Medical Coding Rights

HCPCS/CPT Codes 90670 – Pneumococcal conjugate vaccine, 13 valent (PCV13) , for intramuscular use 90732 – Pneumococcal polysaccharide vaccine, 23-valent (PPSV23) , adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use G0009 – Pneumococcal Administration ICD-10 Codes The specified below ICD codes are covered for CPT G0102 and G0103 but may not be limited and some private payers having specific guidelines. Z23         Encounter for immunization Z71.84 Encounter for health counseling related to travel Who Is Covered All Medicare beneficiaries Fee Value and MUE Edits         CPT         Dosage   Fee    MUE        90670 0.5 ml $241.383 1        90732 0.5 ml $125.918 1 Frequency An initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B A different, second pneumococcal vaccine 1 year after the first vaccine was administered Medicare Beneficiar

HCPCS/CPT Codes G0102 – Prostate cancer screening; digital rectal examination The Physician performs a prostate cancer screening in which he performs a digital rectal examination to assess the male patient’s prostate.  To examine the prostate the provider inserts a gloved and lubricated finger into the rectum and checks for hardness, lumps, or any abnormalities.  This examination helps detect prostate cancer in its early stages. The provider typically performs this test for the first time at the age of 40 for men at risk of having prostate cancer such as those men with a family history of cancer Medicare provides coverage for an annual prostate cancer screening digital rectal examination for men at the age of 50.   G0103 – Prostate cancer screening; prostate specific antigen test (PSA) The Prostate screening examination, the Physician detects the prostate specific antigen, or PSA, level in a patient’s blood. PSA is a protein the prostate gland produces, and he/she may use PSA levels to

Welcome to Medicare Preventive Visit HCPCS/CPT Codes G0402 –  Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment G0403 – Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report G0404 – Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination G0405 –  Electrocardiogram, routine ECG with 12 leads; interpretation and report only , performed as a screening for the initial preventive physical examination Who Is Covered All new Medicare beneficiaries who are within the first 12 months of their first Medicare Part B coverage period Frequency Once in a lifetime Must furnish no later than 12 months after the effective date of the first Medicare Part B coverage period Covered ICD-10 Codes for CPT G

Human Papillomavirus  The lab analyst performs the technical steps to detect human papillomavirus through nucleic acid detection and the Nucleic acid probes permit identification of microorganisms based on their DNA or RNA.  The Nucleic acid quantitation allows assessment of treatment response and the Quantitation refers to measuring the exact amount of a substance. The lab analyst performs this procedure for detection of high risk types of human papillomavirus.  HCPCS/CPT Codes G0476 – Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test  ICD-10 Codes The specified below ICD codes are covered for CPT G0476 but may not be limited and some private payers having specific guidelines. B97.7 Papillomavirus as the cause of diseases classified elsewhere R85.81 Anal high risk human papillomavirus (HPV) DNA test pos

Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD) Also known as a CVD risk reduction visit HCPCS/CPT Codes G0446 – Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes Covered ICD Codes The specified below ICD  codes are covered for CPT G0446 but may not be limited and some private payers having specific guidelines. F53.0    Postpartum depression F53.1    Puerperal psychosis  F68.A    Factitious disorder imposed on another I01.0 Acute rheumatic pericarditis I01.1 Acute rheumatic endocarditis I01.2 Acute rheumatic myocarditis I01.8 Other acute rheumatic heart disease I01.9 Acute rheumatic heart disease, unspecified I02.0 Rheumatic chorea with heart involvement I02.9 Rheumatic chorea without heart involvement I05.0 Rheumatic mitral stenosis I05.1 Rheumatic mitral insufficiency I05.2 Rheumatic mitral stenosis with insufficiency I05.8 Other rheumatic mitral valve diseases I05.9 Rheumatic mitral

HCPCS/CPT Codes G0447 – Face-to-face behavioral counseling for obesity, 15 minutes G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes Covered ICD-10 Codes for CPT G0447 & G0473 The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines, Z68.30 - Body mass index [BMI] 30.0-30.9, adult Z68.31  -Body mass index [BMI] 31.0-31.9, adult Z68.32 - Body mass index [BMI] 32.0-32.9, adult Z68.33 - Body mass index [BMI] 33.0-33.9, adult Z68.34 - Body mass index [BMI] 34.0-34.9, adult Z68.35 - Body mass index [BMI] 35.0-35.9, adult Z68.36 - Body mass index [BMI] 36.0-36.9, adult Z68.37 - Body mass index [BMI] 37.0-37.9, adult Z68.38 - Body mass index [BMI] 38.0-38.9, adult Z68.39 - Body mass index [BMI] 39.0-39.9, adult Z68.41 - Body mass index [BMI] 40.0-44.9, adult Z68.42 - Body mass index [BMI] 45.0-49.9, adult Z68.43 - Body mass index [BMI] 50.0-59.9, adult Z68.44 - Body mass index [BMI] 6

PLACE OF SERVICE - PATIENT TYPES  IN - INPATIENT (POS - 21 ) - A patient who is assigned a room and bed and receives automatic room/bed charges.  INO - OBSERVATION (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge.  OBS - OBSERVATION (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge.  TELE - TELEMETRY (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge and continuous monitoring.  SDC - SURGICAL DAY CARE (POS - 22) - A patient who visits the hospital for outpatient surgery.  SDS - SAME DAY SURGERY (POS - 22) - A patient who visits the hospital for outpatient surgery.  RCR - RECURRING (POS - 22) - An outpatient who returns to the hospital more than two times for related treatments (a series patient). ER - EMERGENCY (POS - 23) - An outpatient who comes to the hospital unscheduled and is treated in the emergenc