-
36400-36410Venipuncture, younger than age 3 years, necessitating
the skill ofa physician or other qualified health care
professional, not to beused for routine venipuncture; femoral or
jugular vein
36400
scalp vein36405
other vein36406
Venipuncture, age 3 years or older, necessitating the skill of
aphysician or other qualified health care professional
(separate
36410
procedure), for diagnostic or therapeutic purposes (not to be
usedfor routine venipuncture)
ExplanationIn 36400, a needle is inserted through the skin to
puncture the femoralor jugular vein of a child younger than age 3.
The needle is insertedinto the vein and used for the withdrawal of
blood for diagnostic studyor for the therapeutic infusion of
intravenous medication. A soft flexiblecatheter may be placed for
prolonged therapy. When the scalp vein ispunctured, see 36405. For
a vein other than the femoral, jugular, sagittalsinus, or scalp
vein, report 36406. In 36410, a needle is inserted throughthe skin
to puncture a vein of a person 3 years of age or older. Theneedle
is inserted into the vein and used for the withdrawal of bloodfor
diagnostic study or for the therapeutic infusion of
intravenousmedication. A soft flexible catheter may be placed for
prolongedtherapy. Once the procedure is complete, the needle or
catheter iswithdrawn and pressure is applied over the puncture site
to controlbleeding. These codes are used for venipuncture
necessitating the skillof a physician or other qualified health
care provider, not when routinevenipuncture is performed.
Coding TipsFor collection of venous blood by venipuncture, see
36415. Collectionof blood specimen by finer, heel, or ear stick is
reported using 36416.Most third-party payers and state scope of
work exclude the use of acode requiring a physician or other
qualified health care provider, bya phlebotomist, or other
unlicensed clinical staff.
Terms To Knowcannula. Tube inserted into a blood vessel, duct,
or body cavity to facilitatepassage.specimen. Tissue cells or
sample of fluid taken for analysis, pathologicexamination, and
diagnosis.venipuncture. Piercing a vein through the skin by a
needle and syringe orsharp-ended cannula or catheter to draw blood,
start an intravenous infusion,instill medication, or inject another
substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
CCI Version 20.069990
Also not with 36400: 99195v
Also not with 36406: 99195v
Also not with 36410: 36450v, 36460v, 36510v, 96523, 99195v
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.590.860.050.160.43...............
0.3836400.........0.490.760.050.130.40...............
0.3136405.........0.270.540.030.060.33...............
0.1836406.........0.280.480.030.070.27...............
0.1836410.........
89CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
36415-36416Collection of venous blood by venipuncture36415
Collection of capillary blood specimen (eg, finger, heel, ear
stick)36416
ExplanationA needle is inserted into the skin over a vein to
puncture the bloodvessel and withdraw blood for venous collection
in 36415. In 36416,a prick is made into the finger, heel, or ear
and capillary blood thatpools at the puncture site is collected in
a pipette. In either case, theblood is used for diagnostic study
and no catheter is placed.
Coding TipsFor a child older than 3 or an adult, see code 36410.
For routinevenipuncture for collection of specimens, see code
36415. For scalpvenipuncture in a child 3 years or younger, see
code 36405. Forvenipuncture, without cutdown, younger than 3, see
codes36400-36406. This procedure does not include laboratory
analysis. Ifa specimen is transported to an outside laboratory,
report code 99000for handling or conveyance. The frequency limit
for reporting code36415 is once per day. Code 36415 is paid under
the laboratory feeschedule. No deductible or coinsurance apply. The
collection of capillaryblood specimen, CPT code 36416, is not
reportable to Medicare. Code36415 is not subject to Medicare
deductible or coinsurance since it ispaid on the laboratory fee
schedule.
Terms To Knowcapillary. Tiny, minute blood vessel that connects
the arterioles (smallestarteries) and the venules (smallest veins)
and acts as a semipermeable membranebetween the blood and the
tissue fluid.pipette. Small, narrow glass or plastic tube with both
ends open used formeasuring or transferring liquids.specimen.
Tissue cells or sample of fluid taken for analysis,
pathologicexamination, and diagnosis.venipuncture. Piercing a vein
through the skin by a needle and syringe orsharp-ended cannula or
catheter to draw blood, start an intravenous infusion,instill
medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
IOM References100-4,16,60.1.4
CCI Version 20.0No CCI Edits apply to this code.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00...............
0.0036415.........0.000.000.000.000.00...............
0.0036416.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.90
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
36420-36425Venipuncture, cutdown; younger than age 1
year36420
age 1 or over36425
ExplanationThe physician makes an incision in the skin directly
over the vessel anddissects the area surrounding the vein. A needle
is passed into the veinfor the withdrawal of blood or for the
infusion of intravenous medicationof a patient under 12 months of
age (in 36420) or over 12 months ofage (in 36425). A catheter may
be left behind. Once the procedure iscomplete, the incision is
repaired with a layered closure.
Coding TipsLocal anesthesia is included in these services. Do
not append modifier63 to code 36420 as the description or nature of
the procedure includesinfants up to 4 kg. If a specimen is
transported to an outside laboratory,report code 99000 for handling
or conveyance. For venipuncture ona patient younger than 3 years of
age, see 36400-36406. Forvenipuncture requiring physician skill on
a patient 3 years of age orolder, see code 36410. Do not report
code 36420 or 36425 if providedwith critical care, see codes
99468-99480. Code 36425 should not bereported with endovenous
ablation (36475-36479).
Terms To Knowcritical care. Treatment of critically ill patients
in a variety of medicalemergencies that requires the constant
attendance of the physician (e.g.,cardiac arrest, shock, bleeding,
respiratory failure, postoperative complications,critically ill
neonate).specimen. Tissue cells or sample of fluid taken for
analysis, pathologicexamination, and diagnosis.venipuncture.
Piercing a vein through the skin by a needle and syringe
orsharp-ended cannula or catheter to draw blood, start an
intravenous infusion,instill medication, or inject another
substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
IOM References100-3,20.18; 100-3,110.5; 100-3,110.7
CCI Version 20.069990
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
1.401.400.110.280.28...............
1.0136420.........1.161.160.110.290.29...............
0.7636425.........
91CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
36430-36440Transfusion, blood or blood components36430
Push transfusion, blood, 2 years or younger36440
ExplanationThe physician transfuses blood or blood components to
a patient in36430. The physician establishes venous access with a
needle andcatheter and transfuses the blood products. Report 36440
when thephysician performs a push transfusion on a child 2 years
old and under.The physician calculates the amount of blood to be
transfused andslowly injects it into the patient using a needle or
existing catheter.
Coding TipsCode 36430 Transfusion, blood or blood components,
should bereported only once per transfusion, regardless of how many
units areadministered. If separate transfusion services are
performed on differentdates, then the code may be reported once for
date of service. To reportcharges for transfusion services, for
providers reporting under OPPS, atransfusion APC will be paid to
the hospital for transfusing blood onceper day, regardless of the
number of units transfused. Bill transfusionservices with revenue
code 0391 Blood administration, and CPT codes3643036460. The
hospital may also bill for blood typing and crossmatching. The OPPS
Integrated Outpatient Code Editor (IOCE) containsan edit that
limits the number of units reported for 36430 to 1. A
claimsubmitted with more than one unit of 36430 reported on the
samedate of service will be returned to provider unprocessed.For
payment,a blood product HCPCS code is required when billing a
transfusionservice code. To report laboratory services associated
with blood orblood component transfusions, see codes 86850-86999.
To reportapheresis, see codes from range 36511-36512. To report
therapeuticphlebotomy, see CPT code 99195.
Terms To Knowblood bank. Facility for collecting, processing,
storing, or distributing humanblood, blood components, or blood
derivatives.blood components. Preparations separated from a single
donation of wholeblood including but not limited to plasma, fresh
frozen plasma, red blood cells,platelets, and
cryoprecipitate.plasma. Liquid portion of the blood, lymph, or
milk.transfusion. Process of transferring whole blood or blood
components fromone person, the donor, to another person, the
recipient, or the process oftaking liquid from one vessel and
putting it into another.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
IOM References100-1,3,20.5; 100-1,3,20.5.2; 100-2,1,10;
100-3,110.5; 100-3,110.7;100-3,110.8; 100-3,110.16;
100-4,3,40.2.2
CCI Version 20.069990
Also not with 36430: 36460v, J1644
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.950.950.010.940.94...............
0.0036430.........1.661.660.230.400.40...............
1.0336440.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.92
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
36511-36513 - NCDTherapeutic apheresis; for white blood
cells36511
for red blood cells36512
for platelets36513
ExplanationTherapeutic apheresis is the removal of some specific
circulating bloodcomponent, cells or plasma solute, that is
directly responsible for adisease process. Cells and plasma
components may also be mobilizedfrom other tissue storage during
apheresis, such as from the spleen andlymph nodes, for enhanced
clearance of the undesired element. Thepatient is prepared much the
same as giving a regular blood donation.Whole blood is drawn out of
one arm and into an instrument called aseparator, which uses a
microprocessing technique to draw the blood,anticoagulate it, and
separate the component to be removed bycentrifugal spinning,
filtration, or column adsorption with the help ofcomputerized
calibration. The cells to be removed are collected whilethe
remainder of the blood is recombined and returned to the
patientthrough a tube and needle in the other arm. Report 36511 for
whiteblood cell isolation and removal (leukapheresis or
lymphocytapheresis),36512 for red blood cell removal, and 36513 for
removal of platelets.
Coding TipsReport code 36511 for white blood cell isolation and
removal(leukapheresis or lymphocytapheresis), code 36512 for red
blood cellremoval, and code 36513 for removal of platelets. For
therapeuticapheresis for plasma pheresis, see code 36514. For
therapeutic apheresiswith extracorporeal immunoadsorption and
plasma reinfusion, see code36515. For therapeutic apheresis with
extracorporeal selectiveadsorption or selective filtration and
plasma reinfusion, see code 36516.Apheresis is covered only when
performed in a hospital setting (eitherinpatient or outpatient) or
in a nonhospital setting (e.g., aphysician-directed clinic).
Nonphysician services furnished to hospitalpatients are covered,
and paid for as hospital services. When coveredservices are
provided to hospital patients by an outside provider orsupplier,
the hospital is responsible for paying the provider or supplierfor
the services. In a nonhospital setting (e.g., a
physician-directedclinic) the following conditions must be met: a)
the physician (ornumber of physicians) is present to perform
medical services and torespond to medical emergencies at all times
during patient care hours;b) each patient is under the care of a
physician; and c) all nonphysicianservices are furnished under the
direct, personal supervision of aphysician.
ICD-9-CM Diagnostic CodesMonoclonal paraproteinemia (Use
additional code toidentify any associated intellectual
disabilities)
273.1
Myasthenia gravis with (acute) exacerbation358.01Goodpasture's
syndrome (Use additional code to identifyrenal disease: 583.81)
446.21
Thrombotic microangiopathy446.6
Chronic kidney disease, Stage I (Use additional code toidentify
kidney transplant status, if applicable: V42.0. Use
585.1
additional code to identify manifestation: 357.4, 420.0.Code
first hypertensive chronic kidney disease, if
applicable:403.00-403.91, 404.00-404.93)Chronic kidney disease,
Stage II (mild) (Use additionalcode to identify kidney transplant
status, if applicable:
585.2
V42.0. Use additional code to identify manifestation:
357.4,420.0. Code first hypertensive chronic kidney disease,
ifapplicable: 403.00-403.91, 404.00-404.93)Chronic kidney disease,
Stage III (moderate) (Useadditional code to identify kidney
transplant status, if
585.3
applicable: V42.0. Use additional code to identifymanifestation:
357.4, 420.0. Code first hypertensive chronickidney disease, if
applicable: 403.00-403.91,404.00-404.93)Chronic kidney disease,
Stage IV (severe) (Use additionalcode to identify kidney transplant
status, if applicable:
585.4
V42.0. Use additional code to identify manifestation:
357.4,420.0. Code first hypertensive chronic kidney disease,
ifapplicable: 403.00-403.91, 404.00-404.93)Chronic kidney disease,
Stage V (Use additional codeto identify kidney transplant status,
if applicable: V42.0.
585.5
Use additional code to identify manifestation: 357.4, 420.0.Code
first hypertensive chronic kidney disease, if
applicable:403.00-403.91, 404.00-404.93)
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
IOM References100-3,110.14; 100-4,4,231.9
CCI Version 20.00213T, 0216T, 0228T, 0230T, 12001-12007,
12011-12057,13100-13133, 13151-13153, 36000, 36400-36410,
36420-36430,36600, 36640, 37202, 43752, 51701-51703,
62310-62319,64400-64435, 64445-64450, 64479, 64483, 64490,
64493,64505-64530, 69990, 93000-93010, 93040-93042, 93318,
94002,94200, 94250, 94680-94690, 94770, 95812-95816, 95819,
95822,95829, 95955, 96360, 96365, 96372, 96374-96376,
99148-99149,99150, 99201-99255, 99281-99285, 99291-99292,
99304-99310,99315-99318, 99324-99328, 99334-99337,
99341-99350,99374-99375, 99377-99378, 99446-99449, 99466,
99468-99480,99485, 99495-99496, G0380-G0384
Also not with 36511: 36440, 36512-36516v
Also not with 36512: 36440-36455v, 36513-36516v
Also not with 36513: 36440, 36514-36516v
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
2.742.740.260.740.74...............
1.7436511.........2.702.700.150.810.81...............
1.7436512.........2.862.860.330.790.79...............
1.7436513.........
93CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
36514-36516 - NCDTherapeutic apheresis; for plasma
pheresis36514
with extracorporeal immunoadsorption and plasma
reinfusion36515
with extracorporeal selective adsorption or selective
filtrationand plasma reinfusion
36516
ExplanationTherapeutic apheresis is the removal of some specific
circulating bloodcomponent, cells or plasma solute, that is
directly responsible for adisease process. Cells and plasma
components may also be mobilizedfrom other tissue storage during
apheresis, such as from the spleen andlymph nodes, for enhanced
clearance of the undesired element. Thepatient is prepared much the
same as giving a regular blood donation.Whole blood is drawn out of
one arm and into an instrument called aseparator, which uses a
microprocessing technique to draw the blood,anticoagulate it, and
separate the component to be removed bycentrifugal spinning,
filtration, or column adsorption with the help ofcomputerized
calibration. Plasmapheresis, reported with 36514 is theisolation of
the plasma from the blood. Plasma exchange isolates,discards, and
replaces the plasma with a substitute fluid, like albumin.Plasma
exchange is nonspecific since the plasma is discarded on thebasis
that toxins and antibodies accumulate in the plasma. The bestmethod
requires treating a disorder by removing the offendingabnormal
plasma component selectively. Apheresis for plasma
withextracorporeal immunoadsorption and reinfusion of the patient's
plasmamay be done, reported with 36515. This procedure uses Protein
Acolumns to specifically remove circulating immune complexes.
Report36516 for extracorporeal selective adsorption or selective
filtration,such as dextran sulfate cellulose columns to selectively
removelow-density lipoproteins, with plasma reinfusion.
Coding TipsFor therapeutic apheresis for white blood cells, see
code 36511. Fortherapeutic apheresis for red blood cells, see
36512. For therapeuticapheresis for platelets, see code 36513.
Apheresis is covered only whenperformed in a hospital setting
(either inpatient or outpatient) ornonhospital setting (e.g., a
physician-directed clinic). Nonphysicianservices furnished to
hospital patients are covered and paid for ashospital services.
When covered services are provided to hospitalpatients by an
outside provider or supplier, the hospital is responsiblefor paying
the provider or supplier for the services. In a nonhospitalsetting
(e.g., a physician-directed clinic), the following conditions
mustbe met: a) the physician (or number of physicians) is present
to performmedical services and to respond to medical emergencies at
all timesduring patient care hours; b) each patient is under the
care of aphysician; and c) all nonphysician services are furnished
under thedirect, personal supervision of a physician. When
reporting theprofessional evaluation, modifier 26 should be
appended to code 36516.
ICD-9-CM Diagnostic CodesPlasma cell leukemia, in
relapse203.12Acute myeloid leukemia, in relapse205.02Chronic
myeloid leukemia, in relapse205.12
Subacute myeloid leukemia, in relapse205.22Acute leukemia of
unspecified cell type, without mentionof having achieved
remission
208.00
Acute leukemia of unspecified cell type, in relapse208.02Chronic
leukemia of unspecified cell type, in relapse208.12Subacute
leukemia of unspecified cell type, in relapse208.22Primary
thrombocytopenia, unspecified287.30Immune thrombocytopenic
purpura287.31Congenital and hereditary thrombocytopenic
purpura287.33Other primary thrombocytopenia287.39Multiple
sclerosis340Unspecified demyelinating disease of central
nervoussystem
341.9
Polyneuropathy in collagen vascular disease (Code
firstunderlying disease: 446.0, 710.0, 714.0)
357.1
Goodpasture's syndrome (Use additional code to identifyrenal
disease: 583.81)
446.21
Pemphigus694.4Systemic lupus erythematosus (Use additional code
toidentify manifestation: 424.91, 581.81, 582.81, 583.81)
710.0
Systemic sclerosis (Use additional code to
identifymanifestation: 359.6, 517.2)
710.1
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
IOM References100-3,20.5; 100-3,110.14; 100-4,4,231.9
CCI Version 20.00213T, 0216T, 0228T, 0230T, 12001-12007,
12011-12057,13100-13133, 13151-13153, 36000, 36400-36410,
36420-36430,36440, 36600, 36640, 37202, 43752, 51701-51703,
62310-62319,64400-64435, 64445-64450, 64479, 64483, 64490,
64493,64505-64530, 69990, 93000-93010, 93040-93042, 93318,
94002,94200, 94250, 94680-94690, 94770, 95812-95816, 95819,
95822,95829, 95955, 96360, 96365, 96372, 96374-96376,
99148-99149,99150, 99201-99255, 99281-99285, 99291-99292,
99304-99310,99315-99318, 99324-99328, 99334-99337,
99341-99350,99374-99375, 99377-99378, 99446-99449, 99466,
99468-99480,99485, 99495-99496, G0380-G0384, J1644
Also not with 36514: 36515-36516v
Also not with 36515: 36516v
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
2.7214.670.260.7212.67...............
1.7436514.........2.5258.270.230.5556.30...............
1.7436515.........2.0457.020.330.4955.47...............
1.2236516.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.94
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
36591-36592Collection of blood specimen from a completely
implantablevenous access device
36591
Collection of blood specimen using established central
orperipheral catheter, venous, not otherwise specified
36592
ExplanationThe physician obtains a blood specimen from a
previously placed,completely implantable venous access device
(36591) or from anestablished central venous or peripheral venous
catheter (36592).Completely implanted devices are those that have
access through asubcutaneous port (e.g., Port-A-Cath, Infusaport).
An implantable accessdevice requires a percutaneous noncoring
needle to accomplish theblood draw. The skin is cleansed with
alcohol or iodine solution. Theneedle is placed into the port.
Heparin is withdrawn. A second needleis inserted and the blood
specimen obtained. The port is flushed withheparin solution. A
central venous catheter (CVC) is one that is insertedthrough the
skin into central veins, such as the femoral, internal jugular,or
subclavian veins. Peripheral catheters include those inserted in
thearm veins (basilic or cephalic), such as a PICC line, saline
lock, or heparinlock. In order to clear the catheter of any
material that couldcontaminate the sample and affect the test
results, a specific volumeof infusing fluid and blood must be
discarded before a blood specimenis obtained; this volume will vary
depending on the type of catheterutilized. With a central venous
catheter, a three-way stopcock is attachedto the catheter's hub and
two syringes attached to the stopcock. Usingone syringe, the
catheter is flushed with normal saline. A specific amountof blood
is aspirated into the same syringe used for the saline flush
anddiscarded. The blood sample is then withdrawn using the other
syringeand placed into an appropriate tube for laboratory analysis.
If using aperipheral venous catheter, a specific amount of blood is
also aspiratedand discarded before the blood sample is drawn.
Coding TipsDo not report 36591or 36592 with any other service
other thanlaboratory procedures. Collection of venous blood
specimen byvenipuncture is reported with code 36415. For collection
of capillaryblood specimen, see 36416. For arterial puncture, see
36600. Surgicaltrays, A4550, are not separately reimbursed by
Medicare; however,other third-party payers may cover them. Check
with the specific payerto determine coverage.
Terms To Knowartery. Vessel through which oxygenated blood
passes away from the heartto any part of the body.aspirate. To
withdraw fluid or air from a body cavity by suction.catheter.
Flexible tube inserted into an area of the body for introducing
orwithdrawing fluid.peripheral. Outside of a structure or
organ.
Port-a-cath. Brand name for an implantable system used for
vascular accesswhen the patient's treatment plan requires repeat
administration of drugs (e.g.,chemotherapy), fluids, and/or
nutrition. This system may also be used forrepeated blood sampling.
Refer to CPT codes 36560-36571 for insertion of animplantable
catheter; 36575-36585 for replacement procedures; 36589-36590for
removal; and 36595-36597 for other procedures on a central venous
catheterdevice.subcutaneous. Below the skin.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
CCI Version 20.0No CCI Edits apply to this code.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.650.650.010.640.64...............
0.0036591.........0.730.730.010.720.72...............
0.0036592.........
95CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
36593Declotting by thrombolytic agent of implanted vascular
accessdevice or catheter
36593
ExplanationTo remove a clot from an implanted vascular access
device or catheter,the physician injects a thrombolytic agent
(e.g., Streptokinase) into thecatheter to dissolve the clot. The
patient is observed for any abnormalsigns of bleeding.
Coding TipsWhen 36593 is performed with another separately
identifiableprocedure, the highest dollar value code is listed as
the primaryprocedure and subsequent procedures are appended with
modifier 51.Do not report code 36593 in conjunction with code
36595, 36596, or36870. For thrombectomy of an arteriovenous
fistula, see codes 36831and 36870. Supplies used when providing
this procedure may bereported with code J2995. Check with the
specific payer to determinecoverage.
Terms To Knowblood clot. Semisolidified, coagulated mass of
mainly platelets and fibrin inthe bloodstream.catheter. Flexible
tube inserted into an area of the body for introducing
orwithdrawing fluid.thrombolytic agent. Drugs or other substances
used to dissolve blood clotsin blood vessels or in tubes that have
been placed into the body.
ICD-9-CM Diagnostic CodesOther complications due to other
vascular device, implant,and graft (Use additional code to identify
complication:338.18-338.19, 338.28-338.29)
996.74
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
CCI Version 20.036005, 69990, 75896, J1642
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.860.860.010.850.85............... 0.0036593.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.96
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
36600Arterial puncture, withdrawal of blood for
diagnosis36600
ExplanationThe physician inserts a needle through the skin and
punctures the arteryto withdraw blood for testing. No catheter is
left in the artery. Pressureis applied to the puncture site to stop
the flow of blood.
Coding TipsThis code is used to report the percutaneous
insertion of a needle orcatheter into a radial, brachial, or
femoral artery, for the purpose ofobtaining a single arterial blood
sample for blood gas analysis.Documentation will indicate that the
needle was removed once thespecimen was obtained. See codes
36620-36640 when documentationindicates that an invasive placement
of an indwelling arterial catheterfor direct and frequent
monitoring of physiologic indexes wasperformed. Report code 36600
only once when multiple tests areperformed on the same arterial
blood draw. This procedure does notinclude laboratory analysis. If
a specimen is transported to an outsidelaboratory, report code
99000 for handling or conveyance.
Terms To Knowarterial catheterization. Introduction of a narrow,
hollow tube within anartery to allow for therapeutic or diagnostic
proceedings, such as visualizationinside the lumen, measurement of
arterial pressures, injections, or repair.percutaneous. Through the
skin.specimen. Tissue cells or sample of fluid taken for analysis,
pathologicexamination, and diagnosis.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
CCI Version 20.036002-36005, 36120-36140, 36625, 69990,
76000-76001,77001-77002, J0670, J2001
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.450.880.030.100.53............... 0.3236600.........
97CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
80047Basic metabolic panel (Calcium, ionized)80047
ExplanationA basic metabolic panel with ionized calcium includes
the followingtests: calcium (ionized) (82330), carbon dioxide
(82374), chloride(82435), creatinine (82565), glucose (82947),
potassium (84132),sodium (84295), and urea nitrogen (BUN) (84520).
Blood specimenis obtained by venipuncture. See the specific codes
for additionalinformation about the listed tests.
Coding TipsReport organ or disease-oriented panel codes only
when each panelcomponent in the panel definition is performed. The
assignment oforgan or disease oriented panel codes is optional for
most non-Medicarepayers. You may assign an organ or disease panel
code or opt to reporteach individual assay code. Medicare
guidelines state that if all tests ofa CPT defined panel are
performed, the provider may bill the panelcode or the individual
component test codes. The panel codes may beused when the tests are
ordered as that panel or if the individualcomponent tests of a
panel are ordered separately. According to CPTguidelines, do not
report two or more organ or disease-oriented panelswhen any of the
same tests are performed in each panel and the panelsare performed
from the same patient collection. When a group of testsoverlap two
or more panels, report the panel that has the greatestnumber of
tests allowing the definition of that panel to be met andthen
report the remaining tests using the appropriate individual
testcodes. This test may be performed using a CLIA-waived test
system.Laboratories with a CLIA-waived certificate must report this
code withmodifier QW CLIA-waived test. See appendix 1 for
CLIA-waived kitsand test systems. An ionized calcium basic
metabolic panel should notbe billed in addition to a comprehensive
metabolic panel (80053).Venipuncture is separately reportable. For
collection of venous bloodby venipuncture, see code 36415. When
venipuncture on a patient 3years of age or older requires the skill
of a physician or other qualifiedhealth care provider, see code
36410. For venipuncture on a patientyounger than 3 years of age
performed by a physician or other qualifiedhealth care provider,
see codes 36400-36406. Most third-party payersand state scope of
work exclude the use of a code requiring a physicianor other
qualified health care provider, by a phlebotomist, or
otherunlicensed clinical staff.
Terms To KnowCLIA. Clinical Laboratory Improvement Amendments.
Requirements set in1988, CLIA imposes varying levels of federal
regulations on clinical procedures.Few laboratories, including
those in physician offices, are exempt. Adopted byMedicare and
Medicaid, CLIA regulations redefine laboratory testing in regardto
laboratory certification and accreditation, proficiency testing,
qualityassurance, personnel standards, and program
administration.
laboratory. Facility for the virological, microbiological,
serological, chemical,immunohematological, hematological,
biophysical, cytological, pathological,or other examination of
materials derived from the human body for the purposeof providing
information for the diagnosis, prevention, or treatment of
anydisease or impairment of or the assessment of the health of
human beings.These examinations also include procedures to
determine, measure, or otherwisedescribe the presence or absence of
various substances or organisms in thebody. Facilities that only
collect or prepare specimens (or both) or act only asa mailing
service and do not perform tests are not considered
laboratories.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
IOM References100-2,11,30.2.2; 100-2,15,80.1; 100-4,16,40.6.1;
100-4,16,70.8;100-4,16,100.6
CCI Version 20.080048, 80051, 82330, 82374, 82435, 82565, 82947,
84132, 84295,84520
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080047.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.98
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
80048Basic metabolic panel (Calcium, total)80048
ExplanationA basic metabolic panel with total calcium includes
the following tests:total calcium (82310), carbon dioxide (82374),
chloride (82435),creatinine (82565), glucose (82947), potassium
(84132), sodium(84295), and urea nitrogen (BUN) (84520). The blood
specimen isobtained by venipuncture. See the specific codes for
additionalinformation about the listed tests.
Coding TipsReport organ or disease-oriented panel codes only
when each panelcomponent in the panel definition is performed. The
assignment oforgan or disease oriented panel codes is optional for
most non-Medicarepayers. You may assign an organ or disease panel
code or opt to reporteach individual assay code. Medicare
guidelines state that if all tests ofa CPT defined panel are
performed, the provider may bill the panelcode or the individual
component test codes. The panel codes may beused when the tests are
ordered as that panel or if the individualcomponent tests of a
panel are ordered separately. According to CPTguidelines, do not
report two or more organ or disease-oriented panelswhen any of the
same tests are performed in each panel and the panelsare performed
from the same patient collection. When a group of testsoverlap two
or more panels, report the panel that has the greatestnumber of
tests allowing the definition of that panel to be met, andthen
report the remaining tests using the appropriate individual
testcodes. This test may be performed using a CLIA-waived test
system.Laboratories with a CLIA-waived certificate must report this
code withmodifier QW CLIA-waived test. See appendix 1 for
CLIA-waived kitsand test systems. A total calcium basic metabolic
panel should not bebilled in addition to a comprehensive metabolic
panel (80053).Venipuncture is separately reportable. For collection
of venous bloodby venipuncture, see code 36415. When venipuncture
on a patient 3years of age or older requires the skill of a
physician or other qualifiedhealth care provider, see code 36410.
For venipuncture on a patientyounger than 3 years of age performed
by a physician or other qualifiedhealth care provider, see codes
36400-36406. Most third-party payersand state scope of work exclude
the use of a code requiring a physicianor other qualified health
care provider, by a phlebotomist, or otherunlicensed clinical
staff.
Terms To KnowCLIA. Clinical Laboratory Improvement Amendments.
Requirements set in1988, CLIA imposes varying levels of federal
regulations on clinical procedures.Few laboratories, including
those in physician offices, are exempt. Adopted byMedicare and
Medicaid, CLIA regulations redefine laboratory testing in regardto
laboratory certification and accreditation, proficiency testing,
qualityassurance, personnel standards, and program
administration.
laboratory. Facility for the virological, microbiological,
serological, chemical,immunohematological, hematological,
biophysical, cytological, pathological,or other examination of
materials derived from the human body for the purposeof providing
information for the diagnosis, prevention, or treatment of
anydisease or impairment of or the assessment of the health of
human beings.These examinations also include procedures to
determine, measure, or otherwisedescribe the presence or absence of
various substances or organisms in thebody. Facilities that only
collect or prepare specimens (or both) or act only asa mailing
service and do not perform tests are not considered
laboratories.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
IOM References100-2,11,30.2.2; 100-4,16,70.8
CCI Version 20.080051, 82310, 82374, 82435, 82565, 82947, 84132,
84295, 84520
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080048.........
99CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
80050General health panel80050
ExplanationA general health panel includes the following tests:
albumin (82040),total bilirubin (82247), calcium (82310), carbon
dioxide (bicarbonate)(82374), chloride (82435), creatinine (82565),
glucose (82947), alkalinephosphatase (84075), potassium (84132),
total protein (84155), sodium(84295), alanine amino transferase
(ALT) (SGPT) (84460), aspartateamino transferase (AST) (SGOT)
(84450), urea nitrogen (BUN) (84520),and thyroid stimulating
hormone (84443). In addition, this panelincludes a hemogram with
automated differential (85025 or 85027and 85004) or hemogram
(85027) with manual differential (85007 or85009). Blood specimen is
obtained by venipuncture. See specific codesfor additional
information about the listed tests.
Coding TipsReport organ or disease-oriented panel codes only
when each panelcomponent in the panel definition is performed. The
assignment oforgan or disease oriented panel codes is optional for
most non-Medicarepayers. You may assign an organ or disease panel
code or opt to reporteach individual assay code. Medicare
guidelines state that if all tests ofa CPT defined panel are
performed, the provider may bill the panelcode or the individual
component test codes. The panel codes may beused when the tests are
ordered as that panel or if the individualcomponent tests of a
panel are ordered separately. According to CPTguidelines, do not
report two or more organ or disease-oriented panelswhen any of the
same tests are performed in each panel and the panelsare performed
from the same patient collection. When a group of testsoverlap two
or more panels, report the panel that has the greatestnumber of
tests allowing the definition of that panel to be met, andthen
report the remaining tests using the appropriate individual
testcodes. Venipuncture is separately reportable. For collection of
venousblood by venipuncture, see code 36415. When venipuncture on
apatient 3 years of age or older requires the skill of a physician
or otherqualified health care provider, see code 36410. For
venipuncture on apatient younger than 3 years of age performed by a
physician or otherqualified health care provider, see codes
36400-36406. Most third-partypayers and state scope of work exclude
the use of a code requiring aphysician or other qualified health
care provider, by a phlebotomist,or other unlicensed clinical
staff.
Terms To KnowCLIA. Clinical Laboratory Improvement Amendments.
Requirements set in1988, CLIA imposes varying levels of federal
regulations on clinical procedures.Few laboratories, including
those in physician offices, are exempt. Adopted byMedicare and
Medicaid, CLIA regulations redefine laboratory testing in regardto
laboratory certification and accreditation, proficiency testing,
qualityassurance, personnel standards, and program
administration.specimen. Tissue cells or sample of fluid taken for
analysis, pathologicexamination, and diagnosis.venipuncture.
Piercing a vein through the skin by a needle and syringe
orsharp-ended cannula or catheter to draw blood, start an
intravenous infusion,instill medication, or inject another
substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
CCI Version 20.0No CCI Edits apply to this code.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080050.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.100
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
80051Electrolyte panel80051
ExplanationAn electrolyte panel includes the following tests:
carbon dioxide(82374), chloride (82435), potassium (84132), and
sodium (84295).Blood specimen is obtained by venipuncture. See
specific codes foradditional information about the listed
tests.
Coding TipsOrgan and disease oriented panels are comprised of a
group of specifiedtests. If all of the tests of a defined panel are
performed, the panel codeor the individual test codes may be
reported. According to CPTguidelines, do not report two or more
organ or disease-oriented panelswhen any of the same tests are
performed in each panel and the panelsare performed from the same
patient collection. When a group of testsoverlap two or more
panels, report the panel that has the greatestnumber of tests
allowing the definition of that panel to be met, andthen report the
remaining tests using the appropriate individual testcodes. This
test may be performed using a CLIA-waived test system.Laboratories
with a CLIA-waived certificate must report this code withmodifier
QW CLIA-waived test. See appendix 1 for CLIA-waived kitsand test
systems. If a specimen is transported to an outside
laboratory,report 99000 for handling or conveyance. This panel is a
componentof the renal function panel, CPT code 80069. Venipuncture
is separatelyreportable. For collection of venous blood by
venipuncture, see code36415. When venipuncture on a patient 3 years
of age or older requiresthe skill of a physician or other qualified
health care provider, see code36410. For venipuncture on a patient
younger than 3 years of ageperformed by a physician or other
qualified health care provider, seecodes 36400-36406. Most
third-party payers and state scope of workexclude the use of a code
requiring a physician or other qualified healthcare provider, by a
phlebotomist, or other unlicensed clinical staff.
Terms To KnowCLIA. Clinical Laboratory Improvement Amendments.
Requirements set in1988, CLIA imposes varying levels of federal
regulations on clinical procedures.Few laboratories, including
those in physician offices, are exempt. Adopted byMedicare and
Medicaid, CLIA regulations redefine laboratory testing in regardto
laboratory certification and accreditation, proficiency testing,
qualityassurance, personnel standards, and program
administration.renal. Referring to the kidney.specimen. Tissue
cells or sample of fluid taken for analysis, pathologicexamination,
and diagnosis.venipuncture. Piercing a vein through the skin by a
needle and syringe orsharp-ended cannula or catheter to draw blood,
start an intravenous infusion,instill medication, or inject another
substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
IOM References100-4,16,40.6.1; 100-4,16,70.8; 100-4,16,100.6
CCI Version 20.082374, 82435, 84132, 84295
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080051.........
101CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
80053Comprehensive metabolic panel80053
ExplanationA comprehensive metabolic panel includes the
following tests: albumin(82040), total bilirubin (82247), total
calcium (82310), carbon dioxide(bicarbonate) (82374), chloride
(82435), creatinine (82565), glucose(82947), alkaline phosphatase
(84075), potassium (84132), total protein(84155), sodium (84295),
alanine amino transferase (ALT) (SGPT)(84460), aspartate amino
transferase (AST) (SGOT) (84450), and ureanitrogen (BUN) (84520).
Blood specimen is obtained by venipuncture.See the specific codes
for additional information about the listed tests.
Coding TipsDo not report 80053 with 80048 or 80076. Organ and
disease orientedpanels are comprised of a group of specified tests.
If all of the tests ofa defined panel are performed, the panel code
or the individual testcodes may be reported. According to CPT
guidelines, do not reporttwo or more organ or disease-oriented
panels when any of the sametests are performed in each panel and
the panels are performed fromthe same patient collection. When a
group of tests overlap two or morepanels, report the panel that has
the greatest number of tests allowingthe definition of that panel
to be met, and then report the remainingtests using the appropriate
individual test codes. This test may beperformed using a
CLIA-waived test system. Laboratories with aCLIA-waived certificate
must report this code with modifier QWCLIA-waived test. See
appendix 1 for CLIA-waived kits and test systems.Report the
individual tests performed instead. If a specimen istransported to
an outside laboratory, report 99000 for handling orconveyance.
Venipuncture is separately reportable. For collection ofvenous
blood by venipuncture, see code 36415. When venipunctureon a
patient 3 years of age or older requires the skill of a physician
orother qualified health care provider, see code 36410. For
venipunctureon a patient younger than 3 years of age performed by a
physician orother qualified health care provider, see codes
36400-36406. Mostthird-party payers and state scope of work exclude
the use of a coderequiring a physician or other qualified health
care provider, by aphlebotomist, or other unlicensed clinical
staff.
Terms To Knowspecimen. Tissue cells or sample of fluid taken for
analysis, pathologicexamination, and diagnosis.venipuncture.
Piercing a vein through the skin by a needle and syringe
orsharp-ended cannula or catheter to draw blood, start an
intravenous infusion,instill medication, or inject another
substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
IOM References100-4,16,40.6.1; 100-4,16,70.8; 100-4,16,100.6
CCI Version 20.080047-80048, 80051, 80069, 80076, 82040, 82247,
82310, 82374,82435, 82565, 82947, 84075, 84132, 84155, 84295,
84450, 84460,84520
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080053.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.102
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
80055Obstetric panel80055
ExplanationAn obstetric panel includes the following tests:
hepatitis B surfaceantigen (HBsAg) (87340), rubella antibody
(86762), qualitativenon-treponemal antibody syphilis test (VDRL,
RPR, ART) (86592), RBCantibody screen (86850), ABO blood typing
(86900), and Rh (D) bloodtyping (86901). In addition, this panel
includes either an automatedcomplete blood count (CBC) and
automated differential white bloodcount (WBC) as described by 85025
or 85027 and 85004 OR automatedCBC (85027) and appropriate manual
differential WBC count (85007or 85009). Blood specimen is obtained
by venipuncture. See specificcodes for additional information about
the listed tests.
Coding TipsOrgan and disease-oriented panels are composed of a
group of specifiedtests. If all of the tests of a defined panel are
performed, the panel codeor the individual test codes may be
reported. According to CPTguidelines, do not report two or more
organ or disease-oriented panelswhen any of the same tests are
performed in each panel and the panelsare performed from the same
patient collection. When a group of testsoverlap two or more
panels, report the panel that has the greatestnumber of tests
allowing the definition of that panel to be met, andthen report the
remaining tests using the appropriate individual testcodes. When
syphilis screening is performed using treponemal
antibodymethodology do not report code 80055. Report each
individual testseparately. If a specimen is transported to an
outside laboratory, reportcode 99000 for handling or conveyance.
Venipuncture is separatelyreportable. For collection of venous
blood by venipuncture, see code36415. When venipuncture on a
patient 3 years of age or older requiresthe skill of a physician or
other qualified health care provider, see code36410. For
venipuncture on a patient younger than 3 years of ageperformed by a
physician or other qualified health care provider, seecodes
36400-36406. Most third-party payers and state scope of workexclude
the use of a code requiring a physician or other qualified
healthcare provider, by a phlebotomist, or other unlicensed
clinical staff.
Terms To Knowantibody. Protein that B cells of the immune system
produce in response tothe presence of a foreign antigen.antigen.
Substance inducing sensitivity or triggering an immune responseand
the production of antibodies.venipuncture. Piercing a vein through
the skin by a needle and syringe orsharp-ended cannula or catheter
to draw blood, start an intravenous infusion,instill medication, or
inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
CCI Version 20.0No CCI Edits apply to this code.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080055.........
103CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
80061 - NCDLipid panel80061
ExplanationA lipid panel includes the following tests: total
serum cholesterol(82465), high-density cholesterol (HDL
cholesterol) by directmeasurement (83718), and triglycerides
(84478). Blood specimen isobtained by venipuncture. See specific
codes for additional informationabout the listed tests.
Coding TipsA national coverage determination (NCD) exists for
this code. See theMedicare National Coverage Determinations Manual,
Pub.100-03,section 190.23. This test may be performed using a
CLIA-waived testsystem. Laboratories with a CLIA-waived certificate
must report thiscode with modifier QW CLIA-waived test. According
to CPT guidelines,do not report two or more organ or
disease-oriented panels when anyof the same tests are performed in
each panel and the panels areperformed from the same patient
collection. When a group of testsoverlap two or more panels, report
the panel that has the greatestnumber of tests, allowing the
definition of that panel to be met. Thenreport the remaining tests
using the appropriate individual test codes.Venipuncture is
separately reportable. For collection of venous bloodby
venipuncture, see code 36415. When venipuncture on a patient 3years
of age or older requires the skill of a physician or other
qualifiedhealth care provider, see code 36410. For venipuncture on
a patientyounger than 3 years of age performed by a physician or
other qualifiedhealth care provider, see codes 36400-36406. Most
third-party payersand state scope of work exclude the use of a code
requiring a physicianor other qualified health care provider, by a
phlebotomist, or otherunlicensed clinical staff.
ICD-9-CM Diagnostic CodesDiabetes mellitus without mention of
complication, typeII or unspecified type, not stated as
uncontrolled
250.00
Diabetes mellitus without mention of complication, typeI
[juvenile type], not stated as uncontrolled
250.01
Diabetes mellitus without mention of complication, typeII or
unspecified type, uncontrolled
250.02
Diabetes mellitus without mention of complication, typeI
[juvenile type], uncontrolled
250.03
Diabetes with renal manifestations, type II or unspecifiedtype,
not stated as uncontrolled (Use additional codeto identify
manifestation: 581.81, 583.81, 585.1-585.9)
250.40
Diabetes with renal manifestations, type I [juvenile type],not
stated as uncontrolled (Use additional code toidentify
manifestation: 581.81, 583.81, 585.1-585.9)
250.41
Diabetes with peripheral circulatory disorders, type II
orunspecified type, not stated as uncontrolled (Useadditional code
to identify manifestation: 443.81, 785.4)
250.70
Diabetes with peripheral circulatory disorders, type I[juvenile
type], not stated as uncontrolled (Use additionalcode to identify
manifestation: 443.81, 785.4)
250.71
Pure hypercholesterolemia (Use additional code toidentify any
associated intellectual disabilities)
272.0
Mixed hyperlipidemia (Use additional code to identifyany
associated intellectual disabilities)
272.2
Other disorders of lipoid metabolism (Use additionalcode to
identify any associated intellectual disabilities)
272.8
Morbid obesity (Use additional code to identify BodyMass Index
(BMI), if known: V85.0-V85.54)
278.01
Overweight (Use additional code to identify Body MassIndex
(BMI), if known: V85.0-V85.54) (Use additional codeto identify any
associated intellectual disabilities)
278.02
Unspecified essential hypertension401.9Malignant hypertensive
heart disease without heart failure402.00Malignant hypertensive
heart disease with heart failure (Use additional code to specify
type of heart failure,428.0-428.43, if known)
402.01
Benign hypertensive heart disease without heart
failure402.10Coronary atherosclerosis of unspecified type of bypass
graft (Use additional code to identify presence ofhypertension:
401.0-405.9)
414.05
Coronary atherosclerosis, of native coronary artery
oftransplanted heart (Use additional code to identifypresence of
hypertension: 401.0-405.9)
414.06
Coronary atherosclerosis due to lipid rich plaque (Codefirst
coronary atherosclerosis (414.00-414.07))
414.3
Other specified forms of chronic ischemic heart disease (Use
additional code to identify presence of
hypertension:401.0-405.9)
414.8
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
IOM References100-3,190.23; 100-4,16,40.6.1; 100-4,16,70.8;
100-4,16,100.6
CCI Version 20.080500-80502, 82465, 83718, 83721, 84478
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080061.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.104
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
80069Renal function panel80069
ExplanationA renal function panel includes the following tests:
albumin (82040),total calcium (82310), carbon dioxide (bicarbonate)
(82374), chloride(82435), creatinine (82565), glucose (82947),
inorganic phosphorus(phosphate) (84100), potassium (84132), sodium
(84295), and ureanitrogen (BUN) (84520).
Coding TipsOrgan and disease-oriented panels are composed of a
group of specifiedtests. If all of the tests of a defined panel are
performed, the panel codeor the individual test codes may be
reported. According to CPTguidelines, do not report two or more
organ or disease-oriented panelswhen any of the same tests are
performed in each panel and the panelsare performed from the same
patient collection. When a group of testsoverlap two or more
panels, report the panel that has the greatestnumber of tests
allowing the definition of that panel to be met andthen report the
remaining tests using the appropriate individual testcodes. This
test may be performed using a CLIA-waived test system.Laboratories
with a CLIA-waived certificate must report this code withmodifier
QW CLIA-waived test. See appendix 1 for CLIA-waived kitsand test
systems. If a specimen is transported to an outside
laboratory,report code 99000 for handling or conveyance.
Venipuncture isseparately reportable. For collection of venous
blood by venipuncture,see code 36415. When venipuncture on a
patient 3 years of age orolder requires the skill of a physician or
other qualified health careprovider, see code 36410. For
venipuncture on a patient younger than3 years of age performed by a
physician or other qualified health careprovider, see codes
36400-36406. Most third-party payers and statescope of work exclude
the use of a code requiring a physician or otherqualified health
care provider, by a phlebotomist, or other unlicensedclinical
staff.
Terms To KnowCLIA. Clinical Laboratory Improvement Amendments.
Requirements set in1988, CLIA imposes varying levels of federal
regulations on clinical procedures.Few laboratories, including
those in physician offices, are exempt. Adopted byMedicare and
Medicaid, CLIA regulations redefine laboratory testing in regardto
laboratory certification and accreditation, proficiency testing,
qualityassurance, personnel standards, and program
administration.renal. Referring to the kidney.specimen. Tissue
cells or sample of fluid taken for analysis, pathologicexamination,
and diagnosis.venipuncture. Piercing a vein through the skin by a
needle and syringe orsharp-ended cannula or catheter to draw blood,
start an intravenous infusion,instill medication, or inject another
substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesHyperparathyroidism,
unspecified252.00Primary hyperparathyroidism252.01Secondary
hyperparathyroidism, non-renal252.02
Other hyperparathyroidism252.08Acute glomerulonephritis with
other specified pathologicallesion in kidney in disease classified
elsewhere (Codefirst underlying disease: 002.0, 070.0-070.9,
072.79, 421.0)
580.81
Other acute glomerulonephritis with other specifiedpathological
lesion in kidney
580.89
Acute glomerulonephritis with unspecified pathologicallesion in
kidney
580.9
Nephritis and nephropathy, not specified as acute orchronic,
with other specified pathological lesion in kidney,
583.81
in diseases classified elsewhere (Code first underlyingdisease:
016.0, 098.19, 249.4, 250.4, 277.30-277.39,446.21, 710.0)Acute
kidney failure with lesion of tubular necrosis584.5Congenital
polycystic kidney, unspecified type753.12Congenital polycystic
kidney, autosomal dominant753.13Other specified congenital cystic
kidney disease753.19
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
IOM References100-4,16,40.6.1; 100-4,16,100.6
CCI Version 20.080047-80048, 80051, 80076, 82040, 82310, 82374,
82435, 82565,82947, 84100, 84132, 84295, 84520
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080069.........
105CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
80074 - NCDAcute hepatitis panel80074
ExplanationAn acute hepatitis panel includes the following
tests: hepatitis Aantibody (HAAb), IgM antibody (86709), hepatitis
B core antibody(HbcAb), IgM antibody (86705), hepatitis B surface
antigen (HbsAg)(87340), and hepatitis C antibody (86803).
Coding TipsOrgan and disease-oriented panels are composed of a
group of specifiedtests. If all of the tests of a defined panel are
performed, the panel codeor the individual test codes may be
reported. If a specimen istransported to an outside laboratory,
report code 99000 for handlingor conveyance. A national coverage
determination (NCD) exists for thiscode. See the Medicare National
Coverage Determinations Manual,Pub. 100-03, section 190.33. Note
that the list of ICD-9-CM codesdoes not contain all diagnostic
codes associated with the NCD. Pleasesee the CD for a complete
list. Venipuncture is separately reportable.For collection of
venous blood by venipuncture, see code 36415. Whenvenipuncture on a
patient 3 years of age or older requires the skill of aphysician or
other qualified health care provider, see code 36410.
Forvenipuncture on a patient younger than 3 years of age performed
bya physician or other qualified health care provider, see
codes36400-36406. Most third-party payers and state scope of work
excludethe use of a code requiring a physician or other qualified
health careprovider, by a phlebotomist, or other unlicensed
clinical staff.
ICD-9-CM Diagnostic CodesViral hepatitis A with hepatic
coma070.0Viral hepatitis A without mention of hepatic
coma070.1Viral hepatitis B with hepatic coma, acute or
unspecified,without mention of hepatitis delta
070.20
Viral hepatitis B with hepatic coma, acute or unspecified,with
hepatitis delta
070.21
Viral hepatitis B with hepatic coma, chronic, withoutmention of
hepatitis delta
070.22
Viral hepatitis B with hepatic coma, chronic, with
hepatitisdelta
070.23
Viral hepatitis B without mention of hepatic coma, acuteor
unspecified, without mention of hepatitis delta
070.30
Viral hepatitis B without mention of hepatic coma, acuteor
unspecified, with hepatitis delta
070.31
Viral hepatitis B without mention of hepatic coma,
chronic,without mention of hepatitis delta
070.32
Viral hepatitis B without mention of hepatic coma, chronic,with
hepatitis delta
070.33
Acute hepatitis C with hepatic coma070.41Hepatitis delta without
mention of active hepatitis B diseasewith hepatic coma
070.42
Hepatitis E with hepatic coma070.43
Chronic hepatitis C with hepatic coma070.44Acute hepatitis C
without mention of hepatic coma070.51Hepatitis delta without
mention of active hepatitis B diseaseor hepatic coma
070.52
Hepatitis E without mention of hepatic coma070.53Chronic
hepatitis C without mention of hepatic coma070.54Hepatic
encephalopathy572.2Portal hypertension (Use additional code for
anyassociated complications, such as: portal
hypertensivegastropathy (537.89))
572.3
Hepatorenal syndrome572.4Chronic fatigue
syndrome780.71Functional quadriplegia780.72Other malaise and
fatigue780.79Jaundice, unspecified, not of
newborn782.4Anorexia783.0Loss of weight (Use additional code to
identify BodyMass Index (BMI), if known: V85.0-V85.54)
783.21
Underweight (Use additional code to identify Body MassIndex
(BMI), if known: V85.0-V85.54)
783.22
Failure to thrive783.41Nausea with vomiting787.01Nausea
alone787.02Abdominal pain, unspecified site789.00Abdominal pain,
right upper quadrant789.01Abdominal pain, left lower
quadrant789.04Abdominal pain, periumbilic789.05Abdominal pain,
epigastric789.06
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
IOM References100-3,190.33
CCI Version 20.086705, 86709, 86803, 87340
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080074.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.106
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
80076Hepatic function panel80076
ExplanationA hepatic function panel includes the following
tests: albumin (82040),total bilirubin (82247), direct bilirubin
(82248), alkaline phosphatase(84075), protein, total (84155),
alanine amino transferase (ALT) (SGPT)(84460), and aspartate amino
transferase (AST) (SGOT) (84450). Bloodspecimen is obtained by
venipuncture. See the specific codes foradditional information
about the listed tests.
Coding TipsDo not report 80076 with 80053. Organ and
disease-oriented panelsare composed of a group of specified tests.
If all of the tests of a definedpanel are performed, the panel code
or the individual test codes maybe reported. According to CPT
guidelines, do not report two or moreorgan or disease-oriented
panels when any of the same tests areperformed in each panel and
the panels are performed from the samepatient collection. When a
group of tests overlap two or more panels,report the panel that has
the greatest number of tests allowing thedefinition of that panel
to be met, and then report the remaining testsusing the appropriate
individual test codes. If a specimen is transportedto an outside
laboratory, report 99000 for handling or conveyance.Venipuncture is
separately reportable. For collection of venous bloodby
venipuncture, see code 36415. When venipuncture on a patient 3years
of age or older requires the skill of a physician or other
qualifiedhealth care provider, see code 36410. For venipuncture on
a patientyounger than 3 years of age performed by a physician or
other qualifiedhealth care provider, see codes 36400-36406. Most
third-party payersand state scope of work exclude the use of a code
requiring a physicianor other qualified health care provider by a
phlebotomist or otherunlicensed clinical staff.
Terms To Knowspecimen. Tissue cells or sample of fluid taken for
analysis, pathologicexamination, and diagnosis.venipuncture.
Piercing a vein through the skin by a needle and syringe
orsharp-ended cannula or catheter to draw blood, start an
intravenous infusion,instill medication, or inject another
substance such as radiopaque dye.
ICD-9-CM Diagnostic CodesViral hepatitis A without mention of
hepatic coma070.1Viral hepatitis B without mention of hepatic coma,
acuteor unspecified, without mention of hepatitis delta
070.30
Viral hepatitis B without mention of hepatic coma, acuteor
unspecified, with hepatitis delta
070.31
Viral hepatitis B without mention of hepatic coma,
chronic,without mention of hepatitis delta
070.32
Viral hepatitis B without mention of hepatic coma, chronic,with
hepatitis delta
070.33
Acute hepatitis C without mention of hepatic coma070.51
Hepatitis delta without mention of active hepatitis B diseaseor
hepatic coma
070.52
Hepatitis E without mention of hepatic coma070.53Chronic
hepatitis C without mention of hepatic coma070.54Other specified
viral hepatitis without mention of hepaticcoma
070.59
Unspecified viral hepatitis with hepatic coma070.6Unspecified
viral hepatitis C without hepatic coma070.70Unspecified viral
hepatitis without mention of hepatic coma070.9Malignant neoplasm of
liver, primary155.0Malignant neoplasm of intrahepatic bile
ducts155.1Alcoholic fatty liver571.0Acute alcoholic
hepatitis571.1Alcoholic cirrhosis of liver571.2Unspecified
alcoholic liver damage571.3Unspecified chronic
hepatitis571.40Chronic persistent hepatitis571.41Other chronic
hepatitis571.49Cirrhosis of liver without mention of alcohol (Code
first,if applicable, viral hepatitis (acute) (chronic):
070.0-070.9)
571.5
Biliary cirrhosis571.6Other chronic nonalcoholic liver
disease571.8Unspecified chronic liver disease without mention of
alcohol571.9Hepatic encephalopathy572.2Portal hypertension (Use
additional code for anyassociated complications, such as: portal
hypertensivegastropathy (537.89))
572.3
Hepatorenal syndrome572.4Hepatomegaly789.1Follow-up examination
following completed treatmentwith high-risk medications, not
elsewhere classified
V67.51
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
IOM References100-4,16,40.6.1; 100-4,16,100.6
CCI Version 20.082040, 82247-82248, 84075, 84155, 84450,
84460
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080076.........
107CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
80100Drug screen, qualitative; multiple drug classes
chromatographicmethod, each procedure
80100
ExplanationThis test may be requested as a drug screen for
multiple drug classes.The screening test must be performed by a
chromatographic techniquethat has good sensitivity, although it may
not be as specific as aconfirmatory test. Thin-layer chromatography
is a commonchromatographic technique for drug screening tests. It
is performedby applying a thin layer adsorbent to a rectangular
plate in thestationary phase. The specimen is applied to the plate
and the end ofthe plate is placed in a solvent. As the solvent
rises along the adsorbenton the plate, the different components of
the specimen are carriedalong at varying rates and deposited along
the plate. The differentcomponents can be separately visualized and
analyzed. Positive testsare always confirmed with a second method.
Specimen type varies.
Coding TipsIf a specimen is transported to an outside
laboratory, report code 99000for handling or conveyance. Use CPT
code 80100 for qualitative drugscreens performed by chromatography
that detect multiple drug classes.Count each combination of
stationary and mobile phase as one. Ifmultiple drugs are detected
using a single analysis (e.g., one stationaryphase with one mobile
phase) use 80100 only once. Refer to specificcodes for quantitation
of drugs screened. See CPT codes 82000-84999for quantitative drug
levels. To report therapeutic drug assays forquantitative drug
screening, see codes 80150-80299.
Terms To KnowCLIA. Clinical Laboratory Improvement Amendments.
Requirements set in1988, CLIA imposes varying levels of federal
regulations on clinical procedures.Few laboratories, including
those in physician offices, are exempt. Adopted byMedicare and
Medicaid, CLIA regulations redefine laboratory testing in regardto
laboratory certification and accreditation, proficiency testing,
qualityassurance, personnel standards, and program
administration.qualitative. To determine the nature of the
component of substance.quantitative. To determine the amount and
nature of the components of asubstance.specimen. Tissue cells or
sample of fluid taken for analysis, pathologicexamination, and
diagnosis.therapeutic. Act meant to alleviate a medical or mental
condition.
ICD-9-CM Diagnostic CodesThe application of this code is too
broad to adequately presentICD-9-CM diagnostic code links here.
Refer to your ICD-9-CM book.
CCI Version 20.080101, 80500-80502, 82486-82489, G0431v
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080100.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.108
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
80101 [80104]Drug screen, qualitative; single drug class method
(eg,immunoassay, enzyme assay), each drug class
80101
multiple drug classes other than chromatographic method,each
procedure
80104
ExplanationThese tests may be requested as drug screens for
multiple drug classes.In 80100, the screening test must be
performed by a chromatographictechnique that has good sensitivity,
although it may not be as specificas a confirmatory test.
Thin-layer chromatography is a commonchromatographic technique for
drug screening tests. It is performedby applying a thin layer
adsorbent to a rectangular plate in thestationary phase. The
specimen is applied to the plate and the end ofthe plate is placed
in a solvent. As the solvent rises along the adsorbenton the plate,
the different components of the specimen are carriedalong at
varying rates and deposited along the plate. The
differentcomponents can be separately visualized and analyzed. In
80104, anumber of different methods are available to screen for
qualitative,nonchromatographic, multiple drug class assays,
including multiplexedscreening kits, urine cups, test cards, or
test strips. Positive tests arealways confirmed with a second
method. Specimen type varies.
Coding TipsCode 80104 is a resequenced code and will not display
in numericorder. Code 80101 is classified as a Clinical Laboratory
ImprovementAmendments (CLIA)-waived test. Append with modifier QW.
If aspecimen is transported to an outside laboratory, report code
99000for handling or conveyance. Each single drug class method
tested andreported is to be counted as one drug class. For example,
if a sampleis aliquoted to five wells and separate class-specific
immunoassays arerun on each of the five wells these are reported
separately by indicatingcode 80101 five times. However, if multiple
drugs can be detected bya single analysis, code 80100 should be
reported only once. Refer tospecific codes for quantitation of
drugs screened. See CPT codes8200084999 for quantitative drug
levels. To report therapeutic drugassays for quantitative drug
screening, see codes 80150780299.
ICD-9-CM Diagnostic CodesOpioid type dependence,
episodic304.02Sedative, hypnotic or anxiolytic dependence,
continuous304.11Sedative, hypnotic or anxiolytic dependence,
episodic304.12Cocaine dependence, continuous304.21Cocaine
dependence, episodic304.22Cannabis dependence,
continuous304.31Cannabis dependence, episodic304.32Amphetamine and
other psychostimulant dependence,continuous
304.41
Amphetamine and other psychostimulant dependence,episodic
304.42
Hallucinogen dependence, continuous304.51
Hallucinogen dependence, episodic304.52Other specified drug
dependence, continuous304.61Other specified drug dependence,
episodic304.62Combinations of opioid type drug with any other
drugdependence, continuous
304.71
Combinations of opioid type drug with any other drugdependence,
episodic
304.72
Combinations of drug dependence excluding opioid typedrug,
continuous
304.81
Combinations of drug dependence excluding opioid typedrug,
episodic
304.82
Nondependent cannabis abuse, continuous305.21Nondependent
cannabis abuse, episodic305.22Nondependent hallucinogen abuse,
continuous305.31Nondependent hallucinogen abuse,
episodic305.32Nondependent sedative hypnotic or anxiolytic
abuse,continuous
305.41
Nondependent sedative, hypnotic or anxiolytic abuse,episodic
305.42
Nondependent opioid abuse, continuous305.51Nondependent opioid
abuse, episodic305.52Nondependent cocaine abuse,
continuous305.61Nondependent cocaine abuse,
episodic305.62Nondependent amphetamine or related
actingsympathomimetic abuse, continuous
305.71
Nondependent amphetamine or related actingsympathomimetic abuse,
episodic
305.72
Nondependent antidepressant type abuse,
continuous305.81Nondependent antidepressant type abuse,
episodic305.82
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
IOM References100-4,16,70.8
CCI Version 20.080500-80502
Also not with 80101: 83516-83518, G0431v
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00...............
0.0080101.........0.000.000.000.000.00...............
0.0080104.........
109CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
80102Drug confirmation, each procedure80102
ExplanationThis test may be requested as drug screen
confirmation. It is performedwhen the initial drug screen
(80100-80101) is positive. Confirmatorytests must be both sensitive
and specific and involve a differenttechnique than the initial
screen. For example, if the initial screen isperformed by thin
layer chromatography identifying a spot on thechromatogram that is
the right color and in the right place to beconsistent with a
particular drug, it is confirmed with a more specificmethod, like
high performance liquid chromatography (HPLC),
gaschromatography-mass spectrometry (GC-MS), or immunoassay. If
thedrug suspected is a barbiturate, for example, a confirmatory
HPLCmethod might be done to prove that the compound had the
correctretention time, etc., and to identify it exactly as a
particular barbiturate.This would be reported with 80102.
Coding TipsIf a specimen is transported to an outside
laboratory, report code 99000for handling or conveyance. Procedures
necessary for confirmation arereported using code 80102. Each
combination of stationary and mobilephase is counted as one
procedure. For example, if confirmation ofthree drugs by
chromatography requires one stationary phase withthree mobile
phases, report code 80102 three times. However, ifmultiple drugs
can be confirmed using a single analysis (e.g., onestationary phase
with one mobile phase), report code 80102 only once.Refer to
specific codes for quantitation of drugs screened. See CPTcodes
82000-84999 for quantitative drug levels. To report therapeuticdrug
assays for quantitative drug screening, see codes 80150-80299.
ICD-9-CM Diagnostic CodesOpioid type dependence,
continuous304.01Opioid type dependence, episodic304.02Sedative,
hypnotic or anxiolytic dependence, continuous304.11Sedative,
hypnotic or anxiolytic dependence, episodic304.12Cocaine
dependence, continuous304.21Cocaine dependence,
episodic304.22Cannabis dependence, continuous304.31Cannabis
dependence, episodic304.32Amphetamine and other psychostimulant
dependence,continuous
304.41
Amphetamine and other psychostimulant dependence,episodic
304.42
Hallucinogen dependence, continuous304.51Hallucinogen
dependence, episodic304.52Combinations of opioid type drug with any
other drugdependence, continuous
304.71
Combinations of opioid type drug with any other drugdependence,
episodic
304.72
Combinations of drug dependence excluding opioid typedrug,
continuous
304.81
Combinations of drug dependence excluding opioid typedrug,
episodic
304.82
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
CCI Version 20.080500-80502
Note: These CCI edits are used for Medicare. Other payers
mayreimburse on codes listed above.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080102.........
2014 OptumInsight, Inc.CPT 2014 American Medical Association.
All Rights Reserved.110
Coding and Payment Guide for Laboratory ServicesProcedure
Codes
-
80103Tissue preparation for drug analysis80103
ExplanationTissue is sometimes tested for the presence of drugs.
This code reportsthe tissue preparation only.
Coding TipsIf a specimen is transported to an outside
laboratory, report code 99000for handling or conveyance. This code
is used to report each preparationof tissue for a drug screen. The
drug screens performed are separatelyreportable in addition to this
code. See CPT codes 82000-84999 forchemistry drug levels. To report
therapeutic drug assays for quantitativedrug screening, see codes
80150-80299.
ICD-9-CM Diagnostic CodesOpioid type dependence,
continuous304.01Opioid type dependence, episodic304.02Sedative,
hypnotic or anxiolytic dependence, continuous304.11Sedative,
hypnotic or anxiolytic dependence, episodic304.12Cocaine
dependence, continuous304.21Cocaine dependence,
episodic304.22Cannabis dependence, continuous304.31Cannabis
dependence, episodic304.32Amphetamine and other psychostimulant
dependence,continuous
304.41
Amphetamine and other psychostimulant dependence,episodic
304.42
Hallucinogen dependence, continuous304.51Hallucinogen
dependence, episodic304.52Other specified drug dependence,
continuous304.61Other specified drug dependence,
episodic304.62Combinations of opioid type drug with any other
drugdependence, continuous
304.71
Combinations of opioid type drug with any other drugdependence,
episodic
304.72
Combinations of drug dependence excluding opioid typedrug,
continuous
304.81
Combinations of drug dependence excluding opioid typedrug,
episodic
304.82
Unspecified drug dependence, unspecified304.90Nondependent
cannabis abuse, continuous305.21Nondependent cannabis abuse,
episodic305.22Nondependent cannabis abuse, in
remission305.23Nondependent hallucinogen abuse,
continuous305.31Nondependent hallucinogen abuse,
episodic305.32Nondependent sedative hypnotic or anxiolytic
abuse,continuous
305.41
Nondependent sedative, hypnotic or anxiolytic abuse,episodic
305.42
Nondependent sedative, hypnotic or anxiolytic abuse,
inremission
305.43
Nondependent opioid abuse, continuous305.51Nondependent opioid
abuse, episodic305.52Nondependent opioid abuse, in
remission305.53Nondependent cocaine abuse,
continuous305.61Nondependent cocaine abuse,
episodic305.62Nondependent cocaine abuse, in
remission305.63Nondependent amphetamine or related
actingsympathomimetic abuse, continuous
305.71
Nondependent amphetamine or related actingsympathomimetic abuse,
episodic
305.72
Nondependent amphetamine or related actingsympathomimetic abuse,
in remission
305.73
Nondependent antidepressant type abuse,
continuous305.81Nondependent antidepressant type abuse,
episodic305.82Nondependent antidepressant type abuse, in
remission305.83Other, mixed, or unspecified nondependent drug
abuse,continuous
305.91
Other, mixed, or unspecified nondependent drug
abuse,episodic
305.92
Other, mixed, or unspecified nondependent drug abuse,in
remission
305.93
Examination for medicolegal reason (Use additionalcode(s) to
identify any special screening examination(s)performed:
V73.0-V82.9)
V70.4
Other laboratory examinationV72.69
This list of ICD-9-CM codes might not be all-inclusive. Please
refer toyour Laboratory Cross Coder to determine if other diagnoses
areapplicable.
CCI Version 20.0No CCI Edits apply to this code.
Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value
0.000.000.000.000.00............... 0.0080103.........
111CPT 2014 American Medical Association. All Rights Reserved.
2014 OptumInsight, Inc.
Procedure CodesCoding and Payment Guide for Laboratory
Services
-
80150Amikacin80150
ExplanationAmikacin is a type of antibiotic. Test specimens are
frequently collectedat peak and trough periods, which is shortly
after administration ofamikacin and again just before the next
administration when serumconcentration is at its lowest. This is an
effective approach to determinea therapeutic level of drug. Method
is radioimmunoassay (RIA) or highperformance liquid chromatography
(HPLC).
Coding TipsEach assay is separately reportable. This code
reports quantitativetherapeutic drug assay from any source. For
qualitative testing, see CPTcodes 80100-80104. Test assays are
frequently collected at peak andtrough periods (i.e., shortly after
administration of the drug andapproximately 12 hours after drug
administration).
Terms To Knowassay. Test of purity.qualitative. To determine the
nature of the component of substance.quantitative. To determine the
amount and nature of the components of asubstance.therapeutic. Act
meant to alleviate a medical or mental condition.
ICD-9-CM Diagnostic CodesMethicillin susceptible Staphylococcus
aureus septicemia (Use additional code for systemic inflammatory
responsesyndrome (SIRS): 995.91-995.92)
038.11
Unspecified staphylococcus infection in conditions
classifiedelsewhere and of unspecified site (Note: This code is
to
041.10
be used as an additional code to identify the bacterial agentin
diseases classified elsewhere and bacterial infections
ofunspecified nature or site)Methicillin susceptible Staphylococcus
aureus (Note:This code is to be used as an additional code to
identify
041.11
the bacterial agent in diseases classified elsewhere
andbacterial infections of unspecified nature or site)Other
staphylococcus infection in conditions classifiedelsewhere and of
unspecified site (Note: This code is to
041.19
be used as an additional code to identify the bacterial agentin
diseases classified elsewhere and bacterial infections
ofunspecified nature or site)Klebsiella pneumoniae infection (Note:
This code is tobe used as an additional code to identify the
bacterial agent
041.3
in diseases classified elsewhere and bacterial infections
ofunspecified nature or site)Shiga toxin-producing Escherichia coli
[E. coli] (STEC) O157infection in conditions classified elsewhere
and ofunspecified site
041.41
Other specified Shiga toxin-producing Escherichia coli [E.coli]
(STEC) infection in conditions classified elsewhere andof
unspecified site
041.42
Unspecified Shiga toxin-producing Escherichia coli [E.
coli](STEC) infection in conditions classified elsewhere and
ofunspecified site
041.43
Other and unspecified Escherichia coli [E. coli] infection
inconditions classified elsewhere and of unspecified site
041.49
Proteus (mirabilis) (morganii) infection in conditionsclassified
elsewhere and of unspecified site (Note: This
041.6
code is to be used as an additional code to identify
thebacterial agent in diseases classified elsewhere and
bacterialinfections of unspecified nature or site)Pseudomonas
infection in conditions classified elsewhereand of unspecified site
(Note: This code is to be used
041.7
as an additional code to identify the bacterial agent indiseases
classified elsewhere and bacterial infections ofunspecified nature
or site)Infection due to other gram-negative organisms inconditions
classified elsewhere and of unspecified site
041.85
(Note: This code is to be used as an additional code toidentify
the bacterial agent in diseases classified elsewhereand bacterial
infections of unspecified nature or site)Other infections specific
to the perinatal period (Useadditional code(s) to further specify
condition. Useadditional code to identify organism:
041.00-041.9)
771.89
Poisoning by other specified antibiotics (Use additionalcode to
specify the effects of poisoning)
960.8
Other laboratory examinationV72.69
This list of ICD-9-CM codes might not be all-