Coding and Payment Guide for Laboratory Services Procedure ... 20_0… · Coding and Payment Guide...

36400-36410Venipuncture, younger than age 3 years, necessitating the skill ofa physician or other qualified health care professional, not to beused for routine venipuncture; femoral or jugular vein

36400

scalp vein36405

other vein36406

Venipuncture, age 3 years or older, necessitating the skill of aphysician or other qualified health care professional (separate

36410

procedure), for diagnostic or therapeutic purposes (not to be usedfor routine venipuncture)

ExplanationIn 36400, a needle is inserted through the skin to puncture the femoralor jugular vein of a child younger than age 3. The needle is insertedinto the vein and used for the withdrawal of blood for diagnostic studyor for the therapeutic infusion of intravenous medication. A soft flexiblecatheter may be placed for prolonged therapy. When the scalp vein ispunctured, see 36405. For a vein other than the femoral, jugular, sagittalsinus, or scalp vein, report 36406. In 36410, a needle is inserted throughthe skin to puncture a vein of a person 3 years of age or older. Theneedle is inserted into the vein and used for the withdrawal of bloodfor diagnostic study or for the therapeutic infusion of intravenousmedication. A soft flexible catheter may be placed for prolongedtherapy. Once the procedure is complete, the needle or catheter iswithdrawn and pressure is applied over the puncture site to controlbleeding. These codes are used for venipuncture necessitating the skillof a physician or other qualified health care provider, not when routinevenipuncture is performed.

Coding TipsFor collection of venous blood by venipuncture, see 36415. Collectionof blood specimen by finer, heel, or ear stick is reported using 36416.Most third-party payers and state scope of work exclude the use of acode requiring a physician or other qualified health care provider, bya phlebotomist, or other unlicensed clinical staff.

Terms To Knowcannula. Tube inserted into a blood vessel, duct, or body cavity to facilitatepassage.specimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.

ICD-9-CM Diagnostic CodesThe application of this code is too broad to adequately presentICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.

CCI Version 20.069990

Also not with 36400: 99195v


Also not with 36410: 36450v, 36460v, 36510v, 96523, 99195v

Note: These CCI edits are used for Medicare. Other payers mayreimburse on codes listed above.

Fac TotalNon-Fac TotalMalpracticeFac PENon-Fac PEWork Value

0.590.860.050.160.43............... 0.3836400.........0.490.760.050.130.40............... 0.3136405.........0.270.540.030.060.33............... 0.1836406.........0.280.480.030.070.27............... 0.1836410.........

89CPT 2014 American Medical Association. All Rights Reserved. 2014 OptumInsight, Inc.

Procedure CodesCoding and Payment Guide for Laboratory Services

36415-36416Collection of venous blood by venipuncture36415

Collection of capillary blood specimen (eg, finger, heel, ear stick)36416

ExplanationA needle is inserted into the skin over a vein to puncture the bloodvessel and withdraw blood for venous collection in 36415. In 36416,a prick is made into the finger, heel, or ear and capillary blood thatpools at the puncture site is collected in a pipette. In either case, theblood is used for diagnostic study and no catheter is placed.

Coding TipsFor a child older than 3 or an adult, see code 36410. For routinevenipuncture for collection of specimens, see code 36415. For scalpvenipuncture in a child 3 years or younger, see code 36405. Forvenipuncture, without cutdown, younger than 3, see codes36400-36406. This procedure does not include laboratory analysis. Ifa specimen is transported to an outside laboratory, report code 99000for handling or conveyance. The frequency limit for reporting code36415 is once per day. Code 36415 is paid under the laboratory feeschedule. No deductible or coinsurance apply. The collection of capillaryblood specimen, CPT code 36416, is not reportable to Medicare. Code36415 is not subject to Medicare deductible or coinsurance since it ispaid on the laboratory fee schedule.

Terms To Knowcapillary. Tiny, minute blood vessel that connects the arterioles (smallestarteries) and the venules (smallest veins) and acts as a semipermeable membranebetween the blood and the tissue fluid.pipette. Small, narrow glass or plastic tube with both ends open used formeasuring or transferring liquids.specimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.


IOM References100-4,16,60.1.4

CCI Version 20.0No CCI Edits apply to this code.


0.000.000.000.000.00............... 0.0036415.........0.000.000.000.000.00............... 0.0036416.........

2014 OptumInsight, Inc.CPT 2014 American Medical Association. All Rights Reserved.90

Coding and Payment Guide for Laboratory ServicesProcedure Codes

36420-36425Venipuncture, cutdown; younger than age 1 year36420

age 1 or over36425

ExplanationThe physician makes an incision in the skin directly over the vessel anddissects the area surrounding the vein. A needle is passed into the veinfor the withdrawal of blood or for the infusion of intravenous medicationof a patient under 12 months of age (in 36420) or over 12 months ofage (in 36425). A catheter may be left behind. Once the procedure iscomplete, the incision is repaired with a layered closure.

Coding TipsLocal anesthesia is included in these services. Do not append modifier63 to code 36420 as the description or nature of the procedure includesinfants up to 4 kg. If a specimen is transported to an outside laboratory,report code 99000 for handling or conveyance. For venipuncture ona patient younger than 3 years of age, see 36400-36406. Forvenipuncture requiring physician skill on a patient 3 years of age orolder, see code 36410. Do not report code 36420 or 36425 if providedwith critical care, see codes 99468-99480. Code 36425 should not bereported with endovenous ablation (36475-36479).

Terms To Knowcritical care. Treatment of critically ill patients in a variety of medicalemergencies that requires the constant attendance of the physician (e.g.,cardiac arrest, shock, bleeding, respiratory failure, postoperative complications,critically ill neonate).specimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.


IOM References100-3,20.18; 100-3,110.5; 100-3,110.7




1.401.400.110.280.28............... 1.0136420.........1.161.160.110.290.29............... 0.7636425.........



36430-36440Transfusion, blood or blood components36430

Push transfusion, blood, 2 years or younger36440

ExplanationThe physician transfuses blood or blood components to a patient in36430. The physician establishes venous access with a needle andcatheter and transfuses the blood products. Report 36440 when thephysician performs a push transfusion on a child 2 years old and under.The physician calculates the amount of blood to be transfused andslowly injects it into the patient using a needle or existing catheter.

Coding TipsCode 36430 Transfusion, blood or blood components, should bereported only once per transfusion, regardless of how many units areadministered. If separate transfusion services are performed on differentdates, then the code may be reported once for date of service. To reportcharges for transfusion services, for providers reporting under OPPS, atransfusion APC will be paid to the hospital for transfusing blood onceper day, regardless of the number of units transfused. Bill transfusionservices with revenue code 0391 Blood administration, and CPT codes3643036460. The hospital may also bill for blood typing and crossmatching. The OPPS Integrated Outpatient Code Editor (IOCE) containsan edit that limits the number of units reported for 36430 to 1. A claimsubmitted with more than one unit of 36430 reported on the samedate of service will be returned to provider unprocessed.For payment,a blood product HCPCS code is required when billing a transfusionservice code. To report laboratory services associated with blood orblood component transfusions, see codes 86850-86999. To reportapheresis, see codes from range 36511-36512. To report therapeuticphlebotomy, see CPT code 99195.

Terms To Knowblood bank. Facility for collecting, processing, storing, or distributing humanblood, blood components, or blood derivatives.blood components. Preparations separated from a single donation of wholeblood including but not limited to plasma, fresh frozen plasma, red blood cells,platelets, and cryoprecipitate.plasma. Liquid portion of the blood, lymph, or milk.transfusion. Process of transferring whole blood or blood components fromone person, the donor, to another person, the recipient, or the process oftaking liquid from one vessel and putting it into another.


IOM References100-1,3,20.5; 100-1,3,20.5.2; 100-2,1,10; 100-3,110.5; 100-3,110.7;100-3,110.8; 100-3,110.16; 100-4,3,40.2.2


Also not with 36430: 36460v, J1644



0.950.950.010.940.94............... 0.0036430.........1.661.660.230.400.40............... 1.0336440.........



36511-36513 - NCDTherapeutic apheresis; for white blood cells36511

for red blood cells36512

for platelets36513

ExplanationTherapeutic apheresis is the removal of some specific circulating bloodcomponent, cells or plasma solute, that is directly responsible for adisease process. Cells and plasma components may also be mobilizedfrom other tissue storage during apheresis, such as from the spleen andlymph nodes, for enhanced clearance of the undesired element. Thepatient is prepared much the same as giving a regular blood donation.Whole blood is drawn out of one arm and into an instrument called aseparator, which uses a microprocessing technique to draw the blood,anticoagulate it, and separate the component to be removed bycentrifugal spinning, filtration, or column adsorption with the help ofcomputerized calibration. The cells to be removed are collected whilethe remainder of the blood is recombined and returned to the patientthrough a tube and needle in the other arm. Report 36511 for whiteblood cell isolation and removal (leukapheresis or lymphocytapheresis),36512 for red blood cell removal, and 36513 for removal of platelets.

Coding TipsReport code 36511 for white blood cell isolation and removal(leukapheresis or lymphocytapheresis), code 36512 for red blood cellremoval, and code 36513 for removal of platelets. For therapeuticapheresis for plasma pheresis, see code 36514. For therapeutic apheresiswith extracorporeal immunoadsorption and plasma reinfusion, see code36515. For therapeutic apheresis with extracorporeal selectiveadsorption or selective filtration and plasma reinfusion, see code 36516.Apheresis is covered only when performed in a hospital setting (eitherinpatient or outpatient) or in a nonhospital setting (e.g., aphysician-directed clinic). Nonphysician services furnished to hospitalpatients are covered, and paid for as hospital services. When coveredservices are provided to hospital patients by an outside provider orsupplier, the hospital is responsible for paying the provider or supplierfor the services. In a nonhospital setting (e.g., a physician-directedclinic) the following conditions must be met: a) the physician (ornumber of physicians) is present to perform medical services and torespond to medical emergencies at all times during patient care hours;b) each patient is under the care of a physician; and c) all nonphysicianservices are furnished under the direct, personal supervision of aphysician.

ICD-9-CM Diagnostic CodesMonoclonal paraproteinemia (Use additional code toidentify any associated intellectual disabilities)

273.1

Myasthenia gravis with (acute) exacerbation358.01Goodpasture's syndrome (Use additional code to identifyrenal disease: 583.81)

446.21

Thrombotic microangiopathy446.6

Chronic kidney disease, Stage I (Use additional code toidentify kidney transplant status, if applicable: V42.0. Use

585.1

additional code to identify manifestation: 357.4, 420.0.Code first hypertensive chronic kidney disease, if applicable:403.00-403.91, 404.00-404.93)Chronic kidney disease, Stage II (mild) (Use additionalcode to identify kidney transplant status, if applicable:

585.2

V42.0. Use additional code to identify manifestation: 357.4,420.0. Code first hypertensive chronic kidney disease, ifapplicable: 403.00-403.91, 404.00-404.93)Chronic kidney disease, Stage III (moderate) (Useadditional code to identify kidney transplant status, if

585.3

applicable: V42.0. Use additional code to identifymanifestation: 357.4, 420.0. Code first hypertensive chronickidney disease, if applicable: 403.00-403.91,404.00-404.93)Chronic kidney disease, Stage IV (severe) (Use additionalcode to identify kidney transplant status, if applicable:

585.4

V42.0. Use additional code to identify manifestation: 357.4,420.0. Code first hypertensive chronic kidney disease, ifapplicable: 403.00-403.91, 404.00-404.93)Chronic kidney disease, Stage V (Use additional codeto identify kidney transplant status, if applicable: V42.0.

585.5

Use additional code to identify manifestation: 357.4, 420.0.Code first hypertensive chronic kidney disease, if applicable:403.00-403.91, 404.00-404.93)

This list of ICD-9-CM codes might not be all-inclusive. Please refer toyour Laboratory Cross Coder to determine if other diagnoses areapplicable.

IOM References100-3,110.14; 100-4,4,231.9

CCI Version 20.00213T, 0216T, 0228T, 0230T, 12001-12007, 12011-12057,13100-13133, 13151-13153, 36000, 36400-36410, 36420-36430,36600, 36640, 37202, 43752, 51701-51703, 62310-62319,64400-64435, 64445-64450, 64479, 64483, 64490, 64493,64505-64530, 69990, 93000-93010, 93040-93042, 93318, 94002,94200, 94250, 94680-94690, 94770, 95812-95816, 95819, 95822,95829, 95955, 96360, 96365, 96372, 96374-96376, 99148-99149,99150, 99201-99255, 99281-99285, 99291-99292, 99304-99310,99315-99318, 99324-99328, 99334-99337, 99341-99350,99374-99375, 99377-99378, 99446-99449, 99466, 99468-99480,99485, 99495-99496, G0380-G0384

Also not with 36511: 36440, 36512-36516v

Also not with 36512: 36440-36455v, 36513-36516v

Also not with 36513: 36440, 36514-36516v



2.742.740.260.740.74............... 1.7436511.........2.702.700.150.810.81............... 1.7436512.........2.862.860.330.790.79............... 1.7436513.........



36514-36516 - NCDTherapeutic apheresis; for plasma pheresis36514

with extracorporeal immunoadsorption and plasma reinfusion36515

with extracorporeal selective adsorption or selective filtrationand plasma reinfusion

36516

ExplanationTherapeutic apheresis is the removal of some specific circulating bloodcomponent, cells or plasma solute, that is directly responsible for adisease process. Cells and plasma components may also be mobilizedfrom other tissue storage during apheresis, such as from the spleen andlymph nodes, for enhanced clearance of the undesired element. Thepatient is prepared much the same as giving a regular blood donation.Whole blood is drawn out of one arm and into an instrument called aseparator, which uses a microprocessing technique to draw the blood,anticoagulate it, and separate the component to be removed bycentrifugal spinning, filtration, or column adsorption with the help ofcomputerized calibration. Plasmapheresis, reported with 36514 is theisolation of the plasma from the blood. Plasma exchange isolates,discards, and replaces the plasma with a substitute fluid, like albumin.Plasma exchange is nonspecific since the plasma is discarded on thebasis that toxins and antibodies accumulate in the plasma. The bestmethod requires treating a disorder by removing the offendingabnormal plasma component selectively. Apheresis for plasma withextracorporeal immunoadsorption and reinfusion of the patient's plasmamay be done, reported with 36515. This procedure uses Protein Acolumns to specifically remove circulating immune complexes. Report36516 for extracorporeal selective adsorption or selective filtration,such as dextran sulfate cellulose columns to selectively removelow-density lipoproteins, with plasma reinfusion.

Coding TipsFor therapeutic apheresis for white blood cells, see code 36511. Fortherapeutic apheresis for red blood cells, see 36512. For therapeuticapheresis for platelets, see code 36513. Apheresis is covered only whenperformed in a hospital setting (either inpatient or outpatient) ornonhospital setting (e.g., a physician-directed clinic). Nonphysicianservices furnished to hospital patients are covered and paid for ashospital services. When covered services are provided to hospitalpatients by an outside provider or supplier, the hospital is responsiblefor paying the provider or supplier for the services. In a nonhospitalsetting (e.g., a physician-directed clinic), the following conditions mustbe met: a) the physician (or number of physicians) is present to performmedical services and to respond to medical emergencies at all timesduring patient care hours; b) each patient is under the care of aphysician; and c) all nonphysician services are furnished under thedirect, personal supervision of a physician. When reporting theprofessional evaluation, modifier 26 should be appended to code 36516.

ICD-9-CM Diagnostic CodesPlasma cell leukemia, in relapse203.12Acute myeloid leukemia, in relapse205.02Chronic myeloid leukemia, in relapse205.12

Subacute myeloid leukemia, in relapse205.22Acute leukemia of unspecified cell type, without mentionof having achieved remission

208.00

Acute leukemia of unspecified cell type, in relapse208.02Chronic leukemia of unspecified cell type, in relapse208.12Subacute leukemia of unspecified cell type, in relapse208.22Primary thrombocytopenia, unspecified287.30Immune thrombocytopenic purpura287.31Congenital and hereditary thrombocytopenic purpura287.33Other primary thrombocytopenia287.39Multiple sclerosis340Unspecified demyelinating disease of central nervoussystem

341.9

Polyneuropathy in collagen vascular disease (Code firstunderlying disease: 446.0, 710.0, 714.0)

357.1

Goodpasture's syndrome (Use additional code to identifyrenal disease: 583.81)

446.21

Pemphigus694.4Systemic lupus erythematosus (Use additional code toidentify manifestation: 424.91, 581.81, 582.81, 583.81)

710.0

Systemic sclerosis (Use additional code to identifymanifestation: 359.6, 517.2)

710.1


IOM References100-3,20.5; 100-3,110.14; 100-4,4,231.9

CCI Version 20.00213T, 0216T, 0228T, 0230T, 12001-12007, 12011-12057,13100-13133, 13151-13153, 36000, 36400-36410, 36420-36430,36440, 36600, 36640, 37202, 43752, 51701-51703, 62310-62319,64400-64435, 64445-64450, 64479, 64483, 64490, 64493,64505-64530, 69990, 93000-93010, 93040-93042, 93318, 94002,94200, 94250, 94680-94690, 94770, 95812-95816, 95819, 95822,95829, 95955, 96360, 96365, 96372, 96374-96376, 99148-99149,99150, 99201-99255, 99281-99285, 99291-99292, 99304-99310,99315-99318, 99324-99328, 99334-99337, 99341-99350,99374-99375, 99377-99378, 99446-99449, 99466, 99468-99480,99485, 99495-99496, G0380-G0384, J1644

Also not with 36514: 36515-36516v




2.7214.670.260.7212.67............... 1.7436514.........2.5258.270.230.5556.30............... 1.7436515.........2.0457.020.330.4955.47............... 1.2236516.........



36591-36592Collection of blood specimen from a completely implantablevenous access device

36591

Collection of blood specimen using established central orperipheral catheter, venous, not otherwise specified

36592

ExplanationThe physician obtains a blood specimen from a previously placed,completely implantable venous access device (36591) or from anestablished central venous or peripheral venous catheter (36592).Completely implanted devices are those that have access through asubcutaneous port (e.g., Port-A-Cath, Infusaport). An implantable accessdevice requires a percutaneous noncoring needle to accomplish theblood draw. The skin is cleansed with alcohol or iodine solution. Theneedle is placed into the port. Heparin is withdrawn. A second needleis inserted and the blood specimen obtained. The port is flushed withheparin solution. A central venous catheter (CVC) is one that is insertedthrough the skin into central veins, such as the femoral, internal jugular,or subclavian veins. Peripheral catheters include those inserted in thearm veins (basilic or cephalic), such as a PICC line, saline lock, or heparinlock. In order to clear the catheter of any material that couldcontaminate the sample and affect the test results, a specific volumeof infusing fluid and blood must be discarded before a blood specimenis obtained; this volume will vary depending on the type of catheterutilized. With a central venous catheter, a three-way stopcock is attachedto the catheter's hub and two syringes attached to the stopcock. Usingone syringe, the catheter is flushed with normal saline. A specific amountof blood is aspirated into the same syringe used for the saline flush anddiscarded. The blood sample is then withdrawn using the other syringeand placed into an appropriate tube for laboratory analysis. If using aperipheral venous catheter, a specific amount of blood is also aspiratedand discarded before the blood sample is drawn.

Coding TipsDo not report 36591or 36592 with any other service other thanlaboratory procedures. Collection of venous blood specimen byvenipuncture is reported with code 36415. For collection of capillaryblood specimen, see 36416. For arterial puncture, see 36600. Surgicaltrays, A4550, are not separately reimbursed by Medicare; however,other third-party payers may cover them. Check with the specific payerto determine coverage.

Terms To Knowartery. Vessel through which oxygenated blood passes away from the heartto any part of the body.aspirate. To withdraw fluid or air from a body cavity by suction.catheter. Flexible tube inserted into an area of the body for introducing orwithdrawing fluid.peripheral. Outside of a structure or organ.

Port-a-cath. Brand name for an implantable system used for vascular accesswhen the patient's treatment plan requires repeat administration of drugs (e.g.,chemotherapy), fluids, and/or nutrition. This system may also be used forrepeated blood sampling. Refer to CPT codes 36560-36571 for insertion of animplantable catheter; 36575-36585 for replacement procedures; 36589-36590for removal; and 36595-36597 for other procedures on a central venous catheterdevice.subcutaneous. Below the skin.




0.650.650.010.640.64............... 0.0036591.........0.730.730.010.720.72............... 0.0036592.........



36593Declotting by thrombolytic agent of implanted vascular accessdevice or catheter

36593

ExplanationTo remove a clot from an implanted vascular access device or catheter,the physician injects a thrombolytic agent (e.g., Streptokinase) into thecatheter to dissolve the clot. The patient is observed for any abnormalsigns of bleeding.

Coding TipsWhen 36593 is performed with another separately identifiableprocedure, the highest dollar value code is listed as the primaryprocedure and subsequent procedures are appended with modifier 51.Do not report code 36593 in conjunction with code 36595, 36596, or36870. For thrombectomy of an arteriovenous fistula, see codes 36831and 36870. Supplies used when providing this procedure may bereported with code J2995. Check with the specific payer to determinecoverage.

Terms To Knowblood clot. Semisolidified, coagulated mass of mainly platelets and fibrin inthe bloodstream.catheter. Flexible tube inserted into an area of the body for introducing orwithdrawing fluid.thrombolytic agent. Drugs or other substances used to dissolve blood clotsin blood vessels or in tubes that have been placed into the body.

ICD-9-CM Diagnostic CodesOther complications due to other vascular device, implant,and graft (Use additional code to identify complication:338.18-338.19, 338.28-338.29)

996.74


CCI Version 20.036005, 69990, 75896, J1642



0.860.860.010.850.85............... 0.0036593.........



36600Arterial puncture, withdrawal of blood for diagnosis36600

ExplanationThe physician inserts a needle through the skin and punctures the arteryto withdraw blood for testing. No catheter is left in the artery. Pressureis applied to the puncture site to stop the flow of blood.

Coding TipsThis code is used to report the percutaneous insertion of a needle orcatheter into a radial, brachial, or femoral artery, for the purpose ofobtaining a single arterial blood sample for blood gas analysis.Documentation will indicate that the needle was removed once thespecimen was obtained. See codes 36620-36640 when documentationindicates that an invasive placement of an indwelling arterial catheterfor direct and frequent monitoring of physiologic indexes wasperformed. Report code 36600 only once when multiple tests areperformed on the same arterial blood draw. This procedure does notinclude laboratory analysis. If a specimen is transported to an outsidelaboratory, report code 99000 for handling or conveyance.

Terms To Knowarterial catheterization. Introduction of a narrow, hollow tube within anartery to allow for therapeutic or diagnostic proceedings, such as visualizationinside the lumen, measurement of arterial pressures, injections, or repair.percutaneous. Through the skin.specimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.


CCI Version 20.036002-36005, 36120-36140, 36625, 69990, 76000-76001,77001-77002, J0670, J2001



0.450.880.030.100.53............... 0.3236600.........



80047Basic metabolic panel (Calcium, ionized)80047

ExplanationA basic metabolic panel with ionized calcium includes the followingtests: calcium (ionized) (82330), carbon dioxide (82374), chloride(82435), creatinine (82565), glucose (82947), potassium (84132),sodium (84295), and urea nitrogen (BUN) (84520). Blood specimenis obtained by venipuncture. See the specific codes for additionalinformation about the listed tests.

Coding TipsReport organ or disease-oriented panel codes only when each panelcomponent in the panel definition is performed. The assignment oforgan or disease oriented panel codes is optional for most non-Medicarepayers. You may assign an organ or disease panel code or opt to reporteach individual assay code. Medicare guidelines state that if all tests ofa CPT defined panel are performed, the provider may bill the panelcode or the individual component test codes. The panel codes may beused when the tests are ordered as that panel or if the individualcomponent tests of a panel are ordered separately. According to CPTguidelines, do not report two or more organ or disease-oriented panelswhen any of the same tests are performed in each panel and the panelsare performed from the same patient collection. When a group of testsoverlap two or more panels, report the panel that has the greatestnumber of tests allowing the definition of that panel to be met andthen report the remaining tests using the appropriate individual testcodes. This test may be performed using a CLIA-waived test system.Laboratories with a CLIA-waived certificate must report this code withmodifier QW CLIA-waived test. See appendix 1 for CLIA-waived kitsand test systems. An ionized calcium basic metabolic panel should notbe billed in addition to a comprehensive metabolic panel (80053).Venipuncture is separately reportable. For collection of venous bloodby venipuncture, see code 36415. When venipuncture on a patient 3years of age or older requires the skill of a physician or other qualifiedhealth care provider, see code 36410. For venipuncture on a patientyounger than 3 years of age performed by a physician or other qualifiedhealth care provider, see codes 36400-36406. Most third-party payersand state scope of work exclude the use of a code requiring a physicianor other qualified health care provider, by a phlebotomist, or otherunlicensed clinical staff.

Terms To KnowCLIA. Clinical Laboratory Improvement Amendments. Requirements set in1988, CLIA imposes varying levels of federal regulations on clinical procedures.Few laboratories, including those in physician offices, are exempt. Adopted byMedicare and Medicaid, CLIA regulations redefine laboratory testing in regardto laboratory certification and accreditation, proficiency testing, qualityassurance, personnel standards, and program administration.

laboratory. Facility for the virological, microbiological, serological, chemical,immunohematological, hematological, biophysical, cytological, pathological,or other examination of materials derived from the human body for the purposeof providing information for the diagnosis, prevention, or treatment of anydisease or impairment of or the assessment of the health of human beings.These examinations also include procedures to determine, measure, or otherwisedescribe the presence or absence of various substances or organisms in thebody. Facilities that only collect or prepare specimens (or both) or act only asa mailing service and do not perform tests are not considered laboratories.


IOM References100-2,11,30.2.2; 100-2,15,80.1; 100-4,16,40.6.1; 100-4,16,70.8;100-4,16,100.6

CCI Version 20.080048, 80051, 82330, 82374, 82435, 82565, 82947, 84132, 84295,84520



0.000.000.000.000.00............... 0.0080047.........



80048Basic metabolic panel (Calcium, total)80048

ExplanationA basic metabolic panel with total calcium includes the following tests:total calcium (82310), carbon dioxide (82374), chloride (82435),creatinine (82565), glucose (82947), potassium (84132), sodium(84295), and urea nitrogen (BUN) (84520). The blood specimen isobtained by venipuncture. See the specific codes for additionalinformation about the listed tests.

Coding TipsReport organ or disease-oriented panel codes only when each panelcomponent in the panel definition is performed. The assignment oforgan or disease oriented panel codes is optional for most non-Medicarepayers. You may assign an organ or disease panel code or opt to reporteach individual assay code. Medicare guidelines state that if all tests ofa CPT defined panel are performed, the provider may bill the panelcode or the individual component test codes. The panel codes may beused when the tests are ordered as that panel or if the individualcomponent tests of a panel are ordered separately. According to CPTguidelines, do not report two or more organ or disease-oriented panelswhen any of the same tests are performed in each panel and the panelsare performed from the same patient collection. When a group of testsoverlap two or more panels, report the panel that has the greatestnumber of tests allowing the definition of that panel to be met, andthen report the remaining tests using the appropriate individual testcodes. This test may be performed using a CLIA-waived test system.Laboratories with a CLIA-waived certificate must report this code withmodifier QW CLIA-waived test. See appendix 1 for CLIA-waived kitsand test systems. A total calcium basic metabolic panel should not bebilled in addition to a comprehensive metabolic panel (80053).Venipuncture is separately reportable. For collection of venous bloodby venipuncture, see code 36415. When venipuncture on a patient 3years of age or older requires the skill of a physician or other qualifiedhealth care provider, see code 36410. For venipuncture on a patientyounger than 3 years of age performed by a physician or other qualifiedhealth care provider, see codes 36400-36406. Most third-party payersand state scope of work exclude the use of a code requiring a physicianor other qualified health care provider, by a phlebotomist, or otherunlicensed clinical staff.

Terms To KnowCLIA. Clinical Laboratory Improvement Amendments. Requirements set in1988, CLIA imposes varying levels of federal regulations on clinical procedures.Few laboratories, including those in physician offices, are exempt. Adopted byMedicare and Medicaid, CLIA regulations redefine laboratory testing in regardto laboratory certification and accreditation, proficiency testing, qualityassurance, personnel standards, and program administration.

laboratory. Facility for the virological, microbiological, serological, chemical,immunohematological, hematological, biophysical, cytological, pathological,or other examination of materials derived from the human body for the purposeof providing information for the diagnosis, prevention, or treatment of anydisease or impairment of or the assessment of the health of human beings.These examinations also include procedures to determine, measure, or otherwisedescribe the presence or absence of various substances or organisms in thebody. Facilities that only collect or prepare specimens (or both) or act only asa mailing service and do not perform tests are not considered laboratories.


IOM References100-2,11,30.2.2; 100-4,16,70.8

CCI Version 20.080051, 82310, 82374, 82435, 82565, 82947, 84132, 84295, 84520



0.000.000.000.000.00............... 0.0080048.........



80050General health panel80050

ExplanationA general health panel includes the following tests: albumin (82040),total bilirubin (82247), calcium (82310), carbon dioxide (bicarbonate)(82374), chloride (82435), creatinine (82565), glucose (82947), alkalinephosphatase (84075), potassium (84132), total protein (84155), sodium(84295), alanine amino transferase (ALT) (SGPT) (84460), aspartateamino transferase (AST) (SGOT) (84450), urea nitrogen (BUN) (84520),and thyroid stimulating hormone (84443). In addition, this panelincludes a hemogram with automated differential (85025 or 85027and 85004) or hemogram (85027) with manual differential (85007 or85009). Blood specimen is obtained by venipuncture. See specific codesfor additional information about the listed tests.

Coding TipsReport organ or disease-oriented panel codes only when each panelcomponent in the panel definition is performed. The assignment oforgan or disease oriented panel codes is optional for most non-Medicarepayers. You may assign an organ or disease panel code or opt to reporteach individual assay code. Medicare guidelines state that if all tests ofa CPT defined panel are performed, the provider may bill the panelcode or the individual component test codes. The panel codes may beused when the tests are ordered as that panel or if the individualcomponent tests of a panel are ordered separately. According to CPTguidelines, do not report two or more organ or disease-oriented panelswhen any of the same tests are performed in each panel and the panelsare performed from the same patient collection. When a group of testsoverlap two or more panels, report the panel that has the greatestnumber of tests allowing the definition of that panel to be met, andthen report the remaining tests using the appropriate individual testcodes. Venipuncture is separately reportable. For collection of venousblood by venipuncture, see code 36415. When venipuncture on apatient 3 years of age or older requires the skill of a physician or otherqualified health care provider, see code 36410. For venipuncture on apatient younger than 3 years of age performed by a physician or otherqualified health care provider, see codes 36400-36406. Most third-partypayers and state scope of work exclude the use of a code requiring aphysician or other qualified health care provider, by a phlebotomist,or other unlicensed clinical staff.

Terms To KnowCLIA. Clinical Laboratory Improvement Amendments. Requirements set in1988, CLIA imposes varying levels of federal regulations on clinical procedures.Few laboratories, including those in physician offices, are exempt. Adopted byMedicare and Medicaid, CLIA regulations redefine laboratory testing in regardto laboratory certification and accreditation, proficiency testing, qualityassurance, personnel standards, and program administration.specimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.




0.000.000.000.000.00............... 0.0080050.........



80051Electrolyte panel80051

ExplanationAn electrolyte panel includes the following tests: carbon dioxide(82374), chloride (82435), potassium (84132), and sodium (84295).Blood specimen is obtained by venipuncture. See specific codes foradditional information about the listed tests.

Coding TipsOrgan and disease oriented panels are comprised of a group of specifiedtests. If all of the tests of a defined panel are performed, the panel codeor the individual test codes may be reported. According to CPTguidelines, do not report two or more organ or disease-oriented panelswhen any of the same tests are performed in each panel and the panelsare performed from the same patient collection. When a group of testsoverlap two or more panels, report the panel that has the greatestnumber of tests allowing the definition of that panel to be met, andthen report the remaining tests using the appropriate individual testcodes. This test may be performed using a CLIA-waived test system.Laboratories with a CLIA-waived certificate must report this code withmodifier QW CLIA-waived test. See appendix 1 for CLIA-waived kitsand test systems. If a specimen is transported to an outside laboratory,report 99000 for handling or conveyance. This panel is a componentof the renal function panel, CPT code 80069. Venipuncture is separatelyreportable. For collection of venous blood by venipuncture, see code36415. When venipuncture on a patient 3 years of age or older requiresthe skill of a physician or other qualified health care provider, see code36410. For venipuncture on a patient younger than 3 years of ageperformed by a physician or other qualified health care provider, seecodes 36400-36406. Most third-party payers and state scope of workexclude the use of a code requiring a physician or other qualified healthcare provider, by a phlebotomist, or other unlicensed clinical staff.

Terms To KnowCLIA. Clinical Laboratory Improvement Amendments. Requirements set in1988, CLIA imposes varying levels of federal regulations on clinical procedures.Few laboratories, including those in physician offices, are exempt. Adopted byMedicare and Medicaid, CLIA regulations redefine laboratory testing in regardto laboratory certification and accreditation, proficiency testing, qualityassurance, personnel standards, and program administration.renal. Referring to the kidney.specimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.


IOM References100-4,16,40.6.1; 100-4,16,70.8; 100-4,16,100.6

CCI Version 20.082374, 82435, 84132, 84295



0.000.000.000.000.00............... 0.0080051.........



80053Comprehensive metabolic panel80053

ExplanationA comprehensive metabolic panel includes the following tests: albumin(82040), total bilirubin (82247), total calcium (82310), carbon dioxide(bicarbonate) (82374), chloride (82435), creatinine (82565), glucose(82947), alkaline phosphatase (84075), potassium (84132), total protein(84155), sodium (84295), alanine amino transferase (ALT) (SGPT)(84460), aspartate amino transferase (AST) (SGOT) (84450), and ureanitrogen (BUN) (84520). Blood specimen is obtained by venipuncture.See the specific codes for additional information about the listed tests.

Coding TipsDo not report 80053 with 80048 or 80076. Organ and disease orientedpanels are comprised of a group of specified tests. If all of the tests ofa defined panel are performed, the panel code or the individual testcodes may be reported. According to CPT guidelines, do not reporttwo or more organ or disease-oriented panels when any of the sametests are performed in each panel and the panels are performed fromthe same patient collection. When a group of tests overlap two or morepanels, report the panel that has the greatest number of tests allowingthe definition of that panel to be met, and then report the remainingtests using the appropriate individual test codes. This test may beperformed using a CLIA-waived test system. Laboratories with aCLIA-waived certificate must report this code with modifier QWCLIA-waived test. See appendix 1 for CLIA-waived kits and test systems.Report the individual tests performed instead. If a specimen istransported to an outside laboratory, report 99000 for handling orconveyance. Venipuncture is separately reportable. For collection ofvenous blood by venipuncture, see code 36415. When venipunctureon a patient 3 years of age or older requires the skill of a physician orother qualified health care provider, see code 36410. For venipunctureon a patient younger than 3 years of age performed by a physician orother qualified health care provider, see codes 36400-36406. Mostthird-party payers and state scope of work exclude the use of a coderequiring a physician or other qualified health care provider, by aphlebotomist, or other unlicensed clinical staff.

Terms To Knowspecimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.


IOM References100-4,16,40.6.1; 100-4,16,70.8; 100-4,16,100.6

CCI Version 20.080047-80048, 80051, 80069, 80076, 82040, 82247, 82310, 82374,82435, 82565, 82947, 84075, 84132, 84155, 84295, 84450, 84460,84520



0.000.000.000.000.00............... 0.0080053.........



80055Obstetric panel80055

ExplanationAn obstetric panel includes the following tests: hepatitis B surfaceantigen (HBsAg) (87340), rubella antibody (86762), qualitativenon-treponemal antibody syphilis test (VDRL, RPR, ART) (86592), RBCantibody screen (86850), ABO blood typing (86900), and Rh (D) bloodtyping (86901). In addition, this panel includes either an automatedcomplete blood count (CBC) and automated differential white bloodcount (WBC) as described by 85025 or 85027 and 85004 OR automatedCBC (85027) and appropriate manual differential WBC count (85007or 85009). Blood specimen is obtained by venipuncture. See specificcodes for additional information about the listed tests.

Coding TipsOrgan and disease-oriented panels are composed of a group of specifiedtests. If all of the tests of a defined panel are performed, the panel codeor the individual test codes may be reported. According to CPTguidelines, do not report two or more organ or disease-oriented panelswhen any of the same tests are performed in each panel and the panelsare performed from the same patient collection. When a group of testsoverlap two or more panels, report the panel that has the greatestnumber of tests allowing the definition of that panel to be met, andthen report the remaining tests using the appropriate individual testcodes. When syphilis screening is performed using treponemal antibodymethodology do not report code 80055. Report each individual testseparately. If a specimen is transported to an outside laboratory, reportcode 99000 for handling or conveyance. Venipuncture is separatelyreportable. For collection of venous blood by venipuncture, see code36415. When venipuncture on a patient 3 years of age or older requiresthe skill of a physician or other qualified health care provider, see code36410. For venipuncture on a patient younger than 3 years of ageperformed by a physician or other qualified health care provider, seecodes 36400-36406. Most third-party payers and state scope of workexclude the use of a code requiring a physician or other qualified healthcare provider, by a phlebotomist, or other unlicensed clinical staff.

Terms To Knowantibody. Protein that B cells of the immune system produce in response tothe presence of a foreign antigen.antigen. Substance inducing sensitivity or triggering an immune responseand the production of antibodies.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.




0.000.000.000.000.00............... 0.0080055.........



80061 - NCDLipid panel80061

ExplanationA lipid panel includes the following tests: total serum cholesterol(82465), high-density cholesterol (HDL cholesterol) by directmeasurement (83718), and triglycerides (84478). Blood specimen isobtained by venipuncture. See specific codes for additional informationabout the listed tests.

Coding TipsA national coverage determination (NCD) exists for this code. See theMedicare National Coverage Determinations Manual, Pub.100-03,section 190.23. This test may be performed using a CLIA-waived testsystem. Laboratories with a CLIA-waived certificate must report thiscode with modifier QW CLIA-waived test. According to CPT guidelines,do not report two or more organ or disease-oriented panels when anyof the same tests are performed in each panel and the panels areperformed from the same patient collection. When a group of testsoverlap two or more panels, report the panel that has the greatestnumber of tests, allowing the definition of that panel to be met. Thenreport the remaining tests using the appropriate individual test codes.Venipuncture is separately reportable. For collection of venous bloodby venipuncture, see code 36415. When venipuncture on a patient 3years of age or older requires the skill of a physician or other qualifiedhealth care provider, see code 36410. For venipuncture on a patientyounger than 3 years of age performed by a physician or other qualifiedhealth care provider, see codes 36400-36406. Most third-party payersand state scope of work exclude the use of a code requiring a physicianor other qualified health care provider, by a phlebotomist, or otherunlicensed clinical staff.

ICD-9-CM Diagnostic CodesDiabetes mellitus without mention of complication, typeII or unspecified type, not stated as uncontrolled

250.00

Diabetes mellitus without mention of complication, typeI [juvenile type], not stated as uncontrolled

250.01

Diabetes mellitus without mention of complication, typeII or unspecified type, uncontrolled

250.02

Diabetes mellitus without mention of complication, typeI [juvenile type], uncontrolled

250.03

Diabetes with renal manifestations, type II or unspecifiedtype, not stated as uncontrolled (Use additional codeto identify manifestation: 581.81, 583.81, 585.1-585.9)

250.40

Diabetes with renal manifestations, type I [juvenile type],not stated as uncontrolled (Use additional code toidentify manifestation: 581.81, 583.81, 585.1-585.9)

250.41

Diabetes with peripheral circulatory disorders, type II orunspecified type, not stated as uncontrolled (Useadditional code to identify manifestation: 443.81, 785.4)

250.70

Diabetes with peripheral circulatory disorders, type I[juvenile type], not stated as uncontrolled (Use additionalcode to identify manifestation: 443.81, 785.4)

250.71

Pure hypercholesterolemia (Use additional code toidentify any associated intellectual disabilities)

272.0

Mixed hyperlipidemia (Use additional code to identifyany associated intellectual disabilities)

272.2

Other disorders of lipoid metabolism (Use additionalcode to identify any associated intellectual disabilities)

272.8

Morbid obesity (Use additional code to identify BodyMass Index (BMI), if known: V85.0-V85.54)

278.01

Overweight (Use additional code to identify Body MassIndex (BMI), if known: V85.0-V85.54) (Use additional codeto identify any associated intellectual disabilities)

278.02

Unspecified essential hypertension401.9Malignant hypertensive heart disease without heart failure402.00Malignant hypertensive heart disease with heart failure (Use additional code to specify type of heart failure,428.0-428.43, if known)

402.01

Benign hypertensive heart disease without heart failure402.10Coronary atherosclerosis of unspecified type of bypass graft (Use additional code to identify presence ofhypertension: 401.0-405.9)

414.05

Coronary atherosclerosis, of native coronary artery oftransplanted heart (Use additional code to identifypresence of hypertension: 401.0-405.9)

414.06

Coronary atherosclerosis due to lipid rich plaque (Codefirst coronary atherosclerosis (414.00-414.07))

414.3

Other specified forms of chronic ischemic heart disease (Use additional code to identify presence of hypertension:401.0-405.9)

414.8


IOM References100-3,190.23; 100-4,16,40.6.1; 100-4,16,70.8; 100-4,16,100.6

CCI Version 20.080500-80502, 82465, 83718, 83721, 84478



0.000.000.000.000.00............... 0.0080061.........



80069Renal function panel80069

ExplanationA renal function panel includes the following tests: albumin (82040),total calcium (82310), carbon dioxide (bicarbonate) (82374), chloride(82435), creatinine (82565), glucose (82947), inorganic phosphorus(phosphate) (84100), potassium (84132), sodium (84295), and ureanitrogen (BUN) (84520).

Coding TipsOrgan and disease-oriented panels are composed of a group of specifiedtests. If all of the tests of a defined panel are performed, the panel codeor the individual test codes may be reported. According to CPTguidelines, do not report two or more organ or disease-oriented panelswhen any of the same tests are performed in each panel and the panelsare performed from the same patient collection. When a group of testsoverlap two or more panels, report the panel that has the greatestnumber of tests allowing the definition of that panel to be met andthen report the remaining tests using the appropriate individual testcodes. This test may be performed using a CLIA-waived test system.Laboratories with a CLIA-waived certificate must report this code withmodifier QW CLIA-waived test. See appendix 1 for CLIA-waived kitsand test systems. If a specimen is transported to an outside laboratory,report code 99000 for handling or conveyance. Venipuncture isseparately reportable. For collection of venous blood by venipuncture,see code 36415. When venipuncture on a patient 3 years of age orolder requires the skill of a physician or other qualified health careprovider, see code 36410. For venipuncture on a patient younger than3 years of age performed by a physician or other qualified health careprovider, see codes 36400-36406. Most third-party payers and statescope of work exclude the use of a code requiring a physician or otherqualified health care provider, by a phlebotomist, or other unlicensedclinical staff.

Terms To KnowCLIA. Clinical Laboratory Improvement Amendments. Requirements set in1988, CLIA imposes varying levels of federal regulations on clinical procedures.Few laboratories, including those in physician offices, are exempt. Adopted byMedicare and Medicaid, CLIA regulations redefine laboratory testing in regardto laboratory certification and accreditation, proficiency testing, qualityassurance, personnel standards, and program administration.renal. Referring to the kidney.specimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.

ICD-9-CM Diagnostic CodesHyperparathyroidism, unspecified252.00Primary hyperparathyroidism252.01Secondary hyperparathyroidism, non-renal252.02

Other hyperparathyroidism252.08Acute glomerulonephritis with other specified pathologicallesion in kidney in disease classified elsewhere (Codefirst underlying disease: 002.0, 070.0-070.9, 072.79, 421.0)

580.81

Other acute glomerulonephritis with other specifiedpathological lesion in kidney

580.89

Acute glomerulonephritis with unspecified pathologicallesion in kidney

580.9

Nephritis and nephropathy, not specified as acute orchronic, with other specified pathological lesion in kidney,

583.81

in diseases classified elsewhere (Code first underlyingdisease: 016.0, 098.19, 249.4, 250.4, 277.30-277.39,446.21, 710.0)Acute kidney failure with lesion of tubular necrosis584.5Congenital polycystic kidney, unspecified type753.12Congenital polycystic kidney, autosomal dominant753.13Other specified congenital cystic kidney disease753.19


IOM References100-4,16,40.6.1; 100-4,16,100.6

CCI Version 20.080047-80048, 80051, 80076, 82040, 82310, 82374, 82435, 82565,82947, 84100, 84132, 84295, 84520



0.000.000.000.000.00............... 0.0080069.........



80074 - NCDAcute hepatitis panel80074

ExplanationAn acute hepatitis panel includes the following tests: hepatitis Aantibody (HAAb), IgM antibody (86709), hepatitis B core antibody(HbcAb), IgM antibody (86705), hepatitis B surface antigen (HbsAg)(87340), and hepatitis C antibody (86803).

Coding TipsOrgan and disease-oriented panels are composed of a group of specifiedtests. If all of the tests of a defined panel are performed, the panel codeor the individual test codes may be reported. If a specimen istransported to an outside laboratory, report code 99000 for handlingor conveyance. A national coverage determination (NCD) exists for thiscode. See the Medicare National Coverage Determinations Manual,Pub. 100-03, section 190.33. Note that the list of ICD-9-CM codesdoes not contain all diagnostic codes associated with the NCD. Pleasesee the CD for a complete list. Venipuncture is separately reportable.For collection of venous blood by venipuncture, see code 36415. Whenvenipuncture on a patient 3 years of age or older requires the skill of aphysician or other qualified health care provider, see code 36410. Forvenipuncture on a patient younger than 3 years of age performed bya physician or other qualified health care provider, see codes36400-36406. Most third-party payers and state scope of work excludethe use of a code requiring a physician or other qualified health careprovider, by a phlebotomist, or other unlicensed clinical staff.

ICD-9-CM Diagnostic CodesViral hepatitis A with hepatic coma070.0Viral hepatitis A without mention of hepatic coma070.1Viral hepatitis B with hepatic coma, acute or unspecified,without mention of hepatitis delta

070.20

Viral hepatitis B with hepatic coma, acute or unspecified,with hepatitis delta

070.21

Viral hepatitis B with hepatic coma, chronic, withoutmention of hepatitis delta

070.22

Viral hepatitis B with hepatic coma, chronic, with hepatitisdelta

070.23

Viral hepatitis B without mention of hepatic coma, acuteor unspecified, without mention of hepatitis delta

070.30

Viral hepatitis B without mention of hepatic coma, acuteor unspecified, with hepatitis delta

070.31

Viral hepatitis B without mention of hepatic coma, chronic,without mention of hepatitis delta

070.32

Viral hepatitis B without mention of hepatic coma, chronic,with hepatitis delta

070.33

Acute hepatitis C with hepatic coma070.41Hepatitis delta without mention of active hepatitis B diseasewith hepatic coma

070.42

Hepatitis E with hepatic coma070.43

Chronic hepatitis C with hepatic coma070.44Acute hepatitis C without mention of hepatic coma070.51Hepatitis delta without mention of active hepatitis B diseaseor hepatic coma

070.52

Hepatitis E without mention of hepatic coma070.53Chronic hepatitis C without mention of hepatic coma070.54Hepatic encephalopathy572.2Portal hypertension (Use additional code for anyassociated complications, such as: portal hypertensivegastropathy (537.89))

572.3

Hepatorenal syndrome572.4Chronic fatigue syndrome780.71Functional quadriplegia780.72Other malaise and fatigue780.79Jaundice, unspecified, not of newborn782.4Anorexia783.0Loss of weight (Use additional code to identify BodyMass Index (BMI), if known: V85.0-V85.54)

783.21

Underweight (Use additional code to identify Body MassIndex (BMI), if known: V85.0-V85.54)

783.22

Failure to thrive783.41Nausea with vomiting787.01Nausea alone787.02Abdominal pain, unspecified site789.00Abdominal pain, right upper quadrant789.01Abdominal pain, left lower quadrant789.04Abdominal pain, periumbilic789.05Abdominal pain, epigastric789.06


IOM References100-3,190.33

CCI Version 20.086705, 86709, 86803, 87340



0.000.000.000.000.00............... 0.0080074.........



80076Hepatic function panel80076

ExplanationA hepatic function panel includes the following tests: albumin (82040),total bilirubin (82247), direct bilirubin (82248), alkaline phosphatase(84075), protein, total (84155), alanine amino transferase (ALT) (SGPT)(84460), and aspartate amino transferase (AST) (SGOT) (84450). Bloodspecimen is obtained by venipuncture. See the specific codes foradditional information about the listed tests.

Coding TipsDo not report 80076 with 80053. Organ and disease-oriented panelsare composed of a group of specified tests. If all of the tests of a definedpanel are performed, the panel code or the individual test codes maybe reported. According to CPT guidelines, do not report two or moreorgan or disease-oriented panels when any of the same tests areperformed in each panel and the panels are performed from the samepatient collection. When a group of tests overlap two or more panels,report the panel that has the greatest number of tests allowing thedefinition of that panel to be met, and then report the remaining testsusing the appropriate individual test codes. If a specimen is transportedto an outside laboratory, report 99000 for handling or conveyance.Venipuncture is separately reportable. For collection of venous bloodby venipuncture, see code 36415. When venipuncture on a patient 3years of age or older requires the skill of a physician or other qualifiedhealth care provider, see code 36410. For venipuncture on a patientyounger than 3 years of age performed by a physician or other qualifiedhealth care provider, see codes 36400-36406. Most third-party payersand state scope of work exclude the use of a code requiring a physicianor other qualified health care provider by a phlebotomist or otherunlicensed clinical staff.

Terms To Knowspecimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.venipuncture. Piercing a vein through the skin by a needle and syringe orsharp-ended cannula or catheter to draw blood, start an intravenous infusion,instill medication, or inject another substance such as radiopaque dye.

ICD-9-CM Diagnostic CodesViral hepatitis A without mention of hepatic coma070.1Viral hepatitis B without mention of hepatic coma, acuteor unspecified, without mention of hepatitis delta

070.30

Viral hepatitis B without mention of hepatic coma, acuteor unspecified, with hepatitis delta

070.31

Viral hepatitis B without mention of hepatic coma, chronic,without mention of hepatitis delta

070.32

Viral hepatitis B without mention of hepatic coma, chronic,with hepatitis delta

070.33

Acute hepatitis C without mention of hepatic coma070.51

Hepatitis delta without mention of active hepatitis B diseaseor hepatic coma

070.52

Hepatitis E without mention of hepatic coma070.53Chronic hepatitis C without mention of hepatic coma070.54Other specified viral hepatitis without mention of hepaticcoma

070.59

Unspecified viral hepatitis with hepatic coma070.6Unspecified viral hepatitis C without hepatic coma070.70Unspecified viral hepatitis without mention of hepatic coma070.9Malignant neoplasm of liver, primary155.0Malignant neoplasm of intrahepatic bile ducts155.1Alcoholic fatty liver571.0Acute alcoholic hepatitis571.1Alcoholic cirrhosis of liver571.2Unspecified alcoholic liver damage571.3Unspecified chronic hepatitis571.40Chronic persistent hepatitis571.41Other chronic hepatitis571.49Cirrhosis of liver without mention of alcohol (Code first,if applicable, viral hepatitis (acute) (chronic): 070.0-070.9)

571.5

Biliary cirrhosis571.6Other chronic nonalcoholic liver disease571.8Unspecified chronic liver disease without mention of alcohol571.9Hepatic encephalopathy572.2Portal hypertension (Use additional code for anyassociated complications, such as: portal hypertensivegastropathy (537.89))

572.3

Hepatorenal syndrome572.4Hepatomegaly789.1Follow-up examination following completed treatmentwith high-risk medications, not elsewhere classified

V67.51


IOM References100-4,16,40.6.1; 100-4,16,100.6

CCI Version 20.082040, 82247-82248, 84075, 84155, 84450, 84460



0.000.000.000.000.00............... 0.0080076.........



80100Drug screen, qualitative; multiple drug classes chromatographicmethod, each procedure

80100

ExplanationThis test may be requested as a drug screen for multiple drug classes.The screening test must be performed by a chromatographic techniquethat has good sensitivity, although it may not be as specific as aconfirmatory test. Thin-layer chromatography is a commonchromatographic technique for drug screening tests. It is performedby applying a thin layer adsorbent to a rectangular plate in thestationary phase. The specimen is applied to the plate and the end ofthe plate is placed in a solvent. As the solvent rises along the adsorbenton the plate, the different components of the specimen are carriedalong at varying rates and deposited along the plate. The differentcomponents can be separately visualized and analyzed. Positive testsare always confirmed with a second method. Specimen type varies.

Coding TipsIf a specimen is transported to an outside laboratory, report code 99000for handling or conveyance. Use CPT code 80100 for qualitative drugscreens performed by chromatography that detect multiple drug classes.Count each combination of stationary and mobile phase as one. Ifmultiple drugs are detected using a single analysis (e.g., one stationaryphase with one mobile phase) use 80100 only once. Refer to specificcodes for quantitation of drugs screened. See CPT codes 82000-84999for quantitative drug levels. To report therapeutic drug assays forquantitative drug screening, see codes 80150-80299.

Terms To KnowCLIA. Clinical Laboratory Improvement Amendments. Requirements set in1988, CLIA imposes varying levels of federal regulations on clinical procedures.Few laboratories, including those in physician offices, are exempt. Adopted byMedicare and Medicaid, CLIA regulations redefine laboratory testing in regardto laboratory certification and accreditation, proficiency testing, qualityassurance, personnel standards, and program administration.qualitative. To determine the nature of the component of substance.quantitative. To determine the amount and nature of the components of asubstance.specimen. Tissue cells or sample of fluid taken for analysis, pathologicexamination, and diagnosis.therapeutic. Act meant to alleviate a medical or mental condition.


CCI Version 20.080101, 80500-80502, 82486-82489, G0431v



0.000.000.000.000.00............... 0.0080100.........



80101 [80104]Drug screen, qualitative; single drug class method (eg,immunoassay, enzyme assay), each drug class

80101

multiple drug classes other than chromatographic method,each procedure

80104

ExplanationThese tests may be requested as drug screens for multiple drug classes.In 80100, the screening test must be performed by a chromatographictechnique that has good sensitivity, although it may not be as specificas a confirmatory test. Thin-layer chromatography is a commonchromatographic technique for drug screening tests. It is performedby applying a thin layer adsorbent to a rectangular plate in thestationary phase. The specimen is applied to the plate and the end ofthe plate is placed in a solvent. As the solvent rises along the adsorbenton the plate, the different components of the specimen are carriedalong at varying rates and deposited along the plate. The differentcomponents can be separately visualized and analyzed. In 80104, anumber of different methods are available to screen for qualitative,nonchromatographic, multiple drug class assays, including multiplexedscreening kits, urine cups, test cards, or test strips. Positive tests arealways confirmed with a second method. Specimen type varies.

Coding TipsCode 80104 is a resequenced code and will not display in numericorder. Code 80101 is classified as a Clinical Laboratory ImprovementAmendments (CLIA)-waived test. Append with modifier QW. If aspecimen is transported to an outside laboratory, report code 99000for handling or conveyance. Each single drug class method tested andreported is to be counted as one drug class. For example, if a sampleis aliquoted to five wells and separate class-specific immunoassays arerun on each of the five wells these are reported separately by indicatingcode 80101 five times. However, if multiple drugs can be detected bya single analysis, code 80100 should be reported only once. Refer tospecific codes for quantitation of drugs screened. See CPT codes8200084999 for quantitative drug levels. To report therapeutic drugassays for quantitative drug screening, see codes 80150780299.

ICD-9-CM Diagnostic CodesOpioid type dependence, episodic304.02Sedative, hypnotic or anxiolytic dependence, continuous304.11Sedative, hypnotic or anxiolytic dependence, episodic304.12Cocaine dependence, continuous304.21Cocaine dependence, episodic304.22Cannabis dependence, continuous304.31Cannabis dependence, episodic304.32Amphetamine and other psychostimulant dependence,continuous

304.41

Amphetamine and other psychostimulant dependence,episodic

304.42

Hallucinogen dependence, continuous304.51

Hallucinogen dependence, episodic304.52Other specified drug dependence, continuous304.61Other specified drug dependence, episodic304.62Combinations of opioid type drug with any other drugdependence, continuous

304.71

Combinations of opioid type drug with any other drugdependence, episodic

304.72

Combinations of drug dependence excluding opioid typedrug, continuous

304.81

Combinations of drug dependence excluding opioid typedrug, episodic

304.82

Nondependent cannabis abuse, continuous305.21Nondependent cannabis abuse, episodic305.22Nondependent hallucinogen abuse, continuous305.31Nondependent hallucinogen abuse, episodic305.32Nondependent sedative hypnotic or anxiolytic abuse,continuous

305.41

Nondependent sedative, hypnotic or anxiolytic abuse,episodic

305.42

Nondependent opioid abuse, continuous305.51Nondependent opioid abuse, episodic305.52Nondependent cocaine abuse, continuous305.61Nondependent cocaine abuse, episodic305.62Nondependent amphetamine or related actingsympathomimetic abuse, continuous

305.71

Nondependent amphetamine or related actingsympathomimetic abuse, episodic

305.72

Nondependent antidepressant type abuse, continuous305.81Nondependent antidepressant type abuse, episodic305.82


IOM References100-4,16,70.8

CCI Version 20.080500-80502

Also not with 80101: 83516-83518, G0431v



0.000.000.000.000.00............... 0.0080101.........0.000.000.000.000.00............... 0.0080104.........



80102Drug confirmation, each procedure80102

ExplanationThis test may be requested as drug screen confirmation. It is performedwhen the initial drug screen (80100-80101) is positive. Confirmatorytests must be both sensitive and specific and involve a differenttechnique than the initial screen. For example, if the initial screen isperformed by thin layer chromatography identifying a spot on thechromatogram that is the right color and in the right place to beconsistent with a particular drug, it is confirmed with a more specificmethod, like high performance liquid chromatography (HPLC), gaschromatography-mass spectrometry (GC-MS), or immunoassay. If thedrug suspected is a barbiturate, for example, a confirmatory HPLCmethod might be done to prove that the compound had the correctretention time, etc., and to identify it exactly as a particular barbiturate.This would be reported with 80102.

Coding TipsIf a specimen is transported to an outside laboratory, report code 99000for handling or conveyance. Procedures necessary for confirmation arereported using code 80102. Each combination of stationary and mobilephase is counted as one procedure. For example, if confirmation ofthree drugs by chromatography requires one stationary phase withthree mobile phases, report code 80102 three times. However, ifmultiple drugs can be confirmed using a single analysis (e.g., onestationary phase with one mobile phase), report code 80102 only once.Refer to specific codes for quantitation of drugs screened. See CPTcodes 82000-84999 for quantitative drug levels. To report therapeuticdrug assays for quantitative drug screening, see codes 80150-80299.

ICD-9-CM Diagnostic CodesOpioid type dependence, continuous304.01Opioid type dependence, episodic304.02Sedative, hypnotic or anxiolytic dependence, continuous304.11Sedative, hypnotic or anxiolytic dependence, episodic304.12Cocaine dependence, continuous304.21Cocaine dependence, episodic304.22Cannabis dependence, continuous304.31Cannabis dependence, episodic304.32Amphetamine and other psychostimulant dependence,continuous

304.41


304.42

Hallucinogen dependence, continuous304.51Hallucinogen dependence, episodic304.52Combinations of opioid type drug with any other drugdependence, continuous

304.71


304.72


304.81


304.82


CCI Version 20.080500-80502



0.000.000.000.000.00............... 0.0080102.........



80103Tissue preparation for drug analysis80103

ExplanationTissue is sometimes tested for the presence of drugs. This code reportsthe tissue preparation only.

Coding TipsIf a specimen is transported to an outside laboratory, report code 99000for handling or conveyance. This code is used to report each preparationof tissue for a drug screen. The drug screens performed are separatelyreportable in addition to this code. See CPT codes 82000-84999 forchemistry drug levels. To report therapeutic drug assays for quantitativedrug screening, see codes 80150-80299.

ICD-9-CM Diagnostic CodesOpioid type dependence, continuous304.01Opioid type dependence, episodic304.02Sedative, hypnotic or anxiolytic dependence, continuous304.11Sedative, hypnotic or anxiolytic dependence, episodic304.12Cocaine dependence, continuous304.21Cocaine dependence, episodic304.22Cannabis dependence, continuous304.31Cannabis dependence, episodic304.32Amphetamine and other psychostimulant dependence,continuous

304.41


304.42

Hallucinogen dependence, continuous304.51Hallucinogen dependence, episodic304.52Other specified drug dependence, continuous304.61Other specified drug dependence, episodic304.62Combinations of opioid type drug with any other drugdependence, continuous

304.71


304.72


304.81


304.82

Unspecified drug dependence, unspecified304.90Nondependent cannabis abuse, continuous305.21Nondependent cannabis abuse, episodic305.22Nondependent cannabis abuse, in remission305.23Nondependent hallucinogen abuse, continuous305.31Nondependent hallucinogen abuse, episodic305.32Nondependent sedative hypnotic or anxiolytic abuse,continuous

305.41

Nondependent sedative, hypnotic or anxiolytic abuse,episodic

305.42

Nondependent sedative, hypnotic or anxiolytic abuse, inremission

305.43

Nondependent opioid abuse, continuous305.51Nondependent opioid abuse, episodic305.52Nondependent opioid abuse, in remission305.53Nondependent cocaine abuse, continuous305.61Nondependent cocaine abuse, episodic305.62Nondependent cocaine abuse, in remission305.63Nondependent amphetamine or related actingsympathomimetic abuse, continuous

305.71

Nondependent amphetamine or related actingsympathomimetic abuse, episodic

305.72

Nondependent amphetamine or related actingsympathomimetic abuse, in remission

305.73

Nondependent antidepressant type abuse, continuous305.81Nondependent antidepressant type abuse, episodic305.82Nondependent antidepressant type abuse, in remission305.83Other, mixed, or unspecified nondependent drug abuse,continuous

305.91

Other, mixed, or unspecified nondependent drug abuse,episodic

305.92

Other, mixed, or unspecified nondependent drug abuse,in remission

305.93

Examination for medicolegal reason (Use additionalcode(s) to identify any special screening examination(s)performed: V73.0-V82.9)

V70.4

Other laboratory examinationV72.69




0.000.000.000.000.00............... 0.0080103.........



80150Amikacin80150

ExplanationAmikacin is a type of antibiotic. Test specimens are frequently collectedat peak and trough periods, which is shortly after administration ofamikacin and again just before the next administration when serumconcentration is at its lowest. This is an effective approach to determinea therapeutic level of drug. Method is radioimmunoassay (RIA) or highperformance liquid chromatography (HPLC).

Coding TipsEach assay is separately reportable. This code reports quantitativetherapeutic drug assay from any source. For qualitative testing, see CPTcodes 80100-80104. Test assays are frequently collected at peak andtrough periods (i.e., shortly after administration of the drug andapproximately 12 hours after drug administration).

Terms To Knowassay. Test of purity.qualitative. To determine the nature of the component of substance.quantitative. To determine the amount and nature of the components of asubstance.therapeutic. Act meant to alleviate a medical or mental condition.

ICD-9-CM Diagnostic CodesMethicillin susceptible Staphylococcus aureus septicemia (Use additional code for systemic inflammatory responsesyndrome (SIRS): 995.91-995.92)

038.11

Unspecified staphylococcus infection in conditions classifiedelsewhere and of unspecified site (Note: This code is to

041.10

be used as an additional code to identify the bacterial agentin diseases classified elsewhere and bacterial infections ofunspecified nature or site)Methicillin susceptible Staphylococcus aureus (Note:This code is to be used as an additional code to identify

041.11

the bacterial agent in diseases classified elsewhere andbacterial infections of unspecified nature or site)Other staphylococcus infection in conditions classifiedelsewhere and of unspecified site (Note: This code is to

041.19

be used as an additional code to identify the bacterial agentin diseases classified elsewhere and bacterial infections ofunspecified nature or site)Klebsiella pneumoniae infection (Note: This code is tobe used as an additional code to identify the bacterial agent

041.3

in diseases classified elsewhere and bacterial infections ofunspecified nature or site)Shiga toxin-producing Escherichia coli [E. coli] (STEC) O157infection in conditions classified elsewhere and ofunspecified site

041.41

Other specified Shiga toxin-producing Escherichia coli [E.coli] (STEC) infection in conditions classified elsewhere andof unspecified site

041.42

Unspecified Shiga toxin-producing Escherichia coli [E. coli](STEC) infection in conditions classified elsewhere and ofunspecified site

041.43

Other and unspecified Escherichia coli [E. coli] infection inconditions classified elsewhere and of unspecified site

041.49

Proteus (mirabilis) (morganii) infection in conditionsclassified elsewhere and of unspecified site (Note: This

041.6

code is to be used as an additional code to identify thebacterial agent in diseases classified elsewhere and bacterialinfections of unspecified nature or site)Pseudomonas infection in conditions classified elsewhereand of unspecified site (Note: This code is to be used

041.7

as an additional code to identify the bacterial agent indiseases classified elsewhere and bacterial infections ofunspecified nature or site)Infection due to other gram-negative organisms inconditions classified elsewhere and of unspecified site

041.85

(Note: This code is to be used as an additional code toidentify the bacterial agent in diseases classified elsewhereand bacterial infections of unspecified nature or site)Other infections specific to the perinatal period (Useadditional code(s) to further specify condition. Useadditional code to identify organism: 041.00-041.9)

771.89

Poisoning by other specified antibiotics (Use additionalcode to specify the effects of poisoning)

960.8

Other laboratory examinationV72.69

This list of ICD-9-CM codes might not be all-

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