Policy Name: Services and Modifiers Not Reimbursable to .../media/Documents/Provider/Services Not... · Services and Modifiers Not Reimbursable to Health Care Professionals Policy

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Policy Name: Services and Modifiers Not Reimbursable to Health Care Professionals

Services Not Reimbursable to Health Care Professionals Code List 2017

Effective: 01/01/2017

Code

NPFS

Status

Indicator

Description

Q0510* E Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant

Q0511* E

Pharmacy supply fee for oral anticancer, oral antiemetic, or immunosuppressive drug(s); for

the first prescription in a 30-day period

Q0512* E Pharmacy supply fee for oral anticancer, oral antiemetic, or immunosuppressive drug(s); for a

subsequent prescription in a 30-day period

Q0513* E Pharmacy dispensing fee for inhalation drug(s); per 30 days

Q0514* E Pharmacy dispensing fee for inhalation drug(s); per 90 days

0500F M Initial prenatal care visit

0509F M Urine incon plan docd

0513F M Elev bp plan of care docd

0517F M Glaucoma plan of care docd

0518F M Fall plan of care docd

0520F M Rad dos limts b/4 3d rad

0521F M Plan of care 4 pain docd

0526F M Subs visit for episode

0528F M Rcmnd flw-up 10 yrs docd

0529F M Intrvl 3/>yr pts clnscp docd

0540F M Gluco mngmnt plan docd

0581F M Pt trnsfrd from anesth to cc

0583F M No trnsfr from anesth to cc

1006F M Osteoarthritis assess

1036F M Tobacco non-user

1038F M Persistent asthma

1039F M Intermittent asthma

1090F M Pres/absn urine incon assess

1100F M Ptfalls assess-docd ge2>/yr

1101F M Pt falls assess-docd le1/yr

1111F M Dschrg med/current med merge

1123F M Acp discuss/dscn mkr docd

1124F M Acp discuss-no dscnmkr docd

1125F M Amnt pain noted pain prsnt

1126F M Amnt pain noted none prsnt

1170F M Fxnl status assessed

1175F M Function stat assessed rvwd

1181F M Neuropsychia sympts assessed

1460F M Qual card diag prior 12 mons

1461F M No qual card diag prior12mon

2000F M Blood pressure measure

2019F M Dilated macul exam done


2022F M Dil retina exam interp rev

2024F M 7 field photo interp doc rev

2026F M Eye image valid to dx rev

2027F M Optic nerve head eval done

3014F M Screen mammo doc rev

3017F M Colorectal ca screen doc rev

3021F M Lvef mod/sever deprs syst

3022F M Lvef >/=40% systolic

3023F M Spirom doc rev

3044F M Hg a1c level lt 7.0%

3045F M Hg a1c level 7.0-9.0%

3046F M Hemoglobin a1c level >9.0%

3060F M Pos microalbuminuria rev

3061F M Neg microalbuminuria rev

3062F M Pos macroalbuminuria rev

3066F M Nephropathy doc tx

3072F M Low risk for retinopathy

3095F M Central dexa results docd

3100F M Image test ref carot diam

3126F M Esoph bx rprt w/dyspl info

3155F M Cytogen test marrow b/4 tx

3160F M Doc fe+ stores b/4 epo thx

3170F M Flow cyto done b/4 tx

3210F M Grp a strep test performed

3250F M Nonprim loc anat bx site tum

3260F M Pt cat/pn cat/hist grd docd

3267F M Path rprt w/ pt pn cat et al

3269F M Bone scn b/4 txmnt/aftr dx

3270F M No bone scn b/4 txmnt/aftrdx

3284F M Iop down >15% of pre-svc lvl

3285F M Iop down <15% of pre-svc lvl

3288F M Fall risk assessment docd

3319F M X-ray/ct/ultrsnd et al ord

3320F M No xray/ct/ et al ordd

3321F M Ajcc cncr 0/ia melan docd

3322F M Melanomaajcc stage 0 or ia

3340F M Mammo assess inc xray docd

3341F M Mammo assess negative docd

3342F M Mammo assess bengn docd

3343F M Mammo probably bengn docd

3344F M Mammo assess susp docd

3345F M Mammo assess hghlymalig doc

3350F M Mammo bx proven malig docd

3394F M Quant her2 ihc eval brst cx

3395F M Quant nonher2 ihc brst cx

3455F M Tb scrng done-interpd 6mon

3470F M Ra disease activity low


3471F M Ra disease activity mod

3472F M Ra disease activity high

3475F M Disease progn ra poor docd

3476F M Disease progn ra good docd

3517F M Hbv assess&results intrp 1yr

3570F M Rprt bone scint xref w xray

3720F M Cognit impairment assessed

3725F M Screen depression performed

3775F M Adenoma detected screening

3776F M Adenoma not detect screening

4004F M Pt tobacco screen rcvd tlk

4008F M Beta-blocker therapy rxd/tkn

4010F M Ace/arb therapy rxd/taken

4040F M Pneumoc vac/admin/rcvd

4044F M Doc order given vte prophylx

4086F M Aspirin/clopidogrel rxd

4090F M Pt rcvng epo thxpy

4100F M Biphos thxpy vein ord/recvd

4110F M Int mam art used for cabg

4115F M Beta blckr admin w/in 24 hrs

4120F M Antibiot rxd/given

4124F M Antibiot not rxd/given

4130F M Topical prep rx aoe

4131F M Syst antimicrobial thx rx

4132F M No syst antimicrobial thx rx

4164F M Adjv hrmnl thxpy rxd

4175F M Vis 20/40/> w/in 90 days

4177F M Talk pt/crgvr re areds prev

4192F M Pt not rcvng glucoco thxpy

4193F M Pt rcvng<10mg daily predniso

4194F M Pt rcvng10mg daily predniso

4195F M Pt rcvng anti-rheum thxpy ra

4196F M Ptnot rcvng anti-rhm thxpyra

4255F M Anesth 60 min/> as docd

4322F M Crgvr prov w/ ed addl rsrcs

4325F M Med txmnt options rvwd w/pt

4340F M Cnslng chldbrng women epi

4400F M Rehab thxpy options w/pt

4500F M Ref to outpt card rehab prog

4510F M Prev cardrehab qualcardevent

4525F M Neuropsychia interven order

4526F M Neuropsychia interven rcvd

4554F M Pt recvd inhal anesthetic

4556F M Pt w/3+ post-op nausea&vom

5010F M Macul result phy/qhp mng dm

5015F M Doc fx & test/txmnt for op

5050F M Plan 2 main dr by 1 month


6030F M Max sterile barriers follwd

6101F M Safety counseling dementia

6102F M Safety counseling dem order

7010F M Pt info into recall system

7025F M Pt infosys alarm 4 nxt mammo

9003F M Aortic anrysm5.5-5.9cm diam

9004F M Aortic anrysm 6/> cm diam

9006F M Sympt sten-tia/strk<120days

9007F M Other carot sten 120 days/>

G0913 M Improve visual funct

G0914 M Survey not complete

G0915 M No improve visual funct

G0916 M Satisfy with care

G0917 M Satisfy survey not complete

G0918 M No satisfy with care

G8395 M Lvef>=40% doc normal or mild

G8396 M Lvef not performed

G8397 M Dil macula/fundus exam/w doc

G8398 M Dil macular/fundus not perfo

G8399 M Pt w/dxa document or order

G8400 M Pt w/dxa no document or orde

G8404 M Low extemity neur exam docum

G8405 M Low extemity neur not perfor

G8410 M Eval on foot documented

G8415 M Eval on foot not performed

G8416 M Pt inelig footwear evaluatio

G8417 M Calc bmi abv up param f/u

G8418 M Calc bmi blw low param f/u

G8419 M Calc bmi out nrm param nof/u

G8420 M Calc bmi norm parameters

G8421 M Bmi not calculated

G8422 M Pt inelig bmi calculation

G8427 M Doc cur meds by prov

G8428 M Cur meds not document

G8430 M Pt inelig med check

G8431 M Pos clin depres scrn f/u doc

G8432 M Clin depression screen not d

G8433 M Pt inelig; scrn clin dep

G8442 M Pt inelig pain assessment

G8450 M Beta-bloc rx pt w/abn lvef

G8451 M Pt w/abn lvef inelig b-bloc

G8452 M Pt w/abn lvef b-bloc no rx

G8465 M High risk recurrence pro ca

G8473 M Ace/arb thxpy rx'd

G8474 M Ace/arb not rx'd; doc reas

G8475 M Ace/arb thxpy not rx'd

G8476 M Bp sys <140 and dias <90


G8477 M Bp sys>=140 and/or dias >=90

G8478 M Bp not performed/doc

G8482 M Flu immunize order/admin

G8483 M Flu imm no admin doc rea

G8484 M Flu immunize no admin

G8506 M Pt rec ace/arb

G8509 M Pos pain assess no f/u doc

G8510 M Pt inelig neg scrn depres

G8511 M Clin depres scrn no f/u doc

G8535 M Pt inelig no eld mal scrn

G8536 M No doc elder mal scrn

G8539 M Doc funct and care plan

G8540 M Pt inelig funct assess

G8541 M No doc cur funct assess

G8542 M Doc funct no deficiencies

G8543 M Cur funct asses; no care pln

G8569 M Prol intubation req

G8570 M No prol intub req

G8571 M Ster wd ifx 30 d postop

G8572 M No ster wd ifx

G8573 M Stk cabg

G8574 M No strk cabg

G8575 M Postop ren fail

G8576 M No postop ren fail

G8577 M Reop req bld grft oth

G8578 M No reop req bld grft oth

G8598 M Asp therp used

G8599 M No asp therp used

G8600 M Tpa initi w/in 3 hrs

G8601 M No elig tpa init w/in 3 hrs

G8602 M No tpa init w/in 3 hrs

G8627 M Surg proc w/in 30 days

G8628 M No surg proc w/in 30 days

G8633 M Pharm ther osteo rx

G8635 M No pharm ther osteo rx

G8647 M Fun stat score knee >= 0

G8648 M Fun stat score knee < 0

G8649 M Fun stat score knee pt noelg

G8650 M Fun stat score knee not done

G8651 M Fun stat score hip >= 0

G8652 M Fun stat score hip < 0

G8653 M Fun stat score hip pt no elg

G8654 M Fun stat score hip not done

G8655 M Fun stat score le >= 0

G8656 M Fun stat score le < 0

G8657 M Fun stat score le pt no elg

G8658 M Fun stat score le not done


G8659 M Fun stat score ls >= 0

G8660 M Fun stat score ls < 0

G8661 M Fun stat score ls pt no elg

G8662 M Fun stat score ls not done

G8663 M Fun stat score shdl >=0

G8664 M Fun stat score shdl < 0

G8665 M Fun stat score shdl pt no el

G8666 M Fun stat score shdl not done

G8667 M Fun stat score ue >=0

G8668 M Fun stat score ue < 0

G8669 M Fun stat score ue pt no elg

G8670 M Fun stat score ue not done

G8671 M Fun stat score neck/ts >=0

G8672 M Fun stat score neck/ts < 0

G8673 M Fun stat scor nek/ts pt no e

G8674 M Fun stat scor nek/ts not don

G8694 M Lvef <40%

G8696 M Antithromb thx presc

G8697 M Antithromb no presc doc reas

G8698 M Antithromb no presc no reas

G8708 M Antibiotic not pres

G8709 M Med reas antibiotic pres

G8710 M Pt pres antibiotic

G8711 M Pres antibiotic

G8712 M Not pres antibiotic

G8721 M Pt, pn, hist grade doc

G8722 M Med reas pt, pn, not doc

G8723 M Spec sit not prim tumor

G8724 M Pt, pn, hist grade not doc

G8730 M Pain doc pos and plan

G8731 M Pain neg no plan

G8732 M No doc of pain

G8733 M Doc pos elder mal scrn plan

G8734 M Doc neg elder mal no plan

G8735 M Eld mal scrn pos no plan

G8749 M Signs of melanoma absent

G8752 M Sys bp less 140

G8753 M Sys bp > or = 140

G8754 M Dias bp less 90

G8755 M Dias bp > or = 90

G8756 M No bp measure doc

G8783 M Bp scrn perf rec interval

G8785 M Bp scrn no perf at interval

G8797 M Specimen site not esophagus

G8798 M Specimen site not prostate

G8806 M Transab or transvag us

G8807 M Doc reas no us


G8808 M No transab or transvag us

G8809 M Rh-immunoglobulin order

G8810 M Doc reas no rh-immuno

G8811 M No rh-immunoglobulin order

G8815 M Doc reas no statin therapy

G8816 M Statin med pres at disch

G8817 M Doc reas no statin med disch

G8818 M Pt disch to home by day#7

G8825 M Pt not disch to home day#7

G8826 M Pt disch home day #2 evar

G8833 M Pt not disch home day#2 evar

G8834 M Pt disch home day #2 cea

G8838 M Not disch home by day #2

G8839 M Sleep apnea assess

G8840 M Doc reas no sleep apnea

G8841 M No sleep apnea assess

G8842 M Ahi or rdi initial dx

G8843 M Doc reas no ahi or rdi

G8844 M No ahi or rdi initial dx

G8845 M Pos airway press prescribed

G8846 M Mod or severe osa

G8849 M Doc reas no pos air press

G8850 M No pap prescribed

G8851 M Adhere pos air press therapy

G8852 M Pos air press prescribe

G8854 M Reas no adhere pos air pres

G8855 M Pos air press adhere no perf

G8856 M Ref for oto eval

G8857 M No elig ref for oto eval

G8858 M Not ref for oto eval

G8861 M Dxa ordered for osteo

G8863 M No assess bone loss

G8864 M Pneumococcal vaccine admin

G8865 M Doc med reas no pneumococcal

G8866 M Doc pt reas no pneumococcal

G8867 M No pneumococcal admin

G8869 M Doc immun hep b 1st antitnf

G8872 M Intraop image confirm excise

G8873 M Specimen not intraop image

G8874 M Tissue not image intraop

G8875 M Breast cancer dx min invsive

G8876 M Doc reas no min inv dx

G8877 M No brst cncr dx min invasive

G8878 M Sent lymph node biopsy

G8879 M Node neg inv brst cncr

G8880 M Doc reas no lymph node biop

G8881 M Brst cncr stage > t1n0m0


G8882 M No sent lymph node biopsy

G8883 M Rev, comm, track, doc biopsy

G8884 M Doc reas biopsy not review

G8885 M No rev, comm, track biopsy

G8923 M Lvef < 40% or lvsd

G8924 M Spiro ev1/fvc <60% copd sym

G8925 M Spiro>=60% or pt no copd sym

G8926 M Spiro no perf or doc

G8934 M Lvef <40% or dep lv sys fcn

G8935 M Rx ace or arb therapy

G8936 M Pt not eligible ace/arb

G8937 M No rx ace/arb therapy

G8938 M Bmi calc, pt no f/u plan elg

G8939 M Pain assess doc, f/u no doc

G8941 M No doc elder scrn, pt no el

G8942 M Doc fcn/care plan w/30 days

G8944 M Ajcc mel cnr stg 0 - iic

G8946 M Mibm but no dx of breast ca

G8947 M 1 or more neuropsych

G8950 M Pre-htn or htn doc, f/u indc

G8952 M Pre-htn/htn, no f/u, not gvn

G8955 M Most recent assess vol mgmt

G8956 M Pt rcv hedia outpt dyls fac

G8958 M Assess vol mgmt not doc

G8959 M Clin tx mdd comm to tx clin

G8960 M Clin tx mdd not comm

G8961 M Csit lowrisk surg pts preop

G8962 M Csit on pt any reas 30 days

G8963 M Csi per asx pt w/pci 2 yrs

G8964 M Csi any other than pci 2 yr

G8965 M Csit perf on low chd rsk

G8966 M Csit perf sx or high chd rsk

G8967 M Wrfrn or oral antigoag pres

G8968 M Md rsn no pres wrfrn or othr

G8969 M Pt rsn no pres wrfrn or othr

G8970 M No rsk fac or 1 mod risk te

G8971 M Warfrn or othr antcog no rx

G8972 M 1>=risk or>= mod risk for te

G8973 M Mst rcnt hbb < 10g/dl

G8974 M Hgb not doc rns not gvn

G8975 M Hgb <10g/dl, med rsn

G8976 M Hgb >= 10 g/dl

G9063 M Onc dx nsclc stgi no progres

G9064 M Onc dx nsclc stg2 no progres

G9065 M Onc dx nsclc stg3a no progre

G9066 M Onc dx nsclc stg3b-4 metasta

G9067 M Onc dx nsclc dx unknown nos


G9068 M Onc dx sclc/nsclc limited

G9069 M Onc dx sclc/nsclc ext at dx

G9070 M Onc dx sclc/nsclc ext unknwn

G9071 M Onc dx brst stg1-2b hr,nopro

G9072 M Onc dx brst stg1-2 noprogres

G9073 M Onc dx brst stg3-hr, no pro

G9074 M Onc dx brst stg3-noprogress

G9075 M Onc dx brst metastic/ recur

G9077 M Onc dx prostate t1no progres

G9078 M Onc dx prostate t2no progres

G9079 M Onc dx prostate t3b-t4noprog

G9080 M Onc dx prostate w/rise psa

G9083 M Onc dx prostate unknwn nos

G9084 M Onc dx colon t1-3,n1-2,no pr

G9085 M Onc dx colon t4, n0 w/o prog

G9086 M Onc dx colon t1-4 no dx prog

G9087 M Onc dx colon metas evid dx

G9088 M Onc dx colon metas noevid dx

G9089 M Onc dx colon extent unknown

G9090 M Onc dx rectal t1-2 no progr

G9091 M Onc dx rectal t3 n0 no prog

G9092 M Onc dx rectal t1-3,n1-2noprg

G9093 M Onc dx rectal t4,n,m0 no prg

G9094 M Onc dx rectal m1 w/mets prog

G9095 M Onc dx rectal extent unknwn

G9096 M Onc dx esophag t1-t3 noprog

G9097 M Onc dx esophageal t4 no prog

G9098 M Onc dx esophageal mets recur

G9099 M Onc dx esophageal unknown

G9100 M Onc dx gastric no recurrence

G9101 M Onc dx gastric p r1-r2noprog

G9102 M Onc dx gastric unresectable

G9103 M Onc dx gastric recurrent

G9104 M Onc dx gastric unknown nos

G9105 M Onc dx pancreatc p r0 res no

G9106 M Onc dx pancreatc p r1/r2 no

G9107 M Onc dx pancreatic unresectab

G9108 M Onc dx pancreatic unknwn nos

G9109 M Onc dx head/neck t1-t2no prg

G9110 M Onc dx head/neck t3-4 noprog

G9111 M Onc dx head/neck m1 mets rec

G9112 M Onc dx head/neck ext unknown

G9113 M Onc dx ovarian stg1a-b no pr

G9114 M Onc dx ovarian stg1a-b or 2

G9115 M Onc dx ovarian stg3/4 noprog

G9116 M Onc dx ovarian recurrence

G9117 M Onc dx ovarian unknown nos


G9123 M Onc dx cml chronic phase

G9124 M Onc dx cml acceler phase

G9125 M Onc dx cml blast phase

G9126 M Onc dx cml remission

G9128 M Onc dx multi myeloma stage i

G9129 M Onc dx mult myeloma stg2 hig

G9130 M Onc dx multi myeloma unknown

G9131 M Onc dx brst unknown nos

G9132 M Onc dx prostate mets no cast

G9133 M Onc dx prostate clinical met

G9134 M Onc nhlstg 1-2 no relap no

G9135 M Onc dx nhl stg 3-4 not relap

G9136 M Onc dx nhl trans to lg bcell

G9137 M Onc dx nhl relapse/refractor

G9138 M Onc dx nhl stg unknown

G9139 M Onc dx cml dx status unknown

G9188 M Beta not given no reason

G9189 M Beta pres or already taking

G9190 M Medical reason for no beta

G9191 M Pt reason for no beta

G9192 M System reason for no beta

G9196 M Med reason for no ceph

G9197 M Order for ceph

G9198 M No order for ceph no reason

G9212 M Doc of dsm-iv init eval

G9213 M No doc of dsm-iv

G9223 M Pjp proph ordered cd4 low

G9225 M Norsn no foot exam

G9226 M 3 comp foot exam completed

G9227 M Docrsn no care plan

G9228 M Gc chl syp documented

G9229 M Ptrsn no gc chl syp test

G9230 M Norsn for gc chl syp test

G9231 M Doc esrd dia trans preg

G9232 M Docrsn no comm comorb

G9239 M Docrsn for catheter

G9240 M Doc pt w cath maint dia

G9241 M Doc pt w out cath maint dia

G9242 M Doc viral load >=200

G9243 M Doc viral load <200

G9246 M No med visit in 24mo

G9247 M 1 med visit in 24mo

G9250 M Doc of pain comfort 48hr

G9251 M Doc no pain comfort 48hr

G9254 M Doc pt dischg >2d

G9255 M Doc pt dischg <=2d

G9256 M Doc death after cas


G9257 M Doc stroke after cas

G9258 M Doc stroke after cea

G9259 M Doc surv no stroke after cas

G9260 M Doc death after cea

G9261 M Doc surv no stroke after cea

G9262 M Doc death in hosp aaa repair

G9263 M Doc surv in hosp aaa repair

G9264 M Docrsn for cath maint dia

G9265 M Doc cath >90d for maint dia

G9266 M Norsn pt cath >=90d

G9267 M Doc comp or mort w in 30d

G9268 M Doc comp or mort w in 90d

G9269 M Doc no comp or mort w in 30d

G9270 M Doc no comp or mort w in 90d

G9273 M Sys<140 and dia<90

G9274 M Bp out of nrml limits

G9275 M Doc of non tobacco user

G9276 M Doc of tobacco user

G9277 M Doc daily aspirin or contra

G9278 M Doc no daily aspirin

G9279 M Pne scrn done doc vac done

G9280 M Pne not given norsn

G9281 M Pne scrn done doc not ind

G9282 M Doc medrsn no histo type

G9283 M Hist type doc on report

G9284 M No hist type doc on report

G9285 M Site not small cell lung ca

G9286 M Doc antibio order w in 7d

G9287 M No doc antibio order w in 7d

G9288 M Doc medrsn no hist type rpt

G9289 M Doc type nsm lung ca

G9290 M No doc type nsm lung ca

G9291 M Not nsm lung ca

G9292 M Medrsn no pt category

G9293 M No pt category on report

G9294 M Pt cat and thck on report

G9295 M Non cutaneous loc

G9296 M Doc share dec prior proc

G9297 M No doc share dec prior proc

G9298 M Eval risk vte card 30d prior

G9299 M No eval riskk vte card prior

G9300 M Doc medrsn no compl antibio

G9301 M Doc compl inf antibio

G9302 M Norsn incomp inf antibio

G9303 M Norsn no pros info op rpt

G9304 M Pros info op rpt

G9305 M No interv req for leak


G9306 M Interv req for leak

G9307 M No ret for surg w in 30d

G9308 M Unplnd ret to surg w in 30d

G9309 M No unplnd hosp readm in 30d

G9310 M Unplnd hosp readm in 30d

G9311 M No surg site infection

G9312 M Surgical site infection

G9313 M Docrsn not first line amox

G9314 M Norsn not first line amox

G9315 M Doc first line amox

G9316 M Doc comm risk calc

G9317 M No doc comm risk calc

G9318 M Image std nomenclature

G9319 M Image not std nomenclature

G9321 M Doc count of ct in 12mo

G9322 M No doc count of ct in 12mo

G9326 M Norsn no ct rpt to reg

G9327 M Ct rpt to reg

G9329 M Norsn no dicom format doc

G9340 M Dicom format doc on rpt

G9341 M Srch for ct w in 12 mos

G9342 M No srch for ct in 12mo norsn

G9344 M Sysrsn no dicom srch

G9345 M Follow up pulm nod

G9347 M No follow up pulm nod norsn

G9348 M Docrsn no sinus ct dx

G9349 M Doc sinus ct 28d

G9350 M No doc sinus ct 28d or dx

G9351 M Doc >1 sinus ct w 90d dx

G9352 M Not >1 sinus ct w 90d dx

G9353 M Medrsn >1 sinus ct w 90d dx

G9354 M Norsn >1 sinus ct w 90d dx

G9355 M No early ind/delivery

G9356 M Early ind/delivery

G9357 M Pp eval/edu perf

G9358 M Pp eval/edu not perf

G9359 M Doc of neg or man pos tb scn

G9360 M No doc of neg or man pos tb

G9361 M Med ind for induction

G9364 M Sinus caus bac inx

G9365 M 1high risk med ord

G9366 M 1high risk no ord

G9367 M 2high risk med ord

G9368 M 2high risk no ord

G9380 M Off assis eol iss

G9381 M Doc med reas no offer eol

G9382 M No off assis eol


G9383 M Recd scrn hcv infec

G9384 M Doc med reas no offer eol

G9385 M Doc pt reas not rec hcv srn

G9386 M Scrn hcv infec not recd

G9389 M Unpln rup post cap

G9390 M No unpln rup post cap

G9393 M Ini phq9 >9 remiss <5

G9394 M Dx bipol, death, nhres, hosp

G9395 M Ini phq9 >9 no remiss >=5

G9396 M Ini phq9 >9 not assess

G9399 M Doc disc tx choices

G9400 M Doc reas no disc tx opt

G9401 M No disc tx choices

G9402 M Recd f/u w/in 30d disch

G9403 M Doc reas no 30 day f/u

G9404 M No 30 day f/u

G9405 M Recd f/u w/in 7d disch

G9406 M Doc reas no 7d f/u

G9407 M No 7d f/u

G9408 M Card tamp w/in 30d

G9409 M No card tamp e/in 30d

G9410 M Admit w/in 180d req remov

G9411 M No admit w/in 180d req remov

G9412 M Admit w/in 180d req surg rev

G9413 M No admit req surg rev

G9414 M 1dose menig vac btwn 11 & 13

G9415 M No 1dose meni vac btwn 11&13

G9416 M Tdap or td or 1tet/dipth

G9417 M No tdap or td or 1tet/dipth

G9418 M Lungcx bx rpt docs class

G9419 M Med reas no rpt histo type

G9420 M Spec site no lung

G9421 M Lung cx bx rpt no doc class

G9422 M Rpt doc class histo type

G9423 M Med reas rpt no histo type

G9424 M Site no lung or lung cx

G9425 M Spec rpt no doc class histo

G9426 M Impr med time edarr pain med

G9427 M No impro med time pain med

G9428 M Rpt pt cat and pt1

G9429 M Doc med reas no pt cat

G9430 M Spec site no cutaneous

G9431 M No pt cat and pt1

G9432 M Asth controlled

G9434 M Asth not controlled

G9448 M Born 1945-1965

G9449 M Hx bld transf b/f 1992


G9450 M Hx injec drug use

G9451 M 1x scrn hcv infect

G9452 M Doc med reas no scrn hcv

G9453 M Pt reas no hcv infect

G9454 M No hcv infect srn

G9455 M Abd imag w/us, ct or mri

G9456 M Doc med pt reas no hcc scrn

G9457 M No abd imag w/o reason

G9458 M Tob user recd cess interv

G9459 M Tob non-user

G9460 M No tob assess or cess inter

G9468 M No recd cortico>=10mg/d >60d

G9469 M Rec cortico>60d or 1rx 600mg

G9470 M No rec cortico>60d 1rx 600mg

G9471 M W/in 2yr dxa not order

G9472 M No dxa no med hx no rv sx

G9496 M Doc rsn no adeno/neopl detec

G9497 M Rec inst no smoke day surg

G9498 M Abx reg prescribed

G9500 M Rad expos ind/exp tm doc

G9501 M Rad expos ind/exp tm no doc

G9502 M Med reas no perf foot exam

G9503 M Pt tk tams hcl

G9504 M Doc reas no hbv status

G9505 M Abx pres w/in 10 dys of symp

G9506 M Bio imm resp mod presc

G9507 M Doc reas on statin or contra

G9508 M Doc pt not on statin

G9509 M Remis 12m phq-9 score <5

G9510 M Remis 12m not phq-9 score <5

G9511 M Phq-9 >9 during 12m time

G9512 M Indiv pdc > 0.8

G9513 M Indiv pdc not > 0.8

G9514 M Req ret or w/in 90d of surg

G9515 M No reas, no ret or w/in 90d

G9516 M Impr vis acuit w/in 90d

G9517 M No impr vis acuit w/in 90d

G9518 M Doc active inj drug use

G9519 M Final ref +/- 0.5 w/in 90d

G9520 M Refract not +/- 0.5 w/in 90d

G9521 M Er and ip hosp <2 in 12 mos

G9522 M Er/ip hosp =/>2 in 12 mos

G9523 M D/c hemo or perit dialysis

G9524 M Refer to hospice

G9525 M Doc pt reas no hospice refer

G9526 M No reason, no refer hospice

G9529 M Minor blunt trauma w/head ct


G9530 M Min hd traum gcs=15 w/ct ed

G9531 M Doc shnt/br tum/on antipl rx

G9532 M Inj >24 hr in ed gcs <15

G9533 M Indic for head ct not valid

G9534 M Adv brain image not ordered

G9535 M Normal neuro exam

G9536 M Doc med reas adv brain image

G9537 M Doc system reas adv imaging

G9538 M Adv brain image ordered

G9539 M Intent pot remv time placemt

G9540 M Pt alive 3 mos post proc

G9541 M Filter gone aft 3mos placmt

G9542 M Doc reass appr remo filt 3ms

G9543 M Doc 2x re-assess filt remov

G9544 M No filt remov w/in 3mos plcm

G9547 M Incid finding liver/kid/adre

G9548 M Abd imag and followup rec

G9549 M Doc med rsn for follow imag

G9550 M Abd imag and followup no rec

G9551 M Abd imag no les,kid/livr/adr

G9552 M Inc thyr node <1.0 in rpt

G9553 M Prior thyroid dise dx

G9554 M Ct/cta/mri/a chst foll rec

G9555 M Doc med rsn for follup image

G9556 M Ct/cta/mri/a no follup imag

G9557 M Ct/cta/mri/a no thyr <1.0cm

G9558 M Tx beta-lactam abx therapy

G9559 M Doc med reas no abx therapy

G9560 M No beta-lactam abx ther, rng

G9561 M Presc opiates >6 wks

G9562 M Foll-up eval q3mo opiod tx

G9563 M No f/u eval q3mo opiod tx

G9573 M Remis 6m w/6mos phq-9 <5

G9574 M Remis 6m w/o 6mos phq-9 <5


G9578 M Doc opioid tx 1x during ther

G9579 M No doc opioid tx 1x at ther

G9580 M Door to punc time <2hrs

G9582 M Door to punc time >2hr, nrg


G9584 M Eval opioid use instr/pt int

G9585 M No eval opi use instr/intv

G9593 M Low pecarn ped head trauma

G9594 M Gsc >15 & hd ct by ed md

G9595 M Doc shnt/tum/coag/thrombocyt

G9596 M Hd inj >24h/gcs >15/no res

G9597 M No low pecarn ped head traum


G9598 M Aor ane 5.5-5.9 cm max diam

G9599 M Aor ane >=6.0 cm max diam

G9600 M Symp aaa urgent repair

G9601 M Pt dchg home post op day 7

G9602 M Pt no dchg home postop day 7

G9603 M Pt surv improv bsline tx

G9604 M Pt surv results not avail

G9605 M Surv score no improv w/tx

G9606 M Intraop cyst eval trac inj

G9607 M Doc rsn no interop cysto

G9608 M Intraop cyst eval not done

G9609 M Doc order anti-plat

G9610 M Doc md rsn no antipla

G9611 M No doc order anti-plat rng

G9612 M Pho doc >1 cecal ldmk com ex

G9613 M Doc post surg anatomy

G9614 M No photodoc cecal ldmk exam

G9615 M Pre-op asst doc

G9616 M Doc rsn no preop assmt

G9617 M Pre-op asst not doc, rng

G9618 M Doc scr uter mal or us/samp

G9620 M No scr utr malig/us/samp rng

G9621 M Scr unheal etoh w/counsel

G9622 M No unheal etoh user

G9623 M Doc med rsn no scr etoh use

G9624 M No etoh scr/no counc/nrg

G9625 M Ptblad inj at surg/1mo post

G9626 M Med rsn no rpt baldder inj

G9627 M No bld inj at surg/1 mo pos

G9628 M Bowel inj at surg/1mos post

G9629 M Med rsn no rpt bowel inj

G9630 M No bow inj at surg/1mos post

G9631 M Urtr inj at surg/1mos post

G9632 M Med rsn for no rpt uret inj

G9633 M No uret inj at surg/1mo post

G9634 M Qual life tool 2x same/impr

G9635 M No doc rsn do qual life assm

G9636 M No life asst 2x same/decr

G9637 M Doc >1 dose reduc tech

G9638 M No doc >1 dose reduc tech

G9639 M Amp no reqd in48h ieler proc

G9640 M Doc plan hybrid/stage proc

G9641 M Amp reqd w/in 48h ieler proc

G9642 M Current smoker

G9643 M Elective surgery

G9644 M No smok b/4 anes day of surg

G9645 M Had smoke b/4 anes day surg


G9646 M Pt w/90d mrs 0-2

G9647 M No mrs score in 90d followup

G9648 M Pt w/90d mrs >2

G9649 M Psori tool doc w/benchmk

G9651 M Psori tool doc/no bnchmk met

G9654 M Mon anesth care

G9655 M Toc tool incl key elem

G9656 M Pt direct anesth loc to pacu

G9658 M Toc tool incl elem not used

G9659 M >85y no hx colo ca/rsn scope

G9660 M Doc med rsn scope pt >85y

G9661 M >85y scope othr rsn

G9662 M Prior dx/active clin ascvd

G9663 M Fast/dir ldl = 190 mg/dl

G9664 M Taking statin or rec'd order

G9665 M No statin/no order statin

G9666 M Fas/dir ldl 70-189mg/dl mst

G9674 M Pt w/clin ascvd dx

G9675 M Pt w/fast/dir lab ldl-c >190

G9676 M 40-75y w/type 1/2 w/ldl-c rs

G9687 M Hospice anytime msmt per

G9688 M Pt w/hosp anytime msmt per

G9689 M Inpt elect carotid intervent

G9690 M Pt rec hospice dur msmt per

G9691 M Pt hosp dur msmt period

G9692 M Hosp recd by pt dur msmt per

G9693 M Pt use hosp during msmt per

G9694 M Hosp srv used pt in msmt per

G9695 M Long act inhal bronchdil pre

G9696 M Med rsn no presc bronchdil

G9697 M Pt rsn no presc bronchdil

G9698 M Sys rsn no presc bronchdil

G9699 M Long inhal bronchdil no pres

G9700 M Pt is w/hosp during msmt per

G9701 M Child anbx 30 prior dx estab


G9703 M Child anbx 30 prior dx phary

G9704 M Ajcc br ca stg i: t1 mic/t1a

G9705 M Ajcc br ca stg ib

G9706 M Low recur prost ca

G9707 M Pt had hosp dur msmt per

G9708 M Bilat mast/hx bi /unilat mas

G9709 M Hosp srv used pt in msmt per

G9710 M Pt prov hosp srv msmt per

G9711 M Pt hx tot col or colon ca

G9712 M Doc med rsn presc anbx



G9714 M Pt is w/hosp during msmt per


G9716 M Bmi not norm, no follow, doc

G9717 M Doc dx depr/dx bipol, no scr


G9719 M Pt not ambul/immob/wc


G9721 M Pt not ambul/immob/wc

G9722 M Doc hx renal fail or cr+ >4

G9723 M Hosp recd by pt dur msmt per

G9724 M Pt w/doc use anticoag mst yr


G9726 M Refused to participate

G9727 M No knee intake prom, no prox


G9729 M No hip intake prom, no proxy


G9731 M No foot prom, no proxy


G9733 M No back intake prom, no prox


G9735 M Pt no foto knee and no proxy


G9737 M Pt no foto elbow, no proxy


G9739 M Pt no foto orth, no proxy

G9740 M Hosp srv to pt dur msmt per


G9742 M Psych sympt assessed

G9743 M Psych symp not assessed, rns

G9744 M Pt not elig, dx htn

G9745 M Doc rsn no scr high bp

G9746 M Mit sten, valve or trans af

G9747 M Pall dialysis with catheter

G9748 M App transpl lvg kidney donor

G9749 M Pall dialysis with catheter

G9750 M App transpl lvg kidney donor

G9751 M Pt died w/in 24 mos rpt time

G9752 M Urgent surgery

G9753 M Doc no dicom, ct other fac

G9754 M Incid pulm nodule

G9755 M Doc med rsn for imaging

G9756 M Surg proc w/silicone oil

G9757 M Surg proc w/silicone oil

G9758 M Hospice or term phase

G9759 M Hx preop post cap rup




G9762 M Pt had hpv b/t 9-13 yr

G9763 M Pt no hpv b/t 9-13 yr

G9764 M Pt tx oral syst/bio med psor

G9765 M Pt decl chan/conind or <6m

G9766 M Cva stroke dx tx transf fac

G9767 M Hosp new dx cva consid evst


G9769 M Bn den 2yr/got ost med/ther

G9770 M Perip nerve block

G9771 M Anes end, 1 temp >35.5(95.9)

G9772 M Doc temp >35.5(95.9), anest

G9773 M No temp >35.5(95.9), anes

G9774 M Pt had hyst

G9775 M Recd 2 anti-emet pre/intraop

G9776 M Doc med rsn no proph antiem

G9777 M Pt no antiemet pre/intraop

G9778 M Pts dx w/pregn

G9779 M Pts breastfeeding

G9780 M Pts dx w/rhabdomyolysis

G9781 M Doc rsn no statin

G9782 M Hx dx fam/pure hypercholes

G9783 M Doc dx dm, fast <70, no stat

G9784 M Path/derm 2nd opin bx

G9785 M Path rpt snt path/derm in 7d

G9786 M No path rpt sent in 7d

G9787 M Pt alive lst day msmt yr

G9788 M Most rct bp </= 140/90

G9789 M Record bp ip, er, urg/self

G9790 M Most rct bp >/= 140/90

G9791 M Most rct tob stat free

G9792 M Most rct tob stat not free

G9793 M Pt on daily asa/antiplat

G9794 M Doc med rsn no asa/antiplat

G9795 M Pt no daily asa/antiplat

G9796 M Pt not currently on statin

G9797 M Pt currently on statin

G9798 M D/c ami btw 7/1-6/30 mst per

G9799 M Med disp evt indic hx asth

G9800 M Pt id intol/alleg beta-block

G9801 M Nonacut transf from inpt


G9803 M Post d/c 180d tx beta-bl ami

G9804 M No post d/c 180d tx bb ami


G9806 M Pt recd cerv cyto/hpv

G9807 M Pt no recd cerv cyto/hpv


G9808 M Pt no asthm cont med mst per


G9810 M Pdc 75% w/asth cont med

G9811 M No pdc 75% w/asth cont med

G9812 M Pt died during inpt/30d aft

G9813 M Pt not died w/in 30d of proc

G9814 M Death occ dur hospitaliz

G9815 M No death occ dur hospitaliz

G9816 M Death occ 30d post proc

G9817 M No death occ 30d post proc

G9818 M Doc sex activity


G9820 M Doc chlam scr test w/follow

G9821 M No doc chlam scr ts w/follow

G9822 M Endo abl proc yr prev ind dt

G9823 M Endo smpl/hyst bx res doc

G9824 M Endo smpl/hyst bx res no doc

G9825 M Her-2 neg,undoc/unkn

G9826 M Transf pract aft init chemo

G9827 M Her-2 targ ther no init tx

G9828 M Her-2 targ ther dur init tx

G9829 M Breast adj chemo admin

G9830 M Her-2 pos

G9831 M Ajcc stg brt ca dx ii or iii

G9832 M Brt ca dx i, no t1/t1a/t1b

G9833 M Transf pract aft init chemo

G9834 M Pt met dis at dx

G9835 M Trastuz given w/in 12 mos dx

G9836 M Rsn no trast given doc

G9837 M Trastuz not in 12 mos dx


G9839 M Anti-egfr mon anti ther

G9840 M Kras tst bfr beg anti moab

G9841 M No kras tst bfr beg ant moab


G9843 M Kras gene mut

G9844 M Pt no recd anti-egfr ther

G9845 M Pt recd anti-egfr ther

G9846 M Pt died from cancer

G9847 M Pt recd chemo last 14d life

G9848 M Pt no chemo last 14d life


G9850 M 1/more ed last 30d life

G9851 M 1/no ed visit last 30d life


G9853 M Icu stay last 30d life

G9854 M No icu stay last 30d life


G9855 M No icu stay last 30d life


G9857 M Pt no hospice

G9858 M Pt admit hospice

G9859 M Pt enroll hospice


G9861 M Pt less 3d hospice

G9862 M Pt more than 3d hospice

G8978 Q Mobility current status

G8979 Q Mobility goal status

G8980 Q Mobility d/c status

G8981 Q Body pos current status

G8982 Q Body pos goal status

G8983 Q Body pos d/c status

G8984 Q Carry current status

G8985 Q Carry goal status

G8986 Q Carry d/c status

G8987 Q Self care current status

G8988 Q Self care goal status

G8989 Q Self care d/c status

G8990 Q Other pt/ot current status

G8991 Q Other pt/ot goal status

G8992 Q Other pt/ot d/c status

G8993 Q Sub pt/ot current status

G8994 Q Sub pt/ot goal status

G8995 Q Sub pt/ot d/c status

G8996 Q Swallow current status

G8997 Q Swallow goal status

G8998 Q Swallow d/c status

G8999 Q Motor speech current status

G9158 Q Motor speech d/c status

G9159 Q Lang comp current status

G9160 Q Lang comp goal status

G9161 Q Lang comp d/c status

G9162 Q Lang express current status

G9163 Q Lang express goal status

G9164 Q Lang express d/c status

G9165 Q Atten current status

G9166 Q Atten goal status

G9167 Q Atten d/c status

G9168 Q Memory current status

G9169 Q Memory goal status

G9170 Q Memory d/c status

G9171 Q Voice current status

G9172 Q Voice goal status

G9173 Q Voice d/c status

G9174 Q Speech lang current status


G9175 Q Speech lang goal status

G9176 Q Speech lang d/c status

G9186 Q Motor speech goal status

96376

X Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional

sequential intravenous push of the same substance/drug provided in a facility (List separately in

addition to code for primary procedure)

G0129 X Occupational therapy services requiring the skills of a qualified occupational therapist,

furnished as a component of a partial hospitalization treatment program, per session (45 minutes

or more)

G0175 X Scheduled interdisciplinary team conference (minimum of 3 exclusive of patient care nursing

staff) with patient present

G0176 X Activity therapy, such as music, dance, art or play therapies not for recreation, related to the

care and treatment of patient's disabling mental health problems, per session (45 minutes or

more)

G0177 X Training and educational services related to the care and treatment of patient's disabling mental

health problems per session (45 minutes or more)

G0299 X Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting,

each 15 minutes

G0300 X Direct skilled nursing services of a license practical nurse (LPN) in the home health or hospice

setting, each 15 minutes









G0333* X Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary

G0337 X Hospice evaluation and counseling services, pre-election

G0378 X Hospital observation service, per hour

G0379 X Direct admission of patient for hospital observation care

G0380 X Level 1 hospital emergency department visit provided in a type B emergency department; (the

ED must meet at least one of the following requirements: (1) it is licensed by the state in which

it is located under applicable state law as an emergency room or emergency department; (2) it is

held out to the public (by name, posted signs, advertising, or other means) as a place that

provides care for emergency medical conditions on an urgent basis without requiring a

previously scheduled appointment; or (3) during the calendar year immediately preceding the

calendar year in which a determination under 42 CFR 489.24 is being made, based on a

representative sample of patient visits that occurred during that calendar year, it provides at

least one-third of all of its outpatient visits for the treatment of emergency medical conditions

on an urgent basis without requiring a previously scheduled appointment)










































G0390 X Trauma response team associated with hospital critical care service

G0410 X Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting,

approximately 45 to 50 minutes

G0411 X Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50

minutes

G0463 X Hospital outpatient clinic visit for assessment and management of a patient

G0491 X Dialysis procedure at a Medicare certified ESRD facility for acute kidney injury without ESRD

G0492 X Dialysis procedure with single evaluation by a physician or other qualified health care

professional for acute kidney injury without ESRD

G0493 X Skilled services of a registered nurse (RN) for the observation and assessment of the patient's

condition, each 15 minutes (the change in the patient's condition requires skilled nursing

personnel to identify and evaluate the patient's need for possible modification of treatment in

the home health or hospice setting)

G0494 X Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the

patient's condition, each 15 minutes (the change in the patient's condition requires skilled

nursing personnel to identify and evaluate the patient's need for possible modification of

treatment in the home health or hospice setting)

G0495 X Skilled services of a registered nurse (RN), in the training and/or education of a patient or

family member, in the home health or hospice setting, each 15 minutes

G0496 X Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient


or family member, in the home health or hospice setting, each 15 minutes

G3001 X Administration and supply of tositumomab, 450 mg

G9473 X Services performed by chaplain in the hospice setting, each 15 minutes

G9474 X Services performed by dietary counselor in the hospice setting, each 15 minutes

G9475 X Services performed by other counselor in the hospice setting, each 15 minutes

G9476 X Services performed by volunteer in the hospice setting, each 15 minutes

G9477 X Services performed by care coordinator in the hospice setting, each 15 minutes

G9478 X Services performed by other qualified therapist in the hospice setting, each 15 minutes

G9479 X Services performed by qualified pharmacist in the hospice setting, each 15 minutes

G9480 X Admission to Medicare care choice model program (MCCM)

* Pay for Medicare/MSHO (Dual Solution) groups only

Medica

® is a registered service mark of Medica Health Plans. “Medica” refers to the family of health plan

businesses that includes Medica Health Plans, Medica Health Plans of Wisconsin, Medica Insurance Company,

Medica Self-Insured, and Medica Health Management, LLC.