| (45) 0769 Specialty Room--Other Specialty Room.
(g) Service and Procedure Categories. The HCPCS code
ranges relating to the surgical and radiological or imaging categories
to be reported shall be specified by DSHS and published on DSHS' website
by November 1st of the year prior to the date on which the services
are performed.
(1) Incision or excision of Central Nervous System
(CNS);
(2) Insertion, replacement, or removal of extracranial
ventricular shunt;
(3) Laminectomy, excision intervertebral disc;
(4) Diagnostic spinal tap;
(5) Insertion of catheter or spinal stimulator and
injection into spinal canal;
(6) Decompression of peripheral nerves;
(7) Other diagnostic nervous system procedures (requiring
surgical or radiological procedures);
(8) Other operating room therapeutic nervous system
surgical procedures;
(9) Thyroidectomy, partial or complete;
(10) Diagnostic endocrine procedures (requiring surgical
or radiological procedures);
(11) Other therapeutic endocrine procedures (requiring
surgical or radiological procedures);
(12) Corneal transplant;
(13) Glaucoma procedures (requiring surgical or radiological
procedures);
(14) Lens and cataract procedures (requiring surgical
or radiological procedures);
(15) Repair of retinal tear, detachment (requiring
surgical or radiological procedures);
(16) Destruction of lesion of retina and choroid (requiring
surgical or radiological procedures);
(17) Diagnostic procedures on eye (requiring surgical
or radiological procedures);
(18) Other therapeutic procedures on eyelids, conjunctiva,
cornea (requiring surgical or radiological procedures);
(19) Other intraocular therapeutic procedures (requiring
surgical or radiological procedures);
(20) Other extraocular muscle and orbit therapeutic
procedures (requiring surgical or radiological procedures);
(21) Tympanoplasty;
(22) Myringotomy;
(23) Mastoidectomy;
(24) Diagnostic procedures on ear (requiring surgical
or radiological procedures);
(25) Other therapeutic ear procedures (requiring surgical
or radiological procedures);
(26) Control of epistaxis (requiring surgical or radiological
procedures);
(27) Plastic procedures on nose (requiring surgical
or radiological procedures);
(28) Oral and Dental Services (requiring surgical or
radiological procedures);
(29) Tonsillectomy or adenoidectomy;
(30) Diagnostic procedures on nose, mouth and pharynx
(requiring surgical or radiological procedures);
(31) Other non-operating room therapeutic procedures
on nose, mouth and pharynx (requiring surgical procedures);
(32) Other operating room therapeutic procedures on
nose, mouth and pharynx (requiring surgical or radiological procedures);
(33) Tracheostomy, temporary and permanent;
(34) Tracheoscopy and laryngoscopy with biopsy;
(35) Lobectomy or pneumonectomy;
(36) Diagnostic bronchoscopy and biopsy of bronchus
(requiring surgical or radiological procedures);
(37) Other diagnostic procedures on lung and bronchus
(requiring surgical or radiological procedures);
(38) Incision of pleura, thoracentesis, chest drainage;
(39) Other diagnostic procedures of respiratory tract
and mediastinum (requiring surgical or radiological procedures);
(40) Other non-operating room therapeutic procedures
on respiratory system (requiring surgical procedures);
(41) Other operating room therapeutic procedures on
respiratory system (requiring surgical or radiological procedures);
(42) Heart valve procedures;
(43) Coronary artery bypass graft (CABG);
(44) Percutaneous transluminal coronary angioplasty
(PTCA);
(45) Coronary thrombolysis (requiring surgical or radiological
procedures);
(46) Diagnostic Cardiovascular (Cardiac) catheterization,
coronary arteriography;
(47) Insertion, revision, replacement, removal of Cardiovascular
(Cardiac) pacemaker or cardioverter/defibrillator (requiring surgical
or radiological procedures);
(48) Other operating room heart procedures (requiring
surgical or radiological procedures);
(49) Extracorporeal circulation auxiliary to open heart
procedures (requiring surgical or radiological procedures);
(50) Endarterectomy, vessel of head and neck;
(51) Aortic resection, replacement or anastomosis;
(52) Varicose vein stripping, lower limb;
(53) Other vascular catheterization, not heart;
(54) Peripheral vascular bypass;
(55) Other vascular bypass and shunt, not heart;
(56) Creation, revision and removal of arteriovenous
fistula or vessel-to-vessel cannula for dialysis;
(57) Hemodialysis;
(58) Other operating room procedures on vessels of
head and neck (requiring surgical or radiological procedures);
(59) Embolectomy and endarterectomy of lower limbs
(requiring surgical or radiological procedures);
(60) Other operating room procedures on vessels other
than head and neck (requiring surgical or radiological procedures);
(61) Other diagnostic cardiovascular procedures (requiring
surgical or radiological procedures);
(62) Other non-operating room therapeutic cardiovascular
procedures (requiring surgical or radiological procedures);
(63) Bone marrow transplant;
(64) Bone marrow biopsy;
(65) Procedures on spleen (requiring surgical or radiological
procedures);
(66) Other therapeutic procedures, hemic or lymphatic
system (requiring surgical or radiological procedures);
(67) Ligation of esophageal varices;
(68) Esophageal dilatation (requiring surgical or radiological
procedures);
(69) Upper gastrointestinal endoscopy, biopsy;
(70) Gastrostomy, temporary or permanent;
(71) Colostomy, temporary or permanent;
(72) Ileostomy and other enterostomy;
(73) Gastrectomy, partial or total;
(74) Small bowel resection;
(75) Colonoscopy or biopsy;
(76) Proctoscopy or anorectal biopsy;
(77) Colorectal resection;
(78) Local excision of large intestine lesion (not
endoscopic);
(79) Appendectomy;
(80) Hemorrhoid procedures (requiring surgical or radiological
procedures);
(81) Endoscopic retrograde cannulation of pancreas
(ERCP);
(82) Biopsy of liver;
(83) Cholecystectomy or common duct exploration (requiring
surgical or radiological procedures);
(84) Inguinal or femoral hernia repair (requiring surgical
or radiological procedures);
(85) Other hernia repair (requiring surgical or radiological
procedures);
(86) Laparoscopy;
(87) Abdominal paracentesis;
(88) Exploratory laparotomy;
(89) Excision, lysis peritoneal adhesions (requiring
surgical or radiological procedures);
(90) Other bowel diagnostic procedures (requiring surgical
or radiological procedures);
(91) Other non-operating room upper GI therapeutic
procedures (requiring surgical or radiological procedures);
(92) Other operating room upper GI therapeutic procedures
(requiring surgical or radiological procedures);
(93) Other non-operating room lower GI therapeutic
procedures (requiring surgical or radiological procedures);
(94) Other operating room lower GI therapeutic procedures
(requiring surgical or radiological procedures);
(95) Other gastrointestinal diagnostic procedures (requiring
surgical or radiological procedures);
(96) Other non-operating room gastrointestinal therapeutic
procedures (requiring surgical or radiological procedures);
Cont'd... |
