1^4 1989PROCEDURECODES FORPREVENTIVECARESERVICES YEAR1REPORT HCFAContract500-92-066 Preparedfor: FeatherDavis,ProjectOfficer OfficeofResearchandDemonstrations HealthCareFinancingAdministration 6325SecurityBoulevard OakMeadowsBuilding Baltimore,MD21207 Preparedby: LisaHerz NormaGavin MarilynEllwood KateSredl SysteMetrics ADivisionofTheMEDSTAT*Group 4401ConnecticutAvenue,N.W. Suite400 Washington.DC20008 REPORTS RA 445 May3,1994 A13 1994 TABLEOFCONTENTS Page I. CPT4,NATIONALHCPCSANDUB82 1 II. GEORGIASTATE-SPECIFICCODES 12 III. TENNESSEESTATE-SPECIFICCODES 15 IV. CAUFORNIASTATE-SPECIFICCODES 21 V. MICHIGANSTATE-SPECIFICCODES 33 ATTACHMENTA 40 1989PROCEDURECODESFORPREVENTIVECARESERVICES CPT4,NATIONALHCPCSANDUB82 9/14/93 A, PREVENTIVECAREVISITS 1. StandaloneCPT-4procedurecodes(donotrequireanaccompanyingpreventivecarediagnosis code) 90750 initial historyand examination relatedtothe healthyindividual, includinganticipatory guidance;adult(age18+) 90751 initial historyand examination relatedtothe healthyindividual, includinganticipatory guidance;adolescent(age12through17years) 90752 initial historyand examination relatedtothe healthy individual, includinganticipatory guidance;latechildhood(age5though11>c-:.-/ 90753 initial historyand examination related tothe healthyindividual, including anticipatory guidance;earlychildhood(age1through4years) 90754 initial historyand examination relatedtothe healthy individual, including anticipatory guidance;infant(ageunder1year) 90755 infantcaretooneyearofage,withamaximumof12officevisitsduringregularoffice hours,includingtuberculinskintestingandimmunizationofDTPandoralpolio 90757 newborncare,inotherthanhospitalsetting,includingphysicalexaminationofbabyand conference(s)withparent(s) 90760 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory guidance,periodictypeofexamination;adult(age18+) 90761 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory guidance,periodictypeofexamination;adolescent(age12through17years) 90762 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory guidance,periodictypeofexamination;latechildhood(age5through11years) 90763 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory guidance,periodictypeofexamination;earlychildhood(age1through4years) 90764 intervalhistoryandexaminationrelatedtothehealthyindividual, includinganticipatory guidance,periodictypeofexamination;infant(ageunder1year) 1 3 PREVENTIVECAREVISITS(Continued) CPT-4 procedure codesforgeneral office visitsthat must be present in combinationwith diagnosiscodesfromprimaryDXlook-uptableinordertobeflaggedasapreventivecarevisit. 90000 officemedicalservice,newpatient;briefservice 90010 officemedicalservice,newpatient;limitedservice 90015 officemedicalservice,newpatient;intermediateservice 90017 officemedicalservice,newpatient;extendedservice 90020 officemedicalservice,newpatient;comprehensiveservice 90030 officemedicalservice,establishedpatient;minimalservice 90040 officemedicalservice,establishedpatient;briefservice 90050 officemedicalservice,establishedpatient;Imitedservice 90060 officemedicalservice,establishedpatient;intermediateservice 90070 officemedicalservice,establishedpatient;extendedservice 90080 officemedicalservice,establishedpatient;comprehensiveservice NationalHCPCScodesforofficevisits(codebooksaysthesearepreventivecarevisitcodes. However,werequirethesecodestoappearincombinationwithpreventivecareICD-9-CMdiagnosis codesfromtheprimaryDXlook-uptable) M0005 officevisitswithtwoormoremodalitiesofthesamearea M0006 office visitswithoneoftheabovementionedtreatmentmodalities, eachadditional 15 minutes M0007 officevisitincludingcombinationofanymodality(s)andprocedure(s),initial30minutes M0008 officevisitincludingcombinationofanymodality(s)andprocedure(s),eachadditional15 minutes M0009 nototherwiseclassified,officevisits A, PREVENTIVECAREVISITS(Continued) 4. UB82revenuecodesforgeneralvisitsthatmustbepresentincombinationwithdiagnosiscodes fromtheprimaryDXlook-uptable. 510 clinic-generalclassification oiy clinic-otherclinic 520 freestandingclinic-generalclassification 521 freestandingclinic-ruralhealthclinic 523 freestandingclinic-familypractice 529 freestandingclinic-other 982 professionalfees-outpatientservices 983 professionalfees-clinic JL DEVELOPMENTALASSESSMENTSCREENING 1. CPT-4procedurecodesthatmustappearwithapreventivediagnosiscodefromtheprimaryDX look-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateofservice. 90774 Administrationandmedicalinterpretationofdevelopmentaltests 2. NationalHCPCScodes Noindividualcodeshere Q IMMUNIZATIONS-CLASSIC 1. cStoadnedfarloomnteheCPpTr-im4arpyroDcXedluoroke-ucpodtaebsle(NdoORnotacnceoemdpaannyacaccolmapiamnfyoirnagpprreevveennttiivveecacraerevidsiitagonnostihse samedateofservice.) 90701 DTP 90702 DT 90703 Tetanustoxoid 90704 mumps 90705 measles 90706 rubella 90707 MMR 3 C IMMUNIZATIONS-CLASSIC(Continued) 1. StandaloneCPT-4procedurecodes(donotneedanaccompanyingpreventivecarediagnosis codefromtheprimaryDXlook-uptableNORaccompanyaclaimforapreventivecarevisitonthe samedateofservice.) 90708 measlesandrubella 90709 rubellaandmumps 90712 oralpolio 90718 Td 90719 diphtheriatoxoid 90731 hepatitisB 90737 HemophilusinfluenzaB 2. StandaloneNationalHCPCScodesforimmunizations(donotneedtoappearincombinationwith diagnosiscodesfromtheprimaryDXlook-uptableNORaccompanyaclaimfcrapreventivecare visitonthesamedateofservice.) J1670 tetanusimmuneglobulin,human D, IMMUNIZATIONS-OTHER 1. cStoadnedfarloomnteheCPpTr-im4arpyroDcXedluoroke-ucpodtaebsle(NdoORnotacnceoemdpaannyacaccolmapiamnfyoirnagprperveevnetnitvievecacraerevidsiitagonnostihse samedateofservice.) 90713 poliomyelitis 90714 typhoid 90717 yellowfever 90724 influenzavirus 90725 cholera 90726 rabies 90727 plague 90728 BCG 90732 pneumococcal 90733 meningococcal 4 C JL IMMUNIZATIONS-OTHER(Continued) 1. cStoadnedfarloomnteheCPpTr-im4arpyroDcXedluoroke-ucpodtaebsle(NdoORnotacnceoemdpaannyacaccolmapiamnfyoirnagpprreevveennttiivevecacraerevidsiitagonnostihse samedateofservice.) 90741 ISG 90742 specifichyperimmuneserumglobin 90749 unlistedimmunizationprocedure 2. StandaloneNationalHCPCScodesforimmunizations(donotneedtoappearincombinationwith diagnosiscodesfromtheprimaryDXlook-uptableNORaccompanyaclaimforapreventivecare visitonthesamedateofservice.) J2750 rabies J6015 typhus J6025 cholera J6045 smallpox E HEARINGEXAM/SCREENING 1. CDPXTl-o4okp-ruopcteadbulreeOcRodaecscotmhaptamnuysatcalpapiemafrorinacoprmebviennattiivoencwairtehvdisiiatgonnostihsecsoadmesefdraotmetohfeseprrviimcae.ry 92506 medicalevaluationspeech,languageand/orhearingproblems 92551 screeningtest,puretone,aironly 92552 puretoneaudiometry(threshold);aironly 92553 puretoneaudiometry(threshold);airandbone 92557 basiccomprehensiveaudiometry 92560 Bekesyaudiometry;screening 2. NationalHCPCScodesthatmustappearincombinationwithdiagnosiscodesfromtheprimary DXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateofservice. V5000 audiometricexam-hearingexamincludingthemeasuringofhearingacuityandtests relatingtoairconduction, boneconduction, speech reception,thresholdandspeech discrimination 5 9 F. VISIONEXAM/SCREENING 1. CPT-4procedurecodes NoIndividualcodeshere-theseservicesaresupposedtobebundledintopreventivecarevisits 2. NationalHCPCScodes Noindividualcodeshere G HEMOGLOBIN/HEMATOCRIT 1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof service. 85014 hematocrit 85018 hemoglobin,colorimeu.~ 85021 hemogram,automated(RBC,WBC,Hgb,Hctandindicesonly) 85025 hemogram,andplateletcount,automated,andautomatedcompletedifferentialWBCcount (CBC) 85031 Bloodcount;hemogram,manual,completeCBC(RBC,WBC,Hgb,Hct,differentialand indices) 2. NationalHCPCScodes Noindividualcodeshere H. URINALYSIS 1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof service. 81000 urinalysis; routine(pH,specificgravity, protein,testsforreducingsubstancessuchas glucose),withmicroscopy 81002 urinalysis;routine,withoutmicroscopy NationalHCPCScodes Noindividualcodeshere 6 L TBTEST 1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof service. 86580 skintest;tuberculosis,intradermal 86585 skintest;tuberculosis,tinetest 2. NationalHCPCScodes Noindividualcodeshere J, SICKLECELL 1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof service. 83020 hemoglobin;electrophoresis(includesA2,S,C,etc) 83052 hemoglobin;sickle,turbidmetric 2. NationalHCPCScodes Noindividualcodeshere jC CHLAMYDIA/GCCULTURE 1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof service. 87072 cultureordirectbacterialidentificationmethod,eachorganism,bycommercialkit,any sourceexcepturine 87110 chlamydiaculture 2. NationalHCPCScodes Noindividualcodeshere 7 L PKU 1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe primaryDXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateof service. 84030 Phenylalanine(PKU),blood;Guthrie 84031 Phenylalanine(PKU),blood;fluorometric 2. NationalHCPCScodes Noindividualcodeshere NL PAPSMEAR 1. CPT-4procedurecodeswhichmustbepresentincombinationwithdiagnosiscodesfromthe primaryDXlook-uptableORaccompanyaclaimforapreveimvecarevisitonthesamedateof service. 88150 cytopat'ology, smears, cervical orvaginal (e.g., Papanicolaou), uptothreesmears; screeningbytechnicianunderphysiciansupervision 88151 cytopathology, smears, cervical orvaginal (e.g., Papanicolaou), uptothree smears; requiringinterpretationbyphysician 2. NationalHCPCScodes Noindividualcodeshere 3. UB82revenuecodeswhichmustbepresentincombinationwithdiagnosiscodesfromtheprimary DXlook-uptableORaccompanyaclaimforapreventivecarevisitonthesamedateofservice. 923 papsmear N, VDRL 1. CprPiTm-a4rypDrXocleodoukr-eupctoadbelseOwhRicahccmoumsptabneyparecsleanitmfionrcaompbrienvaetntiiovnewciatrhedviiasigtnoosnisthceosdeasmefrdoamtethoef service. 86592 Syphilistest;qualitative(EG.,VDRL,RPR,ART) 2. NationalHCPCScodes Noindividualcodeshere 8