Measure Set Two Specifications
The Centers for Medicare & Medicaid Services is considering additional outpatient imaging efficiency measures. The measures would be calculated at the outpatient hospital facililty level based on all Medicare fee-for-service claims data paid under the outpatient prospective payment system. For these measures there is no stratification or risk adjustment applied.
Title of Measure: Use of Brain Computed Tomography (CT) in the Emergency Department for Atraumatic Headache
Brief Description of Measure:
This measure calculates the percentage of Emergency Department (ED) visits for headache with a coincident brain computed tomography (CT) study for Medicare beneficiaries. The results are segmented and reported at the facility level.
Numerator Statement:
Of ED visits identified in the denominator, visits with a coincident Brain CT study (i.e. Brain CT studies on the same day for the same patient).
Numerator Time Window:
Brain CT studies must be conducted on the same day that the patient seen in the ED.
Denominator Statement:
ED patient visits with a primary diagnosis code of headache.
Denominator Time Window:
Any day within a one-year window of claims data.
Denominator Exclusions:
Claims with secondary diagnosis codes related to:
- lumbar puncture,
- dizziness, paresthesia,
- lack of coordination,
- subarachnoid hemorrhage,
- complicated or thunderclap headache
- focal neurologic deficit
- pregnancy
- trauma
- HIV
- tumor/mass
And:
- imaging studies for ED patients admitted to the hospital.
Numerator Codes:
Brain CT CPT Codes:
70450 - CT head or brain, without contrast material;
70460 – CT head or brain; with contrast material(s);
70470 – CT head or brain; without contrast material followed by contrast material(s) and further sections
Denominator Codes:
The ICD-9-CM codes listed below were used for measure development and include codes that were current as of 2007. Certain ICD-9-CM codes were updated, with changes effective October 2008; however, those updates are not captured here as they did not apply to 2007 claims.
ED patient visit revenue codes:
0450-0459 and 0981
Billed with any of the following ICD-9 Diagnosis codes:
307.81 – Tension headache
339.00 – Cluster headache syndrome, unspecified
339.01 – Episodic cluster headache
339.02 – Cluster chronic headache
339.03 – Episodic paroxysmal hemicrania
339.04 – Chronic paroxysmal hemicrania
339.05 – Short lasting unilateral neuralgiform headache with conjuctival injection and tearing
339.10 – Tension headache, unspecified
339.11 – Episodic tension headache
339.12 – Chronic tension headache
339.3 – Drug induced headache
339.42 – New daily persistent headache
339.81 – Hypnic headache
339.82 – Headache associated with sexual activity
339.83 – Primary couch headache
339.84 – Primary exertional headache
339.85 – Primary stabbing headache
339.89 – Other headache syndromes
346.0 - Migraine
346.00 – Migraine, classical, not intractable
346.01 – Migraine with aura with intractable migraine, without mention of status migrainosus
346.10 – Migraine without aura without mention of intractable migraine without mention of status migrainosus
346.11 - Migraine without aura with intractable migraine, without mention of status migrainosus
346.2 – Variants of migraine
346.20 – Variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosus
346.21 – Variants of migraine, not elsewhere classified, with intractable migraine, without mention of status migrainosus
346.8 – Other forms of migraine
346.80 – Other forms of migraine without mention of intractable migraine without mention of status migrainosus
346.81 - Other forms of migraine with intractable migraine, with status migrainosus
346.9 – Migraine, unspecified
346.90 – Migraine unspecified without mention of intractable migraine without mention of status migrainosus
346.91 - Migraine unspecified with intractable migraine, so stated, with status migrainosus
627.2 – Menopausal state, symptomatic
784.0 – Headache
Denominator Exclusion Codes:
The ICD-9-CM codes listed below were used for measure development and include codes that were current as of 2007. Certain ICD-9-CM codes were updated, with changes effective October 2008; however, those updates are not captured here as they did not apply to 2007 claims.
Excluded ICD-9 diagnosis codes:
780.4 - DIZZINESS AND GIDDINESS
780.2 - SYNCOPE AND COLLAPSE
349.0 - LUMBAR PUNCTURE REACTION
781.0 - ABN INVOLUN MOVEMENT NEC
781.1 - SMELL & TASTE DISTURB
781.2 - ABNORMALITY OF GAIT
781.3 - LACK OF COORDINATION
782.0 - SKIN SENSATION DISTURB
430 - SUBARACHNOID HEMORRHAGE
339.43 - PRIM THNDERCLAP HEADACHE
339.44 - COMP HEADACHE SYND NEC
140-239 - NEOPLASMS/MASS
784.2 - SWELLING, MASS, OR LUMP IN HEAD AND NECK
042-044 - HUMAN IMMUNODEFICIENCY VIRUS (HIV)
800 - TRAUMA
839 - TRAUMA
850-854 - TRAUMA
860-869 - TRAUMA
905-909 - TRAUMA
926.11 - TRAUMA
926.12 - TRAUMA
929 - TRAUMA
952 - TRAUMA
958 - TRAUMA
959 - TRAUMA
630-676.9 - PREGNANCY
342 - HEMIPLESIA AND HEMIPARESIS
434 - OCCLUSION OF CEREBRAL ARTERIES
435 - TRANSIENT CEREBRAL ISCHEMIA
436 - ACUTE,BUT ILL-DEFINED, CEREBROVASCULAR DISEASE
438 - LATE EFFECT OF CEREBROVASCULAR DISEASE
Applying specifications to the outpatient file only will exclude ED patients subsequently admitted to the hospital. Claims related to patients visiting the ED but ultimately admitted are captured on the inpatient file.
CPT® only copyright 2008 American Medical Association. All rights reserved.
Title of Measure: Use of Stress Echocardiography, SPECT MPI, and Cardiac Stress MRI Post CABG
Brief Description of Measure:
This measure identifies the post-CABG patients being treated with an outpatient service in an outpatient hospital facility, who also had an imaging procedure done at a hospital outpatient facility (i.e., post-CABG patients receiving imaging procedures without exclusion /post-CABG patients seen at the hospital outpatient facility).
Numerator Statement:
Out of patients in the denominator, patients who received a SPECT MPI, Stress Echocardiography or Stress MRI study not meeting exclusion criteria. The following exclusions will be applied to the numerator alone:
- Patients with claims based indicators for silent ischemia or accelerated coronary artery disease in the 6 months preceding the imaging study;
- Patients with catheterization, percutaneous coronary intervention (PCI) or CABG procedure in 6 months following imaging study; or
- SPECT MPI, Stress Echocardiography or Stress MRI studies within the first 6 months following a CABG procedure.
Numerator Time Window:
Imaging procedures must be conducted in the given calendar year for the measure evaluation.
Numerator Exclusions:
- Patients with claims based indicators for silent ischemia or accelerated coronary artery disease in the 6 months preceding the imaging study;
- Patients with catheterization, percutaneous coronary intervention (PCI) or CABG procedure in 6 months following imaging study; or
- SPECT MPI, Stress Echocardiography or Stress MRI studies within the first 6 months following a CABG procedure.
Denominator Statement:
Number of patients with a CABG procedure in the previous five (5) year period treated at a hospital outpatient department for any hospital outpatient service. CABG procedure may have been performed at a hospital unrelated to the current hospital outpatient service.
Denominator Time Window:
Patients must be seen at the hospital outpatient department in the given calendar year for the measure evaluation.
Denominator Exclusions:
None.
Numerator Codes:
SPECT MPI Codes:
78464 – MPI, SPECT, Single, At Rest or Stress
78465 – MPI, SPECT, Multiple, At Rest and/or Stress
[Note for 2010 there are new SPECT MPI codes replacing 78464 and 78465. The new codes are 78451 and 78452.]
Stress Echocardiography Codes:
93350, C8928 - Echocardiography, transthoracic, real time with image documentation, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress with interpretation and report
93351 (New for 2009) – including performance of continuous electrocardiographic monitoring with physician supervision
Stress MRI Codes:
75559 – MRI with stress/imaging
75560 – MRI with flow/velocity/stress
75563 – MRI with stress imaging and dye
75564 – MRI with flow/velocity/stress and dye.
Numerator Exclusion Codes:
The ICD-9-CM codes listed below were used for measure development and include codes that were current as of 2007. Certain ICD-9-CM codes were updated, with changes effective October 2008; however, those updates are not captured here as they did not apply to 2007 claims.
Clinical Risk Predictor Exclusion Codes
ICD-9-CM Codes:
413.0-413.9 – Angina
427.0-427.89 – Cardiac dysrhythmias
780.2 – Syncope
785.1 – Palpitations
786.02 – Orthopnea
786.05 – Shortness of breath
786.09 – Dyspnea
786.5 – Chest pain, unspecified
786.51 – Precordial pain
786.59 – Other chest pain
794.3 – Abnormal cardiovascular function study
794.31 – Abnormal EKG
V72.81 – Preoperative cardiovascular exam
Catheterization, PCI and CABG Exclusion Codes
Catheterization Codes
CPT – 4 Codes
93501 – Right heart catheterization
93503 – Insert/place heart catheter
93508 – Cath placement, angiography
93510 – Left heart catheterization
93511 – Left heart catheterization
93514 – Left heart catheterization
93524 – Left heart catheterization
93526 – Rt & Lt heart catheters
93527 – Rt & Lt heart catheters
93528 – Rt & Lt heart catheters
93529 – Rt, Lt heart catheterization
93530 – Rt heart cath, congenital
93531 – R & l heart cath, congenital
93532 – R & l heart cath, congenital
93533 – R & l heart cath, congenital
ICD-9-CM Codes:
3721 – Right heart cardiac catheterization
3722 – Left heart cardiac catheterization
3723 – Combined r and l heart cardiac catheterization
3891 – Arterial catheterization
PCI Codes
CPT – 4 Codes
92975 - Thrombolysis, coronary; by intracoronary infusion
92977 - Thrombolysis, coronary; by intravenous infusion
92980 - Transcatheter Placement of Intracoronary Stent(s), Percutaneous
92982 - Percutaneous Transluminal Coronary Balloon Angioplasty
92986 - Percutaneous balloon valvuloplasty; aortic valve
92987 - Percutaneous balloon valvuloplasty; mitral valve
92990 - Percutaneous balloon valvuloplasty; pulmonary valve
92995 - Percutaneous Transluminal Coronary Atherectomy
92997 - Percutaneous transluminal pulmonary artery balloon angioplasty
93580 - Percutaneous transcatheter closure of atrial septal defect
93581 - Percutaneous transcatheter closure of congenital ventricular septal defect
ICD-9-CM Codes
0066 – Percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy
3552 – Repair of atrial septal defect with prosthesis, closed technique
3572 – Other and unspecified repair of ventricular septal defect
3596 – Percutaneous valvuloplasty
3601 – Percutaneous transluminal balloon
3602 – Single Vessel percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy with thrombolytic agent
3604 – Intracoronary artery thrombolytic infusion
3605 – Multiple vessel (percutaneous) transluminal coronary angioplasty [PTCA] or coronary atherectomy performed during the same
operation
3606 – Insertion of non-drug-eluting coronary artery stent(s)
3607 – Insertion of drug-eluting coronary artery stent(s)
CABG Codes:
CPT4 Codes:
33510 - CABG, vein, single
33511 – CABG, vein, two
33512 – CABG, vein, three
33513 – CABG, vein, four
33514 – CABG, vein, five
33516 – CABG, vein, six+
33517 - CABG, artery-vein, single
33518 - CABG, artery-vein, two
33519 - CABG, artery-vein, three
33521 - CABG, artery-vein, four
33522 - CABG, artery-vein, five
33523 - CABG, artery-vein, six+
33533 - CABG, arterial, single
33534 - CABG, arterial, two
33535 - CABG, arterial, three
33536 - CABG, arterial, four+
ICD-9-CM Codes:
3610 - AORTOCORONARY BYPASS NOS
3611 – AORTOCOR BYPAS-1 COR ART
3612 – AORTOCOR BYPAS-2 COR ART
3613 – AORTOCOR BYPAS-3 COR ART
3614 – AORTOCOR BYPAS-4+ COR ART
3615 – 1 INT MAM-COR ART BYPASS
3616 – 2 INT MAM-COR ART BYPASS
3617 – ABD-CORON ART BYPASS
3619 – HRT REVAS BYPS ANAS NEC
Imaging study 6 months post-CABG Exclusion Codes
SPECT MPI Codes:
78464 – MPI, SPECT, Single, At Rest or Stress
78465 – MPI, SPECT, Multiple, At Rest and/or Stress
Stress Echocardiography Codes
93350, C8928 - Echocardiography, transthoracic, real time with image documentation, during rest and cardiovascular stress test using
treadmill, bicycle exercise and/or pharmacologically induced stress with interpretation and report
93351 (New for 2009) – including performance of continuous electrocardiographic monitoring with physician supervision
Stress MRI Codes:
75559 – MRI with stress/imaging
75560 – MRI with flow/velocity/stress
75563 – MRI with stress imaging and dye
75564 – MRI with flow/velocity/stress and dye
Denominator Codes:
The ICD-9-CM codes listed below were used for measure development and include codes that were current as of 2007. Certain ICD-9-CM codes were updated, with changes effective October 2008; however, those updates are not captured here as they did not apply to 2007 claims.
All patients in the HOP files
Included CABG Codes:
CPT4 Codes:
33510 - CABG, vein, single
33511 – CABG, vein, two
33512 – CABG, vein, three
33513 – CABG, vein, four
33514 – CABG, vein, five
33516 – CABG, vein, six+
33517 - CABG, artery-vein, single
33518 - CABG, artery-vein, two
33519 - CABG, artery-vein, three
33521 - CABG, artery-vein, four
33522 - CABG, artery-vein, five
33523 - CABG, artery-vein, six+
33533 - CABG, arterial, single
33534 - CABG, arterial, two
33535 - CABG, arterial, three
33536 - CABG, arterial, four+
ICD-9-CM Codes:
3610 - AORTOCORONARY BYPASS NOS
3611 – AORTOCOR BYPAS-1 COR ART
3612 – AORTOCOR BYPAS-2 COR ART
3613 – AORTOCOR BYPAS-3 COR ART
3614 – AORTOCOR BYPAS-4+ COR ART
3615 – 1 INT MAM-COR ART BYPASS
3616 – 2 INT MAM-COR ART BYPASS
3617 – ABD-CORON ART BYPASS
3619 – HRT REVAS BYPS ANAS NEC
Denominator Exclusion Codes:
None
CPT® only copyright 2008 American Medical Association. All rights reserved.
Title of Measure: Simultaneous Use of Brain Computed Tomography (CT) and Sinus Computed Tomography (CT)
Brief Description of Measure:
This measure calculates the percentage of Brain CT studies with a simultaneous Sinus CT (i.e., Brain and Sinus CT studies performed on the same day at the same facility). Results of this measure are to be segmented and reported at the facility level.
Numerator Statement:
Of studies identified in the denominator, studies with a simultaneous Sinus CT study (i.e., on the same date at the same facility as the Brain CT).
Numerator Time Window:
Same date as the imaging procedure counted in the denominator.
Denominator Statement:
Brain CT studies
Denominator Time Window:
Any day within a one-year window of claims data.
Denominator Exclusions:
Claims with primary or secondary diagnosis codes related to trauma, tumor, orbital cellulitis, or intracranial abscess.
Numerator Codes:
Brain CT CPT Codes:
70450 - CT head or brain, without contrast material;
70460 – CT head or brain; with contrast material(s);
70470 – CT head or brain; without contrast material followed by contrast material(s) and further sections
Sinus CT CPT Codes:
70486 – CT maxillofacial area; without contrast material;
70487 – CT maxillofacial area; with contrast material(s)
70488 – CT maxillofacial area; without contrast material, followed by contrast material(s) and further sections
Denominator Codes:
Brain CT CPT Codes:
70450 - CT head or brain, without contrast material;
70460 – CT head or brain; with contrast material(s);
70470 – CT head or brain; without contrast material followed by contrast material(s) and further sections
Denominator Exclusion Codes:
Neoplasms:
ICD-9-CM codes 140-239
Trauma:
ICD-9-CM codes 800,839,850-854,860-869,905-909, 926.11, 926.12, 929, 952, 958-959
Orbital Cellulitis:
ICD-9 CM Code 376.01
Intracranial abscess:
ICD-9-CM code 324.0
CPT® only copyright 2008 American Medical Association. All rights reserved.
Title of Measure: Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac Low-Risk Surgery
Brief Description of Measure:
This measure calculates the percentage of Stress Echocardiography, SPECT MPI or Stress MRI studies performed at a hospital outpatient facility in the 30 days prior to a low-risk, non-cardiac surgery performed anywhere. Results to be segmented and reported by hospital outpatient facility.
Numerator Statement:
Of patients in the denominator, number of Stress Echocardiography, SPECT MPI and Stress MRI studies performed at the hospital outpatient department within 30 days of low-risk non-cardiac surgery performed at any location (e.g., other hospital, physician office).
Numerator Time Window:
The 30 days preceding a low-risk, non-cardiac surgery.
Denominator Statement:
Number of Stress Echocardiography, SPECT MPI and Stress MRI studies performed at the hospital outpatient department.
Denominator Time Window:
Any day within a one-year window of claims data, between January 1 and November 30.
Denominator Exclusions:
None.
Numerator Codes:
SPECT MPI Codes
78464 – MPI, SPECT, Single, At Rest or Stress
78465 – MPI, SPECT, Multiple, At Rest and/or Stress
[Note for 2010 there are new SPECT MPI codes replacing 78464 and 78465. The new codes are 78451 and 78452.]
Stress Echocardiography Codes
93350, C8928 - Echocardiography, trans-thoracic, real time with image documentation, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress with interpretation and report
93351 (New for 2009) – including performance of continuous electrocardiographic monitoring with physician supervision
Stress MRI Codes
75559 – MRI with stress/imaging
75560 – MRI with flow/velocity/stress
75563 – MRI with stress imaging and dye
75564 – MRI with flow/velocity/stress and dye
With one of the following CPT 4 Codes for Low-Risk Non-Cardiac Surgery:
Surgery/Integumentary System: Breast
19100 Biopsy of breast
19101 Biopsy of breast
19102 Bx breast percut w/image
19103 Bx breast percut w/device
Surgery/Respiratory System: Accessory Sinuses
31231 Nasal endoscopy, dx
31233 Nasal/sinus endoscopy, dx
31235 Nasal/sinus endoscopy, dx
31237 Nasal/sinus endoscopy, surg
31238 Nasal/sinus endoscopy, surg
31239 Nasal/sinus endoscopy, surg
31240 Nasal/sinus endoscopy, surg
31267 Endoscopy, maxillary sinus
31276 Sinus surgical endoscopy
31299 Sinus surgery procedure
Surgery/Respiratory System: Larynx
31505 Diagnostic laryngoscopy
31510 Laryngoscopy with biopsy
31511 Remove foreign body, larynx
31513 Injection into vocal cord
31515 Laryngoscopy for aspiration
31520 Diagnostic laryngoscopy
31525 Diagnostic laryngoscopy
31526 Diagnostic laryngoscopy
31527 Laryngoscopy for treatment
31528 Laryngoscopy and dilatation
31529 Laryngoscopy and dilatation
31530 Operative laryngoscopy
31531 Operative laryngoscopy
31535 Operative laryngoscopy
31536 Operative laryngoscopy
31540 Operative laryngoscopy
31541 Operative laryngoscopy
31560 Operative laryngoscopy
31561 Operative laryngoscopy
31570 Laryngoscopy with injection
31571 Laryngoscopy with injection
31575 Diagnostic laryngoscopy
31576 Laryngoscopy with biopsy
31577 Remove foreign body, larynx
31578 Removal of larynx lesion
31579 Diagnostic laryngoscopy
Surgery/Respiratory System: Trachea and Bronchi
31615 Visualization of windpipe
31620 Endobronchial us add-on
31622 Diagnostic bronchoscopy
31623 Dx bronchoscope/brush
31624 Dx bronchoscope/lavage
31625 Bronchoscopy with biopsy
31628 Bronchoscopy with biopsy
31629 Bronchoscopy with biopsy
31632 Bronchoscopy/lung bx, add’l
31633 Bronchoscopy/needle bx add’l
31645 Bronchoscopy, clear airways
31646 Bronchoscopy,reclear airways
Surgery/Respiratory System: Lungs and Pleura
33508 Endoscopic vein harvest
37500 Endoscopy ligate perf veins
37501 Vascular endoscopy procedure
39400 Visualization of chest
Surgery/Digestive System: Esophagus
43200 Esophagus endoscopy
43201 Esoph scope w/submucous inj
43202 Esophagus endoscopy, biopsy
43204 Esophagus endoscopy & inject
43205 Esophagus endoscopy/ligation
43215 Esophagus endoscopy
43216 Esophagus endoscopy/lesion
43217 Esophagus endoscopy
43219 Esophagus endoscopy
43220 Esophagus endoscopy,dilation
43226 Esophagus endoscopy,dilation
43227 Esophagus endoscopy, repair
43228 Esophagus endoscopy,ablation
43231 Esoph endoscopy w/us exam
43232 Esoph endoscopy w/us fn bx
43234 Upper GI endoscopy, exam
43235 Upper GI endoscopy,diagnosis
43236 Upper GI scope w/submuc inj
43237 Endoscopic us exam, esoph
43238 Upper GI endoscopy w/us fn bx
43239 Upper GI endoscopy, biopsy
43241 Upper GI endoscopy with tube
43242 Upper GI endoscopy w/us fn bx
43243 Upper GI endoscopy & inject.
43244 Upper GI endoscopy/ligation
43246 Place gastrostomy tube
43247 Operative upper GI endoscopy
43248 Upper GI endoscopy/guidewire
43249 Esophagus endoscopy,dilation
43260 Endoscopy, bile duct/pancreas
43261 Endoscopy, bile duct/pancreas
43262 Endoscopy, bile duct/pancreas
43263 Endoscopy, bile duct/pancreas
43264 Endoscopy, bile duct/pancreas
43265 Endoscopy, bile duct/pancreas
43267 Endoscopy, bile duct/pancreas
43268 Endoscopy, bile duct/pancreas
43269 Endoscopy, bile duct/pancreas
43271 Endoscopy, bile duct/pancreas
43272 Endoscopy, bile duct/pancreas
Surgery/Digestive System: Intestines (Except Rectum)
44360 Small bowel endoscopy
44361 Small bowel endoscopy, biopsy
44363 Small bowel endoscopy
44383 Ileoscopy w/stent
44385 Endoscopy of bowel pouch
44386 Endoscopy, bowel pouch, biopsy
44388 Colon endoscopy
44389 Colonoscopy with biopsy
44390 Colonoscopy for foreign body
44391 Colonoscopy for bleeding
44392 Colonoscopy & polypectomy
44393 Colonoscopy, lesion removal
44397 Colonoscopy w stent
Surgery/Digestive System: Rectum
45300 Proctosigmoidoscopy
45303 Proctosigmoidoscopy
45305 Proctosigmoidoscopy; biopsy
45307 Proctosigmoidoscopy
45308 Proctosigmoidoscopy
45309 Proctosigmoidoscopy
45315 Proctosigmoidoscopy
45317 Proctosigmoidoscopy
45320 Proctosigmoidoscopy
45321 Proctosigmoidoscopy
45327 Proctosigmoidoscopy w/stent
45330 Sigmoidoscopy, diagnostic
45331 Sigmoidoscopy and biopsy
45332 Sigmoidoscopy
45333 Sigmoidoscopy & polypectomy
45334 Sigmoidoscopy for bleeding
45335 Sigmoidoscope w/submuc inj
45337 Sigmoidoscopy, decompression
45338 Sigmoidoscopy
45339 Sigmoidoscopy
45340 Sig w/balloon dilation
45341 Sigmoidoscopy w/ultrasound
45342 Sigmoidoscopy w/us guide bx
45345 Sigmoidoscopy w/stent
45378 Diagnostic colonoscopy
45379 Colonoscopy
45380 Colonoscopy and biopsy
45381 Colonoscope, submucous inj
45382 Colonoscopy,control bleeding
45383 Colonoscopy, lesion removal
45384 Colonoscopy
45385 Colonoscopy, lesion removal
45387 Colonoscopy w/stent
45391 Colonoscopy w/endoscope us
45392 Colonoscopy w/endoscopic fnb
Surgery/Digestive System: Anus
46600 Diagnostic anoscopy
46604 Anoscopy and dilation
46606 Anoscopy and biopsy
46608 Anoscopy; remove foreign body
46610 Anoscopy; remove lesion
46612 Anoscopy; remove lesions
46614 Anoscopy; control bleeding
Surgery/Digestive System: Biliary Tract
47561 Laparo w/cholangio/biopsy
Surgery/Digestive System: Abdomen, Peritoneum and Omentum
49322 Laparoscopy, aspiration
Surgery/Urinary System: Kidney
50551 Kidney endoscopy
50553 Kidney endoscopy
50555 Kidney endoscopy & biopsy
50557 Kidney endoscopy & treatment
50559 Renal endoscopy; radiotracer
50561 Kidney endoscopy & treatment
Surgery/Urinary System: Ureter
50951 Endoscopy of ureter
50953 Endoscopy of ureter
50955 Ureter endoscopy & biopsy
50970 Ureter endoscopy
50972 Ureter endoscopy & catheter
50974 Ureter endoscopy & biopsy
50976 Ureter endoscopy & treatment
50978 Ureter endoscopy & tracer
50980 Ureter endoscopy & treatment
Surgery/Urinary System: Bladder
51715 Endoscopic injection/implant
52000 Cystoscopy
52001 Cystoscopy, removal of clots
52005 Cystoscopy & ureter catheter
52007 Cystoscopy and biopsy
52010 Cystoscopy & duct catheter
52204 Cystoscopy
52282 Cystoscopy, implant stent
52327 Cystoscopy, inject material
52330 Cystoscopy and treatment
52351 Cystouretro & or pyeloscope
52352 Cystouretro w/stone remove
52353 Cystouretero w/lithotripsy
52354 Cystouretero w/biopsy
52355 Cystouretero w/excise tumor
52402 Cystourethro cut ejacul duct
Surgery/Female Genital System: Cervix Uteri
57452 Examination of vagina
57454 Vagina examination & biopsy
57455 Biopsy of cervix w/scope
57456 Endocerv curettage w/scope
57460 Cervix excision
57461 Conz of cervix w/scope, leep
Surgery/Female Genital System: Corpus Uteri
58555 Hysteroscopy, dx, sep proc
58558 Hysteroscopy, biopsy
58559 Hysteroscopy, lysis
58560 Hysteroscopy, resect septum
58562 Hysteroscopy, remove fb
58565 Hysteroscopy, sterilization
Surgery/Female Genital System: Oviduct/Ovary
58670 Laparoscopy, tubal cautery
58671 Laparoscopy, tubal block
Surgery/Eye and Ocular Adnexa: Anterior Segment
66820 Incision, secondary cataract
66821 After cataract laser surgery
66830 Removal of lens lesion
66982 Cataract surgery, complex
66983 Remove cataract, insert lens
Denominator Codes:
SPECT MPI Codes
78464 – MPI, SPECT, Single, At Rest or Stress
78465 – MPI, SPECT, Multiple, At Rest and/or Stress
[Note for 2010 there are new SPECT MPI codes replacing 78464 and 78465. The new codes are 78451 and 78452.]
Stress Echocardiography Codes
93350, C8928 - Echocardiography, trans-thoracic, real time with image documentation, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress with interpretation and report
93351 (New for 2009) – including performance of continuous electrocardiographic monitoring with physician supervision
Stress MRI Codes
75559 – MRI with stress/imaging
75560 – MRI with flow/velocity/stress
75563 – MRI with stress imaging and dye
75564 – MRI with flow/velocity/stress and dye
Denominator Exclusion Codes:
None.
CPT® only copyright 2008 American Medical Association. All rights reserved.
Note that CMS contracted with The Lewin Group to develop this second set of imaging efficiency measures. The Lewin Group subcontracted with Dobson|DaVanzo, and National Imaging Associates to support this effort.