ENT SUPERBILL DANIEL TODD, MD, FACS FACILITY: SVH MCK SFSC VA CLINIC PT NAME_______________________________________ DOB_____________________________ DATE____________________________ NEW PATIENT EST PATIENT LOW 99202 LOW 99212 MED 99203 MOD 99213 HIGH 99204 HIGH 99214 OUT PATIENT CONSULT INPATIENT CONSULT IN CONSULT SUBSEQUENT LOW 99242 MEDIUM 99252 LOW 99231 MODERATE 99243 HIGH 99253 MEDIUM 99232 HIGH 99244 COMPLEX 99254 HIGH 99233 HOSPITAL ADMISSIONS HOSPITAL SUBSEQUENT HOSPITAL DISCHARGE LOW 99221 LOW 99231 LOW 99238 MEDIUM 99222 MEDIUM 99232 HIGH 99239 HIGH 99223 HIGH 99233 NASAL PROCEDURES ORAL/PHARYNX EAR PROCEDURES SKIN BIOPSY 11100 TONGUE BX 41110 CERUMEN 69210 EXC BENIGN <0.5 11440 VEST BX 40808 EXT EAR BX 69100 EXC CANCER <0.5 11640 FOM BX 41116 EXC LESION EAR 69110 COMPLEX REPAIR 13150 OP BX 42800 EAC LESION EXC 69145 RIDGID ENDO 31231 LIP BX 40490 MASTOID CLEAN 69220 FDE 31276 DL 31525 PET 69436 SEPTO 30520 DL WITH MICRO 31526 REMOVAL PET 69424 TE 31255 DL/MICRO/BX 31536 T-PLASTY 69631/20926-59 MA WITH TISSUE 31267 DL/MICRO/EXC 31541 TYMPMASTIOD 69641 AE 31254 FRENULOPLAST 41520 MYRINGOTOMY 69421 SPHENOID 31287 FLEXIBLE 31575 STAPES 69660 MA 31256 BRONCH 31622 MICRODISSECT 69990 SUBMUC TURB 30140 ESOPH 43200 MEE 69440 CONCHA BULL 31240 T&A <12 42820 NECK PROCEDURES POLYP/DEBRIDE 31237 T&A >12 42821 NECK NODE 38510 SEPTORHINO 30420 TONSIL >12 42826 NECK DISSECT. 38724 RHINO 30410 UP3 42145 SUBMAX 42440 NASAL VALVE 30465 ADENOID <12 42830 SUP. PAROTID 42415 OPEN RED FX 21335 ADENOID >12 42831 SUPRAHYOID 38700 SEPTAL GRAFT 20912(spreaders) 2ND ADEN <12 42835 THYROID 60240 VTI 61795 2ND ADEN >12 42836 EXC JUG NODES 38542 ENDO CAUTERY 31238 POST T&A BLEED 42962 TRACH 31600 OUT FX TURBS 30930 UVULECTOMY 42140 TRACH CHANGE 31502 CAUTERY SIM 30901 DRAIN PTA 42700 FNA NODE 10021 CAUTERY COM 30903 EVAL TONSIL BLEED 42961 TGDC 60280 FB NOSE 30300 OP TONSIL BLEED 42962 PAPER PATCH 69610-52 FB EAR CLINIC 69200 EXT DRAIN PPA 42725 KENALOG TURB 30200 NASAL SYNECHIAE 30560 BOT SOMNUS 0088T MICROSCOPY 92504 EPPLEY 92700 THYROPLASTY 31588 BLEPH 15823 CRYO 17000/17003 (2-14) VENIPUNCTURE 36415 STREP TEST 87070 REGIONAL FLAP 14060 PET OFFICE 69433 EAR DIAGNOSIS NOSE DIAGNOSIS ORAL CAVITY DIAGNOSIS Cerumen Impaction 380.4 Deviated septum 470 Halitosis 784.9 Cholesteatoma 385.30 NAO/Stenosis 478.1/519.8 Thrush 112.0 Language delay 315.31 Epistaxis 784.7 Sialadenitis 527.2 Dizziness 780.4 Vestibulitis/Mucocele 478.1 Sialolithiasis 527.5 E Tube dysfunction 381.81 Anosmia 781.1 Ankyloglossia 750.0 Conductive Hearing Loss 389.00 Polyp, nasal cavity 471.0 NECK & FACE DIAGNOSIS Mixed Hearing Loss 389.2 Rhinitis, Acute 460 Neck Cancer 196 Sensorineural H. Loss 389.10 Rhinitis, Allergic 477.9 Cervical LAD 785.6 Otitis Externa, Acute 380.10 Rhinitis, Chronic 472.0 Thyroid goiter 240.0 Otitis Externa, Chronic 380.23 Sinusitis NOS 473.9 Skin Cancer Face 173.3 Allergic Otitis 381.05 Polyp, sinus 471.8 Face/Neck Injury 959.09 Otitis Media, Acute 381.00 Sinusitis Ethmoid Chronic 473.2 Thyroid nodule 241.0 Otitis Media, Chronic 381.10 Sinusitis Frontal Chronic 473.1 Mass 784.2 NIPTS 388.12 Sinusitis Maxillary Chronic 473.0 Facial/Head pain 784.0 Eczema of Ext. Ear 380.22 Sinusitis Maxillary Acute 461.0 TMJ 524.60 Otorrhea 388.60 Sinusitis Sphenoid Chronic 473.3 Complex face lacs 873.50 TM perforation 384.20 Turbinate hypertrophy 478.0 LARYNX DIAGNOSIS TM perforation, traumatic 872.61 Nasal fracture 802.0 Globus sensation 784.1 Otalgia, unspecified 388.70 Facial Pain 784.0 Cough 786.2 Otomycosis 111.8 Aquired Deformity 738.0 Hoarseness 784.49 BPPV 386.11 PHARYNX DIAGNOSIS Laryngitis, chronic 476.0 Tinnitus, subjective 388.31 Adenoid hypertrophy 474.12 Vocal cord nodule 478.5 Vertigo peripheral 386.10 Mono 075 Bronchitis 490 Otosclerosis 387.0 Dysphagia 787.2 GERD 530.81 Auricle cancer 173.2 Strep throat 034.0 OTHER SLEEP DIAGNOSIS Tonsil hypertrophy 474.11 Urticaria 708.0 Snoring 786.09 T&A hypertrophy 474.10 Allergic Conjunctivitis 372.14 Sleep Disturbance NOS 780.50 Tonsillitis, chronic 474.00 URT Allergic RXN 478.8 Insomnia 780.52 Tonsillitis/adenoiditis chronic 474.02 Asthma 493.00 Fatigue 780.79 PTA 475 Resp Dz 518.81 Obstructive apnea 780.53 ParaPharynx Abscess 478.22 Larynx Dz 478.79 Hypothyroid 244.9 Post Op Tonsil Bleed 998.11 Dehydration 276.5 Stridor 786.1 Tonsil CA 146.0 Larynx CA 161.0 Blepharochalasia 374.34 F.B. Nose 932.0 F.B. Ear 931.0 Atopic Dermatitis 691.8 Food Allergies 693.1 MODIFIERS: 25-UNRELATED PROCEDURE 79-UNRELATED POST OP PROCEDURE 24-UNRELATED POST OP SERVICE 57-URGENT DECISION FOR SURGERY 59-DISTINCT PROCEDURE 22-DIFFICULT/UNUSUAL 58-STAGED PROCEDURE 78-RETURN TO OR FOR RELATED PROCEDURE/COMPLICATION.