| COLORECTAL CANCER SCREENINGS |
| 45330-45339, G0104, G0106 |
Sigmoidoscopy, flexible; diagnostic ... |
- If the purpose of the test was preventive, the procedure is considered preventive even when polyps are removed.
- The claim system cannot tell if the purpose of the test was preventive or diagnostic. If the deductible is applied, send in the medical record indicating the purpose of the test and the claim will be reviewed and adjusted if appropriate.
- G codes are for Medicare members only.
|
| 45378-45385, G0105, G0120, G0121 |
Colonoscopy, flexible, proximal to splenic flexure; diagnostic ... |
- If the purpose of the test was preventive, the procedure is considered preventive even when polyps are removed.
- The claim system cannot tell if the purpose of the test was preventive or diagnostic. If the deductible is applied, send in the medical record indicating the purpose of the test and the claim will be reviewed and adjusted if appropriate.
- G codes are for Medicare members only.
|
| 74263 |
Computed tomographic (CT) colonography, screening, including image postprocessing |
Subject AIM authorization requirements. |
| 74270, 74280, G0106, G0120, G0122 |
Barium enema
74270: Radiologic examination, colon; barium enema, with or without KUB
74280: Air contrast with specific high-density barium, with or without glucagon |
|
| 99144 |
Moderate sedation services by same physician w/observer, age 5 years or older, first 30 min. |
Clinical edit: This line will deny as a subset due to clinical edit when billed with colonoscopy. |
| 99145 |
Moderate sedation services by same physician w/observer, age 5 years or older, each additional 15 min. |
Clinical edit: This line will deny as a subset due to clinical edit when billed with colonoscopy. |
| 00810 |
Anethesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum |
|
| RADIOLOGY |
| G0202 |
Screening mammography, producing direct digital image, bilateral, all views |
|
| G0204 |
Diagnostic mammography, producing direct digital image, bilateral, all views |
|
| G0206 |
Diagnostic mammography, producing direct digital image, unilateral, all views |
|
| 77051 |
Computer-aided detection, w/ or w/o digitization of radiographic images; screening mammogram (add-on code) |
|
| 77052 |
Computer-aided detection with further physician review for interpretation, with or without digitization of film radiographic images;screening mammography (add-on code) |
|
77055
|
Mammography; unilateral |
|
| 77056 |
Mammography; bilateral |
|
| 77057 |
Screening mammography, bilateral (two-view film study of each breast) |
|
| 75625, 93544 |
Aortography, abdominal, by serialography, radiological supervision and interpretation
Injection procedure during cardiac catheterization; for aortography |
Clinical test for men 65+ per Preventive Health Care Guidelines |
| LABS |
| 36415 |
Collection of venous blood by venipuncture |
|
| 80061 |
Lipid panel |
|
| 82465 |
Cholesterol, serum or whole blood total |
|
82270, 82274
|
Blood, occult |
|
| G0328 |
Colorectal cancer screening; fecal occult blood test |
Medicare only |
| 82947 |
Glucose quantitative, blood (except reagent strip) |
|
| 82948 |
Glucose quantitative, blood |
|
| 82950 |
Post glucose dose |
|
| 83655 |
Lead screening |
|
| 83718 |
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) |
|
| 83721 |
Direct measurement LDL cholesterol |
|
| 84478 |
Triglycerides |
|
| 85014 |
Hematocrit |
|
| 85018 |
Hemoglobin |
|
| 82025, 85027 |
Complete CBC |
|
| 86580 |
Tuberculin skin test |
|
| 86592 |
Syphilis test, non-treponemal antibody; qualitative (e.g., VDRL, RPR, ART) |
|
| 86701-86073 |
HIV |
|
| 86762 |
Rubella antibody (titer) |
|
| 87110, 87270, 87320, 87490-87492 |
Chlamydia |
|
| 87590-87592, 87802, 87810, 87850 |
Neisseria gonorrhoeae |
|
| 88141-88143, 88147-88155, 88164-88167, 88174-88175 |
Cytopathology ... cervical or vaginal |
|
| VACCINES |
| 90460-90461, 90471-90474 |
Immunization administration |
Use the corresponding diagnosis and CPT codes appropriate for members age.
Also see notes on Medicaid & Medicare patients under Vaccines. |
90644
|
Meningococcal confugate vaccine |
*Will verify FDA Approval prior to addition to preventive list. If no approval, will not add to list. |
| 90645-90648 |
Hebophilus influenza b vaccine |
Use the corresponding diagnosis and CPT codes. |
| 771 |
Vaccine administration |
For claims submitted on a UB92: This REV code must be billed with the correct procedure code. For Medicare patients: Follow the Medicare guidelines for immunizations |
| G0008 |
Administration of influenza virus vaccine |
Medicare only: Must be billed with REV code 771 |
G0009
|
Administration of pneumococcal vaccine |
Medicare only: Must be billed with REV code 771 |
| 90632-90636 |
Hepatitis A |
Use the corresponding diagnosis and CPT codes. |
| 90649-90650 |
HPV |
CPT 90650 for females only. Use the corresponding diagnosis and CPT codes. |
90655-90660
Q2035-Q2039 |
Influenza… |
Use the corresponding diagnosis and CPT codes.
Medicare patients: Utilize appropriate Q code effective 1/1/2011 in place of CPT 90658.
Also see Billing for flu shots in this manual. |
| 90669 |
Pneumococcal conjugate vaccine, polyvalent… |
Use the corresponding diagnosis and CPT codes. |
| 90680-90681 |
Rotavirus |
Use the corresponding diagnosis and CPT codes. |
| 90696 |
Diphtheria, tetanus toxoids, acellular pertussis, vaccine and poliovirus vaccine, inactivated (DTaP-IPV... |
Use the corresponding diagnosis and CPT codes. |
| 90698-90702 |
DTap,-Hib-IPV, STaP, DTP, DT… |
Use the corresponding diagnosis and CPT codes. |
| 90703 |
Tetanus... |
Use the corresponding diagnosis and CPT codes. |
| 90704-90710 |
Mumps, measles, rubella… |
Use the corresponding diagnosis and CPT codes. |
| 90712-90713 |
Poliovirus vaccine… |
Use the corresponding diagnosis and CPT codes. |
| 90714-90715 |
Td, Tdap… |
Use the corresponding diagnosis and CPT codes. |
| 90716 |
Varicella vaccine |
Use the corresponding diagnosis and CPT codes. |
| 90718-90723 |
Tetanus and diphtheria toxoids… |
Use the corresponding diagnosis and CPT codes. |
| 90732 |
Pneumoccoal polysaccharide vaccine… |
Use the corresponding diagnosis and CPT codes. |
| 90733-90734 |
Meningococcal polysaccharide vaccine |
Use the corresponding diagnosis and CPT codes. |
| 90736 |
Zoster (shingles) vaccine, live for subcutaneous injection |
Specific coverage as preventive for 60+ age group |
| 90740-90748 |
Hepatitis B vaccine… |
Use the corresponding diagnosis and CPT codes. |
| 636 |
Drugs requiring detailed coding |
For claims submitted on a UB92: This code must be billed with the corresponding CPT code. |
| PREVENTIVE MEDICINE |
| 99381-99387 |
New patient preventive visit ... |
|
| 99391-99397 |
Established patient preventive visit ... |
|
| 99460 |
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant |
|
| 99461 |
Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center |
|
| 99462 |
Subsequent hospital care, per day, for evaluation and management of normal newborn |
|
| 99463 |
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date |
|
| 92551 |
Screening test, pure tone, air only |
|
| 99173 |
Screening test of visual acuity, quantitative, bilateral |
|
| G0101 |
Cervical or vaginal cancer screening; pelvic and clinical breast examination |
Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services. |
| G1002 |
Prostate cancer screening; digital rectal examination |
Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services. |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
|
Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services. |
G0439
|
Annual wellness visit; includes a personalized prevention plan of service (pps), subsequent visit |
Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services. |
| Q0091 |
Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services. |
| PREVENTIVE COUNSELING |
| 96040 |
Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family |
|
| 97802 |
Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
|
| 97803 |
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
|
| 97804 |
Medical nutrition therapy; group (2 or more individuals), each 30 minutes |
|
| 99401-99404 |
Preventive medicine counseling |
|
| 99420 |
Administration and interpretation ... |
|
| 99406 |
Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes |
|
| 99407 |
Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes |
|
| G0436 |
Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes |
|
| G0437 |
Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes |
|
| G0442 |
Annual alcohol misuse screening, 15 mins |
Medicare members only. |
| G0443 |
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes |
Medicare members only. |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
Medicare members only. |
| G0449 |
Annual face-to-face obesity screening, 15 minutes |
Medicare members only. |
| 99408 |
Alcohol and/or substance (other than tobacco) structured screening (e.g., AUDIT, DAST) and brief intervention (SBI) services; 15 to 30 minutes |
|
| 99409 |
Alcohol and/or substance (other than tobacco) structured screening (e.g., AUDIT, DAST) and brief intervention (SBI) services; greater than 30 minutes |
|
| 99411-99412 |
Preventive medicine group counseling |
|
