Treatment Category Inpatient Treatment Categories DRG (MS DRG) ICD9 [Hip & Knee Only]

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1 NCCT List of Procedures Treatment Category Inpatient Treatment Categories DRG (MS DRG) ICD9 [Hip & Knee Only] Bariatric Surgery - Laparoscopic Gastric Bypass DRG MS DRG Cardiac Angioplasty with Drug Eluting Stent DRG MS DRG Cardiac Defibrillator Implant without Cardiac DRG MS DRG Catheterization Coronary Bypass (CABG) without Cardiac DRG MS DRG Catheterization C-Section Delivery DRG-371, 391 MS DRG 766, 795 Vaginal Delivery DRG-373, 391 MS DRG 775, 795 Hip Replacement DRG-544 MS DRG , 8152 Hysterectomy DRG MS DRG Knee Replacement DRG-544 MS DRG Laminectomy - Inpatient DRG-500 MS DRG 491 Spinal Fusion (Anterior) DRG-520 MS DRG 473 Spinal Fusion (Posterior) DRG-498 MS DRG 460 Outpatient Treatment Categories Primary CPT Code Breast Biopsy Percutaneous with Imaging CPT Breast Biopsy with Device CPT Breast Lumpectomy CPT Hammertoe Correction CPT Bunionectomy CPT Shoulder Arthroscopy CPT Shoulder Arthroscopy with Rotator Cuff Repair CPT Knee Arthroscopy with Cartilage Repair CPT ACL Repair by Arthroscopy CPT Nasal/Sinus Corrective Surgery - Septoplasty CPT Nasal/Sinus Endoscopy - Sinus Surgery CPT Tonsillectomy and Adenectomy, under age 12 CPT Bariatric Surgery - Lap Band CPT Laparoscopic Gall Bladder Removal CPT Hernia Inguinal Repair 5 Years and Older CPT Lithotripsy - Fragmenting of Kidney Stones CPT

2 Bladder Repair For Incontinence (Sling) CPT Dilation & Curettage - D&C CPT Outpatient Treatment Categories Primary CPT Code Laparoscopic Removal of Ovaries and/or Fallopian CPT Tubes Laparoscopic Tubal Block or Tubal Ligation CPT Back Surgery - Laminectomy CPT Carpal Tunnel CPT Cataract Removal CPT Tympanostomy CPT Left Heart Catheterization CPT Diagnostic Outpatient Treatment Categories Primary CPT Code Upper GI Endoscopy CPT Upper GI Endoscopy with Biopsy CPT Colonoscopy with Biopsy CPT Screening Colonoscopy CPT Bronchoscopy CPT Urethra and Bladder Scope CPT Mammogram, one breast CPT Mammogram, both breasts CPT Mammogram, screening... CPT Analog Mammography (Avg cost of the above listed Total CPT Mammogram, screening... CPT - G Mammogram, one breast CPT - G Mammogram, both breasts CPT - G Digital Mammography (Average cost of the above listed Total CPT CT abdomen without dye CPT CT abdomen with dye CPT CT abdomen without and with dye CPT CT angiography abdomen without and with dye CPT CT Scan Abdomen (Avg cost for the above listed CPT Total

3 CT head/brain without dye CPT CT head/brain with dye CPT CT head/brain without and with dye CPT CT angiography, head... CPT CT Scan Head (Average cost for the above listed CPT Total CT angiography pelvis with dye CPT CT pelvis without dye CPT CT pelvis with dye CPT CT pelvis without and with dye CPT CT Scan Pelvis (Average cost for the above listed CPT Total MRI brain without dye CPT MRI brain with dye CPT MRI brain without and with dye CPT MRI brain without dye CPT MRI brain with dye CPT MRI brain without and with dye CPT MRI Brain (Averge cost for the above listed CPT Total MRI lower extremity with dye CPT MRI lower extremity without dye CPT MRI lwr extremity without and with dye CPT MRI Lower Limb (Avg cost for the above listed CPT Total MRI lumbar spine with dye CPT MRI lumbar spine without dye CPT MRI lumbar spine without and with dye CPT MRI neck spine with dye CPT MRI neck spine without dye CPT MRI neck spine without and with dye CPT MRI orbit/face/neck with dye CPT MRI orbit/face/neck without dye CPT MRI orbit/face/neck without and with dye CPT MRI Spine (Average cost for the above listed CPT Total

4 MRI upper extremity with dye CPT MRI upper extremity without dye CPT MRI upper extremity with dye CPT MRI Upper Limb (Average cost for the above listed CPT Total MRI lower extremity joint without contrast. CPT MRI lower extremity joint with contrast CPT MRI lower extremity joint without and with contrast CPT MRI Lower Limb with Joint (Average cost for the above Total listed CPT Bone Density study of spine or pelvis CPT Office Visits Treatment Primary CPT Code Chiropractic treatment, including consultation, Average cost per visit billed by the manipulation and therapy individual Doctor of Chiropractic Periodic comprehensive preventive medicine reevaluation and management of an individual Cytopathology, cervical or vaginal, collected in preservative fluid Periodic Well Woman GYN exam, Pap Test CPT CPT Short visit (low to moderate severity) CPT Moderate visit (moderate to high severity) CPT Long visit (high severity) CPT Physician Care Existing Short visit (low to moderate severity) CPT Moderate visit (moderate to high severity) CPT Long visit (high severity) CPT Physician Care New Patient Preventive checkup for a well child ages 1-11 CPT , 99383

5 Preventive checkup for a well child ages CPT Pediatric Well Visit

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