Rvs Code Description Requirement Annex 10. List

Rvs Code Description Requirement Annex 10. List

ANNEX 10. LIST OF ALTERNATIVE DOCUMENTS FOR RECORD OF OPERATIVE OR SURGICAL TECHNIQUE RVS CODE DESCRIPTION REQUIREMENT none ; operating room and anesthesia 77401 Radiation treatment delivery (Linear Accelerator) records are waived none ; operating room and anesthesia 77401 Radiation treatment delivery (Cobalt) records are waived Dialysis procedure other than hemodialysis (e.g. none ; operating room and anesthesia 90945 peritoneal, hemofiltration) records are waived none ; operating room and anesthesia 96408 Chemotherapy administration records are waived none ; operating room and anesthesia 79000 Radiopharmaceutical (radioactive iodine) therapy records are waived Simple repair of superficial wounds of scalp, neck, axillae, doctor's order and/or nurse's notes 12001 external genitalia, trunk and/or extremities (including indicating performance of the procedure hands and feet); 2.5 cm or less Simple repair of superficial wounds of scalp, neck, axillae, doctor's order and/or nurse's notes 12002 external genitalia, trunk and/or extremities (including indicating performance of the procedure hands and feet); 2.6 cm to 7.5 cm Simple repair of superficial wounds of scalp, neck, axillae, doctor's order and/or nurse's notes 12004 external genitalia, trunk and/or extremities (including indicating performance of the procedure hands and feet); 7.6 cm to 12.5 cm Simple repair of superficial wounds of scalp, neck, axillae, doctor's order and/or nurse's notes 12005 external genitalia, trunk and/or extremities (including indicating performance of the procedure hands and feet); 12.6 cm to 20.0 cm Simple repair of superficial wounds of scalp, neck, axillae, doctor's order and/or nurse's notes 12006 external genitalia, trunk and/or extremities (including indicating performance of the procedure hands and feet); 20.1 cm to 30.0 cm Simple repair of superficial wounds of scalp, neck, axillae, doctor's order and/or nurse's notes 12007 external genitalia, trunk and/or extremities (including indicating performance of the procedure hands and feet); over 30.0 cm Simple repair of superficial wounds of face, ears, eyelids, doctor's order and/or nurse's notes 12011 nose, lips and/or mucous membranes; 2.5 cm or less indicating performance of the procedure Simple repair of superficial wounds of face, ears, eyelids, doctor's order and/or nurse's notes 12013 nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm indicating performance of the procedure Simple repair of superficial wounds of face, ears, eyelids, doctor's order and/or nurse's notes 12014 nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm indicating performance of the procedure Simple repair of superficial wounds of face, ears, eyelids, doctor's order and/or nurse's notes 12015 nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm indicating performance of the procedure Simple repair of superficial wounds of face, ears, eyelids, doctor's order and/or nurse's notes 12016 nose, lips and/or mucous membranes; 12.6 cm to 20.0 indicating performance of the procedure cm Simple repair of superficial wounds of face, ears, eyelids, doctor's order and/or nurse's notes 12017 nose, lips and/or mucous membranes; 20.1 cm to 30.0 indicating performance of the procedure cm Simple repair of superficial wounds of face, ears, eyelids, doctor's order and/or nurse's notes 12018 nose, lips and/or mucous membranes; over 30.0 cm indicating performance of the procedure Page 1 of 14 ANNEX 10. LIST OF ALTERNATIVE DOCUMENTS FOR RECORD OF OPERATIVE OR SURGICAL TECHNIQUE RVS CODE DESCRIPTION REQUIREMENT Layer closure of wounds of scalp, axillae, trunk, and/or doctor's order and/or nurse's notes 12031 extremities (excluding hands and feet); 2.5 cm or less indicating performance of the procedure Layer closure of wounds of scalp, axillae, trunk, and/or doctor's order and/or nurse's notes 12032 extremities (excluding hands and feet); 2.6 cm to 7.5 cm indicating performance of the procedure Layer closure of wounds of scalp, axillae, trunk, and/or doctor's order and/or nurse's notes 12034 extremities (excluding hands and feet); 7.6 cm to 12.5 cm indicating performance of the procedure Layer closure of wounds of scalp, axillae, trunk, and/or doctor's order and/or nurse's notes 12035 extremities (excluding hands and feet); 12.6 cm to 20.0 indicating performance of the procedure cm Layer closure of wounds of scalp, axillae, trunk, and/or doctor's order and/or nurse's notes 12036 extremities (excluding hands and feet); 20.1 cm to 30.0 indicating performance of the procedure cm Layer closure of wounds of scalp, axillae, trunk, and/or doctor's order and/or nurse's notes 12037 extremities (excluding hands and feet); over 30.0 cm indicating performance of the procedure Layer closure of wounds of neck, hands, feet and/or doctor's order and/or nurse's notes 12041 external genitalia; 2.5 cm or less indicating performance of the procedure Layer closure of wounds of neck, hands, feet and/or doctor's order and/or nurse's notes 12042 external genitalia; 2.6 cm to 7.5 cm indicating performance of the procedure Layer closure of wounds of neck, hands, feet and/or doctor's order and/or nurse's notes 12044 external genitalia; 7.6 cm to 12.5 cm indicating performance of the procedure Layer closure of wounds of neck, hands, feet and/or doctor's order and/or nurse's notes 12045 external genitalia; 12.6 cm to 20.0 cm indicating performance of the procedure Layer closure of wounds of neck, hands, feet and/or doctor's order and/or nurse's notes 12046 external genitalia; 20.1 cm to 30.0 cm indicating performance of the procedure Layer closure of wounds of neck, hands, feet and/or doctor's order and/or nurse's notes 12047 external genitalia; over 30.0 cm indicating performance of the procedure Layer closure of wounds of face, ears, eyelids, nose, lips doctor's order and/or nurse's notes 12051 and/or mucous membrances; 2.5 cm or less indicating performance of the procedure Layer closure of wounds of face, ears, eyelids, nose, lips doctor's order and/or nurse's notes 12052 and/or mucous membrances; 2.6 cm to 5.0 cm indicating performance of the procedure Layer closure of wounds of face, ears, eyelids, nose, lips doctor's order and/or nurse's notes 12053 and/or mucous membrances; 5.1 cm to 7.5 cm indicating performance of the procedure Layer closure of wounds of face, ears, eyelids, nose, lips doctor's order and/or nurse's notes 12054 and/or mucous membrances; 7.6 cm to 12.5 cm indicating performance of the procedure Layer closure of wounds of face, ears, eyelids, nose, lips doctor's order and/or nurse's notes 12055 and/or mucous membrances; 12.6 cm to 20.0 cm indicating performance of the procedure Layer closure of wounds of face, ears, eyelids, nose, lips doctor's order and/or nurse's notes 12056 and/or mucous membrances; 20.1 cm to 30.0 cm indicating performance of the procedure Page 2 of 14 ANNEX 10. LIST OF ALTERNATIVE DOCUMENTS FOR RECORD OF OPERATIVE OR SURGICAL TECHNIQUE RVS CODE DESCRIPTION REQUIREMENT Layer closure of wounds of face, ears, eyelids, nose, lips doctor's order and/or nurse's notes 12057 and/or mucous membrances; over 30.0 cm indicating performance of the procedure doctor's order and/or nurse's notes 31600 Tracheostomy, planned ; indicating performance of the procedure doctor's order and/or nurse's notes 31601 Tracheostomy, planned ; under two years indicating performance of the procedure doctor's order and/or nurse's notes 31603 Tracheostomy, emergency procedure; transtracheal indicating performance of the procedure Tracheostomy, emergency procedure; cricothyroid doctor's order and/or nurse's notes 31605 membrane indicating performance of the procedure doctor's order and/or nurse's notes 31610 Tracheostomy, fenestration procedure with skin flaps indicating performance of the procedure Thoracentesis, puncture of pleural cavity for aspiration, doctor's order and/or nurse's notes 32000 initial or subsequent indicating performance of the procedure Thoracentesis w/ insertion of tube w/ or w/o water seal doctor's order and/or nurse's notes 32002 (e.g., for pneumothorax) indicating performance of the procedure Tube thoracostomy w/ or w/o water seal (e.g., for doctor's order and/or nurse's notes 32020 abscess, hemothorax, empyema) indicating performance of the procedure Arterial catheterization for prolonged infusion therapy doctor's order and/or nurse's notes 36640 (chemotherapy), cutdown indicating performance of the procedure Placement of central venous catheter (subclavian, jugular, or other vein) (e.g., for central venous pressure, doctor's order and/or nurse's notes 36488 hyperalimentation, hemodialysis, or chemotherapy); indicating performance of the procedure percutaneous or cutdown doctor's order and/or nurse's notes 38220 Bone marrow aspiration and/or biopsy indicating performance of the procedure Peritoneocentesis, abdominal paracentesis, or peritoneal doctor's order and/or nurse's notes 49080 lavage (diagnostic or therapeutic) indicating performance of the procedure doctor's order and/or nurse's notes 62270 Spinal puncture, lumbar, diagnostic indicating performance of the procedure 31231 Nasal endoscopy, diagnostic, unilateral or bilateral official report Nasal/sinus endoscopy, diagnostic w/ maxillary 31233 sinusoscopy (via inferior meatus or canine fossa official report puncture) Nasal/sinus endoscopy, diagnostic w/ sphenoid 31235 sinusoscopy (via puncture of sphenoidal face or official report cannulation of ostium) Nasal/sinus endoscopy, surgical; w/ biopsy, polypectomy 31237 official report or debridement 31238 Nasal/sinus endoscopy, surgical; w/ control of epistaxis official report Page 3 of 14 ANNEX 10.

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