Need access to the UnitedHealthcare Provider Portal? Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990. It has a semi-rigid shell that helps support the leg while providing protection. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495. Effective Date: 10.01.2022 This policy addresses skin and soft tissue substitutes. A physician states that an acoustic reflex test of the left ear was performed. Effective Date: 02.01.2020 This policy addresses multiple services/procedures. With the use of AquaBeam water ablation therapy, the enlarged prostate tissue was removed. Effective Date: 09.01.2022 This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Effective Date: 10.01.2022 This policy addresses pneumatic compression devices. Applicable Procedure Code: J0202. Effective Date: 11.01.2022 This policy addresses multi-gene panel testing for the diagnosis of neuromuscular disorders. Effective Date: 10.01.2022 This policy addresses whole exome and whole genome sequencing. evaluation for traumatic arthrotomy of the knee. A physician documented the following surgical procedure for treatment of chronic otitis media: "Myringotomy with insertion of ventilating tubes in both ears. obtain radiographs including joint above and below fracture. The physician performs a detailed history, comprehensive examination, and medical decision-making is of moderate complexity. Most toe fractures are caused by an axial force (e.g., a stubbed toe) or a crushing injury (e.g., from a falling object). Which three of the following scenarios are considered special exceptions to the APC payment? Applicable Procedure Codes: 0656T, 0657T, 22899. It seems to be a right spermatocele. Applicable Procedure Codes: 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133. Effective Date: 01.01.2022 This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Cleveland Combined Hand Fellowship Lecture Series 2018-2019, Metacarpophalangeal Joint Deformity - John Delaney, MD, Open Reduction of an Irreducible MCP Dislocation - Dr David Tuckman. 45385 colonoscopy with removal using snare. Effective Date: 03.01.2022 This policy addresses the use of injectable testosterone and testosterone pellets for replacement therapy in conditions associated with a deficiency or absence of endogenous testosterone. Applicable Procedure Code: J1427. Nurse asks about diet and exercise program. If the total duration was 1 hour and 45 minutes, the CPT code assignment would be: The new patient is seen in the physician's office for a rash across the lower back. Symptoms include pain, bruising, and rapid-onset swelling. Physician Office Record Physician monitors the management of a patient who it taking long-term warfarin therapy. Applicable Procedure Codes: 90283, 90284, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1599. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017. What is the correct CPT code assignment from the Medicine chapter for IM injection of Leukine? Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines, and Utilization Review Guidelines are developed as needed, are regularly reviewed and updated, and are subject to change. Effective Date: 06.01.2022 This policy addresses epidural steroid injections for spinal pain. Which of the following contains a complete description of CPT modifiers? The result was an underpayment of $145.24. True or false: The following CPT code assignment (S01.81XA) is correct for this scenario? Using meticulous care and caution, the spermatocele was divided from the testicle and the vas deferens was identified. Applicable Procedure Codes: 59072, 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411. Applicable Procedure Codes: 0060U, 0327U, 81420, 81422, 81479, 81507. Effective Date: 06.01.2022 This policy addresses wheelchair seating. Applicable Procedure Codes: 19328, 19330, 19355, 19370, 19371, 19380. traction, and flexion of wrist. Applicable Procedure Codes: T1000, T1002, T1003. Shaving of 1.5 cm epidermal lesion, scalp. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870. Sharp uterine curette was introduced and the uterine cavity systematically curetted with minimal amount of tissue. Effective Date: 12.01.2022 This policy addresses the medical necessity of certain elective procedures when performed in a hospital outpatient department. Effective Date: 11.01.2022 This policy addresses the use of Nplate (romiplostim) for the treatment of chronic immune thrombocytopenic purpura (ITP). Effective Date: 08.01.2022 This policy addresses prostrate surgeries and interventions, including transurethral ablation, cryoablation, surgical prostatectomy, prostatic urethral lift (PUL), high-energy water vapor thermotherapy, and transperineal placement of biodegradable material. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726. indications. This specimen was sent to the Pathologist for further evaluation. The wound was irrigated and hemostasis assured. CPT code 69610 (tympanic membrane repair) is considered to be unilateral. Effective Date: 07.01.2022 This policy addresses the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 81412, 81443, 81479. Effective Date: 07.01.2022 This policy addresses outpatient hospital facility-based intravenous medication infusion. False; The correct code is 34705. Ambulatory Payment Classifications (APCs) are part of which payment system? The correct code assignment for a Gross and microscopic examination of a wedge biopsy of the lung is 88305. Operative Report Preoperative Diagnosis: Chronic laryngitis with polypoid disease Postoperative Diagnosis: Same Procedure: Laryngoscopy with removal of polyps After adequate premedication, the 60-year-old female patient was taken to the operating room and placed in supine position. Which of the following E/M services rely on documentation of new vs. established patient? Effective Date: 10.01.2022 This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation. Procedure: tubal banding. The polyps were removed from the right cord up to the anterior commissure. There were no complications. Effective Date: 06.01.2022 This policy addresses power mobility devices. Coverage Determination Guidelines are used to determine whether a service falls within a benefit category or is excluded from coverage. It looks like you don't have access to this content. Applicable Procedures Codes: J0185, J1453, J1454, J1626, J1627, J2405, J2469, J8501, J8655, J8670, Q0162, Q0166. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all tissues); Applicable Procedure Codes: C9096, C9399, J1442, J1447, J2506, J2820, J3490, J3590, Q5101, Q5108, Q5110, Q5111, Q5120, Q5122. Effective Date: 06.01.2022 This policy addresses preimplantation genetic testing (PGT). Good hemostasis was found at the site of the polypectomy. The surgeon created a twist drill hole for evacuation of a subdural hematoma. Effective Date: 09.01.2022 This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. What is the correct CPT code assignment for this physician? Diagnosis: internal derangement of medical meniscus with degenerative changes. A tourniquet was used and inflated to approximately 250 mm of mercury after exsanguination of the hand. Radial head and neck fractures in children are a relatively common traumatic injury that usually affects the radial neck (metaphysis) in children 9-10 years of age. The spermatocele was handed off intact to the scrubbed personnel. Applicable Procedure Codes: A4636, A4637, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158, E0159, E0637, E0638, E0641, E0642, E8000, E8001, E8002. If you need further assistance, please contact Support. Effective Date: 07.01.2022 This policy addresses core decompression for avascular necrosis. The result is an underpayment of $69.91. After multiple observations, the patient was very concerned about carcinoma and wanted to have this area excised. What is the correct CPT code assignment for this procedure? In younger people, these fractures typically occur during sports or a motor vehicle collision. Effective Date: 12.01.2022 This policy addresses lysis intranasal synechia, repair of nasal vestibular stenosis or alar collapse, rhinoplasty, rhinophyma, septal dermatoplasty, and nasal polypectomy. Applicable Procedure Code: J2796. The patient received an additional Demerol and Versed during the procedure to a total of 75 of Demerol and 9 of Versed. Applicable Procedure Codes: J3357, J3358. Applicable Procedure Codes: 17106, 17107, 17108, 17380. No tourniquet was utilized. What is the appropriate E/M service code? If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool. Effective Date: 12.01.2022 This policy addresses the use of buprenorphine (Probuphine and Sublocade) for the treatment of opioid dependence/opioid use disorder. Operative Report Preoperative Diagnosis: Abnormal uterine bleeding Postoperative Diagnosis: Same Procedure: Diagnostic hysteroscopy with D&C There was an approximately 8-mm polyp of the cervix. The payment rates for most separately payable medical and surgical services are determined by multiplying the prospectively established scaled relative weight for the service's clinical APC by a conversion factor (CF) to arrive at a national __________ payment rate for the APC. Applicable Procedure Codes: 0421T, 0582T, 0655T, 37243, 52441, 52442, 53850, 53852, 53854, 53855, 55866, 55873, 55874. Effective Date: 06.01.2022 This policy addresses surgery of the elbow. Applicable Procedure Codes: 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411. Effective Date: 08.01.2022 This policy addresses minimally invasive endoscopic procedures and devices for treating gastroesophageal reflux disease (GERD) and the Per Oral Endoscopic Myotomy (POEM) procedure for achalasia or diffuse esophageal spasm. Infraumbilical incision was closed using 4-0 Vicryl subcuticular sutures, and Steri-Strips. A biopsy was taken of tissue in the ascending colon; the source of the bleeding was not found (facility price).True or false: The following CPT code assignment (K62.5) is correct for this scenario? They are also used to decide whether a given health service is medically necessary. Effective Date: 09.01.2022 This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 55899, 64999. Applicable Procedure Codes: 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133. The patient was then transferred to the recovery room in satisfactory condition. Plantar fasciitis is defined as the traction degeneration of the plantar fascia at its origin on the heel. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573. The fracture was reduced and the alignment was checked with imaging. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, E0770, E1399, K1016, K1017, K1020, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33418, 33419, 33477, 33999, 93799. Operative Report Preoperative Diagnosis: Laceration of nerve and tendon, left 5th digit Postoperative Diagnosis: Ulnar nerve laceration, no tendon laceration, left 5th digit Operation: Repair of ulnar nerve Procedure: The patient was brought into the operating room and prepared and draped in the usual sterile manner. Applicable Procedure Code: J3262. The correct code assignment is 73721. The skin was not closed and was allowed to drain. The facility price for code 11403 is $153.17 The facility price for code 11604 is $223.08. Effective Date: 01.01.2022 This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Effective Date: 06.01.2022 This policy addresses measurement of corneal hysteresis, measurement of ocular blood flow, and monitoring of intraocular pressure. Applicable Procedure Codes: 0254U, 81228, 81229, 81479. I was able to visualize the epiglottis, larynx, and vocal cords. Using the straight-cup forceps, the polyps were removed from the left cord first. Applicable Procedure Codes: 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235, 75710, 75716. Effective Date: 05.01.2022 This policy addresses the use of Stelara (ustekinumab) for the treatment of Crohns disease, plaque psoriasis, psoriatic arthritis, and ulcerative colitis. What is the correct code assignment for removal of 16 skin tags? Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573. The prep was poor. Applicable Procedure Codes: J0470, J0600, J0895, J3490, J8499, M0300, S9355. Operative Report. Applicable Procedure Code: 93580. CPT code 00172 is reported. Use modifier 52 if the test is applied to one ear instead of two. It also packages payment for other items and services that are not typically packaged under the OPPS. Effective Date: 12.01.2022 This policy addresses the use of vascular endothelial growth factor (VEGF) inhibitors. Effective Date: 11.01.2022 This policy addresses the use of Krystexxa (pegloticase) for treatment of chronic gout refractory to conventional therapy. The above findings were noted with no obvious pathology. Applicable Procedure Codes: 21175, D5924, L0112, L0113, S1040. Effective Date: 10.01.2022 This policy addresses parameters for coverage of injectable oncology medications. The correct code assignment is 10060-LT. False- No modifier is appended because the CPT description does not specify site and the procedure was performed on the skin. Effective Date: 03.01.2022 This policy addresses the use of specialty pharmacy medications administered by the intravitreal route for certain ophthalmologic conditions. The physician performs a problem-focused history, expanded problem-focused examination with straightforward medical decision-making. Effective Date: 10.01.2022 This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp (darbepoetin alfa), Epogen (epoetin alfa), Mircera (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit (epoetin alfa), and Retacrit (epoetin alfa). Effective Date: 05.01.2022 This policy addresses vertebral body tethering for the treatment of scoliosis. The knee was irrigated well using normal saline. The final diagnosis was acute pharyngitis (nonfacility price). If you have questions or concerns about a specific service for a member, refer to the appropriate Benefits, Claims, or Prior Authorization/Notification process. Endoscope inserted orally and advanced to the duodenum. True or False? Effective Date: 01.01.2022 This policy addresses cosmetic and reconstructive procedures. Effective Date: 11.01.2022 This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Effective Date: 09.01.2022 This policy addresses intramuscular and subcutaneous injection of 17-alpha-hydroxyprogesterone caproate, commonly called 17P or Makena. Effective Date: 07.01.2022 This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Effective Date: 06.01.2022 This policy addresses autologous chondrocyte transplantation (ACT), osteochondral autograft and allograft transplantation, microfracture repair of the knee, and focal articular cartilage repair. Abdomen deflated of gas and instruments removed. The InterQual criteria are proprietary to Change Healthcareand are not published on this website. The patient receives anesthesia for repair of cleft palate. Effective Date: 06.01.2022 This policy addresses surgery of the shoulder. Applicable Procedure Code: J0879. An incision was made along the upper arm over the 2.0 cm lipoma, which was deep in the subfascia. Effective Date: 07.01.2022 This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. An established patient was seen in the physician's office for sore throat and fever. Effective Date: 10.01.2022 This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 20930, 20931, 20939, 22899. The Jako laryngoscope was then inserted. Applicable Procedure Code: J0791. Type I (non-displaced) fractures. Sometimes new services are assigned to New Technology APCs, which are based on similarity of resource use only, until cost data are available to permit assignment to a ________ APC. Effective Date: 05.01.2022 This policy addresses private duty nursing (PDN) services. Effective Date: 11.01.2022 This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Effective Date: 10.01.2022 This policy addresses covered routine patient costs during qualified clinical trials. Open reduction. The correct code assignment is 11604. Office Visit Date of service: 9/28/18 Last date of treatment: 8/3/15 The patient is seen for a chief complaint of shortness of breath and fatigue. The blood pressure was stabilized but the decision was to abort the procedure at this time. The conversion factor (CF) translates the scaled relative weights into ______ payment rates. Applicable Procedure Codes: 87505, 87506, 87507. Effective Date: 08.01.2022 This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140. Applicable Procedure Code: J0896. Gargling with warm salt water is not helping. Applicable Procedure Code: J0584. Effective Date: 11.01.2022 This policy addresses surgical repair for treating athletic pubalgia. CT. indications. If false, determine the difference in payment using the Physician Fee Schedule Look-Up tool. A MRI of brain (without contrast material) was performed to rule out the diagnosis of cerebral vascular accident. The surgeon performed a screening colonoscopy and reached the cecum, but due to a poor prep, the procedure was discontinued and rescheduled. The result is an overpayment of $29.55. Effective Date: 06.01.2022 This policy addresses lower extremity vascular angiography and endovascular revascularization procedures. Enter your email below and we'll resend your username to you. Applicable Procedure Codes: J1930, J2353, J2354, J2502. The mission of Urology , the "Gold Journal," is to provide practical, timely, and relevant clinical and scientific information to physicians and researchers practicing the art of urology worldwide; to promote equity and diversity among authors, reviewers, and editors; to provide a platform for discussion of current ideas in urologic education, patient engagement, What codes will the hospital use on its billing form to present the diagnosis of "fractured humerus?". If only one or the other is performed, then modifier 52, reduced services, should be appended to the code. Effective Date: 09.01.2022 This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Effective Date: 06.01.2022 This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Code: 82523. The flexible endoscope was passed from the mouth into the esophagus and continued into the stomach and into the duodenal bulb. decreases pain, minimizes soft The correct code assignment is 70100. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688. Betadine was applied to the hernia. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325. Good hemostasis was achieved using the Bovie and the remaining cut ends of the tissue were reapproximated using interrupted #3-0 chromic suture. Applicable Procedure Codes: 11981, 11982, 11983, J3490, J7999. Applicable Procedure Codes: 37243, 79445, S2095. [2016] if they also have other prehospital triage indications for major trauma. Applicable Procedure Codes: A7025, A7026, E0481, E0483. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146. CPT codes: 29877 arthroscopy, knee; debridement. Then a #3-0 chromic suture was placed on the dorsum ventral side connecting the cut ends of tissue. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879. What is the correct CPT code assignment for this procedure? Treatment depends on the degree of angulation and is surgical if angulation remains greater than 30 degrees after closed reduction is attempted. To account for _________ differences in input prices, the labor portion of the national unadjusted payment rate (60 percent) is further adjusted by the hospital wage index for the area where payment is being made. An elliptical skin incision was made surrounding the lesion. Applicable Procedure Codes: 0029U, 0078U, 0173U, 0175U, 0286U, 0290U, 0291U, 0292U, 0293U, 0345U, 0347U, 0348U, 0349U, 0350U, 81479. Which of the following is considered part of the Social History? Under ultrasound guidance, percutaneous, the surgeon inserted a breast marker and performed a biopsy (facility price). Applicable Procedure Code: J3245. Effective Date: 09.01.2022 This policy addresses the use of Zolgensma (onasemnogene abeparvovec-xioi) for the treatment of spinal muscular atrophy (SMA). Applicable Procedure Codes: 0232T, G0460, M0076, P9020. Applicable Procedure Codes: 0237U, 81410, 81411, 81413, 81414, 81439, 81479, 81493. Effective Date: 11.01.2022 This policy addresses the use of Cabenuva (cabotegravir/rilpivirine) for the treatment of a human immunodeficiency virus type-1 (HIV-1) in patients who are virologically suppressed. Operative Report. Effective Date: 02.01.2022 This policy addresses oral and enteral nutrition. Effective Date: 11.01.2022 This policy addresses surgical repair of pectus excavatum and pectus carinatum. If pulse is lost, release and reapply traction/splint. Effective Date: 12.01.2022 This policy addresses the use of Korsuva (difelikefalin) for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adults undergoing hemodialysis. The physician shaved the entire nevus with minimal blood loss. Applicable Procedure Code: J1305. Applicable Procedure Codes: J0881, J0882, J0885, J0887, J0888, Q4081, Q5105, Q5106. The epididymis was then re-attached to the testicle. What would be the correct CPT code assignment for the anesthesiologist's services? Effective Date: 12.01.2022 This policy addresses epidural steroid injections for spinal pain. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118. Enter your username below and we'll send you an email explaining how to change your password. Effective Date: 02.01.2021 This policy addresses serum or urine collagen crosslinks or biochemical markers. Effective Date: 09.01.2022 This policy addresses surgery of the shoulder. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120. Applicable Procedure Codes: 31660, 31661. The repair included insertion of mesh. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, S9432, S9433, S9434, S9435. Applicable Procedure Code: J0491. Physician performs a detailed interval history, comprehensive examination, and medical decision making is of moderate complexity. A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. A physician draws blood to test for levels of T3 on a non-Medicare patient. Applicable Procedure Code: J1632. Applicable Procedure Codes: J0256, J0257. The same physician performs both the injection and the supervision and interpretation. The surgeon did not perform any procedure related to the rectal bleeding. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146. Applicable Procedure Codes: 76497, 76498. Unlisted codes do not describe a specific service; therefore, it is not necessary to utilize modifiers. This page was last edited 17:09, 16 June 2021 by, https://www.wikem.org/w/index.php?title=Coaptation_splint&oldid=307301, Assess distal pulses, motor, and sensation, While maintaining traction, apply padding and splint material (e.g. True- Unilateral. Effective Date: 08.01.2022 This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. A listing of the Medical Policy Update Bulletins for the past two rolling years. The Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines, Utilization Review Guidelines and corresponding update bulletins for UnitedHealthcare Community Plan are listed below. This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines (CDG), and/or Utilization Review Guidelines (URG). Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950. A patient is seen in the emergency department with a severe headache that is not responding to over the counter medications. Services determined to be experimental, investigational, unproven, or not medically necessary by the clinical evidence are typically not covered. Complications: Operative Report Preoperative Diagnosis: Mass, superior aspect of the left breast Postoperative Diagnosis: Benign mass, superior aspect of the left breast Operation: Excision The patient is a female who has had a lump palpable over the superior aspect of the left breast for the past several months. The surgeon created a femoral-popliteal artery bypass using a vein graft. Effective Date: 09.01.2022 This policy addresses the use of Tepezza (teprotumumab-trbw) for the treatment of thyroid eye disease. No other defects were noted. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515. Pathology report identifies the specimen as "interdermal nevi." The correct code is 59812. I had done a needle aspiration and did not get any fluid out. The radiologist performed an MRI, without contrast, of the patient's knee. True or False? Effective Date: 04.01.2022 This policy addresses the use of Parsabiv (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. Acetaminophen (Tylenol) is a drug used to relieve pain and reduce fever. The skin was then closed with 5-0 nylon and a sterile dressing was applied. Effective Date: 01.01.2022 This policy addresses minimally invasive endoscopic procedures and devices for treating gastroesophageal reflux disease (GERD) and the Per Oral Endoscopic Myotomy (POEM) procedure for achalasia or diffuse esophageal spasm. A limited duplex scan of the patient's lower extremity veins was performed. Surgical Technique: The patient was lying down supine. False (Append modifier 50 to the CPT code). Which of the following modifiers would be appended to a CPT code for repair of the right upper eyelid? 43233 EGD with dilation. Effective Date: 10.01.2022 This policy addresses the use of Enjaymo (sutimlimab-jome) for the treatment of cold agglutinin disease (CAD). Estimated blood loss 15 cc. Effective Date: 12.01.2022 This policy addresses facet joint injections/medial branch blocks for spinal pain. Effective Date: 06.01.2022 This policy addresses sites of care for outpatient speech, occupational, and physical therapy services. Effective Date: 05.01.2022 This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Effective Date: 11.01.2022 This policy addresses varicose vein ablative and stripping procedures and ligation procedures. If everything listed in code 95922 is not performed, the code is reported with modifier 52. Applicable Procedure Code: 42699. Under fluoroscopic guidance, the surgeon inserted a modular bifurcated endograft that extended into both iliac arteries (facility price).True or false: The following CPT code assignment (I71.4) is correct for this scenario? Applicable Procedure Code: 27599. Utilization Review Guidelines apply clinical practice guidelines to determine whether the health care services provided or planned for an individual member are the most appropriate and cost-effective services under the specific circumstances. Applicable Procedure Code: 19499. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941. Effective Date: 01.01.2022 This policy addresses skilled care and custodial care services. Applicable Procedure Codes: J1300, J1303. Effective Date: 06.01.2022 This policy addresses orthognathic (jaw) surgery. Hemostasis was achieved. Effective Date: 08.01.2022 This policy addresses breast repair/reconstruction not following mastectomy. Effective Date: 09.01.2022 This policy addresses planned elective inpatient admission for certain surgeries or procedures. Benzoin and Steri-Strips and a pressure dressing were applied. Applicable Procedure Codes: 93653, 93655, 93656, 93657. Office Visit Date of service 11/24/18 Last date of treatment: 7/12/17 The patient is seen for a routine blood pressure check. Applicable Procedure Code: 37241. Applicable Procedure Codes: J1437, J1439, Q0138. Applicable Procedure Code: J0223. Ulnar or radial gutter splint if fracture had to be reduced ; perform postreduction radiography in splint Repeat radiography in 7 to 10 days to evaluate for alignment Follow-up every 2 weeks Effective Date: 01.01.2022 This policy addresses laser interstitial thermal therapy. Traction is the application of _____ force to hold a bone in alignment. Download the Anesthesia Central app by Unbound Medicine, 2. Applicable Procedure Codes: 0308T, 67036, 67299, 92499. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, G0308, G0309, K0553, K0554, S1030, S1031, S1034, S1035, S1036, S1037. Effective Date: 09.01.2021 This policy addresses the use of devices to generate electric tumor treatment fields (TTF). The wound was closed using interrupted 3-0 Vicryl sutures, the skin was closed with subcuticular running 5-0 Dexon. Effective Date: 07.01.2022 This policy addresses the use of Amondys 45 (casimersen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Codes: 90283, 90284, C9075, C9399, J0129, J0180, J0221, J0222, J0223, J0224, J0256, J0257, J0490, J0517, J0584, J0638, J0717, J0791, J0896, J1300, J1301, J1303, J1322, J1426, J1427, J1428, J1429, J1458, J1459, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1599, J1602, J1743, J1745, J1746, J1786, J1823, J1931, J2182, J2786, J2840, J3032, J3060, J3241, J3245, J3262, J3357, J3358, J3380, J3385, J3397, J3490, J3590, Q5103, Q5104, Q5121. Applicable Procedure Code: J3398. Benefit coverage for health services is determined by the member specific benefit plan document, such as a Certificate of Coverage, Schedule of Benefits, or Summary Plan Description, and applicable laws that may require coverage for a specific service. 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