Procedural Cross Coder

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Essential links from ICD-9-CM volume 3 procedure codes to CPT® and HCPCS Level II codes

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Contents

Introduction...... i Operations on the Hemic and Lymphatic History...... i System (40–41) ...... 121 Format...... i Operations on the Digestive System (42–54) ...... 127 Organization...... i Operations on the Urinary System (55–59) ...... 170 Crosswalking the Codes...... ii Operations on the Male Genital Organs Procedures and Interventions NEC (00) ...... 1 (60–64) ...... 184 Operations on the Nervous System (01–05) ...... 8 Operations on the Female Genital Organs Operations on the Endocrine System (06–07) ...... 26 (65–71) ...... 193 Operations on the Eye (08–16) ...... 31 Obstetrical Procedures (72–75) ...... 211 Other Miscellaneous Diagnositic and Operations on the Musculoskeletal Therapeutic Procedures (17.1–17.71) ...... 52 System (76–84) ...... 217 Operations on the Ear (18–20) ...... 55 Operations on the Integumentary Operations on the Nose Mouth, and System (85–86) ...... 288 Pharynx (21–29) ...... 61 Miscellaneous Diagnostic and Therapeutic Operations on the Respiratory System (30–34)..... 77 Procedures (87–99)...... 305 Operations on the Cardiovascular Glossary ...... 387 System (35–39)...... 87

Introduction

Parallel procedural coding systems have been in place in U.S. • Each ICD-9-CM volume 3 code is linked to all applicable CPT medical reimbursement circles for decades. ICD-9-CM volume 3, codes, which are printed with their official, complete AMA established in 1975 by the federal Centers for Medicare and descriptions. Medicaid Services (CMS), is now in its fifth edition. ICD-9-CM, • Each ICD-9-CM volume 3 code is linked to all applicable volume 3 is the coding system used by hospitals to report inpatient surgical HCPCS codes. care. The American Medical Association’s (AMA) Current Procedural Terminology (CPT®), first published in 1966, is now in its fourth • All ICD-9-CM volume 3 codes are valid and of the highest edition. This coding system covers outpatient (office) services, and level of specificity. inpatient (hospital) services performed specifically by the • The ICD-9-CM volume 3, CPT, and HCPCS code sets have physician. Each system has strengths within the market it serves. been updated to include 2011 changes. Until recently, each was autonomous. Organization Today’s consolidated health care environment is creating conflicts Prior to using the OptumInsight 2012 Procedural Cross Coder, take between the two systems. Many hospitals operate outpatient the time to study the format and to understand the conventions of facilities in which CPT coding is used instead of ICD-9-CM ICD-9-CM and CPT coding. The crosswalk is organized similar to procedural coding. With the advent of ambulatory surgical centers ICD-9-CM volume 3. These codes are presented in numeric order, and physician office surgical suites, many procedures that were and the section title from ICD-9-CM appears at the top of each once performed exclusively for inpatient services now can be page. The sections are organized by anatomy, rather than surgical performed as either inpatient or outpatient services. Consequently, specialty: two coding systems are in use for the same procedures. Procedures and Interventions, NEC (00) Managers have difficulty tracking frequencies or costs when the Operations on the Nervous System (01-05) facility data contains both ICD-9-CM and CPT codes. Payers and government statisticians become mired in tracking trends when Operations on the Endocrine System (06-07) their statistics contain both code sets. The OptumInsight 2012 Operations on the Eye (08-16) Procedural Cross Coder is designed to act as a bridge to connect Other Miscellaneous Diagnostic and Therapeutic ICD-9-CM procedural codes and CPT codes. It gives coders an Procedures (17) easy-to-use reference when selecting the correct CPT procedural Operations on the Ear (18-20) code from ICD-9-CM volume 3 codes. The crosswalk translates the Operations on the Nose, Mouth, and Pharynx (21-29) selected procedural codes for services provided by the physician in either the inpatient or outpatient setting. Operations on the Respiratory System (30-34) History Operations on the Cardiovascular System (35-39) Operations on the Hemic and Lymphatic Systems (40-41) ICD-9-CM volume 3 draws heavily from procedural classifications developed in the early 1970s by an international committee Operations on the Digestive System (42-54) sponsored by the World Health Organization (WHO). Significant Operations on the Urinary System (55-59) work on surgical procedures for this project came from the United Operations on the Male Genital Organs (60-64) States, and that original work is the basis for today’s ICD-9-CM, Operations on the Female Genital Organs (65-71) volume 3. Current procedural coding evolved from a three- to Obstetrical Procedures (72-75) four-digit system necessitated by the demand for more specific clinical detail. Operations on the Musculoskeletal System (76-84) Operations on the Integumentary System (85-86) CMS maintains the volume 3 codes, which include operative, diagnostic, and therapeutic procedures. Annual code revisions Miscellaneous Diagnostic and Therapeutic Procedures (87-99) reflect the goal of a procedure coding system that can be used with The most important factor in ICD-9-CM procedure coding is equal efficiency both in hospitals and other primary care settings. understanding the rules. Format Only valid codes—those that are coded to their highest level of OptumInsight 2012 Procedural Cross Coder offers these features: specificity—are included in the crosswalk. If you are seeking information about a code that is not at its highest level of specificity, • Numeric listing of all valid ICD-9-CM volume 3 codes and you should seek your answer among all the valid codes within that their official, complete government descriptions. rubric. For instance, if you are working with the invalid code 24.3, review 24.31, 24.32, and 24.39 for the best CPT crosswalk.

© 2011 Optum CPT © 2011 American Medical Association. All Rights Reserved. i Procedural Cross Coder 45.62 45.41 45383 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or Excision of lesion or tissue of large intestine snare technique CPT Codes 45384 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), 44110 Excision of 1 or more lesions of small or large intestine not requiring anastomosis, or other lesion(s) by hot biopsy forceps or bipolar cautery exteriorization, or fistulization; single enterotomy 45385 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), 44111 Excision of 1 or more lesions of small or large intestine not requiring anastomosis, or other lesion(s) by snare technique exteriorization, or fistulization; multiple enterotomies 45.49 45.42 Other destruction of lesion of large intestine Endoscopic polypectomy of large intestine CPT Codes CPT Codes 44799 Unlisted procedure, intestine 44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery 45.50 44393 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not Isolation of intestinal segment, not otherwise specified amenable to removal by hot biopsy forceps, bipolar cautery or snare technique 44394 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by CPT Codes snare technique See code for primary procedure. 45320 Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, 45.51 laser) Isolation of segment of small intestine 45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery CPT Codes 45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare See code for primary procedure. technique 45339 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not 45.52 amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Isolation of segment of large intestine 45383 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or CPT Codes snare technique See code for primary procedure. 45384 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery 45.61 45385 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), Multiple segmental resection of small intestine or other lesion(s) by snare technique CPT Codes 44110 Excision of 1 or more lesions of small or large intestine not requiring anastomosis, 45.43 exteriorization, or fistulization; single enterotomy Endoscopic destruction of other lesion or tissue of large intestine 44111 Excision of 1 or more lesions of small or large intestine not requiring anastomosis, CPT Codes exteriorization, or fistulization; multiple enterotomies 44391 Colonoscopy through stoma; with control of bleeding (eg, injection, bipolar cautery, 44120 Enterectomy, resection of small intestine; single resection and anastomosis unipolar cautery, laser, heater probe, stapler, plasma coagulator) 44121 Enterectomy, resection of small intestine; each additional resection and anastomosis 44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by (List separately in addition to code for primary procedure) hot biopsy forceps or bipolar cautery 44125 Enterectomy, resection of small intestine; with enterostomy 44393 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique 45.62 44394 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by Other partial resection of small intestine snare technique 45317 Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, CPT Codes unipolar cautery, laser, heater probe, stapler, plasma coagulator) 43496 Free jejunum transfer with microvascular anastomosis 45320 Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not 44120 Enterectomy, resection of small intestine; single resection and anastomosis amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, 44121 Enterectomy, resection of small intestine; each additional resection and anastomosis laser) (List separately in addition to code for primary procedure) 45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot 44125 Enterectomy, resection of small intestine; with enterostomy biopsy forceps or bipolar cautery 44126 Enterectomy, resection of small intestine for congenital atresia, single resection and 45334 Sigmoidoscopy, flexible; with control of bleeding (eg, injection, bipolar cautery, unipolar anastomosis of proximal segment of intestine; without tapering cautery, laser, heater probe, stapler, plasma coagulator) 44127 Enterectomy, resection of small intestine for congenital atresia, single resection and 45335 Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance anastomosis of proximal segment of intestine; with tapering 45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare 44128 Enterectomy, resection of small intestine for congenital atresia, single resection and technique anastomosis of proximal segment of intestine; each additional resection and anastomosis 45339 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not (List separately in addition to code for primary procedure) amenable to removal by hot biopsy forceps, bipolar cautery or snare technique 44132 Donor enterectomy (including cold preservation), open; from cadaver donor 45381 Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), 44133 Donor enterectomy (including cold preservation), open; partial, from living donor any substance 44202 Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and 45382 Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding (eg, injection, anastomosis bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) 44203 Laparoscopy, surgical; each additional small intestine resection and anastomosis (List separately in addition to code for primary procedure)

25652 Open treatment of ulnar styloid fracture 28445 Open treatment of talus fracture, includes internal fixation, when performed 28446 Open osteochondral autograft, talus (includes obtaining graft[s]) 79.23 28465 Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal Open reduction of fracture of carpals and metacarpals without internal fixation fixation, when performed, each 28485 Open treatment of metatarsal fracture, includes internal fixation, when performed, each CPT Codes 25628 Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when 79.28 performed Open reduction of fracture of phalanges of foot without internal fixation 25645 Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone CPT Codes 26615 Open treatment of metacarpal fracture, single, includes internal fixation, when 28505 Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, performed, each bone when performed 26665 Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), 28525 Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal includes internal fixation, when performed fixation, when performed, each 28531 Open treatment of sesamoid fracture, with or without internal fixation 79.24 Open reduction of fracture of phalanges of hand without internal fixation 79.29 CPT Codes Open reduction of fracture of other specified bone, except facial bones, without 26735 Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or internal fixation thumb, includes internal fixation, when performed, each CPT Codes 26746 Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal 21805 Open treatment of rib fracture without fixation, each joint, includes internal fixation, when performed, each 21825 Open treatment of sternum fracture with or without skeletal fixation 26765 Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, 22325 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior when performed, each approach, 1 fractured vertebra or dislocated segment; lumbar 22326 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior 79.25 approach, 1 fractured vertebra or dislocated segment; cervical Open reduction of fracture of femur without internal fixation 22327 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic CPT Codes 22328 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior 27254 Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra fracture, with or without internal or external fixation or dislocated segment (List separately in addition to code for primary procedure) 27269 Open treatment of femoral fracture, proximal end, head, includes internal fixation, 23515 Open treatment of clavicular fracture, includes internal fixation, when performed when performed 23585 Open treatment of scapular fracture (body, glenoid or acromion) includes internal 27511 Open treatment of femoral supracondylar or transcondylar fracture without intercondylar fixation, when performed extension, includes internal fixation, when performed 27202 Open treatment of coccygeal fracture 27513 Open treatment of femoral supracondylar or transcondylar fracture with intercondylar 27215 Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral, extension, includes internal fixation, when performed for pelvic bone fracture patterns that do not disrupt the pelvic ring, includes internal 27514 Open treatment of femoral fracture, distal end, medial or lateral condyle, includes fixation, when performed internal fixation, when performed 27217 Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed 79.26 (includes pubic symphysis and/or ipsilateral superior/inferior rami) Open reduction of fracture of tibia and fibula without internal fixation 27218 Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed CPT Codes (includes ipsilateral ilium, sacroiliac joint and/or sacrum) 27535 Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal 27766 Open treatment of medial malleolus fracture, includes internal fixation, when performed fixation, when performed 27769 Open treatment of posterior malleolus fracture, includes internal fixation, when 27536 Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal performed fixation 27814 Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral 27540 Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, and posterior malleoli, or medial and posterior malleoli), includes internal fixation, includes internal fixation, when performed when performed 27784 Open treatment of proximal fibula or shaft fracture, includes internal fixation, when 27822 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, performed medial and/or lateral malleolus; without fixation of posterior lip 27792 Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, 27823 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, when performed medial and/or lateral malleolus; with fixation of posterior lip 27829 Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed HCPCS Level II Procedure Codes 28446 Open osteochondral autograft, talus (includes obtaining graft[s]) G0412 Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring, includes internal fixation, when performed 79.27 G0414 Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns Open reduction of fracture of tarsals and metatarsals without internal fixation which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when CPT Codes performed (includes pubic symphysis and/or superior/inferior rami) 28415 Open treatment of calcaneal fracture, includes internal fixation, when performed; G0415 Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns 28420 Open treatment of calcaneal fracture, includes internal fixation, when performed; with which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when primary iliac or other autogenous bone graft (includes obtaining graft) performed (includes ilium, sacroiliac joint and/or sacrum)