Version 1
An episode of care, also known as an episode, groups all relevant services provided to a patient for a particular condition within a confined time range. An episode of care serves as a unit of accounting as well as a unit of accountability for providers who take on financial risk for the episode. Defining an episode in such a manner helps to identify sources of variation and to standardize care.
An episode of care for Colonoscopy, sometimes abbreviated COLOS, is a procedural episode. The Colonoscopy episode includes services related to the procedure such as a facility stay, anesthesia services, as well as services within the 3-day pre- and 14-day post-operative care time window, such as diagnostic services, (imaging, labs etc.), office visits, and ancillary services.
Episode Components
| Triggers | A Colonoscopy episode is triggered by an outpatient facility or a professional claim with a procedure trigger code (in any position) and a qualifying diagnosis code (in any position) on the same claim. (Table 1) |
| Typical Diagnosis | Typical diagnosis codes (ICD 10 DX codes) indicate typical care. Claims with typical diagnosis codes usually associated with an episode help steer services into this episode. However, a relevant procedure code is required on the same claim/claim line for the indicated diagnosis code to be incorporated into the episode. (Table 2) |
| Actionable adverse events (AAE) | Actionable adverse events (AAE) are events that are recognized by diagnosis codes (ICD 10 DX codes) and their timing to indicate potential complications of care. They require a relevant procedure code (ICD 10 PX codes; CPT/HCPCS codes) on the same claim/claim line to assign the claim to the episode. Additional rules are used to identify AAEs in addition to the presence of AAE diagnosis codes. For example, relevant acute inpatient readmission claims are flagged as actionable adverse events regardless of the presence of AAE codes. (Table 3) |
| Relevant Procedure Codes | All relevant services within the timeframe of an episode are included within an episode. These include office visits, emergency room visits, inpatient professional or facility services, labs, radiology or ancillary services. Relevant diagnosis and procedure codes help identify which services are included. Some procedure codes are sufficient to stand alone, while others require typical or actionable adverse event (AAE) diagnosis codes on the same claim/claim line to steer services into the episode. (Tables 4 and 5) |
| Relevant Pharmacy | All relevant pharmacy services are included within an episode. These are identified by National Drug Codes (NDC) on a pharmacy claim and are grouped using the RxNorm grouping classification for ease of assigning them into episodes. (Table 6) |
| SubTypes | Episode subtypes are used to adjust the target price and/or to subset episode type for reporting purposes. They are specific to the episode and identified from the trigger claim or from claims during the look-back period. Examples of Subtype Groups: Colonoscopy with BiopsyPolypectomyPartial ColectomyColonoscopyCancer of ColonCancer of Rectum and AnusCancer of Other GI Organs |
Code Tables
Table 1: Trigger Codes
| Trigger Type | Code Value |
| CPT / HCPCS Triggers | 44388, 44389, 44392, 44394, 44403, 44404, 45330, 45331, 45333, 45335, 45338, 45378, 45380, 45381, 45384, 45385, 45390, G0104, G0105, G0106, G0120, G0121, G0122, G9936, G9937 |
| ICD-10-CM (DX) Qualifying Diagnosis | A047, C180, C181, C182, C183, C184, C185, C186, C187, C188, C189, C19, C20, C210, C211, C212, C218, C260, C269, C457, C459, C463, C464, C467, C469, C758, C759, C762, C763, C768, C772, C775, C778, C779, C784, C785, C786, C787, C7880, C7889, C7989, C799, C7A00, C7A020, C7A021, C7A022, C7A023, C7A024, C7A025, C7A026, C7A029, C7A096, C7A098, C7A1, C7A8, C7B00, C7B01, C7B02, C7B04, C7B09, C7B8, C800, C801, C960, C962, C96A, D010, D011, D012, D013, D0140, D0149, D017, D019, D093, D098, D099, D120, D121, D122, D123, D124, D125, D126, D127, D128, D129, D139, D175, D1771, D1803, D191, D200, D201, D371, D372, D373, D374, D375, D378, D379, D3A010, D3A011, D3A012, D3A019, D3A020, D3A021, D3A022, D3A023, D3A024, D3A025, D3A026, D3A029, D3A095, D3A096, D438, D439, D440, D442, D449, D483, D484, D487, D489, D490, D4989, D499, K5000, K50011, K50012, K50013, K50014, K50018, K50019, K5010, K50111, K50112, K50113, K50114, K50118, K50119, K5080, K50811, K50812, K50813, K50814, K50818, K50819, K5090, K50911, K50912, K50913, K50914, K50918, K50919, K5100, K51011, K51012, K51013, K51014, K51018, K51019, K5120, K51211, K51212, K51213, K51214, K51218, K51219, K5130, K51311, K51312, K51313, K51314, K51318, K51319, K5140, K51411, K51412, K51413, K51414, K51418, K51419, K5150, K51511, K51512, K51513, K51514, K51518, K51519, K5180, K51811, K51812, K51813, K51814, K51818, K51819, K5190, K51911, K51912, K51913, K51914, K51918, K51919, K520, K521, K522, K5221, K5222, K5229, K523, K5281, K5282, K52831, K52832, K52838, K52839, K5289, K529, K55031, K55032, K55039, K55041, K55042, K55049, K5520, K560, K561, K562, K567, K5700, K5701, K5710, K5712, K5713, K5720, K5721, K5730, K5732, K5733, K5740, K5741, K5750, K5752, K5753, K5780, K5781, K5790, K5792, K5793, K580, K581, K582, K588, K589, K5900, K5901, K5902, K5903, K5904, K591, K592, K593, K5931, K5939, K598, K599, K625, K6282, K635, K900, K901, K902, K904, K9041, K9049, K9089, K909, K911, K913, K9181, K921, K922, K9400, K9401, K9402, K9403, K9409, K9410, K9411, K9412, K9413, K9419, Q412, Q418, Q419, Q420, Q421, Q422, Q423, Q428, Q429, Q430, Q431, Q432, Q433, Q434, Q435, Q436, Q437, Q438, Q439, Q458, Q459, Q8500, Q8501, Q8502, Q8503, Q8509, R1113, R180, R85610, R85611, R85612, R85613, R85614, R85615, R85616, R85618, R85619, R8581, R8582, Z1210, Z1211, Z1212, Z1213, Z1279, Z1289, Z432, Z433, Z434, Z800, Z8371, Z8379, Z8500, Z8501, Z85020, Z85028, Z85030, Z85038, Z85040, Z85048, Z85060, Z85068, Z8507, Z8509, Z85110, Z85230, Z85520, Z85821, Z85831, Z8589, Z859, Z86010, Z8719, Z87738, Z932, Z933, Z934, Z980 |
| ICD-10-PCS (PX) Triggers | 0DBE7ZX, 0DBE8ZX, 0DBH8ZZ, 0DBK8ZZ, 0DBM8ZZ, 0DBN8ZZ, 0DJD4ZZ, 0DJD7ZZ, 0DJD8ZZ |
Table 2: ICD-10 Typical Diagnosis
| Group ID | Group Name | Code Value |
| DXX05297 | Hypotension / Syncope | I9589 |
| DXX05345 | Orthostatic Hypotension / Dizziness | I950, I951, R42 |
| DXX0607 | ID – other bacterial | A213, A222 |
| DXX06157 | GI – food poisoning | A054, A055 |
| DXX06158 | GI – gastroenteritis – bacterial | A0220, A0225, A0229, A045, A046 |
| DXX06160 | Gastroenteritis | A080, A0811, A0819, A082, A0831, A0832, A0839, A084, A088, A09, K5289, K529 |
| DXX06161 | GI – gastroenteritis – protozoal | A073, A074, A078, A079 |
| DXX06162 | GI – diarrhea | R197 |
| DXX06173 | GI – peritoneal ds – nec / nos | K668, K669 |
| DXX06187 | Hemorrhoids | K640, K641, K642, K643, K648, K649 |
| DXX06189 | GI – hemorrhoids – nos | K645 |
| DXX06190 | GI – hemorrhoids – residual tags | K644 |
| DXX06204 | GI – constipation | R150 |
| DXX06206 | GI – abdominal pain | R1012, R1032 |
| DXX06207 | GI – flatulence / gas pain | R140, R141, R142, R143 |
| DXX06208 | GI – symptoms – nec / nos | R194, R198 |
| DXX06211 | GI – abnormal bowel sounds | R1911, R1912, R1915 |
| DXX06212 | GI – visible peristalsis | R192 |
| DXX06213 | GI – abnormal feces | R195 |
| DXX06214 | GI – abdominal tenderness | R10812, R10822 |
| DXX06216 | GI – abdominal mass | R1902, R1904 |
| DXX06218 | GI – abnormal abdominal imaging study | R935 |
| DXX06219 | GI – abnormal gi imaging study | R933 |
| DXX06221 | GI – personal hx of GI disease | Z8719 |
| DXX06222 | GI – family hx of GI disease | Z8379 |
| DXX06267 | Nausea, vomiting | R110, R1110, R1111, R1112, R112 |
| DXX06274 | Intestinal infection | A029, A030, A031, A032, A033, A038, A039, A040, A041, A042, A043, A044, A048, A049, A050, A051, A052, A053, A058, A059, A070 |
| DXX06276 | Anal and rectal conditions | K594, R151, R152, R159 |
| DXX06277 | Irritable Bowel and other functional GI disor | K580, K581, K582, K588, K589, K5900, K5901, K5902, K5903, K5904, K591, K598, K599, K634, K6389, K639, K9289, K929 |
| DXX06281 | Diverticulitis, colitis | K5221, K5222, K5282, K5712, K5732, K5752, K5792 |
| DXX06283 | Intestinal Malabsorption, Celiac Disease | K900, K901, K902, K904, K9041, K9049, K9089, K909 |
| DXX06285 | Previous bowel surgery, ostomy status | Z432, Z433, Z434, Z4651, Z4659, Z932, Z933, Z934, Z980 |
| DXX06286 | Personal history of GI cancer | Z8500, Z8501, Z85028, Z85038, Z85048, Z85068, Z8507, Z8509 |
| DXX06287 | Hx of colon polyps, family Hx of colon cancer | Z800, Z8371, Z86010 |
| DXX06288 | Cancer of colon | C180, C181, C182, C183, C184, C185, C186, C187, C188, C189, C260, C7A020, C7A021, C7A022, C7A023, C7A024, C7A025, C7A029 |
| DXX06290 | Cancer of other GI organs; peritoneum | C269, D0140, D0149, D017, D019 |
| DXX06291 | Cancer of rectum and anus | C19, C20, C210, C211, C212, C218, C7A026, R85610, R85611, R85612, R85613, R85614, R85619 |
| DXX06295 | Digestive congenital anomalies | Q434, Q435, Q436, Q437, Q438, Q439, Q458, Q459, Z87738 |
| DXX06297 | Cancer in situ, Colon | D010 |
| DXX06298 | Cancer in situ, Anorectal | D011, D012, D013 |
| DXX06306 | GI Bleed | K625, K921, K922 |
| DXX06307 | Intestinal Obstruction | K560, K561, K562, K565, K5660, K5669, K567, R1113 |
| DXX06311 | Vascular Insufficiency of intestine | K550, K55011, K55012, K55019, K55021, K55022, K55029, K55031, K55031, K55032, K55032, K55039, K55039, K55041, K55041, K55042, K55042, K55049, K55049, K55051, K55052, K55059, K55061, K55062, K55069, K551, K5530, K5531, K5532, K5533, K558, K559 |
| DXX06314 | Digestive system complications | K592, K593, K5931, K5939 |
| DXX06315 | Fistula GI tract | K632 |
| DXX06316 | Achalasia, Esophageal Spasm, Stricture, Dysphagia | R1310 |
| DXX06326 | Diverticulosis, Meckel’s diverticulum, Angiodyspalsia | K5710, K5711, K5730, K5731, K5750, K5751, K5790, K5791, Q430 |
| DXX06332 | Dysphagia | R130, R1311, R1312, R1313, R1314, R1319 |
| DXX06335 | Retroperitoneal Abscess | K689 |
| DXX06336 | Diverticulitis with hemorrhage | K5701, K5713, K5721, K5733, K5741, K5753, K5781, K5793 |
| DXX06337 | Toxic Gastroenteritis | K521 |
| DXX06340 | GI inflammation from chemotherapy | K9281 |
| DXX06341 | Crohn’s Disease | K5000, K5010, K5080, K5090 |
| DXX06342 | Ulcerative Colitis | K5100, K5120, K5130, K5150, K5180, K5190 |
| DXX06348 | Ulceration of Intestine | K633 |
| DXX06349 | Angiodysplasia of intestine | K5520, K5521, K6381 |
| DXX06351 | Pseudopolyposis of colon | K5140, K51411, K51418, K51419 |
| DXX06353 | Perforation, Peritonitis, Abd Abscess | R188, R1930, R1931, R1932, R1933, R1934, R1935, R1936, R1937 |
| DXX06354 | Perianal disease | K600, K601, K602, K603, K604, K605, K610, K611, K612, K613, K614, K620, K621, K624, K626, K627, K6281, K6289, K629 |
| DXX06355 | Rectal Prolapse | K622, K623 |
| DXX06356 | Nonspecific Gastroenteritis | K523, K52831, K52832, K52838, K52839 |
| DXX06364 | Heartburn | R12 |
| DXX06365 | Abdominal pain | R100, R1010, R1011, R102, R1030, R1031, R1033, R1084, R109 |
| DXX06366 | Abdominal mass | R1900, R1901, R1903, R1905, R1906, R1907, R1909 |
| DXX06367 | Abdominal tenderness | R10811, R10813, R10814, R10815, R10816, R10817, R10819, R10821, R10823, R10824, R10825, R10826, R10827, R10829 |
| DXX06368 | Benign Carcinoid Tumor of the GI tract | D120, D121, D122, D123, D124, D125, D126, D127, D128, D129, D139, D191, D200, D201, D3A010, D3A011, D3A012, D3A019, D3A020, D3A021, D3A022, D3A023, D3A024, D3A025, D3A026, D3A029, D3A095, D3A096, K635 |
| DXX06370 | Crohn’s Disease w Fistula | K50013, K50113, K50813, K50913 |
| DXX06371 | Crohn’s Disease w Abscess | K50014, K50114, K50814, K50914 |
| DXX06372 | Ulc Colitis w Obstruction | K51012, K51212, K51312, K51412, K51512, K51812, K51912 |
| DXX06373 | Ulc Colitis w Fistula | K51013, K51213, K51313, K51413, K51513, K51813, K51913 |
| DXX06374 | Ulc Colitis w Abscess | K51014, K51214, K51314, K51414, K51514, K51814, K51914 |
| DXX06375 | Allergic, Dietetic, Eosinophilic Gastroenteritis | K522, K5229, K5281 |
| DXX06376 | Diverticulitis w Perf, Abscess | K5700, K5720, K5740, K5780 |
| DXX06381 | Ulcerative colitis w rectal bleeding | K51011, K51211, K51311, K51511, K51811, K51911 |
| DXX06382 | Ulcerative colitis w other complications | K51018, K51019, K51218, K51219, K51318, K51319, K51518, K51519, K51818, K51819, K51918, K51919 |
| DXX06383 | Crohn’s disease w rectal bleeding | K50011, K50111, K50811, K50911 |
| DXX06384 | Crohn’s disease w other complications | K50018, K50019, K50118, K50119, K50818, K50819, K50918, K50919 |
| DXX06394 | Premalignancy anus/rectum | K6282, R85618, R8582 |
| DXX06395 | Post GI Surgery Syndromes | K911 |
| DXX06396 | Crohn’s disease w intestinal obstruction | K50012, K50112, K50812, K50912 |
| DXX0647 | Neoplsm – hemangioma – gi – nos | D1803 |
| DXX0648 | Neoplsm – lipoma – gi – nos | D175, D1771 |
| DXX0656 | Neoplsm – gi – premalignant – anus / rectum | R85615, R85616, R8581 |
| DXX0657 | Neoplsm – screening – small intestine | Z1213 |
| DXX0658 | Neoplsm – screening – colon – nos | Z1211 |
| DXX0659 | Neoplsm – screening – rectum | Z1212 |
| DXX0660 | Neoplsm – screening – gi – nos | Z1210 |
| DXX10120 | Thyroid Cancer | D093, D440 |
| DXX13108 | Postop adhesions | K660, N994 |
| DXX1583 | Congenital GI Problems in NB | Q412, Q418, Q419, Q420, Q421, Q422, Q423, Q428, Q429, Q431, Q432, Q433 |
| DXX16239 | Blood – anemia due to esrd | D631 |
| DXX16240 | Blood – anemia due to cancer / rx | D630 |
| DXX16242 | Blood – other anemia | D640, D641, D642, D643 |
| DXX16289 | Prvn – screening – other | Z130 |
| DXX16293 | Iron deficiency and other anemias | D500, D501, D508, D509, D638, D644, D6489, D649 |
| DXX16297 | Bone Marrow Suppression | D6481 |
| DXX1763 | Neoplsm – screening – nos | Z1279, Z1289 |
| DXX1767 | Cancer; other and unspecified primary | C457, C459, C762, C763, C768, C7A00, C7A096, C7A098, C7B00, C7B09, C7B8, C801 |
| DXX1768 | Secondary malignancies | C772, C775, C778, C779, C785, C786, C787, C7880, C7889, C7989, C799, C7B01, C7B02, C7B04, R180 |
| DXX1771 | Metastatic Cancer and Acute Leukemia | C784 |
| DXX1772 | Neoplasms of unspecified nature or uncertain behavior | D098, D099, D371, D372, D373, D374, D375, D378, D379, D438, D439, D442, D449, D483, D484, D487, D489, D490, D4989, D499, Q8500, Q8501, Q8502, Q8503, Q8509 |
| DXX1773 | Disseminated Metastatic Cancer | C800 |
| DXX1774 | Neuroendocrine, Myeloproliferative Cancers | C463, C464, C467, C469, C758, C759, C7A1, C7A8, C960, C962, C96A |
| DXX1854 | Parasitic Infections: Amebiasis, Giardiasis | A060, A061, A062, A063, A067, A0681, A0682, A0689, A069, A071 |
| DXX1963 | Anxiety Disorders | F064 |
| DXX2104 | NS – acute pain – post op | G8918 |
| DXX2159 | Toxic Effects of Radiation | K520 |
| DXX2332 | Sxs – symptoms -other | R6889 |
| DXX2370 | Fever & Chills | R5081, R509, R6883 |
| DXX2385 | Personal history of cancer | Z85020, Z85030, Z85040, Z85060, Z85110, Z85230, Z85520, Z85821, Z85831, Z8589, Z859 |
Table 3: ICD-10 Actionable Adverse Events
| Group ID | Group Name | Code Value |
| DXX01384 | Hemorrhagic Stroke | I60, I600, I6000, I6001, I6002, I601, I6010, I6011, I6012, I602, I6020, I6021, I6022, I603, I6030, I6031, I6032, I604, I605, I6050, I6051, I6052, I606, I607, I608, I609, I610, I611, I612, I613, I614, I615, I616, I618, I619, I6200, I6201, I6202, I6203, I621, I629 |
| DXX01385 | Thromboembolic Stroke | I6300, I63011, I63012, I63013, I63019, I6302, I63031, I63032, I63033, I63039, I6309, I6310, I63111, I63112, I63113, I63119, I6312, I63131, I63132, I63133, I63139, I6319, I6320, I63211, I63212, I63213, I63219, I6322, I63231, I63232, I63233, I63239, I6329, I6330, I63311, I63312, I63313, I63319, I63321, I63322, I63323, I63329, I63331, I63332, I63333, I63339, I63341, I63342, I63343, I63349, I6339, I6340, I63411, I63412, I63413, I63419, I63421, I63422, I63423, I63429, I63431, I63432, I63433, I63439, I63441, I63442, I63443, I63449, I6349, I6350, I63511, I63512, I63513, I63519, I63521, I63522, I63523, I63529, I63531, I63532, I63533, I63539, I63541, I63542, I63543, I63549, I6359, I636, I638, I639 |
| DXX01388 | Transient cerebral ischemia, TIA | G450, G451, G452, G458, G459, G460, G461, G462, I67841, I67848 |
| DXX01391 | Meningitis / Encephalitis | G038 |
| DXX01392 | Delirium, Encephalopathy | F05, G92, G9340, G9341, G9349, I6783 |
| DXX04126 | other lung complications | J90, J940, J941, J942, J949, J954, J955, J95859, J9588, R091 |
| DXX04127 | empyema, lung abscess | J869 |
| DXX04130 | Aspiration Pneumonia | J690, J691, J698 |
| DXX04138 | Viral Pneumonia | B012, J120, J122, J123, J1289, J129 |
| DXX04142 | Respiratory Failure | J80, J9584, J9600, J9601, J9602, J9610, J9611, J9612, J9620, J9621, J9622, J9690, J9691, J9692, R092 |
| DXX04154 | Respiratory Insufficiency | R0681, R0901, R0902, Y654, Z9981 |
| DXX04164 | Chronic Fungal and Other Pneumonias | A70, B390, B391, B392, B440, B7781 |
| DXX04170 | Ventilator Associated Pnuemonia | J95851 |
| DXX04172 | Gram Negative Pneumonia | J155, J156 |
| DXX04173 | MRSA Pneumonia | J15212 |
| DXX04174 | Other Staph Pneumonia | J1520, J15211, J1529 |
| DXX04176 | Resp Failure following trauma / surgery | J951, J952, J953, J95821, J95822 |
| DXX04177 | Ventilator Dependence | Z9911, Z9912 |
| DXX04187 | Other lung problems | J918, J9811, J9819, R063 |
| DXX04188 | Other Bacterial Pneumonia | J158, J159, J17, J188, J189 |
| DXX04189 | Debilitating Viral Pneumonia | J09X1 |
| DXX04190 | Influenza with Pneumonia | J1000, J1001, J1008, J1100, J1108 |
| DXX05272 | dic, coagulation, hemorrhagic disorders | D65, D7582 |
| DXX05274 | Transfusion, Infusion related complications | D6951, E8771, R5084, T8029XA, T8030XA, T80310A, T80311A, T80319A, T8039XA, T8040XA, T80410A, T80411A, T80419A, T8049XA, T8051XA, T8059XA, T8061XA, T8069XA, T80818A, T8089XA, T8090XA, T80910A, T80911A, T80919A, T8092XA, T80A0XA, T80A10A, T80A11A, T80A19A, T80A9XA, Y620, Y621, Y623, Y630, Y631, Y640, Y650, Y651 |
| DXX05275 | Phlebitis, Deep vein thrombosis (DVT) | I8000, I8001, I8002, I8003, I8010, I8011, I8012, I8013, I80201, I80202, I80203, I80209, I80211, I80212, I80213, I80219, I80221, I80222, I80223, I80229, I80231, I80232, I80233, I80239, I80291, I80292, I80293, I80299, I803, I809, I821, I82401, I82402, I82403, I82409, I82411, I82412, I82413, I82419, I82421, I82422, I82423, I82429, I82431, I82432, I82433, I82439, I82441, I82442, I82443, I82449, I82491, I82492, I82493, I82499, I824Y1, I824Y2, I824Y3, I824Y9, I824Z1, I824Z2, I824Z3, I824Z9, I82811, I82812, I82813, I82819, I82890, I8290, I87001, I87002, I87003, I87009, I87011, I87012, I87013, I87019, I87021, I87022, I87023, I87029, I87031, I87032, I87033, I87039, I87091, I87092, I87093, I87099 |
| DXX05281 | STEMI | I2101, I2102, I2109, I2111, I2119, I2121, I2129, I213 |
| DXX05289 | Subendocardial infarct | I214 |
| DXX05291 | Recent AMI | I220, I221, I222, I228, I229 |
| DXX05297 | Hypotension / Syncope | I952, I9581, I959, R55 |
| DXX05298 | Fluid Electrolyte Acid Base Problems | E8330, E8339, E8340, E8341, E8342, E8349, E870, E871, E872, E873, E874, E875, E876, E8770, E8779, E878 |
| DXX05299 | Shock / Cardiac Arrest | I462, I468, I469, I4901, I4902, R570, R571, R578, R579, T782XXA, T882XXA, T886XXA |
| DXX05308 | Pulmonary Embolism | I2690, I2692, I2699 |
| DXX05309 | IVC & other intra-abd venous thrombosis | I82220, I82221, I823 |
| DXX05311 | Other Phlebitis, Lymphangitis, varices | I808, I891 |
| DXX05320 | Atrial Flutter / Fibrillation | I480, I481, I482, I483, I484, I4891, I4892 |
| DXX05335 | Sinus Node Dysfunction | I498, R001 |
| DXX05336 | Supraventricular Tachyarrhythmias | I471, I492 |
| DXX05339 | Ventricular Arrhythmias | I470, I472 |
| DXX05340 | Other cardiac arrhythmias | I479, I499, R000, R002 |
| DXX05342 | Acute cor pulmonale | I2601, I2602, I2609 |
| DXX05367 | Hypertensive Urgency | I160, I161, I169 |
| DXX05375 | Dehydration | E860, E861, E869 |
| DXX06305 | C-Difficile Infection | A047 |
| DXX06314 | Digestive system complications | K913, K9181, K9182, K9183 |
| DXX06335 | Retroperitoneal Abscess | K6812, K6819 |
| DXX06338 | Complications of colostomy, enterostomy | K9400, K9401, K9402, K9403, K9409, K9410, K9411, K9412, K9413, K9419 |
| DXX06352 | Hemoperitoneum | K661 |
| DXX06353 | Perforation, Peritonitis, Abd Abscess | K630, K631, K650, K651, K658, K659, N733 |
| DXX09192 | Dermatitis, Urticaria | T7841XA |
| DXX11143 | Urinary Tract Infection | N10, N110, N111, N118, N119, N12, N136, N151, N159, N16, N2884, N2885, N2886, N3000, N3001, N3010, N3011, N3020, N3021, N3030, N3031, N3080, N3081, N3090, N3091, N340, N341, N342, N343, N35111, N35112, N35113, N35114, N35119, N3512, N37, N390, R309 |
| DXX11145 | Urinary Complications | N99520, N99521, N99522, N99523, N99524, N99528, N99530, N99531, N99532, N99533, N99534, N99538, N9981, N9989 |
| DXX11167 | Acute Kidney Failure | N170, N171, N172, N178, N179, N19, N990 |
| DXX16296 | Hemorrhage | R58, R710 |
| DXX1846 | Opportunistic Infections | B3781, B395, B399, B488 |
| DXX1849 | Other bacterial infections | R899 |
| DXX1850 | MRSA, Drug Resistant Infections | A4902, B9562, Z1610, Z1611, Z1612, Z1619, Z1620, Z1621, Z1622, Z1623, Z1624, Z1629, Z1630, Z1631, Z1632, Z1633, Z16341, Z16342, Z1635, Z1639 |
| DXX1851 | Sepsis | A392, A394, A400, A401, A403, A408, A409, A4101, A4102, A411, A412, A413, A414, A4150, A4151, A4152, A4153, A4159, A4181, A4189, A419, A5486, B007, B377 |
| DXX1852 | Severe Sepsis | A483, R6511, R6520, R6521 |
| DXX1853 | Bacteremia, SIRS, no organ dysfunction | R6510, R7881 |
| DXX19103 | Altered mental status | F060, F062, R400, R401 |
| DXX2161 | Complications from Central Line | T80218A, T80219A, T8022XA |
| DXX2171 | Adverse effects of drugs | G4440, G4441, K1232, R502, T360X5A, T360X5D, T361X5A, T361X5D, T362X5A, T362X5D, T363X5A, T363X5D, T364X5A, T364X5D, T365X5A, T365X5D, T366X5A, T366X5D, T367X5A, T367X5D, T368X5A, T368X5D, T3695XA, T3695XD, T370X5A, T370X5D, T371X5A, T371X5D, T372X5A, T372X5D, T373X5A, T373X5D, T374X5A, T374X5D, T375X5A, T375X5D, T378X5A, T378X5D, T3795XA, T3795XD, T380X5A, T380X5D, T381X5A, T381X5D, T382X5A, T382X5D, T383X5A, T383X5D, T384X5A, T384X5D, T385X5A, T385X5D, T386X5A, T386X5D, T387X5A, T387X5D, T38805A, T38805D, T38815A, T38815D, T38895A, T38895D, T38905A, T38905D, T38995A, T38995D, T39015A, T39015D, T39095A, T39095D, T391X5A, T391X5D, T392X5A, T392X5D, T39315A, T39315D, T39395A, T39395D, T394X5A, T394X5D, T398X5A, T398X5D, T3995XA, T3995XD, T400X5A, T400X5D, T402X5A, T402X5D, T403X5A, T403X5D, T404X5A, T404X5D, T40605A, T40605D, T40695A, T40695D, T407X5A, T407X5D, T40905A, T40905D, T40995A, T40995D, T415X5A, T415X5D, T420X5A, T420X5D, T421X5A, T421X5D, T422X5A, T422X5D, T423X5A, T423X5D, T424X5A, T424X5D, T425X5A, T425X5D, T426X5A, T426X5D, T4275XA, T4275XD, T428X5A, T428X5D, T43015A, T43015D, T43025A, T43025D, T431X5A, T431X5D, T43205A, T43205D, T43215A, T43215D, T43225A, T43225D, T43295A, T43295D, T433X5A, T433X5D, T434X5A, T434X5D, T43505A, T43505D, T43595A, T43595D, T43605A, T43605D, T43615A, T43615D, T43625A, T43625D, T43635A, T43635D, T43695A, T43695D, T438X5A, T438X5D, T4395XA, T4395XD, T440X5A, T440X5D, T441X5A, T441X5D, T442X5A, T442X5D, T443X5A, T443X5D, T444X5A, T444X5D, T445X5A, T445X5D, T446X5A, T446X5D, T447X5A, T447X5D, T448X5A, T448X5D, T44905A, T44905D, T44995A, T44995D, T450X5A, T450X5D, T451X5A, T451X5D, T452X5A, T452X5D, T453X5A, T453X5D, T454X5A, T454X5D, T45515A, T45515D, T45525A, T45525D, T45605A, T45605D, T45615A, T45615D, T45625A, T45625D, T45695A, T45695D, T457X5A, T457X5D, T458X5A, T458X5D, T4595XA, T4595XD, T460X5A, T460X5D, T461X5A, T461X5D, T462X5A, T462X5D, T463X5A, T463X5D, T464X5A, T464X5D, T465X5A, T465X5D, T466X5A, T466X5D, T467X5A, T467X5D, T468X5A, T468X5D, T46905A, T46905D, T46995A, T46995D, T470X5A, T470X5D, T471X5A, T471X5D, T472X5A, T472X5D, T473X5A, T473X5D, T474X5A, T474X5D, T475X5A, T475X5D, T476X5A, T476X5D, T477X5A, T477X5D, T478X5A, T478X5D, T4795XA, T4795XD, T480X5A, T480X5D, T481X5A, T481X5D, T48205A, T48205D, T48295A, T48295D, T483X5A, T483X5D, T484X5A, T484X5D, T485X5A, T485X5D, T486X5A, T486X5D, T48905A, T48905D, T48995A, T48995D, T490X5A, T490X5D, T491X5A, T491X5D, T492X5A, T492X5D, T493X5A, T493X5D, T494X5A, T494X5D, T495X5A, T495X5D, T496X5A, T496X5D, T497X5A, T497X5D, T498X5A, T498X5D, T4995XA, T4995XD, T500X5A, T500X5D, T501X5A, T501X5D, T502X5A, T502X5D, T503X5A, T503X5D, T504X5A, T504X5D, T505X5A, T505X5D, T506X5A, T506X5D, T507X5A, T507X5D, T508X5A, T508X5D, T50905A, T50905D, T50995A, T50995D, T50A15A, T50A25A, T50A95A, T50B15A, T50B15D, T50B95A, T50B95D, T50Z15A, T50Z15D, T50Z95A, T50Z95D |
| DXX2175 | Complications of anesthesia | T410X5A, T411X5A, T41205A, T41295A, T413X5A, T4145XA, T883XXA, T884XXA, T8852XA, T8853XA, T8859XA, Y653, Y700, Y701, Y702, Y703, Y708 |
| DXX2361 | complications of surgical procedures | D7801, D7802, D7811, D7812, D7821, D7822, D7831, D7832, D7833, D7834, E3601, E3602, E3611, E3612, E89810, E89811, E89820, E89821, E89822, E89823, G970, G9731, G9732, G9748, G9749, G9751, G9752, G9761, G9762, G9763, G9764, G9781, G9782, I97410, I97411, I97418, I9742, I9751, I9752, I97610, I97611, I97618, I9762, I97620, I97621, I97622, I97630, I97631, I97638, I97640, I97641, I97648, I9789, J9561, J9562, J9571, J9572, J95830, J95831, J95860, J95861, J95862, J95863, J9589, K910, K912, K9161, K9162, K9171, K9172, K91840, K91841, K91850, K91858, K91870, K91871, K91872, K91873, K9189, L7601, L7602, L7611, L7612, L7621, L7622, L7631, L7632, L7633, L7634, M96810, M96811, M96820, M96821, M96830, M96831, M96840, M96841, M96842, M96843, N9961, N9962, N9971, N9972, N99820, N99821, N99840, N99841, N99842, N99843, R5082, T81718A, T81719A, T8172XA, T8189XA, T819XXA, T888XXA, Y624, Y626, Y628, Y629, Y652, Y6551, Y6552, Y710, Y711, Y712, Y713, Y718, Y720, Y721, Y722, Y723, Y728, Y730, Y731, Y732, Y733, Y738, Y740, Y741, Y742, Y743, Y748, Y750, Y751, Y752, Y753, Y758, Y760, Y761, Y762, Y763, Y768, Y770, Y771, Y772, Y773, Y778, Y780, Y781, Y782, Y783, Y788, Y790, Y791, Y792, Y793, Y798, Y800, Y801, Y802, Y803, Y808, Y810, Y811, Y812, Y813, Y818, Y828, Y829, Y848 |
| DXX2362 | complications of medical care | D7881, D7889, E368, E8989, I973, J95850, L7681, L7682, M9689, R680, T7841XD, T801XXA, T8181XA, T880XXA, T881XXA, T887XXA, T889XXA, Y633, Y635, Y636, Y638, Y639, Y641, Y648, Y649, Y658, Y66, Y69, Y844, Y846, Y847 |
| DXX2395 | Foreign body left during procedure | T81500A, T81501A, T81502A, T81503A, T81504A, T81505A, T81506A, T81507A, T81508A, T81509A, T81510A, T81511A, T81512A, T81513A, T81514A, T81515A, T81516A, T81517A, T81518A, T81519A, T81520A, T81521A, T81522A, T81523A, T81524A, T81525A, T81526A, T81527A, T81528A, T81529A, T81530A, T81531A, T81532A, T81533A, T81534A, T81535A, T81536A, T81537A, T81538A, T81539A, T81590A, T81591A, T81592A, T81593A, T81594A, T81595A, T81596A, T81597A, T81598A, T81599A, T8160XA, T8161XA, T8169XA |
| DXX9910 | HAC 02: Air Embolism | T800XXA |
Table 4: ICD-10 Relevant Procedure Codes
| Group ID | Group Name | Code Value |
| PXX03231 | Other therapeutic procedures – 231 | 069Y3ZZ, 069Y4ZZ, 0WQFXZZ, 3E0G33Z, 3E0H33Z, 3E0M33Z, 3E0P33Z |
| PXX04178 | CT scan chest – 178 | BW2400Z, BW240ZZ, BW2410Z, BW241ZZ, BW24Y0Z, BW24YZZ, BW24ZZZ |
| PXX0441 | Other non-OR therapeutic procedures on respiratory system – 041 | 3E0M3SF |
| PXX0442 | Other OR therapeutic procedures on respiratory system – 042 | 0DQW0ZZ, 0DQW3ZZ, 0DQW4ZZ |
| PXX05226 | Other diagnostic radiology and related techniques – 226 | BD14ZZZ |
| PXX0561 | Other OR procedures on vessels other than head and neck – 061 | 069Y0ZZ, 3E033TZ |
| PXX06179 | CT scan abdomen – 179 | B52F00Z, B52F0ZZ, B52F10Z, B52F1ZZ, B52FY0Z, B52FYZZ, B52FZZZ, B52G00Z, B52G0ZZ, B52G10Z, B52G1ZZ, B52GY0Z, B52GYZZ, B52GZZZ, B52H00Z, B52H0ZZ, B52H10Z, B52H1ZZ, B52HY0Z, B52HYZZ, B52HZZZ, BD2400Z, BD240ZZ, BD2410Z, BD241ZZ, BD24Y0Z, BD24YZZ, BD24ZZZ, BF2500Z, BF250ZZ, BF2510Z, BF251ZZ, BF25Y0Z, BF25YZZ, BF25ZZZ, BF2600Z, BF260ZZ, BF2610Z, BF261ZZ, BF26Y0Z, BF26YZZ, BF26ZZZ, BF2700Z, BF270ZZ, BF2710Z, BF271ZZ, BF27Y0Z, BF27YZZ, BF27ZZZ, BF2C00Z, BF2C0ZZ, BF2C10Z, BF2C1ZZ, BF2CY0Z, BF2CYZZ, BF2CZZZ, BW2000Z, BW200ZZ, BW2010Z, BW201ZZ, BW20Y0Z, BW20YZZ, BW20ZZZ, BW2G00Z, BW2G0ZZ, BW2G10Z, BW2G1ZZ, BW2GY0Z, BW2GYZZ, BW2GZZZ |
| PXX06185 | Upper gastrointestinal X-ray – 185 | BD11YZZ, BD15YZZ, BD15ZZZ |
| PXX06186 | Lower gastrointestinal X-ray – 186 | BD14YZZ |
| PXX06194 | Diagnostic ultrasound of gastrointestinal tract – 194 | BD41ZZZ, BD42ZZZ, BD47ZZZ, BD48ZZZ, BD49ZZZ, BD4CZZZ, BF40ZZZ, BF42ZZZ, BF43ZZZ, BF45ZZZ, BF46ZZZ, BF47ZZZ, BF4CZZZ |
| PXX06196 | Diagnostic ultrasound of abdomen or retroperitoneum – 196 | BW40ZZZ |
| PXX06223 | Enteral and parenteral nutrition – 223 | 3E0G36Z |
| PXX06250 | Colonoscopy | 0DJD8ZZ |
| PXX06251 | Colonoscopy w biopsy, polypectomy | 0D9E3ZX, 0DBE3ZX, 0DBE4ZX, 0DBE7ZX, 0DBE8ZX, 0DBH8ZZ, 0DBK8ZZ, 0DBM8ZZ, 0DBN8ZZ |
| PXX0670 | Upper gastrointestinal endoscopy, biopsy – 070 | 0DB83ZX |
| PXX0677 | Proctoscopy and anorectal biopsy – 077 | 0D9P3ZX, 0D9P4ZX, 0D9P7ZX, 0D9P8ZX, 0D9Q0ZX, 0D9Q3ZX, 0D9Q4ZX, 0D9Q7ZX, 0D9Q8ZX, 0D9QXZX, 0D9R0ZX, 0D9R3ZX, 0D9R4ZX, 0DBP0ZX, 0DBP3ZX, 0DBP4ZX, 0DBP7ZX, 0DBP8ZX, 0DBQ0ZX, 0DBQ3ZX, 0DBQ4ZX, 0DBQ7ZX, 0DBQ8ZX, 0DBQXZX, 0DBR0ZX, 0DBR3ZX, 0DBR4ZX |
| PXX0692 | Other bowel diagnostic procedures – 092 | 0D980ZX, 0D990ZX, 0D9A0ZX, 0D9B0ZX, 0D9C0ZX, 0D9E0ZX, 0D9F0ZX, 0D9G0ZX, 0D9H0ZX, 0D9K0ZX, 0D9L0ZX, 0D9M0ZX, 0D9N0ZX, 0D9P0ZX, 0DB80ZX, 0DB90ZX, 0DBA0ZX, 0DBB0ZX, 0DBC0ZX, 0DBE0ZX, 0DBF0ZX, 0DBG0ZX, 0DBH0ZX, 0DBK0ZX, 0DBL0ZX, 0DBM0ZX, 0DBN0ZX, 0DJD3ZZ, 0DJD4ZZ, 0DJD7ZZ |
| PXX0693 | Other non-OR upper GI therapeutic procedures – 093 | 0D20X0Z, 0D20XUZ, 0D20XYZ, 0DL57DZ, 0DL58DZ, 3E0G76Z, 3E0G7GC, 3E0G86Z, 3E0G8GC, 3E1G78X, 3E1G78Z |
| PXX0695 | Other non-OR lower GI therapeutic procedures – 095 | 0D2DX0Z, 0D2DXUZ, 0D2DXYZ, 0D5E4ZZ, 0D5E8ZZ, 0D5F4ZZ, 0D5F8ZZ, 0D5G4ZZ, 0D5G8ZZ, 0D5H4ZZ, 0D5H8ZZ, 0D5K4ZZ, 0D5K8ZZ, 0D5L4ZZ, 0D5L8ZZ, 0D5M4ZZ, 0D5M8ZZ, 0D5N4ZZ, 0D5N8ZZ, 0D5P0ZZ, 0D5P3ZZ, 0D5P4ZZ, 0D5P7ZZ, 0D5P8ZZ, 0D5Q4ZZ, 0D5Q8ZZ, 0D5R4ZZ, 0D780DZ, 0D783DZ, 0D784DZ, 0D787DZ, 0D787ZZ, 0D788DZ, 0D788ZZ, 0D790DZ, 0D793DZ, 0D794DZ, 0D797DZ, 0D797ZZ, 0D798DZ, 0D798ZZ, 0D7A0DZ, 0D7A3DZ, 0D7A4DZ, 0D7A7DZ, 0D7A7ZZ, 0D7A8DZ, 0D7A8ZZ, 0D7B0DZ, 0D7B3DZ, 0D7B4DZ, 0D7B7DZ, 0D7B7ZZ, 0D7B8DZ, 0D7B8ZZ, 0D7C0DZ, 0D7C3DZ, 0D7C4DZ, 0D7C7DZ, 0D7C7ZZ, 0D7C8DZ, 0D7C8ZZ, 0D7E0DZ, 0D7E3DZ, 0D7E4DZ, 0D7E7DZ, 0D7E7ZZ, 0D7E8DZ, 0D7E8ZZ, 0D7F0DZ, 0D7F3DZ, 0D7F4DZ, 0D7F7DZ, 0D7F7ZZ, 0D7F8DZ, 0D7F8ZZ, 0D7G0DZ, 0D7G3DZ, 0D7G4DZ, 0D7G7DZ, 0D7G7ZZ, 0D7G8DZ, 0D7G8ZZ, 0D7H0DZ, 0D7H3DZ, 0D7H4DZ, 0D7H7DZ, 0D7H7ZZ, 0D7H8DZ, 0D7H8ZZ, 0D7K0DZ, 0D7K3DZ, 0D7K4DZ, 0D7K7DZ, 0D7K7ZZ, 0D7K8DZ, 0D7K8ZZ, 0D7L0DZ, 0D7L3DZ, 0D7L4DZ, 0D7L7DZ, 0D7L7ZZ, 0D7L8DZ, 0D7L8ZZ, 0D7M0DZ, 0D7M3DZ, 0D7M4DZ, 0D7M7DZ, 0D7M7ZZ, 0D7M8DZ, 0D7M8ZZ, 0D7N0DZ, 0D7N3DZ, 0D7N4DZ, 0D7N7DZ, 0D7N7ZZ, 0D7N8DZ, 0D7N8ZZ, 0D7P7DZ, 0D7P7ZZ, 0D7P8DZ, 0D7P8ZZ, 0D7Q7DZ, 0D7Q8DZ, 0D9P70Z, 0D9P80Z, 0DBP8ZZ, 0DH80DZ, 0DH83DZ, 0DH84DZ, 0DH87DZ, 0DH88DZ, 0DH90DZ, 0DH93DZ, 0DH94DZ, 0DH97DZ, 0DH98DZ, 0DHA0DZ, 0DHA3DZ, 0DHA4DZ, 0DHA7DZ, 0DHA8DZ, 0DHB0DZ, 0DHB3DZ, 0DHB4DZ, 0DHB7DZ, 0DHB8DZ, 0DHE0DZ, 0DHE3DZ, 0DHE4DZ, 0DHE7DZ, 0DHE8DZ, 0DHP0DZ, 0DHP3DZ, 0DHP4DZ, 0DHP7DZ, 0DHP8DZ, 0DP0X0Z, 0DP0XUZ, 0DPDX0Z, 0DPDXUZ, 0DS97ZZ, 0DS98ZZ, 0DSA7ZZ, 0DSA8ZZ, 0DSB7ZZ, 0DSB8ZZ, 0DSK7ZZ, 0DSK8ZZ, 0DSL7ZZ, 0DSL8ZZ, 0DSM7ZZ, 0DSM8ZZ, 0DSN7ZZ, 0DSN8ZZ, 0DSPXZZ, 0HB9XZZ, 2Y43X5Z, 3E0G37Z, 3E0G73Z, 3E0G77Z, 3E0G83Z, 3E0G87Z, 3E0H36Z, 3E0H37Z, 3E0H73Z, 3E0H76Z, 3E0H77Z, 3E0H7GC, 3E0H83Z, 3E0H86Z, 3E0H87Z, 3E0H8GC, 3E1H78Z, 8E0VX1D |
| PXX0696 | Other OR lower GI therapeutic procedures – 096 | 0D9870Z, 0D9880Z, 0D9E70Z, 0D9E80Z, 0DNP7ZZ, 0DNP8ZZ |
| PXX0697 | Other gastrointestinal diagnostic procedures – 097 | 0D9S0ZX, 0D9S3ZX, 0D9S4ZX, 0D9T0ZX, 0D9T3ZX, 0D9T4ZX, 0D9V0ZX, 0D9V3ZX, 0D9V4ZX, 0D9W0ZX, 0D9W3ZX, 0D9W4ZX, 0DBS0ZX, 0DBS3ZX, 0DBS4ZX, 0DBT0ZX, 0DBT3ZX, 0DBT4ZX, 0DBV0ZX, 0DBV3ZX, 0DBV4ZX, 0DBW0ZX, 0DBW3ZX, 0DBW4ZX, 0DJU3ZZ, 0DJV3ZZ, 0DJW3ZZ, 0W9G0ZX, 0W9G3ZX, 0W9G4ZX, 0W9H0ZX, 0W9H3ZX, 0W9H4ZX, 0W9J0ZX, 0W9J3ZX, 0W9J4ZX, 0WBH0ZX, 0WBH3ZX, 0WBH4ZX, 0WJF3ZZ, 0WJG3ZZ, 0WJH3ZZ, 0WJH4ZZ, 0WJJ3ZZ, 0WJP3ZZ, 0WJP7ZZ, 0WJP8ZZ, 0WJR3ZZ, 0WJR7ZZ, 0WJR8ZZ, 0Y950ZX, 0Y953ZX, 0Y954ZX, 0Y960ZX, 0Y963ZX, 0Y964ZX, 0YB50ZX, 0YB53ZX, 0YB54ZX, 0YB60ZX, 0YB63ZX, 0YB64ZX, 0YB70ZX, 0YB73ZX, 0YB74ZX, 0YB80ZX, 0YB83ZX, 0YB84ZX, 0YJ53ZZ, 0YJ54ZZ, 0YJ63ZZ, 0YJ64ZZ, 0YJ73ZZ, 0YJ74ZZ, 0YJ83ZZ, 0YJ84ZZ, 0YJA3ZZ, 0YJA4ZZ, 0YJE3ZZ, 0YJE4ZZ, 3E1M38X, 3E1M38Z |
| PXX0698 | Other non-OR gastrointestinal therapeutic procedures – 098 | 07PPX0Z, 07PPX3Z, 0D9970Z, 0D9980Z, 0D9A70Z, 0D9A80Z, 0D9B70Z, 0D9B80Z, 0D9F70Z, 0D9F80Z, 0D9G70Z, 0D9G80Z, 0D9H70Z, 0D9H80Z, 0D9K70Z, 0D9K80Z, 0D9L70Z, 0D9L80Z, 0D9M70Z, 0D9M80Z, 0D9N70Z, 0D9N80Z, 0DN87ZZ, 0DN88ZZ, 0DN97ZZ, 0DN98ZZ, 0DNA7ZZ, 0DNA8ZZ, 0DNB7ZZ, 0DNB8ZZ, 0DNE7ZZ, 0DNE8ZZ, 0DNF7ZZ, 0DNF8ZZ, 0DNG7ZZ, 0DNG8ZZ, 0DNH7ZZ, 0DNH8ZZ, 0DNK7ZZ, 0DNK8ZZ, 0DNL7ZZ, 0DNL8ZZ, 0DNM7ZZ, 0DNM8ZZ, 0DNN7ZZ, 0DNN8ZZ, 0DP0X2Z, 0DP0X3Z, 0DP0XDZ, 0DP571Z, 0DP581Z, 0DP5X1Z, 0DP5X2Z, 0DP5X3Z, 0DP5XUZ, 0DP6X2Z, 0DP6X3Z, 0DP6XDZ, 0DPDX2Z, 0DPDX3Z, 0DPDXDZ, 0DPP71Z, 0DPP81Z, 0DPPX1Z, 0DQV0ZZ, 0DQV3ZZ, 0DQV4ZZ, 0DS9XZZ, 0DSAXZZ, 0DSBXZZ, 0DSHXZZ, 0DSKXZZ, 0DSLXZZ, 0DSMXZZ, 0DSNXZZ, 0DWU00Z, 0DWU30Z, 0DWU40Z, 0DWV00Z, 0DWV30Z, 0DWV40Z, 0DWW00Z, 0DWW30Z, 0DWW40Z, 0FP0X2Z, 0FP0X3Z, 0FP4X2Z, 0FP4X3Z, 0FP4XDZ, 0FPBX1Z, 0FPBX2Z, 0FPBX3Z, 0FPDX1Z, 0FPDX2Z, 0FPDX3Z, 0FPDXDZ, 0FPGX2Z, 0FPGX3Z, 0W1G0J9, 0W1G0JB, 0W1G0JG, 0W1G0JJ, 0W1G4J9, 0W1G4JB, 0W1G4JG, 0W1G4JJ, 0W1J0J4, 0W1J0JY, 0W1J3J4, 0W1J4J4, 0W1J4JY, 0WCP7ZZ, 0WCP8ZZ, 0WFJ0ZZ, 0WFJ3ZZ, 0WFJ4ZZ, 0WFP0ZZ, 0WFP3ZZ, 0WFP4ZZ, 0WFP7ZZ, 0WFP8ZZ, 0WHP0YZ, 0WHP33Z, 0WHP3YZ, 0WHP43Z, 0WHP4YZ, 0WHP73Z, 0WHP7YZ, 0WHP83Z, 0WHP8YZ, 0WPFX0Z, 0WPFX1Z, 0WPFX3Z, 0WPFX7Z, 0WPFXJZ, 0WPFXKZ, 0WPFXYZ, 0WPGX0Z, 0WPGX1Z, 0WPGX3Z, 0WPJ00Z, 0WPJ01Z, 0WPJ03Z, 0WPJ0JZ, 0WPJ0YZ, 0WPJ30Z, 0WPJ31Z, 0WPJ33Z, 0WPJ3JZ, 0WPJ3YZ, 0WPJ40Z, 0WPJ41Z, 0WPJ43Z, 0WPJ4JZ, 0WPJ4YZ, 0WPP31Z, 0WPP33Z, 0WPP3YZ, 0WPP41Z, 0WPP43Z, 0WPP4YZ, 0WPP71Z, 0WPP73Z, 0WPP7YZ, 0WPP81Z, 0WPP83Z, 0WPP8YZ, 0WPPX1Z, 0WPPX3Z, 0WPPXYZ, 0WWP31Z, 0WWP33Z, 0WWP3YZ, 0WWP41Z, 0WWP43Z, 0WWP4YZ, 0WWP71Z, 0WWP73Z, 0WWP7YZ, 0WWP81Z, 0WWP83Z, 0WWP8YZ, 2W53X0Z, 2W53X4Z, 2W53X5Z, 2W53X6Z, 2W53X7Z, 2W53XYZ, 2Y53X5Z, 3E0M36Z, 3E0M37Z, 3E0M3BZ, 3E0M3GC, 3E0M3HZ, 3E0M3KZ, 3E0M3TZ, 3E0M7SF, 3E0P36Z, 3E0P37Z, 3E0P3BZ, 3E0P3HZ, 3E0P3KZ, 3E0P3TZ, 3E0P7BZ, 3E0P7HZ, 3E0P7KZ, 3E0P7TZ, 3E0P8BZ, 3E0P8HZ, 3E0P8KZ, 3E0P8TZ, 3E1H78X, 3E1J78X, 3E1J78Z, 3E1J88X, 3E1J88Z |
Table 5: Relevant Procedure Codes CPT/HCPCS
| Group ID | Group Name | Code Value |
| CT0001 | Sigmoidoscopy w biopsy, polypectomy | 45331, 45333, 45338 |
| CT0002 | Colonoscopy thru stoma w biopsy, polypectomy | 44389, 44392, 44394 |
| CT0003 | Colonoscopy w biopsy, polypectomy | 45380, 45384, 45385 |
| CT00100 | Sigmoidoscopy | 45330 |
| CT0025 | Preventive Medicine, Care Coordination | 98960, 98961, 98962, 98966, 98967, 98968, 99078, 99361, 99362, 99366, 99367, 99368, 99371, 99372, 99373, 99382, 99383, 99384, 99385, 99386, 99387, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99441, 99442, 99443, 99446, 99447, 99448, 99449, 99499, G0175, G0406, G0407, G0408, G0425, G0426, G0427, G8686, G8688, G8690, G8692, H0034, H0039, H0040, S0220, S0221, S0315, S0316, S0317, S0320 |
| CT0026 | Anesthesia and pain meds | J0400, J0780, J1630, J1631, J1960, J2270, J2310, J2358, J2426, J2680, J2794, J3010, J3070, J3230, J3486, S0012, S0092, S0093, S0136, S0166 |
| CT0027 | Colonoscopy – therapeutic | 45382, 45383, 45386, 45387, 45391, 45392 |
| CT0070 | Upper GI endoscopy | 91112 |
| CT0080 | Imaging Abdomen | 74000, 74010, 74020, 74022, 74150, 74160, 74170, 74175, 74181, 74182, 74183, 74185, 74261, 74262, 74263, 74270, 74280, 76700, 76705, 76975, 76999, C8900, C8901, C8902 |
| CT0082 | Pain meds | 96372, H0033, J0592, J1230, J2315 |
| CT0083 | Blood Type, Coomb’s test | 86077, 86880, 86900, 86901 |
| CT0086 | Flexible Sigmoidoscopy /Colonoscopy | 45388, 45389, 45390, 45393, 45398, G6019, G6020, G6022, G6023, G6024, G6025, G9252, G9253 |
| CT0088 | Hepatitis B vaccine | 90744, G0010 |
| CT0089 | Metabolic Renal Hepatic Chemistry Panel | 80047, 80048, 80050, 80051, 80053, 80069, 80074, 80076, 82040, 82247, 82248, 82310, 82330, 82374, 82435, 82565, 82575, 82947, 84132, 84155, 84295, 84450, 84460, 84520, 84550 |
| CT0090 | Physical Therapy / Rehab | 97001, 97002, 97003, 97004, 97005, 97006, 97033, 97034, 97035, 97036, 97039, 97139, 97150, 97545, 97546, 97750, 97755, S9129, S9131 |
| CT0091 | Physician Services – Outpatient | 99050, 99051, 99053, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99354, 99355, 99381, 99391, T1015 |
| CT0092 | Physician Services – Inpatient | 99221, 99222, 99223, 99238, 99239, 99252, 99253, 99254, 99255 |
| CT0093 | Routine Immunizations | 90471 |
| CT0094 | Screen for amino acid disorders | 84030 |
| CT0097 | Vitamin K administration | J3430 |
| CT0098 | Colonoscopy/Sigmoidoscopy ColorectalCa Screen | 81528, 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0328, G0464, S3890 |
| CT0099 | Colonoscopy | 45378, 45381 |
| CT0131 | Procedure – anesthesia | 01991, 01992 |
| CT0136 | Rx – central nervous system – antidepressants | J1320, S0106 |
| CT0137 | Rx – central nervous system – tranq/antipsychotics | J1790, J2950, J3310, J3400 |
| CT0138 | Rx – central nervous system – amphetamines | S0160 |
| CT0139 | Rx – central nervous system – non-amphetamine stimulants | J0706 |
| CT01394 | Medications (Injections, infusions and other forms) | C9270, C9272, C9275, C9276, C9277, C9279, C9281, C9282, C9283, C9285, J0171, J0558, J0561, J0597, J0638, J0775, J1290, J1559, J1599, J1680, J1786, J1826, J2793, J3095, J3357, J3385, J7121, J7184, J7309, J7312, J7335, J7686, J8562, Q2026, Q2027, Q2040, Q2041, Q2042, Q2044, S0148, S0169 |
| CT01395 | DME and supplies | A4337, A4466, A9273, C9362, C9365, C9367, C9406, C9800, E0433, E0446, E1036, E2622, E2623, E2624, E2625, K0740, K0741, K0742, K0743, K0744, K0745, K0746, Q4117, Q4118, Q4119, Q4120, Q4121, T1505 |
| CT0140 | Rx – central nervous system – barbiturates | J0300, J2515, J2560 |
| CT0141 | Rx – central nervous system – benzodiazepines | J1990, J2060, J2250, J3360 |
| CT0142 | Rx – central nervous system – anxiolytic/sedative/hypnot nec | J3410 |
| CT02387 | Pathology | 81276, 81311, 81525, 81540 |
| CT0351 | Therapy – habilitation | T2012 |
| CT0378 | Tests – ent – swallowing evaluation | 92611 |
| CT0380 | Tests – ent – other dx | 92504 |
| CT0424 | Rx – respiratory – beta agonists | J7606 |
| CT0425 | Rx – respiratory – phenylephrine | J2370 |
| CT0426 | Rx – respiratory – mucolytics/cold comb | J0132 |
| CT0427 | Rx – respiratory – methylxanthines | J0280, J1180, J2810 |
| CT04280 | Lung Function Tests | 94010 |
| CT04281 | Blood Gases, Pulse Oximetry | 82800, 82803, 82805, 82810, 94760, 94761, 94762 |
| CT0429 | Other care – respiratory therapy | S5180, S5181 |
| CT0434 | Other care – respiratory – oxygen / oxygen concentrator | E0424, E0425, E0430, E0431, E0434, E0435, E0439, E0440, E0441, E0442, E0443, E0444, E1390, E1391, E1392, K0738 |
| CT0438 | Other care – respiratory – equipment / supplies – nebulizer | E0555, E1405, E1406 |
| CT0439 | Other care – respiratory – equipment / supplies – peak flow meter | S8096 |
| CT0440 | Other care – respiratory – equipment / supplies – spirometer | A9284 |
| CT0441 | Other care – respiratory – equipment / supplies – apnea monitor | A4556, A4557 |
| CT0442 | Other care – respiratory – equipment / supplies | E0445, E0455, E0457, E0459, E0487, E0605, E0606, E1353, E1354, E1355, E1356, E1357, E1358, E1399, K0195 |
| CT0444 | Other care – prevention – smoking cessation | S9453 |
| CT0453 | Tests – pulmonary – peak flow | S8110 |
| CT0463 | Tests – pulmonary – other | 94770 |
| CT05171 | Procedure – central venous catheter – insertion | S5522, S5523 |
| CT05172 | Procedure – central venous catheter – fluoroscopy – guidance | 77001 |
| CT05184 | Procedure – vascular access – port / pump – insertion | C1772, C2626, E0782, E0783, E0786 |
| CT05194 | Rx – cardiovascular system – cardiac glycosides | J1160 |
| CT05196 | Rx – cardiovascular system – beta blockers | J1800 |
| CT05198 | Rx – cardiovascular system – vasodilating agents, nec | S9347 |
| CT05199 | Rx – cardiovascular system – vasodilating rx | J1325, J2440, J2670, J3285, K0455, S0155 |
| CT05201 | Rx – cardiovascular system – natriuretic peptides | J2325 |
| CT05202 | Rx – diuretics, loop diuretics | J1940, J3265, S0171, S9361 |
| CT05203 | Rx – diuretics, osmotic | J2150, J3350 |
| CT05204 | Rx – diuretics, thiazides / related | J1205 |
| CT05205 | Rx – diuretics – diuretic, carb anhydrase inhib | J1120 |
| CT05217 | Imaging – nuclear – venous thrombosis – scan | 78456, 78457, 78458 |
| CT05218 | Imaging – nuclear – venous thrombosis – radiopharmaceutical | A9504 |
| CT05233 | Tests – cardiac – ecg – ecg – 12 lead | R0076 |
| CT05256 | Tests – cardiac – radiopharmaceuticals | A9500, A9501, A9502, A9505, A9526, A9555 |
| CT05307 | Electrocardiogram – EKG monitoring | 93005, 93010 |
| CT0608 | Procedure – ugi endoscopy – small bowel endoscopy | 44360, 44361, 44363, 44364, 44365, 44369, 44370, 44372, 44376, 44377, 44378, 44379, 44380, 44382 |
| CT0609 | Procedure – ugi endoscopy – other | 44383, 44385, 44386 |
| CT06104 | Imaging – nuclear – shilling test | 78270, 78271, 78272 |
| CT06105 | Imaging – nuclear – shilling test – radiopharmaceutical | A9546, A9559 |
| CT06106 | Imaging – nuclear – gi blood loss | 78278 |
| CT06107 | Imaging – nuclear – other gi | 78261, 78264, 78267, 78268, 78282, 78290, 78291, 78299 |
| CT06108 | Imaging – pet – colorectal cancer – recurrence / metastasis | G0163 |
| CT06109 | Imaging – x-ray – abdomen | 74190 |
| CT06110 | Imaging – x-ray – upper gi – esophagus – contrast | 74220, 74230 |
| CT06112 | Imaging – x-ray – upper gi – small bowel – contrast | 74250, 74251, 74355 |
| CT06113 | Imaging – x-ray – upper gi – duodenogram | 74260 |
| CT06114 | Imaging – x-ray – upper gi – other | 74340 |
| CT06115 | Imaging – x-ray – lower gi – large bowel – contrast | 74283 |
| CT06118 | Tests – gi – esophageal balloon distension test | 91040 |
| CT06119 | Tests – gi – gastric motility study | 91020 |
| CT0612 | Procedure – esophageal / gastric intubation | 91000, 91105 |
| CT06120 | Tests – gi – duodeneal motility study | 91022 |
| CT06121 | Tests – gi – other dx | 91052, 91055, 91065, 91110, 91111, 91120, 91122, 91132, 91133, 91299 |
| CT06122 | Lab – gi – fat absorption | S3708 |
| CT06304 | Esophageal Motility and Diagnostic Workup | 74240, 74241, 74245, 74246, 74247, 74249, 78258, 78262, 91034, 91035, 91037, 91038 |
| CT06312 | Colonoscopy through Stoma | 44388, 44390, 44391, 44393, 44397, 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45355 |
| CT0657 | Procedure – other lower gi procedures – other bowel dx | 44020, 44100 |
| CT0658 | Procedure – other lower gi procedures – other or rx | 44500 |
| CT0659 | Procedure – other lower gi procedures – other non – or rx | 45520, 91100 |
| CT0664 | Procedure – hemorrhoidectomy | 46250, 46255, 46257, 46258, 46260, 46261, 46262 |
| CT0665 | Procedure – hemorrhoid destruction / ligation | 46221, 46930, 46934, 46935, 46936, 46945, 46946 |
| CT0666 | Procedure – other hemorrhoid procedures | 46083, 46230, 46320, 46500, 46947 |
| CT0667 | Procedure – other anal / rectal procedures – other procedures – rectum / anus | 45190, 45905, 45910, 45915, 45999, 46020, 46030, 46070, 46220, 46900, 46910, 46916, 46917, 46922, 46924, 46937, 46938, 46940, 46942, 46999, 91123 |
| CT0672 | Procedure – proctosigmoidoscopy – dx | 45300, 45305 |
| CT0673 | Procedure – proctosigmoidoscopy – rx | 45303, 45308, 45309, 45315, 45317, 45320, 45321, 45327 |
| CT0674 | Procedure – proctoscopy – screening | S0601 |
| CT0675 | Procedure – anoscopy | 46600, 46604, 46606, 46610, 46611, 46612, 46614, 46615 |
| CT0676 | Procedure – proctoscopy / anoscopy – other | 45100 |
| CT0688 | Procedure – other gi dx | 45990, 49180, 49400, 49424, 49427 |
| CT0690 | Procedure – anesthesia | 00700, 00730, 00740, 00800, 00810, 00820, 00840, 00902 |
| CT0692 | Therapy – neurostimulator – nausea / vomiting | E0765 |
| CT0693 | Rx – gi – antichol/antispasmodics | J0500, J1980 |
| CT0694 | Rx – gi – antiemetics | J1240, J1626, J2405, J2469, J2550, J2765, J3250, J3280, J8501, S0091, S0174, S0181, S0183, S9351, S9370 |
| CT0695 | Rx – gi – h2 antagonists | J2780, S0023, S0028 |
| CT0696 | Rx – gi drug misc,nec | S0191 |
| CT0697 | Rx – gi – ppis | C9113, S0164 |
| CT0698 | Rx – diagnostic rx – gastric function | J2805, J2850 |
| CT0728 | Procedure – other procedures – pancreas | 48400 |
| CT08106 | Imaging – x-ray – other – joint survey | R0070 |
| CT08113 | DME – heat/cold application | E0200, E0205, E0210, E0215, E0217, E0218, E0221, E0225, E0231, E0232, E0235, E0236, E0239 |
| CT08116 | DME – rehabilitation | E2000 |
| CT0849 | Procedure – anesthesia | 1905 |
| CT0857 | Rx – muscle relaxants – muscle relax, skeletal central | J0475, J0476, J2800, S9363 |
| CT0858 | Rx – muscle relaxants – muscle relax, skeletal, misc | J2360 |
| CT0859 | Rx – muscle relaxants – muscle relax, neuromusc block | J0330 |
| CT0959 | Procedure – other non – or rx – other non – or skin procedures | 96999, 97602, S0630 |
| CT0963 | Rx – skin / mucous membrane – antiinflam s/mm agnts / comb nec | J7311 |
| CT0964 | Rx – skin / mucous membrane – s/mm miscellaneous | J7308, S0157 |
| CT0969 | Other care – chronic edema – surgical stockings | A4490, A4495, A4500, A4510 |
| CT0972 | Other care – chronic edema – appliance – segmental | E0656, E0657 |
| CT1011 | Rx – antidiabetic rx – insulins | J1815 |
| CT1012 | Rx – antidiabetic rx, misc | J1610 |
| CT1013 | Rx – endocrine – other – parathyroid hormones | J0630 |
| CT1017 | Rx – vitamins – vitamin b / b complex | J3411, J3415, J3420 |
| CT1019 | Rx – vitamins – vitamin d | J0636, J1270, J2501 |
| CT1021 | Rx – vitamins – multivit prep | A9152, A9153, S0194 |
| CT1023 | Rx – diagnostic rx, misc | J7674 |
| CT1025 | Other care – diabetes care – glucose monitoring – other supplies | A4250, A4256, A4257 |
| CT1026 | Other care – diabetes care – glucose monitoring – lancet | A4258, A4259, E0620 |
| CT1027 | Other care – diabetes care – glucose monitoring | A9279, A9280 |
| CT10295 | Thyroid Function Tests | 84432, 84436, 84437, 84439, 84442, 84443, 84445, 84479, 84480, 84481, 84482 |
| CT10296 | Low dose steroids | J0702, J1020, J1094, J1100, J1700, J1710, J1720, J2650, J3300, J3301, J3302, J3303, J7506, J7509, J7510, J8540, S9490 |
| CT10297 | High dose steroids | J1030, J1040, J2920, J2930, Q0138 |
| CT1030 | Other care – diabetes care – insulin pump | E0784 |
| CT1036 | Other care – nutrition – assessment | 97802, 97803, G0270, G0271 |
| CT1037 | Other care – nutrition – enteral – administration | S9340, S9341, S9342, S9343 |
| CT1038 | Other care – nutrition – enteral | B4034, B4035, B4036, B4081, B4100, B4104, B9998 |
| CT1039 | Other care – nutrition – enteral – tubing | B4082, B4083, B4087, B4088 |
| CT1040 | Other care – nutrition – enteral – formula | B4102, B4103, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9000 |
| CT1041 | Other care – nutrition – enteral – pump | B9002 |
| CT1042 | Other care – nutrition – parenteral – nutrition solution | B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4199, B5000, B5100, B5200 |
| CT1043 | Other care – nutrition – parenteral | B4216, B4220, B4222, B4224, B9999 |
| CT1044 | Other care – nutrition – parenteral – pump | B9004, B9006, E0791 |
| CT1045 | Other care – nutrition – parenteral – all – inclusive | S9364, S9365, S9366, S9367, S9368 |
| CT1046 | Other care – nutrition – education | S9452 |
| CT1047 | Other care – nutrition – medical food | S9433, S9434, S9435 |
| CT1048 | Other care – nutrition – counseling – dietician | S9470 |
| CT1049 | Other care – other – weight management | S9449 |
| CT1061 | Lab – endocrine response test | 80400, 80402, 80406, 80408, 80410, 80412, 80414, 80415, 80416, 80417, 80418, 80420, 80422, 80424, 80426, 80428, 80430, 80432, 80434, 80435, 80436, 80438, 80439, 80440 |
| CT1062 | Lab – endocrine | S3650, S3652 |
| CT1137 | Procedure – anesthesia | 860 |
| CT1146 | Therapy – dialysis – supplies | A4932 |
| CT1148 | Rx – gu – other – bladder rx | J0520 |
| CT1166 | Lab – urinalysis | 81007, 81015, 81020, 81050, 81099 |
| CT1167 | Lab – specimen collection – urine | P9612, P9615 |
| CT1222 | Imaging – us – transrectal | 76872 |
| CT1616 | Therapy – transfusion – blood | P9010, P9011, P9016, P9021, P9022, P9038, P9039, P9040, P9051, P9054, P9056, P9057, P9058, S9538 |
| CT1617 | Therapy – transfusion – plasma | P9017, P9023, P9043, P9044, P9048, P9059, P9060 |
| CT1618 | Therapy – transfusion – granulocytes | P9050 |
| CT1619 | Therapy – transfusion – platelets | P9019, P9020, P9031, P9032, P9033, P9034, P9035, P9036, P9037, P9052, P9053, P9055 |
| CT1620 | Therapy – phlebotomy | 99195 |
| CT1622 | Rx – immune system – interferons | J1830, Q3025, Q3026, S0145, S9559 |
| CT1626 | Rx – blood derivatives | P9041, P9045, P9046, P9047 |
| CT1627 | Rx – hematopoietic system – other | J1640 |
| CT1628 | Rx – hematopoietic system – iron / related | J1750, J1756, J2916 |
| CT16296 | Lipid Level Monitoring | 80061, 82465, 83695, 83698, 83700, 83701, 83704, 83718, 83719, 83721, 84478 |
| CT16297 | Blood Count | 82728, 83540, 83550, 85004, 85007, 85008, 85009, 85013, 85014, 85018, 85025, 85027, 85032, 85041, 85044, 85045, 85046, 85048, 85049, 85060, G0306, G0307 |
| CT16299 | Bleeding Status | 85002, 85345, 85347, 85348, 85610, 85611, 85670, 85675, 85705, 85730, 85732, 99363, 99364, S9401 |
| CT1630 | Rx – coagulation system – anticoagulants | C9121, J0583, J1644, J1645, J1650, J1652, J1655, J1945, J7197, S9336, S9372 |
| CT1631 | Rx – coagulation system – antiheparin agnt | J2720 |
| CT16316 | Blood transfusion | P9070, P9071, P9072 |
| CT1632 | Rx – coagulation system – hemostatics | J0365, J7185, J7186, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7196, J7198, J7199, P9012, S0017 |
| CT1633 | Rx – coagulation system – thrombolytic rx | J0350, J2993, J2995, J2997, J3101, J3364, J3365 |
| CT1634 | Rx – coagulation system – antiplatelet rx | J0130, J1245, J1327, J3246 |
| CT1635 | Rx – serums, toxoids, vaccines – serums | 90281, 90283, 90291, 90296, 90371, 90375, 90376, 90384, 90385, 90386, 90389, 90396, 90399, J0850, J1162, J1459, J1460, J1560, J1561, J1562, J1566, J1568, J1569, J1571, J1572, J1573, J1670, J2788, J2790, J2791, J2792, J7504 |
| CT1636 | Rx – serums, toxoids, vaccines – toxins | J0585, J0586, J0587 |
| CT1638 | Rx – administration – injection | 90772, 90773, 90774, 90775, 96373, 96374, 96375, 96376, 99506 |
| CT1639 | Rx – administration – infusion | 90765, 90766, 90767, 90768, 90779, 96361, 96365, 96366, 96367, 96368, 96369, 96370, 96371, 96379, 99601, 99602, A4220, A4221, A4222, A4223, A4305, A4306, C8957, E0776, E0779, E0780, E0781, K0552, K0601, K0602, K0603, K0604, K0605, S1015, S1016, S5035, S5036, S5497, S5498, S5501, S5502, S5517, S5518, S5520, S5521, S9379, S9542, S9810 |
| CT1640 | Imaging – nuclear – red cell survival | 78130, 78135 |
| CT1642 | Imaging – nuclear – platelet kinetics | 78190, 78191 |
| CT1643 | Imaging – nuclear – other blood / related | 78140, 78199 |
| CT1645 | Lab – blood gases | 82820 |
| CT1646 | Lab – hematology – coagulation | 85170, 85175, 85210, 85220, 85230, 85240, 85244, 85245, 85246, 85247, 85250, 85260, 85270, 85280, 85290, 85291, 85292, 85293, 85300, 85301, 85302, 85303, 85305, 85306, 85307, 85335, 85337, 85360, 85362, 85366, 85370, 85378, 85379, 85380, 85384, 85385, 85390, 85396, 85397, 85400, 85410, 85415, 85420, 85421, 85612, 85613, 85635 |
| CT1647 | Lab – hematology – blood count | 85055 |
| CT1648 | Lab – hematology – blood count – eosinophil count | S3630 |
| CT1649 | Lab – other hematology | 85130, 85441, 85445, 85460, 85461, 85475, 85520, 85525, 85530, 85536, 85540, 85547, 85549, 85555, 85557, 85576, 85597, 85660, 85810, 85999, 88738, 88740, 88741 |
| CT1651 | Lab – immunology | 86000, 86001, 86003, 86005, 86021, 86022, 86023, 86038, 86039, 86060, 86063, 86078, 86079, 86146, 86147, 86148, 86155, 86156, 86157, 86160, 86161, 86162, 86171, 86185, 86200, 86215, 86225, 86226, 86235, 86243, 86255, 86256, 86277, 86280, 86294, 86300, 86301, 86304, 86305, 86308, 86309, 86310, 86316, 86320, 86325, 86327, 86329, 86331, 86332, 86334, 86335, 86336, 86337, 86340, 86341, 86343, 86344, 86352, 86353, 86355, 86356, 86357, 86359, 86360, 86361, 86367, 86376, 86378, 86382, 86384, 86403, 86406, 86430, 86431, 86480, 86485, 86486, 86490, 86510, 86580, 86586, 86590, 86592, 86593 |
| CT1652 | Lab – transfusion medicine | 86850, 86860, 86870, 86885, 86886, 86890, 86891, 86903, 86904, 86905, 86906, 86910, 86911, 86920, 86921, 86922, 86923, 86927, 86930, 86931, 86932, 86940, 86941, 86945, 86950, 86960, 86965, 86970, 86971, 86972, 86975, 86976, 86977, 86978, 86985, 86999 |
| CT1794 | Imaging – pet – tumor imaging | 78812, 78813, 78815, 78816 |
| CT1795 | Imaging – pet – lymphoma – staging | G0164 |
| CT1797 | Lab – tumor marker | S3711 |
| CT1805 | Rx – antibiotics / antivirals / antifungals – infusion | S9345, S9494, S9497, S9500, S9501, S9502, S9503, S9504 |
| CT1807 | Rx – antibiotics – cephalosporins | J0690, J0692, J0694, J0696, J0697, J0698, J0710, J0713, J0715, J1890 |
| CT1808 | Rx – b-lactam antibiotics | J0743, J1335, J2185, S0073 |
| CT1809 | Rx – antibiotics – chloramphenicol / comb | J0720 |
| CT1810 | Rx – antibiotics – macrolides | J0456, J1364, Q0144 |
| CT1811 | Rx – antibiotics – penicillins | J0290, J0295, J2510, J2540, J2543, J2700, S0032, S0040, S0081 |
| CT1812 | Rx – antibiotics – tetracyclines | J0120, J2460 |
| CT1813 | Rx – antibiotics, misc | J0770, J2010, J2020, J2770, J3320, J3370, S0021, S0074, S0077, S0142 |
| CT1814 | Rx – antibiotics – quinolones | J0744, J1590, J1956, J2280, S0034 |
| CT1815 | Rx – antibiotics – sulfonamides / comb | S0039 |
| CT1816 | Rx – antibiotics – anti-infectives, misc | J3305, S0030, S0080 |
| CT1818 | Rx – antifungals | J0285, J0287, J0288, J0289, J0637, J1450, J1835 |
| CT1820 | Other care – other – infection control | S8301 |
| CT1821 | Lab – infectious agent antigen | 87260, 87265, 87267, 87269, 87271, 87272, 87273, 87274, 87275, 87276, 87277, 87278, 87279, 87280, 87281, 87283, 87285, 87290, 87299, 87300, 87301, 87305, 87324, 87327, 87328, 87329, 87332, 87335, 87336, 87337, 87338, 87339, 87340, 87341, 87350, 87380, 87385, 87390, 87391, 87400, 87420, 87425, 87427, 87430, 87449, 87450, 87451 |
| CT1822 | Lab – infectious agent antibody | 86317, 86318, 86602, 86603, 86606, 86609, 86611, 86612, 86615, 86617, 86618, 86619, 86622, 86625, 86628, 86635, 86638, 86641, 86644, 86645, 86648, 86651, 86652, 86653, 86654, 86658, 86663, 86664, 86665, 86666, 86668, 86671, 86674, 86677, 86682, 86684, 86687, 86688, 86689, 86692, 86694, 86695, 86696, 86698, 86701, 86702, 86703, 86704, 86705, 86706, 86707, 86708, 86709, 86710, 86713, 86717, 86720, 86723, 86727, 86729, 86732, 86735, 86738, 86741, 86744, 86747, 86750, 86753, 86756, 86757, 86759, 86762, 86765, 86768, 86771, 86774, 86777, 86778, 86780, 86781, 86784, 86787, 86788, 86789, 86790, 86793, 86800, 86803, 86804, S3645 |
| CT1823 | Lab – infectious agent dna | 87470, 87471, 87472, 87475, 87476, 87477, 87480, 87481, 87482, 87493, 87495, 87496, 87497, 87498, 87500, 87510, 87511, 87512, 87515, 87516, 87517, 87520, 87521, 87522, 87525, 87526, 87527, 87528, 87529, 87530, 87531, 87532, 87533, 87534, 87535, 87536, 87537, 87538, 87539, 87540, 87541, 87542, 87550, 87551, 87552, 87555, 87556, 87557, 87560, 87561, 87562, 87580, 87581, 87582, 87590, 87591, 87592, 87620, 87621, 87622, 87640, 87641, 87650, 87651, 87652, 87653, 87660, 87797, 87798, 87799, 87800, 87801, 87802, 87803, 87804, 87807, 87808, 87809, 87850, 87880, 87899, 87900, 87901, 87902, 87903, 87904 |
| CT1824 | Lab – microbiology – other | 87015, 87164, 87166, 87168, 87169, 87172, 87176, 87177, 87230, 87905, 87999 |
| CT1825 | Lab – microbiology – c & s | 87040, 87045, 87046, 87070, 87071, 87073, 87075, 87076, 87077, 87081, 87084, 87086, 87088, 87101, 87102, 87103, 87106, 87107, 87109, 87116, 87118, 87140, 87143, 87147, 87149, 87150, 87152, 87153, 87158, 87181, 87184, 87185, 87186, 87187, 87188, 87190, 87197 |
| CT1826 | Lab – microbiology – microscopic exam | 87205, 87206, 87207, 87209, 87210, 87220 |
| CT1827 | Lab – microbiology – viral culture | 87250, 87252, 87253, 87254, 87255 |
| CT1828 | Lab – microbiology | P7001 |
| CT1829 | Lab – microscopic – pinworm | Q0113 |
| CT18302 | CHLAMYDIA SCREENING | 86631, 86632, 87110, 87270, 87320, 87485, 87486, 87487, 87490, 87491, 87492, 87810 |
| CT1901 | Therapy – behavior – evaluation and therapy | 96150, 96151, 96152, 96153, 96154, 96155 |
| CT1905 | Therapy – behavior – partial hospitalization | S0201 |
| CT1907 | Tests – neuro – sleep studies | 95803 |
| CT19303 | Psychiatry Evaluations | T1023 |
| CT19304 | Psychiatry Services | 97535, H0031, H2010, H2015, H2016, H2021, H2022, S3005, S9454, S9482, T2034 |
| CT19378 | Laboratory – Chemistry and Hematology | 83987, G0435 |
| CT19381 | Smoking / Tobacco Cessation | 99406, 99407 |
| CT19384 | Peer Services | H0038 |
| CT2006 | Alcohol / Drug Use Management | H0045 |
| CT2009 | Alcohol / Drug Use Screening | 80100, 80101, 80102, 80103, 82009, 82010, 99408, 99409, G0431, G0432, G0433 |
| CT20376 | Other Laboratory | G9143, S3713, S3865, S3866, S3870 |
| CT2101 | Lab – therapeutic drug assay | 80150, 80152, 80154, 80156, 80157, 80158, 80160, 80162, 80164, 80166, 80168, 80170, 80172, 80173, 80174, 80176, 80178, 80182, 80184, 80185, 80186, 80188, 80190, 80192, 80194, 80195, 80196, 80197, 80198, 80200, 80201, 80202, 80299 |
| CT2301 | Therapy – allergy treatment | 95115, 95117, 95120, 95125, 95130, 95131, 95132, 95133, 95134, 95144, 95145, 95146, 95147, 95148, 95149, 95165, 95170, 95180, 95199 |
| CT2302 | Therapy – behavior – other | H2000, H2033, T2036, T2037 |
| CT2304 | Therapy – pt – exercises / activities | 97537, 97542 |
| CT2305 | Therapy – pt – modalities | G0283, S8948 |
| CT2309 | Therapy – activity therapy | H2032 |
| CT2311 | Therapy – vaccination – mmr / related | 90704, 90705, 90706, 90707, 90708, 90710 |
| CT2312 | Therapy – vaccination – dtp / related | 90696, 90698, 90700, 90701, 90702, 90703, 90718, 90719, 90720, 90721, 90723, 90749 |
| CT2313 | Therapy – vaccination – hib vaccine | 90645, 90646, 90647, 90648 |
| CT2314 | Therapy – vaccination – hepatitis a vaccine | 90632, 90633, 90634, 90636 |
| CT2315 | Therapy – vaccination – hepatitis b | 90740, 90743, 90746, 90747, 90748 |
| CT2316 | Therapy – vaccination – poliovirus vaccine | 90712, 90713 |
| CT2317 | Therapy – vaccination – chicken pox | 90716 |
| CT2319 | Therapy – vaccination – other vaccine | 90476, 90477, 90581, 90585, 90665, 90675, 90676, 90680, 90690, 90691, 90692, 90693, 90714, 90715, 90717, 90725, 90727, 90733, 90734, 90735, 90736 |
| CT2320 | Therapy – vaccination – vaccine administration | 90465, 90466, 90467, 90468, 90472, 90473, 90474 |
| CT2326 | Other care – bladder / bowel care – other supplies | A4310, A4320, A4321, A4322, A4330, A4331, A4332, A4333, A4334, A4335, A4336, A4354, A4355, A4356, A5113, A5114 |
| CT2327 | Other care – bladder / bowel care – catheter | A4311, A4312, A4313, A4314, A4315, A4316, A4326, A4327, A4328, A4338, A4340, A4344, A4346, A4349, A4351, A4352, A4353 |
| CT2328 | Other care – bladder / bowel care – drainage bag | A4357, A4358, A5102, A5105, A5112 |
| CT2329 | Other care – bladder / bowel care – other supplies – diaper / related | A4360, A4520, A4554, T4521, T4522, T4523, T4524, T4525, T4526, T4527, T4528, T4529, T4530, T4531, T4532, T4533, T4534, T4535, T4536, T4537, T4538, T4539, T4540, T4541, T4542, T4543 |
| CT2330 | Other care – bladder / bowel care – other supplies – skin barrier | A5120, A5121, A5122, A5126, A5131, A5200 |
| CT23307 | Vaccine for flu or Pneumonia | 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90663, 90669, 90670, 90732, G0008, G0009, G9141, G9142, Q2035, Q2036, Q2037, Q2038, Q2039, S0195 |
| CT23308 | Other therapeutic Sigmoidoscopy | 45332, 45334, 45335, 45337, 45339, 45340, 45341, 45342, 45345, 45346, 45347, 45349, 45350 |
| CT23309 | Markers for Inflammation | 85651, 85652, 86140, 86141 |
| CT2331 | Other care – observation | G0379 |
| CT2332 | Other care – child care – foster care | S5140, S5141, S5145, S5146 |
| CT2338 | Other care – other – education | S9445, S9446 |
| CT23393 | Prophylactic vaccinations and inoculations | 90284, 90681, 90738 |
| CT23398 | Ancillary Services | 99415, 99416, G9474, G9475, G9476, G9477, G9478, G9479 |
| CT23400 | HPV VACCINE | 90649, 90650 |
| CT2341 | Other care – other – exercise classes | S9451 |
| CT2342 | Tests – allergy tests – percutaneous | 95004, 95010 |
| CT2343 | Tests – allergy tests – intradermal | 95015, 95024, 95027, 95028 |
| CT2344 | Tests – allergy tests – patch | 95044 |
| CT2345 | Tests – allergy tests – other | 95052, 95056, 95070, 95071, 95075 |
| CT2352 | DME – mobility aids | A4635, A4636, A4637, E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116, E0117, E0118, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0153, E0154, E0155, E0156, E0157, E0158, E0159, E0955, E0956, E0957, E0958, E0959, E0960, E0961, E0966, E0967, E0968, E0969, E0970, E0971, E0973, E0974, E0978, E0980, E0981, E0982, E0983, E0984, E0985, E0986, E0990, E0992, E0994, E0995, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1009, E1010, E1011, E1014, E1015, E1016, E1017, E1018, E1020, E1028, E1029, E1030, E1031, E1035, E1037, E1038, E1039, E1050, E1060, E1070, E1083, E1084, E1085, E1086, E1087, E1088, E1089, E1090, E1092, E1093, E1100, E1110, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172, E1180, E1190, E1195, E1200, E1220, E1221, E1222, E1223, E1224, E1225, E1226, E1227, E1228, E1229, E1230, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239, E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295, E1296, E1297, E1298, E2201, E2202, E2203, E2204, E2205, E2206, E2207, E2208, E2209, E2210, E2211, E2212, E2213, E2214, E2215, E2216, E2217, E2218, E2219, E2220, E2221, E2222, E2224, E2225, E2226, E2227, E2228, E2230, E2231, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2310, E2311, E2312, E2313, E2321, E2322, E2323, E2324, E2325, E2326, E2327, E2328, E2329, E2330, E2331, E2340, E2341, E2342, E2343, E2351, E2360, E2361, E2362, E2363, E2364, E2365, E2366, E2367, E2368, E2369, E2370, E2371, E2372, E2373, E2374, E2375, E2376, E2377, E2381, E2382, E2383, E2384, E2385, E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396, E2397, E2601, E2602, E2603, E2604, E2605, E2606, E2607, E2608, E2609, E2610, E2611, E2612, E2613, E2614, E2615, E2616, E2617, E2619, E2620, E2621, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009, K0010, K0011, K0012, K0014, K0015, K0017, K0018, K0019, K0020, K0037, K0038, K0039, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0056, K0065, K0069, K0070, K0071, K0072, K0073, K0077, K0098, K0105, K0108, K0669, K0733, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898, K0899 |
| CT2353 | DME – patient lifts | E0621, E0625, E0627, E0628, E0629, E0630, E0635, E0636, E0637, E0638, E0639, E0640, E0641, E0642 |
| CT9902 | E & M – consultation | Q3014, T1014 |
| CT9903 | E & M – hospital | 99217, 99218, 99219, 99220, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99292, 99293, 99294, 99466, 99481, 99482, G0378, G0390, S0310 |
| CT9904 | E & M – emergency care | 99058, 99281, 99282, 99283, 99284, 99285, G0380, G0381, G0382, G0383, G0384, S9083, S9088 |
| CT9905 | E & M – home visit | 99224, 99225, 99226, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, S0273 |
| CT9906 | E & M – nursing home | 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337 |
| CT9907 | E & M – prevention | 99420, S0302 |
| CT9908 | E & M – other | 96040, 99026, 99027, 99056, 99060, 99150, 99288, 99289, 99290, 99360, 99450, 99455, 99456, 99485, 99486, 99488, S0260 |
| CT9909 | Procedure – maintenance – cns / spinal pump / port | 95991 |
| CT9910 | Procedure – anesthesia | 01922, 01996, 01999, 99100, 99116, 99135, 99140 |
| CT99101 | Other care – other – lead assessment | T1029 |
| CT99102 | Other care – other | H0043, H0044, S1001, S1002, S9988, S9989, S9990, S9991, S9999, T2025, T2035, T2038, T2040, T2041 |
| CT99103 | Imaging – ct – follow – up | 76380 |
| CT99104 | Imaging – ct – other | 76497 |
| CT99105 | Imaging – ct – guidance | 77012 |
| CT99107 | Imaging – mri – other | 76498, C1770, S8042 |
| CT99108 | Imaging – mri – guidance | 77021 |
| CT99109 | Imaging – mri – contrast agent | A9576, A9577, A9578, A9579, A9581, A9583, Q9953, Q9954 |
| CT9911 | Procedure – sedation | 99143, 99144, 99145, 99148, 99149 |
| CT99111 | Imaging – us – retroperitoneum | 76770, 76775 |
| CT99113 | Imaging – us – guide – biopsy | 76942 |
| CT99114 | Imaging – us – guide – other | 76936, 76937, 76940, 76998 |
| CT99115 | Imaging – us – other | 76970 |
| CT99118 | Imaging – nuclear – blood / plasma volume – scan | 78110, 78111, 78120, 78121, 78122 |
| CT99120 | Imaging – nuclear – lymphatics | 78195 |
| CT99124 | Imaging – nuclear – tumor localization | 78800, 78801, 78802, 78803, 78804 |
| CT99125 | Imaging – nuclear – localization of inflammation | 78805, 78806, 78807 |
| CT99127 | Imaging – nuclear – other – automated data add – on | 78890, 78891 |
| CT99129 | Imaging – nuclear – radiopharmaceutical – radiopharmaceutical – other | A4641, A4642, A9507, A9512, A9521, A9538, A9540, A9541, A9547, A9550, A9553, A9556, A9560, A9566, A9568, A9569, A9570, A9571, A9572, A9582 |
| CT99130 | Imaging – pet – other | A9552, A9580, G0235, S8085 |
| CT99133 | Imaging – other imaging – fluoroscopy | 76000, 76001, 76496 |
| CT99134 | Imaging – other imaging – fluoroscopy – guidance | 77002, 77003 |
| CT99136 | Imaging – other imaging | 74210, 75809, 75900, 76100, 76101, 76102, 76120, 76125, 76140, 76150, 76350, 76376, 76377, 76390, 76499, Q0092, R0075 |
| CT99137 | Imaging – therapeutic procedure – abscess drainage | 75989 |
| CT99139 | Imaging – supplies – contrast agent – low osmolar | Q9951, Q9965, Q9966, Q9967 |
| CT99140 | Imaging – supplies – contrast agent – high osmolar | A9698, Q9958, Q9959, Q9960, Q9961, Q9962, Q9963, Q9964 |
| CT99141 | Imaging – supplies – ultrasound related | A4559 |
| CT99142 | Lab – pathology consultation | 80500, 80502 |
| CT99143 | Lab – chemistry | 82000, 82003, 82013, 82016, 82017, 82024, 82030, 82045, 82085, 82088, 82101, 82103, 82104, 82108, 82127, 82128, 82131, 82135, 82136, 82139, 82140, 82143, 82145, 82150, 82154, 82157, 82160, 82163, 82164, 82172, 82175, 82180, 82190, 82205, 82232, 82239, 82240, 82252, 82261, 82271, 82272, 82274, 82286, 82300, 82306, 82307, 82308, 82331, 82340, 82355, 82360, 82365, 82370, 82373, 82375, 82376, 82378, 82379, 82380, 82382, 82383, 82384, 82387, 82390, 82397, 82415, 82436, 82438, 82441, 82480, 82482, 82485, 82486, 82487, 82488, 82489, 82491, 82492, 82495, 82507, 82520, 82523, 82525, 82528, 82530, 82533, 82540, 82541, 82542, 82543, 82544, 82550, 82552, 82553, 82554, 82570, 82585, 82595, 82600, 82607, 82608, 82610, 82615, 82626, 82627, 82633, 82634, 82638, 82646, 82649, 82651, 82652, 82654, 82656, 82657, 82658, 82664, 82666, 82668, 82670, 82671, 82672, 82677, 82679, 82690, 82693, 82696, 82705, 82710, 82715, 82725, 82726, 82735, 82742, 82746, 82747, 82759, 82760, 82775, 82776, 82784, 82785, 82787, 82926, 82928, 82938, 82941, 82943, 82945, 82946, 82950, 82951, 82952, 82953, 82955, 82960, 82962, 82963, 82965, 82975, 82977, 82978, 82979, 82980, 82985, 83003, 83008, 83009, 83010, 83012, 83013, 83014, 83015, 83018, 83020, 83021, 83026, 83045, 83050, 83051, 83055, 83060, 83065, 83068, 83069, 83070, 83071, 83080, 83088, 83090, 83150, 83491, 83497, 83498, 83499, 83500, 83505, 83516, 83518, 83519, 83520, 83525, 83527, 83528, 83570, 83582, 83586, 83593, 83605, 83615, 83625, 83630, 83631, 83632, 83633, 83634, 83670, 83690, 83727, 83735, 83775, 83785, 83788, 83789, 83805, 83825, 83835, 83840, 83857, 83858, 83864, 83866, 83872, 83873, 83874, 83876, 83880, 83883, 83885, 83887, 83890, 83891, 83892, 83893, 83894, 83896, 83897, 83898, 83900, 83901, 83902, 83903, 83904, 83905, 83906, 83907, 83908, 83909, 83912, 83913, 83914, 83915, 83916, 83918, 83919, 83921, 83925, 83930, 83935, 83937, 83945, 83950, 83951, 83970, 83986, 83992, 83993, 84022, 84035, 84060, 84061, 84066, 84075, 84078, 84080, 84081, 84085, 84087, 84100, 84105, 84106, 84110, 84119, 84120, 84126, 84127, 84133, 84134, 84135, 84138, 84140, 84143, 84144, 84145, 84146, 84150, 84152, 84153, 84154, 84156, 84157, 84160, 84165, 84166, 84181, 84182, 84202, 84203, 84206, 84207, 84210, 84220, 84228, 84233, 84234, 84235, 84238, 84244, 84252, 84255, 84260, 84270, 84275, 84285, 84300, 84302, 84305, 84307, 84311, 84315, 84375, 84376, 84377, 84378, 84379, 84392, 84402, 84403, 84425, 84430, 84431, 84446, 84449, 84466, 84484, 84485, 84488, 84490, 84510, 84512, 84525, 84540, 84545, 84560, 84577, 84578, 84580, 84583, 84585, 84586, 84588, 84590, 84591, 84597, 84600, 84620, 84630, 84681, 84999 |
| CT99144 | Lab – tissue typing | 86805, 86806, 86807, 86808, 86812, 86813, 86816, 86817, 86821, 86822, 86825, 86826, 86849 |
| CT99146 | Lab – cytology | 88104, 88106, 88107, 88108, 88112, 88160, 88161, 88162, 88172, 88173, 88182, 88184, 88185, 88187, 88188, 88189, 88199 |
| CT99147 | Lab – cytogenetics | 88230, 88233, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291, 88299 |
| CT99148 | Lab – surgical pathology | 88300, 88302, 88304, 88305, 88307, 88309, 88312, 88313, 88314, 88318, 88319, 88321, 88323, 88325, 88329, 88331, 88332, 88333, 88334, 88342, 88346, 88347, 88348, 88349, 88355, 88356, 88358, 88360, 88361, 88362, 88365, 88367, 88368, 88371, 88372, 88380, 88381, 88384, 88385, 88386, 88387, 88388, 88399 |
| CT99149 | Lab – other clinical lab | 88400, 89050, 89051, 89055, 89060, 89100, 89105, 89125, 89130, 89132, 89135, 89136, 89140, 89141, 89160, 89190, 89220, 89225, 89230, 89235, 89240 |
| CT99166 | Lab – genetic testing – cardiac ion channel syndrome | S3860, S3862 |
| CT99167 | Lab – genetic testing – brugada syndrome | S3861 |
| CT99168 | Lab – chemistry and toxicology tests | P2028, P2029, P2031, P2033, P2038 |
| CT99169 | Lab – specimen collection – blood – venous – venipuncture | 36415, S9529 |
| CT9917 | Procedure – related supplies – access catheter | A4301 |
| CT99173 | Lab – specimen collection – specimen handling | 99000 |
| CT99174 | Lab – microscopic – wet mount | Q0111 |
| CT99175 | Lab – microscopic – koh prep | Q0112 |
| CT99176 | Lab – stat request | S3600, S3601 |
| CT99182 | Transportation – paramedic | S0207, S0208 |
| CT99183 | Transportation – other transportation | A0021, A0080, A0090, A0100, A0110, A0120, A0130, A0140, A0160, A0170, A0180, A0190, A0200, A0210, A0225, A0380, A0382, A0384, A0390, A0392, A0394, A0396, A0398, A0420, A0422, A0424, A0425, A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436, A0888, A0998, A0999, P9603, P9604, S0209, S0215, S9992, T2001, T2002, T2003, T2004, T2005, T2007, T2049 |
| CT99184 | DME – other | A4639, A4640, A9281, A9283, A9300, A9900, A9901, A9999, S9381, T1999, T2029, T2039, T5999 |
| CT99185 | DME – bath / toilet aids | E0160, E0161, E0162, E0163, E0165, E0167, E0168, E0170, E0171, E0172, E0175, E0240, E0241, E0242, E0243, E0244, E0245, E0246, E0247, E0248, E0249 |
| CT99186 | DME – beds / accessories | E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0270, E0271, E0272, E0273, E0274, E0275, E0276, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0315, E0316, E0325, E0326, E0328, E0329, E0350, E0352, E0370, E0371, E0372, E0373, E0462 |
| CT99187 | DME – safety equipment | E0700, E0705 |
| CT99188 | DME – restraints | E0710 |
| CT99190 | DME – repair / maintenance | K0739 |
| CT99191 | Supplies | A4206, A4207, A4208, A4209, A4210, A4211, A4212, A4213, A4215, A4216, A4217, A4218, A4244, A4245, A4246, A4247, A4265, A4270, A4450, A4452, A4455, A4456, A4458, A4461, A4463, A4465, A4470, A4480, A4550, A4601, A4649, A6000, A6010, A6011, A6021, A6022, A6023, A6024, A6025, A6154, A6196, A6197, A6198, A6199, A6203, A6204, A6205, A6206, A6207, A6208, A6209, A6210, A6211, A6212, A6213, A6214, A6215, A6216, A6217, A6218, A6219, A6220, A6221, A6222, A6223, A6224, A6228, A6229, A6230, A6231, A6232, A6233, A6234, A6235, A6236, A6237, A6238, A6239, A6240, A6241, A6242, A6243, A6244, A6245, A6246, A6247, A6248, A6250, A6251, A6252, A6253, A6254, A6255, A6256, A6257, A6258, A6259, A6260, A6261, A6262, A6266, A6402, A6403, A6404, A6407, A6413, A6441, A6442, A6443, A6444, A6445, A6446, A6447, A6448, A6449, A6450, A6451, A6452, A6453, A6454, A6455, A6456, A6457, A6550, A7000, A7001, A7002, A9155, C1751, C1769, C9898, J1642, T2028 |
| CT99195 | Prosthetics – other | K0462 |
| CT99197 | Other – non – covered | A9270, G0293, G0294, S9986 |
| CT99198 | PQRI | G8427, G8428, G8430, G8440, G8441, G8442, G8447, G8448, G8508, G8509, G8524, G8525, G8526, G8530, G8531, G8532, G8534, G8535, G8536, G8537, G8538, G8539, G8540, G8541, G8542, G8543, G9019, G9020, G9033, G9035, G9036, G9140 |
| CT9920 | Procedure – related supplies – catheter | C1758, C2627 |
| CT9921 | Procedure – related supplies – dilation / stenting | C1726, C1876, C1877, C2617, C2625 |
| CT9922 | Procedure – related supplies – drainage | C1729 |
| CT9927 | Procedure – related supplies – other | C1727, C1765, C9250, C9359, C9360, C9361, C9363, C9364, Q9968 |
| CT9928 | Therapy – accupuncture | 97810, 97811, 97813, 97814 |
| CT9930 | Therapy – habilitation | T2013, T2014, T2015, T2016, T2017, T2018, T2019, T2020, T2021 |
| CT99309 | Physician Services | 99251 |
| CT9931 | Therapy – rehabilitation – other | G0409 |
| CT99311 | Urine Protein | 81000, 81001, 81002, 81003, 81005, 82042, 82043, 82044 |
| CT99312 | HbA1C | 83036, 83037 |
| CT99314 | Robotic Surgery | S2900 |
| CT99316 | Physician Services – Inpatient | 99356, 99357 |
| CT9932 | Therapy – nonoperative removal of foreign body | 45307, 45379, 46608 |
| CT9937 | Therapy – neurostimulator – tens – leads | A4595 |
| CT99392 | Other diagnostic procedures (interview, evaluation, consultation) | C1749, G0436, G0437, G0438, G0439, Q5010 |
| CT9940 | Therapy – other | 99024, E0761, M0075, M0300, S9355 |
| CT99400 | Advance care planning | S0255, S0257 |
| CT99401 | Bundled Payment / Medical Home | S0280, S0281 |
| CT99402 | Care Plan Oversight | 99339, 99340, 99374, 99375, 99377, 99378, 99379, 99380 |
| CT99403 | Case Management Services | G0162, G9012, S0250, T1001, T1016, T1017, T2022, T2023, T2024 |
| CT99407 | Case Management Services – Oncology | G9054, S0353, S0354 |
| CT99408 | Chronic Care Management | 99487, 99489 |
| CT99409 | Home Health / Hospice | G0179, G0180, G0181, G0182 |
| CT9941 | Rx – allergy – antihistamines / comb | J0945, J1200 |
| CT99410 | Coordinated Care Fees/Services | G9001, G9002, G9003, G9004, G9005, G9006, G9007, G9008, G9009, G9010, G9011 |
| CT99411 | Medication Therapy Management Services | 99605, 99606, 99607 |
| CT99412 | Online Management | 98969, 99444 |
| CT99413 | Personal Care Services | T1019, T1020 |
| CT99415 | Physician Services – Outpatient | 99358, 99359 |
| CT99416 | Procedures and Reporting | 99080, 99090, 99091 |
| CT99419 | Wellness Assessment | S5190 |
| CT9942 | Rx – gi – antichol/antispasmodics | J0461 |
| CT99420 | LEAD SCREENING | 83655 |
| CT9944 | Rx – autonomic rx – sympathomimetic rx | J0380, J0395, J1250, J1265, J3105, S9348 |
| CT9946 | Rx – analg/antipy/nsaids – nsaids | J1885 |
| CT9947 | Rx – analg/antipy/nsaids – narcotics | J0364, J0595, J0745, J1170, J1810, J2175, J2180, J2271, J2275, J2300, J2410, S0109 |
| CT9949 | Rx – electrolytic, caloric, water – calcium supplements | J0610, J0620 |
| CT9950 | Rx – electrolytic, caloric, water – potassium supp | J3480, S5012 |
| CT9951 | Rx – electrolytic, caloric, water – multi-mineral prep | J7120, S5014 |
| CT9952 | Rx – electrolytic, caloric, water – sodium chlor preps | J7030, J7040, J7050, J7130 |
| CT9953 | Rx – electrolytic, caloric, water – replacement preparations, misc | J7100, J7110 |
| CT9954 | Rx – electrolytic, caloric, water – caloric rx, amino acid prep | J1955 |
| CT9955 | Rx – electrolytic, caloric, water – caloric rx dextrose / rel | J7042, J7060, J7070, S5010, S5011, S5013 |
| CT9956 | Rx – electrolytic, caloric, water – hydration – unspecfied | 90760, 90761, Q0081, S9373, S9374, S9375, S9376, S9377 |
| CT9958 | Rx – miscellaneous rx – enzymes | J0180, J0205, J0220, J1931, J2504, J3470, J3471, J3472, J3473, S9357 |
| CT9959 | Rx – miscellaneous rx – heavy metal antagonists | J0470, J0600, J0895, J1190, J3520 |
| CT9960 | Rx – miscellaneous rx – anesthetics, local | J0670, J2001, J2400, J2795, S0020 |
| CT9961 | Rx – diagnostic rx – roentgenography | Q9957 |
| CT9962 | Rx – other | J0598, S9346, T1503 |
| CT9963 | Rx – pharmacy fee | Q0513, Q0514, S9430 |
| CT9964 | Other care – home care – specialized visit | 99507, 99509, 99510, 99511, 99600 |
| CT9965 | Other care – home care – physician supervision | G0372, S0270, S0272 |
| CT9966 | Other care – home care – nursing care | G0128, T1000, T1002, T1003, T1004 |
| CT9967 | Other care – home care – nursing care – rn | G0154, S9123, T1030 |
| CT9968 | Other care – home care – nursing care – lpn | S9124, T1031 |
| CT9969 | Other care – home care – nursing care – np | S0274 |
| CT9970 | Other care – home care – rehabilitation – physical therapy | G0151, G0157, G0158 |
| CT9971 | Other care – home care – rehabilitation – occupational therapy | G0152 |
| CT9973 | Other care – home care – social worker | G0155, S9127 |
| CT9974 | Other care – home care – home health aide | G0156, S9122, T1021 |
| CT9975 | Other care – home care – other care – day care | S5100, S5101, S5102, S5105 |
| CT9976 | Other care – home care – other care – chore care | S5120, S5121 |
| CT9977 | Other care – home care – other care – attendant care | S5125, S5126 |
| CT9978 | Other care – home care – other care – homemaker | S5130, S5131 |
| CT9979 | Other care – home care – other care – companion care | S5135, S5136 |
| CT9980 | Other care – home care – other care – respite care | S5150, S5151, S9125, T1005 |
| CT9981 | Other care – home care – other care | S5165, S5175, S5185, S5199, T1022 |
| CT9982 | Other care – home care – training | S5108, S5109, S5110, S5111, S5115, S5116 |
| CT9983 | Other care – home care – emergency response system | S5160, S5161, S5162 |
| CT9984 | Other care – home care – meals | S5170 |
| CT9985 | Other care – pain management – pca / related | S9325, S9326, S9327, S9328 |
| CT9986 | Other care – hospice | G0337, Q5001, Q5002, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5009, S0271, S9126, T2042, T2043, T2044, T2045, T2046 |
| CT9987 | Other care – long term care – residential care | T2010, T2011, T2032, T2033 |
| CT9988 | Other care – long term care – assisted living | T2030, T2031 |
| CT9990 | Other care – other – ancillary services | 97804, 99001, 99002, 99070, 99071, 99075, 99082, 99199 |
| CT9995 | Other care – other – irrigation | S9590 |
| CT9996 | Other care – other – lodging | S9976, S9994 |
| CT9997 | Other care – other – meals | S9977, S9996 |
| CT9998 | Other care – other – medical records | S9981, S9982 |
| XX0000 | Ungrouped Codes | 0007M, 0226T, 0227T, 0249T, 0355T, 0377T, 33952, 33954, 33958, 33962, 33966, 33984, 37191, 37192, 37193, 37619, 44384, 45399, 46601, 46607, 6030F, 7010F, 81288, 81435, 81436, 90769, 90770, 90771, 90776, 91117, 96360, A4459, A5056, A5057, C9443, C9444, C9446, C9735, G0434, G0472, G0473, G6021, G6027, G6028, G6045, G6046, G8155, G8156, G8157, G8214, G8217, G8219, G8220, G8221, G8569, G8570, G8571, G8572, G8575, G8576, G8577, G8578, G8579, G8580, G8581, G8582, G8583, G8584, G8585, G8586, G8587, G8588, G8589, G8590, G8591, G8592, G8593, G8594, G8595, G8596, G8597, G8598, G8599, G8600, G8601, G8602, G8603, G8604, G8605, G8606, G8607, G8608, G8609, G8610, G8611, G8612, G8613, G8614, G8615, G8616, G8617, G8618, G8619, G8620, G8621, G8622, G8623, G8624, G8625, G8626, G8627, G8628, G8629, G8630, G8631, G8632, G8633, G8634, G8635, G8636, G8637, G8638, G8639, G8640, G8641, G8642, G8643, G8644, G8675, G8676, G8677, G8678, G8679, G8680, G8687, G8689, G8691, G8693, G8696, G8697, G8698, G8967, G8968, G8969, G8970, G8971, G8972, G9199, G9200, G9201, G9298, G9299, G9362, G9363, G9496, G9497, G9500, G9501, G9612, G9613, G9614, G9637, G9638, G9642, G9644, G9645, G9659, G9660, G9661, G9936, G9937, J2274, J2704, Q9974, S0144 |
Table 6: Relevant Typical Drug Groups
| Group ID | Group Name |
| RX001 | contrast media |
| RX002 | diagnostic agents |
| RX0111 | parasympathomimetics |
| RX017 | hypnotics and sedatives |
| RX0324 | throat preparations |
| RX0531 | Agents for hypertensive emergencies |
| RX0538 | diuretics |
| RX0539 | i.v. solutions & additives |
| RX0540 | Nitrates and other antianginals |
| RX0541 | other antihypertensives |
| RX0546 | Antiplatelet agents, thrombin inhibitors |
| RX0645 | antacids |
| RX0646 | antidiarrheals intestinal adsorbents |
| RX0647 | antiemetics and antinauseants |
| RX0648 | digestives incl. enzymes |
| RX0649 | drugs for constipation |
| RX0650 | drugs for functional gastrointestinal disorders |
| RX0651 | drugs for peptic ulcer and gerd |
| RX0652 | intestinal antiinfectives |
| RX0653 | intestinal antiinflammatory agents |
| RX0654 | stomatological preparations |
| RX0857 | antiinflammatory and antirheumatic products |
| RX0860 | muscle relaxants |
| RX0861 | opioids |
| RX0862 | other analgesics and antipyretics |
| RX0864 | topical products for joint and muscular pain |
| RX0965 | agents for treatment of hemorrhoids and anal fissures for topical use |
| RX0968 | antibiotics and chemotherapeutics for dermatological use |
| RX0969 | antifungals for dermatological use |
| RX0970 | antipruritics incl. antihistamines anesthetics etc. |
| RX0971 | antiseptics and disinfectants |
| RX0976 | irrigating solutions |
| RX0977 | medicated dressings |
| RX0979 | preparations for treatment of wounds and ulcers |
| RX1086 | corticosteroids for systemic use |
| RX1087 | drugs affecting bone structure and mineralization |
| RX1088 | drugs for inborn errors of metabolism |
| RX1194 | urinary antiinfectives and antiseptics |
| RX13104 | GYNECOLOGICAL ANTIINFECTIVES AND ANTISEPTICS |
| RX16106 | iron preparations |
| RX16109 | vitamin b12 and folic acid |
| RX18114 | agents against amoebiasis and other protozoal diseases |
| RX18115 | agents against leishmaniasis and trypanosomiasis |
| RX18116 | anthelmintics |
| RX18117 | antibacterials for systemic use |
| RX18119 | antiinfectives |
| RX19125 | anxiolytics |
| RX23131 | mineral supplements |
| RX23133 | other nutrients |
| RX23135 | vitamins |
| RX99136 | anesthetics general |
| RX99137 | anesthetics local |
| RX99138 | medical gas |