MA Bulletin , Keystone Mercy Health Plan is implementing the following changes:

Transcription

1 September 1, 2006 Dear AmeriHealth Mercy Provider: Effective July 17, 2006, the Pennsylvania Department of Public Welfare (DPW) has end-dated several local procedure codes pertaining to services offered in Acute Care General Hospitals and Hospital-Based Medical Clinics. These local procedures codes were cross-walked by DPW to national procedure codes many of which are already listed on the Medical Assistance (MA) Program Fee Schedule. However, in some cases, the correlating national procedure code requires the addition of a pricing and/or informational modifier when billing the replacement national procedure code. modifiers should be placed in the 1 st modifier position, with informational modifiers placed in the subsequent position. Failure to use the appropriate national procedure code and modifier(s) combination will result in inappropriate claim payment or claim denial. Additionally, payment for the correlating national procedure code may be reimbursed at a higher or lower amount than its counterpart. As a result of the changes outlined by DPW in MA Bulletin , Keystone Mercy Health Plan is implementing the following changes: If your facility currently bills for services using any of the local codes appearing on Attachment A, you may continue to bill using the local procedure code for services rendered on or before September 30, When billing for services rendered on or after October 1, 2006, you will need to begin using the corresponding national procedure code along with any pricing or informational modifier as it appears on Attachment A. If you have any questions regarding this change in reimbursement, please contact your Provider Contracting Representative, or call Provider Services at (800) Thank you for your participation in our network and your commitment to AmeriHealth Mercy Health Plan members. Sincerely, Charles J. Russo Associate Vice President Provider & Community Affairs Attachment

2 Acute Care General Hospitals Hospital Based Medical Clinics to Procedure Cross Walk Definition Definition W0644 General medical exam, pre-admission assessment program T1015 U7 Clinic visit/encounter, all-inclusive W0663 Outpatient hospital physical therapy service(s) T1015 U8 GP Clinic visit/encounter, all-inclusive W0664 Outpatient hospital occupational service(s) T1015 U8 GO Clinic visit/encounter, all-inclusive W0665 Outpatient hospital speech therapy service(s) T1015 U8 GN Clinic visit/encounter, all-inclusive W0666 Outpatient hospital physical therapy service(s) T1015 U7 GP Clinic visit/encounter, all-inclusive W0667 Outpatient hospital occupational service(s) T1015 U7 GO Clinic visit/encounter, all-inclusive W0668 Outpatient hospital speech therapy service(s) T1015 U7 GN Clinic visit/encounter, all-inclusive W6013 Packed cells, per unit P9021 Red Blood Cells, each unit W6014 Platelets, per unit P9019 Platelets, each unit W9045 ER Support Services, Special Nonemergency services (Enrollment U5 patient, which requiresthese three components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. 1

3 to Procedure Cross Walk Definition Definition W9045 ER Support Services, Special Nonemergency services (Enrollment U5 Q6 patient, which requiresthese three components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. W9045 ER Support Services, Special Nonemergency services (Enrollment U5 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity 2

4 to Procedure Cross Walk Definition Definition W9045 ER Support Services, Special Nonemergency services (Enrollment U5 Q6 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity W9045 ER Support Services, Special Nonemergency services (Enrollment U5 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity 3

5 to Procedure Cross Walk Definition Definition W9045 ER Support Services, Special Nonemergency services (Enrollment U5 components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and require urgent evaluation by the physician but do not pose an immediate threat to life or physiologic function. W9045 ER Support Services, Special Nonemergency services (Enrollment U5 components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status; a comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose and immediate threat to life or physiologic funnction. 4

6 to Procedure Cross Walk Definition Definition W9046 ER Support Services, Basic, Nonemergency services U4 components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other provders or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. W9046 ER Support Services, Basic, Nonemergency services U4 Q6 components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other provders or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. 5

7 to Procedure Cross Walk Definition Definition W9046 ER Support Services, Basic, Nonemergency services U4 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. W9046 ER Support Services, Basic, Nonemergency services U4 Q6 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. 6

8 to Procedure Cross Walk Definition Definition W9046 ER Support Services, Basic, Nonemergency services U4 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. W9046 ER Support Services, Basic, Nonemergency services U4 components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and require urgent evalutation by the physician but do not pose an immediate significant threat to life or physiologic function. 7

9 to Procedure Cross Walk Definition Definition W9046 ER Support Services, Basic, Nonemergency services U4 components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate threat to life or physiologic function. W9047 ER Support Services, Special Emergency Services (Enrollment U5 components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. 8

10 to Procedure Cross Walk Definition Definition W9047 ER Support Services, Special Emergency Services (Enrollment U5 Q6 components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. W9047 ER Support Services, Special Emergency Services (Enrollment U5 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. 9

11 to Procedure Cross Walk Definition Definition W9047 ER Support Services, Special Emergency Services (Enrollment U5 Q6 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. W9047 ER Support Services, Special Emergency Services (Enrollment U5 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. 10

12 to Procedure Cross Walk Definition Definition W9047 ER Support Services, Special Emergency Services (Enrollment U5 components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and require urgent evalutation by the physician but do not pose an immediate significant threat to life or physiologic function. 11

13 to Procedure Cross Walk Definition Definition W9047 ER Support Services, Special Emergency Services (Enrollment U5 components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate threat to life or physiologic function. W9048 ER Support Services, Basic, Emergency Services U4 components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. 12

14 to Procedure Cross Walk Definition Definition W9048 ER Support Services, Basic, Emergency Services U4 Q6 components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. W9048 ER Support Services, Basic, Emergency Services U4 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. 13

15 to Procedure Cross Walk Definition Definition W9048 ER Support Services, Basic, Emergency Services U4 Q6 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. W9048 ER Support Services, Basic, Emergency Services U4 components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. 14

16 to Procedure Cross Walk Definition Definition W9048 ER Support Services, Basic, Emergency Services U4 components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and require urgent evalutation by the physician but do not pose an immediate significant threat to life or physiologic function. 15

17 W9048 Definition ER Support Services, Basic, Emergency Services Acute Care General Hospitals Hospital Based Medical Clinics to Procedure Cross Walk U4 Definition components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate threat to life or physiologic function. W9049 Hospital outpatient clinic visit (enrollment approval required) T1015 U5 Clinic visit/encounter, all-inclusive W9051 Basic hospital outpatient clinic visit T1015 U4 Clinic visit/encounter, all-inclusive W9064 Medical school clinic visit (enrollment T1015 U5 Clinic visit/encounter, all-inclusive approval required) W9254 Electronystagmography, complete W9416 Peak expiratory flow rate (PERF) W9564 Administration of Rho(D) Immune Globulin Spontaneous nystagmus test, including gaze and fixation mystagmus, with recording Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation Rho(D) immune globin (Rhlg), human, full-dose, for intramuscular use

18 W9564 W9564 W9591 W9592 W9593 Definition Administration of Rho(D) Immune Globulin Administration of Rho(D) Immune Globulin Electromyography, including nerve conduction velocites, one extremity and related para-spinal area Electromyography, including nerve conduction velocites, two extremities and related para-spinal area Electromyography, including nerve conduction velocites, three extremities and related para-spinal area Acute Care General Hospitals Hospital Based Medical Clinics to Procedure Cross Walk Definition Rho(D) immune globin (Rhlg), human, mini-dose, for intramuscular use Rho(D) immune globin (RhlgIV), human, for intravenous use Needle electromyography, one extremity with or without related paraspinal areas Needle electromyography, two extremities with or without related paraspinal areas Needle electromyography, three extremities with or without related paraspinal areas W9630 General medical examination T1015 U7 Clinic visit/encounter, all-inclusive W9633 W9640 W9640 W9640 W9640 Comprehensive medical examination by general practitioner when requested by the Department to determine eligibility Administration of Chemotherapy for malignant disease; perfusion Administration of Chemotherapy for malignant disease; perfusion Administration of Chemotherapy for malignant disease; perfusion Administration of Chemotherapy for malignant disease; perfusion T1015 U7 Clinic visit/encounter, all-inclusive Chemotherapy administration, intravenous; push technique Chemotherapy administration, intravenous; infusion technique, up to one hour Chemotherapy administration, intravenous; infusion technique, one to eight hours, each additional hour Chemotherapy administration, intravenous, infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump 17

19 to Procedure Cross Walk W9640 W9640 Definition Administration of Chemotherapy for malignant disease; perfusion Administration of Chemotherapy for malignant disease; perfusion Definition Chemotherapy administration, intraarterial; push technique Chemotherapy administration, intraarterial; infusion technique, up to one hour W9640 Administration of Chemotherapy for malignant disease; perfusion Chemotherapy administration, intraarterial; infusion technique, one to eight hours, each additional hour W9640 Administration of Chemotherapy for malignant disease; perfusion Chemotherapy administration, intraarterial; infusion technique, initiation of prolonged infusion (more than 8 hours) requiring the use of a portable or implantable pump W9715 W9871 W9872 Physical therapy, two or more modalities and/or two or more procedures; initial 30 minutes General Assistance Exception. Independent/Basic Hospital Clinic Visit General Assisatnce Exception, Hospital or Medical School Clinic Visit T1015 U7 GP Clinic visit/encounter, all-inclusive T1015 U7 SC Clinic visit/encounter, all-inclusive T1015 U8 SC Clinic visit/encounter, all-inclusive X1101 Debridement of Ulcer, foot; initial Debridement; skin, partial thickness X1101 Debridement of Ulcer, foot; initial Debridement; skin, full thickness X1101 Debridement of Ulcer, foot; initial Debridement; skin, subcutaneous tissue X1101 Debridement of Ulcer, foot; initial Debridement; skin, subcutaneous tissue and muscle X1101 Debridement of Ulcer, foot; initial Debridement; skin, subcutaneous tissue, muscle and bone 18

20 to Procedure Cross Walk Definition X1102 Debridement of Ulcer, foot; subsequent X1102 Debridement of Ulcer, foot; subsequent X1166 X1166 X1167 X1167 Debridement of hypertrophic nails; initial, multiple Debridement of hypertrophic nails; initial, multiple Debridement of hypertrophic nails; subsequent, multiple Debridement of hypertrophic nails; subsequent, multiple X1172 Avulsion of nail, partial, one nail X1172 Avulsion of nail, partial, one nail X1175 X1177 X1720 Excision of nail and nail matrix; partial, one nail Excision of nail and nail matrix; complete, one nail Plantar verruca or verrucae, removal by any method except excision, such as superficial cutting or paring, chemotherapy, etc; subsequent treatment T1-T9, TA, F1- F9, FA T1-T9, TA, F1- F9, FA T1-T9, TA, F1- F9, FA T1-T9, TA, F1- F9, FA Definition Debridement of extensive eczematous or infected skin; up to 10% of body surface Debridement of extensive eczematous or infected skin; each additional 10% of the body surface Debridement of nail(s) by any method(s); one to five Debridement of nail(s) by any method(s); six or more Debridement of nail(s) by any method(s); one to five Debridement of nail(s) by any method(s); six or more Avulsion of nail plate, partial or complete, simple; single Avulsion of nail plate, partial or complete, simple; single; each additional nail plate Exclusion of nail or nail matrix, partial or complete, (e.g. ingrown or deformed nail) for permanent removal Exclusion of nail or nail matrix, partial or complete, (e.g. ingrown or deformed nail) for permanent removal Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; first lesion 19

21 to Procedure Cross Walk Definition Definition X1720 Plantar verruca or verrucae, removal by any method except excision, such as superficial cutting or paring, chemotherapy, etc; subsequent treatment Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; second through 14 lesions, each (list separately in addition to code for first lesion) X1720 X3643 X5741 X5746 X5746 X5746 Plantar verruca or verrucae, removal by any method except excision, such as superficial cutting or paring, chemotherapy, etc; subsequent treatment Transfusion, blood or blood components; direct Gynecological examinationasymptomatic patient Intensive Colposcopic examination with biopsy and/or excision of lesion(s) Intensive Colposcopic examination with biopsy and/or excision of lesion(s) Intensive Colposcopic examination with biopsy and/or excision of lesion(s) Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (e.g., actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Transfusion, blood or blood components T1015 U7 Clinic visit/encounter, all-inclusive Colposcopy of the entire vagina, with cervix if present; with biopsy(s) 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 20

22 to Procedure Cross Walk X5746 Definition Intensive Colposcopic examination with biopsy and/or excision of lesion(s) Definition Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage X5746 Intensive Colposcopic examination with biopsy and/or excision of lesion(s) Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix X5746 Intensive Colposcopic examination with biopsy and/or excision of lesion(s) Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix Y7030 Y7202 Y7202 Y7202 Y7202 Y7202 Radiology diagnostic, both mandible and temporomandibular joints, panoramic views Radiologic examination, spine, three views, any level Radiologic examination, spine, three views, any level Radiologic examination, spine, three views, any level Radiologic examination, spine, three views, any level Radiologic examination, spine, three views, any level Radiologic examination, temporomandibular joint, open and closed mouth; bilateral Radiologic examination, spine, cervical; two or three views Radiologic examination, spine, cervical; minimum of four views Radiologic examination, spine, thoracic, three views Radiologic examination, spine, thoracic, minimum of four views Radiologic examination, spine, lumbosacral; two or three views Y7202 Radiologic examination, spine, three views, any level Radiologic examination, spine, lumbosacral; minimum of four views Y7202 Y7211 Radiologic examination, spine, three views, any level Radiologic diagnostic, lumbal spine and pelvis; complete lumbal spine with anteroposterior views of pelvis Radiologic examination, spine, lumbosacral, bending views only, minimum of four views Radiologic examination, spine, entire, survey study, anteroposterior and lateral Y7308 Radiologic examination, elbow, comprehensive, minimum of five views RT, LT 50 Radiologic examination, elbow, complete, minimum of three views 21

23 to Procedure Cross Walk Definition Definition Y7310 Radiologic examination, wrist; comprehensive, minimum of five views RT, LT 50 Radiologic examination, wrist, complete, minimum of three views Y7311 Y7311 Radiology diagnostic, hand and wrist; limited, fewer that three views Radiology diagnostic, hand and wrist; limited, fewer that three views RT, LT RT, LT 50 Radiologic examination, wrist; two views Radiologic examination, hand; two views Y7312 Radiology diagnostic, hand and wrist; complete, fewer that three views RT, LT 50 Radiologic examination, wrist; complete, minimum of three views Y7312 Radiology diagnostic, hand and wrist; complete, fewer that three views RT, LT 50 Radiologic examination, hand; complete, minimum of three views Y7322 Y7323 Magnetic Resonance (e.g., Proton) Imaging, upper extremity, other that joint with contrast material Magnetic Resonance Imaging, upper extremity, other that joint, without contrast materials, followed by contrast material RT, LT RT, LT 50 Magnetic resonance imaging, upper extremity, other that joint with contrast materials Magnetic resonance imaging, upper extremity, other that joint, without contrast materials and further sequencing Y7324 Magnetic Resonance (e.g., Proton) Imaging, any joint of upper extremity; with contrast material RT, LT 50 Magnetic resonance (e.g., proton) imaging, any joint of upper extremity; with contrast material(s) Y7325 Y7360 Y7419 Magnetic resonance imaging, any joint of upper extremity without contrast material, followed by contrast materials Radiologic examination, ankle; comprehensive, minimum of five views Magnetic resonance imaging, abdomen; without contrast material, followed by contrast material RT, LT RT, LT Magnetic resonance imaging, any joint of upper extremity without contrast material, followed by contrast material(s) and further sequences Radiologic examination, ankle, complete, minimum of 3 views Magnetic resonance imaging, abdomen; without contrast material, followed by contrast material(s) and further sequences 22

24 to Procedure Cross Walk Y7600 Definition Extended room time with periodic fluoroscopy (radiological guidance), per 30 minutes Z0832 Pregnancy Test Z0832 Pregnancy Test Z0832 Pregnancy Test Z2100 Z2101 Z2102 Z2103 Z2105 Alcohol (Ethanol), blood; quantitative (all methods) Alcohol(ethanol), urine; qualitative (all methods) Alcohol(ethanol), urine; quantitative (all methods) Drug screen (amphetamines, barbiturates, benzodiazepine, cocaine, methadone, methaqualone, opiates, phencyclidine (PCP), propoxyphene, THC (all methods) 1-5 Drug screen, fentanyl, fentanyl derivatives (all methods) Definition Fluoroscopy, physician time more than one hour, assisting a nonradiologic physician (e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy) Urine pregnancy test, by visual color comparison methods Gonadotropin, chronic (hcg); quantitative Gonadotropin, chronic (hcg); qualitative Alcohol (ethanol); any specimen except breath Alcohol (ethanol); any specimen except breath Alcohol (ethanol); any specimen except breath Drug screen, qualitative; multiple drug classes chromatographic method, each procedure Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class Z2106 Drug screen (amphetamines, barbiturates, benzodiazepine, cocaine, methadone, methaqualone, opiates, phencyclidine (PCP), propoxyphene, THC (all methods) Drug screen, qualitative; multiple drug classes chromatographic method, each procedure Z8020 AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio) Antibody; HTLV or HIV antibody, confirmatory test (e.g., Western Blot) 23

25 Z8020 Z8020 Z8020 Z8020 Z8020 Z8227 Definition AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio) AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio) AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio) AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio) AIDS Profile III - lymphocyte subset panel (includes Total B, Total T, T Subset, T Helper/T Suppressor Ratio) Blood; occult feces, screening - asymptomatic patient Acute Care General Hospitals Hospital Based Medical Clinics to Procedure Cross Walk Antibody; HIV Antibody; HIV Definition Anti-body; HIV-1 and HIV-2, single assay Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; HIV-1 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; HIV-2 Blood occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations Z8294 Glucose; 2 hour postprandial Glucose; quantitative, blood (except reagent strip) Z8309 Haldol (Haloperidol) Haloperidol Z8374 Ludiomil (Maprotiline) Quantitation of drug, not elsewhere Z8391 Norpace (Disopryamide) Z8503 Blood count, hemogram, manual, completed CBC (RBC, WBC, Hgb, Hct, Differential and Indicies) - Asymptomatic patient specified Quantitation of drug, not elsewhere specified Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 24

26 Z8503 Z8555 Z8555 Z8556 Z8556 Z8557 Z8557 Definition Blood count, hemogram, manual, completed CBC (RBC, WBC, Hgb, Hct, Differential and Indicies) - Asymptomatic patient Blood cont; hematocrit - asymptomatic patient Blood cont; hematocrit - asymptomatic patient Blood count; Hematocrit and Hemoglobin (Hct and Hgb) Blood count; Hematocrit and Hemoglobin (Hct and Hgb) - asymptomatic patient Blood count; Hematocrit and Hemoglobin (Hct and Hgb) Blood count; Hematocrit and Hemoglobin (Hct and Hgb) Acute Care General Hospitals Hospital Based Medical Clinics to Procedure Cross Walk Definition Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Blood count; hematocrit (Hct) Blood count; hematocrit (Hct) Z8604 Anti-Parietal AB Z8627 Z8627 Z8627 Z8631 Antibody; Epstein-Barr Virus (EBV), Complete Evaluation Antibody; Epstein-Barr Virus (EBV), Complete Evaluation Antibody; Epstein-Barr Virus (EBV), Complete Evaluation Immunoassay for Prostate Specific Antigen (PSA); Asymptomatic Patient Z8636 Mast Allergy Test; up to 5 antigens Z8637 Mast Allergy Test; 6 or more antigens Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Fluorescent noninfectious agent antibody; screen, each antibody Antibody; Epstein-Barr (EB) virus, early antigen (EA) Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA) Epstein-Barr (EB) virus, viral capsid (VCA) Prostate specific antigen (PSA); total Allergen specific IgE; quantitative or semiquantitative, each allergen Allergen specific IgE; quantitative or semiquantitative, each allergen Z8704 Campylobacter Culture, feces Antibody; campylobacter 25

27 to Procedure Cross Walk Z8708 Definition Culture, screening for organism including sensitivity study, sources other than blood Definition Culture, presumptive, pathogenic organisms, screening only Z8708 Culture, screening for organism including sensitivity study, sources other than blood Susceptibility studies, antimicrobial agent, agar, dilution method, per agent (e.g., antibiotic gradient strip) Z8708 Culture, screening for organism including sensitivity study, sources other than blood Susceptibility studies, antimicrobial agent, mycobacteria, proportion method, each agent Z8712 Culture, urine; quantitative, with colony count including sensitivity study, screening Culture, bacteria; quantitative colony count urine Z8712 Culture, urine; quantitative, with colony count including sensitivity study, screening Susceptibility studies, antimicrobial agent, agar, dilution method, per agent (e.g., antibiotic gradient strip) Z8712 Culture, urine; quantitative, with colony count including sensitivity study, screening Susceptibility studies, antimicrobial agent, mycobacteria, proportion method, each agent Z8713 Z8713 Culture urine; definitive and sensitivity study for specific microorganisms, with isolation of organism Culture urine; definitive and sensitivity study for specific microorganisms, with isolation of organism Culture, bacteria; quantitative colony count urine Culture, bacteria; with isolation and presumptive identification of isolates, urine 26