DUPLEX SCAN OF EXTRACRANIAL ARTERIES - Oxford Health Plans

More documents

Recommendations

Info

G82.51 Quadriplegia, C1-C4 completeG82.52 Quadriplegia, C1-C4 incompleteG82.53 Quadriplegia, C5-C7 completeG82.54 Quadriplegia, C5-C7 incompleteG83.0 Diplegia of upper limbsG83.11 Monoplegia of lower limb affecting right dominant sideG83.12 Monoplegia of lower limb affecting left dominant sideG83.13 Monoplegia of lower limb affecting right nondominant sideG83.14 Monoplegia of lower limb affecting left nondominant sideG83.21 Monoplegia of upper limb affecting right dominant sideG83.22 Monoplegia of upper limb affecting left dominant sideG83.23 Monoplegia of upper limb affecting right nondominant sideG83.24 Monoplegia of upper limb affecting left nondominant sideH34.00 Transient retinal artery occlusion, unspecified eyeH34.01 Transient retinal artery occlusion, right eyeH34.02 Transient retinal artery occlusion, left eyeH34.03 Transient retinal artery occlusion, bilateralH34.10 Central retinal artery occlusion, unspecified eyeH34.11 Central retinal artery occlusion, right eyeH34.12 Central retinal artery occlusion, left eyeH34.13 Central retinal artery occlusion, bilateralH34.211 Partial retinal artery occlusion, right eyeH34.212 Partial retinal artery occlusion, left eyeH34.213 Partial retinal artery occlusion, bilateralH34.219 Partial retinal artery occlusion, unspecified eyeH34.231 Retinal artery branch occlusion, right eyeH34.232 Retinal artery branch occlusion, left eyeH34.233 Retinal artery branch occlusion, bilateralH34.239 Retinal artery branch occlusion, unspecified eyeH34.811 Central retinal vein occlusion, right eyeH34.812 Central retinal vein occlusion, left eyeH34.813 Central retinal vein occlusion, bilateralH34.819 Central retinal vein occlusion, unspecified eyeH34.821 Venous engorgement, right eyeH34.822 Venous engorgement, left eyeH34.823 Venous engorgement, bilateralH34.829 Venous engorgement, unspecified eyeH34.831 Tributary (branch) retinal vein occlusion, right eyeH34.832 Tributary (branch) retinal vein occlusion, left eyeH34.833 Tributary (branch) retinal vein occlusion, bilateralH34.839 Tributary (branch) retinal vein occlusion, unspecified eyeH35.82 Retinal ischemiaH53.10 Unspecified subjective visual disturbancesH53.11 Day blindnessH53.121 Transient visual loss, right eyeH53.122 Transient visual loss, left eyeH53.123 Transient visual loss, bilateralH53.129 Transient visual loss, unspecified eyeH53.131 Sudden visual loss, right eyeH53.132 Sudden visual loss, left eyeH53.133 Sudden visual loss, bilateralH53.139 Sudden visual loss, unspecified eyeH53.2 DiplopiaH53.411 Scotoma involving central area, right eyeH53.412 Scotoma involving central area, left eyeH53.413 Scotoma involving central area, bilateralDuplex Scan of Extracranial Arteries: Clinical Policy (Effective 11/01/2012)©1996-2012, Oxford Health Plans, LLC6
H53.419 Scotoma involving central area, unspecified eyeH53.421 Scotoma of blind spot area, right eyeH53.422 Scotoma of blind spot area, left eyeH53.423 Scotoma of blind spot area, bilateralH53.429 Scotoma of blind spot area, unspecified eyeH53.431 Sector or arcuate defects, right eyeH53.432 Sector or arcuate defects, left eyeH53.433 Sector or arcuate defects, bilateralH53.439 Sector or arcuate defects, unspecified eyeH53.451 Other localized visual field defect, right eyeH53.452 Other localized visual field defect, left eyeH53.453 Other localized visual field defect, bilateralH53.459 Other localized visual field defect, unspecified eyeH53.461 Homonymous bilateral field defects, right sideH53.462 Homonymous bilateral field defects, left sideH53.469 Homonymous bilateral field defects, unspecified sideH53.47 Heteronymous bilateral field defectsH53.481 Generalized contraction of visual field, right eyeH53.482 Generalized contraction of visual field, left eyeH53.483 Generalized contraction of visual field, bilateralH53.489 Generalized contraction of visual field, unspecified eyeH81.41 Vertigo of central origin, right earH81.42 Vertigo of central origin, left earH81.43 Vertigo of central origin, bilateralH81.49 Vertigo of central origin, unspecified earI60.00Nontraumatic subarachnoid hemorrhage from unspecified carotidsiphon and bifurcationI60.01Nontraumatic subarachnoid hemorrhage from right carotid siphon andbifurcationI60.02Nontraumatic subarachnoid hemorrhage from left carotid siphon andbifurcationI60.10Nontraumatic subarachnoid hemorrhage from unspecified middlecerebral arteryI60.11Nontraumatic subarachnoid hemorrhage from right middle cerebralarteryI60.12Nontraumatic subarachnoid hemorrhage from left middle cerebralarteryI60.20Nontraumatic subarachnoid hemorrhage from unspecified anteriorcommunicating arteryI60.21Nontraumatic subarachnoid hemorrhage from right anteriorcommunicating arteryI60.22Nontraumatic subarachnoid hemorrhage from left anteriorcommunicating arteryI60.30Nontraumatic subarachnoid hemorrhage from unspecified posteriorcommunicating arteryI60.31Nontraumatic subarachnoid hemorrhage from right posteriorcommunicating arteryI60.32Nontraumatic subarachnoid hemorrhage from left posteriorcommunicating arteryI60.4 Nontraumatic subarachnoid hemorrhage from basilar arteryI60.50Nontraumatic subarachnoid hemorrhage from unspecified vertebralarteryI60.51 Nontraumatic subarachnoid hemorrhage from right vertebral arteryI60.52 Nontraumatic subarachnoid hemorrhage from left vertebral arteryI60.6Nontraumatic subarachnoid hemorrhage from other intracranialarteriesDuplex Scan of Extracranial Arteries: Clinical Policy (Effective 11/01/2012)©1996-2012, Oxford Health Plans, LLC7
Page 1: CLINICAL POLICYDUPLEX SCAN OF EXTRA
Page 4 and 5: 433.81Occlusion and stenosis of oth
Page 8 and 9: I60.7Nontraumatic subarachnoid hemo
Page 10 and 11: I65.29 Occlusion and stenosis of un
Page 12 and 13: T82.320AT82.321AT82.322AT82.328AT82
Page 14 and 15: T84.83XAHemorrhage due to internal

DUPLEX SCAN OF EXTRACRANIAL ARTERIES - Oxford Health Plans

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?