACEMAKER* V533
Page 301 and 302: V6289 PSYCHOLOGICAL STRESS NEC V629
Page 303 and 304: V738 SCREEN VRAL CHLM DIS NEC* V738
Page 305 and 306: Appendix Q International Classifica
Page 307 and 308: 0405 GASSERIAN GANGLIONECTOMY 0406
Page 309 and 310: 0752 PINEAL GLAND INCISION 0753 PAR
Page 311 and 312: 098 NASO-LACRIMAL FISTULIZAT* 0981
Page 313 and 314: 1274 CIL BODY DIMINUTION NOS 1279 G
Page 315 and 316: 161 REMOVE PENETRAT FB EYE 162 ORBI
Page 317 and 318: 2098 IMP/REP MCHAN COCHL PROS 2099
Page 319 and 320: 2499 DENTAL OPERATION NEC 25 OPERAT
Page 321 and 322: 2991 PHARYNGEAL DILATION 2992 DIVIS
Page 323 and 324: 3423 CHEST WALL BIOPSY 3424 PLEURAL
Page 325 and 326: 3631 OPEN CHEST TRANS REVASC 3632 O
Page 327 and 328: 385 VARICOSE LIGAT & STRIP* 3850 VA
Page 329 and 330: 406 THORACIC DUCT OPERATIONS* 4061
Page 331 and 332: 4400 VAGOTOMY NOS 4401 TRUNCAL VAGO
Page 333: 4624 DELAY OPENING ILEOSTOMY 463 OT
Page 337 and 338: 5196 PERC EXTRAC COM DUC CALC 5198
Page 339 and 340: 5495 PERITONEAL INCISION 5496 INJEC
Page 341 and 342: 5749 TU DESTRUC BLADD LES NEC 575 B
Page 343 and 344: 6091 PERCUT PROSTATIC ASPIRAT 6092
Page 345 and 346: 6525 OTH LAP LOC EXC DEST OVA 6529
Page 347 and 348: 686 RADICAL ABD HYSTERECTOMY 687 RA
Page 349 and 350: 7254 TOT BREECH EXTRAC NEC 726 FORC
Page 351 and 352: 7699 FACIAL BONE/JNT OP NEC 77 INCI
Page 353 and 354: 7802 BONE GRAFT TO HUMERUS 7803 BON
Page 355 and 356: 7909 CLOSED FX REDUCTION NEC 791 CL
Page 357 and 358: 8019 OTHER ARTHROTOMY NEC 802 ARTHR
Page 359 and 360: 8151 TOTAL HIP REPLACEMENT 8152 PAR
Page 361 and 362: 8339 EXC LES SOFT TISSUE NEC 834 OT
Page 363 and 364: 8541 UNILAT SIMPLE MASTECTOMY 8542
Page 365 and 366: 8729 SPINAL X-RAY NEC 873 THORAX SO
Page 367 and 368: 8862 CONTR PHLEBOGRAM-PULMON 8863 T
Page 369 and 370: 901 MICRO EXAM-ENDOCRINE* 9011 BACT
Page 371 and 372: 9151 BACT SMEAR-MUSCULOSKEL 9152 CU
Page 373 and 374: 934 SKELETAL & OTH TRACTION* 9341 S
Page 375 and 376: 9507 DARK ADAPTATION STUDY 9509 EYE
Page 377 and 378: 9723 REPLACE TRACH TUBE 9724 REPLAC
Page 379 and 380: 9927 IONTOPHORESIS 9928 IMMUNOTHERA
Page 381 and 382: Appendix R Diagnostic Related Group
Page 383 and 384: 104 MDC 05P CARDIAC VALVE & OTH MAJ
Page 385 and 386:
218 MDC 08P LOWER EXTREM & HUMER PR
Page 387 and 388:
332 MDC 11M OTHER KIDNEY & URINARY
Page 389 and 390:
446 MDC 21M TRAUMATIC INJURY AGE 0-
Page 391 and 392:
Appendix S Alpha-Numeric HCPCS Code
Page 393 and 394:
A0425 GROUND MILEAGE, PER STATUTE M
Page 395 and 396:
A4356 EXTERNAL URETHRAL CLAMP OR CO
Page 397 and 398:
A4636 REPLACEMENT, HANDGRIP, CANE,
Page 399 and 400:
A6021 COLLAGEN DRESSING, PAD SIZE 1
Page 401 and 402:
EACH DRESSING A6259 TRANSPARENT FIL
Page 403 and 404:
HOMEMIX B4178 PARENTERAL NUTRITION
Page 405 and 406:
C1047 CATHETER, DIAGNOSTIC, NAVI-ST
Page 407 and 408:
C1134 PACEMAKER, DUAL CHAMBER, SIGM
Page 409 and 410:
SOMNOPLASTY COAGULATING ELECTRODE C
Page 411 and 412:
C1812 ANCHOR, OBL 2.0MM MINI TAC AC
Page 413 and 414:
C2104 CATHETER, ELECTROPHYSIOLOGY,
Page 415 and 416:
C4607 LEAD, PACEMAKER, FINELINE II
Page 417 and 418:
C5601 VASCULAR CLOSURE DEVICE, VASC
Page 419 and 420:
C8513 LEAD, NEUROSTIMULATION, PISCE
Page 421 and 422:
E0147 HEAVY DUTY, MULTIPLE BREAKING
Page 423 and 424:
E0424 STATIONARY COMPRESSED GASEOUS
Page 425 and 426:
E0757 IMPLANTABLE NEUROSTIMULATOR R
Page 427 and 428:
AWAY DETACHABLE FOOTRESTS E1100 SEM
Page 429 and 430:
E1635 COMPACT (PORTABLE) TRAVEL HEM
Page 431 and 432:
PATIENT'S CARE, INTEGRATION OF NEW
Page 433 and 434:
G0115 NETT PULM-REHAB; PSYCHOLOGICA
Page 435 and 436:
INVOLVED IN THE PATIENT’S CARE, I
Page 437 and 438:
J0200 INJECTION, ALATROFLOXACIN MES
Page 439 and 440:
J1364 INJECTION, ERYTHROMYCIN LACTO
Page 441 and 442:
J2512 INJECTION, PENTAGASTRIN, PER
Page 443 and 444:
J7320 HYLAN G-F 20, 16 MG, FOR INTR
Page 445 and 446:
J9000 DOXORUBICIN HCL, 10 MG J9001
Page 447 and 448:
K0034 HEEL LOOP,EACH K0035 HEEL LOO
Page 449 and 450:
K0171 ADMINISTRATION SET, SMALL VOL
Page 451 and 452:
K0462 TEMPORARY REPLACEMENT FOR PAT
Page 453 and 454:
L0340 TLSO, ANTERIOR-POSTERIOR-LATE
Page 455 and 456:
CUSTOM FABRICATED L1686 HIP ORTHOSI
Page 457 and 458:
CUSTOM-FABRICATED L2112 ANKLE FOOT
Page 459 and 460:
L2780 ADDITION TO LOWER EXTREMITY O
Page 461 and 462:
L3640 TRANSFER OF AN ORTHOSIS FROM
Page 463 and 464:
RECLINING, PREFABRICATED, INCLUDES
Page 465 and 466:
SYSTEM, PYLON, NO COVER, SACH FOOT,
Page 467 and 468:
L5697 ADDITION TO LOWER EXTREMITY,
Page 469 and 470:
L6100 BELOW ELBOW, MOLDED SOCKET, F
Page 471 and 472:
L6765 TERMINAL DEVICE, HOOK, DORRAN
Page 473 and 474:
L8020 BREAST PROSTHESIS, MASTECTOMY
Page 475 and 476:
P2029 CONGO RED, BLOOD P2031 HAIR A
Page 477 and 478:
Q0172 CHLORPROMAZINE HYDROCHLORIDE,
Page 479 and 480:
Q9936 INJECTION OF EPO, PER 1000 UN
Page 481 and 482:
S2371 EACH ADDITIONAL INTERSPACE (L
Page 483 and 484:
S9310 NURSING SERVICES AND ALL NECE
Page 485 and 486:
V2212 SPHEROCYLINDER, BIFOCAL, PLUS
Page 487:
V5130 BINAURAL, IN THE EAR V5140 BI
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