False; The correct code is 19083 (ultrasound guidance). For California members, note that the materials provided to you are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. What would be the correct CPT code assignment for the anesthesiologist's services? Effective Date: 12.01.2022 This policy addresses electroencephalographic (EEG) monitoring and video recording. Effective Date: 09.01.2022 This policy addresses liposuction for lipedema when used to treat functional impairment. Effective Date: 08.01.2022 This policy addresses observation services in a hospital setting. Effective Date: 09.01.2022 This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. The CO2 was desufflated. Effective Date: 05.01.2022 This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. The flexible endoscope was passed from the mouth into the esophagus and continued into the stomach and into the duodenal bulb. A physician draws blood to test for levels of T3 on a non-Medicare patient. Traction is the application of _____ force to hold a bone in alignment. At this point, I was notified that the patient's blood pressure was 150/80 and then dropped to 90/55. Effective Date: 09.01.2022 This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Effective Date: 06.01.2022 This policy addresses surgery of the shoulder. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 29830, 29834, 29837, 29838. Applicable Procedure Codes: E0953, E0955, E0956, E0957, E0960, E0966, E0992, E1028, E2231, E2291, E2292, E2293, E2294, E2601, E2602, E2603, E2604, E2605, E2606, E2607, E2608, E2609, E2610, E2611, E2612, E2613, E2614, E2615, E2616, E2617, E2619, E2620, E2621, E2622, E2623, E2624, E2625, K0108, K0669. Effective Date: 08.01.2022 This policy addresses the use of Entyvio (vedolizumab) for the treatment of Crohn's disease, ulcerative colitis, and immune checkpoint inhibitor-related toxicities. The physician documents an initial observation care visit with a detailed history, comprehensive examination with moderate medical decision-making. A surgeon performed a procedure that is unfamiliar to the coding professional, who is having trouble locating an appropriate CPT code. Effective Date: 07.01.2022 This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. There was erosion of the head of the fifth metatarsal consistent with osteomyelitis. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996. The result is an overpayment of $10.09. Do not submit protected health information using this form. Skilled Nursing Home Visit Date of service: 1/9/18 Last date of treatment: 12/22/17 Physician visits and elderly patient in the skilled care facility. Effective January 1, 2015, CMS established _____________ APCs to provide all-inclusive payments for certain procedures. Effective Date: 06.01.2022 This policy addresses cognitive rehabilitation and coma stimulation. The specimen was submitted to pathology for analysis. Applicable Procedure Codes: J1437, J1439, Q0138. Report only the treatment, not the x-ray or ED E/M service. Effective Date: 09.01.2022 This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Physician performs a detailed interval history, comprehensive examination, and medical decision making is of moderate complexity. CPT Codes: 58615 occlusion of fallopian tubes by device. Lateral meniscus is normal. The polyps were removed from the right cord up to the anterior commissure. The surgeon created a twist drill hole for evacuation of a subdural hematoma. Applicable Procedure Codes: 15877, 15878, 15879. The facility price for code 45380 is $211.55. Effective Date: 11.01.2022 This policy addresses certain specialty injectable drug products that are only covered under the pharmacy benefit, including growth hormones, insulin-like growth factors, interferon alpha, monoclonal antibodies, multiple sclerosis agents, osteoporosis treatments, and tumor necrosis factor (TNF) antagonists. This page was last edited 17:09, 16 June 2021 by, https://www.wikem.org/w/index.php?title=Coaptation_splint&oldid=307301, Assess distal pulses, motor, and sensation, While maintaining traction, apply padding and splint material (e.g. a traction splint or adjacent leg as a splint if the suspected fracture is above the knee. Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830. Effective Date: 06.01.2022 This policy addresses power mobility devices. Effective Date: 07.01.2022 This policy addresses the use of Amondys 45 (casimersen) for the treatment of Duchenne muscular dystrophy (DMD). This monthly journal offers comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery.Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral cancer, jaw reconstruction, anesthesia and analgesia.The journal also includes 1. Effective Date: 12.01.2022 This policy addresses intra-articular injections of sodium hyaluronate. Although he has been gargling with warm salt water, it was not helping. Effective Date: 06.01.2022 This policy addresses functional endoscopic sinus surgery (FESS). A patient is seen in a clinic for a laceration of the elbow. [2016] if they also have other prehospital triage indications for major trauma. The laryngeal mirror is inserted into the back of the mouth just above the uvula. Applicable Procedure Codes: E0769, G0281, G0282, G0295, G0329. The assignment of these two codes together would be referred to as: An asymmetric nevi, total excision size of 1.0 cm x 2.0 cm was removed from the patient's back. Effective Date: 05.01.2022 This policy addresses private duty nursing (PDN) services. They are also used to decide whether a given health service is medically necessary. The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports.Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of The patient had a laparoscopic incisional herniorrhaphy for a recurrent reducible hernia. Copyright 2022 Lineage Medical, Inc. All rights reserved. There were no complications. What is the correct CPT code assignment for the anesthesiologist's services? True or false: The following CPT code assignment (O03.4) is correct for this scenario? The wound required suturing. After this, copious irrigation was undertaken and bleeders were cauterized. Applicable Procedure Codes: 0232T, G0460, M0076, P9020. Applicable Procedure Code: J0567. What is the correct code assignment for tattooing of The patient was given a general oral endotracheal anesthetic with a small endotracheal tube. Incision was made from 2 cm above the pubic tubercle toward the anterior iliac spine and deepened to the external oblique. The lateral meniscus was partially detached and this portion was removed. Wound was closed. The result is an underpayment of $69.91. Applicable Procedure Codes: C9399, J3490, J3590. Effective Date: 07.01.2022 This policy addresses apheresis/therapeutic apheresis. Plantar fasciitis is defined as the traction degeneration of the plantar fascia at its origin on the heel. Operative Report Preoperative Diagnosis: Chronic laryngitis with polypoid disease Postoperative Diagnosis: Same Procedure: Laryngoscopy with removal of polyps After adequate premedication, the 60-year-old female patient was taken to the operating room and placed in supine position. The patient receives anesthesia for repair of cleft palate. Effective Date: 10.01.2022 This policy addresses the intravenous use of Skyrizi (risankizumab-rzaa) for the treatment of Crohns disease. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33418, 33419, 33477, 33999, 93799. This was done down to the desired site of the circumcision. Effective Date: 12.01.2022 This policy addresses multiple services/procedures. Effective Date: 07.01.2022 This policy addresses the use of inhaled nitric oxide (iNO) for treating term or near-term infants with hypoxic respiratory failure or echocardiographic evidence of persistent pulmonary hypertension of the newborn (PPHN). The subcutaneous tissue was very loosely reapproximated utilizing 4-0 Vicryl suture. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232. The patient has a transverse incision near where we are feeling this lump, which was over about the 11 o'clock position, high up in the superior aspect of the left breast. The risks and benefits of the procedure were explained in detail. Effective Date: 10.01.2022 This policy addresses occupational therapy and physical therapy evaluation and treatment services. The final diagnosis was acute pharyngitis (nonfacility price). If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120. The surgeon replaces the peripherally inserted central venous catheter (PICC) through same access. Effective Date: 04.01.2020 This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). I could not get the scope to any further. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990. Applicable Procedure Code: J3245. Effective Date: 06.01.2022 This policy addresses lower extremity vascular angiography and endovascular revascularization procedures. Effective Date: 07.01.2022 This policy addresses virtual upper gastrointestinal endoscopy. This Community Plan medical policy library does not apply to the following states; click the link to view the applicable Medical & Drug Policies and Coverage Determination Guidelines: ForLouisiana, clickhereto view MCG criteria for the top Outpatient procedures and Admission diagnoses. Examples of the most common NSAIDs include: aspirin salsalate (Amigesic), diflunisal (Dolobid), ibuprofen (Motrin), ketoprofen (Orudis), nabumetone (Relafen), piroxicam (Feldene), naproxen (Aleve, Naprosyn,) diclofenac (Voltaren), Research the description of the procedure. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676. Effective Date: 08.01.2022 This policy addresses the use of intensity-modulated radiation therapy (IMRT). Effective Date: 10.01.2022 This policy addresses the use of Ketalar (ketamine) for anesthesia purposes and Spravato (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Operative Report Preoperative Diagnosis: Abnormal uterine bleeding Postoperative Diagnosis: Same Procedure: Diagnostic hysteroscopy with D&C There was an approximately 8-mm polyp of the cervix. Applicable Procedure Code: J0491. Effective Date: 05.01.2022 This policy addresses the use of Crysvita (burosumab-twza) for the treatment of X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia (TIO). The physician performs a detailed history, comprehensive examination, and medical decision-making is of moderate complexity. What is the correct code assignment for a left cardiac catheterization performed with left ventriculography? Open reduction, ligament repair and fixation +/- carpal tunnel release short arm thumb spica splint converted to short arm cast at first post-op visit. Effective Date: 09.01.2022 This policy addresses the medical necessity of certain planned surgical procedures when performed in a hospital outpatient department. Applicable Procedure Codes: 0060U, 0327U, 81420, 81422, 81479, 81507. Effective Date: 12.01.2022 This policy addresses the use of Gamifant (emapalumab-lzsg) for the treatment of primary and secondary hemophagocytic lymphohistiocytosis (HLH). Applicable Procedure Codes: 27412, 27415, 27416, 28446, 29866, 29867, 29879, J7330, S2112. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941. The scope was removed. The patient tolerated the procedure well. The physician documented the diagnosis as calculus of the ureter. Effective Date: 10.01.2022 This policy addresses proton beam radiation therapy. Applicable Procedure Code: J9332. Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830. Treatment ranges from splint immobilization for certain extra-articular fractures to surgical fixation for displaced Bennett or Rolando fractures. Applicable Procedure Code: 37241. The patient was returned to the recovery room in stable condition. Effective Date: 06.01.2022 This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Additionally, UnitedHealthcare may use tools developed by third parties, such as the InterQual criteria, to assist us in administering health benefits. duration of casting varies, but at least 6 weeks. Effective Date: 09.01.2022 This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. False; 58120 is for a nonobstetric D&C. Effective Date: 12.01.2022 This policy addresses lysis intranasal synechia, repair of nasal vestibular stenosis or alar collapse, rhinoplasty, rhinophyma, nasal polypectomy, nasal septal swell body reduction and nasal implants. Effective Date: 10.01.2022 This policy addresses autologous chondrocyte transplantation (ACT), osteochondral autograft and allograft transplantation, microfracture repair of the knee, and focal articular cartilage repair. Effective Date: 11.01.2022 This policy addresses spinal fusion enhancement products. Effective Date: 12.01.2022 This policy addresses breast reconstruction post-mastectomy and for treatment of Poland's syndrome. Closed reduction of right radial shaft fracture. Applicable Procedure Codes: J1930, J2353, J2354, J2502. Effective Date: 05.01.2022 This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. From field to hospital: When applied, Sager Splint model SX404 is radiolucent to all areas of a femoral fracture. Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340. Patient tolerated the procedure well and was sent to recovery in satisfactory condition. Effective Date: 09.01.2022 This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Effective Date: 12.01.2022 This policy addresses the use of Luxturna (voretigene neparvovec-rzyl) for the treatment of inherited retinal dystrophies (IRD) caused by mutations in the retinal pigment epithelium-specific protein 65kDa (RPE65) gene. An established patient was seen in the physician's office for sore throat and fever. Effective Date: 09.01.2022 This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Codes: 99509, S5100, S5101, S5102, S5105, S5120, S5121, S5125, S5126, S5130, S5131, S5135, S5136, S5140, S5141, S5150, S5151, S5170, S5175, S9125, T1005, T1019, T1020. Applicable Procedure Codes: 0036U, 0094U, 0212U, 0213U, 0214U, 0215U, 0265U, 0335U, 0336U, 81415, 81416, 81417, 81425, 81426, 81427. Applicable Procedure Codes: 11981, 11982, 11983, J3490, J7999. The repair included insertion of mesh. Effective Date: 11.01.2022 This policy addresses intrauterine fetal surgery. Applicable Procedure Codes: A7025, A7026, E0481, E0483. Effective Date: 04.01.2022 This policy addresses the use of Parsabiv (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. Effective Date: 11.01.2022 This policy addresses the use of Ocrevus (ocrelizumab) for the treatment of multiple sclerosis. In younger people, these fractures typically occur during sports or a motor vehicle collision. Effective Date: 06.01.2022 This policy addresses occlusion therapy, pharmacologic penalization therapy, orthoptic or vision therapy, prism adaptation therapy, visual perception therapy, vision restoration therapy, and the use of visual information processing evaluations to diagnose reading or learning disabilities. a vacuum splint for all other suspected long bone fractures. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495. Effective Date: 11.01.2022 This policy addresses the maximum dosage per administration and dosing frequency for certain medications administered by a medical professional. Effective Date: 07.01.2022 This policy addresses Reblozyl (luspatercept-aamt) for the treatment of anemia in adult patients with beta thalassemia and symptomatic anemia in patients with myelodysplastic syndromes or myelodysplastic/myeloproliferative neoplasms. The fracture was reduced and the alignment was checked with imaging. Gargling with warm salt water is not helping. Applicable Procedure Code: J0896. The non-facility price is $45.77 for code 99212 versus $75.32 for code 99213. True or False? Effective Date: 06.01.2022 This policy addresses collection and storage of umbilical cord blood. Clinic Record Procedure: Laryngoscopy This 45-year-old patient is seen in the ENT clinic for a chronic sore throat. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017. Applicable Procedure Codes: J0222, J3490, J3590, C9399. Applicable Procedure Code: J9210. apply sugar tong splint. Applicable Procedure Codes: 74261, 74262, 74263. traction, and flexion of wrist. Which of the following services require the patient's age as a criterion for selection of E/M service? What is the correct CPT code assignment for this procedure? Effective Date: 06.01.2022 This policy addresses pediatric gait trainers, standing systems, and walkers. Need access to the UnitedHealthcare Provider Portal? Operative NotePreoperative Diagnosis: Painful left wristPostoperative Diagnosis: Closed distal radial fractureOperation: Closed reduction of left wristUnder satisfactory general anesthesia the patient was placed in supine position. General anesthetic was initiated. The non-facility price is $111.36 for code 12011 and it is $91.18 for code 12001. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017. The patient is seen by a primary care specialist in the Community Partnership for persistent cough and watery eyes. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140. Effective Date: 05.01.2020 This policy addresses computerized dynamic posturography (CDP) testing. The right-sided fluid sac was then exuded from the right hemiscrotum. Effective Date: 11.01.2022 This policy addresses surgical repair for treating athletic pubalgia. Warm the extremity and reassess pulses. Current indications for the best technique of pinning, the extent and duration of immobilisation are uncertain, thus the risk of complications likely outweighs the therapeutic benefits of pinning. Effective Date: 07.01.2022 This policy addresses the use of Exondys 51 (eteplirsen) for the treatment of Duchenne muscular dystrophy (DMD). Effective Date: 01.01.2022 This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems. Applicable Procedure Codes: 0254U, 81228, 81229, 81479. MCP Dislocations are a dislocation of the metacarpophalangeal joint, usually dorsal, caused by a fall and hyperextension of the MCP joint. Effective Date: 07.01.2022 This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Note: Your username may be different from the email address used to register your account. The patient's mouth is open wide and the tongue held down with a tongue depressor. Effective Date: 12.01.2022 This policy addresses hospital services for observation versus inpatient level of care. Applicable Procedure Codes: J9311, J9312, Q5115, Q5119, Q5123. If the procedure is performed bilaterally, modifier 50, bilateral procedure, should be appended. Applicable Procedure Codes: 99509, S5100, S5101, S5102, S5105, S5120, S5121, S5125, S5126, S5130, S5131, S5135, S5136, S5140, S5141, S5150, S5151, S5170, S5175, S9125, T1005, T1019, T1020. A physician states that an acoustic reflex test of the left ear was performed. Endoscope inserted orally and advanced to the duodenum. Applicable Procedure Codes: 19499, 20999, 27599, 32999, 53899, 55899, 61736, 61737, 64999. Effective Date: 11.01.2022 This policy addresses patient lifts. The toe was amputated and the entire specimen was sent to the pathology department. Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999. After the tissue was crushed it was divided and then the excess foreskin was removed. obtain radiographs including joint above and below fracture. Effective Date: 07.01.2022 This policy addresses the use of antiemetics for prevention of chemotherapy-induced nausea and vomiting associated with anticancer agents. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Cleveland Combined Hand Fellowship Lecture Series 2018-2019, Metacarpophalangeal Joint Deformity - John Delaney, MD, Open Reduction of an Irreducible MCP Dislocation - Dr David Tuckman. Effective Date: 10.01.2022 This policy addresses speech and language therapy (speech-language pathology services) for the treatment of disorders of speech, language, voice, communication, and auditory processing. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, E0770, E1399, K1016, K1017, K1020, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688. Benzoin and Steri-Strips and a pressure dressing were applied. Wound closed with #4-0 nylon and dressed. Effective Date: 11.01.2022 This policy addresses varicose vein ablative and stripping procedures and ligation procedures. Applicable Procedure Codes: 59072, 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411. What is the correct code assignment for percutaneous radiofrequency ablation of a neoplasm of the liver performed under CT guidance? Applicable Procedure Code: 82523. You can cancel anytime within the 30-day trial, or continue using Anesthesia Central to begin a 1-year subscription ($39.95). Effective Date: 11.01.2022 This policy addresses the use of intensity-modulated radiation therapy (IMRT). Effective Date: 05.01.2020 This policy addresses embolization of the ovarian or internal iliac veins. Effective Date: 06.01.2022 This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: 30117, 30120, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30468, 30560, 30999, 31237, L8699. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0569T, 0570T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33418, 33419, 33477, 33999, 93799. Applicable Procedure Codes: 0068U, 0330U, 0352U, 81513, 81514, 87480, 87481, 87482, 87510, 87511, 87512, 87660, 87661, 87797, 87798, 87799, 87800, 87801. What is the correct CPT code assignment from the Medicine chapter for IM injection of Leukine? Effective Date: 06.01.2022 This policy addresses orthognathic (jaw) surgery. Effective Date: 06.01.2022 This policy addresses fecal measurement of calprotectin. Applicable Procedures Codes: J0185, J1453, J1454, J1626, J1627, J2405, J2469, J8501, J8655, J8670, Q0162, Q0166. Applicable Procedure Codes: 30120, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30468, 30560, 30620, 31237. Effective Date: 06.01.2022 This policy addresses transpupillary thermotherapy. The appearance of a health service (e.g., test, drug, device or procedure) in the Medical Policy Update Bulletin does not imply that UnitedHealthcare provides coverage for the health service. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21198, 21209, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702. Effective Date: 09.01.2022 This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems. Effective Date: 08.01.2022 This policy addresses the use of Orencia (abatacept) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, chronic graft-versus-host disease, and immune checkpoint inhibitor-related toxicities. I could not find any gross pathologic changes. The physician performs a detailed history, expanded problem-focused examination and medical decision making is of moderate complexity. The scope was then carefully withdrawn. Effective Date: 05.01.2022 This policy addresses the use of Evkeeza (evinacumab-dgnb) for the treatment of homozygous familial hypercholesterolemia (HoFH). True or False? Effective Date: 09.01.2022 This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950. Effective Date: 03.01.2022 This policy addresses the use of compounded implantable drug pellets. This policy packages payment for all items and services typically packaged under the OPPS. True or false: The following CPT code assignment (S01.81XA) is correct for this scenario? Applicable Procedure Codes: 0422T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080. Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines, and Utilization Review Guidelines are the property of UnitedHealthcare. Applicable Procedure Codes: S9123, S9124. Effective Date: 09.01.2022 This policy addresses chemotherapy observation or overnight (inpatient) stay. Applicable Procedure Code: J0897. What is the correct code assignment for a direct laryngoscopy with tracheoscopy to determine the cause of chronic hoarseness in a 65-year-old patient? The correct code assignment for an extracapsular cataract extraction with insertion of lens, OS is 66984-LT. Applicable Procedure Codes: 90283, 90284, J0129, J0180, J0221, J0256, J0257, J1300, J1303, J1322, J1426, J1427, J1428, J1429, J1458, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1599, J1602, J1743, J1745, J1931, J2840, J3245, J3262, J3380, J3397, J3590, Q5103, Q5104, Q5121. Effective Date: 06.01.2022 This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Closed Reduction - In closed reduction, displaced radial fragments are repositioned using different manoeuvres while the arm is in traction. Applicable Procedure Codes: J3490, S0013. Effective Date: 11.01.2022 This policy addresses home hemodialysis (HHD). evaluation for traumatic arthrotomy of the knee. Applicable Procedure Code: J1302. Diagnosis: Dysphagia. Effective Date: 06.01.2022 This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Code: S9123, S9124, T1000, T1001, T1002, T1003, T1030, T1031. The patient received anesthesia for an open reduction of a fracture of the head of the tibia. Effective Date: 06.01.2022 This policy addresses manual wheelchairs. A small infraumbilical skin incision was made, carried down through the adipose tissue. Applicable Procedure Codes: J0881, J0882, J0885, J0887, J0888, Q4081, Q5105, Q5106.Effective Date: 03.01.2022 This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp (darbepoetin alfa), Epogen (epoetin alfa), Mircera (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit (epoetin alfa), and Retacrit (epoetin alfa). For the June 7, 2020 patient encounter, the hospital will electronically submit codes on what billing form? The payment rate and copayment calculated for an APC apply to each _______ within the APC. Treatment is closed reduction unless soft tissue interposition blocks reduction, in which case open reduction is indicated. Effective Date: 11.01.2022 This policy addresses functional endoscopic sinus surgery (FESS). Effective Date: 04.01.2022 This policy addresses occupational therapy and physical therapy evaluation and treatment services. Reference codes 11920 through 19222 for tattooing. Effective Date: 10.01.2022 This policy addresses pharmacogenetic multi-gene panel testing. Effective Date: 11.01.2022 This policy addresses hepatitis screening. Applicable Procedure Codes: 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235, 75710, 75716. Effective Date: 07.01.2022 This policy addresses implanted electrical stimulators for spinal cord. Applicable Procedure Codes: 0054T, 0055T, 20985. Effective Date: 11.01.2022 This policy addresses the use of Xolair (omalizumab) for subcutaneous use for the treatment of moderate to severe persistent asthma, chronic urticaria, and nasal polyps. If pulse is lost, release and reapply traction/splint. Effective Date: 11.01.2022 This policy addresses the use of Cabenuva (cabotegravir/rilpivirine) for the treatment of a human immunodeficiency virus type-1 (HIV-1) in patients who are virologically suppressed. Effective Date: 10.01.2022 This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp (darbepoetin alfa), Epogen (epoetin alfa), Mircera (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit (epoetin alfa), and Retacrit (epoetin alfa). Applicable Procedure Codes: J1786, J3060, J3385. Study with Quizlet and memorize flashcards containing terms like Reference codes 11200 and 11201 for removal of skin tags. She was then prepped and draped. Effective Date: 08.01.2022 This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. The allergist would identify this patient as: The physician documented the appropriate elements to report complex chronic care management services (99487-99489). Effective Date: 02.01.2022 This policy addresses bronchial thermoplasty. dorsal approach. If only one or the other is performed, then modifier 52, reduced services, should be appended to the code. Applicable Procedure Codes: 90283, 90284, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1599. It seems to be a right spermatocele. Under fluoroscopic guidance, the surgeon inserted a modular bifurcated endograft that extended into both iliac arteries (facility price).True or false: The following CPT code assignment (I71.4) is correct for this scenario? Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, S9432, S9433, S9434, S9435. False; The only code that should be reported is 45380. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599. Effective Date: 07.01.2022 This policy addresses balloon sinus ostial dilation. Applicable Procedure Code: J0638. Effective Date: 02.01.2022 This policy addresses transcutaneous electrical nerve stimulator (TENS), including supplies and conductive garments. The scaled relative weight for an APC measures the resource requirements of the service and is based on the _________ mean cost of services in that APC. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64633, 64634, 64722, 64744, 64771, 64999, K1023, L8679, L8680, L8685. The spermatocele was handed off intact to the scrubbed personnel. The correct code assignment is 80061. Effective Date: 09.01.2022 This policy addresses catheter ablation for atrial fibrillation. CPT codes: 11402 excision benign lesion. The remaining 40 percent is not adjusted. No tourniquet was utilized. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29822, 29823, 29824, 29825, 29826, 29827, 29828. Effective Date: 08.01.2022 This policy addresses outpatient hospital facility-based intravenous medication infusion. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400. Effective Date: 11.01.2022 This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183, 66184, 66185, 66989, 66991, C1889, L8612. The fascia was opened in the midline, and the peritoneal cavity under direct vision using laparoscopic technique. Shaving of 1.5 cm epidermal lesion, scalp. Applicable Procedure Code: J0879. Which of the following modifiers would be appended to a CPT code for repair of the right upper eyelid? Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017. Applicable Procedure Code: 19300. The hand was secured with traction. Effective Date: 04.01.2022 This policy addresses measurement of corneal hysteresis, measurement of ocular blood flow, and monitoring of intraocular pressure. Research the description about the procedure. Effective Date: 12.01.2022 This policy addresses the use of Leqvio (inclisiran) for the treatment of heterozygous familial hypercholesterolemia (HeFH) and clinical atherosclerotic cardiovascular disease (ASCVD). True or False? Abdomen deflated of gas and instruments removed. The knee joint was then examined in routine manner, the medial meniscus was intact. Neuropraxia of the radial nerve arises secondary to traction, swelling, or stiffness. Operative Report. Effective Date: 10.01.2022 This policy addresses pneumatic compression devices. Effective Date: 11.01.2022 This policy addresses the use of Trogarzo (ibalizumab-uiyk) for the treatment of multi-drug resistant human immunodeficiency virus (HIV). Operative Report. Effective Date: 09.01.2022 This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 93653, 93655, 93656, 93657. On the claim form, which of the following types of codes would be assigned to represent the laceration? Five months later, the patient sees an allergist in the same Community Partnership office. He was told to watch for any red streaks, swelling, pain or pus. Effective Date: 10.01.2022 This policy addresses molecular oncology testing for cancer indications, including breast cancer, thyroid cancer, hematological cancer, lung cancer and uveal melanoma. Effective Date: 06.01.2022 This policy addresses hysterectomy. Applicable Procedure Codes: A4636, A4637, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158, E0159, E0637, E0638, E0641, E0642, E8000, E8001, E8002. The external oblique was closed with 2-0 running chromic. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29822, 29823, 29824, 29825, 29826, 29827, 29828. Effective Date: 12.01.2022 This policy addresses autologous cellular therapy. Patient is seen by her primary care physician for headaches. Applicable Procedure Codes: 0278T, 0720T, 63650, 63655, 63663, 63664, 63685, 64555, 64566, 64999, A4556, A4557, A4558, A4595, A4630, E0720, E0730, E0731, E0744, E0745, E0762, E0764, E0770, E1399, K1023, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131. What is the correct CPT code assignment for hysteroscopy with lysis of intrauterine adhesions? The patient left the Procedure Room in stable condition. Steps to getting contracted plus plan information, Phone numbers and links for connecting with us, List of contracted, high-quality independent lab providers, Update, verify and attest to your practice's demographic data, Provider search for doctors, clinics and facilities, plus dental and behavioral health, Policies for most plan types, plus protocols, guidelines and credentialing information, Specifically for Commercial and Medicare Advantage (MA) products, Pharmacy resources, tools, and references, Updates and getting started with our range of tools and programs, Reports and programs for operational efficiency and member support, Resources and support to prepare for and deliver care by telehealth, Tools, references and guides for supporting your practice, Log in for our suite of tools to assist you in caring for your patients. Effective Date: 10.01.2022 This policy addresses the use of intravenous (IV) and subcutaneous (SC) immune globulin (IG) products. The InterQual criteria are proprietary to Change Healthcareand are not published on this website. Effective Date: 12.01.2022 This policy addresses private duty nursing services. Effective Date: 11.01.2022 This policy addresses manipulation under anesthesia (MUA). Specimen: meniscus. CPT code 00172 is reported. Effective Date: 01.01.2022 This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Sharp uterine curette was introduced and the uterine cavity systematically curetted with minimal amount of tissue. There's more to see -- the rest of this topic is available only to subscribers. Applicable Procedures Codes: 96372, 96401, J0717. A transverse incision across the right hemiscrotum was then made approximately 3.5 cm in length using electrocautery to further dissect this area. Incision and drainage of carbuncle on left hip is performed. Effective Date: 04.01.2022 This policy addresses speech and language therapy (speech-language pathology services) for the treatment of disorders of speech, language, voice, communication, and auditory processing. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146. Indications. Effective Date: 09.01.2022 This policy addresses electrical stimulation and electromagnetic therapy for ulcers or wounds. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400. In older people, the most common cause is falling on an outstretched hand. Applicable Procedure Codes: 63650, 63655, 63685, 63688, C1767, C1778, C1816, C1820, C1822, C1823, C1883, C1897, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695. The payment represents the expected ____ of a day of intensive and structured outpatient mental health care in a partial hospitalization program provided in the hospital or in a CMHC. Applicable Procedure Code: J1428. Which of the following procedures can be identified as destruction of lesions? Applicable Procedure Codes: J0739, J0741. Effective Date: 01.01.2022 This policy addresses skilled care and custodial care services. Effective Date: 10.01.2022 This policy addresses whole exome and whole genome sequencing. The radiologist provides only the supervision and interpretation of a hysterosalpingography. Applicable Procedure Codes: 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T,0436T, 0466T, 0467T, 0468T, 21199, 21206, 21685, 41512, 41530, 41599, 42145, 42299, 64553, 64568, 64569, 64570, E0485, E0486, K1001, K1027, L8679, L8680, L8686, S2080, S2900. If everything listed in code 95922 is not performed, the code is reported with modifier 52. Effective Date: 06.01.2022 This policy addresses wheelchair options and accessories. Effective Date: 06.01.2022 This policy addresses measurement of corneal hysteresis, measurement of ocular blood flow, and monitoring of intraocular pressure. Physician excised a 2.0-cm lesion (basal cell carcinoma) from the patient's left arm. Operative Report Preoperative Diagnosis: Osteomyelitis, fifth metatarsal, left Postoperative Diagnosis: Same Procedure: Amputation of toe The patient was brought to the operating room and placed in supine position. Effective Date: 06.01.2022 This policy addresses speech and language therapy (speech-language pathology services) for the treatment of disorders of speech, language, voice, communication, and auditory processing. The remainder of the endocervix was unremarkable. What is the correct code assignment for electrophysiologic evaluation of dual-chamber transvenous pacing cardioverter-defibrillator? The correct code assignment for a Gross and microscopic examination of a wedge biopsy of the lung is 88305. When these policies are used to determine medical necessity, clinical guidelines will be applied in the following order: By clicking "I Agree," you agree to be bound by the terms and conditions expressed herein, in addition to our Site Use Agreement. An incision was made along the upper arm over the 2.0 cm lipoma, which was deep in the subfascia. Effective Date: 07.01.2022 This policy addresses breast reconstruction post-mastectomy and for treatment of Poland syndrome. Utilization Review Guidelines apply clinical practice guidelines to determine whether the health care services provided or planned for an individual member are the most appropriate and cost-effective services under the specific circumstances. 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