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Appendix F – ICD Codes for Measures #1 and #2 Error Prevention Measurement Methodology, Appendix F & G January 1 to June 30, 2008 Version 9.0a Updated for ICD-9 CM and CPT Code Changes Effective January 1, 2008 Questions or comments can be directed to Bob Beaverson at 608-274-1820 or [email protected].

Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

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Page 1: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

Error Prevention Measurement Methodology,

Appendix F & G

January 1 to June 30, 2008 Version 9.0a

Updated for ICD-9 CM and CPT Code Changes Effective January 1, 2008

Questions or comments can be directed to Bob Beaverson at 608-274-1820 or [email protected].

Page 2: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 0070 REV HIP REPLACEMENT, BOTH ACETABULA 0071 REV HIP REPLACEMENT, ACETABULAR COM 0072 REV HIP REPLACEMENT, FEMORAL COMPON 0073 REV HIP REPLACEMENT 0080 REV KNEE REPLACEMENT, TOTAL 0081 REV KNEE REPLACEMENT, TIBIAL 0082 REV KNEE REPLACEMENT, FEMORAL 0083 REV KNEE REPLACEMENT, PATELLAR 0084 REV TOTAL KNEE REPLACEMENT, TIBIAL 0085 HIP RESURFACING-TOTAL OCT 06 0086 HIP RESURFACING-FEM HEAD OCT 06 0087 HIP RESURFACING-ACETAB OCT 06 0111 CLO PERCUT NEEDLE BX CEREB MENINGE 0112 OP BX CEREBRAL MENINGES 0113 CLO [PERCUT] [NEEDLE] BX BRAIN 0114 OP BX BRAIN 0115 BX SKULL 0118 OTH DX PROC BRAIN-CEREB MENINGES 0121 I&D CRANIAL SINUS 0122 REMOVAL INTRACRAN NEUROSTIM LEAD(S) 0123 REOPEN CRANIOTOMY SITE 0124 OTH CRANIOTOMY 0125 OTH CRANIEC 0128 PLACE IC CATH-BURR HOLE 1-Oct-06 0131 INCIS CEREBRAL MENINGES 0132 LOBOTOMY & TRACTOTOMY 0139 OTH INCIS BRAIN 0141 OPER THALAMUS 0142 OPER GLOBUS PALLIDUS 0151 EXC LES/TISS CEREBRAL MENINGES 0152 HEMISPHERECTOMY 0153 LOBEC BRAIN 0159 OTH EXC/DESTRUC LES/TISS BRAIN 016 EXC LES SKULL 0201 OPENING CRANIAL SUT 0202 ELEV SKULL FX FRAGMENTS 0203 FORMATION CRANIAL BONE FLAP 0204 BONE GFT SKULL 0205 INSRT SKULL PLATE 0206 OTH CRANIAL OSTEOPLASTY 0207 REMOV SKULL PLATE

Page 3: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 0212 OTH REPR CEREBRAL MENINGES 0213 LIG MENINGEAL VESSEL 0214 CHOROID PLEXECTOMY 022 VENTRICULOSTOMY 0231 VENT SHUNT HEAD & NECK STRUCT 0232 VENT SHUNT-CIRC SYST 0233 VENT SHUNT-THOR CAVITY 0234 VENT SHUNT-ABD CAVITY & ORGANS 0235 VENT SHUNT-URIN SYST 0239 OTH OPER ESTAB VENT DRAIN 0241 IRRIGATION&EXPL VENTRICULAR SHUNT 0242 REPLCMT VENT SHUNT 0243 REMOV VENT SHUNT 0291 LYSIS CORTICAL ADHES 0292 REPR BRAIN 0293 IMPL/REPL INTRACRAN NEUROSTIM LEAD 0301 REMOV FB SPINAL CANAL 0309 OTH EXPLOR & DECOMP SPINAL CANAL 031 DIVIS INTRASPINAL NERV ROOT 0321 PERCUT CHORDOTOMY 0329 OTH CHORDOTOMY 036 LYSIS ADHES SPINAL CORD-NERV ROOTS 0371 SPINAL SUBARACHNOID-PERITON SHUNT 0372 SPINAL SUBARACHNOID-URETERAL SHUNT 0379 OTH SHUNT SPINAL THECA 038 INJ DESTRUCT AGENT SPINAL CANAL 0401 EXC ACOUSTIC NEUROMA 0402 DIVIS TRIGEMINAL NERV 0403 DIVIS/CRUSH OTH CRANIAL-PERIPH NERV 0404 OTH INCIS CRANIAL & PERIPH NERV 0405 GASSERIAN GANGLIONECTOMY 0406 OTH CRANIAL/PERIPH GANGLIONECTOMY 0407 OTH EXC/AVUL CRANIAL & PERIPH NERV 0411 CLO BX CRANIAL/PERIPH NERV/GANGL 0412 OP BX CRANIAL/PERIPH NERV/GANGL 0419 OTH DX CRANIAL-PERIPH NERV-GANGL 042 DESTRUC CRANIAL & PERIPH NERV 0441 DECOMP TRIGEMINAL NERV ROOT 0442 OTH CRANIAL NERV DECOMP 0443 RELEASE CARPAL TUNNEL 0444 RELEASE TARSAL TUNNEL

Page 4: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 0449 OTH PERIPH NERV/GANGL DECOMP/LYSIS 045 CRANIAL/PERIPH NERV GFT 046 TRANSPOSITION CRANIAL & PERIPH NERV 0471 HYPOGLOSSAL-FACIAL NERV ANASTOM 0472 ACCESS-FACIAL NERV ANASTOM 0473 ACCESS-HYPOGLOSSAL NERV ANASTOM 0474 OTH ANASTOM CRANIAL/PERIPH NERV 0475 REVIS PREV REPR CRANIAL-PERIPH NERV 0476 REPR OLD TRAUMA CRANIAL-PERIPH NERV 0479 OTH NEUROPLASTY 0480 PERIPH NERV INJ-NOS 0481 INJ ANES PERIPH NERV-ANALGESIA 0489 INJ NON-NEUROLYTIC PERIPH NERV 0491 NEURECTASIS 050 DIVIS SYMPATHETIC NERV/GANGL 0511 BX SYMPATHETIC NERV/GANGL 0519 OTH DX PROC SYMPATH NERV/GANGL 0521 SPHENOPALATINE GANGLIONECTOMY 0522 CERV SYMPATHECTOMY 0523 LUMB SYMPATHECTOMY 0524 PRESACRAL SYMPATHECTOMY 0525 PERIARTERIAL SYMPATHECTOMY 0529 OTH SYMPATHECTOMY-GANGLIONECT 0531 INJ ANES SYMPATHETIC NERV-ANALGES 0532 INJ NEUROLYTIC SYMPATHETIC NERV 0539 OTH INJ SYMPATHETIC NERV/GANGL 0589 OTH OPER SYMPATHETIC NERV/GANGL 059 OTH OPER NERV SYST 0801 INCIS LID MARGIN 0802 SEVER BLEPHARORRHAPHY 0809 OTH EYELID INCIS 0811 BX EYELID 0819 OTH DX PROC EYELID 0820 REMOV LES EYELID-NOS 0821 EXC CHALAZION 0822 EXC OTH MINOR LES EYELID 0823 EXC MAJOR LES EYELID-PART THICK 0824 EXC MAJOR LES EYELID-FULL-THICK 0825 DESTRUC LES EYELID 0831 REPR BLEPHAROPT-FRONTALIS MUSC-SUT 0832 REPR BLEPHAROPT-FRONTALIS MUS-SLING

Page 5: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 0833 REPR BLEPHAROPT-RESECT/ADVANC LEVAT 0834 REPR BLEPHAROPT-OTH LEVATOR MUSC 0835 REPR BLEPHAROPTOSIS-TARSAL TECH 0836 REPR BLEPHAROPTOSIS-OTH TECH 0837 REDUC OVERCORRECT PTOSIS 0838 CORRECT LID RETRACT 0841 REPR ENTROPION/ECTROP-THERMOCAUT 0842 REPR ENTROPION/ECTROPION-SUT TECH 0843 REPR ENTROPION/ECTROP-WEDGE RESECT 0844 REPR ENTROPION/ECTROP-LID RECON 0849 OTH REPR ENTROPION/ECTROPION 0851 CANTHOTOMY 0852 BLEPHARORRHAPHY 0859 OTH ADJUSTMENT LID POSIT 0861 RECON EYELID W/SKIN FLAP/GFT 0862 RECON LID-MUCOUS MEMBRN FLAP/GFT 0863 RECON EYELID W/HAIR FOLLICLE GFT 0864 RECON LID-TARSOCONJUNCTIVAL FLAP 0869 OTH RECON EYELID W/FLAPS/GFT 0870 RECON EYELID-NOS 0871 RECON LID INVOLV MARGIN-PART-THICK 0872 OTH RECON EYELID-PART-THICK 0873 RECON LID INVOLV MARGIN-FULL-THICK 0874 OTH RECON EYELID-FULL-THICK 0882 REPR LAC EYELID MARGIN-PART-THICK 0883 OTH REPR LAC EYELID-PART-THICK 0884 REPR LAC EYELID MARGIN-FULL-THICK 0885 OTH REPR LAC EYELID-FULL-THICK 0886 LOWER EYELID RHYTIDECTOMY 0887 UPPER EYELID RHYTIDECTOMY 0889 OTH EYELID REPR 0891 ELEC-SURG EPILATION EYELID 0892 CRYOSURG EPILATION EYELID 0893 OTH EYELID EPILATION 0899 OTH OPER EYELIDS 0911 BX LACRML GLAND 0912 BX LACRML SAC 0919 OTH DX PROC LACRML SYST 0920 EXC LACRML GLAND-NOS 0921 EXC LES LACRML GLAND 0922 OTH PART DACRYOADENECTOMY

Page 6: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 0923 TOT DACRYOADENECTOMY 093 OTH OPER LACRML GLAND 0941 PROBE LACRML PUNCTUM 0942 PROBE LACRML CANALICULI 0944 INTUBATE NASOLACRML DUCT 0949 OTH MANIP LACRML PASSAGE 0951 INCIS LACRML PUNCTUM 0952 INCIS LACRML CANALICULI 0953 INCIS LACRML SAC 0959 OTH INCIS LACRML PASSAGES 096 EXC LACRML SAC & PASSAGE 0971 CORRECT EVERTED PUNCTUM 0972 OTH REPR PUNCTUM 0973 REPR CANALICULUS 0981 DACRYOCYSTORHINOSTOMY [DCR] 0982 CONJUNCTIVOCYSTORHINOSTOMY 0983 CONJUNCTIVORHINOSTOMY W/TUBE/STENT 0991 OBLIT LACRML PUNCTUM 0999 OTH OPER LACRML SYST 100 INCIS W/REMOV EMBEDDED FB-CONJ 101 OTH CONJ INCIS 1021 BX CONJ 1029 OTH DX PROC CONJ 1031 EXC LES/TISS CONJ 1032 DESTRUC LES CONJ 1033 OTH CONJ DESTRUC PROC 1041 REPR SYMBLEPHARON W/FREE GFT 1042 RECON CONJ CUL-DE-SAC W/FREE GFT 1043 OTH RECON CONJ CUL-DE-SAC 1044 OTH FREE GFT CONJ 1049 OTH CONJUNCTIVOPLASTY 105 LYSIS CONJ & EYELID ADHES 1091 SUBCONJUNCTIVAL INJ 1099 OTH OPER CONJ 110 MAGNETIC REMOV EMBEDDED FB CORNEA 111 INCIS CORNEA 1121 SCRAPE CORNEA-SMEAR/CULT 1122 BX CORNEA 1129 OTH DX PROC CORNEA 1131 TRANSPOSITION PTERYGIUM 1132 EXC PTERYGIUM W/CORNEAL GFT

Page 7: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 1139 OTH EXC PTERYGIUM 1141 MECH REMOV CORNEAL EPITHELIUM 1142 THERMOCAUTERIZATION CORNEAL LES 1143 CRYOTHERAPY CORNEAL LES 1149 OTH REMOV/DESTRUC CORNEAL LES 1159 OTH CORNEAL REPR 1160 CORNEAL TRANSPL-NOS 1161 LAMELLAR KERATOPLASTY W/AUTOGFT 1162 OTH LAMELLAR KERATOPLASTY 1163 PENETRATING KERATOPLASTY W/AUTOGFT 1164 OTH PENETRATING KERATOPLASTY 1169 OTH CORNEAL TRANSPL 1172 KERATOPHAKIA 1173 KERATOPROSTHESIS 1174 THERMOKERATOPLASTY 1175 RADIAL KERATOTOMY 1176 EPIKERATOPHAKIA 1179 OTH RECON & REFRACTIVE CORNEA SURG 1191 TATTOOING CORNEA 1192 REMOV ARTIFICIAL IMPLNT CORNEA 1199 OTH OPER CORNEA 1200 REMOV INTRAOCCU FB ANT SEGMT-NOS 1201 REMOV INTRAOCCU FB ANT SEGMT-MAGNET 1202 REMOV INTRAOCCU FB ANT SEGMT WO MAG 1211 IRIDOTOMY W/TRANSFIXION 1212 OTH IRIDOTOMY 1213 EXC PROLAPSED IRIS 1214 OTH IRIDECTOMY 1221 DX ASPIR ANT CHAMBR-EYE 1222 BX IRIS 1229 OTH IRIS-CILIARY-SCLERA-ANT CHAMBR 1231 LYSIS GONIOSYNECHIAE 1232 LYSIS OTH ANT SYNECHIAE 1233 LYSIS POST SYNECHIAE 1234 LYSIS CORNEOVITREAL ADHES 1235 COREOPLASTY 1239 OTH IRIDOPLASTY 1240 REMOV LES ANT SEGMT-EYE-NOS 1241 DESTRUC LES IRIS-NONEXCISONAL 1242 EXC LES IRIS 1243 DESTRUC LES CILIARY BODY-NONEXCIS

Page 8: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 1244 EXC LES CILIARY BODY 1251 GONIOPUNCTURE WO GONIOTOMY 1252 GONIOTOMY WO GONIOPUNCTURE 1253 GONIOTOMY W/GONIOPUNCTURE 1254 TRABECULOTOMY AB EXT 1255 CYCLODIALYSIS 1259 OTH FACILITATION INTRAOCCULAR CIRC 1261 TREPHINATION SCLERA W/IRIDECTOMY 1262 THERMOCAUTERIZE SCLERA W/IRIDECTOMY 1263 IRIDENCLEISIS & IRIDOTASIS 1264 TRABECULECTOMY AB EXT 1265 OTH SCLERAL FISTULIZA-IRIDECTOMY 1266 POSTOP REVIS SCLERL FISTULIZAT PROC 1269 OTH SCLERAL FISTULIZING PROC 1271 CYCLODIATHERMY 1272 CYCLOCRYOTHERAPY 1273 CYCLOPHOTOCOAGULATION 1274 DIMINUTION CILIARY BODY-NOS 1279 OTH GLAU PROC 1281 SUT LAC SCLERA 1282 REPR SCLERAL FIST 1283 REVIS OPER WOUND ANT SEGMT-NEC 1284 EXC/DESTRUC LES SCLERA 1285 REPR SCLERAL STAPHYLOMA W/GFT 1286 OTH REPR SCLERAL STAPHYLOMA 1287 SCLERAL REINFORCEMENT W/GFT 1288 OTH SCLERAL REINFORCEMENT 1289 OTH OPER SCLERA 1291 THERAP EVAC ANT CHAMBR 1292 INJ ANT CHAMBR 1293 REMOV/DESTRUC EPITHEL-ANT CHAMBR 1297 OTH OPER IRIS 1298 OTH OPER CILIARY BODY 1299 OTH OPER ANT CHAMBR 1301 REMOV FB LENS W/MAGNET 1302 REMOV FB LENS WO MAGNET 1311 INTRACAP LENS EXTRCT-TEMPORAL INFER 1319 OTH INTRACAPSUL LENS EXTRACT 132 EXTRACAP LENS EXTRCT-LINEAR EXTRACT 133 EXTRACAP LENS EXTRACT-SIMPL ASPIR 1341 PHACOEMULSIFICATION-ASPIR CATARACT

Page 9: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 1342 MECH PHACOFRAG-ASPIR CATARACT-POST 1343 MECH PHACOFRAG-OTH ASPIR CATARACT 1351 EXTRACAP LENS EXTRCT-TEMPORAL INFER 1359 OTH EXTRACAPSUL LENS EXTRACT 1364 DISCISSION SECNDRY MEMBRN 1365 EXC SECNDRY MEMBRN [AFTER CATARACT] 1366 MECH FRAGMENT SECNDRY MEMBRN 1369 OTH CATARACT EXTRACT 1370 INSRT PSEUDOPHAKOS-NOS 1371 IOL PROSTH-CATARACT EXTRACT-1-STAGE 1372 SECNDRY INSRT IOL PROSTH 138 REMOV LENS IMPLNT 1390 OPERATION ON LENS-NEC OCT 06 1391 IMPL INOC TESC PROSTH OCT 06 1400 REMOV FB POST SEGMT-EYE-NOS 1401 REMOV FB POST SEGMT-EYE W/MAGNET 1402 REMOV FB POST SEGMT-EYE WO MAGNET 1411 DX ASPIR VITREOUS 1419 OTH RETINA-CHOROID-VIT-POST CHAMBR 1421 DEST CHORIORETIN LES-DIATHERMY 1422 DEST CHORIORETIN LES-CRYOTHERAPY 1423 DEST CHORIORETIN LES-XENON ARC 1424 DEST CHORIORETIN LES-LASER PHOTO 1425 DEST CHORIORETIN LES-PHOTOCOAG-UNS 1426 DEST CHORIORETIN LES-RAD THERAP 1427 DEST CHORIORETIN LES-IMPLNT RAD 1429 OTH DESTRUC CHORIORETINAL LES 1431 REPR RETINAL TEAR-DIATHERMY 1432 REPR RETINAL TEAR-CRYOTHERAPY 1433 REPR RETINAL TEAR-XENON ARC 1434 REPR RETINAL TEAR-LASER PHOTOCOAG 1435 REPR RETINAL TEAR-UNS PHOTOCOAG 1439 OTH REPR RETINAL TEAR 1441 SCLERAL BUCKLING W/IMPLNT 1449 OTH SCLERAL BUCKLING 1451 REPR RETINAL DETACH-DIATHERMY 1452 REPR RETINAL DETACH-CRYOTHERAPY 1453 REPR RETINAL DETACH-XENON ARC 1454 REPR RETINAL DETACH-LASER 1455 REPR RETINAL DETACH-UNS PHOTOCOAG 1459 OTH REPR RETINAL DETACH

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 146 REMOV SURG IMPLNT MAT-POST SEGMT 1471 REMOV VITREOUS-ANT APPRCH 1472 OTH VITREOUS REMOV 1474 OTH MECH VITRECTOMY 1475 INJ VITREOUS SUBSTITUTE 1479 OTH OPER VITREOUS 149 OTH OPER RETINA-CHOROID-POST CHAMBR 1501 BX EXTRAOCCULAR MUSC/TENDON 1509 OTH DX PROC EXTRAOCC MUSC-TENDONS 1511 RECESSION 1 EXTRAOCCULAR MUSC 1512 ADVANCEMENT 1 EXTRAOCCULAR MUSC 1513 RESECT 1 EXTRAOCCULAR MUSC 1519 OTH 1 EXTRAOCC MUSC-TEMP DETACH 1521 LENGTHEN PROC 1 EXTRAOCCULAR MUSC 1522 SHORTEN PROC 1 EXTRAOCCULAR MUSC 1529 OTH OPER 1 EXTRAOCCULAR MUSC 153 >=2 EXTRAOCC MUSC-TEMP DETCH-1/BOTH 154 >=2 EXTRAOCCULAR MUSC-1/BOTH EYES 155 TRANSPOSITION EXTRAOCCULAR MUSC 156 REVIS EXTRAOCCULAR MUSC SURG 159 OTH OPER EXTRAOCC MUSC-TENDONS 1691 RETROBULBAR INJ THERAP AGENT 1692 EXC LES ORBIT 1693 EXC LES EYE-UNS STRUCT 1698 OTH OPER ORBIT 1699 OTH OPER EYEBALL 1802 INCIS EXT AUDITORY CANAL 1809 OTH INCIS EXT EAR 1812 BX EXT EAR 1821 EXC PREAURICULAR SINUS 1829 EXC/DESTRUC OTH LES EXT EAR 1831 RAD EXC LES EXT EAR 1839 OTH EXC EXT EAR 185 SURG CORRECT PROMINENT EAR 186 RECON EXT AUDITORY CANAL 1871 CONSTRUCTION AURICLE EAR 1879 OTH PLSTC REPR EXT EAR 189 OTH OPER EXT EAR 190 STAPES MOBILIZATION 1911 STAPEDECTOMY W/INCUS REPLCMT 1919 OTH STAPEDECTOMY

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 1921 REVIS STAPEDECTOMY W/INCUS REPLCMT 1929 OTH REVIS STAPEDECTOMY 193 OTH OPER OSSICULAR CHAIN 194 MYRINGOPLASTY 1952 TYPE II TYMPANOPLASTY 1953 TYPE III TYMPANOPLASTY 1954 TYPE IV TYMPANOPLASTY 1955 TYPE V TYMPANOPLASTY 196 REVIS TYMPANOPLASTY 199 OTH REPR MID EAR 2021 INCIS MASTOID 2022 INCIS PETROUS PYRAMID AIR CELLS 2023 INCIS MID EAR 2032 BX MID & INNER EAR 2039 OTH DX PROC MID & INNER EAR 2041 SIMPL MASTOIDECTOMY 2042 RAD MASTOIDECTOMY 2049 OTH MASTOIDECTOMY 2051 EXC LES MID EAR 2059 OTH EXC MID EAR 2061 FENESTRATION INNER EAR (INITIAL) 2062 REVIS FENESTRATION INNER EAR 2071 ENDOLYMPHATIC SHUNT 2072 INJ INNER EAR 2079 OTH INCIS-EXC & DESTRUC INNER EAR 208 OPER EUSTACHIAN TUBE 2091 TYMPANOSYMPATHECTOMY 2092 REVIS MASTOIDECTOMY 2093 REPR OVAL & ROUND WINDOWS 2094 INJ TYMPANUM 2096 IMPLNT/REPLCMT COCH PROSTH-NOS 2097 IMPLNT/REPLCMT COCH PROSTH-1 CHNNL 2098 IMPLNT/REPLCMT COCH PROSTH-MX CHNNL 2099 OTH OPER MID & INNER EAR 301 HEMILARYNGECTOMY 3021 EPIGLOTTIDECTOMY 3022 VOCAL CORDECTOMY 3029 OTH PART LARYNGECTOMY 310 INJ LARYNX 311 TEMP TRACHEOSTOMY 313 OTH INCIS LARYNX/TRACHEA

Page 12: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 3141 TRACHEOSCOPY THRU ARTIFICIAL STOMA 3143 CLO [ENDO] BX LARYNX 3144 CLO [ENDO] BX TRACHEA 3145 OP BX LARYNX/TRACHEA 3148 OTH DX PROC LARYNX 3149 OTH DX PROC TRACHEA 315 LOC EXC/DESTRUC LES/TISS TRACHEA 3162 CLO FIST LARYNX 3163 REVIS LARYNGOSTOMY 3164 REPR LARYNGEAL FX 3169 OTH REPR LARYNX 3175 RECON TRACH-CONSTRUCT ART LARYNX 3179 OTH REPR & PLSTC OPER TRACHEA 3191 DIVIS LARYNGEAL NERV 3192 LYSIS TRACHEA/LARYNX ADHES 3193 REPLCMT LARYNGEAL/TRACHEAL STENT 3195 TRACHEOESOPHAGEAL FISTULIZATION 3198 OTH OPER LARYNX 3201 ENDO EXC/DESTRUC LES/TISS BRONCHUS 3209 OTH LOC EXC/DEST LES/TISS BRONCH 321 OTH EXC BRONCHUS 3220 THORASCOPIC EXCISION LESION/TISSUE LUNG OCT 07 3221 PLICATION EMPHYSEMATOUS BLEB 3222 LUNG VOL REDUC SURG 3223 OPEN ABLATION LUNG LESION OCT 06 3224 PERC ABLATION LUNG LESION OCT 06 3225 THORASCOPIC ABLATION LUNG LES/TISS OCT 06 3226 ABLATION LUNG LESION NEC & NOS OCT 06 3228 ENDO EXC/DESTRUC LES/TISS LUNG 3229 OTH LOC EXC/DEST LES/TISS LUNG 3230 THORASCOPIC SEGMENTAL RESECTION LUNG OCT 07 3241 THORASCOPIC LOBECTOMY OF LUNG OCT 07 3249 OTHER LOBECTOMY OF LUNG OCT 07 3250 THORASCOPIC PNEUMONECTOMY OCT 07 3259 OTHER AND UNSPECIFIED PNEUMONECTOMY OCT 07 323 SEGMENTAL RESECT LUNG 324 LOBEC LUNG 325 COMPLT PNEUMONECTOMY 326 RAD DISSECTION THOR STRUCT 329 OTH EXC LUNG 331 INCIS LUNG

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 3320 THORASCOPIC LUNG BIOPSY OCT 07 3328 OP BX LUNG 3329 OTH DX PROC LUNG & BRONCHUS 3332 ARTIFICIAL PNEUMOTHOR-COLLAPSE LUNG 3333 PNEUMOPERITONEUM-COLLAPSE LUNG 3334 THORACOPLASTY 3339 OTH SURG LUNG COLLAPSE 3349 OTH REPR & PLSTC OPER LUNG 3350 LUNG TRANSPL-NOS 3351 UNILAT LUNG TRANSPL 336 COMBO HEART-LUNG TRANSPL 3393 PUNCT LUNG 3399 OTH OPER LUNG 3401 INCIS CHEST WALL 3402 EXPLOR THORACOTOMY 3403 REOPEN RECENT THORACOTOMY SITE 3404 INSRT INTERCOSTAL DRAIN CATH 3405 CREATE PLEUROPERITONEAL SHUNT 3406 THORASCOPIC DRAINAGE OF PLEURAL CAVITY OCT 07 3409 OTH INCIS PLEURA 3420 THORASCOPIC PLEURAL BIOPSY OCT 07 3421 TRANSPLEURAL THORACOSCOPY 3423 BX CHEST WALL 3424 PLEURAL BX 3427 BX DIAPHRAGM 3428 OTH DX CHEST WALL-PLEURA-DIAPHRAGM 344 EXC/DESTRUC LES CHEST WALL 3451 DECORTIC LUNG 3452 THORASCOPIC DECORTICATION OF LUNG OCT 07 3459 OTH EXC PLEURA 346 SCARIFICATION PLEURA 3473 CLO OTH FIST-THOR 3474 REPR PECTUS DEFORM 3479 OTH CHEST WALL REPR 3481 EXC LES/TISS-DIAPHRAGM 3483 CLO FIST DIAPHRAGM 3484 OTH REPR DIAPHRAGM 3485 IMPLNT DIAPHRAGMATIC PACEMAKER 3489 OTH OPER DIAPHRAGM 3492 INJ THOR CAVITY

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 3493 REPR PLEURA 3499 OTH OPER THOR 3800 INCISION OF VESSEL UNSPECIFIED SITE 3801 INCIS INTRACRAN VESSELS 3802 INCIS OTH VESSELS HEAD & NECK 3803 INCIS UPPER LIMB VESSELS 3804 INCIS AORTA 3805 INCIS OTH THOR VESSELS 3806 INCIS ABD ART 3807 INCIS ABD VEINS 3808 INCIS LOWER LIMB ART 3809 INCIS LOWER LIMB VEINS 3810 ENDARTERECTOMY UNS SITE 3811 ENDARTERECT INTRACRAN VESSEL 3812 ENDARTERECT OTH VESSELS HEAD-NECK 3814 ENDARTERECTOMY AORTA 3815 ENDARTERECT OTH THOR VESSELS 3816 ENDARTERECTOMY ABD ART 3818 ENDARTERECTOMY LOWER LIMB ART 3821 BX BLD VESSEL 3822 PERCUT ANGIOSCOPY 3830 RESECT VESSEL W/ANASTOM UNS SITE 3831 RESECT INTRACRAN VESSELS-ANASTOM 3832 RESECT OTH HEAD-NECK VESSEL-ANASTOM 3833 RESECT UP LIMB VESSELS W/ANASTOM 3834 RESECT AORTA W/ANASTOM 3835 RESECT OTH THOR VESSELS-ANASTOM 3836 RESECT ABD ART W/ANASTOM 3837 RESECT ABD VEINS W/ANASTOM 3838 RESECT LOWER LIMB ART W/ANASTOM 3839 RESECT LOWER LIMB VEINS W/ANASTOM 3840 RESECT VESSEL W/REPLCMT UNS SITE 3841 RESECT INTRACRAN VESSELS-REPLCMT 3842 RESECT OTH HEAD-NECK VESSEL-REPLCMT 3843 RESECT UPPER LIMB VESSELS W/REPLCMT 3844 RESECT ABD AORTA W/REPLCMT 3845 RESECT OTH THOR VESSELS W/REPLCMT 3846 RESECT ABD ART W/REPLCMT 3847 RESECT ABD VEINS W/REPLCMT 3848 RESECT LOWER LIMB ART W/REPLCMT 3849 RESECT LOWER LIMB VEINS W/REPLCMT

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 3850 LIG & STRIP VARICOSE VEINS-UNS SITE 3851 LIG-STRIP VARICOSE VEINS-INTRACRAN 3852 LIG-STRIP VARICOSE VEINS HEAD-NECK 3853 LIG-STRIP VARICOSE VEINS-UP LIMB 3855 LIG-STRIP VARICOSE VEINS-THOR 3857 LIG-STRIP VARICOSE VEINS-ABD VEINS 3859 LIG-STRIP VARICOSE VEINS-LOWER LIMB 3860 OTH EXC VESSELS UNS SITE 3861 OTH EXC INTRACRAN VESSELS 3862 OTH EXC OTH VESSELS HEAD & NECK 3863 OTH EXC UPPER LIMB VESSELS 3864 OTH EXC ABD AORTA 3865 OTH EXC THOR VESSEL 3866 OTH EXC ABD ART 3867 OTH EXC ABD VEINS 3868 OTH EXC LOWER LIMB ART 3869 OTH EXC LOWER LIMB VEINS 387 INTERRUPTION VENA CAVA 3880 OTH SURG OCCLU VESSELS-UNS SITE 3881 OTH SURG OCCLU-INTRACRAN VESSEL 3882 OTH OCCLU-OTH VESSEL HEAD-NECK 3883 OTH SURG OCCLU-UP LIMB VESSEL 3884 OTH SURG OCCLU-ABD AORTA 3885 OTH SURG OCCLU-THOR VESSEL 3886 OTH SURG OCCLU-ABD ART 3887 OTH SURG OCCLU-ABD VEINS 3888 OTH SURG OCCLU-LOWER LIMB ART 3891 ART CATH 3892 UMB VEIN CATH 3894 VENOUS CUTDN 3898 OTH PUNCT ART 3899 OTH PUNCT VEIN 390 SYSTEMIC-PULM ART SHUNT 391 INTRA-ABD-VENOUS SHUNT 3921 CAVAL-PULM ART ANASTOM 3922 AORTA-SUBCLAVIAN-CAROTID BYPASS 3923 OTH INTRATHOR VASC SHUNT/BYPASS 3924 AORTA-RENAL BYPASS 3925 AORTA-ILIAC-FEM BYPASS 3929 OTH (PERIPH) VASC SHUNT/BYPASS 3974 ENDOV RMVL HEAD/NECK VESS OBSTR OCT 06

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 3979 OTH ENDOVASCULAR REPAIR OTH VESSELS 398 OPER CAROTID BODY-OTH VASC BODIES 3990 INSRT NON-RX-ELUT PERIPH VES STENTS 3991 FREEING VESSEL 3992 INJ VEIN W/SCLEROSING AGENT 3993 INSRT VESSEL-TO-VESSEL CANNULA 3994 REPLCMT VESSEL-TO-VESSEL CANNULA 3998 CNTRL HEMORR-NOS 3999 OTH OPER VESSELS 400 INCIS LYMPHATIC STRUCT 4105 ALLO HEMAT ST CELL TRNSPLT W/O PURG 4106 CORD BLD STEM CELL TRANSPL 4107 AUTO HEMAT ST CELL TRNSPLT W PURG 4108 ALLO HEMAT ST CELL TRNSPLT W PURG 4109 AUTO BONE MARR TRNSPLT W PURG 4138 OTH DX PROC BONE MARROW 4191 ASPIR DONOR BONE MARROW TRANSPL 4192 INJ BONE MARROW 4198 OTH OPER BONE MARROW 5300 UNILAT REPR ING HERN-NOS 5301 UNILAT REPR DIRECT ING HERN 5302 UNILAT REPR INDIRECT ING HERN 5303 UNILAT REPR DIRECT ING HERN-GFT 5304 UNILAT REPR INDIRECT ING HERN-GFT 5305 UNILAT REPR ING HERN-GFT-NOS 5321 UNILAT REPR FEM HERN W/GFT/PROSTH 5329 OTH UNILAT FEM HERNIORRHAPHY 5501 NEPHROTOMY 5502 NEPHROSTOMY 5503 PERCUT NEPHROSTOMY WO FRAGMENT 5504 PERCUT NEPHROSTOMY W/FRAGMENT 5511 PYELOTOMY 5512 PYELOSTOMY 5523 CLO [PERCUT] [NEEDLE] BX KIDNEY 5524 OP BX KIDNEY 5529 OTH DX PROC KIDNEY 5531 MARSUP KIDNEY LES 5539 OTH LOC DEST/EXC RENAL LES/TISS 554 PART NEPHRECTOMY 5551 NEPHROURETERECTOMY 5552 NEPHRECTOMY REMAINING KIDNEY

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 5553 REMOV TRANSPL/REJECTED KIDNEY 5554 BILAT NEPHRECTOMY APRIL 07 5561 RENAL AUTOTRANSPL 5569 OTH KIDNEY TRANSPL 557 NEPHROPEXY 5582 CLO NEPHROSTOMY & PYELOSTOMY 5583 CLO OTH KIDNEY FIST 5584 REDUC TORSION RENAL PEDICLE 5585 SYMPHYSIOTOMY HORSESHOE KIDNEY 5586 ANASTOM KIDNEY 5587 CORRECT URETEROPELVIC JUNCTION 5589 OTH REPR KIDNEY 5591 DECAPSULATION KIDNEY 5592 PERCUT ASPIR KIDNEY (PELV) 5593 REPLCMT NEPHROSTOMY TUBE 5594 REPLCMT PYELOSTOMY TUBE 5595 LOC PERFUSION KIDNEY 5596 OTH INJ THERAP SUBSTANCE KIDNEY 5597 IMPLNT/REPLCMT MECH KIDNEY 5598 REMOV MECH KIDNEY 5599 OTH OPER KIDNEY 5632 CLO PERCUT BX URETER 5634 OP BX URETER 5640 URETERECTOMY-NOS 5641 PART URETERECTOMY 5642 TOT URETERECTOMY 5672 REVIS URETEROINTESTINAL ANASTOM 5673 NEPHROCYSTANASTOMOSIS-NOS 5681 LYSIS INTRALUMINAL URETER ADHES 5684 CLO OTH FIST URETER 5685 URETEROPEXY 5686 REMOV LIG URETER 5689 OTH REPR URETER 5691 DILAT URETERAL MEATUS 5692 IMPLNT ELECTRONIC URETERAL STIM 5693 REPLCMT ELECTRONIC URETERAL STIM 5694 REMOV ELECTRONIC URETERAL STIM 5695 LIG URETER 6501 LAP OOPHOROTOMY 6509 OTH OOPHORECTOMY 6511 ASPIR BX OVARY

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 6512 OTH BX OVARY 6513 LAP BX OVARY 6514 OTH LAP DX PROC OVARIES 6519 OTH DX PROC OVARIES 6521 MARSUP OVARIAN CYST 6522 WEDGE RESECT OVARY 6523 LAP MARSUP OVARIAN CYST 6524 LAP WEDGE RESECT OVARY 6525 OTH LAP LOC EXC/DESTRUC OVARY 6529 OTH LOC EXC/DESTRUC OVARY 6531 LAP UNILAT OOPHORECTOMY 6539 OTH UNILAT OOPHORECTOMY 6541 LAP UNILAT SALPINGO-OOPHORECTOMY 6549 OTH UNILAT SALPINGO-OOPHORECTOMY 6552 OTH REMOV REMAINING OVARY 6562 OTH REMOV REMAINING OVARY & TUBE 6564 LAP REMOV REMAINING OVARY & TUBE 6572 OTH REIMPLNT OVARY 6573 OTH SALPINGO-OOPHOROPLASTY 6576 LAP SALPINGO-OOPHOROPLASTY 6579 OTH REPR OVARY 6581 LAP LYSIS OVARY-FALLOP TUBE ADHES 6589 OTH LYSIS OVARY-FALLOP TUBE ADHES 6591 ASPIR OVARY 6592 TRANSPL OVARY 6593 MANUAL RUPT OVARIAN CYST 6594 OVARIAN DENERVATION 6595 RELEASE TORSION OVARY 6599 OTH OPER OVARY 6601 SALPINGOTOMY 6602 SALPINGOSTOMY 6611 BX FALLOPIAN TUBE 6619 OTH DX PROC FALLOPIAN TUBES 664 TOT UNILAT SALPINGECTOMY 6652 REMOV REMAINING FALLOPIAN TUBE 6661 EXC/DESTRUC LES FALLOPIAN TUBE 6662 SALPINGECTOMY W/REMOV TUBAL PG 6663 BILAT PART SALPINGECTOMY-NOS APRIL 07 6669 OTH PART SALPINGECTOMY 6672 SALPINGO-OOPHOROSTOMY 6673 SALPINGO-SALPINGOSTOMY

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 6674 SALPINGO-UTEROSTOMY 668 INSUFFLATION FALLOPIAN TUBE 6691 ASPIR FALLOPIAN TUBE 6692 UNILAT DEST/OCCLU FALLOPIAN TUBE 6693 IMPLNT/REPLCE PROSTH FALLOP TUBE 6694 REMOV PROSTH FALLOPIAN TUBE 6695 INSUFFLAT THERAP AGENT FALLOP TUBES 6696 DILAT FALLOPIAN TUBE 6697 BURY FIMBRIAE UTERINE WALL 6699 OTH OPER FALLOPIAN TUBES 7601 SEQUESTREC FACIAL BONE 7609 OTH INCIS FACIAL BONE 7611 BX FACIAL BONE 7619 OTH DX PROC FACIAL BONES & JT 762 LOC EXC/DESTRUC LES FACIAL BONE 7631 PART MANDIBULECTOMY 7639 PART OSTEC OTH FACIAL BONE 7643 OTH RECON MANDIB 7644 TOT OSTEC OTH FACIAL BONE-RECON 7646 OTH RECON OTH FACIAL BONE 765 TEMPOROMANDIB ARTHROPLSTY 7670 REDUC FACIAL FX-NOS 7671 CLO REDUC MALAR & ZYGO FX 7672 OP REDUC MALAR & ZYGO FX 7673 CLO REDUC MAXIL FX 7674 OP REDUC MAXIL FX 7675 CLO REDUC MANDIB FX 7676 OP REDUC MANDIB FX 7677 OP REDUC ALVEOL FX 7678 OTH CLO REDUC FACIAL FX 7679 OTH OP REDUC FACIAL FX 7691 BONE GFT FACIAL BONE 7692 INSRT SYNTHETIC IMPLNT FACIAL BONE 7693 CLO REDUC TEMPOROMANDIB DISLOC 7694 OP REDUC TEMPOROMANDIB DISLOC 7695 OTH MANIP TMJ 7696 INJ THERAP SUBSTANCE TMJ 7697 REMOV INT FIX DEVICE FACIAL BONE 7699 OTH OPER FACIAL BONES & JT 7700 SEQUESTREC-UNS SITE 7701 SEQUESTREC-SCAPULA-CLAV-THOR

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 7702 SEQUESTREC-HUMERUS 7703 SEQUESTREC-RADIUS & ULNA 7704 SEQUESTREC-CARPALS & METACARPALS 7705 SEQUESTREC-FEM 7706 SEQUESTREC-PATELLA 7707 SEQUESTREC-TIBIA & FIB 7708 SEQUESTREC-TARSALS & METATARSALS 7709 SEQUESTREC-OTH BONE 7710 OTH INCIS BONE WO DIVIS-UNS SITE 7711 OTH INCIS WO DIVIS-SCAPLA-CLAV-THOR 7712 OTH INCIS WO DIVIS-HUMERUS 7713 OTH INCIS WO DIVIS-RADIUS & ULNA 7714 OTH INCIS WO DIVIS-CARP-METACARP 7715 OTH INCIS WO DIVIS-FEM 7716 OTH INCIS WO DIVIS-PATELLA 7717 OTH INCIS WO DIVIS-TIBIA & FIB 7718 OTH INCIS WO DIVIS-TARSAL-METATARS 7719 OTH INCIS WO DIVIS-OTH BONE 7720 WEDGE OSTEOT-UNS SITE 7721 WEDGE OSTEOT-SCAPULA-CLAV & THOR 7722 WEDGE OSTEOT-HUMERUS 7723 WEDGE OSTEOT-RADIUS & ULNA 7724 WEDGE OSTEOT-CARPALS & METACARPALS 7725 WEDGE OSTEOT-FEM 7726 WEDGE OSTEOT-PATELLA 7727 WEDGE OSTEOT-TIBIA & FIB 7729 WEDGE OSTEOT-OTH BONE 7730 OTH DIVIS BONE-UNS SITE 7731 OTH DIVIS-SCAPULA-CLAV-THOR 7732 OTH DIVIS-HUMERUS 7733 OTH DIVIS-RADIUS & ULNA 7734 OTH DIVIS-CARPALS & METACARPALS 7735 OTH DIVIS-FEM 7736 OTH DIVIS-PATELLA 7737 OTH DIVIS-TIBIA & FIB 7738 OTH DIVIS-TARSALS & METATARSALS 7739 OTH DIVIS-OTH BONE 7740 BX BONE-UNS SITE 7741 BX-SCAPULA-CLAV & THOR 7742 BX-HUMERUS 7743 BX-RADIUS & ULNA

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 7744 BX-CARPALS & METACARPALS 7745 BX-FEM 7746 BX-PATELLA 7747 BX-TIBIA & FIB 7748 BX-TARSALS & METATARSALS 7749 BX-OTH BONE 7751 BUNIONEC SOFT-OSTEOT 1ST METATARS 7752 BUNIONEC-SOFT TIS-ARTHRODESIS 7753 OTH BUNIONEC W/SOFT TISS CORRECT 7754 EXC/CORRECT BUNIONETTE 7756 REPR HAMMER TOE 7757 REPR CLAW TOE 7758 OTH EXC-FUSION & REPR TOES 7759 OTH BUNIONEC 7760 LOC EXC LES/TISS-BONE-UNS SITE 7761 LOC EXC LES SCAPULA-CLAV & THOR 7762 LOC EXC LES/TISS-HUMERUS 7763 LOC EXC LES/TISS-RADIUS & ULNA 7764 LOC EXC LES/TISS-CARP-METACARP 7765 LOC EXC LES/TISS-FEM 7766 LOC EXC LES/TISS-PATELLA 7767 LOC EXC LES/TISS-TIBIA & FIB 7768 LOC EXC LES/TISS-TARS-METATARS 7769 LOC EXC LES/TISS-OTH BONE 7770 EXC-BONE GFT-UNS SITE 7771 EXC BONE GFT-SCAPULA-CLAV-THOR 7772 EXC BONE GFT-HUMERUS 7773 EXC BONE GFT-RADIUS & ULNA 7774 EXC BONE GFT-CARPALS-METACARPALS 7775 EXC BONE GFT-FEM 7776 EXC BONE GFT-PATELLA 7777 EXC BONE GFT-TIBIA & FIB 7778 EXC BONE GFT-TARSALS-METATARSALS 7779 EXC BONE GFT-OTH BONE 7780 OTH PART OSTEC-UNS SITE 7781 OTH PART OSTEC-SCAPULA-CLAV-THOR 7782 OTH PART OSTEC-HUMERUS 7783 OTH PART OSTEC-RADIUS & ULNA 7784 OTH PART OSTEC-CARPALS-METACARPALS 7785 OTH PART OSTEC-FEM 7786 OTH PART OSTEC-PATELLA

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 7787 OTH PART OSTEC-TIBIA & FIB 7788 OTH PART OSTEC-TARSALS-METATARSALS 7790 TOT OSTEC-UNS SITE 7791 TOT OSTEC-SCAPULA-CLAV-THOR 7792 TOT OSTEC-HUMERUS 7793 TOT OSTEC-RADIUS & ULNA 7794 TOT OSTEC-CARPALS & METACARPALS 7795 TOT OSTEC-FEM 7796 TOT OSTEC-PATELLA 7797 TOT OSTEC-TIBIA & FIB 7798 TOT OSTEC-TARSALS & METATARSALS 7799 TOT OSTEC OTH BONE 7800 BONE GFT-UNS SITE 7801 BONE GFT-SCAPULA-CLAV & THOR 7802 BONE GFT-HUMERUS 7803 BONE GFT-RADIUS & ULNA 7804 BONE GFT-CARPALS & METACARPALS 7805 BONE GFT-FEM 7806 BONE GFT-PATELLA 7807 BONE GFT-TIBIA & FIB 7808 BONE GFT-TARSALS & METATARSALS 7809 BONE GFT-OTH BONE 7810 APPLIC EXT FIX DEVICE-UNS SITE 7811 APPLIC EXT FIX-SCAPULA-CLAV-THOR 7812 APPLIC EXT FIX DEVICE-HUMERUS 7813 APPLIC EXT FIX DEVICE-RADIUS & ULNA 7814 APPLIC EXT FIX DEVICE-CARP-METACARP 7815 APPLIC EXT FIX DEVICE-FEM 7816 APPLIC EXT FIX DEVICE-PATELLA 7817 APPLIC EXT FIX DEVICE-TIBIA & FIB 7818 APPLIC EXT FIX-TARSALS-METATARSALS 7819 APPLIC EXT FIX DEVICE-OTH BONE 7820 LIMB SHORTEN PROC-UNS SITE 7822 LIMB SHORTEN PROC-HUMERUS 7823 LIMB SHORTEN PROC-RADIUS & ULNA 7824 LIMB SHORTEN PROC-CARPAL-METACARPAL 7825 LIMB SHORTEN PROC-FEM 7827 LIMB SHORTEN PROC-TIBIA & FIB 7828 LIMB SHORTEN PROC-TARSAL-METATARSAL 7829 LIMB SHORTEN PROC-OTH BONE 7830 LIMB LENGTHEN PROC-UNS SITE

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 7832 LIMB LENGTHEN PROC-HUMERUS 7833 LIMB LENGTHEN PROC-RADIUS & ULNA 7834 LIMB LENGTHEN PROC-CARP-METACARP 7835 LIMB LENGTHEN PROC-FEM 7837 LIMB LENGTHEN PROC-TIBIA & FIB 7838 LIMB LENGTHEN PROC-TARS-METATARS 7839 LIMB LENGTHEN PROC-OTH BONE 7840 OTH REPR/PLSTC OPER BONE-UNS SITE 7841 OTH REPR OPER-SCAPULA-CLAV & THOR 7842 OTH REPR/PLSTC OPER-HUMERUS 7843 OTH REPR/PLSTC OPER-RADIUS & ULNA 7844 OTH REPR OPER-CARPALS-METACARPALS 7845 OTH REPR/PLSTC OPER-FEM 7846 OTH REPR/PLSTC OPER-PATELLA 7847 OTH REPR/PLSTC OPER-TIBIA & FIB 7848 OTH REPR OPER-TARSALS-METATARSALS 7850 INT FIX-BONE WO FX REDUC-UNS SITE 7851 INT FIX WO REDUC-SCAPULA-CLAV-THOR 7852 INT FIX WO FX REDUC-HUMERUS 7853 INT FIX WO FX REDUC-RADIUS & ULNA 7854 INT FIX WO REDUC-CARPAL-METACARPAL 7855 INT FIX WO FX REDUC-FEM 7856 INT FIX WO FX REDUC-PATELLA 7857 INT FIX WO FX REDUC-TIBIA & FIB 7858 INT FIX WO REDUC-TARSAL-METATARSAL 7859 INT FIX WO FX REDUC-OTH BONE 7860 REMOV IMPLNT DEVICE-UNS SITE 7861 REMOV IMPLNT-SCAPULA-CLAV-THOR 7862 REMOV IMPLNT DEVICE-HUMERUS 7863 REMOV IMPLNT DEVICE-RADIUS & ULNA 7864 REMOV IMPLNT DEVICE-CARP-METACARP 7865 REMOV IMPLNT DEVICE-FEM 7866 REMOV IMPLNT DEVICE-PATELLA 7867 REMOV IMPLNT DEVICE-TIBIA & FIB 7868 REMOV IMPLNT DEVICE-TARS-METATARS 7869 REMOV IMPLNT DEVICE-OTH BONE 7870 OSTEOCLASIS-UNS SITE 7871 OSTEOCLASIS-SCAPULA-CLAV-THOR 7872 OSTEOCLASIS-HUMERUS 7873 OSTEOCLASIS-RADIUS & ULNA 7874 OSTEOCLASIS-CARPALS & METACARPALS

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 7875 OSTEOCLASIS-FEM 7876 OSTEOCLASIS-PATELLA 7877 OSTEOCLASIS-TIBIA & FIB 7878 OSTEOCLASIS-TARSALS & METATARSALS 7879 OSTEOCLASIS-OTH BONE 7880 DX PROC BONE-NEC-UNS SITE 7881 DX PROC-NEC-SCAPULA-CLAV-THOR 7882 DX PROC-NEC-HUMERUS 7883 DX PROC-NEC-RADIUS & ULNA 7884 DX PROC-NEC-CARPALS & METACARPALS 7885 DX PROC-NEC-FEM 7886 DX PROC-NEC-PATELLA 7887 DX PROC-NEC-TIBIA & FIB 7888 DX PROC-NEC-TARSALS & METATARSALS 7889 DX PROC-NEC-OTH BONE 7890 INSRT BONE GROWTH STIM-UNS SITE 7891 INSRT GROWTH STIM-SCAPULA-CLAV-THOR 7892 INSRT BONE GROWTH STIM-HUMERUS 7893 INSRT BONE GROWTH STIM-RADIUS-ULNA 7894 INSRT GROWTH STIM-CARPAL-METACARPAL 7895 INSRT BONE GROWTH STIM-FEM 7896 INSRT BONE GROWTH STIM-PATELLA 7897 INSRT BONE GROWTH STIM-TIBIA & FIB 7898 INSRT GROWTH STIM-TARSAL-METATARSAL 7899 INSRT BONE GROWTH STIM-OTH BONE 7920 OP REDUC FX WO INT FIX-UNS SITE 7921 OP REDUC FX WO INT FIX-HUMERUS 7922 OP REDUC WO INT FIX-RADIUS & ULNA 7923 OP REDUC WO INT FIX-CARP-METACARP 7924 OP REDUC WO INT FIX-PHALANGES HAND 7925 OP REDUC FX WO INT FIX-FEM 7926 OP REDUC FX WO INT FIX-TIBIA & FIB 7927 OP REDUC WO INT FIX-TARS-METATARS 7928 OP REDUC FX WO INT FIX-PHALANGES FT 7929 OP REDUC FX WO INT FIX-OTH BONE 7930 OP REDUC FX W/INT FIX-UNS SITE 7931 OP REDUC FX W/INT FIX-HUMERUS 7932 OP REDUC FX W/INT FIX-RADIUS & ULNA 7933 OP REDUC W/INT FIX-CARP-METACARP 7934 OP REDUC W/INT FIX-PHALANGES HAND 7935 OP REDUC FX W/INT FIX-FEM

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 7936 OP REDUC FX W/INT FIX-TIBIA & FIB 7937 OP REDUC W/INT FIX-TARS-METATARS 7938 OP REDUC FX W/INT FIX-PHALANGES FT 7939 OP REDUC FX W/INT FIX-OTH BONE 7940 CLO REDUC SEPART EPIPHYSIS-UNS SITE 7941 CLO REDUC SEPART EPIPHYSIS-HUMERUS 7942 CLO REDUC SEPART EPIPHYSIS-RAD-ULNA 7945 CLO REDUC SEPART EPIPHYSIS-FEM 7949 CLO REDUC SEPART EPIPHYSIS-OTH BONE 7950 OP REDUC SEPART EPIPHYSIS-UNS SITE 7951 OP REDUC SEPART EPIPHYSIS-HUMERUS 7952 OP REDUC SEPART EPIPHYSIS-RAD-ULNA 7955 OP REDUC SEPART EPIPHYSIS-FEM 7956 OP REDUC SEPART EPIPHYSIS-TIBIA-FIB 7959 OP REDUC SEPART EPIPHYSIS-OTH BONE 7980 OP REDUC DISLOC-UNS SITE 7981 OP REDUC DISLOC-SHLDR 7982 OP REDUC DISLOC-ELB 7983 OP REDUC DISLOC-WRIST 7984 OP REDUC DISLOC-HAND & FINGR 7985 OP REDUC DISLOC-HIP 7986 OP REDUC DISLOC-KNEE 7987 OP REDUC DISLOC-ANK 7988 OP REDUC DISLOC-FT & TOE 7989 OP REDUC DISLOC-OTH SPEC SITE 7990 UNS OPER BONE INJURY-UNS SITE 7991 UNS OPER BONE INJURY-HUMERUS 7992 UNS OPER BONE INJURY-RADIUS & ULNA 7993 UNS OPER BONE INJURY-CARP-METACARP 7994 UNS OPER BONE INJURY-PHALANGES HAND 7995 UNS OPER BONE INJURY-FEM 7996 UNS OPER BONE INJURY-TIBIA & FIB 7997 UNS OPER BONE INJURY-TARS-METATARS 7998 UNS OPER BONE INJURY-PHALANGES FT 7999 UNS OPER BONE INJURY-OTH SPEC BONE 8000 ARTHROT REMOV PROSTH-UNS SITE 8001 ARTHROT REMOV PROSTH-SHLDR 8002 ARTHROT REMOV PROSTH-ELB 8003 ARTHROT REMOV PROSTH-WRIST 8004 ARTHROT REMOV PROSTH-HAND & FINGR 8005 ARTHROT REMOV PROSTH-HIP

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8007 ARTHROT REMOV PROSTH-ANK 8008 ARTHROT REMOV PROSTH-FT & TOE 8009 ARTHROT REMOV PROSTH-OTH SPEC SITE 8010 OTH ARTHROT-UNS SITE 8011 OTH ARTHROT-SHLDR 8012 OTH ARTHROT-ELB 8013 OTH ARTHROT-WRIST 8014 OTH ARTHROT-HAND & FINGR 8015 OTH ARTHROT-HIP 8016 OTH ARTHROT-KNEE 8017 OTH ARTHROT-ANK 8018 OTH ARTHROT-FT & TOE 8019 OTH ARTHROT-OTH SPEC SITE 8020 ARTHSCPY-UNS SITE 8021 ARTHSCPY-SHLDR 8022 ARTHSCPY-ELB 8023 ARTHSCPY-WRIST 8024 ARTHSCPY-HAND & FINGR 8025 ARTHSCPY-HIP 8026 ARTHSCPY-KNEE 8027 ARTHSCPY-ANK 8028 ARTHSCPY-FT & TOE 8029 ARTHSCPY-OTH SPEC SITE 8030 BX JT STRUCT-UNS SITE 8031 BX JT STRUCT-SHLDR 8032 BX JT STRUCT-ELB 8033 BX JT STRUCT-WRIST 8034 BX JT STRUCT-HAND & FINGR 8035 BX JT STRUCT-HIP 8036 BX JT STRUCT-KNEE 8037 BX JT STRUCT-ANK 8038 BX JT STRUCT-FT & TOE 8039 BX JT STRUCT-OTH SPEC SITE 8040 DIVIS JT CAP-LIGAMNT/CART-UNS SITE 8041 DIVIS JT CAP-LIGAMNT/CART-SHLDR 8042 DIVIS JT CAP-LIGAMNT/CART-ELB 8043 DIVIS JT CAP-LIGAMNT/CART-WRIST 8044 DIVIS JT CAP-LIGAMNT/CART-HND-FINGR 8045 DIVIS JT CAP-LIGAMNT/CART-HIP 8046 DIVIS JT CAP-LIGAMNT/CART-KNEE 8047 DIVIS JT CAP-LIGAMNT/CART-ANK

Page 27: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8048 DIVIS JT CAP-LIGAMNT/CART-FT & TOE 8049 DIVIS JT CAP-LIGAMNT/CART-OTH SITE 8050 EXC/DESTRUC INTERVERTEBRAL DISC-UNS 8051 EXC INTERVERTEBRAL DISC 8052 INTERVERTEBRAL CHEMONUCLEOLYSIS 8059 OTH DESTRUC INTERVERTEBRAL DISC 806 EXC SEMILUNAR CARTILAGE-KNEE 8070 SYNOVECT-UNS SITE 8071 SYNOVECT-SHLDR 8072 SYNOVECT-ELB 8073 SYNOVECT-WRIST 8074 SYNOVECT-HAND & FINGR 8075 SYNOVECT-HIP 8076 SYNOVECT-KNEE 8077 SYNOVECT-ANK 8078 SYNOVECT-FT & TOE 8079 SYNOVECT-OTH SPEC SITE 8080 OTH LOC EXC/DEST JT LES-UNS SITE 8081 OTH LOC EXC/DESTRUC JT LES-SHLDR 8082 OTH LOC EXC/DESTRUC JT LES-ELB 8084 OTH LOC EXC/DEST JT LES-HND-FINGR 8085 OTH LOC EXC/DESTRUC JT LES-HIP 8086 OTH LOC EXC/DESTRUC JT LES-KNEE 8087 OTH LOC EXC/DESTRUC JT LES-ANK 8088 OTH LOC EXC/DEST JT LES-FT-TOE 8089 OTH LOC EXC/DEST JT LES-OTH SITE 8090 OTH EXC JT-UNS SITE 8091 OTH EXC JT-SHLDR 8092 OTH EXC JT-ELB 8093 OTH EXC JT-WRIST 8094 OTH EXC JT-HAND & FINGR 8095 OTH EXC JT-HIP 8096 OTH EXC JT-KNEE 8097 OTH EXC JT-ANK 8098 OTH EXC JT-FT & TOE 8099 OTH EXC-JT OTH SPEC SITE 8100 SPINAL FUSION-NOS 8101 ATLAS-AXIS SPINAL FUSION 8102 OTH CERV FUSION-ANT TECH 8103 OTH CERV FUSION-POST TECH 8104 DORSAL-DORSOLUMBAR FUS-ANT TECH

Page 28: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8105 DORSAL-DORSOLUMBAR FUS-POST TECH 8106 LUMB & LUMBOSACRAL FUSION-ANT TECH 8107 LUMB-LUMBOSACRAL FUS-LAT TRANSVERSE 8108 LUMB-LUMBOSACRAL FUSION-POST TECH 8111 ANK FUSION 8112 TRIPLE ARTHRODESIS 8113 SUBTALAR FUSION 8114 MIDTARSAL FUSION 8115 TARSOMETATARSAL FUSION 8116 METATARSOPHALANGEAL FUSION 8117 OTH FUSION FT 8120 ARTHRODESIS UNS JT 8121 ARTHRODESIS HIP 8122 ARTHRODESIS KNEE 8123 ARTHRODESIS SHLDR 8124 ARTHRODESIS ELB 8125 CARPORADIAL FUSION 8126 METACARPOCARPAL FUSION 8127 METACARPOPHALANGEAL FUSION 8128 INTERPHALANGEAL FUSION 8129 ARTHRODESIS OTH SPEC JT 8130 REFUSION OF SPINE NOS 8131 REFUSION OF ATLAS-AXIS SPINE 8132 REFUSION OTH C-SPINE ANT TECHNIQUE 8133 REFUS OTH C-SPINE POST TECHNIQUE 8134 REFUS DORS&DORSOLUMB SPN ANT TECH 8135 REFUS DORS&DORSOLUMB SPN POST TECH 8136 REFUS LUMB&LUMBOSAC SPN ANT TECH 8137 REFUS LUMB&LUMBOSAC SPN LAT TRNS 8138 REFUS LUMB&LUMBOSAC SPN POST TECH 8139 REFUSION OF SPINE NEC 8140 REPR HIP-NEC 8142 5-IN-1 KNEE REPR 8143 TRIAD KNEE REPR 8144 PATELLAR STABILIZATION 8145 OTH REPR CRUCIATE LIGAMNT 8146 OTH REPR COLLAT LIGAMNT 8147 OTH REPR KNEE 8149 OTH REPR ANK 8151 TOTAL HIP REPLACEMENT Correction 8152 PART HIP REPLCMT

Page 29: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8153 REVIS HIP REPLCMT 8154 TOT KNEE REPLCMT 8155 REVIS KNEE REPLCMT 8156 TOT ANK REPLCMT 8157 REPLCMT JT FT & TOE 8159 REVIS JT REPLCMT LOWER EXTREM-NEC 8162 FUSION OR REFUSION OF 2-3 VERTEBRAE 8163 FUSION OR REFUSION OF 4-8 VERTEBRAE 8164 FUSION/REFUSION 9/MORE VERTEBRAE 8165 VERTEBROPLASTY 8166 KYPHOPLASTY 8171 ARTHROPLSTY MCP-IP JT W/IMPLNT 8172 ARTHROPLSTY MCP-IP JT WO IMPLNT 8173 TOT WRIST REPLCMT 8174 ARTHRPLSTY CARPOCARPAL JT W/IMPLNT 8175 ARTHRPLSTY CARPOCARPAL JT WO IMPLNT 8179 OTH REPR HAND-FINGR & WRIST 8180 TOT SHLDR REPLCMT 8181 PART SHLDR REPLCMT 8182 REPR RECUR DISLOC SHLDR 8183 OTH REPR SHLDR 8184 TOT ELB REPLCMT 8185 OTH REPR ELB 8191 ARTHROCEN 8192 INJ THERAP SUBSTANCE JT/LIGAMNT 8301 EXPLOR TENDON SHEATH 8302 MYOTOMY 8303 BURSOTOMY 8309 OTH INCIS SOFT TISS 8311 ACHILLOTENOTOMY 8312 ADDUCTOR TENOT HIP 8313 OTH TENOT 8314 FASCIOTOMY 8319 OTH DIVIS SOFT TISS 8321 BX SOFT TISS 8329 OTH DX MUSC-TENDN-FASCIA-BURSA HAND 8331 EXC LES TENDON SHEATH 8332 EXC LES MUSC 8339 EXC LES OTH SOFT TISS 8341 EXC TENDON GFT 8342 OTH TENONECTOMY

Page 30: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8343 EXC MUSC/FASCIA GFT 8344 OTH FASCIECT 8345 OTH MYECTOMY 8349 OTH EXC SOFT TISS 835 BURSECTOMY 8362 DELAYED SUT TENDON 8363 ROTATOR CUFF REPAIR Correction 8371 ADVANCEMENT TENDON 8372 RECESSION TENDON 8373 REATTACHMENT TENDON 8374 REATTACHMENT MUSC 8375 TENDON TRANSF/TRANSPL 8376 OTH TENDON TRANSPOSITION 8377 MUSC TRANSF/TRANSPL 8379 OTH MUSC TRANSPOSITION 8381 TENDON GFT 8382 GFT MUSC/FASCIA 8383 TENDON PULLEY RECON 8384 RELEASE CLUB FT-NEC 8385 OTH CHANGE MUSC/TENDON LENGTH 8386 QUADRICEPSPLASTY 8387 OTH PLSTC OPER MUSC 8388 OTH PLSTC OPER TENDON 8389 OTH PLSTC OPER FASCIA 8391 LYSIS MUSC-TENDN-FASCIA-BURSA ADHES 8392 INSRT/REPLCMT SKEL MUSC STIM 8393 REMOV SKEL MUSC STIM 8395 ASPIR OTH SOFT TISS 8396 INJ THERAP SUBSTANCE BURSA 8397 INJ THERAP SUBSTANCE TENDON 8398 INJ LOC TX SUBSTNCE OTH SOFT TISS 8400 UPPER LIMB AMPUT-NOS 8401 AMPUT & DISART FINGR 8402 AMPUT & DISART THUMB 8403 AMPUT THRU HAND 8404 DISART WRIST 8405 AMPUT THRU FOREARM 8406 DISART ELB 8407 AMPUT THRU HUMERUS 8408 DISART SHLDR 8409 INTERTHORACOSCAPULAR AMPUT

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Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8410 LOWER LIMB AMPUT-NOS 8411 AMPUT TOE 8412 AMPUT THRU FT 8413 DISART ANK 8414 AMPUT ANK THRU MALLEOLI TIBIA & FIB 8415 OTH AMPUT BELOW KNEE 8416 DISART KNEE 8417 AMPUT ABOVE KNEE 8418 DISART HIP 8419 ABDOMINOPELVIC AMPUT 8421 THUMB REATTACHMENT 8422 FINGR REATTACHMENT 8423 FOREARM-WRIST/HAND REATTACHMENT 8424 UPPER ARM REATTACHMENT 8425 TOE REATTACHMENT 8426 FT REATTACHMENT 8427 LOWER LEG/ANK REATTACHMENT 8428 THIGH REATTACHMENT 8429 OTH REATTACHMENT EXTREM 843 REVIS AMPUT STUMP 8440 IMPLNT/FITTING PROSTH LIMB-NOS 8441 FITTING PROSTH UPPER ARM & SHLDR 8442 FITTING PROSTH LOWER ARM & HAND 8443 FITTING PROSTH ARM-NOS 8444 IMPLNT PROSTH DEVICE ARM 8445 FITTING PROSTH ABOVE KNEE 8446 FITTING PROSTH BELOW KNEE 8447 FITTING PROSTH LEG-NOS 8448 IMPLNT PROSTH DEVICE LEG 8451 INSERTION INTRBOD SPINAL FUS DEVICE 8452 INSRT RECOMB BN MORPHOGENETIC PROT 8453 IMPL INTRL LIMB LEN DEV KINET DSTRC 8454 IMPL OTH INTRL LIMB LEN DEVICE 8455 INSERTION OF BONE VOID FILLER 8459 INSERTION OF OTHER SPINAL DEVICES 8460 INSERTION SPINAL DISC PROSTH NOS 8461 INSRTION PART SP DISC PROSTH CERV 8462 INSRTION TOTAL SP DISC PROSTH CERV 8463 INSERTION SPINAL DISC PROSTH THOR 8464 INSRTION PART SP DISC PROS LUMBOSAC 8465 INSRTION TOT SP DISC PROS LUMBOSAC

Page 32: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8466 REV/REPL ARTFICL SP DISC PROS CERV 8467 REV/REPL ARTFICL SP DISC PROS THOR 8468 REV/REPL ARTF SP DISC PROS LUMBOSAC 8469 REV/REPL ARTFICL SP DISC PROS NOS 8480 INSERT/REPLACE INTERSPINOUS PROCESS OCT 07 8481 REVISION INTERSPINOUS PROCESS DEVICES OCT 07 8482 INSERTION/REPLACE PEDICLE-BASED DYNAMIC OCT 07 8483 REVISION-BASED DYNAMIC STAB DEVICE OCT 07 8484 INSERTION/REPLACEMENT FACET DEVICE OCT 07 8485 REVISION FACET REPLACEMENT DEVICE OCT 07 8491 AMPUT-NOS 850 MASTOTOMYS 8511 CLO [PERCUT] [NEEDLE] BX BREAST 8512 OP BX BREAST 8519 OTH DX PROC BREAST 8520 EXC/DESTRUC BREAST TISS-NOS 8521 LOC EXC LES BREAST 8522 RESECT BREAST QUADRANT 8523 SUBTOT MASTEC 8524 EXC ECTOPIC BREAST TISS 8525 EXC NIPPLE 8531 UNILAT REDUC MAMMO 8533 UNILAT SUBQ MAMMECTOMY W/IMPLNT 8534 OTH UNILAT SUBQ MAMMECTOMY 8541 UNILAT SIMPL MASTEC 8543 UNILAT EXTEN SIMPL MASTEC 8545 UNILAT RAD MASTEC 8547 UNILAT EXTEN RAD MASTEC 8550 AUG MAMMO-NOS 8551 UNILAT AUG INJ BREAST 8553 UNILAT BREAST IMPLNT 856 MASTOPEXY 857 TOT RECON BREAST 8582 SPLIT-THICK GFT BREAST 8583 FULL-THICK GFT BREAST 8584 PEDICLE GFT BREAST 8585 MUSC FLAP GFT BREAST 8586 TRANSPOSITION NIPPLE 8587 OTH REPR/RECON NIPPLE 8589 OTH MAMMO 8591 ASPIR BREAST

Page 33: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8592 INJ THERAP AGENT BREAST 8593 REVIS IMPLNT BREAST 8594 REMOV IMPLNT BREAST 8595 INSRT BREAST TISS EXPANDER 8596 REMOV BREAST TISS EXPANDER(S) 8599 OTH OPER BREAST 8601 ASPIR SKIN & SUBQ TISS 8602 INJ/TATTOOING SKIN LES/DEFEC 8603 INCIS PILONIDAL SINUS/CYST 8605 INCI W/REMOVL FB/DEVC SKN&SUBQ TISS 8609 OTH INCIS SKIN & SUBQ TISS 8611 BX SKIN & SUBQ TISS 8619 OTH DX PROC SKIN & SUBQ TISS 8623 REMOV NAIL-NAILBED/NAIL FOLD 863 OTH LOC EXC LES SKIN-SUBQ TISS 864 RAD EXC SKIN LES 8660 FREE SKIN GFT-NOS 8661 FULL-THICK SKIN GFT HAND 8662 OTH SKIN GFT HAND 8663 FULL-THICK SKIN GFT OTH SITES 8664 HAIR TRANSPL 8665 HETEROGRAFT SKIN 8666 HOMOGRAFT SKIN 8667 DERMAL REGENERATIVE GRAFT 8670 PEDICLE/FLAP GFT-NOS 8671 CUTTING & PREP PEDICLE GFT/FLAPS 8672 ADVANCEMENT PEDICLE GFT 8673 ATTACHMENT PEDICLE/FLAP GFT HAND 8674 ATTACH PEDICLE/FLAP GFT OTH SITES 8675 REVIS PEDICLE/FLAP GFT 8681 REPR FACIAL WEAKNESS 8682 FACIAL RHYTIDECTOMY 8683 SIZE REDUC PLSTC OPER 8684 RELAX SCAR/WEB CONTRACTURE SKIN 8685 CORRECT SYNDACTYLY 8686 ONYCHOPLASTY 8689 OTH REPR & RECON SKIN & SUBQ TISS 8691 EXC SKIN GFT 8692 ELECTROLYSIS & OTH EPILATION SKIN 8693 INSRT TISS EXPANDER 8694 INSRT/REPL 1 ARAY NEUROSTM PLSE GEN

Page 34: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix F – ICD Codes for Measures #1 and #2

ICD Code Code Description A 06 D 06 A 07 D 07 8695 INSRT/REPL 2 ARAY NEUROSTM PLSE GEN 8696 INSRT/REPL OTH NEUROSTIM PULSE GEN

Page 35: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 0016T THERMOTX CHOROID VASC LESION 0017T PHOTOCOAGULAT MACULAR DRUSEN 0027T ENDOSCOPIC EPIDURAL LYSIS 0046T CATH LAVGE MAMM DUCT EA BRST;1 DUCT 0047T CATH LAVGE MAMM DUCT EA BRST;EA ADD 0061T DESTRUC MAL BRST TUMR MW THERMOTX 0077T IMPL&SECUR CERBRL THRML PRFUS PROBE 0090T TOT DISC ARTHPLSTY ANT 1; CERV 0091T TOT DISC ARTHPLSTY ANT 1; LUMB JAN 07 0092T TOT DISC ARTHPLSTY ANT 1; EA ADD 0093T REMV TOT DISC ARTHPLSTY ANT 1;CERV 0094T REMV TOT DISC ARTHPLSTY ANT 1; LUMB JAN 07 0095T REMV TOT DISC ARTHPLST ANT 1;EA ADD 0096T REV TOT DISC ARTHPLSTY ANT 1; CERV 0097T REV TOT DISC ARTHPLSTY ANT 1; LUMB JAN 07 0098T REV TOT DISC ARTHPLSTY ANT 1;EA ADD 0099T IMPL INTRASTROMAL CORNEAL RING SEG 0100T PLCMT RET PROS&ELEC ARRAY W/VITRECT 0163T TOTAL DISC ARTHROPLASTY JAN 07 0164T REMOVAL TOTAL DISC ARTHROPLASTY JAN 07 0165T REVISION TOTAL DISC ARTHROPLASTY JAN 07 0171T INSERTION POST SPINOUS, LUMB, SINGLE JAN 08 0172T INSERION POST SPINOUS, LUMB, ADDITION JAN 08 10021 FNA W/O IMAGE 10022 FNA W/IMAGE 10040 ACNE SURGERY 10060 DRAINAGE OF SKIN ABSCESS 10061 DRAINAGE OF SKIN ABSCESS 10080 DRAINAGE OF PILONIDAL CYST 10081 DRAINAGE OF PILONIDAL CYST 10120 REMOVE FOREIGN BODY 10121 REMOVE FOREIGN BODY 10160 PUNCTURE DRAINAGE OF LESION 11043 DEBRIDE TISSUE/MUSCLE 11044 DEBRIDE TISSUE/MUSCLE/BONE 11055 TRIM SKIN LESION 11056 TRIM SKIN LESIONS- 2 TO 4 11057 TRIM SKIN LESIONS- OVER 4

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 11100 BX SKIN &/ SUBQ TISSUE; 1 LESION 11101 BX SKIN &/ SUBQ TISSUE; EA ADD 11200 REMOVAL OF SKIN TAGS 11201 REMOVE SKIN TAGS ADD-ON 11300 SHAVE SKIN LESION 11301 SHAVE SKIN LESION 11302 SHAVE SKIN LESION 11303 SHAVE SKIN LESION 11305 SHAVE SKIN LESION 11306 SHAVE SKIN LESION 11307 SHAVE SKIN LESION 11308 SHAVE SKIN LESION 11310 SHAVE SKIN LESION 11311 SHAVE SKIN LESION 11312 SHAVE SKIN LESION 11313 SHAVE SKIN LESION 11400 EXC TR-EXT B9+MARG 0.5 < CM 11401 EXC TR-EXT B9+MARG 0.6-1 CM 11402 EXC TR-EXT B9+MARG 1.1-2 CM 11403 EXC TR-EXT B9+MARG 2.1-3 CM 11404 EXC TR-EXT B9+MARG 3.1-4 CM 11406 EXC TR-EXT B9+MARG > 4.0 CM 11420 EXC H-F-NK-SP B9+MARG 0.5 < 11421 EXC H-F-NK-SP B9+MARG 0.6-1 11422 EXC H-F-NK-SP B9+MARG 1.1-2 11423 EXC H-F-NK-SP B9+MARG 2.1-3 11424 EXC H-F-NK-SP B9+MARG 3.1-4 11426 EXC H-F-NK-SP B9+MARG > 4 CM 11440 EXC FACE-MM B9+MARG 0.5 < CM 11441 EXC FACE-MM B9+MARG 0.6-1 CM 11442 EXC FACE-MM B9+MARG 1.1-2 CM 11443 EXC FACE-MM B9+MARG 2.1-3 CM 11444 EXC FACE-MM B9+MARG 3.1-4 CM 11446 EXC FACE-MM B9+MARG > 4 CM 11450 REMOVAL- SWEAT GLAND LESION 11451 REMOVAL- SWEAT GLAND LESION 11462 REMOVAL- SWEAT GLAND LESION 11463 REMOVAL- SWEAT GLAND LESION

Page 37: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 11470 REMOVAL- SWEAT GLAND LESION 11471 REMOVAL- SWEAT GLAND LESION 11600 EXC TR-EXT MLG+MARG 0.5 < CM 11601 EXC TR-EXT MLG+MARG 0.6-1 CM 11602 EXC TR-EXT MLG+MARG 1.1-2 CM 11603 EXC TR-EXT MLG+MARG 2.1-3 CM 11604 EXC TR-EXT MLG+MARG 3.1-4 CM 11606 EXC TR-EXT MLG+MARG > 4 CM 11620 EXC H-F-NK-SP MLG+MARG 0.5 < 11621 EXC H-F-NK-SP MLG+MARG 0.6-1 11622 EXC H-F-NK-SP MLG+MARG 1.1-2 11623 EXC H-F-NK-SP MLG+MARG 2.1-3 11624 EXC H-F-NK-SP MLG+MARG 3.1-4 11626 EXC H-F-NK-SP MLG+MAR > 4 CM 11640 EXC FACE-MM MALIG+MARG 0.5 < 11641 EXC FACE-MM MALIG+MARG 0.6-1 11642 EXC FACE-MM MALIG+MARG 1.1-2 11643 EXC FACE-MM MALIG+MARG 2.1-3 11644 EXC FACE-MM MALIG+MARG 3.1-4 11646 EXC FACE-MM MLG+MARG > 4 CM 11730 REMOVAL OF NAIL PLATE 11732 REMOVE NAIL PLATE- ADD-ON 11750 REMOVAL OF NAIL BED 11752 REMOVE NAIL BED/FINGER TIP 11755 BIOPSY- NAIL UNIT 11760 REPAIR OF NAIL BED 11762 RECONSTRUCTION OF NAIL BED 11765 EXCISION OF NAIL FOLD- TOE 11900 INJECTION INTO SKIN LESIONS 11901 ADDED SKIN LESIONS INJECTION 11920 CORRECT SKIN COLOR DEFECTS 11921 CORRECT SKIN COLOR DEFECTS 11922 CORRECT SKIN COLOR DEFECTS 11950 THERAPY FOR CONTOUR DEFECTS 11951 THERAPY FOR CONTOUR DEFECTS 11952 THERAPY FOR CONTOUR DEFECTS 11954 THERAPY FOR CONTOUR DEFECTS 11960 INSERT TISSUE EXPANDER(S)

Page 38: Error Prevention Measurement Methodology, Appendix F & G1263 iridencleisis & iridotasis 1264 trabeculectomy ab ext 1265 oth scleral fistuliza-iridectomy 1266 postop revis sclerl fistulizat

Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 11970 REPLACE TISSUE EXPANDER 11971 REMOVE TISSUE EXPANDER(S) 11976 REMOVAL OF CONTRACEPTIVE CAP 11982 REMOVE DRUG IMPLANT DEVICE 13100 REPAIR OF WOUND OR LESION 13101 REPAIR OF WOUND OR LESION 13102 REPAIR WOUND/LESION ADD-ON 13120 REPAIR OF WOUND OR LESION 13121 REPAIR OF WOUND OR LESION 13122 REPAIR WOUND/LESION ADD-ON 13131 REPAIR OF WOUND OR LESION 13132 REPAIR OF WOUND OR LESION 13133 REPAIR WOUND/LESION ADD-ON 13150 REPAIR OF WOUND OR LESION 13151 REPAIR OF WOUND OR LESION 13152 REPAIR OF WOUND OR LESION 13153 REPAIR WOUND/LESION ADD-ON 13160 LATE CLOSURE OF WOUND 14000 SKIN TISSUE REARRANGEMENT 14001 SKIN TISSUE REARRANGEMENT 14020 SKIN TISSUE REARRANGEMENT 14021 SKIN TISSUE REARRANGEMENT 14040 SKIN TISSUE REARRANGEMENT 14041 SKIN TISSUE REARRANGEMENT 14060 SKIN TISSUE REARRANGEMENT 14061 SKIN TISSUE REARRANGEMENT 14300 SKIN TISSUE REARRANGEMENT 14350 SKIN TISSUE REARRANGEMENT 15000 SKIN GRAFT JAN 07 15001 SKIN GRAFT ADD-ON JAN 07 15050 SKIN PINCH GRAFT 15100 SKIN SPLIT GRAFT 15101 SKIN SPLIT GRAFT ADD-ON 15120 SKIN SPLIT GRAFT 15121 SKIN SPLIT GRAFT ADD-ON 15200 SKIN FULL GRAFT 15201 SKIN FULL GRAFT ADD-ON 15220 SKIN FULL GRAFT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 15221 SKIN FULL GRAFT ADD-ON 15240 SKIN FULL GRAFT 15241 SKIN FULL GRAFT ADD-ON 15260 SKIN FULL GRAFT 15261 SKIN FULL GRAFT ADD-ON 15342 CULTURED SKIN GRAFT- 25 CM 15343 CULTURE SKN GRAFT ADDL 25 CM 15350 SKIN HOMOGRAFT 15351 SKIN HOMOGRAFT ADD-ON 15400 SKIN HETEROGRAFT 15401 SKIN HETEROGRAFT ADD-ON 15570 FORM SKIN PEDICLE FLAP 15572 FORM SKIN PEDICLE FLAP 15574 FORM SKIN PEDICLE FLAP 15576 FORM SKIN PEDICLE FLAP 15600 SKIN GRAFT 15610 SKIN GRAFT 15620 SKIN GRAFT 15630 SKIN GRAFT 15650 TRANSFER SKIN PEDICLE FLAP 15732 MUSCLE-SKIN GRAFT- HEAD/NECK 15734 MUSCLE-SKIN GRAFT- TRUNK 15736 MUSCLE-SKIN GRAFT- ARM 15738 MUSCLE-SKIN GRAFT- LEG 15740 ISLAND PEDICLE FLAP GRAFT 15750 NEUROVASCULAR PEDICLE GRAFT 15756 FREE MYO/SKIN FLAP MICROVASC 15757 FREE SKIN FLAP- MICROVASC 15758 FREE FASCIAL FLAP- MICROVASC 15760 COMPOSITE SKIN GRAFT 15775 HAIR TRANSPLANT PUNCH GRAFTS 15776 HAIR TRANSPLANT PUNCH GRAFTS 15781 ABRASION TREATMENT OF SKIN 15782 ABRASION TREATMENT OF SKIN 15783 ABRASION TREATMENT OF SKIN 15819 PLASTIC SURGERY- NECK 15820 REVISION OF LOWER EYELID 15821 REVISION OF LOWER EYELID

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 15822 REVISION OF UPPER EYELID 15823 REVISION OF UPPER EYELID 15824 REMOVAL OF FOREHEAD WRINKLES 15825 REMOVAL OF NECK WRINKLES 15826 REMOVAL OF BROW WRINKLES 15828 REMOVAL OF FACE WRINKLES 15829 REMOVAL OF SKIN WRINKLES 15831 EXCISE EXCESSIVE SKIN TISSUE JAN 07 15832 EXCISE EXCESSIVE SKIN TISSUE 15833 EXCISE EXCESSIVE SKIN TISSUE 15834 EXCISE EXCESSIVE SKIN TISSUE 15835 EXCISE EXCESSIVE SKIN TISSUE 15836 EXCISE EXCESSIVE SKIN TISSUE 15837 EXCISE EXCESSIVE SKIN TISSUE 15838 EXCISE EXCESSIVE SKIN TISSUE 15839 EXCISE EXCESSIVE SKIN TISSUE 15840 GRAFT FOR FACE NERVE PALSY 15841 GRAFT FOR FACE NERVE PALSY 15842 FLAP FOR FACE NERVE PALSY 15845 SKIN AND MUSCLE REPAIR- FACE 15860 TEST FOR BLOOD FLOW IN GRAFT 15876 SUCTION ASSISTED LIPECTOMY 15877 SUCTION ASSISTED LIPECTOMY 15878 SUCTION ASSISTED LIPECTOMY 15879 SUCTION ASSISTED LIPECTOMY 15920 REMOVAL OF TAIL BONE ULCER 15922 REMOVAL OF TAIL BONE ULCER 15931 REMOVE SACRUM PRESSURE SORE 15933 REMOVE SACRUM PRESSURE SORE 15934 REMOVE SACRUM PRESSURE SORE 15935 REMOVE SACRUM PRESSURE SORE 15936 REMOVE SACRUM PRESSURE SORE 15937 REMOVE SACRUM PRESSURE SORE 15940 REMOVE HIP PRESSURE SORE 15941 REMOVE HIP PRESSURE SORE 15944 REMOVE HIP PRESSURE SORE 15945 REMOVE HIP PRESSURE SORE 15946 REMOVE HIP PRESSURE SORE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 15950 REMOVE THIGH PRESSURE SORE 15951 REMOVE THIGH PRESSURE SORE 15952 REMOVE THIGH PRESSURE SORE 15953 REMOVE THIGH PRESSURE SORE 15956 REMOVE THIGH PRESSURE SORE 15958 REMOVE THIGH PRESSURE SORE 15999 REMOVAL OF PRESSURE SORE 16035 INCISION OF BURN SCAB- INITI 16036 INCISE BURN SCAB- ADDL INCIS 17000 DESTROY BENIGN/PREMLG LESION 17003 DESTROY LESIONS- 2-14 17004 DESTROY LESIONS- 15 OR MORE 17106 DESTRUCTION OF SKIN LESIONS 17107 DESTRUCTION OF SKIN LESIONS 17108 DESTRUCTION OF SKIN LESIONS 17110 DESTRUCT LESION- 1-14 17111 DESTRUCT LESION- 15 OR MORE 17250 CHEMICAL CAUTERY- TISSUE 17260 DESTRUCTION OF SKIN LESIONS 17261 DESTRUCTION OF SKIN LESIONS 17262 DESTRUCTION OF SKIN LESIONS 17263 DESTRUCTION OF SKIN LESIONS 17264 DESTRUCTION OF SKIN LESIONS 17266 DESTRUCTION OF SKIN LESIONS 17270 DESTRUCTION OF SKIN LESIONS 17271 DESTRUCTION OF SKIN LESIONS 17272 DESTRUCTION OF SKIN LESIONS 17273 DESTRUCTION OF SKIN LESIONS 17274 DESTRUCTION OF SKIN LESIONS 17276 DESTRUCTION OF SKIN LESIONS 17280 DESTRUCTION OF SKIN LESIONS 17281 DESTRUCTION OF SKIN LESIONS 17282 DESTRUCTION OF SKIN LESIONS 17283 DESTRUCTION OF SKIN LESIONS 17284 DESTRUCTION OF SKIN LESIONS 17286 DESTRUCTION OF SKIN LESIONS 17340 CRYOTHERAPY OF SKIN 17380 HAIR REMOVAL BY ELECTROLYSIS

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 17999 SKIN TISSUE PROCEDURE 19000 DRAINAGE OF BREAST LESION 19001 DRAIN BREAST LESION ADD-ON 19020 INCISION OF BREAST LESION 19030 INJECTION FOR BREAST X-RAY 19100 BX BREAST PERCUT W/O IMAGE 19101 BIOPSY OF BREAST- OPEN 19102 BX BREAST PERCUT W/IMAGE 19103 BX BREAST PERCUT W/DEVICE 19110 NIPPLE EXPLORATION 19112 EXCISE BREAST DUCT FISTULA 19120 REMOVAL OF BREAST LESION 19125 EXCISION- BREAST LESION 19126 EXCISION- ADDL BREAST LESION 19140 REMOVAL OF BREAST TISSUE JAN 07 19160 MASTECTOMY PARTIAL; JAN 07 19162 MASTECT PART; AXILLARY LYMPHADENECT JAN 07 19180 REMOVAL OF BREAST JAN 07 19182 REMOVAL OF BREAST JAN 07 19200 REMOVAL OF BREAST JAN 07 19220 REMOVAL OF BREAST JAN 07 19240 REMOVAL OF BREAST JAN 07 19260 REMOVAL OF CHEST WALL LESION 19271 REVISION OF CHEST WALL 19272 EXTENSIVE CHEST WALL SURGERY 19290 PLACE NEEDLE WIRE- BREAST 19291 PLACE NEEDLE WIRE- BREAST 19295 PLACE BREAST CLIP- PERCUT 19296 RT BALLN CATH;DATE SEP PART MASTECT 19298 RT BRCHYTX CATH FLW PART MASTECT 19316 SUSPENSION OF BREAST 19318 REDUCTION OF LARGE BREAST 19324 ENLARGE BREAST 19325 ENLARGE BREAST WITH IMPLANT 19328 REMOVAL OF BREAST IMPLANT 19330 REMOVAL OF IMPLANT MATERIAL 19340 IMMEDIATE BREAST PROSTHESIS 19342 DELAYED BREAST PROSTHESIS

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 19350 BREAST RECONSTRUCTION 19355 CORRECT INVERTED NIPPLE(S) 19357 BREAST RECONSTRUCTION 19361 BREAST RECONSTRUCTION 19364 BREAST RECONSTRUCTION 19366 BREAST RECONSTRUCTION 19367 BREAST RECONSTRUCTION 19368 BREAST RECONSTRUCTION 19369 BREAST RECONSTRUCTION 19370 SURGERY OF BREAST CAPSULE 19371 REMOVAL OF BREAST CAPSULE 19380 REVISE BREAST RECONSTRUCTION 19396 DESIGN CUSTOM BREAST IMPLANT 19499 BREAST SURGERY PROCEDURE 20000 INCISION OF ABSCESS 20005 INCISION OF DEEP ABSCESS 20100 EXPLORE WOUND- NECK 20101 EXPLORE WOUND- CHEST 20102 EXPLORE WOUND- ABDOMEN 20103 EXPLORE WOUND- EXTREMITY 20150 EXCISE EPIPHYSEAL BAR 20200 MUSCLE BIOPSY 20205 DEEP MUSCLE BIOPSY 20206 NEEDLE BIOPSY- MUSCLE 20220 BONE BIOPSY- TROCAR/NEEDLE 20225 BONE BIOPSY- TROCAR/NEEDLE 20240 BIOPSY BONE OPEN; SUPERFICIAL 20245 BIOPSY BONE OPEN; DEEP 20250 OPEN BONE BIOPSY 20251 OPEN BONE BIOPSY 20500 INJECTION OF SINUS TRACT 20501 INJECT SINUS TRACT FOR X-RAY 20520 REMOVAL OF FOREIGN BODY 20525 REMOVAL OF FOREIGN BODY 20550 INJECTION; 1 TENDON SHEATH/LIGAMENT 20551 INJECTION; 1 TENDON ORIGIN/INSERTIO 20552 INJ; SINGLE/MX TRIG POINT 1/2 MUSCL 20553 INJECT TRIGGER POINTS- =/> 3

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 20600 DRAIN/INJECT- JOINT/BURSA 20605 DRAIN/INJECT- JOINT/BURSA 20610 DRAIN/INJECT- JOINT/BURSA 20612 ASPIRATE/INJ GANGLION CYST 20615 TREATMENT OF BONE CYST 20670 REMOVAL OF SUPPORT IMPLANT 20680 REMOVAL OF SUPPORT IMPLANT 20690 APPLY BONE FIXATION DEVICE 20692 APPLY BONE FIXATION DEVICE 20693 ADJUST BONE FIXATION DEVICE 20694 REMOVE BONE FIXATION DEVICE 20802 REPLANTATION- ARM- COMPLETE 20805 REPLANT FOREARM- COMPLETE 20808 REPLANTATION HAND- COMPLETE 20816 REPLANTATION DIGIT- COMPLETE 20822 REPLANTATION DIGIT- COMPLETE 20824 REPLANTATION THUMB- COMPLETE 20827 REPLANTATION THUMB- COMPLETE 20838 REPLANTATION FOOT- COMPLETE 20900 REMOVAL OF BONE FOR GRAFT 20902 REMOVAL OF BONE FOR GRAFT 20910 REMOVE CARTILAGE FOR GRAFT 20920 REMOVAL OF FASCIA FOR GRAFT 20922 REMOVAL OF FASCIA FOR GRAFT 20924 REMOVAL OF TENDON FOR GRAFT 20926 REMOVAL OF TISSUE FOR GRAFT 20930 SPINAL BONE ALLOGRAFT 20931 SPINAL BONE ALLOGRAFT 20936 SPINAL BONE AUTOGRAFT 20937 SPINAL BONE AUTOGRAFT 20938 SPINAL BONE AUTOGRAFT 20950 FLUID PRESSURE- MUSCLE 20955 FIBULA BONE GRAFT- MICROVASC 20956 ILIAC BONE GRAFT- MICROVASC 20957 MT BONE GRAFT- MICROVASC 20962 OTHER BONE GRAFT- MICROVASC 20969 BONE/SKIN GRAFT- MICROVASC 20970 BONE/SKIN GRAFT- ILIAC CREST

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 20972 BONE/SKIN GRAFT- METATARSAL 20973 BONE/SKIN GRAFT- GREAT TOE 20975 ELECTRICAL BONE STIMULATION 20982 ABLAT BN TUMR RADIOFRQ PERQ CT GUID 20999 MUSCULOSKELETAL SURGERY 21010 INCISION OF JAW JOINT 21015 RESECTION OF FACIAL TUMOR 21025 EXCISION OF BONE- LOWER JAW 21026 EXCISION OF FACIAL BONE(S) 21029 CONTOUR OF FACE BONE LESION 21030 EXCISE MAX/ZYGOMA B9 TUMOR 21031 REMOVE EXOSTOSIS- MANDIBLE 21034 EXCISE MAX/ZYGOMA MLG TUMOR 21040 EXCISE MANDIBLE LESION 21044 REMOVAL OF JAW BONE LESION 21045 EXTENSIVE JAW SURGERY 21046 REMOVE MANDIBLE CYST COMPLEX 21047 EXCISE LWR JAW CYST W/REPAIR 21048 REMOVE MAXILLA CYST COMPLEX 21049 EXCIS UPPR JAW CYST W/REPAIR 21050 REMOVAL OF JAW JOINT 21060 REMOVE JAW JOINT CARTILAGE 21070 REMOVE CORONOID PROCESS 21116 INJECTION- JAW JOINT X-RAY 21123 RECONSTRUCTION OF CHIN 21125 AUGMENTATION- LOWER JAW BONE 21127 AUGMENTATION- LOWER JAW BONE 21137 REDUCTION OF FOREHEAD 21138 REDUCTION OF FOREHEAD 21139 REDUCTION OF FOREHEAD 21141 RECONSTRUCT MIDFACE- LEFORT 21142 RECONSTRUCT MIDFACE- LEFORT 21143 RECONSTRUCT MIDFACE- LEFORT 21145 RECONSTRUCT MIDFACE- LEFORT 21146 RECONSTRUCT MIDFACE- LEFORT 21147 RECONSTRUCT MIDFACE- LEFORT 21150 RECONSTRUCT MIDFACE- LEFORT 21151 RECONSTRUCT MIDFACE- LEFORT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 21154 RECONSTRUCT MIDFACE- LEFORT 21155 RECONSTRUCT MIDFACE- LEFORT 21159 RECONSTRUCT MIDFACE- LEFORT 21160 RECONSTRUCT MIDFACE- LEFORT 21172 RECONSTRUCT ORBIT/FOREHEAD 21175 RECONSTRUCT ORBIT/FOREHEAD 21179 RECONSTRUCT ENTIRE FOREHEAD 21180 RECONSTRUCT ENTIRE FOREHEAD 21181 CONTOUR CRANIAL BONE LESION 21182 RECONSTRUCT CRANIAL BONE 21183 RECONSTRUCT CRANIAL BONE 21184 RECONSTRUCT CRANIAL BONE 21188 RECONSTRUCTION OF MIDFACE 21194 RECONST LWR JAW W/GRAFT 21208 AUGMENTATION OF FACIAL BONES 21210 FACE BONE GRAFT 21215 LOWER JAW BONE GRAFT 21230 RIB CARTILAGE GRAFT 21235 EAR CARTILAGE GRAFT 21240 RECONSTRUCTION OF JAW JOINT 21242 RECONSTRUCTION OF JAW JOINT 21243 RECONSTRUCTION OF JAW JOINT 21244 RECONSTRUCTION OF LOWER JAW 21245 RECONSTRUCTION OF JAW 21246 RECONSTRUCTION OF JAW 21247 RECONSTRUCT LOWER JAW BONE 21248 RECONSTRUCTION OF JAW 21249 RECONSTRUCTION OF JAW 21255 RECONSTRUCT LOWER JAW BONE 21256 RECONSTRUCTION OF ORBIT 21260 REVISE EYE SOCKETS 21261 REVISE EYE SOCKETS 21263 REVISE EYE SOCKETS 21267 REVISE EYE SOCKETS 21268 REVISE EYE SOCKETS 21270 AUGMENTATION- CHEEK BONE 21275 REVISION- ORBITOFACIAL BONES 21280 REVISION OF EYELID

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 21282 REVISION OF EYELID 21295 REVISION OF JAW MUSCLE/BONE 21296 REVISION OF JAW MUSCLE/BONE 21299 CRANIO/MAXILLOFACIAL SURGERY 21300 TREATMENT OF SKULL FRACTURE JAN 07 21345 TREAT NOSE/JAW FRACTURE 21346 TREAT NOSE/JAW FRACTURE 21347 TREAT NOSE/JAW FRACTURE 21348 TREAT NOSE/JAW FRACTURE 21355 TREAT CHEEK BONE FRACTURE 21356 TREAT CHEEK BONE FRACTURE 21360 TREAT CHEEK BONE FRACTURE 21365 TREAT CHEEK BONE FRACTURE 21366 TREAT CHEEK BONE FRACTURE 21385 TREAT EYE SOCKET FRACTURE 21386 TREAT EYE SOCKET FRACTURE 21387 TREAT EYE SOCKET FRACTURE 21390 TREAT EYE SOCKET FRACTURE 21395 TREAT EYE SOCKET FRACTURE 21401 TREAT EYE SOCKET FRACTURE 21406 TREAT EYE SOCKET FRACTURE 21407 TREAT EYE SOCKET FRACTURE 21408 TREAT EYE SOCKET FRACTURE 21421 TREAT MOUTH ROOF FRACTURE 21422 TREAT MOUTH ROOF FRACTURE 21423 TREAT MOUTH ROOF FRACTURE 21431 TREAT CRANIOFACIAL FRACTURE 21432 TREAT CRANIOFACIAL FRACTURE 21433 TREAT CRANIOFACIAL FRACTURE 21435 TREAT CRANIOFACIAL FRACTURE 21436 TREAT CRANIOFACIAL FRACTURE 21440 TREAT DENTAL RIDGE FRACTURE 21445 TREAT DENTAL RIDGE FRACTURE 21451 TREAT LOWER JAW FRACTURE 21452 TREAT LOWER JAW FRACTURE 21453 TREAT LOWER JAW FRACTURE 21454 TREAT LOWER JAW FRACTURE 21461 TREAT LOWER JAW FRACTURE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 21462 TREAT LOWER JAW FRACTURE 21465 TREAT LOWER JAW FRACTURE 21470 TREAT LOWER JAW FRACTURE 21480 RESET DISLOCATED JAW 21485 RESET DISLOCATED JAW 21490 REPAIR DISLOCATED JAW 21493 TREAT HYOID BONE FRACTURE 21494 TREAT HYOID BONE FRACTURE 21495 TREAT HYOID BONE FRACTURE 21499 HEAD SURGERY PROCEDURE 21501 DRAIN NECK/CHEST LESION 21502 DRAIN CHEST LESION 21510 DRAINAGE OF BONE LESION 21550 BIOPSY OF NECK/CHEST 21555 REMOVE LESION- NECK/CHEST 21556 REMOVE LESION- NECK/CHEST 21557 REMOVE TUMOR- NECK/CHEST 21600 PARTIAL REMOVAL OF RIB 21610 PARTIAL REMOVAL OF RIB 21615 REMOVAL OF RIB 21616 REMOVAL OF RIB AND NERVES 21620 PARTIAL REMOVAL OF STERNUM 21627 STERNAL DEBRIDEMENT 21630 EXTENSIVE STERNUM SURGERY 21632 EXTENSIVE STERNUM SURGERY 21700 REVISION OF NECK MUSCLE 21705 REVISION OF NECK MUSCLE/RIB 21720 REVISION OF NECK MUSCLE 21725 REVISION OF NECK MUSCLE 21740 RECONSTRUCTION OF STERNUM 21742 REPAIR STERN/NUSS W/O SCOPE 21743 REPAIR STERNUM/NUSS W/SCOPE 21750 REPAIR OF STERNUM SEPARATION 21805 TREATMENT OF RIB FRACTURE 21810 TREATMENT OF RIB FRACTURE(S) 21825 TREAT STERNUM FRACTURE 21899 NECK/CHEST SURGERY PROCEDURE 21920 BIOPSY SOFT TISSUE OF BACK

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 21925 BIOPSY SOFT TISSUE OF BACK 21930 REMOVE LESION- BACK OR FLANK 21935 REMOVE TUMOR- BACK 22100 REMOVE PART OF NECK VERTEBRA 22101 REMOVE PART- THORAX VERTEBRA 22102 REMOVE PART- LUMBAR VERTEBRA 22103 REMOVE EXTRA SPINE SEGMENT 22110 REMOVE PART OF NECK VERTEBRA 22112 REMOVE PART- THORAX VERTEBRA 22114 REMOVE PART- LUMBAR VERTEBRA 22116 REMOVE EXTRA SPINE SEGMENT 22206 OSTEOTOMY SPINE, POST/POSTLAT, THORA JAN 08 22207 OSTEOTOMY SPINE, POST/POSTLAT, LUMB JAN 08 22208 OSTEOTOMY SPINE, EACH ADDL VERT SEG JAN 08 22210 REVISION OF NECK SPINE 22212 REVISION OF THORAX SPINE 22214 REVISION OF LUMBAR SPINE 22216 REVISE- EXTRA SPINE SEGMENT 22220 REVISION OF NECK SPINE 22222 REVISION OF THORAX SPINE 22224 REVISION OF LUMBAR SPINE 22226 REVISE- EXTRA SPINE SEGMENT 22520 PERCUT VERTEBROPLASTY THOR 22521 PERCUT VERTEBROPLASTY LUMB 22522 PERCUT VERTEBROPLASTY ADDL 22532 ARTHRDSIS LAT MINI DISKECT; THOR 22533 ARTHRDSIS LAT MINI DISKECT; LUMB 22534 ARTHRDSIS LAT MINI DISKECT; EA ADD 22548 NECK SPINE FUSION 22554 NECK SPINE FUSION 22556 THORAX SPINE FUSION 22558 LUMBAR SPINE FUSION 22585 ADDITIONAL SPINAL FUSION 22590 SPINE & SKULL SPINAL FUSION 22595 NECK SPINAL FUSION 22600 NECK SPINE FUSION 22610 THORAX SPINE FUSION 22612 LUMBAR SPINE FUSION

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 22614 SPINE FUSION- EXTRA SEGMENT 22630 LUMBAR SPINE FUSION 22632 SPINE FUSION- EXTRA SEGMENT 22800 FUSION OF SPINE 22802 FUSION OF SPINE 22804 FUSION OF SPINE 22808 FUSION OF SPINE 22810 FUSION OF SPINE 22812 FUSION OF SPINE 22818 KYPHECTOMY- 1-2 SEGMENTS 22819 KYPHECTOMY- 3 OR MORE 22841 INSERT SPINE FIXATION DEVICE 22849 REINSERT SPINAL FIXATION 22850 REMOVE SPINE FIXATION DEVICE 22851 APPLY SPINE PROSTH DEVICE 22852 REMOVE SPINE FIXATION DEVICE 22855 REMOVE SPINE FIXATION DEVICE 22899 SPINE SURGERY PROCEDURE 22900 REMOVE ABDOMINAL WALL LESION 23000 REMOVAL OF CALCIUM DEPOSITS 23020 RELEASE SHOULDER JOINT 23030 DRAIN SHOULDER LESION 23031 DRAIN SHOULDER BURSA 23035 DRAIN SHOULDER BONE LESION 23040 EXPLORATORY SHOULDER SURGERY 23044 EXPLORATORY SHOULDER SURGERY 23065 BIOPSY SHOULDER TISSUES 23066 BIOPSY SHOULDER TISSUES 23075 REMOVAL OF SHOULDER LESION 23076 REMOVAL OF SHOULDER LESION 23077 REMOVE TUMOR OF SHOULDER 23100 BIOPSY OF SHOULDER JOINT 23101 SHOULDER JOINT SURGERY 23105 REMOVE SHOULDER JOINT LINING 23106 INCISION OF COLLARBONE JOINT 23107 EXPLORE TREAT SHOULDER JOINT 23120 PARTIAL REMOVAL- COLLAR BONE 23125 REMOVAL OF COLLAR BONE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 23130 REMOVE SHOULDER BONE- PART 23140 REMOVAL OF BONE LESION 23145 REMOVAL OF BONE LESION 23146 REMOVAL OF BONE LESION 23150 REMOVAL OF HUMERUS LESION 23155 REMOVAL OF HUMERUS LESION 23156 REMOVAL OF HUMERUS LESION 23170 REMOVE COLLAR BONE LESION 23172 REMOVE SHOULDER BLADE LESION 23174 REMOVE HUMERUS LESION 23180 REMOVE COLLAR BONE LESION 23182 REMOVE SHOULDER BLADE LESION 23184 REMOVE HUMERUS LESION 23190 PARTIAL REMOVAL OF SCAPULA 23195 REMOVAL OF HEAD OF HUMERUS 23200 REMOVAL OF COLLAR BONE 23210 REMOVAL OF SHOULDER BLADE 23220 PARTIAL REMOVAL OF HUMERUS 23221 PARTIAL REMOVAL OF HUMERUS 23222 PARTIAL REMOVAL OF HUMERUS 23330 REMOVE SHOULDER FOREIGN BODY 23331 REMOVE SHOULDER FOREIGN BODY 23332 REMOVE SHOULDER FOREIGN BODY 23395 MUSCLE TRANSFER-SHOULDER/ARM 23397 MUSCLE TRANSFERS 23400 FIXATION OF SHOULDER BLADE 23405 INCISION OF TENDON & MUSCLE 23406 INCISE TENDON(S) & MUSCLE(S) 23410 OP REP AC RC OR M/C RUPT OCT 06 23412 OP REP CHR RC/M/T RUPT OCT 06 23415 RELEASE OF SHOULDER LIGAMENT 23420 RECONST COMP RC AVUL OCT 06 23430 REPAIR BICEPS TENDON 23440 REMOVE/TRANSPLANT TENDON 23450 REPAIR SHOULDER CAPSULE 23455 REPAIR SHOULDER CAPSULE 23460 REPAIR SHOULDER CAPSULE 23462 REPAIR SHOULDER CAPSULE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 23465 REPAIR SHOULDER CAPSULE 23466 REPAIR SHOULDER CAPSULE 23470 RECONSTRUCT SHOULDER JOINT 23472 RECONSTRUCT SHOULDER JOINT 23480 REVISION OF COLLAR BONE 23485 REVISION OF COLLAR BONE 23490 REINFORCE CLAVICLE 23491 REINFORCE SHOULDER BONES 23515 TREAT CLAVICLE FRACTURE 23530 TREAT CLAVICLE DISLOCATION 23532 TREAT CLAVICLE DISLOCATION 23550 TREAT CLAVICLE DISLOCATION 23552 TREAT CLAVICLE DISLOCATION 23585 TREAT SCAPULA FRACTURE 23615 TREAT HUMERUS FRACTURE 23616 TREAT HUMERUS FRACTURE 23630 TREAT HUMERUS FRACTURE 23660 TREAT SHOULDER DISLOCATION 23670 TREAT DISLOCATION/FRACTURE 23680 TREAT DISLOCATION/FRACTURE 23700 FIXATION OF SHOULDER 23800 FUSION OF SHOULDER JOINT 23802 FUSION OF SHOULDER JOINT 23900 AMPUTATION OF ARM & GIRDLE 23920 AMPUTATION AT SHOULDER JOINT 23921 AMPUTATION FOLLOW-UP SURGERY 23929 SHOULDER SURGERY PROCEDURE 23930 DRAINAGE OF ARM LESION 23931 DRAINAGE OF ARM BURSA 23935 DRAIN ARM/ELBOW BONE LESION 24000 EXPLORATORY ELBOW SURGERY 24006 RELEASE ELBOW JOINT 24065 BIOPSY ARM/ELBOW SOFT TISSUE 24066 BIOPSY ARM/ELBOW SOFT TISSUE 24075 REMOVE ARM/ELBOW LESION 24076 REMOVE ARM/ELBOW LESION 24077 REMOVE TUMOR OF ARM/ELBOW 24100 BIOPSY ELBOW JOINT LINING

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 24101 EXPLORE/TREAT ELBOW JOINT 24102 REMOVE ELBOW JOINT LINING 24105 REMOVAL OF ELBOW BURSA 24110 REMOVE HUMERUS LESION 24115 REMOVE/GRAFT BONE LESION 24116 REMOVE/GRAFT BONE LESION 24120 REMOVE ELBOW LESION 24125 REMOVE/GRAFT BONE LESION 24126 REMOVE/GRAFT BONE LESION 24130 REMOVAL OF HEAD OF RADIUS 24134 REMOVAL OF ARM BONE LESION 24136 REMOVE RADIUS BONE LESION 24138 REMOVE ELBOW BONE LESION 24140 PARTIAL REMOVAL OF ARM BONE 24145 PARTIAL REMOVAL OF RADIUS 24147 PARTIAL REMOVAL OF ELBOW 24149 RADICAL RESECTION OF ELBOW 24150 EXTENSIVE HUMERUS SURGERY 24151 EXTENSIVE HUMERUS SURGERY 24152 EXTENSIVE RADIUS SURGERY 24153 EXTENSIVE RADIUS SURGERY 24155 REMOVAL OF ELBOW JOINT 24160 REMOVE ELBOW JOINT IMPLANT 24164 REMOVE RADIUS HEAD IMPLANT 24200 REMOVAL OF ARM FOREIGN BODY 24201 REMOVAL OF ARM FOREIGN BODY 24301 MUSCLE/TENDON TRANSFER 24305 ARM TENDON LENGTHENING 24310 REVISION OF ARM TENDON 24320 REPAIR OF ARM TENDON 24330 REVISION OF ARM MUSCLES 24331 REVISION OF ARM MUSCLES 24332 TENOLYSIS- TRICEPS 24340 REPAIR OF BICEPS TENDON 24341 REPAIR ARM TENDON/MUSCLE 24342 REPAIR OF RUPTURED TENDON 24343 REPR ELBOW LAT LIGMNT W/TISS 24344 RECONSTRUCT ELBOW LAT LIGMNT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 24345 REPR ELBW MED LIGMNT W/TISSU 24346 RECONSTRUCT ELBOW MED LIGMNT 24350 REPAIR OF TENNIS ELBOW JAN 0824351 REPAIR OF TENNIS ELBOW JAN 0824352 REPAIR OF TENNIS ELBOW JAN 0824354 REPAIR OF TENNIS ELBOW JAN 0824356 REVISION OF TENNIS ELBOW JAN 0824357 TENOTOMY, ELBOW, LAT/MED, PERCUTAN JAN 08 24358 TENOTOMY, ELBOW, LAT/MED, DEBRI, OPEN JAN 08 24359 TENOTOMY, ELDBOW, LAT/MED, TENDN REP JAN 08 24360 RECONSTRUCT ELBOW JOINT 24361 RECONSTRUCT ELBOW JOINT 24362 RECONSTRUCT ELBOW JOINT 24363 REPLACE ELBOW JOINT 24365 RECONSTRUCT HEAD OF RADIUS 24366 RECONSTRUCT HEAD OF RADIUS 24400 REVISION OF HUMERUS 24410 REVISION OF HUMERUS 24420 REVISION OF HUMERUS 24430 REPAIR OF HUMERUS 24435 REPAIR HUMERUS WITH GRAFT 24470 REVISION OF ELBOW JOINT 24495 DECOMPRESSION OF FOREARM 24498 REINFORCE HUMERUS 24515 TREAT HUMERUS FRACTURE 24516 TREAT HUMERUS FRACTURE 24545 TREAT HUMERUS FRACTURE 24546 TREAT HUMERUS FRACTURE 24575 TREAT HUMERUS FRACTURE 24579 TREAT HUMERUS FRACTURE 24586 TREAT ELBOW FRACTURE 24587 TREAT ELBOW FRACTURE 24615 TREAT ELBOW DISLOCATION 24635 TREAT ELBOW FRACTURE 24665 TREAT RADIUS FRACTURE 24666 TREAT RADIUS FRACTURE 24685 TREAT ULNAR FRACTURE 24800 FUSION OF ELBOW JOINT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 24802 FUSION/GRAFT OF ELBOW JOINT 24900 AMPUTATION OF UPPER ARM 24920 AMPUTATION OF UPPER ARM 24925 AMPUTATION FOLLOW-UP SURGERY 24930 AMPUTATION FOLLOW-UP SURGERY 24931 AMPUTATE UPPER ARM & IMPLANT 24935 REVISION OF AMPUTATION 24940 REVISION OF UPPER ARM 24999 UPPER ARM/ELBOW SURGERY 25020 DECOMPRESS FOREARM 1 SPACE 25023 DECOMPRESS FOREARM 1 SPACE 25028 DRAINAGE OF FOREARM LESION 25031 DRAINAGE OF FOREARM BURSA 25035 TREAT FOREARM BONE LESION 25040 EXPLORE/TREAT WRIST JOINT 25065 BIOPSY FOREARM SOFT TISSUES 25066 BIOPSY FOREARM SOFT TISSUES 25075 REMOVEL FOREARM LESION SUBCU 25076 REMOVEL FOREARM LESION DEEP 25077 REMOVE TUMOR- FOREARM/WRIST 25085 INCISION OF WRIST CAPSULE 25100 BIOPSY OF WRIST JOINT 25101 EXPLORE/TREAT WRIST JOINT 25105 REMOVE WRIST JOINT LINING 25107 REMOVE WRIST JOINT CARTILAGE 25110 REMOVE WRIST TENDON LESION 25115 REMOVE WRIST/FOREARM LESION 25116 REMOVE WRIST/FOREARM LESION 25119 PARTIAL REMOVAL OF ULNA 25120 REMOVAL OF FOREARM LESION 25125 REMOVE/GRAFT FOREARM LESION 25126 REMOVE/GRAFT FOREARM LESION 25130 REMOVAL OF WRIST LESION 25135 REMOVE & GRAFT WRIST LESION 25136 REMOVE & GRAFT WRIST LESION 25145 REMOVE FOREARM BONE LESION 25150 PARTIAL REMOVAL OF ULNA 25151 PARTIAL REMOVAL OF RADIUS

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 25170 EXTENSIVE FOREARM SURGERY 25210 REMOVAL OF WRIST BONE 25215 REMOVAL OF WRIST BONES 25230 PARTIAL REMOVAL OF RADIUS 25240 PARTIAL REMOVAL OF ULNA 25248 REMOVE FOREARM FOREIGN BODY 25250 REMOVAL OF WRIST PROSTHESIS 25251 REMOVAL OF WRIST PROSTHESIS 25263 REPAIR FOREARM TENDON/MUSCLE 25265 REPAIR FOREARM TENDON/MUSCLE 25272 REPAIR FOREARM TENDON/MUSCLE 25274 REPAIR FOREARM TENDON/MUSCLE 25275 REPAIR FOREARM TENDON SHEATH 25280 REVISE WRIST/FOREARM TENDON 25290 INCISE WRIST/FOREARM TENDON 25295 RELEASE WRIST/FOREARM TENDON 25310 TRANSPLANT FOREARM TENDON 25312 TRANSPLANT FOREARM TENDON 25315 REVISE PALSY HAND TENDON(S) 25316 REVISE PALSY HAND TENDON(S) 25320 REPAIR/REVISE WRIST JOINT 25332 REVISE WRIST JOINT 25335 REALIGNMENT OF HAND 25337 RECONSTRUCT ULNA/RADIOULNAR 25350 REVISION OF RADIUS 25355 REVISION OF RADIUS 25360 REVISION OF ULNA 25365 REVISE RADIUS & ULNA 25370 REVISE RADIUS OR ULNA 25375 REVISE RADIUS & ULNA 25390 SHORTEN RADIUS OR ULNA 25391 LENGTHEN RADIUS OR ULNA 25392 SHORTEN RADIUS & ULNA 25393 LENGTHEN RADIUS & ULNA 25394 REPAIR CARPAL BONE- SHORTEN 25400 REPAIR RADIUS OR ULNA 25405 REPAIR/GRAFT RADIUS OR ULNA 25415 REPAIR RADIUS & ULNA

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 25420 REPAIR/GRAFT RADIUS & ULNA 25425 REPAIR/GRAFT RADIUS OR ULNA 25426 REPAIR/GRAFT RADIUS & ULNA 25430 VASC GRAFT INTO CARPAL BONE 25431 REPAIR NONUNION CARPAL BONE 25440 REPAIR/GRAFT WRIST BONE 25441 RECONSTRUCT WRIST JOINT 25442 RECONSTRUCT WRIST JOINT 25443 RECONSTRUCT WRIST JOINT 25444 RECONSTRUCT WRIST JOINT 25445 RECONSTRUCT WRIST JOINT 25446 WRIST REPLACEMENT 25447 REPAIR WRIST JOINT(S) 25450 REVISION OF WRIST JOINT 25455 REVISION OF WRIST JOINT 25490 REINFORCE RADIUS 25491 REINFORCE ULNA 25492 REINFORCE RADIUS AND ULNA 25515 TREAT FRACTURE OF RADIUS 25525 TREAT FRACTURE OF RADIUS 25526 TREAT FRACTURE OF RADIUS 25545 TREAT FRACTURE OF ULNA 25574 TREAT FRACTURE RADIUS & ULNA 25575 TREAT FRACTURE RADIUS/ULNA 25605 TREAT FRACTURE RADIUS/ULNA 25611 TREAT FRACTURE RADIUS/ULNA JAN 07 25620 TREAT FRACTURE RADIUS/ULNA JAN 07 25628 TREAT WRIST BONE FRACTURE 25645 TREAT WRIST BONE FRACTURE 25652 TREAT FRACTURE ULNAR STYLOID 25670 TREAT WRIST DISLOCATION 25676 TREAT WRIST DISLOCATION 25685 TREAT WRIST FRACTURE 25695 TREAT WRIST DISLOCATION 25800 FUSION OF WRIST JOINT 25805 FUSION/GRAFT OF WRIST JOINT 25810 FUSION/GRAFT OF WRIST JOINT 25820 FUSION OF HAND BONES

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 25825 FUSE HAND BONES WITH GRAFT 25830 FUSION- RADIOULNAR JNT/ULNA 25900 AMPUTATION OF FOREARM 25905 AMPUTATION OF FOREARM 25907 AMPUTATION FOLLOW-UP SURGERY 25909 AMPUTATION FOLLOW-UP SURGERY 25915 AMPUTATION OF FOREARM 25920 AMPUTATE HAND AT WRIST 25922 AMPUTATE HAND AT WRIST 25924 AMPUTATION FOLLOW-UP SURGERY 25927 AMPUTATION OF HAND 25929 AMPUTATION FOLLOW-UP SURGERY 25931 AMPUTATION FOLLOW-UP SURGERY 25999 FOREARM OR WRIST SURGERY 26034 TREAT HAND BONE LESION 26070 EXPLORE/TREAT HAND JOINT 26075 EXPLORE/TREAT FINGER JOINT 26080 EXPLORE/TREAT FINGER JOINT 26100 BIOPSY HAND JOINT LINING 26105 BIOPSY FINGER JOINT LINING 26110 BIOPSY FINGER JOINT LINING 26115 REMOVEL HAND LESION SUBCUT 26130 REMOVE WRIST JOINT LINING 26135 REVISE FINGER JOINT- EACH 26140 REVISE FINGER JOINT- EACH 26160 REMOVE TENDON SHEATH LESION 26185 REMOVE FINGER BONE 26200 REMOVE HAND BONE LESION 26205 REMOVE/GRAFT BONE LESION 26210 REMOVAL OF FINGER LESION 26215 REMOVE/GRAFT FINGER LESION 26230 PARTIAL REMOVAL OF HAND BONE 26235 PARTIAL REMOVAL- FINGER BONE 26236 PARTIAL REMOVAL- FINGER BONE 26250 EXTENSIVE HAND SURGERY 26255 EXTENSIVE HAND SURGERY 26260 EXTENSIVE FINGER SURGERY 26261 EXTENSIVE FINGER SURGERY

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 26262 PARTIAL REMOVAL OF FINGER 26320 REMOVAL OF IMPLANT FROM HAND 26499 REVISION OF FINGER 26516 FUSION OF KNUCKLE JOINT 26517 FUSION OF KNUCKLE JOINTS 26518 FUSION OF KNUCKLE JOINTS 26520 RELEASE KNUCKLE CONTRACTURE 26525 RELEASE FINGER CONTRACTURE 26530 REVISE KNUCKLE JOINT 26531 REVISE KNUCKLE WITH IMPLANT 26535 REVISE FINGER JOINT 26536 REVISE/IMPLANT FINGER JOINT 26540 REPAIR HAND JOINT 26541 REPAIR HAND JOINT WITH GRAFT 26542 REPAIR HAND JOINT WITH GRAFT 26545 RECONSTRUCT FINGER JOINT 26546 REPAIR NONUNION HAND 26548 RECONSTRUCT FINGER JOINT 26556 TOE JOINT TRANSFER 26560 REPAIR OF WEB FINGER 26561 REPAIR OF WEB FINGER 26562 REPAIR OF WEB FINGER 26565 CORRECT METACARPAL FLAW 26567 CORRECT FINGER DEFORMITY 26568 LENGTHEN METACARPAL/FINGER 26580 REPAIR HAND DEFORMITY 26587 RECONSTRUCT EXTRA FINGER 26607 TREAT METACARPAL FRACTURE 26615 TREAT METACARPAL FRACTURE 26665 TREAT THUMB FRACTURE 26685 TREAT HAND DISLOCATION 26686 TREAT HAND DISLOCATION 26715 TREAT KNUCKLE DISLOCATION 26735 TREAT FINGER FRACTURE- EACH 26746 TREAT FINGER FRACTURE- EACH 26765 TREAT FINGER FRACTURE- EACH 26785 TREAT FINGER DISLOCATION 26820 THUMB FUSION WITH GRAFT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 26841 FUSION OF THUMB 26842 THUMB FUSION WITH GRAFT 26843 FUSION OF HAND JOINT 26844 FUSION/GRAFT OF HAND JOINT 26850 FUSION OF KNUCKLE 26852 FUSION OF KNUCKLE WITH GRAFT 26860 FUSION OF FINGER JOINT 26861 FUSION OF FINGER JNT- ADD-ON 26862 FUSION/GRAFT OF FINGER JOINT 26863 FUSE/GRAFT ADDED JOINT 26910 AMPUTATE METACARPAL BONE 26951 AMPUTATION OF FINGER/THUMB 26952 AMPUTATION OF FINGER/THUMB 26989 HAND/FINGER SURGERY 26990 DRAINAGE OF PELVIS LESION 26991 DRAINAGE OF PELVIS BURSA 26992 DRAINAGE OF BONE LESION 27000 INCISION OF HIP TENDON 27001 INCISION OF HIP TENDON 27003 INCISION OF HIP TENDON 27005 INCISION OF HIP TENDON 27006 INCISION OF HIP TENDONS 27025 INCISION OF HIP/THIGH FASCIA 27030 DRAINAGE OF HIP JOINT 27033 EXPLORATION OF HIP JOINT 27035 DENERVATION OF HIP JOINT 27036 EXCISION OF HIP JOINT/MUSCLE 27040 BIOPSY OF SOFT TISSUES 27041 BIOPSY OF SOFT TISSUES 27047 REMOVE HIP/PELVIS LESION 27048 REMOVE HIP/PELVIS LESION 27049 REMOVE TUMOR- HIP/PELVIS 27050 BIOPSY OF SACROILIAC JOINT 27052 BIOPSY OF HIP JOINT 27054 REMOVAL OF HIP JOINT LINING 27060 REMOVAL OF ISCHIAL BURSA 27062 REMOVE FEMUR LESION/BURSA 27065 REMOVAL OF HIP BONE LESION

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 27066 REMOVAL OF HIP BONE LESION 27067 REMOVE/GRAFT HIP BONE LESION 27070 PARTIAL REMOVAL OF HIP BONE 27071 PARTIAL REMOVAL OF HIP BONE 27077 EXTENSIVE HIP SURGERY 27078 EXTENSIVE HIP SURGERY 27079 EXTENSIVE HIP SURGERY 27080 REMOVAL OF TAIL BONE 27086 REMOVE HIP FOREIGN BODY 27087 REMOVE HIP FOREIGN BODY 27090 REMOVAL OF HIP PROSTHESIS 27091 REMOVAL OF HIP PROSTHESIS 27096 INJECT SACROILIAC JOINT 27097 REVISION OF HIP TENDON 27098 TRANSFER TENDON TO PELVIS 27100 TRANSFER OF ABDOMINAL MUSCLE 27105 TRANSFER OF SPINAL MUSCLE 27110 TRANSFER OF ILIOPSOAS MUSCLE 27111 TRANSFER OF ILIOPSOAS MUSCLE 27120 RECONSTRUCTION OF HIP SOCKET 27122 RECONSTRUCTION OF HIP SOCKET 27125 PARTIAL HIP REPLACEMENT 27130 TOTAL HIP ARTHROPLASTY OCT 06 27132 CONVERSION TO TOTAL HIP OCT 06 27134 REVISE HIP JOINT REPLACEMENT 27137 REVISE HIP JOINT REPLACEMENT 27138 REVISE HIP JOINT REPLACEMENT 27140 TRANSPLANT FEMUR RIDGE 27146 INCISION OF HIP BONE 27147 REVISION OF HIP BONE 27151 INCISION OF HIP BONES 27156 REVISION OF HIP BONES 27158 REVISION OF PELVIS 27161 INCISION OF NECK OF FEMUR 27165 INCISION/FIXATION OF FEMUR 27170 REPAIR/GRAFT FEMUR HEAD/NECK 27176 TREAT SLIPPED EPIPHYSIS 27177 TREAT SLIPPED EPIPHYSIS

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 27178 TREAT SLIPPED EPIPHYSIS 27179 REVISE HEAD/NECK OF FEMUR 27181 TREAT SLIPPED EPIPHYSIS 27185 REVISION OF FEMUR EPIPHYSIS 27187 REINFORCE HIP BONES 27202 TREAT TAIL BONE FRACTURE 27215 TREAT PELVIC FRACTURE(S) 27217 TREAT PELVIC RING FRACTURE 27218 TREAT PELVIC RING FRACTURE 27226 TREAT HIP WALL FRACTURE 27227 TREAT HIP FRACTURE(S) 27228 TREAT HIP FRACTURE(S) 27236 TREAT THIGH FRACTURE 27244 TREAT THIGH FRACTURE 27245 TREAT THIGH FRACTURE 27248 TREAT THIGH FRACTURE 27253 TREAT HIP DISLOCATION 27254 TREAT HIP DISLOCATION 27258 TREAT HIP DISLOCATION 27259 TREAT HIP DISLOCATION 27266 TREAT HIP DISLOCATION 27267 CLOSD TX FEM FX, PROX END, W/OUT MANIP JAN 08 27268 CLOSD TX FEM FX, PROX HEAD W/ MANIP JAN 08 27269 OPEN TX FEM FX, PROX HEAD, INT FIX JAN 08 27280 FUSION OF SACROILIAC JOINT 27282 FUSION OF PUBIC BONES 27284 FUSION OF HIP JOINT 27286 FUSION OF HIP JOINT 27290 AMPUTATION OF LEG AT HIP 27295 AMPUTATION OF LEG AT HIP 27299 PELVIS/HIP JOINT SURGERY OCT 06 27301 DRAIN THIGH/KNEE LESION 27303 DRAINAGE OF BONE LESION 27305 INCISE THIGH TENDON & FASCIA 27306 INCISION OF THIGH TENDON 27307 INCISION OF THIGH TENDONS 27310 EXPLORATION OF KNEE JOINT 27315 PARTIAL REMOVAL- THIGH NERVE JAN 07

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 27320 PARTIAL REMOVAL- THIGH NERVE JAN 07 27323 BIOPSY- THIGH SOFT TISSUES 27324 BIOPSY- THIGH SOFT TISSUES 27327 REMOVAL OF THIGH LESION 27328 REMOVAL OF THIGH LESION 27329 REMOVE TUMOR- THIGH/KNEE 27330 BIOPSY- KNEE JOINT LINING 27331 EXPLORE/TREAT KNEE JOINT 27332 REMOVAL OF KNEE CARTILAGE 27333 REMOVAL OF KNEE CARTILAGE 27334 REMOVE KNEE JOINT LINING 27335 REMOVE KNEE JOINT LINING 27340 REMOVAL OF KNEECAP BURSA 27345 REMOVAL OF KNEE CYST 27347 REMOVE KNEE CYST 27350 REMOVAL OF KNEECAP 27355 REMOVE FEMUR LESION 27356 REMOVE FEMUR LESION/GRAFT 27357 REMOVE FEMUR LESION/GRAFT 27358 REMOVE FEMUR LESION/FIXATION 27360 PARTIAL REMOVAL- LEG BONE(S) 27365 EXTENSIVE LEG SURGERY 27372 REMOVAL OF FOREIGN BODY 27381 REPAIR/GRAFT KNEECAP TENDON 27386 REPAIR/GRAFT OF THIGH MUSCLE 27390 INCISION OF THIGH TENDON 27391 INCISION OF THIGH TENDONS 27392 INCISION OF THIGH TENDONS 27393 LENGTHENING OF THIGH TENDON 27394 LENGTHENING OF THIGH TENDONS 27395 LENGTHENING OF THIGH TENDONS 27396 TRANSPLANT OF THIGH TENDON 27397 TRANSPLANTS OF THIGH TENDONS 27400 REVISE THIGH MUSCLES/TENDONS 27403 REPAIR OF KNEE CARTILAGE 27405 REPAIR OF KNEE LIGAMENT 27407 REPAIR OF KNEE LIGAMENT 27409 REPAIR OF KNEE LIGAMENTS

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 27412 AUTOL CHONDROCYTE IMPLANTATION KNEE 27415 OSTEOCHONDRAL ALLOGRAFT KNEE OPEN 27416 OSTEOCHONDRAL AUTOGRAFT KNEE OPEN JAN 08 27418 REPAIR DEGENERATED KNEECAP 27420 REVISION OF UNSTABLE KNEECAP 27422 REVISION OF UNSTABLE KNEECAP 27424 REVISION/REMOVAL OF KNEECAP 27425 LAT RETINACULAR RELEASE OPEN 27427 RECONSTRUCTION- KNEE 27428 RECONSTRUCTION- KNEE 27429 RECONSTRUCTION- KNEE 27430 REVISION OF THIGH MUSCLES 27435 INCISION OF KNEE JOINT 27437 REVISE KNEECAP 27438 REVISE KNEECAP WITH IMPLANT 27440 REVISION OF KNEE JOINT 27441 REVISION OF KNEE JOINT 27442 REVISION OF KNEE JOINT 27443 REVISION OF KNEE JOINT 27445 REVISION OF KNEE JOINT 27446 REVISION OF KNEE JOINT 27447 TOTAL KNEE ARTHROPLASTY 27448 INCISION OF THIGH 27450 INCISION OF THIGH 27454 REALIGNMENT OF THIGH BONE 27455 REALIGNMENT OF KNEE 27457 REALIGNMENT OF KNEE 27465 SHORTENING OF THIGH BONE 27466 LENGTHENING OF THIGH BONE 27468 SHORTEN/LENGTHEN THIGHS 27470 REPAIR OF THIGH 27472 REPAIR/GRAFT OF THIGH 27475 SURGERY TO STOP LEG GROWTH 27477 SURGERY TO STOP LEG GROWTH 27479 SURGERY TO STOP LEG GROWTH 27485 SURGERY TO STOP LEG GROWTH 27486 REVISE/REPLACE KNEE JOINT 27487 REVISE/REPLACE KNEE JOINT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 27488 REMOVAL OF KNEE PROSTHESIS 27495 REINFORCE THIGH 27496 DECOMPRESSION OF THIGH/KNEE 27497 DECOMPRESSION OF THIGH/KNEE 27498 DECOMPRESSION OF THIGH/KNEE 27499 DECOMPRESSION OF THIGH/KNEE 27506 TREATMENT OF THIGH FRACTURE 27507 TREATMENT OF THIGH FRACTURE 27511 TREATMENT OF THIGH FRACTURE 27513 TREATMENT OF THIGH FRACTURE 27514 TREATMENT OF THIGH FRACTURE 27517 TREAT THIGH FX GROWTH PLATE 27519 TREAT THIGH FX GROWTH PLATE 27524 TREAT KNEECAP FRACTURE 27535 TREAT KNEE FRACTURE 27536 TREAT KNEE FRACTURE 27540 TREAT KNEE FRACTURE 27556 TREAT KNEE DISLOCATION 27557 TREAT KNEE DISLOCATION 27558 TREAT KNEE DISLOCATION 27566 TREAT KNEECAP DISLOCATION 27580 FUSION OF KNEE 27590 AMPUTATE LEG AT THIGH 27591 AMPUTATE LEG AT THIGH 27592 AMPUTATE LEG AT THIGH 27594 AMPUTATION FOLLOW-UP SURGERY 27596 AMPUTATION FOLLOW-UP SURGERY 27598 AMPUTATE LOWER LEG AT KNEE 27599 LEG SURGERY PROCEDURE 27600 DECOMPRESSION OF LOWER LEG 27601 DECOMPRESSION OF LOWER LEG 27602 DECOMPRESSION OF LOWER LEG 27603 DRAIN LOWER LEG LESION 27604 DRAIN LOWER LEG BURSA 27605 INCISION OF ACHILLES TENDON 27606 INCISION OF ACHILLES TENDON 27607 TREAT LOWER LEG BONE LESION 27610 EXPLORE/TREAT ANKLE JOINT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 27612 EXPLORATION OF ANKLE JOINT 27613 BIOPSY LOWER LEG SOFT TISSUE 27614 BIOPSY LOWER LEG SOFT TISSUE 27615 REMOVE TUMOR- LOWER LEG 27618 REMOVE LOWER LEG LESION 27619 REMOVE LOWER LEG LESION 27620 EXPLORE/TREAT ANKLE JOINT 27625 REMOVE ANKLE JOINT LINING 27626 REMOVE ANKLE JOINT LINING 27630 REMOVAL OF TENDON LESION 27635 REMOVE LOWER LEG BONE LESION 27637 REMOVE/GRAFT LEG BONE LESION 27638 REMOVE/GRAFT LEG BONE LESION 27640 PARTIAL REMOVAL OF TIBIA 27641 PARTIAL REMOVAL OF FIBULA 27645 EXTENSIVE LOWER LEG SURGERY 27646 EXTENSIVE LOWER LEG SURGERY 27647 EXTENSIVE ANKLE/HEEL SURGERY 27650 REPAIR ACHILLES TENDON 27652 REPAIR/GRAFT ACHILLES TENDON 27654 REPAIR OF ACHILLES TENDON 27658 REPAIR OF LEG TENDON- EACH 27659 REPAIR OF LEG TENDON- EACH 27664 REPAIR OF LEG TENDON- EACH 27665 REPAIR OF LEG TENDON- EACH 27675 REPAIR LOWER LEG TENDONS 27676 REPAIR LOWER LEG TENDONS 27680 RELEASE OF LOWER LEG TENDON 27681 RELEASE OF LOWER LEG TENDONS 27685 REVISION OF LOWER LEG TENDON 27686 REVISE LOWER LEG TENDONS 27687 REVISION OF CALF TENDON 27690 REVISE LOWER LEG TENDON 27691 REVISE LOWER LEG TENDON 27692 REVISE ADDITIONAL LEG TENDON 27695 REPAIR OF ANKLE LIGAMENT 27696 REPAIR OF ANKLE LIGAMENTS 27698 REPAIR OF ANKLE LIGAMENT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 27700 REVISION OF ANKLE JOINT 27702 RECONSTRUCT ANKLE JOINT 27703 RECONSTRUCTION- ANKLE JOINT 27704 REMOVAL OF ANKLE IMPLANT 27705 INCISION OF TIBIA 27707 INCISION OF FIBULA 27709 INCISION OF TIBIA & FIBULA 27712 REALIGNMENT OF LOWER LEG 27715 REVISION OF LOWER LEG 27720 REPAIR OF TIBIA 27722 REPAIR/GRAFT OF TIBIA 27724 REPAIR/GRAFT OF TIBIA 27725 REPAIR OF LOWER LEG 27726 REPAIR FIBULA INTERNAL FIXATION JAN 08 27727 REPAIR OF LOWER LEG 27730 REPAIR OF TIBIA EPIPHYSIS 27732 REPAIR OF FIBULA EPIPHYSIS 27734 REPAIR LOWER LEG EPIPHYSES 27740 REPAIR OF LEG EPIPHYSES 27742 REPAIR OF LEG EPIPHYSES 27745 REINFORCE TIBIA 27758 TREATMENT OF TIBIA FRACTURE 27759 TREATMENT OF TIBIA FRACTURE 27766 TREATMENT OF ANKLE FRACTURE 27767 CLOSED TX POST MALL FX W/O, MANIPULAT JAN 08 27768 CLOSED TX POST MALL FX, W MANIPULAT JAN 08 27769 OPEN TX POST MALL, FX W/ INT FIX JAN 08 27784 TREATMENT OF FIBULA FRACTURE 27792 TREATMENT OF ANKLE FRACTURE 27814 TREATMENT OF ANKLE FRACTURE 27822 TREATMENT OF ANKLE FRACTURE 27823 TREATMENT OF ANKLE FRACTURE 27826 TREAT LOWER LEG FRACTURE 27827 TREAT LOWER LEG FRACTURE 27828 TREAT LOWER LEG FRACTURE 27829 TREAT LOWER LEG JOINT 27832 TREAT LOWER LEG DISLOCATION 27846 TREAT ANKLE DISLOCATION

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 27848 TREAT ANKLE DISLOCATION 27870 FUSION OF ANKLE JOINT- OPEN 27871 FUSION OF TIBIOFIBULAR JOINT 27880 AMPUTATION OF LOWER LEG 27881 AMPUTATION OF LOWER LEG 27882 AMPUTATION OF LOWER LEG 27884 AMPUTATION FOLLOW-UP SURGERY 27886 AMPUTATION FOLLOW-UP SURGERY 27888 AMPUTATION OF FOOT AT ANKLE 27889 AMPUTATION OF FOOT AT ANKLE 27892 DECOMPRESSION OF LEG 27893 DECOMPRESSION OF LEG 27894 DECOMPRESSION OF LEG 27899 LEG/ANKLE SURGERY PROCEDURE 28001 DRAINAGE OF BURSA OF FOOT 28002 TREATMENT OF FOOT INFECTION 28003 TREATMENT OF FOOT INFECTION 28005 TREAT FOOT BONE LESION 28008 INCISION OF FOOT FASCIA 28010 INCISION OF TOE TENDON 28011 INCISION OF TOE TENDONS 28020 EXPLORATION OF FOOT JOINT 28022 EXPLORATION OF FOOT JOINT 28024 EXPLORATION OF TOE JOINT 28030 REMOVAL OF FOOT NERVE JAN 07 28035 DECOMPRESSION OF TIBIA NERVE 28043 EXCISION OF FOOT LESION 28045 EXCISION OF FOOT LESION 28046 RESECTION OF TUMOR- FOOT 28050 BIOPSY OF FOOT JOINT LINING 28052 BIOPSY OF FOOT JOINT LINING 28054 BIOPSY OF TOE JOINT LINING 28060 PARTIAL REMOVAL- FOOT FASCIA 28062 REMOVAL OF FOOT FASCIA 28070 REMOVAL OF FOOT JOINT LINING 28072 REMOVAL OF FOOT JOINT LINING 28080 REMOVAL OF FOOT LESION 28086 EXCISE FOOT TENDON SHEATH

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 28088 EXCISE FOOT TENDON SHEATH 28090 REMOVAL OF FOOT LESION 28092 REMOVAL OF TOE LESIONS 28100 REMOVAL OF ANKLE/HEEL LESION 28102 REMOVE/GRAFT FOOT LESION 28103 REMOVE/GRAFT FOOT LESION 28104 REMOVAL OF FOOT LESION 28106 REMOVE/GRAFT FOOT LESION 28107 REMOVE/GRAFT FOOT LESION 28108 REMOVAL OF TOE LESIONS 28110 PART REMOVAL OF METATARSAL 28111 PART REMOVAL OF METATARSAL 28112 PART REMOVAL OF METATARSAL 28113 PART REMOVAL OF METATARSAL 28114 REMOVAL OF METATARSAL HEADS 28116 REVISION OF FOOT 28118 REMOVAL OF HEEL BONE 28119 REMOVAL OF HEEL SPUR 28120 PART REMOVAL OF ANKLE/HEEL 28122 PARTIAL REMOVAL OF FOOT BONE 28124 PARTIAL REMOVAL OF TOE 28130 REMOVAL OF ANKLE BONE 28140 REMOVAL OF METATARSAL 28150 REMOVAL OF TOE 28160 PARTIAL REMOVAL OF TOE 28171 EXTENSIVE FOOT SURGERY 28173 EXTENSIVE FOOT SURGERY 28175 EXTENSIVE FOOT SURGERY 28190 REMOVAL OF FOOT FOREIGN BODY 28192 REMOVAL OF FOOT FOREIGN BODY 28193 REMOVAL OF FOOT FOREIGN BODY 28200 REPAIR OF FOOT TENDON 28202 REPAIR/GRAFT OF FOOT TENDON 28208 REPAIR OF FOOT TENDON 28210 REPAIR/GRAFT OF FOOT TENDON 28220 RELEASE OF FOOT TENDON 28222 RELEASE OF FOOT TENDONS 28225 RELEASE OF FOOT TENDON

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 28226 RELEASE OF FOOT TENDONS 28230 INCISION OF FOOT TENDON(S) 28232 INCISION OF TOE TENDON 28234 INCISION OF FOOT TENDON 28238 REVISION OF FOOT TENDON 28240 RELEASE OF BIG TOE 28250 REVISION OF FOOT FASCIA 28260 RELEASE OF MIDFOOT JOINT 28261 REVISION OF FOOT TENDON 28262 REVISION OF FOOT AND ANKLE 28264 RELEASE OF MIDFOOT JOINT 28270 RELEASE OF FOOT CONTRACTURE 28272 RELEASE OF TOE JOINT- EACH 28280 FUSION OF TOES 28285 REPAIR OF HAMMERTOE 28286 REPAIR OF HAMMERTOE 28288 PARTIAL REMOVAL OF FOOT BONE 28289 REPAIR HALLUX RIGIDUS 28290 CORRECTION OF BUNION 28292 CORRECTION OF BUNION 28293 CORRECTION OF BUNION 28294 CORRECTION OF BUNION 28296 CORRECTION OF BUNION 28297 CORRECTION OF BUNION 28298 CORRECTION OF BUNION 28299 CORRECTION OF BUNION 28300 INCISION OF HEEL BONE 28302 INCISION OF ANKLE BONE 28304 INCISION OF MIDFOOT BONES 28305 INCISE/GRAFT MIDFOOT BONES 28306 INCISION OF METATARSAL 28307 INCISION OF METATARSAL 28308 INCISION OF METATARSAL 28309 INCISION OF METATARSALS 28310 REVISION OF BIG TOE 28312 REVISION OF TOE 28313 REPAIR DEFORMITY OF TOE 28315 REMOVAL OF SESAMOID BONE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 28320 REPAIR OF FOOT BONES 28322 REPAIR OF METATARSALS 28340 RESECT ENLARGED TOE TISSUE 28341 RESECT ENLARGED TOE 28344 REPAIR EXTRA TOE(S) 28345 REPAIR WEBBED TOE(S) 28360 RECONSTRUCT CLEFT FOOT 28415 TREAT HEEL FRACTURE 28420 TREAT/GRAFT HEEL FRACTURE 28445 TREAT ANKLE FRACTURE 28446 OPEN OSTEOCHONDR AUTOGRAFT, TALUS JAN 08 28465 TREAT MIDFOOT FRACTURE- EACH 28485 TREAT METATARSAL FRACTURE 28505 TREAT BIG TOE FRACTURE 28525 TREAT TOE FRACTURE 28531 TREAT SESAMOID BONE FRACTURE 28555 REPAIR FOOT DISLOCATION 28585 REPAIR FOOT DISLOCATION 28615 REPAIR FOOT DISLOCATION 28645 REPAIR TOE DISLOCATION 28675 REPAIR OF TOE DISLOCATION 28705 FUSION OF FOOT BONES 28715 FUSION OF FOOT BONES 28725 FUSION OF FOOT BONES 28730 FUSION OF FOOT BONES 28735 FUSION OF FOOT BONES 28737 REVISION OF FOOT BONES 28740 FUSION OF FOOT BONES 28750 FUSION OF BIG TOE JOINT 28755 FUSION OF BIG TOE JOINT 28760 FUSION OF BIG TOE JOINT 28800 AMPUTATION OF MIDFOOT 28805 AMPUTATION THRU METATARSAL 28810 AMPUTATION TOE & METATARSAL 28820 AMPUTATION OF TOE 28825 PARTIAL AMPUTATION OF TOE 28899 FOOT/TOES SURGERY PROCEDURE 29800 JAW ARTHROSCOPY/SURGERY

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 29804 JAW ARTHROSCOPY/SURGERY 29805 SHOULDER ARTHROSCOPY- DX 29807 SHOULDER ARTHROSCOPY/SURGERY 29819 SHOULDER ARTHROSCOPY/SURGERY 29820 SHOULDER ARTHROSCOPY/SURGERY 29821 SHOULDER ARTHROSCOPY/SURGERY 29822 SHOULDER ARTHROSCOPY/SURGERY 29823 SHOULDER ARTHROSCOPY/SURGERY 29824 SHOULDER ARTHROSCOPY/SURGERY 29825 SHOULDER ARTHROSCOPY/SURGERY 29826 SHOULDER ARTHROSCOPY/SURGERY 29827 SHOULDER ARTHROSCOPY-RC REPAIR OCT 06 29828 SHOULDER ARTHRO W/ BICEPS TENODESIS JAN 08 29904 ARTHRO SUBTALAR JOINT W/ REMOVAL JAN 08 29905 ARTHRO SUBTALAR W/ SYNOVECTOMY JAN 08 29906 ARTHRO SUBTALAR W/ DEBRIDEMENT JAN 08 29907 ARTHRO SUBTALAR ARTHRODESIS JAN 08 29830 ELBOW ARTHROSCOPY 29834 ELBOW ARTHROSCOPY/SURGERY 29835 ELBOW ARTHROSCOPY/SURGERY 29836 ELBOW ARTHROSCOPY/SURGERY 29837 ELBOW ARTHROSCOPY/SURGERY 29838 ELBOW ARTHROSCOPY/SURGERY 29840 WRIST ARTHROSCOPY 29843 WRIST ARTHROSCOPY/SURGERY 29844 WRIST ARTHROSCOPY/SURGERY 29845 WRIST ARTHROSCOPY/SURGERY 29847 WRIST ARTHROSCOPY/SURGERY 29848 WRIST ENDOSCOPY/SURGERY 29851 KNEE ARTHROSCOPY/SURGERY 29856 TIBIAL ARTHROSCOPY/SURGERY 29860 HIP ARTHROSCOPY- DX 29861 HIP ARTHROSCOPY/SURGERY 29862 HIP ARTHROSCOPY/SURGERY 29863 HIP ARTHROSCOPY/SURGERY

29866 SCOPE KNEE; OSTEOCHONDRAL AUTOGRAFT

29867 SCOPE KNEE; OSTEOCHONDRAL ALLOGRAFT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 29868 SCOPE KNEE; MENISCAL TPLNT MED/LAT 29870 KNEE ARTHROSCOPY- DX 29871 KNEE ARTHROSCOPY/DRAINAGE 29873 KNEE ARTHROSCOPY/SURGERY 29874 KNEE ARTHROSCOPY/SURGERY 29875 KNEE ARTHROSCOPY/SURGERY 29876 KNEE ARTHROSCOPY/SURGERY 29877 KNEE ARTHROSCOPY/SURGERY 29879 KNEE ARTHROSCOPY/SURGERY 29880 KNEE ARTHROSCOPY/SURGERY 29881 KNEE ARTHROSCOPY/SURGERY 29882 KNEE ARTHROSCOPY/SURGERY 29883 KNEE ARTHROSCOPY/SURGERY 29884 KNEE ARTHROSCOPY/SURGERY 29885 KNEE ARTHROSCOPY/SURGERY 29886 KNEE ARTHROSCOPY/SURGERY 29887 KNEE ARTHROSCOPY/SURGERY 29888 KNEE ARTHROSCOPY/SURGERY 29889 KNEE ARTHROSCOPY/SURGERY 29891 ANKLE ARTHROSCOPY/SURGERY 29892 ANKLE ARTHROSCOPY/SURGERY 29893 SCOPE- PLANTAR FASCIOTOMY 29894 ANKLE ARTHROSCOPY/SURGERY 29895 ANKLE ARTHROSCOPY/SURGERY 29897 ANKLE ARTHROSCOPY/SURGERY 29898 ANKLE ARTHROSCOPY/SURGERY 29899 ANKLE ARTHROSCOPY/SURGERY 29900 MCP JOINT ARTHROSCOPY- DX 29901 MCP JOINT ARTHROSCOPY- SURG 29902 MCP JOINT ARTHROSCOPY- SURG 29999 ARTHROSCOPY OF JOINT 31239 NASAL/SINUS ENDOSCOPY- SURG 31290 NASAL/SINUS ENDOSCOPY- SURG 31291 NASAL/SINUS ENDOSCOPY- SURG 31292 NASAL/SINUS ENDOSCOPY- SURG 31293 NASAL/SINUS ENDOSCOPY- SURG 31294 NASAL/SINUS ENDOSCOPY- SURG 31300 REMOVAL OF LARYNX LESION

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 31320 DIAGNOSTIC INCISION- LARYNX 31367 PARTIAL REMOVAL OF LARYNX 31368 PARTIAL REMOVAL OF LARYNX 31370 PARTIAL REMOVAL OF LARYNX 31375 PARTIAL REMOVAL OF LARYNX 31380 PARTIAL REMOVAL OF LARYNX 31382 PARTIAL REMOVAL OF LARYNX 31400 REVISION OF LARYNX 31420 REMOVAL OF EPIGLOTTIS 31510 LARYNGOSCOPY WITH BIOPSY 31513 INJECTION INTO VOCAL CORD 31528 LARYNGOSCOPY AND DILATION 31529 LARYNGOSCOPY AND DILATION 31535 OPERATIVE LARYNGOSCOPY 31536 OPERATIVE LARYNGOSCOPY 31545 LARYN OP MIC REMV LES;RECN TISS FLP 31546 LARYN OP MIC REMV LES;RECNSTR W/GFT 31560 OPERATIVE LARYNGOSCOPY 31561 OPERATIVE LARYNGOSCOPY 31570 LARYNGOSCOPY WITH INJECTION 31571 LARYNGOSCOPY WITH INJECTION 31576 LARYNGOSCOPY WITH BIOPSY 31579 DIAGNOSTIC LARYNGOSCOPY 31580 REVISION OF LARYNX 31582 REVISION OF LARYNX 31584 TREAT LARYNX FRACTURE 31585 TREAT LARYNX FRACTURE 31586 TREAT LARYNX FRACTURE 31587 REVISION OF LARYNX 31588 REVISION OF LARYNX 31590 REINNERVATE LARYNX 31595 LARYNX NERVE SURGERY 31599 LARYNX SURGERY PROCEDURE 31603 INCISION OF WINDPIPE 31605 INCISION OF WINDPIPE 31611 SURGERY/SPEECH PROSTHESIS 31612 PUNCTURE/CLEAR WINDPIPE 31615 VISUALIZATION OF WINDPIPE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 31628 BRNCHSCPY; TRNSBRNCH LUNG BX 1 LOBE JAN 0831629 BRNCHSCPY;NABX TRACH STEM&/BRNCH JAN 0831631 BRONCHOSCOPY; PLCMT TRACHEAL STENT JAN 0831633 BRNCHSCPY; W/TBNA BX EA ADD LOBE JAN 0831638 BRO;REV TRACH/BRNCH STNT INSRT PREV JAN 0831640 BRONCHOSCOPY; W/EXCISION OF TUMOR JAN 0831641 BRONCHOSCOPY- TREAT BLOCKAGE JAN 0831656 BRONCHOSCOPY- INJ FOR X-RAY JAN 0831715 INJECTION FOR BRONCHUS X-RAY JAN 0831750 REPAIR OF WINDPIPE 31755 REPAIR OF WINDPIPE 31760 REPAIR OF WINDPIPE 31766 RECONSTRUCTION OF WINDPIPE 31775 RECONSTRUCT BRONCHUS 31780 RECONSTRUCT WINDPIPE 31781 RECONSTRUCT WINDPIPE 31785 REMOVE WINDPIPE LESION 31786 REMOVE WINDPIPE LESION 31899 AIRWAYS SURGICAL PROCEDURE 32002 TREATMENT OF COLLAPSED LUNG JAN 0832005 TREAT LUNG LINING CHEMICALLY JAN 0832019 INSRT INDWELL TUNNLD PLEURAL CATH JAN 0832020 INSERTION OF CHEST TUBE JAN 0832035 EXPLORATION OF CHEST 32036 EXPLORATION OF CHEST 32095 BIOPSY THROUGH CHEST WALL 32100 EXPLORATION/BIOPSY OF CHEST 32110 EXPLORE/REPAIR CHEST 32120 RE-EXPLORATION OF CHEST 32124 EXPLORE CHEST FREE ADHESIONS 32140 REMOVAL OF LUNG LESION(S) 32141 REMOVE/TREAT LUNG LESIONS 32150 REMOVAL OF LUNG LESION(S) 32151 REMOVE LUNG FOREIGN BODY 32200 DRAIN- OPEN- LUNG LESION 32201 DRAIN- PERCUT- LUNG LESION 32215 TREAT CHEST LINING 32220 RELEASE OF LUNG

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 32225 PARTIAL RELEASE OF LUNG 32310 REMOVAL OF CHEST LINING 32320 FREE/REMOVE CHEST LINING 32400 NEEDLE BIOPSY CHEST LINING 32402 OPEN BIOPSY CHEST LINING 32420 PUNCTURE/CLEAR LUNG 32421 THORACENTSIS PLEURAL CAVITY JAN 08 32422 THORACENTSIS INSERTION TUBE JAN 08 32440 REMOVAL OF LUNG 32442 SLEEVE PNEUMONECTOMY 32445 REMOVAL OF LUNG 32480 PARTIAL REMOVAL OF LUNG 32482 BILOBECTOMY 32484 SEGMENTECTOMY 32486 SLEEVE LOBECTOMY 32488 COMPLETION PNEUMONECTOMY 32491 LUNG VOLUME REDUCTION 32500 PARTIAL REMOVAL OF LUNG 32520 REMOVE LUNG & REVISE CHEST 32522 REMOVE LUNG & REVISE CHEST 32525 REMOVE LUNG & REVISE CHEST 32540 REMOVAL OF LUNG LESION 32550 INSERTION INDWELLING PLEURAL CATH JAN 08 32551 TUBE THORACOSTOMY, WATER SEAL JAN 08 32560 CHEMICAL PLEURODESIS JAN 08 32601 THORACOSCOPY- DIAGNOSTIC 32602 THORACOSCOPY- DIAGNOSTIC 32650 THORACOSCOPY- SURGICAL 32651 THORACOSCOPY- SURGICAL 32652 THORACOSCOPY- SURGICAL 32653 THORACOSCOPY- SURGICAL 32654 THORACOSCOPY- SURGICAL 32655 THORACOSCOPY- SURGICAL 32656 THORACOSCOPY- SURGICAL 32657 THORACOSCOPY- SURGICAL 32663 THORACOSCOPY- SURGICAL 32664 THORACOSCOPY- SURGICAL 32800 REPAIR LUNG HERNIA

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 32820 RECONSTRUCT INJURED CHEST 32851 LUNG TRANSPLANT- SINGLE 32852 LUNG TRANSPLANT WITH BYPASS 32900 REMOVAL OF RIB(S) 32905 REVISE & REPAIR CHEST WALL 32906 REVISE & REPAIR CHEST WALL 32940 REVISION OF LUNG 32960 THERAPEUTIC PNEUMOTHORAX 32999 CHEST SURGERY PROCEDURE OCT 06 33282 IMPLANT PAT-ACTIVE HT RECORD 33284 REMOVE PAT-ACTIVE HT RECORD 33606 ANASTOMOSIS/ARTERY-AORTA 33619 REPAIR SINGLE VENTRICLE 33690 REINFORCE PULMONARY ARTERY 33750 MAJOR VESSEL SHUNT 33755 MAJOR VESSEL SHUNT 33762 MAJOR VESSEL SHUNT 33764 MAJOR VESSEL SHUNT & GRAFT 33766 MAJOR VESSEL SHUNT 33767 MAJOR VESSEL SHUNT 33802 REPAIR VESSEL DEFECT 33803 REPAIR VESSEL DEFECT 33820 REVISE MAJOR VESSEL 33822 REVISE MAJOR VESSEL 33824 REVISE MAJOR VESSEL 33840 REMOVE AORTA CONSTRICTION 33845 REMOVE AORTA CONSTRICTION 33851 REMOVE AORTA CONSTRICTION 33852 REPAIR SEPTAL DEFECT 33853 REPAIR SEPTAL DEFECT 33860 ASCENDING AORTIC GRAFT 33861 ASCENDING AORTIC GRAFT 33863 ASCENDING AORTIC GRAFT 33870 TRANSVERSE AORTIC ARCH GRAFT 33875 THORACIC AORTIC GRAFT 33877 THORACOABDOMINAL GRAFT 33910 REMOVE LUNG ARTERY EMBOLI 33915 REMOVE LUNG ARTERY EMBOLI

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 33916 SURGERY OF GREAT VESSEL 33917 REPAIR PULMONARY ARTERY 33918 REPAIR PULMONARY ATRESIA 33919 REPAIR PULMONARY ATRESIA 33922 TRANSECT PULMONARY ARTERY 33935 TRANSPLANTATION- HEART/LUNG 34001 REMOVAL OF ARTERY CLOT 34051 REMOVAL OF ARTERY CLOT 34101 REMOVAL OF ARTERY CLOT 34111 REMOVAL OF ARM ARTERY CLOT 34151 REMOVAL OF ARTERY CLOT 34201 REMOVAL OF ARTERY CLOT 34203 REMOVAL OF LEG ARTERY CLOT 34401 REMOVAL OF VEIN CLOT 34421 REMOVAL OF VEIN CLOT 34451 REMOVAL OF VEIN CLOT 34471 REMOVAL OF VEIN CLOT 34490 REMOVAL OF VEIN CLOT 34502 RECONSTRUCT VENA CAVA 34520 CROSS-OVER VEIN GRAFT 34530 LEG VEIN FUSION 34808 ENDOVASC ABDO OCCLUD DEVICE 34900 ENDOVASC GRAFT PLCMT REP ILIAC ART 35001 REPAIR DEFECT OF ARTERY 35002 REPAIR ARTERY RUPTURE- NECK 35005 REPAIR DEFECT OF ARTERY 35011 REPAIR DEFECT OF ARTERY 35013 REPAIR ARTERY RUPTURE- ARM 35021 REPAIR DEFECT OF ARTERY 35022 REPAIR ARTERY RUPTURE- CHEST 35045 REPAIR DEFECT OF ARM ARTERY 35081 REPAIR DEFECT OF ARTERY 35082 REPAIR ARTERY RUPTURE- AORTA 35091 REPAIR DEFECT OF ARTERY 35092 REPAIR ARTERY RUPTURE- AORTA 35102 REPAIR DEFECT OF ARTERY 35103 REPAIR ARTERY RUPTURE- GROIN 35111 REPAIR DEFECT OF ARTERY

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 35112 REPAIR ARTERY RUPTURE-SPLEEN 35121 REPAIR DEFECT OF ARTERY 35122 REPAIR ARTERY RUPTURE- BELLY 35131 REPAIR DEFECT OF ARTERY 35132 REPAIR ARTERY RUPTURE- GROIN 35141 REPAIR DEFECT OF ARTERY 35142 REPAIR ARTERY RUPTURE- THIGH 35151 REPAIR DEFECT OF ARTERY 35152 REPAIR ARTERY RUPTURE- KNEE 35180 REPAIR BLOOD VESSEL LESION 35182 REPAIR BLOOD VESSEL LESION 35184 REPAIR BLOOD VESSEL LESION 35188 REPAIR BLOOD VESSEL LESION 35189 REPAIR BLOOD VESSEL LESION 35190 REPAIR BLOOD VESSEL LESION 35301 RECHANNELING OF ARTERY 35311 RECHANNELING OF ARTERY 35331 RECHANNELING OF ARTERY 35341 RECHANNELING OF ARTERY 35351 RECHANNELING OF ARTERY 35355 RECHANNELING OF ARTERY 35361 RECHANNELING OF ARTERY 35363 RECHANNELING OF ARTERY 35371 RECHANNELING OF ARTERY 35372 RECHANNELING OF ARTERY 35381 RECHANNELING OF ARTERY JAN 07 35400 ANGIOSCOPY 35500 HARVEST VEIN FOR BYPASS 35501 ARTERY BYPASS GRAFT 35506 ARTERY BYPASS GRAFT 35507 ARTERY BYPASS GRAFT JAN 07 35509 ARTERY BYPASS GRAFT 35511 ARTERY BYPASS GRAFT 35512 BYPS GRAFT W/VEIN; SUBCLAVIAN-BRACH 35515 ARTERY BYPASS GRAFT 35516 ARTERY BYPASS GRAFT 35518 ARTERY BYPASS GRAFT 35521 ARTERY BYPASS GRAFT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 35522 BYPASS GRAFT W/VEIN; AX-BRACHIAL 35523 BYPASS GRAFT W/ BRACHIAL ULNAR/RADIAL JAN 08 35525 BYPASS GRAFT W/VEIN; BRACH-BRACH 35526 ARTERY BYPASS GRAFT 35533 ARTERY BYPASS GRAFT 35536 ARTERY BYPASS GRAFT 35541 ARTERY BYPASS GRAFT JAN 07 35546 ARTERY BYPASS GRAFT JAN 07 35548 ARTERY BYPASS GRAFT 35549 ARTERY BYPASS GRAFT 35551 ARTERY BYPASS GRAFT 35556 ARTERY BYPASS GRAFT 35558 ARTERY BYPASS GRAFT 35560 ARTERY BYPASS GRAFT 35565 ARTERY BYPASS GRAFT 35566 ARTERY BYPASS GRAFT 35571 ARTERY BYPASS GRAFT 35583 VEIN BYPASS GRAFT 35585 VEIN BYPASS GRAFT 35587 VEIN BYPASS GRAFT 35601 ARTERY BYPASS GRAFT 35606 ARTERY BYPASS GRAFT 35612 ARTERY BYPASS GRAFT 35616 ARTERY BYPASS GRAFT 35621 ARTERY BYPASS GRAFT 35623 BYPASS GRAFT- NOT VEIN 35626 ARTERY BYPASS GRAFT 35631 ARTERY BYPASS GRAFT 35636 ARTERY BYPASS GRAFT 35641 ARTERY BYPASS GRAFT JAN 07 35645 ARTERY BYPASS GRAFT 35646 ARTERY BYPASS GRAFT 35647 ARTERY BYPASS GRAFT 35650 ARTERY BYPASS GRAFT 35651 ARTERY BYPASS GRAFT 35654 ARTERY BYPASS GRAFT 35656 ARTERY BYPASS GRAFT 35661 ARTERY BYPASS GRAFT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 35665 ARTERY BYPASS GRAFT 35666 ARTERY BYPASS GRAFT 35671 ARTERY BYPASS GRAFT 35693 ARTERIAL TRANSPOSITION 35694 ARTERIAL TRANSPOSITION 35695 ARTERIAL TRANSPOSITION 35701 EXPLORATION- CAROTID ARTERY 35721 EXPLORATION- FEMORAL ARTERY 35741 EXPLORATION POPLITEAL ARTERY 35761 EXPLORATION OF ARTERY/VEIN 35800 EXPLORE NECK VESSELS 35820 EXPLORE CHEST VESSELS 35840 EXPLORE ABDOMINAL VESSELS 35860 EXPLORE LIMB VESSELS 35870 REPAIR VESSEL GRAFT DEFECT 36013 PLACE CATHETER IN ARTERY 36014 PLACE CATHETER IN ARTERY 36015 PLACE CATHETER IN ARTERY 36100 ESTABLISH ACCESS TO ARTERY 36120 ESTABLISH ACCESS TO ARTERY 36140 ESTABLISH ACCESS TO ARTERY 36160 ESTABLISH ACCESS TO AORTA 36200 PLACE CATHETER IN AORTA 36215 PLACE CATHETER IN ARTERY 36216 PLACE CATHETER IN ARTERY 36217 PLACE CATHETER IN ARTERY 36218 PLACE CATHETER IN ARTERY 36245 PLACE CATHETER IN ARTERY 36246 PLACE CATHETER IN ARTERY 36247 PLACE CATHETER IN ARTERY 36248 PLACE CATHETER IN ARTERY 36260 INSERTION OF INFUSION PUMP 36262 REMOVAL OF INFUSION PUMP 36299 VESSEL INJECTION PROCEDURE 36400 VENIPUNCT UND AGE 3 YR; FEM/JUGULAR 36405 VENIPUNCT UNDER AGE 3 YR; SCLP VEIN 36406 VENIPUNCT UNDER AGE 3 YR; OTH VEIN 36410 VENIPUNCT AGE 3 MD SKILL SEP PROC

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 36415 ROUTINE VENIPUNCTURE 36416 CAPILLARY BLOOD DRAW 36420 VEIN ACCESS CUTDOWN < 1 YR 36425 VEIN ACCESS CUTDOWN > 1 YR 36468 INJECTION(S)- SPIDER VEINS 36469 INJECTION(S)- SPIDER VEINS 36470 INJECTION THERAPY OF VEIN 36471 INJECTION THERAPY OF VEINS 36475 ENDOVENUS ABLAT TX VEIN EXT RF;1 VN 36476 ENDOVEN ABLAT TX EXT RF;2&>VNS 1EXT 36478 ENDOVEN ABLAT TX VN EXT LASR; 1 VN 36479 ENDOVEN ABLAT VN EXT LASR; 2&>1 EXT 36510 INSERTION OF CATHETER- VEIN 36555 INSRT NON-TUNNL CNTRL CVC; <5 YR 36556 INSRT NON-TUNNL CNTRL CVC; 5/> 36557 INSRT TUNNL CVC NO PORT/PUMP;<5 YR 36558 INSRT TUNNL CVC NO PORT/PUMP;5 YR/> 36568 INSERT PICC W/O PORT/PUMP; < 5 YR 36569 INSERT PICC W/O PORT/PUMP; 5 YR/> 36575 REP CV ACSS CATH W/O PORT/PUMP 36580 REPL NON-TUNNLD CVC W/O PORT/PUMP 36581 REPL TUNNLD CNTRL CVC W/O PORT/PUMP 36584 REPL PICC W/O PORT/PUMP SAME ACSS 36589 REMV TUNNLD CVC W/O SUBQ PORT/PUMP 36590 REMV TUNNLD CVAD W/SUBQ PORT/PUMP 36597 REPSTN PREV PLCD CVC FLUORO GUID 36600 WITHDRAWAL OF ARTERIAL BLOOD 36620 INSERTION CATHETER- ARTERY 36625 INSERTION CATHETER- ARTERY 36640 INSERTION CATHETER- ARTERY 36660 INSERTION CATHETER- ARTERY 36680 INSERT NEEDLE- BONE CAVITY 36800 INSERTION OF CANNULA 36810 INSERTION OF CANNULA 36815 INSERTION OF CANNULA 36818 AV ANAST OPN;ARM CEPHAL VN TRNSPSTN 36819 AV FUSION/UPPR ARM VEIN 36820 AV FUSION/FOREARM VEIN

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 36821 AV FUSION DIRECT ANY SITE 36823 INSERTION OF CANNULA(S) 36835 ARTERY TO VEIN SHUNT 37140 REVISION OF CIRCULATION 37145 REVISION OF CIRCULATION 37160 REVISION OF CIRCULATION 37180 REVISION OF CIRCULATION 37181 SPLICE SPLEEN/KIDNEY VEINS 37182 INSERT HEPATIC SHUNT (TIPS) 37184 PERC MECH ART THROMB-1st OCT 06 37185 PERC MECH ART THROMB-2nd OCT 06 37186 2nd PERC THROMB NON-COR OCT 06 37187 PERC MECH VEIN THROMB OCT 06 37188 PERC MECH THROMB VN-REPT OCT 06 37200 TRANSCATHETER BIOPSY 37201 TRANSCATHETER THERAPY INFUSE 37202 TRANSCATHETER THERAPY INFUSE 37204 TRANSCATHETER OCCLUSION 37205 TRANSCATH IVASC STENT PERQ;INIT VES 37206 TRANSCATH IVASC STENT PERQ; EA ADD 37207 TRANSCATHETER STENT 37208 TRANSCATHETER STENT ADD-ON 37209 EXCHANGE INTRAVASCULAR CATHETER 37500 ENDOSCOPY LIGATE PERF VEINS 37501 VASCULAR ENDOSCOPY PROCEDURE 37565 LIGATION OF NECK VEIN 37600 LIGATION OF NECK ARTERY 37605 LIGATION OF NECK ARTERY 37606 LIGATION OF NECK ARTERY 37609 TEMPORAL ARTERY PROCEDURE 37615 LIGATION OF NECK ARTERY 37616 LIGATION OF CHEST ARTERY 37617 LIGATION OF ABDOMEN ARTERY 37618 LIGATION OF EXTREMITY ARTERY 37620 REVISION OF MAJOR VEIN 37660 REVISION OF MAJOR VEIN 37700 REVISE LEG VEIN 37720 REMOVAL OF LEG VEIN

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 37730 REMOVAL OF LEG VEINS 37735 REMOVAL OF LEG VEINS/LESION 37760 LIGATION- LEG VEINS- OPEN 37765 STAB PHLEBECT VV 1 EXT; 10-20 INCI 37766 STAB PHLEBECT VV 1 EXT; >20 INCI 37780 REVISION OF LEG VEIN 37785 LIG &/ EXC VARICOSE VN CLUSTR 1 LEG 37799 VASCULAR SURGERY PROCEDURE OCT 06 38230 BONE MARROW COLLECTION 38240 BONE MARROW/STEM TRANSPLANT 38241 BONE MARROW/STEM TRANSPLANT 38242 LYMPHOCYTE INFUSE TRANSPLANT 38300 DRAINAGE- LYMPH NODE LESION 38305 DRAINAGE- LYMPH NODE LESION 38308 INCISION OF LYMPH CHANNELS 38999 BLOOD/LYMPH SYSTEM PROCEDURE 39499 CHEST PROCEDURE 39560 RESECT DIAPHRAGM- SIMPLE 39561 RESECT DIAPHRAGM- COMPLEX 39599 DIAPHRAGM SURGERY PROCEDURE 41150 TONGUE- MOUTH- JAW SURGERY 41155 TONGUE- JAW- & NECK SURGERY 42210 RECONSTRUCT CLEFT PALATE 43243 UPPER GI ENDOSCOPY & INJECT 44378 SMALL BOWEL ENDOSCOPY 47561 LAPARO W/CHOLANGIO/BIOPSY 49321 LAPAROSCOPY- BIOPSY 49322 LAPAROSCOPY- ASPIRATION 49491 RPR HERN PREEMIE REDUC 49492 RPR ING HERN PREMIE- BLOCKED 49495 RPR ING HERNIA BABY- REDUC 49496 RPR ING HERNIA BABY- BLOCKED 49500 RPR ING HERNIA- INIT- REDUCE 49501 RPR ING HERNIA- INIT BLOCKED 49505 PRP I/HERN INIT REDUC>5 YR 49507 PRP I/HERN INIT BLOCK>5 YR 49520 REREPAIR ING HERNIA- REDUCE 49521 REREPAIR ING HERNIA- BLOCKED

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 49525 REPAIR ING HERNIA- SLIDING 49550 RPR REM HERNIA- INIT- REDUCE 49553 RPR FEM HERNIA- INIT BLOCKED 49555 REREPAIR FEM HERNIA- REDUCE 49557 REREPAIR FEM HERNIA- BLOCKED 49650 LAPARO HERNIA REPAIR INITIAL 49651 LAPARO HERNIA REPAIR RECUR 49659 LAPARO PROC- HERNIA REPAIR 49904 OMENTAL FLAP- EXTRA-ABDOM 50010 EXPLORATION OF KIDNEY 50020 RENAL ABSCESS- OPEN DRAIN 50021 RENAL ABSCESS- PERCUT DRAIN 50040 DRAINAGE OF KIDNEY 50045 EXPLORATION OF KIDNEY 50060 REMOVAL OF KIDNEY STONE 50065 INCISION OF KIDNEY 50070 INCISION OF KIDNEY 50075 REMOVAL OF KIDNEY STONE 50080 REMOVAL OF KIDNEY STONE 50081 REMOVAL OF KIDNEY STONE 50120 EXPLORATION OF KIDNEY 50125 EXPLORE AND DRAIN KIDNEY 50130 REMOVAL OF KIDNEY STONE 50135 EXPLORATION OF KIDNEY 50200 BIOPSY OF KIDNEY 50205 BIOPSY OF KIDNEY 50220 REMOVE KIDNEY- OPEN 50225 REMOVAL KIDNEY OPEN- COMPLEX 50230 REMOVAL KIDNEY OPEN- RADICAL 50234 REMOVAL OF KIDNEY & URETER 50236 REMOVAL OF KIDNEY & URETER 50240 PARTIAL REMOVAL OF KIDNEY 50280 REMOVAL OF KIDNEY LESION 50320 DONOR NEPRECTOMY; OPEN LIVING DONOR 50340 REMOVAL OF KIDNEY 50360 RENAL ALLOTRANSPL;W/O DONR NEPHRECT 50365 TRANSPLANTATION OF KIDNEY 50370 REMOVE TRANSPLANTED KIDNEY

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 50380 REIMPLANTATION OF KIDNEY 50390 DRAINAGE OF KIDNEY LESION 50392 INSERT KIDNEY DRAIN 50393 INSERT URETERAL TUBE 50394 INJECTION FOR KIDNEY X-RAY 50395 CREATE PASSAGE TO KIDNEY 50398 CHANGE KIDNEY TUBE 50400 REVISION OF KIDNEY/URETER 50405 REVISION OF KIDNEY/URETER 50520 CLOSE KIDNEY-SKIN FISTULA 50525 REPAIR RENAL-ABDOMEN FISTULA 50526 REPAIR RENAL-ABDOMEN FISTULA 50540 REVISION OF HORSESHOE KIDNEY 50541 LAPARO ABLATE RENAL CYST 50542 LAPARO ABLATE RENAL MASS 50543 LAPARO PARTIAL NEPHRECTOMY 50544 LAPAROSCOPY- PYELOPLASTY 50545 LAPARO RADICAL NEPHRECTOMY 50546 LAPAROSCOPIC NEPHRECTOMY 50547 LAP SURG; DONR NEPHRECT-LIVING DONR 50548 LAPARO REMOVE K/URETER 50549 LAPAROSCOPE PROC- RENAL 50555 KIDNEY ENDOSCOPY & BIOPSY 50557 KIDNEY ENDOSCOPY & TREATMENT 50562 RENAL SCOPE W/TUMOR RESECT 50574 KIDNEY ENDOSCOPY & BIOPSY 50575 KIDNEY ENDOSCOPY 50576 KIDNEY ENDOSCOPY & TREATMENT 50650 REMOVAL OF URETER 50660 REMOVAL OF URETER 50700 REVISION OF URETER 50740 FUSION OF URETER & KIDNEY 50750 FUSION OF URETER & KIDNEY 50840 REPLACE URETER BY BOWEL 50930 CLOSURE URETER/BOWEL FISTULA 50940 RELEASE OF URETER 50957 URETER ENDOSCOPY & TREATMENT 50972 URETER ENDOSCOPY & CATHETER

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 50976 URETER ENDOSCOPY & TREATMENT 51535 REPAIR OF URETER LESION 52007 CYSTOSCOPY AND BIOPSY 52300 CYSTOSCOPY AND TREATMENT 52301 CYSTOSCOPY AND TREATMENT 52327 CYSTOSCOPY- INJECT MATERIAL 52334 CREATE PASSAGE TO KIDNEY 52343 CYSTO W/RENAL STRICTURE TX 52346 CYSTOURETERO W/RENAL STRICT 52354 CYSTOURETERO W/BIOPSY 52355 CYSTOURETERO W/EXCISE TUMOR 53899 UROLOGY SURGERY PROCEDURE 54640 SUSPENSION OF TESTIS 55540 REVISE HERNIA & SPERM VEINS 57287 REVISE/REMOVE SLING REPAIR 57531 REMOVAL OF CERVIX- RADICAL 58150 TOTAL HYSTERECTOMY 58152 TOTAL HYSTERECTOMY 58180 PARTIAL HYSTERECTOMY 58200 EXTENSIVE HYSTERECTOMY 58210 EXTENSIVE HYSTERECTOMY 58262 VAG HYST INCLUDING T/O 58263 VAG HYST W/T/O & VAG REPAIR 58291 VAG HYST INCL T/O- COMPLEX 58292 VAG HYST T/O & REPAIR- COMPL 58340 CATH&INTRO SALINE/CONTRAST SIS/HSG 58345 REOPEN FALLOPIAN TUBE 58350 REOPEN FALLOPIAN TUBE 58410 SUSPENSION OF UTERUS 58552 LAPARO-VAG HYST INCL T/O 58554 LAPARO-VAG HYST W/T/O- COMPL 58615 OCCLUDE FALLOPIAN TUBE(S) 58660 LAPAROSCOPY- LYSIS 58661 LAPAROSCOPY- REMOVE ADNEXA 58662 LAPAROSCOPY- EXCISE LESIONS 58673 LAPAROSCOPY- SALPINGOSTOMY 58679 LAPARO PROC- OVIDUCT-OVARY 58700 REMOVAL OF FALLOPIAN TUBE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 58720 REMOVAL OF OVARY/TUBE(S) 58740 REVISE FALLOPIAN TUBE(S) 58750 REPAIR OVIDUCT 58752 REVISE OVARIAN TUBE(S) 58770 CREATE NEW TUBAL OPENING 58800 DRAINAGE OF OVARIAN CYST(S) 58805 DRAINAGE OF OVARIAN CYST(S) 58820 DRAIN OVARY ABSCESS- OPEN 58822 DRAIN OVARY ABSCESS- PERCUT 58823 DRAIN PELVIC ABSCESS- PERCUT 58825 TRANSPOSITION- OVARY(S) 58900 BIOPSY OF OVARY(S) 58920 PARTIAL REMOVAL OF OVARY(S) 58925 REMOVAL OF OVARIAN CYST(S) 58940 REMOVAL OF OVARY(S) 58943 REMOVAL OF OVARY(S) 58970 RETRIEVAL OF OOCYTE 58974 TRANSFER OF EMBRYO 58976 TRANSFER OF EMBRYO 58999 GENITAL SURGERY PROCEDURE 59120 TREAT ECTOPIC PREGNANCY 59121 TREAT ECTOPIC PREGNANCY 59150 TREAT ECTOPIC PREGNANCY 59151 TREAT ECTOPIC PREGNANCY 60600 REMOVE CAROTID BODY LESION 60605 REMOVE CAROTID BODY LESION 61026 INJECTION INTO BRAIN CANAL 61055 INJECTION INTO BRAIN CANAL 61070 BRAIN CANAL SHUNT PROCEDURE 61107 DRILL SKULL FOR IMPLANTATION 61120 BURR HOLE FOR PUNCTURE 61140 PIERCE SKULL FOR BIOPSY 61150 PIERCE SKULL FOR DRAINAGE 61151 PIERCE SKULL FOR DRAINAGE 61154 PIERCE SKULL & REMOVE CLOT 61156 PIERCE SKULL FOR DRAINAGE 61210 PIERCE SKULL- IMPLANT DEVICE 61250 PIERCE SKULL & EXPLORE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 61253 PIERCE SKULL & EXPLORE 61304 OPEN SKULL FOR EXPLORATION 61305 OPEN SKULL FOR EXPLORATION 61312 OPEN SKULL FOR DRAINAGE 61313 OPEN SKULL FOR DRAINAGE 61314 OPEN SKULL FOR DRAINAGE 61315 OPEN SKULL FOR DRAINAGE 61316 IMPLT CRAN BONE FLAP TO ABDO 61320 OPEN SKULL FOR DRAINAGE 61321 OPEN SKULL FOR DRAINAGE 61322 DECOMPRESSIVE CRANIOTOMY 61323 DECOMPRESSIVE LOBECTOMY 61333 EXPLORE ORBIT/REMOVE LESION 61340 SUBTEMPORAL DECOMPRESSION 61343 INCISE SKULL (PRESS RELIEF) 61345 RELIEVE CRANIAL PRESSURE 61440 INCISE SKULL FOR SURGERY 61450 INCISE SKULL FOR SURGERY 61458 INCISE SKULL FOR BRAIN WOUND 61460 INCISE SKULL FOR SURGERY 61470 INCISE SKULL FOR SURGERY 61480 INCISE SKULL FOR SURGERY 61490 INCISE SKULL FOR SURGERY 61500 REMOVAL OF SKULL LESION 61501 REMOVE INFECTED SKULL BONE 61510 REMOVAL OF BRAIN LESION 61512 REMOVE BRAIN LINING LESION 61514 REMOVAL OF BRAIN ABSCESS 61516 REMOVAL OF BRAIN LESION 61518 REMOVAL OF BRAIN LESION 61519 REMOVE BRAIN LINING LESION 61520 REMOVAL OF BRAIN LESION 61521 REMOVAL OF BRAIN LESION 61522 REMOVAL OF BRAIN ABSCESS 61524 REMOVAL OF BRAIN LESION 61526 REMOVAL OF BRAIN LESION 61530 REMOVAL OF BRAIN LESION 61531 IMPLANT BRAIN ELECTRODES

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 61533 IMPLANT BRAIN ELECTRODES 61534 REMOVAL OF BRAIN LESION 61536 REMOVAL OF BRAIN LESION 61537 CRANIOT; LOBECT TEMPORL W/O ECOG 61538 CRANIOT W/FLAP; LOBECTOMY TEMP LOBE 61539 CRANIOT W/FLAP;LOBECT-NOT TEMP LOBE 61540 CRANIOT; LOBECT NO TEMPORL NO ECOG 61541 INCISION OF BRAIN TISSUE 61542 REMOVAL OF BRAIN TISSUE 61543 CRANIOTOMY; PART HEMISPHERECTOMY 61544 REMOVE & TREAT BRAIN LESION 61550 RELEASE OF SKULL SEAMS 61552 RELEASE OF SKULL SEAMS 61556 INCISE SKULL/SUTURES 61557 INCISE SKULL/SUTURES 61558 EXCISION OF SKULL/SUTURES 61559 EXCISION OF SKULL/SUTURES 61563 EXCISION OF SKULL TUMOR 61564 EXCISION OF SKULL TUMOR

61566 CRANIOT;SELCTV AMYGDALOHIPPOCAMPECT

61567 CRANIOT; MX SUBPIAL TRANSECT W/ECOG 61570 REMOVE FOREIGN BODY- BRAIN 61571 INCISE SKULL FOR BRAIN WOUND 61575 SKULL BASE/BRAINSTEM SURGERY 61576 SKULL BASE/BRAINSTEM SURGERY 61600 RESECT/EXCISE CRANIAL LESION 61601 RESECT/EXCISE CRANIAL LESION 61605 RESECT/EXCISE CRANIAL LESION 61606 RESECT/EXCISE CRANIAL LESION 61607 RESECT/EXCISE CRANIAL LESION 61608 RESECT/EXCISE CRANIAL LESION 61609 TRANSECT ARTERY- SINUS 61610 TRANSECT ARTERY- SINUS 61611 TRANSECT ARTERY- SINUS 61612 TRANSECT ARTERY- SINUS 61613 REMOVE ANEURYSM- SINUS 61615 RESECT/EXCISE LESION- SKULL

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 61616 RESECT/EXCISE LESION- SKULL 61618 REPAIR DURA 61619 REPAIR DURA 61624 TRANSCATH OCCLUSION- CNS 61626 TRANSCATH OCCLUSION- NON-CNS 61680 INTRACRANIAL VESSEL SURGERY 61682 INTRACRANIAL VESSEL SURGERY 61684 INTRACRANIAL VESSEL SURGERY 61686 INTRACRANIAL VESSEL SURGERY 61690 INTRACRANIAL VESSEL SURGERY 61692 INTRACRANIAL VESSEL SURGERY 61697 BRAIN ANEURYSM REPR- COMPLX 61698 BRAIN ANEURYSM REPR- COMPLX 61700 BRAIN ANEURYSM REPR- SIMPLE 61702 INNER SKULL VESSEL SURGERY 61703 CLAMP NECK ARTERY 61705 REVISE CIRCULATION TO HEAD 61708 REVISE CIRCULATION TO HEAD 61710 REVISE CIRCULATION TO HEAD 61720 INCISE SKULL/BRAIN SURGERY 61735 INCISE SKULL/BRAIN SURGERY 61750 INCISE SKULL/BRAIN BIOPSY 61751 BRAIN BIOPSY W/CT/MR GUIDE 61760 IMPLANT BRAIN ELECTRODES 61770 INCISE SKULL FOR TREATMENT 61790 TREAT TRIGEMINAL NERVE 61791 TREAT TRIGEMINAL TRACT 61793 FOCUS RADIATION BEAM 61850 IMPLANT NEUROELECTRODES 61860 IMPLANT NEUROELECTRODES 61863 TWST DRL BURR CRANIOT NO REC;1 ARAY 61864 TWST DRL BURR CRANIOT NO REC;EA ADD 61867 TWST DRL BURR CRANIOT W/REC;1 ARRAY 61868 TWST DRL BURR CRANIOT W/REC; EA ADD 61870 IMPLANT NEUROELECTRODES 61875 IMPLANT NEUROELECTRODES 61880 REVISE/REMOVE NEUROELECTRODE 61885 INSRT/REPL CRAN NEUROSTIM; 1 ARRAY

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 61886 INSRT/REPL CRAN NEUROSTM; 2/>ARRAYS 61888 REVISE/REMOVE NEURORECEIVER 62000 TREAT SKULL FRACTURE 62005 TREAT SKULL FRACTURE 62010 TREATMENT OF HEAD INJURY 62100 REPAIR BRAIN FLUID LEAKAGE 62115 REDUCTION OF SKULL DEFECT 62116 REDUCTION OF SKULL DEFECT 62117 REDUCTION OF SKULL DEFECT 62120 REPAIR SKULL CAVITY LESION 62121 INCISE SKULL REPAIR 62140 REPAIR OF SKULL DEFECT 62141 REPAIR OF SKULL DEFECT 62142 REMOVE SKULL PLATE/FLAP 62143 REPLACE SKULL PLATE/FLAP 62145 REPAIR OF SKULL & BRAIN 62146 REPAIR OF SKULL WITH GRAFT 62147 REPAIR OF SKULL WITH GRAFT 62161 DISSECT BRAIN W/SCOPE 62162 REMOVE COLLOID CYST W/SCOPE 62163 NEUROENDOSCOPY W/FB REMOVAL 62164 REMOVE BRAIN TUMOR W/SCOPE 62180 ESTABLISH BRAIN CAVITY SHUNT 62190 ESTABLISH BRAIN CAVITY SHUNT 62192 ESTABLISH BRAIN CAVITY SHUNT 62194 REPLACE/IRRIGATE CATHETER 62200 ESTABLISH BRAIN CAVITY SHUNT 62201 BRAIN CAVITY SHUNT W/SCOPE 62220 ESTABLISH BRAIN CAVITY SHUNT 62223 ESTABLISH BRAIN CAVITY SHUNT 62225 REPLACE/IRRIGATE CATHETER 62230 REPLACE/REVISE BRAIN SHUNT 62256 REMOVE BRAIN CAVITY SHUNT 62258 REPLACE BRAIN CAVITY SHUNT 62263 EPIDURAL LYSIS MULT SESSIONS 62264 EPIDURAL LYSIS ON SINGLE DAY 62272 DRAIN CEREBRO SPINAL FLUID 62280 TREAT SPINAL CORD LESION

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 62281 TREAT SPINAL CORD LESION 62282 TREAT SPINAL CANAL LESION 62287 PERCUTANEOUS DISKECTOMY 62292 INJECTION INTO DISK LESION 62294 INJECTION INTO SPINAL ARTERY 62355 REMOVE SPINAL CANAL CATHETER 62365 REMOVE SPINE INFUSION DEVICE 63001 REMOVAL OF SPINAL LAMINA 63003 REMOVAL OF SPINAL LAMINA 63005 REMOVAL OF SPINAL LAMINA 63011 REMOVAL OF SPINAL LAMINA 63012 REMOVAL OF SPINAL LAMINA 63015 REMOVAL OF SPINAL LAMINA 63016 REMOVAL OF SPINAL LAMINA 63017 REMOVAL OF SPINAL LAMINA 63020 NECK SPINE DISK SURGERY 63030 LOW BACK DISK SURGERY 63035 SPINAL DISK SURGERY ADD-ON 63040 LAMINOTOMY- SINGLE CERVICAL 63042 LAMINOTOMY- SINGLE LUMBAR 63043 LAMINOTOMY- ADDL CERVICAL 63044 LAMINOTOMY- ADDL LUMBAR 63045 REMOVAL OF SPINAL LAMINA 63046 REMOVAL OF SPINAL LAMINA 63047 REMOVAL OF SPINAL LAMINA 63048 REMOVE SPINAL LAMINA ADD-ON 63050 LAMINOPLSTY CERV 2/> VERT SEG; 63055 DECOMPRESS SPINAL CORD 63056 DECOMPRESS SPINAL CORD 63057 DECOMPRESS SPINE CORD ADD-ON 63064 DECOMPRESS SPINAL CORD 63066 DECOMPRESS SPINE CORD ADD-ON 63075 NECK SPINE DISK SURGERY 63076 NECK SPINE DISK SURGERY 63077 SPINE DISK SURGERY- THORAX 63078 SPINE DISK SURGERY- THORAX 63081 REMOVAL OF VERTEBRAL BODY 63082 REMOVE VERTEBRAL BODY ADD-ON

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 63085 REMOVAL OF VERTEBRAL BODY 63086 REMOVE VERTEBRAL BODY ADD-ON 63087 REMOVAL OF VERTEBRAL BODY 63088 REMOVE VERTEBRAL BODY ADD-ON 63090 REMOVAL OF VERTEBRAL BODY 63091 REMOVE VERTEBRAL BODY ADD-ON 63101 VERT CORPCT SC&/NRV ROOT;THOR 1 SEG 63102 VERT CORPCT SC&/NRV ROOT;LUMB 1 SEG 63103 VERT CORPCT SC&/NRV ROOT;T/L EA ADD 63170 INCISE SPINAL CORD TRACT(S) 63172 DRAINAGE OF SPINAL CYST 63173 LAMINECT DRAIN CYST;PERITON/PLEURAL 63180 REVISE SPINAL CORD LIGAMENTS 63182 REVISE SPINAL CORD LIGAMENTS 63185 INCISE SPINAL COLUMN/NERVES 63190 INCISE SPINAL COLUMN/NERVES 63191 INCISE SPINAL COLUMN/NERVES 63194 INCISE SPINAL COLUMN & CORD 63195 INCISE SPINAL COLUMN & CORD 63196 INCISE SPINAL COLUMN & CORD 63197 INCISE SPINAL COLUMN & CORD 63198 INCISE SPINAL COLUMN & CORD 63199 INCISE SPINAL COLUMN & CORD 63200 RELEASE OF SPINAL CORD 63300 REMOVAL OF VERTEBRAL BODY 63301 REMOVAL OF VERTEBRAL BODY 63302 REMOVAL OF VERTEBRAL BODY 63303 REMOVAL OF VERTEBRAL BODY 63304 REMOVAL OF VERTEBRAL BODY 63305 REMOVAL OF VERTEBRAL BODY 63306 REMOVAL OF VERTEBRAL BODY 63307 REMOVAL OF VERTEBRAL BODY 63308 REMOVE VERTEBRAL BODY ADD-ON 63600 REMOVE SPINAL CORD LESION 63685 INSRT/REPL SP NEUROSTIM GEN/RECV 63688 REVISE/REMOVE NEURORECEIVER 63740 INSTALL SPINAL SHUNT 63741 INSTALL SPINAL SHUNT

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 64400 N BLOCK INJ- TRIGEMINAL 64402 N BLOCK INJ- FACIAL 64405 N BLOCK INJ- OCCIPITAL 64408 N BLOCK INJ- VAGUS 64410 N BLOCK INJ- PHRENIC 64412 N BLOCK INJ- SPINAL ACCESSOR 64413 N BLOCK INJ- CERVICAL PLEXUS 64415 N BLOCK INJ- BRACHIAL PLEXUS 64416 N BLOCK CONT INFUSE- B PLEX 64417 N BLOCK INJ- AXILLARY 64418 N BLOCK INJ- SUPRASCAPULAR 64420 N BLOCK INJ- INTERCOST- SNG 64421 N BLOCK INJ- INTERCOST- MLT 64425 N BLOCK INJ ILIO-ING/HYPOGI 64430 N BLOCK INJ- PUDENDAL 64435 N BLOCK INJ- PARACERVICAL 64445 N BLOCK INJ- SCIATIC- SNG 64446 N BLK INJ- SCIATIC- CONT INF 64447 N BLOCK INJ FEM- SINGLE 64448 N BLOCK INJ FEM- CONT INF 64449 INJ ANES; LUMB PLEX POST CONT DAILY 64450 N BLOCK- OTHER PERIPHERAL 64470 INJ PARAVERTEBRAL C/T 64472 INJ PARAVERTEBRAL C/T ADD-ON 64475 INJ PARAVERTEBRAL L/S 64476 INJ PARAVERTEBRAL L/S ADD-ON 64505 N BLOCK- SPENOPALATINE GANGL 64508 N BLOCK- CAROTID SINUS S/P 64510 N BLOCK- STELLATE GANGLION 64517 INJ ANES AGT; SUP HYPOGASTR PLEXUS 64520 N BLOCK- LUMBAR/THORACIC 64530 N BLOCK INJ- CELIAC PELUS 64590 INSRT/REPL PERIPH NEUROSTM GEN/RECV 64595 REVISE/REMOVE NEURORECEIVER 64600 INJECTION TREATMENT OF NERVE 64605 INJECTION TREATMENT OF NERVE 64610 INJECTION TREATMENT OF NERVE 64612 DESTROY NERVE- FACE MUSCLE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 64613 DESTROY NERVE- NECK MUSCLE 64614 DESTROY NERVE- EXTREM MUSC 64620 INJECTION TREATMENT OF NERVE 64622 DESTR PARAVERTEBRL NERVE L/S 64623 DESTR PARAVERTEBRAL N ADD-ON 64626 DESTR PARAVERTEBRL NERVE C/T 64627 DESTR PARAVERTEBRAL N ADD-ON 64630 INJECTION TREATMENT OF NERVE 64640 INJECTION TREATMENT OF NERVE 64680 DESTRCT W/WO RAD MON; CELIAC PLEXUS 64681 DESTRUC NEURLYT;SUP HYPOGASTRC PLEX 64702 REVISE FINGER/TOE NERVE 64704 REVISE HAND/FOOT NERVE 64708 REVISE ARM/LEG NERVE 64712 REVISION OF SCIATIC NERVE 64713 REVISION OF ARM NERVE(S) 64714 REVISE LOW BACK NERVE(S) 64716 REVISION OF CRANIAL NERVE 64718 REVISE ULNAR NERVE AT ELBOW 64719 REVISE ULNAR NERVE AT WRIST 64721 CARPAL TUNNEL SURGERY 64722 RELIEVE PRESSURE ON NERVE(S) 64726 RELEASE FOOT/TOE NERVE 64727 INTERNAL NERVE REVISION 64732 INCISION OF BROW NERVE 64734 INCISION OF CHEEK NERVE 64736 INCISION OF CHIN NERVE 64738 INCISION OF JAW NERVE 64740 INCISION OF TONGUE NERVE 64742 INCISION OF FACIAL NERVE 64744 INCISE NERVE- BACK OF HEAD 64746 INCISE DIAPHRAGM NERVE 64761 INCISION OF PELVIS NERVE 64763 INCISE HIP/THIGH NERVE 64766 INCISE HIP/THIGH NERVE 64771 SEVER CRANIAL NERVE 64772 INCISION OF SPINAL NERVE 64774 REMOVE SKIN NERVE LESION

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 64776 REMOVE DIGIT NERVE LESION 64778 DIGIT NERVE SURGERY ADD-ON 64782 REMOVE LIMB NERVE LESION 64783 LIMB NERVE SURGERY ADD-ON 64784 REMOVE NERVE LESION 64786 REMOVE SCIATIC NERVE LESION 64787 IMPLANT NERVE END 64788 REMOVE SKIN NERVE LESION 64790 REMOVAL OF NERVE LESION 64792 REMOVAL OF NERVE LESION 64795 BIOPSY OF NERVE 64802 REMOVE SYMPATHETIC NERVES 64804 REMOVE SYMPATHETIC NERVES 64809 REMOVE SYMPATHETIC NERVES 64818 REMOVE SYMPATHETIC NERVES 64820 REMOVE SYMPATHETIC NERVES 64821 REMOVE SYMPATHESTIC NERVES 64822 REMOVE SYMPATHETIC NERVES 64823 REMOVE SYMPATHETIC NERVES 64856 REPAIR/TRANSPOSE NERVE 64866 FUSION OF FACIAL/OTHER NERVE 64868 FUSION OF FACIAL/OTHER NERVE 64870 FUSION OF FACIAL/OTHER NERVE 64872 SUBSEQUENT REPAIR OF NERVE 64874 REPAIR & REVISE NERVE ADD-ON 64876 REPAIR NERVE/SHORTEN BONE 64885 NERVE GRAFT- HEAD OR NECK 64886 NERVE GRAFT- HEAD OR NECK 64890 NERVE GRAFT- HAND OR FOOT 64891 NERVE GRAFT- HAND OR FOOT 64892 NERVE GRAFT- ARM OR LEG 64893 NERVE GRAFT- ARM OR LEG 64895 NERVE GRAFT- HAND OR FOOT 64896 NERVE GRAFT- HAND OR FOOT 64897 NERVE GRAFT- ARM OR LEG 64898 NERVE GRAFT- ARM OR LEG 64901 NERVE GRAFT ADD-ON 64902 NERVE GRAFT ADD-ON

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 64905 NERVE PEDICLE TRANSFER 64907 NERVE PEDICLE TRANSFER 64999 NERVOUS SYSTEM SURGERY 65210 REMOVE FOREIGN BODY FROM EYE 65220 REMOVE FOREIGN BODY FROM EYE 65222 REMOVE FOREIGN BODY FROM EYE 65235 REMOVE FOREIGN BODY FROM EYE 65260 REMOVE FOREIGN BODY FROM EYE 65265 REMOVE FOREIGN BODY FROM EYE 65270 REPAIR OF EYE WOUND 65280 REPAIR OF EYE WOUND 65285 REPAIR OF EYE WOUND 65286 REPAIR OF EYE WOUND 65400 REMOVAL OF EYE LESION 65410 BIOPSY OF CORNEA 65420 REMOVAL OF EYE LESION 65426 REMOVAL OF EYE LESION 65430 CORNEAL SMEAR 65435 CURETTE/TREAT CORNEA 65436 CURETTE/TREAT CORNEA 65450 TREATMENT OF CORNEAL LESION 65600 REVISION OF CORNEA 65710 CORNEAL TRANSPLANT 65730 CORNEAL TRANSPLANT 65750 CORNEAL TRANSPLANT 65755 CORNEAL TRANSPLANT 65765 REVISION OF CORNEA 65767 CORNEAL TISSUE TRANSPLANT 65770 REVISE CORNEA WITH IMPLANT 65771 RADIAL KERATOTOMY 65772 CORRECTION OF ASTIGMATISM 65775 CORRECTION OF ASTIGMATISM 65780 OCULR RECNSTR; AMNIOTIC MEMB TPLNT 65781 OCULR RECNSTR;LMBL STEM CELL ALLGFT 65782 OCULR RECNSTR;LIMBL CONJNCT AUTOGFT 65800 DRAINAGE OF EYE 65805 DRAINAGE OF EYE 65810 DRAINAGE OF EYE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 65815 DRAINAGE OF EYE 65820 RELIEVE INNER EYE PRESSURE 65850 INCISION OF EYE 65855 LASER SURGERY OF EYE 65860 INCISE INNER EYE ADHESIONS 65865 INCISE INNER EYE ADHESIONS 65870 INCISE INNER EYE ADHESIONS 65875 INCISE INNER EYE ADHESIONS 65880 INCISE INNER EYE ADHESIONS 65900 REMOVE EYE LESION 65920 REMOVE IMPLANT OF EYE 65930 REMOVE BLOOD CLOT FROM EYE 66020 INJECTION TREATMENT OF EYE 66030 INJECTION TREATMENT OF EYE 66130 REMOVE EYE LESION 66150 GLAUCOMA SURGERY 66155 GLAUCOMA SURGERY 66160 GLAUCOMA SURGERY 66165 GLAUCOMA SURGERY 66170 GLAUCOMA SURGERY 66172 INCISION OF EYE 66180 IMPLANT EYE SHUNT 66185 REVISE EYE SHUNT 66220 REPAIR EYE LESION 66225 REPAIR/GRAFT EYE LESION 66250 FOLLOW-UP SURGERY OF EYE 66500 INCISION OF IRIS 66505 INCISION OF IRIS 66600 REMOVE IRIS AND LESION 66605 REMOVAL OF IRIS 66625 REMOVAL OF IRIS 66630 REMOVAL OF IRIS 66635 REMOVAL OF IRIS 66680 REPAIR IRIS & CILIARY BODY 66682 REPAIR IRIS & CILIARY BODY 66700 DESTRUCTION- CILIARY BODY 66710 CILIARY DESTRC; CYCLO-PC TRNSSCLRAL 66711 CILIARY BDY DESTRUC; CYCLO-PC ENDO

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 66720 DESTRUCTION- CILIARY BODY 66740 DESTRUCTION- CILIARY BODY 66761 REVISION OF IRIS 66762 REVISION OF IRIS 66770 REMOVAL OF INNER EYE LESION 66820 INCISION- SECONDARY CATARACT 66821 AFTER CATARACT LASER SURGERY 66825 REPOSIT IOL W INCISION OCT 06 66830 REMOVAL OF LENS LESION 66840 REMOVAL OF LENS MATERIAL 66850 REMOVAL OF LENS MATERIAL 66852 REMOVAL OF LENS MATERIAL 66920 EXTRACTION OF LENS 66930 EXTRACTION OF LENS 66940 EXTRACTION OF LENS 66982 CATARACT SURGERY- COMPLEX 66983 CATARACT SURG W/IOL- 1 STAGE 66984 CATARACT SURG W/IOL- 1 STAGE 66985 INSERT LENS PROSTHESIS 66986 EXCHANGE LENS PROSTHESIS 66999 EYE SURGERY PROCEDURE OCT 06 67005 PARTIAL REMOVAL OF EYE FLUID 67015 RELEASE OF EYE FLUID 67025 REPLACE EYE FLUID 67027 IMPLANT EYE DRUG SYSTEM 67028 INJECTION EYE DRUG 67030 INCISE INNER EYE STRANDS 67031 LASER SURGERY- EYE STRANDS 67036 REMOVAL OF INNER EYE FLUID 67038 STRIP RETINAL MEMBRANE JAN 0867039 LASER TREATMENT OF RETINA 67040 LASER TREATMENT OF RETINA 67101 REPAIR DETACHED RETINA 67105 REPAIR DETACHED RETINA 67107 REPAIR DETACHED RETINA 67108 REPAIR DETACHED RETINA 67110 REPAIR DETACHED RETINA 67112 REREPAIR DETACHED RETINA

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 67113 REPAIR RETINAL DETACH W VITRECTOMY JAN 08 67115 RELEASE ENCIRCLING MATERIAL 67120 REMOVE EYE IMPLANT MATERIAL 67121 REMOVE EYE IMPLANT MATERIAL 67141 TREATMENT OF RETINA 67145 TREATMENT OF RETINA 67208 TREATMENT OF RETINAL LESION 67210 TREATMENT OF RETINAL LESION 67218 TREATMENT OF RETINAL LESION 67220 TREATMENT OF CHOROID LESION 67221 OCULAR PHOTODYNAMIC THER 67225 EYE PHOTODYNAMIC THER ADD-ON 67227 TREATMENT OF RETINAL LESION 67228 TREATMENT OF RETINAL LESION 67229 TREATMENT RETINOPATHY PRETERM INFAN JAN 08 67250 REINFORCE EYE WALL 67255 REINFORCE/GRAFT EYE WALL 67299 EYE SURGERY PROCEDURE 67311 REVISE EYE MUSCLE 67312 REVISE TWO EYE MUSCLES 67314 REVISE EYE MUSCLE 67316 REVISE TWO EYE MUSCLES 67318 REVISE EYE MUSCLE(S) 67320 REVISE EYE MUSCLE(S) ADD-ON 67331 EYE SURGERY FOLLOW-UP ADD-ON 67332 REREVISE EYE MUSCLES ADD-ON 67334 REVISE EYE MUSCLE W/SUTURE 67340 REVISE EYE MUSCLE ADD-ON 67345 DESTROY NERVE OF EYE MUSCLE 67350 BIOPSY EYE MUSCLE JAN 07 67399 EYE MUSCLE SURGERY PROCEDURE 67412 EXPLORE/TREAT EYE SOCKET 67420 EXPLORE/TREAT EYE SOCKET 67500 INJECT/TREAT EYE SOCKET 67505 INJECT/TREAT EYE SOCKET 67515 INJECT/TREAT EYE SOCKET 67570 DECOMPRESS OPTIC NERVE 67599 ORBIT SURGERY PROCEDURE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 67700 DRAINAGE OF EYELID ABSCESS 67710 INCISION OF EYELID 67715 INCISION OF EYELID FOLD 67800 REMOVE EYELID LESION 67801 REMOVE EYELID LESIONS 67805 REMOVE EYELID LESIONS 67808 REMOVE EYELID LESION(S) 67810 BIOPSY OF EYELID 67820 REVISE EYELASHES 67825 REVISE EYELASHES 67830 REVISE EYELASHES 67835 REVISE EYELASHES 67840 REMOVE EYELID LESION 67850 TREAT EYELID LESION 67875 CLOSURE OF EYELID BY SUTURE 67880 REVISION OF EYELID 67882 REVISION OF EYELID 67900 REPAIR BROW DEFECT 67901 REPAIR EYELID DEFECT 67902 REPAIR EYELID DEFECT 67903 REPAIR EYELID DEFECT 67904 REPAIR EYELID DEFECT 67906 REPAIR EYELID DEFECT 67908 REPAIR EYELID DEFECT 67909 REVISE EYELID DEFECT 67911 REVISE EYELID DEFECT 67912 CORR LAGOPHTHALMOS IMPL UP EYELD 67914 REPAIR EYELID DEFECT 67915 REPAIR EYELID DEFECT 67916 REPAIR ECTROPION; EXC TARSAL WEDGE 67917 REPAIR OF ECTROPION; EXTENSIVE 67921 REPAIR EYELID DEFECT 67922 REPAIR EYELID DEFECT 67923 REPAIR ENTROPION; EXC TARSAL WEDGE 67924 REPAIR OF ENTROPION; EXTENSIVE 67930 REPAIR EYELID WOUND 67935 REPAIR EYELID WOUND 67938 REMOVE EYELID FOREIGN BODY

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 67950 REVISION OF EYELID 67961 REVISION OF EYELID 67966 REVISION OF EYELID 67971 RECONSTRUCTION OF EYELID 67973 RECONSTRUCTION OF EYELID 67974 RECONSTRUCTION OF EYELID 67975 RECONSTRUCTION OF EYELID 67999 REVISION OF EYELID 68020 INCISE/DRAIN EYELID LINING 68040 TREATMENT OF EYELID LESIONS 68100 BIOPSY OF EYELID LINING 68110 REMOVE EYELID LINING LESION 68115 REMOVE EYELID LINING LESION 68130 REMOVE EYELID LINING LESION 68135 REMOVE EYELID LINING LESION 68200 TREAT EYELID BY INJECTION 68320 REVISE/GRAFT EYELID LINING 68325 REVISE/GRAFT EYELID LINING 68326 REVISE/GRAFT EYELID LINING 68328 REVISE/GRAFT EYELID LINING 68330 REVISE EYELID LINING 68335 REVISE/GRAFT EYELID LINING 68340 SEPARATE EYELID ADHESIONS 68360 REVISE EYELID LINING 68362 REVISE EYELID LINING 68371 HARV CONJUNCT ALLOGFT LIVING DONR 68399 EYELID LINING SURGERY 68400 INCISE/DRAIN TEAR GLAND 68420 INCISE/DRAIN TEAR SAC 68440 INCISE TEAR DUCT OPENING 68500 REMOVAL OF TEAR GLAND 68505 PARTIAL REMOVAL- TEAR GLAND 68510 BIOPSY OF TEAR GLAND 68520 REMOVAL OF TEAR SAC 68525 BIOPSY OF TEAR SAC 68530 CLEARANCE OF TEAR DUCT 68540 REMOVE TEAR GLAND LESION 68550 REMOVE TEAR GLAND LESION

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 68700 REPAIR TEAR DUCTS 68705 REVISE TEAR DUCT OPENING 68720 CREATE TEAR SAC DRAIN 68745 CREATE TEAR DUCT DRAIN 68750 CREATE TEAR DUCT DRAIN 68760 CLOSE TEAR DUCT OPENING 68761 CLOSE TEAR DUCT OPENING 68770 CLOSE TEAR SYSTEM FISTULA 68801 DILATE TEAR DUCT OPENING 68815 PROBE NASOLACRIMAL DUCT 68816 PROBE NASOLACRIMAL DUCT W/ BAL CATH JAN 08 68840 EXPLORE/IRRIGATE TEAR DUCTS 68850 INJECTION FOR TEAR SAC X-RAY 68899 TEAR DUCT SYSTEM SURGERY 69000 DRAIN EXTERNAL EAR LESION 69005 DRAIN EXTERNAL EAR LESION 69020 DRAIN OUTER EAR CANAL LESION 69100 BIOPSY OF EXTERNAL EAR 69105 BIOPSY OF EXTERNAL EAR CANAL 69110 REMOVE EXTERNAL EAR- PARTIAL 69120 REMOVAL OF EXTERNAL EAR 69140 REMOVE EAR CANAL LESION(S) 69145 REMOVE EAR CANAL LESION(S) 69150 EXTENSIVE EAR CANAL SURGERY 69155 EXTENSIVE EAR/NECK SURGERY 69200 CLEAR OUTER EAR CANAL 69205 CLEAR OUTER EAR CANAL 69220 CLEAN OUT MASTOID CAVITY 69222 CLEAN OUT MASTOID CAVITY 69300 REVISE EXTERNAL EAR 69310 REBUILD OUTER EAR CANAL 69320 REBUILD OUTER EAR CANAL 69399 OUTER EAR SURGERY PROCEDURE 69400 INFLATE MIDDLE EAR CANAL 69401 INFLATE MIDDLE EAR CANAL 69405 CATHETERIZE MIDDLE EAR CANAL 69410 INSET MIDDLE EAR (BAFFLE) 69440 EXPLORATION OF MIDDLE EAR

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 69450 EARDRUM REVISION 69501 MASTOIDECTOMY 69502 MASTOIDECTOMY 69505 REMOVE MASTOID STRUCTURES 69511 EXTENSIVE MASTOID SURGERY 69530 EXTENSIVE MASTOID SURGERY 69535 REMOVE PART OF TEMPORAL BONE 69540 REMOVE EAR LESION 69550 REMOVE EAR LESION 69552 REMOVE EAR LESION 69554 REMOVE EAR LESION 69601 MASTOID SURGERY REVISION 69602 MASTOID SURGERY REVISION 69603 MASTOID SURGERY REVISION 69604 MASTOID SURGERY REVISION 69605 MASTOID SURGERY REVISION 69610 TYMPANIC MEMB REPR W/WO SITE PREP 69620 REPAIR OF EARDRUM 69631 REPAIR EARDRUM STRUCTURES 69632 REBUILD EARDRUM STRUCTURES 69633 REBUILD EARDRUM STRUCTURES 69635 REPAIR EARDRUM STRUCTURES 69636 REBUILD EARDRUM STRUCTURES 69637 REBUILD EARDRUM STRUCTURES 69641 REVISE MIDDLE EAR & MASTOID 69642 REVISE MIDDLE EAR & MASTOID 69643 REVISE MIDDLE EAR & MASTOID 69644 REVISE MIDDLE EAR & MASTOID 69645 REVISE MIDDLE EAR & MASTOID 69646 REVISE MIDDLE EAR & MASTOID 69650 RELEASE MIDDLE EAR BONE 69660 REVISE MIDDLE EAR BONE 69661 REVISE MIDDLE EAR BONE 69662 REVISE MIDDLE EAR BONE 69666 REPAIR MIDDLE EAR STRUCTURES 69667 REPAIR MIDDLE EAR STRUCTURES 69670 REMOVE MASTOID AIR CELLS 69676 REMOVE MIDDLE EAR NERVE

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Appendix G – CPT Codes for Measures #1 and #2 *Codes with 50 modifier should be excluded as they are bilateral procedures

CPT Code CPT Description A 07 D 07 A 08 D 08 69700 CLOSE MASTOID FISTULA 69711 REMOVE/REPAIR HEARING AID 69714 IMPLANT TEMPLE BONE W/STIMUL 69715 TEMPLE BNE IMPLNT W/STIMULAT 69717 TEMPLE BONE IMPLANT REVISION 69718 REVISE TEMPLE BONE IMPLANT 69720 RELEASE FACIAL NERVE 69725 RELEASE FACIAL NERVE 69799 MIDDLE EAR SURGERY PROCEDURE 69801 INCISE INNER EAR 69802 INCISE INNER EAR 69805 EXPLORE INNER EAR 69806 EXPLORE INNER EAR 69820 ESTABLISH INNER EAR WINDOW 69840 REVISE INNER EAR WINDOW 69905 REMOVE INNER EAR 69910 REMOVE INNER EAR & MASTOID 69915 INCISE INNER EAR NERVE 69930 IMPLANT COCHLEAR DEVICE 69949 INNER EAR SURGERY PROCEDURE 69950 INCISE INNER EAR NERVE 69955 RELEASE FACIAL NERVE 69960 RELEASE INNER EAR CANAL 69970 REMOVE INNER EAR LESION 69979 TEMPORAL BONE SURGERY 92020 SPECIAL EYE EVALUATION 92504 EAR MICROSCOPY EXAMINATION 95920 INTRAOP NERVE TEST ADD-ON 96440 CHEMOTHERAPY- INTRACAVITARY 97799 PHYSICAL MEDICINE PROCEDURE 99195 PHLEBOTOMY