FY 2016 BCCCNP Procedure Code Reference Chart

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1 77057 G G G0204 G0279 FY 2016 Procedure Reference Chart Screening mammography, bilateral (two view film study of each breast) Screening mammography producing direct digital image, bilateral, all views Digital Screening Breast Tomosynthesis (Bilateral) Mammography; unilateral Diagnostic mammography, producing direct digital image, unilateral, all views Mammography; bilateral Diagnostic mammography, producing direct digital image, bilateral, all views Digital Diagnostic Breast Tomosynthesis (Bilateral) Service Billable with ( Definition) Screening mammogram Two views of each breast Performed on an asymptomatic woman Digital screening mammogram Two views of each breast Performed on an asymptomatic woman Digital Screening Breast Tomosynthesis (Bilateral) Performed in conjunction with digital screening mammography Diagnostic mammogram Two or more views of one breast Performed on a symptomatic woman Digital diagnostic mammogram Two or more views of one breast Performed on a symptomatic woman Diagnostic mammogram Two or more views of each breast Performed on a symptomatic woman Digital diagnostic mammogram Two or more views of each breast Performed on a symptomatic woman Digital Screening Breast Tomosynthesis (Bilateral) Performed in conjunction with digital diagnostic mammography FY16 1

2 Procedure Reference Chart Cytopathology, cervical or vaginal (any reporting system); requiring interpretation by physician (List separately in addition to code for technical service) Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening, under physician supervision Service Billable with ( Definition) Pap test Laboratory professional services Use in conjunction with codes 88142, 88143, 88164, when physician interpretation of Pap test is required Thin Prep Pap test Laboratory technical services Manual screening Professional component indicated by when physician interpretation required Thin Prep Pap test - Rescreening Laboratory technical services Manual screening Professional component indicted by when physician interpretation required Conventional Pap test Laboratory technical services Professional component indicated by when physician interpretation required Conventional Pap test Rescreening Laboratory technical services Professional component indicated by when physician interpretation required Thin Prep Pap test Laboratory technical services Automated screening Thin Prep Pap test - Rescreening Laboratory technical services Automated screening with manual rescreening FY16 2

3 Procedure Reference Chart G0123 G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision. Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician. G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a problem focused history; a problem focused examination; and straight forward medical decision making. Counseling and/or coordination of care with other providers or agencies are and/or family s needs. Usually, the presenting problems are self limited or minor. Providers typically spend 10 minutes face-to-face with the patient and/or family. Service Billable with ( Definition) Thin Prep Pap test Laboratory technical services Automated screening Thin Prep Pap test Automated screening Professional component indicated by when physician interpretation required Thin Prep Pap test Laboratory technical services Automated screening with manual rescreening HPV typing of high-risk strain Partial annual clinical exam Either CBE only OR pelvic/pap only Symptomatic or diagnosed new patient FY16 3

4 Procedure Reference Chart Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and straight forward medical decision making. Counseling and/or coordination of care with other providers or agencies are and/or family s needs. Usually, the presenting problem(s) are of low to moderate severity. Providers typically spend 20 minutes face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are and/or family s needs. Usually the presenting problem(s) are of moderate severity. Providers typically spend 30 minutes face-to-face with the patient and/or family. Service Billable with ( Definition) Partial annual clinical exam Either CBE only OR pelvic/pap only Symptomatic or diagnosed new patient OR colposcopy office visit Symptomatic or diagnosed new patient FY16 4

5 Procedure Reference Chart Breast or Cervical Consultation Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are and/or family s needs. Usually the presenting problem(s) are of moderate to high severity. Providers typically spend 45 minutes face-to-face with the patient and/or family Breast or Cervical Consultation Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are and/or family s needs. Usually the presenting problem(s) are of moderate to high severity. Providers typically spend 60 minutes face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. Service Billable with ( Definition) Symptomatic or diagnosed new patient Symptomatic or diagnosed new patient Partial annual clinical exam Either CBE only OR pelvic/pap only (including repeat Paps) FY16 5

6 Procedure Reference Chart Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components: a problem focused history; a problem focused examination; straight forward medical decision making. Counseling and/or coordination of care with other providers or agencies are and/or family s needs. Usually, the presenting problem(s) are self limited or minor. Providers typically spend 10 minutes face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are and/or family s needs. Usually, the presenting problem(s) are of low to moderate severity. Providers typically spend 15 minutes face-to-face with the patient and/or family. Service Billable with ( Definition) Partial annual clinical exam Either CBE only OR pelvic/pap only (includes repeat Paps) Symptomatic or diagnosed established patient FY16 6

7 Procedure Reference Chart Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are and/or family s needs. Usually the presenting problem(s) are of moderate to high severity. Providers typically spend 25 minutes face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are and/or family s needs. Usually the presenting problem(s) are of moderate to high severity. Providers typically spend 40 minutes face-to-face with the patient and/or family Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunizations(s), laboratory/diagnostic procedures, new patient; years Service Billable with ( Definition) Symptomatic or diagnosed established patient Symptomatic or diagnosed established patient Cervical Consult on day of colposcopy FY16 7

8 Procedure Reference Chart Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunizations(s), laboratory/diagnostic procedures, new patient; years Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunizations(s), laboratory/diagnostic procedures, new patient; 65 years and over Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient; years Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient; years Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient; 65 years and over Service Billable with ( Definition) Asymptomatic new patient between the ages of 40 and 64 Asymptomatic new patient age 65 and older Cervical Consult on day of colposcopy Asymptomatic established patient between the ages of 40 and 64 CBE AND pelvic/pap(if due for Pap test) Asymptomatic established patient age 65 and older Urine pregnancy test Urine pregnancy test; with colposcopy Colposcopy of the cervix including upper/adjacent vagina Colposcopy Office visit billed separately FY16 8

9 Procedure Reference Chart Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage Endocervical curettage (not done as part of a dilation and curettage) Fine needle aspiration; without imaging guidance Fine needle aspiration; with imaging guidance Puncture aspiration of cyst of breast Service Billable with ( Definition) Colposcopy with biopsy of the cervix and endocervical curettage Office visit billed separately Colposcopy with biopsy of the cervix Office visit billed separately Colposcopy with endocervical curettage Office visit billed separately ECC Endocervical curettage Not part of D & C Fine needle aspiration of superficial breast tissue Not using imaging guidance Fine needle aspiration of superficial breast tissue Using imaging guidance Puncture aspiration, breast cyst FY16 9

10 Procedure Reference Chart Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure); (Use in conjunction with code 19000) Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance Each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19081) Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance Each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19083) Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance Each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19085) Service Billable with ( Definition) Puncture aspiration, breast cyst Each additional cyst Stereotactic localization placement of metallic clip during breast biopsy Stereotactic localization placement of metallic clip during breast biopsy Each additional lesion Ultrasonic guidance placement of metallic localization clip during breast biopsy Imaging supervision and interpretation Ultrasonic guidance placement of metallic localization clip during breast biopsy Imaging supervision and interpretation Each additional lesion Magnetic resonance guidance placement of metallic localization clip during breast biopsy Imaging supervision and interpretation Magnetic resonance guidance placement of metallic localization clip during breast biopsy Imaging supervision and interpretation Each additional lesion FY16 10

11 Procedure Reference Chart Biopsy of breast; percutaneous, needle core, not using imaging guidance Biopsy of breast; open, incisional Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion, open, male or female, one or more lesions Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure); (Use in conjunction with code 19125) Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance Each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19281) Service Billable with ( Definition) Breast biopsy, needle core Not using imaging guidance Breast biopsy, incisional Breast biopsy, excisional Breast biopsy, excision of single lesion identified by radiological marker Breast biopsy, excision of lesion identified by radiological marker Each additional lesion Mammographic localization guidance for needle placement Mammographic localization guidance for needle placement Each additional lesion FY16 11

12 Procedure Reference Chart Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance Each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19283) Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance Each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19285) Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance Each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) (Use in conjunction with 19287) Radiological examination, surgical specimen Service Billable with ( Definition) Stereotactic localization guidance for needle placement Stereotactic localization guidance for needle placement Each additional lesion Ultrasonic guidance of breast needle placement Imaging supervision and interpretation Ultrasonic guidance of breast needle placement Imaging supervision and interpretation Each additional lesion Magnetic resonance guidance for needle placement Magnetic resonance guidance for needle placement Each additional lesion Radiological examination, surgical specimen FY16 12

13 FY 2016 Procedure Reference Chart Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation Ultrasound, breast(s) (unilateral or bilateral), Complete exam, including axilla -Technical Component Ultrasound, breast(s) (unilateral or bilateral), Limited exam, including axilla -Technical Component Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation Level IV Surgical pathology, gross and microscopic examination; Breast, biopsy, not requiring microscopic evaluation of surgical margins; Cervix, biopsy Level V Surgical pathology; gross and microscopic examination; Breast, excision of lesion, requiring microscopic evaluation of surgical margins; Cervix, conization Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain -Technical component Service Billable with ( Definition) Magnetic resonance guidance for needle placement Breast ultrasound Breast ultrasound Ultrasonic guidance of breast needle placement Imaging supervision and interpretation Breast or cervical biopsy, laboratory evaluation of tissue sample Level IV Breast or cervical biopsy, laboratory evaluation of tissue sample Level V Immunohistochemistry or immunocytochemistry FY16 13

14 FY 2016 Procedure Reference Chart Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) -Technical component Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s) Cytopathology, evaluation of fine needle aspirate; interpretation and report Cytopathology, Selective Cellular Enhancement Technique with Interpretation (e.g. Liquid Based Slide Preparation Method), except Cervical or Vaginal **Cannot bill in conjunction with 88173** -Technical component G9012 Unlisted evaluation and management Patient Navigation Service Billable with ( Definition) Immunohistochemistry or immunocytochemistry Each additional specimen or stain Cytopathology, evaluation of fine needle aspirate to determine specimen adequacy Cytopathology, evaluation of fine needle aspirate Interpretation and report Cytopathology, Selective Cellular Enhancement Technique with Interpretation Interpretation and reports FY16 14

15 Procedure Reference Chart AA -AD -QK -QX -QY -QZ Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified -Anesthesia service performed personally by anesthesiologist -Medical supervision by a physician: more than four concurrent anesthesia procedures -Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals -CRNA service: with medical direction by a physician -Anesthesiologist medically directs one CRNA -CRNA service: (supervised) without medical direction by a physician Cone - Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser **Cannot bill in conjunction with Cone - Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser; loop electrode excision **Cannot bill in conjunction with Service Billable with ( Definition) Anesthesia CPT code used when billing for Breast biopsy, excisional (19120 or 19125) Anesthesia service performed personally by anesthesiologist Medical supervision by a physician: more than four concurrent anesthesia procedures Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals CRNA service: with medical direction by a physician Anesthesiologist medically directs one CRNA CRNA service: (supervised) without medical direction by a physician Cone - Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser Cannot bill in conjunction with Cone - Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser; loop electrode excision Cannot bill in conjunction with FY16 15

16 Procedure Reference Chart EMB - Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method **Cannot bill in conjunction with EMB - Endometrial sampling (biopsy) performed in conjunction with a colposcopy (List separately in addition to code for primary procedure ~ (Colposcopy 57452, 57454, 57455, 57456)) **Cannot bill in conjunction with LEEP - Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix **Cannot bill in conjunction with LEEP - Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix **Cannot bill in conjunction with MRI Breast, with and/or without contrast, Unilateral -Technical component MRI Breast, with and/or without contrast, Bilateral -Technical component Service Billable with ( Definition) EMB - Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method Cannot bill in conjunction with EMB - Endometrial sampling (biopsy) performed in conjunction with a colposcopy (List separately in addition to code for primary procedure ~ Colposcopy 57452, 57454, 57455, 57456)) Cannot bill in conjunction with LEEP - Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix Cannot bill in conjunction with LEEP - Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix Cannot bill in conjunction with MRI Breast, with and/or without contrast Unilateral MRI Breast, with and/or without contrast Bilateral FY16 16

17 Procedure Reference Chart Biopsy of Skin, Subcutaneous tissue and/or mucous membrane Excisional procedure: Breast nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct Ultrasound; Axilla -Technical component Mammary Ductogram or Galactogram, Single Duct, Radiological Supervision and Interpretation -Technical component Mammary Ductogram or Galactogram, Multiple Ducts, Radiological Supervision and Interpretation -Technical component Service Billable with ( Definition) Biopsy of Skin, Subcutaneous tissue and/or mucous membrane Excisional procedure: Breast nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct Ultrasound; Axilla Mammary Ductogram or Galactogram, Single Duct, Radiological Supervision and Interpretation Mammary Ductogram or Galactogram, Multiple Ducts, Radiological Supervision and Interpretation FY16 17

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