commonly billed codes - medtronic...30630 repair nasal septal defect 090 n/a 18.45 $666 $666 30801...

12
1$6$/ $1' 6,186 352&('85(6 ())(&7,9( -$18$5< &20021/< %,//(' &2'(6 8&G(1

Upload: others

Post on 23-Dec-2020

0 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

1$6$/�$1'�6,186� 352&('85(6 ())(&7,9(�-$18$5<�����

&20021/<�%,//('�&2'(6

8&���������G(1

Page 2: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

0HGWURQLF� SURYLGHV� WKLV� LQIRUPDWLRQ� IRU� \RXU� FRQYHQLHQFH� RQO\�� ,W� GRHV� QRW� FRQVWLWXWH� OHJDO� DGYLFH� RU� D�UHFRPPHQGDWLRQ� UHJDUGLQJ� FOLQLFDO� SUDFWLFH�� ,QIRUPDWLRQ� SURYLGHG� LV� JDWKHUHG� IURP� WKLUG-SDUW\� VRXUFHV� DQG� LV�VXEMHFW� WR� FKDQJH� ZLWKRXW� QRWLFH� GXH� WR� IUHTXHQWO\� FKDQJLQJ� ODZV�� UXOHV� DQG� UHJXODWLRQV�� 7KH� SURYLGHU� KDV� WKH�UHVSRQVLELOLW\�WR�GHWHUPLQH�PHGLFDO�QHFHVVLW\�DQG� �WR�VXEPLW�DSSURSULDWH�FRGHV�DQG�FKDUJHV�IRU�WKH�FDUH�SURYLGHG��0HGWURQLF�PDNHV�QR�JXDUDQWHH�WKDW�WKH�XVH�RI�WKLV�LQIRUPDWLRQ�ZLOO�SUHYHQW�GLƪHUHQFHV�RI�RSLQLRQ�RU�GLVSXWHV�ZLWK�0HGLFDUH� RU� RWKHU� SD\HUV� DV� WR� WKH� FRUUHFW� IRUP�RI� ELOOLQJ� RU� WKH� DPRXQW� WKDW�ZLOO� EH� SDLG� WR� SURYLGHUV� RI� VHUYLFH��3OHDVH� FRQWDFW� \RXU� 0HGLFDUH� FRQWUDFWRU�� RWKHU� SD\HUV�� UHLPEXUVHPHQW� VSHFLDOLVWV� DQG�RU� OHJDO� FRXQVHO� IRU�LQWHUSUHWDWLRQ�RI�FRGLQJ��FRYHUDJH�DQG�SD\PHQW�SROLFLHV��7KLV�GRFXPHQW�SURYLGHV�DVVLVWDQFH� IRU�)'$�DSSURYHG�RU�FOHDUHG� LQGLFDWLRQV�� :KHUH� UHLPEXUVHPHQW� LV� VRXJKW� IRU� XVH� RI� D� SURGXFW� WKDW� PD\� EH� LQFRQVLVWHQW� ZLWK�� RU� QRW�H[SUHVVO\�VSHFLƬHG�LQ��WKH�)'$�FOHDUHG�RU�DSSURYHG�ODEHOLQJ��H�J��LQVWUXFWLRQV�IRU�XVH��RSHUDWRUpV�PDQXDO�RU�SDFNDJH�LQVHUW���FRQVXOW�ZLWK�\RXU�ELOOLQJ�DGYLVRUV�RU�SD\HUV�RQ�KDQGOLQJ�VXFK�ELOOLQJ�LVVXHV��6RPH�SD\HUV�PD\�KDYH�SROLFLHV�WKDW�PDNH�LW�LQDSSURSULDWH�WR�VXEPLW�FODLPV�IRU�VXFK�LWHPV�RU�UHODWHG�VHUYLFH�� 7KH�IROORZLQJ�LQIRUPDWLRQ�LV�FDOFXODWHG�SHU�WKH�IRRWQRWHV�LQFOXGHG�DQG�GRHV�QRW�WDNH�LQWR�HƪHFW�0HGLFDUH�SD\PHQW�UHGXFWLRQV�UHVXOWLQJ�IURP�VHTXHVWUDWLRQ�DVVRFLDWHG�ZLWK�WKH�%XGJHW�&RQWURO�$FW�RI�������6HTXHVWUDWLRQ�UHGXFWLRQV�ZHQW�LQWR�HƪHFW�RQ��$SULO���������

,&'-��-&0��'LDJQRVLV�&RGHV 'LDJQRVLV� FRGHV� DUH� XVHG� E\� ERWK� SK\VLFLDQV� DQG� KRVSLWDOV� WR� GRFXPHQW� WKH� LQGLFDWLRQ� IRU� WKH� SURFHGXUH��%HFDXVH�V\PSWRPV�FRGHV�DUH�JHQHUDOO\�QRW�DFFHSWDEOH�DV�WKH�SULQFLSDO�GLDJQRVLV��WKH�SULQFLSDO�GLDJQRVLV�LV�FRGHG�WR�WKH�XQGHUO\LQJ�FRQGLWLRQ�DV�VKRZQ�

$FXWH�5HFXUUHQW��6LQXVLWLV� &KURQLF�6LQXVLWLV�

1DVDO��DQG�6HSWDO�'LVRUGHUV

-���� &KURQLF�0D[LOODU\�6LQXVLWLV

-���� &KURQLF�)URQWDO�6LQXVLWLV

-���� &KURQLF�(WKPRLGDO�6LQXVLWLV

-���� &KURQLF�6SKHQRLGDO�6LQXVLWLV

-���� &KURQLF�3DQVLQXVLWLV

-���� &KURQLF�6LQXVLWLV��8QVSHFLƬHG

-����� $FXWH�5HFXUUHQW�0D[LOODU\�6LQXVLWLV

-����� $FXWH�5HFXUUHQW��)URQWDO�6LQXVLWLV

-����� $FXWH�5HFXUUHQW�(WKPRLGDO�6LQXVLWLV

-����� $FXWH�5HFXUUHQW��6SKHQRLGDO�6LQXVLWLV

-����� $FXWH�5HFXUUHQW��3DQVLQXVLWLV

-����� 2WKHU�$FXWH�5HFXUUHQW�6LQXVLWLV

-����� $FXWH�5HFXUUHQW�6LQXVLWLV��8QVSHFLƬHG�

-���� 'HYLDWHG�1DVDO�6HSWXP��DFTXLUHG�

-���� +\SHUWURSK\�RI�1DVDO�7XUELQDWHV�

-����� 2WKHU�6SHFLƬHG�'LVRUGHU�RI�1RVH�DQG�1DVDO�6LQXVHV

-���� 8QVSHFLƬHG�'LVRUGHU�RI�1RVH�DQG�1DVDO�6LQXVHV

-���� 2WKHU�&KURQLF�6LQXVLWLV

-���� &\VW�DQG�0XFRFHOH�RI�1RVH�DQG�1DVDO�6LQXV

-���� 3RO\S�RI�1DVDO�&DYLW\

-���� 2WKHU�3RO\S�RI�6LQXV��DFFHVVRU\��HWKPRLGDO��PD[LOODU\��VSKHQRLGDO�

)25�48(67,216�3/($6(�&217$&7�86�$7�(17�86�5(,0%856(0(17#0('7521,&�&20

8&���������G(1 &217,18('�21�1(;7�3$*(

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

Page 3: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

+&3&6�,,�'HYLFH�&RGHV� 7KHVH�FRGHV�DUH�XVHG�E\�WKH�HQWLW\�WKDW�SXUFKDVHG�DQG�VXSSOLHG�WKH�PHGLFDO�GHYLFH��'0(��GUXJ��RU�VXSSO\�WR�WKH�SDWLHQW�� 0HGLFDUH� SURYLGHV� &-FRGHV� IRU� KRVSLWDO� XVH� LQ� ELOOLQJ� 0HGLFDUH� IRU� PHGLFDO� GHYLFHV� LQ� WKH� RXWSDWLHQW�VHWWLQJ��$OWKRXJK�RWKHU�SD\HUV�PD\�DOVR�DFFHSW�&-FRGHV�� UHJXODU�+&3&6�,,�GHYLFH�FRGHV�DUH�JHQHUDOO\�XVHG�IRU�ELOOLQJ�QRQ-0HGLFDUH�SD\HUV��� $6&V��KRZHYHU��XVXDOO\�VKRXOG�QRW�DVVLJQ�RU�UHSRUW�+&3&6�,,�GHYLFH�FRGHV�IRU�GHYLFHV�RQ�FODLPV�VHQW�WR�0HGLFDUH��0HGLFDUH�JHQHUDOO\�GRHV�QRW�PDNH�D�VHSDUDWH�SD\PHQW� IRU�GHYLFHV� LQ�WKH�$6&�� ,QVWHDG��SD\PHQW� LV� qSDFNDJHGr�LQWR� WKH�SD\PHQW� IRU� WKH�$6&�SURFHGXUH��$6&V�DUH� VSHFLƬFDOO\� LQVWUXFWHG�QRW� WR�ELOO�+&3&6� ,,� GHYLFH�FRGHV� WR�0HGLFDUH�IRU�GHYLFHV�WKDW�DUH�SDFNDJHG��

'HYLFH�RU�3URGXFW +&3&6 'HVFULSWLRQ���&RPPHQW

(17�6OLGH-2Q70��(QGRVKHDWK706\VWHP� $���� 'LVSRVDEOH�HQGRVFRSH�VKHDWK��HDFK

1X9HQW70���(0�6LQXV�'LODWLRQ�6\VWHP� &���� &DWKHWHU��EDOORRQ�GLODWLRQ��QRQ-YDVFXODU

1RYDSDN70�1DVDO�6LQXV�3DFNLQJ�DQG�6WHQW� &���� &RQQHFWLYH�WLVVXH��QRQ-KXPDQ��LQFOXGHV�V\QWKHWLF�

0HUR3DFN70�%LRUHVRUEDEOH�1DVDO��'UHVVLQJ�DQG�6LQXV�6WHQW�

&���� &RQQHFWLYH�WLVVXH��QRQ-KXPDQ��LQFOXGHV�V\QWKHWLF�

1DVDO�6HSWDO�%XWWRQ 1�$� &RQVLGHU�UHSRUWLQJ�DVVRFLDWHG�FKDUJHV�XQGHU�JHQHUDO�UHYHQXH�FRGH�����IRU�PHGLFDO-VXUJLFDO�VXSSOLHV�

$/$5w�1DVDO�9DOYH�6WHQWV�� 1�$� &RQVLGHU�UHSRUWLQJ�DVVRFLDWHG�FKDUJHV�XQGHU�JHQHUDO�UHYHQXH�FRGH�����IRU�PHGLFDO-VXUJLFDO�VXSSOLHV�

3RZHUHG�6XUJLFDO�(TXLSPHQW��&RQVROH���0LFURGHEULGHU��%XUV��%ODGHV

1�$� &RQVLGHU�UHSRUWLQJ�DVVRFLDWHG�FKDUJHV�XQGHU�JHQHUDO�UHYHQXH�FRGH�����IRU�PHGLFDO-VXUJLFDO�VXSSOLHV�

(17�1DYLJDWLRQ�6\VWHP���,QVWUXPHQWV��$FFHVVRULHV

1�$� &RQVLGHU�UHSRUWLQJ�DVVRFLDWHG�FKDUJHV�XQGHU�JHQHUDO�UHYHQXH�FRGH�����IRU�PHGLFDO-VXUJLFDO�VXSSOLHV�

�� &HQWHUV�IRU�'LVHDVH�&RQWURO�DQG�3UHYHQWLRQ��1DWLRQDO�&HQWHU�IRU�+HDOWK�6WDWLVWLFV��,QWHUQDWLRQDO�&ODVVLƬFDWLRQ�RI�'LVHDVHV��7HQWK�5HYLVLRQ��&OLQLFDO�0RGLƬFDWLRQ��,&'-��-&0���KWWSV���ZZZ�FGF�JRY�QFKV�LFG�LFG��FP�KWP��$FFHVVHG�'HFHPEHU�����������

�� +HDOWKFDUH�&RPPRQ�3URFHGXUH�&RGLQJ�6\VWHP��+&3&6��/HYHO�,,�FRGHV��LQFOXGLQJ�GHYLFH�&-FRGHV��DUH�PDLQWDLQHG�E\�WKH�&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV���KWWS���ZZZ�FPV�JRY�0HGLFDUH�&RGLQJ�+&3&65HOHDVH&RGH6HWV�$OSKD-1XPHULF-+&3&6�KWPO���$FFHVVHG�'HFHPEHU���������

�� $6&V�VKRXOG�UHSRUW�DOO�FKDUJHV�LQFXUUHG��+RZHYHU��RQO\�FKDUJHV�IRU�QRQ-SDFNDJHG�LWHPV�VKRXOG�EH�ELOOHG�DV�VHSDUDWH�OLQH�LWHPV��%HFDXVH�RI�D�0HGLFDUH�UHTXLUHPHQW�WR�SD\�WKH�OHVVHU�RI�WKH�$6&�UDWH�RU�WKH�OLQH-LWHP�FKDUJH��EUHDNLQJ�WKHVH�SDFNDJHG�FKDUJHV�RXW�RQWR�WKHLU�RZQ�OLQHV�FDQ�UHVXOW�LQ�LQFRUUHFW�SD\PHQW�WR�WKH�$6&���&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV���0HGLFDUH�&ODLPV�3URFHVVLQJ�0DQXDO��&KDSWHU���—$PEXODWRU\�6XUJLFDO�&HQWHUV��6HFWLRQ������KWWS���ZZZ�FPV�JRY�5HJXODWLRQV-DQG-*XLGDQFH�*XLGDQFH�0DQXDOV�GRZQORDGV�FOP���F���SGI���$FFHVVHG�'HFHPEHU�����������6HH�DOVR�0/1�0DWWHUV�6(�����S��-�����&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV���0/1�0DWWHUV�1XPEHU�6(�����5HYLVHG���KWWS���ZZZ�FPV�JRY�2XWUHDFK-DQG-(GXFDWLRQ�0HGLFDUH-/HDUQLQJ-1HWZRUN-0/1�0/10DWWHUV$UWLFOHV�GRZQORDGV�6(�����SGI���$FFHVVHG�'HFHPEHU���������

�� 6OLGH-2Q70���(QGR6KHDWK70��1X9HQWw��0HUR*HO70���0HUR3DFN70���1RYDSDN70����+\GUR&OHDQVHw��+\GURGHEULGHU70�DQG�$/$5w�DUH�WUDGHPDUNV�RI�0HGWURQLF��,QF���&KLWRJHO70�LV�GLVWULEXWHG�E\�0HGWURQLF��,QF�

�� 1�$��LQGLFDWHV�WKDW�&06�DQG�RWKHU�SD\HUV�GR�QRW�KDYH�D�QHHG�IRU�WKHVH�LWHPV�WR�EH�LQGLYLGXDOO\�LGHQWLƬHG��DOWKRXJK�WKH�DVVRFLDWHG�FKDUJHV�PXVW�VWLOO�EH�UHSRUWHG��:KHQ�KRVSLWDOV�XVH�D�GHYLFH�RU�VXSSO\�WKDW�GRHV�QRW�KDYH�D�+&3&6�,,�FRGH��WKH\�VKRXOG�UHSRUW�WKH�FKDUJHV�LQ�WKH�JHQHUDO�UHYHQXH�FRGH�IRU�WKH�LWHP��W\SLFDOO\�UHYHQXH�FRGH�����IRU�0HGLFDO-6XUJLFDO�6XSSOLHV��

+\GUR&OHDQVH70��6LQXV�:DVK�'HOLYHU\�6\VWHP���+\GURGHEULGHU70�(QGRVFRSLF�6LQXV�,UULJDWLRQ�6\VWHP�

1�$� &RQVLGHU�UHSRUWLQJ�DVVRFLDWHG�FKDUJHV�XQGHU�JHQHUDO�UHYHQXH�FRGH�����IRU�PHGLFDO-VXUJLFDO�VXSSOLHV�

&KLWRJHO70��(QGRVFRSLF�6LQXV�6XUJHU\�.LW�� &���� &RQQHFWLYH�WLVVXH��QRQ-KXPDQ��LQFOXGHV�V\QWKHWLF�

0HUR*HO70�%LRUHVRUEDEOH�1DVDO�3DFNLQJ�3URGXFWV�

&���� &RQQHFWLYH�WLVVXH��QRQ-KXPDQ��LQFOXGHV�V\QWKHWLF�

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

8&���������G(1

Page 4: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

3K\VLFLDQ�&RGLQJ�DQG�3D\PHQW�—�(ƪHFWLYH�-DQXDU\�������� &37��3URFHGXUH�&RGHV 3K\VLFLDQV�XVH�&37�FRGHV�IRU�DOO�VHUYLFHV��8QGHU�0HGLFDUHpV�5HVRXUFH-%DVHG�5HODWLYH�9DOXH�6FDOH��5%596��PHWKRGRORJ\�IRU� SK\VLFLDQ�SD\PHQW��HDFK�&37�FRGH�LV�DVVLJQHG�D�SRLQW�YDOXH��NQRZQ�DV�WKH�UHODWLYH�YDOXH�XQLW��598���ZKLFK�LV�WKHQ�FRQYHUWHG�WR�D�ƮDW�SD\PHQW�DPRXQW�

3URFHGXUH

&37�&RGH�DQG�'HVFULSWLRQ�

6XUJLFDO *OREDO�

0HGLFDUH 598V�

0HGLFDUH 1DWLRQDO�$YHUDJH�

)RU�SK\VLFLDQ�VHUYLFHV�SURYLGHG�LQ��

3K\VLFLDQ 2ƯFH�

)DFLOLW\ 3K\VLFLDQ 2ƯFH�

)DFLOLW\

&RPSXWHUL]HG�7RPRJUDSK\��

������&RPSXWHG�WRPRJUDSK\��PD[LOORIDFLDO�DUHD��ZLWKRXW�FRQWUDVW�PDWHULDO���&7�6LQXV�

1�$ ���� 1�$ ���� 1�$

6XUJLFDO�1DYLJDWLRQ�

������6WHUHRWDFWLF�FRPSXWHU-DVVLVWHG��QDYLJDWLRQDO��SURFHGXUH��FUDQLDO��H[WUDGXUDO

1�$ 1�$ ���� ���� ����

,QIHULRU�7XUELQDWH�UHVHFWLRQ��DEODWLRQ��5KLQRSODVW\��6HSWRSODVW\�� 6LQXV�/DYDJH��

�������([FLVLRQ�QDVDO�SRO\S��V���VLPSOH ��� ���� ���� ���� ����

�������([FLVLRQ�QDVDO�SRO\S��V����H[WHQVLYH ��� 1�$ ����� ���� ����

������6XEPXFRXV�UHVHFWLRQ��LQIHULRU�WXUELQDWH��SDUWLDO�RU�FRPSOHWH��DQ\�PHWKRG��

��� ���� ���� ���� ����

������5KLQRSODVW\��SULPDU\��LQFOXGLQJ�PDMRU�VHSWDO�UHSDLU

��� 1�$ ����� ������ ������

������5HSDLU�RI�QDVDO�YHVWLEXODU�VWHQRVLV��H�J��VSUHDGHU�JUDIWLQJ��ODWHUDO�QDVDO�ZDOO�UHFRQVWUXFWLRQ������

��� 1�$ ����� ������ ������

������6HSWRSODVW\�RU�VXEPXFRXV�UHVHFWLRQ��ZLWK�RU�ZLWKRXW�FDUWLODJH�VFRULQJ��FRQWRXULQJ�RU�UHSODFHPHQW�ZLWK�JUDIW��

��� 1�$ ����� ���� ����

������6HSWDO�RU�RWKHU�LQWUDQDVDO�GHUPDWRSODVW\ ��� 1�$ ����� ���� ����

������5HSDLU�QDVDO�VHSWDO�GHIHFW ��� 1�$ ����� ���� ����

������&DXWHU\�DQG�RU�DEODWLRQ��PXFRVD�RI�LQIHULRU�WXUELQDWHV��XQLODWHUDO�RU�ELODWHUDO��DQ\�PHWKRG��VXSHUƬFLDO

��� ���� ���� ���� ����

������$EODWLRQ��VRIW�WLVVXH�RI�LQIHULRU�WXUELQDWHV��XQLODWHUDO�RU�ELODWHUDO��DQ\�PHWKRG��H�J��HOHFWURFDXWHU\��UDGLRIUHTXHQF\�DEODWLRQ��RU�WLVVXH�YROXPH�UHGXFWLRQ���LQWUDPXUDO��L�H��VXEPXFRVDO���

��� ���� ���� ���� ����

������)UDFWXUH�QDVDO�LQIHULRU�WXUELQDWH�V���WKHUDSHXWLF�� ��� 1�$ ���� ���� ����

������/DYDJH�E\�FDQQXODWLRQ��PD[LOODU\�VLQXV��DQWUXP�SXQFWXUH�RU�QDWXUDO�RVWLXP�

��� ���� ���� ���� ����

������/DYDJH�E\�FDQQXODWLRQ��VSKHQRLG�VLQXV��DQWUXP�SXQFWXUH�RU�QDWXUDO�RVWLXP�

��� 1�$ ���� ���� ����

1DVDO�6LQXV�(QGRVFRS\�����

������1DVDO�HQGRVFRS\��GLDJQRVWLF��XQLODWHUDO�RU�ELODWHUDO��VHSDUDWH�SURFHGXUH�

��� ���� ���� ���� ���

�������'LDJQRVWLF�HQGRVFRS\�RI�QRVH�DQG�PD[LOODU\�VLQXV�YLD�LQIHULRU�PHDWXVSXQFWXUH

��� ���� ���� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�ELRSV\��SRO\SHFWRP\�RU�GHEULGHPHQWV��VHSDUDWH�SURFHGXUH�

��� ���� ���� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�FRQFKD�EXOORVD�UHVHFWLRQ

��� 1�$ ���� ���� ����

�������6XUJLFDO�HQGRVFRS\�RI�QRVH�ZLWK�FRQWURO�RI�QDVDO�KHPRUUKDJH

��� ���� ���� ���� ����

������,QVHUWLRQ��QDVDO�VHSWDO�SURVWKHVLV��EXWWRQ� ��� ���� ���� ���� ����

&217,18('�21�1(;7�3$*(

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

8&���������G(1

Page 5: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

3K\VLFLDQ�&RGLQJ�DQG�3D\PHQW�FRQWLQXHG

3URFHGXUH

&37�&RGH�DQG�'HVFULSWLRQ�

6XUJLFDO *OREDO�

0HGLFDUH 598V�

0HGLFDUH 1DWLRQDO�$YHUDJH�

)RU�SK\VLFLDQ�VHUYLFHV�SURYLGHG�LQ��

3K\VLFLDQ 2ƯFH�

)DFLOLW\ 3K\VLFLDQ 2ƯFH�

)DFLOLW\

1DVDO�6LQXV�(QGRVFRS\������&RQWLQXHG� �

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK OLJDWLRQ�RI�VSKHQRSDODWLQH�DUWHU\

��� 1�$ ����� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG�SRVWHULRU��LQFOXGLQJ�IURQWDO�VLQXV�H[SORUDWLRQ��ZLWK�RU�ZLWKRXW�UHPRYDO�RI�WLVVXH�IURP�IURQWDO�VLQXV

��� 1�$ ����� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK HWKPRLGHFWRP\��SDUWLDO��DQWHULRU�

��� ����� ���� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG�SRVWHULRU�

��� 1�$ ���� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK PD[LOODU\�DQWURVWRP\

��� 1�$ ���� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU��LQFOXGLQJ�VSKHQRLGRWRP\

��� 1�$ ����� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU��LQFOXGLQJ�VSKHQRLGRWRP\��ZLWK�UHPRYDO�RI�WLVVXH�IURP�VSKHQRLG�VLQXV

��� 1�$ ����� ���� ����

�������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK PD[LOODU\�DQWURVWRP\��ZLWK�UHPRYDO�RI WLVVXH�IURP�PD[LOODU\�VLQXV

��� 1�$ ���� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�IURQWDO�VLQXV�H[SORUDWLRQ��ZLWK�RU�ZLWKRXW�UHPRYDO�RI�WLVVXH�IURP�IURQWDO�VLQXV

��� 1�$ ����� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�VSKHQRLGRWRP\

��� 1�$ ���� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�VSKHQRLGRWRP\��ZLWK�UHPRYDO�RI�WLVVXH�IURP�WKH�VSKHQRLG�VLQXV

��� 1�$ ���� ���� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�PD[LOODU\�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ���WUDQVQDVDO�RU�YLD�FDQLQH�IRVVD

��� ����� ���� ����� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�IURQWDO�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ�

��� ����� ���� ����� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�VSKHQRLG�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ�

��� ����� ���� ����� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI��IURQWDO�DQG�VSKHQRLG�VLQXV�RVWLXP� �H�J��EDOORRQ�GLODWLRQ�

��� ������ ���� ����� ����

�������1DVRSKDU\QJRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�WKH�HXVWDFKLDQ�WXEH���L�H�EDOORRQ�GLODWLRQ����XQLODWHUDO

��� ����� ���� ����� ����

������1DVRSKDU\QJRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�WKH�HXVWDFKLDQ�WXEH���L�H�EDOORRQ�GLODWLRQ����ELODWHUDO

��� ����� ���� ����� ����

127(��&37�FRGHV���������������������� DQG�������DSSO\� WR�FDVHV� LQ�ZKLFK�D�EDOORRQ�FDWKHWHU� LV� WKH�RQO\�LQVWUXPHQW� RU� WRRO� XVHG� DQG� QR� WLVVXH� LV� UHPRYHG�� � 'R� QRW� UHSRUW� ������� ������� ������� RU� ������ ZLWK�HQGRVFRSLF�VLQXV�VXUJHU\�FRGHV�ZKHQ�SHUIRUPHG�RQ�VDPH�VLQXV���

%DOORRQ�'LODWLRQ�RI�(XVWDFKLDQ�7XEH��%'(7�

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

&217,18('�21�1(;7�3$*( 8&���������G(1

Page 6: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

�� &37�FRS\ULJKW������$PHULFDQ�0HGLFDO�$VVRFLDWLRQ��$OO�ULJKWV�UHVHUYHG��&37��LV�D�UHJLVWHUHG�WUDGHPDUN�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ��$SSOLFDEOH�)$56�')$56�5HVWULFWLRQV�$SSO\�WR�*RYHUQPHQW�8VH��)HH�VFKHGXOHV��UHODWLYH�YDOXH�XQLWV��FRQYHUVLRQ�IDFWRUV�DQG�RU�UHODWHG�FRPSRQHQWV�DUH�QRW�DVVLJQHG�E\�WKH�$0$��DUH�QRW�SDUW�RI�&37��DQG�WKH�$0$�LV�QRW�UHFRPPHQGLQJ�WKHLU�XVH��7KH�$0$�GRHV�QRW�GLUHFWO\�RU�LQGLUHFWO\�SUDFWLFH�PHGLFLQH�RU�GLVSHQVH�PHGLFDO�VHUYLFHV��7KH�$0$�DVVXPHV�QR�OLDELOLW\�IRU�GDWD�FRQWDLQHG�RU�QRW�FRQWDLQHG�KHUHLQ�

�� 6XUJLFDO�SURFHGXUHV�DUH�VXEMHFW�WR�D�qJOREDO�SHULRG�r�7KH�JOREDO�SHULRG�GHƬQHV�RWKHU�SK\VLFLDQ�VHUYLFHV�WKDW�DUH�JHQHUDOO\�FRQVLGHUHG�SDUW�RI�WKH�VXUJHU\�SDFNDJH��7KH�VHUYLFHV�DUH�QRW�VHSDUDWHO\�FRGHG��ELOOHG��RU�SDLG�ZKHQ�UHQGHUHG�E\�WKH�SK\VLFLDQ�ZKR�SHUIRUPHG�WKH�VXUJHU\��7KHVH�VHUYLFHV�LQFOXGH��SUHRSHUDWLYH�YLVLWV�WKH�GD\�EHIRUH�RU�WKH�GD\�RI�WKH�VXUJHU\��SRVWRSHUDWLYH�YLVLWV�UHODWHG�WR�UHFRYHU\�IURP�WKH�VXUJHU\�IRU����GD\V�RU����GD\V�GHSHQGLQJ�RQ�WKH�VSHFLƬF�SURFHGXUH��WUHDWPHQW�RI�FRPSOLFDWLRQV�XQOHVV�WKH\�UHTXLUH�D�UHWXUQ�YLVLW�WR�WKH�RSHUDWLQJ�URRP��DQG�PLQRU�SRVWRSHUDWLYH�VHUYLFHV�VXFK�DV�GUHVVLQJ�FKDQJHV�DQG�VXWXUH�UHPRYDO�

�� &HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV�&<������3K\VLFLDQ�)HH�6FKHGXOH�)LQDO�5XOH��&06-����-)��KWWSV���ZZZ�FPV�JRY�PHGLFDUHPHGLFDUH-IHH-VHUYLFH-SD\PHQWSK\VLFLDQIHHVFKHGSIV-IHGHUDO-UHJXODWLRQ-QRWLFHV�FPV-����-I���3XEOLVKHG�'HFHPEHU����������5HYLVHG�'HFHPEHU�����������$FFHVVHG�-DQXDU\�����������7KH�WRWDO�598�DV�VKRZQ�KHUH�LV�WKH�VXP�RI�WKUHH�FRPSRQHQWV��SK\VLFLDQ�ZRUN�598��SUDFWLFH�H[SHQVH�598��DQG�PDOSUDFWLFH�598�

�� 0HGLFDUH�QDWLRQDO�DYHUDJH�SD\PHQW�LV�GHWHUPLQHG�E\�PXOWLSO\LQJ�WKH�VXP�RI�WKH�WKUHH�598V�E\�WKH�FRQYHUVLRQ�IDFWRU��7KH�FRQYHUVLRQ�IDFWRU�IRU�&<������LV�����������&HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV�&<������3K\VLFLDQ�)HH�6FKHGXOH�)LQDO�5XOH��&06-����-)��KWWSV���ZZZ�FPV�JRY�PHGLFDUHPHGLFDUH-IHH-VHUYLFH-SD\PHQWSK\VLFLDQIHHVFKHGSIV-IHGHUDO-UHJXODWLRQ-QRWLFHV�FPV-����-I����3XEOLVKHG�'HFHPEHU����������5HYLVHG�'HFHPEHU�����������$FFHVVHG�-DQXDU\����������

�� 7KH�598V�VKRZQ�DUH�IRU�WKH�SK\VLFLDQpV�VHUYLFHV�DQG�SD\PHQW�LV�PDGH�WR�WKH�SK\VLFLDQ��+RZHYHU��WKHUH�DUH�GLƪHUHQW�598V�DQG�SD\PHQWV�GHSHQGLQJ�RQ�WKH�VHWWLQJ�LQ�ZKLFK�WKH�SK\VLFLDQ�UHQGHUHG�WKH�VHUYLFH��q)DFLOLW\r�LQFOXGHV�SK\VLFLDQ�VHUYLFHV�UHQGHUHG�LQ�KRVSLWDOV��$6&V��DQG�61)V��3K\VLFLDQ�598V�DQG�SD\PHQWV�DUH�JHQHUDOO\�ORZHU�LQ�WKH�q)DFLOLW\r�VHWWLQJ�EHFDXVH�WKH�IDFLOLW\�LV�LQFXUULQJ�WKH�FRVW�RI�VRPH�RI�WKH�VXSSOLHV�DQG�RWKHU�PDWHULDOV��3K\VLFLDQ�598V�DQG�SD\PHQWV�DUH�JHQHUDOO\�KLJKHU�LQ�WKH�q3K\VLFLDQ�2ƯFHr�VHWWLQJ�EHFDXVH�WKH�SK\VLFLDQ�LQFXUV�DOO�FRVWV�WKHUH�

�� q1�$r�VKRZQ�LQ�3K\VLFLDQ�2ƯFH�VHWWLQJ�LQGLFDWHV�WKDW�0HGLFDUH�KDV�QRW�GHYHORSHG�598V�LQ�WKH�RƯFH�VHWWLQJ�EHFDXVH�WKH�VHUYLFH�LV�W\SLFDOO\�SHUIRUPHG�LQ�D�IDFLOLW\���H�J�LQ�D�KRVSLWDO���+RZHYHU��LI�WKH�ORFDO�FRQWUDFWRU�GHWHUPLQHV�WKDW�LW�ZLOO�FRYHU�WKH�VHUYLFH�LQ�WKH�RƯFH��WKHQ�LW�LV�SDLG�XVLQJ�WKH�IDFLOLW\�598V�DW�WKH�IDFLOLW\�UDWH��&HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV�&<������3K\VLFLDQ�)HH�6FKHGXOH�)LQDO�5XOH��&06-����-)��KWWSV���ZZZ�FPV�JRY�PHGLFDUHPHGLFDUH-IHH-VHUYLFH-SD\PHQWSK\VLFLDQIHHVFKHGSIV-IHGHUDO-UHJXODWLRQ-QRWLFHV�FPV-����-I����3XEOLVKHG�'HFHPEHU����������5HYLVHG�'HFHPEHU�����������$FFHVVHG�-DQXDU\����������

�� $OORZDEOH�UDWH�LQFOXGHV�ERWK�WKH�WHFKQLFDO�DQG�SURIHVVLRQDO�FRPSRQHQWV��:KHQ�ELOOLQJ�IRU�SURIHVVLRQDO�VHUYLFH�RQO\��D����PRGLƬHU�ZRXOG�EH�DGGHG�DQG�DOORZDEOH�UDWH�ZRXOG�EH�UHGXFHG�DFFRUGLQJO\�

�� $V�PHGLFDOO\�QHFHVVDU\��WKH�XVH�RI�D�VWHUHRWDFWLF�JXLGDQFH�V\VWHP�PD\�EH�UHSRUWHG�LQ�DGGLWLRQ�WR�WKH�DSSURSULDWH�FRGHV�IRU�WKH�SULPDU\�(17�SURFHGXUH��'RFXPHQWDWLRQ�VKRXOG�H[SODLQ�ERWK�WKH�PHGLFDO�QHFHVVLW\�DQG�SUH-SODQQLQJ�DFWLYLWLHV��&37�FRGH�������LV�DQ�qDGG-RQr�FRGH�DQG�PXVW�EH�UHSRUWHG�LQ�DGGLWLRQ�WR�WKH�SULPDU\�SURFHGXUH�

�� 0HGLFDUH�SHUPLWV�WKH�XVH�RI�ELODWHUDO�PRGLƬHU�-����IRU�ELODWHUDO�SURFHGXUHV��&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV��7UDQVPLWWDO�������&5��������KWWS���ZZZ�FPV�JRY�5HJXODWLRQV-DQG-*XLGDQFH�*XLGDQFH�7UDQVPLWWDOV�'RZQORDGV�5����271�SGI���5HOHDVHG�$XJXVW������������$FFHVVHG�1RYHPEHU�������������6HH�DOVR�0HGLFDUH�&ODLPV�3URFHVVLQJ�0DQXDO��&KDSWHU���—3K\VLFLDQV�1RQSK\VLFLDQ�3UDFWLWLRQHUV��VHFWLRQ������%���KWWSV���ZZZ�FPV�JRY�5HJXODWLRQV-DQG-*XLGDQFH�*XLGDQFH�0DQXDOV�'RZQORDGV�FOP���F���SGI���$FFHVVHG�1RYHPEHU������������6HH�DOVR�1DWLRQDO�&RUUHFW�&RGLQJ�,QLWLDWLYH��1&&,��(GLWV�3ROLF\�0DQXDO���KWWSV���ZZZ�FPV�JRY�0HGLFDUH�&RGLQJ�1DWLRQDO&RUUHFW&RG,QLW(G�LQGH[�KWPO��3XEOLVKHG�2FWREHU�����������$FFHVVHG�1RYHPEHU���������

��� &RGLQJ�IRU�WXUELQRSODVW\�SURFHGXUHV�LV�EDVHG�RQ�ZKHWKHU�ERQH�ZDV�UHPRYHG�GXULQJ�SURFHGXUH��6RIW�WLVVXH�UHGXFWLRQ�RI�WXUELQDWHV��ZLWKRXW�UHPRYDO�RI�ERQH��LV�UHSRUWHG�ZLWK�FRGH��������,I�ERQH�LV�UHPRYHG��LW�LV�UHSRUWHG�ZLWK���������7XUELQRSODVW\�DQG�RXWIUDFWXUH�DUH�VRPHWLPHV�SHUIRUPHG�WRJHWKHU��$FFRUGLQJ�WR�1&&,�HGLWV��DQG�RU�&37�GHVFULSWLRQV��&37�FRGH�������VKRXOG�QRW�EH�ELOOHG�ZLWK��������,I�&37�FRGHV�FRGH�������DQG�������DUH�UHSRUWHG�WRJHWKHU��RQO\�RQH�FRGH�LV�SDLG�XQOHVV�SURFHGXUHV�DUH�SHUIRUPHG�LQGHSHQGHQWO\�RQ�RSSRVLWH�VLGHV�

��� &37�������LV�XVHG�WR�UHSRUW�D�ELODWHUDO�SURFHGXUH���)RU�XQLODWHUDO�SURFHGXUH��XVH�PRGLƬHU����� ��� <RX�PD\�DOVR�UHSRUW�D�VHSDUDWH�FRGH�ZKHQ�\RX�KDUYHVW�JUDIW�PDWHULDO�WKURXJK�D�VHSDUDWH�LQFLVLRQ��H�J�������-�&DUWLODJH�

JUDIW��QDVDO�VHSWXP���+RZHYHU��LI�D�VHSWRSODVW\��&37��������LV�SHUIRUPHG�DQG�UHSRUWHG�GXULQJ�WKH�VDPH�RSHUDWLYH�VHVVLRQ��WKHQ�\RX�PD\�QRW�VHSDUDWHO\�UHSRUW�JUDIW�KDUYHVW�

��� �6SHFLDO�UXOHV�IRU�PXOWLSOH�HQGRVFRSLF�SURFHGXUHV�DSSO\�ZKHQ�QDVDO�VLQXV�HQGRVFRS\�SURFHGXUHV�DUH�ELOOHG�WRJHWKHU�IRU�WKH�VDPH�SDWLHQW�RQ�WKH�VDPH�GD\��0XOWLSOH�HQGRVFRSLF�SD\PHQW�UXOHV�DSSO\�WR�D�FRGH�IDPLO\�EHIRUH�UDQNLQJ�WKH�IDPLO\�ZLWK�RWKHU�SURFHGXUHV�SHUIRUPHG�RQ�WKH�VDPH�GD\��:KHQ�D�QDVDO�VLQXV�HQGRVFRS\�SURFHGXUH�LV�UHSRUWHG�WRJHWKHU�ZLWK�LWV�EDVH�SURFHGXUH��&37��������WKHQ��SD\PHQW�IRU�WKH�EDVH�SURFHGXUH�LV�LQFOXGHG�LQ�WKH�SD\PHQW�IRU�WKH�RWKHU�QDVDO�VLQXV�HQGRVFRS\�SURFHGXUH��)RU�DGGLWLRQDO�LQIRUPDWLRQ�DERXW�WKH�SD\PHQW�DGMXVWPHQW�XQGHU�WKH�VSHFLDO�UXOH�IRU�PXOWLSOH�HQGRVFRSLF�VHUYLFHV��SOHDVH�UHIHUHQFH�&<������3)6�ƬQDO�UXOH�ZKHUH�WKLV�SROLF\�ZDV�HVWDEOLVKHG�����)5��������DQG�WR�3XE�����-����0HGLFDUH�&ODLPV�3URFHVVLQJ�0DQXDO��&KDSWHU�����DYDLODEOH�RQ�WKH�&06�:HE�VLWH�DW�KWWSV���ZZZ�FPV�JRY�5HJXODWLRQV-DQG-*XLGDQFH�*XLGDQFH�0DQXDOV�'RZQORDGV�FOP���F���SGI���&HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV��0HGLFDUH�3URJUDP��&<�����5HYLVLRQV�WR�3D\PHQW�3ROLFLHV�8QGHU�WKH�3K\VLFLDQ�)HH�6FKHGXOH�DQG�2WKHU�5HYLVLRQV�WR�3DUW�%�3ROLFLHV�)LQDO�5XOH�����)HG��5HJ�������-�������KWWSV���ZZZ�JRYLQIR�JRY�FRQWHQW�SNJ�)5-����-��-���SGI�����-������SGI����3XEOLVKHG�1RYHPEHU������������

��� &37�$VVLVWDQW��-DQXDU\������9ROXPH�����,VVXH����

3K\VLFLDQ�&RGLQJ�DQG�3D\PHQW�FRQWLQXHG

8&���������G(1

Page 7: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

+RVSLWDO�2XWSDWLHQW�&RGLQJ�DQG�3D\PHQW�—�(ƪHFWLYH�-DQXDU\��������

&37��3URFHGXUH�&RGHV +RVSLWDOV�XVH�&37�FRGHV�IRU�RXWSDWLHQW�VHUYLFHV��8QGHU�0HGLFDUHpV�$3&�PHWKRGRORJ\�IRU�KRVSLWDO�RXWSDWLHQW�SD\PHQW��HDFK�&37�FRGH�LV�DVVLJQHG�WR�DQ�$3&��(DFK�$3&�KDV�D�UHODWLYH�ZHLJKW�WKDW�LV�WKHQ�FRQYHUWHG�WR�D�ƮDW�SD\PHQW�DPRXQW����0XOWLSOH�$3&V�FDQ�VRPHWLPHV�EH�DVVLJQHG�IRU�HDFK�HQFRXQWHU��GHSHQGLQJ�RQ�WKH�QXPEHU�RI�SURFHGXUHV�FRGHG�DQG�ZKHWKHU�DQ\�RI�WKH�SURFHGXUH�FRGHV�PDS�WR�D�&RPSUHKHQVLYH�$3&��&-$3&����� $�&37�SURFHGXUH�FRGH�DVVLJQHG�WR�&-$3&�LV�FRQVLGHUHG�D�SULPDU\�VHUYLFH��DQG�DOO�RWKHU�SURFHGXUHV�DQG�VHUYLFHV�FRGHG�RQ�WKH� ELOO� DUH� FRQVLGHUHG� DGMXQFWLYH� WR� GHOLYHU\� RI� WKH� SULPDU\� VHUYLFH�� � � 7KLV� UHVXOWV� LQ� D� VLQJOH� $3&� SD\PHQW� DQG� D� VLQJOH�EHQHƬFLDU\�FRSD\PHQW�IRU�WKH�HQWLUH�RXWSDWLHQW�HQFRXQWHU��EDVHG�VROHO\�RQ�WKH�SULPDU\�VHUYLFH�� �6HSDUDWH�SD\PHQW� LV�QRW�PDGH�IRU�DQ\�RI�WKH�RWKHU�DGMXQFWLYH�VHUYLFHV���,QVWHDG��WKH�SD\PHQW�OHYHO�IRU�WKH�&-$3&�LV�FDOFXODWHG�WR�LQFOXGH�WKH�FRVWV�RI�WKH�RWKHU�DGMXQFWLYH�VHUYLFHV��ZKLFK�DUH�SDFNDJHG�LQWR�WKH�SD\PHQW�IRU�WKH�SULPDU\�VHUYLFH����� :KHQ�PRUH�WKDQ�RQH�SULPDU\�VHUYLFH�LV�FRGHG�IRU�WKH�VDPH�RXWSDWLHQW�HQFRXQWHU��WKH�FRGHV�DUH�UDQNHG�DFFRUGLQJ�WR�D�Ƭ[HG�KLHUDUFK\�� � 7KH� &-$3&� LV� WKHQ� DVVLJQHG� DFFRUGLQJ� WR� WKH� KLJKHVW� UDQNHG� FRGH�� � � ,Q� VRPH� VSHFLDO� FLUFXPVWDQFHV�� WKH�FRPELQDWLRQ�RI� � WZR�SULPDU\� VHUYLFHV� OHDGV� WR� D� qFRPSOH[LW\� DGMXVWPHQWr� LQ�ZKLFK� WKH� HQWLUH� HQFRXQWHU� LV� UH-PDSSHG� WR�DQRWKHU�KLJKHU-OHYHO�$3&��� $V�VKRZQ�RQ�WKH�WDEOHV�EHORZ��WKH�SURFHGXUHV�WKDW�DUH�VXEMHFW�WR�&-$3&V�DUH�LGHQWLƬHG�E\�VWDWXV�LQGLFDWRU�-��������

3URFHGXUH &37�&RGH�DQG�'HVFULSWLRQ� $3&� $3&�7LWOH� 6,��� 5HODWLYH :HLJKW�

0HGLFDUH 1DWLRQDO $YHUDJH���

6XUJLFDO�1DYLJDWLRQ

������6WHUHRWDFWLF�FRPSXWHU-DVVLVWHG��QDYLJDWLRQDO��SURFHGXUH��FUDQLDO��H[WUDGXUDO

1�$ 1�$ 1 1�$ 1�$

,QIHULRU�7XUELQDWH�UHVHFWLRQ��DEODWLRQ��5KLQRSODVW\��6HSWRSODVW\�� 6LQXV�/DYDJH�

������([FLVLRQ�QDVDO�SRO\S��V���H[WHQVLYH ���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������6XEPXFRXV�UHVHFWLRQ��LQIHULRU�WXUELQDWH��SDUWLDO�RU�FRPSOHWH��DQ\�PHWKRG�

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������5KLQRSODVW\��SULPDU\��LQFOXGLQJ�PDMRU�VHSWDO�UHSDLU

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������5HSDLU�RI�QDVDO�YHVWLEXODU�VWHQRVLV��H�J��VSUHDGHU�JUDIWLQJ��ODWHUDO�QDVDO�ZDOO�UHFRQVWUXFWLRQ����

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������6HSWRSODVW\�RU�VXEPXFRXV�UHVHFWLRQ��ZLWK�RU�ZLWKRXW�FDUWLODJH�VFRULQJ��FRQWRXULQJ�RU�UHSODFHPHQW�ZLWK�JUDIW�

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������6HSWDO�RU�RWKHU�LQWUDQDVDO�GHUPDWRSODVW\

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������5HSDLU�QDVDO�VHSWDO�GHIHFW ���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������&DXWHU\�DQG�RU�DEODWLRQ��PXFRVD�RI�LQIHULRU�WXUELQDWHV��XQLODWHUDO�RU�ELODWHUDO��DQ\�PHWKRG��VXSHUƬFLDO

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������$EODWLRQ��VRIW�WLVVXH�RI�LQIHULRU�WXUELQDWHV��XQLODWHUDO�RU�ELODWHUDO��DQ\�PHWKRG��H�J��HOHFWURFDXWHU\��UDGLRIUHTXHQF\�DEODWLRQ��RU�WLVVXH�YROXPH�UHGXFWLRQ���LQWUDPXUDO��L�H��VXEPXFRVDO��

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������)UDFWXUH�QDVDO�LQIHULRU�WXUELQDWH�V���WKHUDSHXWLF�

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������/DYDJH�E\�FDQQXODWLRQ��PD[LOODU\�VLQXV��DQWUXP�SXQFWXUH�RU�QDWXUDO�RVWLXP�

���� /HYHO���(17�3URFHGXUHV

7 ������ ����

������/DYDJH�E\�FDQQXODWLRQ��VSKHQRLG�VLQXV��DQWUXP�SXQFWXUH�RU�QDWXUDO�RVWLXP�

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

&217,18('�21�1(;7�3$*(

1$6$/��$1'�6,186��352&('85(6 &20021/<�%,//('�&2'(6

h�ϮϬϭϵϬϴϳϳϲĚ�E

Page 8: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

+RVSLWDO�2XWSDWLHQW�&RGLQJ�DQG�3D\PHQW�FRQWLQXHG

3URFHGXUH &37�&RGH�DQG�'HVFULSWLRQ� $3&� $3&�7LWOH� 6,��� 5HODWLYH :HLJKW�

0HGLFDUH 1DWLRQDO $YHUDJH���

1DVDO�DQG�6LQXV�(QGRVFRS\��

������1DVDO�HQGRVFRS\��GLDJQRVWLF��XQLODWHUDO�RU�ELODWHUDO��VHSDUDWH�SURFHGXUH�

���� /HYHO���$LUZD\�(QGRVFRS\

7 ������ ����

�������'LDJQRVWLF�HQGRVFRS\�RI�QRVH�DQG PD[LOODU\�VLQXV�YLD�LQIHULRU�PHDWXVSXQFWXUH

���� /HYHO���$LUZD\�(QGRVFRS\

7 ������ ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�ELRSV\��SRO\SHFWRP\�RU�GHEULGHPHQWV��VHSDUDWH�SURFHGXUH�

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

�������6XUJLFDO�HQGRVFRS\�RI�QRVH�ZLWK�FRQWURO�RI�QDVDO�KHPRUUKDJH

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�FRQFKD�EXOORVD�UHVHFWLRQ

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK OLJDWLRQ�RI�VSKHQRSDODWLQH�DUWHU\

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU��LQFOXGLQJ�IURQWDO�VLQXV�H[SORUDWLRQ��ZLWK�RU�ZLWKRXW�UHPRYDO�RI�WLVVXH�IURP�IURQWDO�VLQXV

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�HWKPRLGHFWRP\��SDUWLDO��DQWHULRU�

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU�

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�PD[LOODU\�DQWURVWRP\

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU��LQFOXGLQJ�VSKHQRLGRWRP\

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU��LQFOXGLQJ�VSKHQRLGRWRP\��ZLWK�UHPRYDO�RI�WLVVXH�IURP�VSKHQRLG�VLQXV

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

�������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�PD[LOODU\�DQWURVWRP\��ZLWK�UHPRYDO�RI�WLVVXH�IURP�PD[LOODU\�VLQXV

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�IURQWDO�VLQXV�H[SORUDWLRQ��ZLWK�RU�ZLWKRXW�UHPRYDO�RI�WLVVXH�IURP�IURQWDO�VLQXV

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�VSKHQRLGRWRP\

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�VSKHQRLGRWRP\��ZLWK�UHPRYDO�RI�WLVVXH�IURP�WKH�VSKHQRLG�VLQXV

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�PD[LOODU\�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ���WUDQVQDVDO�RU�YLD�FDQLQH�IRVVD

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�IURQWDO�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ�

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

&217,18('�21�1(;7�3$*( h�ϮϬϭϵϬϴϳϳϲĚ�E

Page 9: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

�� &37�FRS\ULJKW������$PHULFDQ�0HGLFDO�$VVRFLDWLRQ��$OO�ULJKWV�UHVHUYHG��&37��LV�D�UHJLVWHUHG�WUDGHPDUN�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ��$SSOLFDEOH�)$56�')$56�5HVWULFWLRQV�$SSO\�WR�*RYHUQPHQW�8VH���)HH�VFKHGXOHV��UHODWLYH�YDOXH XQLWV��FRQYHUVLRQ�IDFWRUV�DQG�RU�UHODWHG�FRPSRQHQWV�DUH�QRW�DVVLJQHG�E\�WKH�$0$��DUH�QRW�SDUW�RI�&37��DQG�WKH�$0$�LV�QRW�UHFRP�PHQGLQJ�WKHLU�XVH��7KH�$0$�GRHV�QRW�GLUHFWO\�RU�LQGLUHFWO\�SUDFWLFH�PHGLFLQH�RU�GLVSHQVH�PHGLFDO�VHUYLFHV��7KH�$0$�DV�VXPHV�QR�OLDELOLW\�IRU�GDWD�FRQWDLQHG�RU�QRW�FRQWDLQHG�KHUHLQ�

�� 0HGLFDUH�3URJUDP��+RVSLWDO�2XWSDWLHQW�3URVSHFWLYH�3D\PHQW��$6&�3D\PHQW�6\VWHPV�3URSRVHG�5XOH��&06-����-)&��2ƯFH�RI�WKH�)HGHUDO�5HJLVWHU�ZHEVLWH��&HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV�3DJH�KWWSV���ZZZ�FPV�JRY��PHGLFDUH�PHGLFDUH-IHH-VHUYLFH-SD\PHQWDVFSD\PHQWDVF-UHJXODWLRQV-DQG-QRWLFHV�FPV-����-IF���$FFHVVHG�'HFHPEHU��UG��������

�� 6WDWXV�,QGLFDWRU��6,��VKRZV�KRZ�D�FRGH�LV�KDQGOHG�IRU�SD\PHQW�SXUSRVHV���-�� �SDLG�XQGHU�D�FRPSUHKHQVLYH�$3&��VLQJOH�SD\�PHQW�EDVHG�RQ�SULPDU\�VHUYLFH�ZLWKRXW�VHSDUDWH�SD\PHQW�IRU�RWKHU�DGMXQFWLYH�VHUYLFHV��1� �SDFNDJHG�VHUYLFH��QR�VHSDUDWH�SD\PHQW��7� ���6LJQLƬFDQW�SURFHGXUH�VXEMHFW�WR�PXOWLSOH�SURFHGXUH�GLVFRXQWLQJ��

�� 0HGLFDUH�QDWLRQDO�DYHUDJH�SD\PHQW�LV�GHWHUPLQHG�E\�PXOWLSO\LQJ�WKH�$3&�ZHLJKW�E\�WKH�FRQYHUVLRQ�IDFWRU��7KH�ƬQDO�FRQYHU�VLRQ�IDFWRU�IRU������LV���������DV�SXEOLVKHG�LQ�&06-����-)��$FFHVVHG�'HFHPEHU��UG���������7KH�FRQYHUVLRQ�IDFWRU�RI���������DVVXPHV�WKDW�KRVSLWDOV�PHHW�UHSRUWLQJ�UHTXLUHPHQWV�RI�WKH�+RVSLWDO�2XWSDWLHQW�4XDOLW\�'DWD�5HSRUWLQJ�3URJUDP��0HGLFDUH�3URJUDP��+RVSLWDO�2XWSDWLHQW�3URVSHFWLYH�3D\PHQW�6\VWHP�)LQDO�5XOH��&06-����-)��2ƯFH�RI�WKH�)HGHUDO�5HJLV�WHU�ZHEVLWH��&HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV�3DJH��&06-����-)��KWWSV���ZZZ�FPV�JRY�PHGLFDUHPHGLFDUH-IHH-VHUYLFH-SD\PHQWKRVSLWDORXWSDWLHQWSSVKRVSLWDO-RXWSDWLHQW-UHJXODWLRQV-DQG-QRWLFHV�FPV-����-IF���$FFHVVHG�'HFHPEHU��UG��������

�� 0HGLFDUH�SHUPLWV�WKH�XVH�RI�ELODWHUDO�PRGLƬHU�-����&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV��7UDQVPLWWDO�������&5��������KWWS���ZZZ�FPV�JRY�5HJXODWLRQV-DQG-*XLGDQFH�*XLGDQFH�7UDQVPLWWDOV�'RZQORDGV�5����271�SGI���5HOHDVHG�$XJXVW������������$FFHVVHG�'HFHPEHU������������6HH�DOVR�0HGLFDUH�&ODLPV�3URFHVVLQJ�0DQXDO��&KDSWHU��—3DUW�%�+RVSLWDO��VHFWLRQV������DQG�����������KWWSV���ZZZ�FPV�JRY�5HJXODWLRQV-DQG-*XLGDQFH�*XLGDQFH�0DQXDOV�'RZQORDGV�FOP���F���SGI����$F�FHVVHG�'HFHPEHU�����������

�� &RGLQJ�IRU�WXUELQRSODVW\�SURFHGXUHV�LV�EDVHG�RQ�ZKHWKHU�ERQH�ZDV�UHPRYHG�GXULQJ�SURFHGXUH��6RIW�WLVVXH�UHGXFWLRQ�RI�WXU�ELQDWHV��ZLWKRXW�UHPRYDO�RI�ERQH��LV�UHSRUWHG�ZLWK�FRGH��������,I�ERQH�LV�UHPRYHG��LW�LV�UHSRUWHG�ZLWK���������7XUELQRSODVW\�DQG�RXWIUDFWXUH�DUH�VRPHWLPHV�SHUIRUPHG�WRJHWKHU��$FFRUGLQJ�WR�1&&,�HGLWV��DQG�RU�&37�GHVFULSWLRQV��&37�FRGH�������VKRXOG�QRW�EH�ELOOHG�ZLWK��������,I�&37�FRGHV�FRGH�������DQG�������DUH�UHSRUWHG�WRJHWKHU��RQO\�RQH�FRGH�LV�SDLG�XQOHVV�SUR�FHGXUHV�DUH�SHUIRUPHG�LQGHSHQGHQWO\�RQ�RSSRVLWH�VLGHV�

�� &37�������LV�XVHG�WR�UHSRUW�D�ELODWHUDO�SURFHGXUH���)RU�XQLODWHUDO�SURFHGXUH��XVH�PRGLƬHU����� �� <RX�PD\�DOVR�UHSRUW�D�VHSDUDWH�FRGH�ZKHQ�\RX�KDUYHVW�JUDIW�PDWHULDO�WKURXJK�D�VHSDUDWH�LQFLVLRQ��H�J�������-�&DUWLODJH�JUDIW��

QDVDO�VHSWXP���+RZHYHU��LI�D�VHSWRSODVW\��&37��������LV�SHUIRUPHG�DQG�UHSRUWHG�GXULQJ�WKH�VDPH�RSHUDWLYH�VHVVLRQ��WKHQ�\RX�PD\�QRW�VHSDUDWHO\�UHSRUW�JUDIW�KDUYHVW�

�� &37�$VVLVWDQW��-DQXDU\������9ROXPH�����,VVXH����

+RVSLWDO�2XWSDWLHQW�&RGLQJ�DQG�3D\PHQW�FRQWLQXHG

3URFHGXUH &37�&RGH�DQG�'HVFULSWLRQ� $3&� $3&�7LWOH� 6,��� 5HODWLYH :HLJKW�

0HGLFDUH 1DWLRQDO $YHUDJH���

1DVDO�DQG�6LQXV�(QGRVFRS\��

�&RQWLQXHG��

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�VSKHQRLG�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ�

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI��IURQWDO�DQG�VSKHQRLG�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ�

���� /HYHO���$LUZD\�(QGRVFRS\

-� ������� ������

�������1DVRSKDU\QJRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�WKH�HXVWDFKLDQ�WXEH���L�H�EDOORRQ�GLODWLRQ����XQLODWHUDO

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

������1DVRSKDU\QJRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�WKH�HXVWDFKLDQ�WXEH���L�H�EDOORRQ�GLODWLRQ����ELODWHUDO

���� /HYHO���(17�3URFHGXUHV

-� ������� ������

127(�� &37� FRGHV� ������� ������������ DQG� ������ DSSO\� WR� FDVHV� LQ� ZKLFK� D� EDOORRQ� FDWKHWHU� LV� WKH� RQO\�LQVWUXPHQW� RU� WRRO� XVHG� DQG� QR� WLVVXH� LV� UHPRYHG�� � 'R� QRW� UHSRUW� ������� ������� ������ RU� ������ ZLWK�HQGRVFRSLF�VLQXV�VXUJHU\�FRGHV��ZKHQ�SHUIRUPHG�RQ�VDPH�VLQXV��

%DOORRQ�'LODWLRQ�RI�(XVWDFKLDQ�7XEH��%'(7�

h�ϮϬϭϵϬϴϳϳϲĚ�E

Page 10: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

$6&�&RGLQJ�DQG�3D\PHQW�—�(ƪHFWLYH�-DQXDU\��������

&37��3URFHGXUH�&RGHV $6&V� XVH�&37� FRGHV� IRU� WKHLU� VHUYLFHV��0HGLFDUH� SD\PHQW� IRU� SURFHGXUHV� SHUIRUPHG� LQ� DQ� DPEXODWRU\� VXUJHU\� FHQWHU� LV�EDVHG� RQ� 0HGLFDUHpV� DPEXODWRU\� SDWLHQW� FODVVLƬFDWLRQ� �$3&�� PHWKRGRORJ\� IRU� KRVSLWDO� RXWSDWLHQW� SD\PHQW�� +RZHYHU��&RPSUHKHQVLYH�$3&V��&-$3&V��DUH�XVHG�RQO\�IRU�KRVSLWDO�RXWSDWLHQW�VHUYLFHV�DQG�DUH�QRW�DSSOLHG�WR�SURFHGXUHV�SHUIRUPHG�LQ�$6&V��� (DFK� &37� FRGH� GHVLJQDWHG� DV� D� FRYHUHG� SURFHGXUH� LQ� DQ� $6&� LV� DVVLJQHG� D� FRPSDUDEOH� ZHLJKW� DV� XQGHU� WKH� KRVSLWDO�RXWSDWLHQW�$3&�V\VWHP��7KLV�LV�WKHQ�FRQYHUWHG�WR�D�ƮDW�SD\PHQW�DPRXQW�XVLQJ�D�FRQYHUVLRQ�IDFWRU�XQLTXH�WR�$6&V��0XOWLSOH�SURFHGXUHV�FDQ�EH�SDLG�IRU�HDFK�FODLP��&HUWDLQ�DQFLOODU\�VHUYLFHV��VXFK�DV�LPDJLQJ��DUH�DOVR�FRYHUHG�ZKHQ�WKH\�DUH�LQWHJUDO�WR�FRYHUHG� VXUJLFDO� SURFHGXUHV�� DOWKRXJK� WKH\�PD\� QRW� EH� VHSDUDWHO\� SD\DEOH�� ,Q� JHQHUDO�� WKHUH� LV� QR� VHSDUDWH� SD\PHQW� IRU�GHYLFHV��WKHLU�SD\PHQW�LV�SDFNDJHG�LQWR�WKH�SD\PHQW�IRU�WKH�SURFHGXUH��

3URFHGXUH &37�&RGH�DQG�'HVFULSWLRQ� 3D\PHQW ,QGLFDWRU���

0XOWLSOH 3URFHGXUH

'LVFRXQWLQJ�

5HODWLYH :HLJKW���

0HGLFDUH 1DWLRQDO $YHUDJH���

6XUJLFDO�1DYLJDWLRQ

������6WHUHRWDFWLF�FRPSXWHU-DVVLVWHG��QDYLJDWLRQDO��SURFHGXUH��FUDQLDO��H[WUDGXUDO

1� 1 1�$ 1�$

,QIHULRU�7XUELQDWH�UHVHFWLRQ���DEODWLRQ��5KLQRSODVW\��6HSWRSODVW\�� 6LQXV�/DYDJH���

������([FLVLRQ�QDVDO�SRO\S�V���H[WHQVLYH $� < ������� ������

������6XEPXFRXV�UHVHFWLRQ��LQIHULRU�WXUELQDWH��SDUWLDO�RU�FRPSOHWH��DQ\�PHWKRG�

$� < ������� ������

������,QVHUWLRQ��QDVDO�VHSWDO�SURVWKHVLV��EXWWRQ� $� < ������� ����

������5HSDLU�RI�QDVDO�YHVWLEXODU�VWHQRVLV��HJ��VSUHDGHU�JUDIWLQJ��ODWHUDO�QDVDO�ZDOO�UHFRQVWUXFWLRQ�����

$� < ������� ������

������6HSWRSODVW\�RU�VXEPXFRXV�UHVHFWLRQ��ZLWK�RU�ZLWKRXW�FDUWLODJH�VFRULQJ��FRQWRXULQJ�RU�UHSODFHPHQW�ZLWK�JUDIW��

$� < ������� ������

������6HSWDO�RU�RWKHU�LQWUDQDVDO�GHUPDWRSODVW\ $� < ������� ������

������5HSDLU�QDVDO�VHSWDO�GHIHFW $� < ������� ������

������&DXWHU\�DQG�RU�DEODWLRQ��PXFRVD�RI�LQIHULRU�WXUELQDWHV��XQLODWHUDO�RU�ELODWHUDO��DQ\�PHWKRG��VXSHUƬFLDO

$� < ������� ����

������$EODWLRQ��VRIW�WLVVXH�RI�LQIHULRU�WXUELQDWHV��XQLODWHUDO�RU�ELODWHUDO��DQ\�PHWKRG��H�J��HOHFWURFDXWHU\��UDGLRIUHTXHQF\�DEODWLRQ��RU�WLVVXH�YROXPH�UHGXFWLRQ���LQWUDPXUDO��L�H��VXEPXFRVDO��

$� < ������� ����

������)UDFWXUH�QDVDO�LQIHULRU�WXUELQDWH�V���WKHUDSHXWLF�

$� < ������� ������

������/DYDJH�E\�FDQQXODWLRQ��PD[LOODU\�VLQXV��DQWUXP�SXQFWXUH�RU�QDWXUDO�RVWLXP�

3� < ������ ����

������/DYDJH�E\�FDQQXODWLRQ��VSKHQRLG�VLQXV��DQWUXP�SXQFWXUH�RU�QDWXUDO�RVWLXP�

-� < ������� ����

1DVDO�DQG�6LQXV�(QGRVFRS\����

������1DVDO�HQGRVFRS\��GLDJQRVWLF��XQLODWHUDO�RU�ELODWHUDO��VHSDUDWH�SURFHGXUH�

3� < ������ ���

�������'LDJQRVWLF�HQGRVFRS\�RI�QRVH�DQG PD[LOODU\�VLQXV�YLD�LQIHULRU�PHDWXV�SXQFWXUH

$� < ������ ����

�������6XUJLFDO�HQGRVFRS\�RI�QRVH�ZLWK�FRQWURO�RI�QDVDO�KHPRUUKDJH

$� < ������� ����

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�ELRSV\��SRO\SHFWRP\�RU�GHEULGHPHQWV��VHSDUDWH�SURFHGXUH�

$� < ������� ����

������5KLQRSODVW\��SULPDU\��LQFOXGLQJ�PDMRU�VHSWDO�UHSDLU

$� < ������� ������

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

&217,18('�21�1(;7�3$*( 8&���������G(1

Page 11: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

$6&�&RGLQJ�DQG�3D\PHQW��FRQWLQXHG

3URFHGXUH &37�&RGH�DQG�'HVFULSWLRQ� 3D\PHQW ,QGLFDWRU���

0XOWLSOH 3URFHGXUH

'LVFRXQWLQJ�

5HODWLYH :HLJKW���

0HGLFDUH 1DWLRQDO $YHUDJH���

1DVDO�DQG�6LQXV�(QGRVFRS\�����&RQWLQXHG� �

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�FRQFKD�EXOORVD�UHVHFWLRQ

$� < ������� ����

�������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU��LQFOXGLQJ�IURQWDO�VLQXV�H[SORUDWLRQ��ZLWK�RU�ZLWKRXW�UHPRYDO�RI�WLVVXH�IURP�IURQWDO�VLQXV

*� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK HWKPRLGHFWRP\��SDUWLDO��DQWHULRU�

$� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU�

$� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�PD[LOODU\�DQWURVWRP\

$� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU��LQFOXGLQJ�VSKHQRLGRWRP\

*� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�HWKPRLGHFWRP\��WRWDO��DQWHULRU�DQG SRVWHULRU��LQFOXGLQJ�VSKHQRLGRWRP\��ZLWK�UHPRYDO�RI�WLVVXH�IURP�VSKHQRLG�VLQXV

*� < ������� ������

�������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�PD[LOODU\�DQWURVWRP\��ZLWK�UHPRYDO�RI�WLVVXH�IURP�PD[LOODU\�VLQXV

$� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO�ZLWK�IURQWDO�VLQXV�H[SORUDWLRQ��ZLWK�RU�ZLWKRXW�UHPRYDO�RI�WLVVXH�IURP�IURQWDO�VLQXV

$� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�VSKHQRLGRWRP\

$� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�VSKHQRLGRWRP\��ZLWK�UHPRYDO�RI�WLVVXH�IURP�WKH�VSKHQRLG�VLQXV

$� < ������� ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�PD[LOODU\�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ���WUDQVQDVDO�RU�YLD�FDQLQH�IRVVD

3� < � ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�IURQWDO�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ�

3� < � ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�VSKHQRLG�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ�

3� < � ������

������1DVDO�VLQXV�HQGRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�IURQWDO�DQG�VSKHQRLG�VLQXV�RVWLXP��H�J��EDOORRQ�GLODWLRQ�

3�

< ������� ������

�������1DVRSKDU\QJRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�WKH�HXVWDFKLDQ�WXEH���L�H�EDOORRQ�GLODWLRQ����XQLODWHUDO

-� < ������� ������

������1DVRSKDU\QJRVFRS\��VXUJLFDO��ZLWK�GLODWLRQ�RI�WKH�HXVWDFKLDQ�WXEH���L�H�EDOORRQ�GLODWLRQ����ELODWHUDO

-� < ������� ������

127(��&37�FRGHV����������������������DQG�������DSSO\�WR�FDVHV�LQ�ZKLFK�D�EDOORRQ�FDWKHWHU�LV�WKH�RQO\�LQVWUXPHQW�RU�WRRO�XVHG�DQG�QR�WLVVXH�LV�UHPRYHG���'R�QRW�UHSRUW����������������������DQG��������ZLWK�HQGRVFRSLF�VLQXV�VXUJHU\�FRGHV�ZKHQ�SHUIRUPHG�RQ�VDPH�VLQXV����

%DOORRQ�'LODWLRQ�RI�(XVWDFKLDQ�7XEH��%'(7�

&217,18('�21�1(;7�3$*( 8&���������G(1

Page 12: COMMONLY BILLED CODES - Medtronic...30630 Repair nasal septal defect 090 N/A 18.45 $666 $666 30801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral,

1$6$/��$1'�6,186�352&('85(6 &20021/<�%,//('�&2'(6

�� &37�FRS\ULJKW������$PHULFDQ�0HGLFDO�$VVRFLDWLRQ��$OO�ULJKWV�UHVHUYHG��&37��LV�D�UHJLVWHUHG�WUDGHPDUN�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ��$SSOLFDEOH�)$56�')$56�5HVWULFWLRQV�$SSO\�WR�*RYHUQPHQW�8VH���)HH�VFKHGXOHV��UHODWLYH�YDOXH XQLWV��FRQYHUVLRQ�IDFWRUV�DQG�RU�UHODWHG�FRPSRQHQWV�DUH�QRW�DVVLJQHG�E\�WKH�$0$��DUH�QRW�SDUW�RI�&37��DQG�WKH�$0$�LV�QRW�UHFRP�PHQGLQJ�WKHLU�XVH��7KH�$0$�GRHV�QRW�GLUHFWO\�RU�LQGLUHFWO\�SUDFWLFH�PHGLFLQH�RU�GLVSHQVH�PHGLFDO�VHUYLFHV��7KH�$0$�DV�VXPHV�QR�OLDELOLW\�IRU�GDWD�FRQWDLQHG�RU�QRW�FRQWDLQHG�KHUHLQ�

�� &HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV��0HGLFDUH�3URJUDP��+RVSLWDO�2XWSDWLHQW�3URVSHFWLYH�3D\PHQW��$6&�3D\PHQW�6\VWHPV�3URSRVHG�5XOH��&06-����-)&��2ƯFH�RI�WKH�)HGHUDO�5HJLVWHU�ZHEVLWH��&HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV�3DJH�KWWSV���ZZZ�FPV�JRY�PHGLFDUHPHGLFDUH-IHH-VHUYLFH-SD\PHQWDVFSD\PHQWDVF-UHJXODWLRQV-DQG-QRWLFHV�FPV-����-IF���$FFHVVHG�'HFHPEHU��UG��������

�� 7KH�3D\PHQW�,QGLFDWRU�VKRZV�KRZ�D�FRGH�LV�KDQGOHG�IRU�SD\PHQW�SXUSRVHV��$� �6XUJLFDO�SURFHGXUH�RQ�$6&�OLVW�LQ�&<�������SD\PHQW�EDVHG�RQ�2336�UHODWLYH�SD\PHQW�ZHLJKW��*�� �VXUJLFDO�SURFHGXUH��QRQ-RƯFH-EDVHG��SD\PHQW�EDVHG�RQ�KRVSLWDO�RXWSDWLHQW�UDWH�DGMXVWHG�IRU�$6&��-�� �GHYLFH-LQWHQVLYH�SURFHGXUH��SD\PHQW�DPRXQW�DGMXVWHG�WR�LQFRUSRUDWH�GHYLFH�FRVW��1� �3DFNDJHG�VHUYLFH�LWHP��QR�VHSDUDWH�SD\PHQW�PDGH��3� �RƯFH-EDVHG�VXUJLFDO�SURFHGXUH�DGGHG�WR�$6&�OLVW�LQ�&<������RU�ODWHU�ZLWK�03)6�QRQ-IDFLOLW\�3(�598V��SD\PHQW�EDVHG�RQ�2336�UHODWLYH�SD\PHQW�ZHLJKW��3� �RƯFH-EDVHG�VXUJLFDO�SURFH�GXUH�DGGHG�WR�$6&�OLVW�LQ�&<������RU�ODWHU�ZLWK�03)6�QRQ-IDFLOLW\�3(�598V��SD\PHQW�EDVHG�RQ�03)6�QRQ-IDFLOLW\�3(�598V��5� �2ƯFH-EDVHG�VXUJLFDO�SURFHGXUH�DGGHG�WR�$6&�OLVW�LQ�&<������RU�ODWHU�ZLWKRXW�03)6�QRQ-IDFLOLW\�3(�598V��SD\PHQW�EDVHG�RQ�2336�UHODWLYH�SD\PHQW�ZHLJKW�

�� 0HGLFDUH�QDWLRQDO�DYHUDJH�SD\PHQW�LV�GHWHUPLQHG�E\�PXOWLSO\LQJ�WKH�UHODWLYH�ZHLJKW�E\�WKH�$6&�FRQYHUVLRQ�IDFWRU��7KH������$6&�FRQYHUVLRQ�IDFWRU�LV��������� �7KH�FRQYHUVLRQ�IDFWRU�RI���������DVVXPHV�WKH�$6&�PHHWV�TXDOLW\�UHSRUWLQJ�UHTXLUH�PHQWV�� &HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HUYLFHV��0HGLFDUH�3URJUDP��+RVSLWDO�2XWSDWLHQW�3URVSHFWLYH�3D\PHQW��$6&�3D\�PHQW�6\VWHPV�3URSRVHG�5XOH��&06-����-)&��2ƯFH�RI�WKH�)HGHUDO�5HJLVWHU�ZHEVLWH��&HQWHUV�IRU�0HGLFDUH��0HGLFDLG�6HU�YLFHV�3DJH�KWWSV���ZZZ�FPV�JRY�PHGLFDUHPHGLFDUH-IHH-VHUYLFH-SD\PHQWDVFSD\PHQWDVF-UHJXODWLRQV-DQG-QRWLFHV�FPV-����-IF���$FFHVVHG�'HFHPEHU��UG��������3D\PHQW�LV�DGMXVWHG�E\�WKH�ZDJH�LQGH[�IRU�HDFK�$6&pV�VSHFLƬF�JHRJUDSKLF�ORFDOLW\��VR�SD\PHQW�ZLOO�YDU\�IURP�WKH�VWDWHG�QDWLRQDO�DYHUDJH�0HGLFDUH�SD\PHQW�OHYHOV�GLVSOD\HG��$OVR�QRWH�WKDW�DQ\�DSSOLFDEOH�FRLQ�VXUDQFH��GHGXFWLEOH��DQG�RWKHU�DPRXQWV�WKDW�DUH�SDWLHQW�REOLJDWLRQV�DUH�LQFOXGHG�LQ�WKH�QDWLRQDO�DYHUDJH�SD\PHQW�DPRXQW�VKRZQ�

�� :KHQ�PXOWLSOH�SURFHGXUHV�DUH�FRGHG�DQG�ELOOHG��SD\PHQW�LV�XVXDOO\�PDGH�DW������RI�WKH�UDWH�IRU�WKH�ƬUVW�SURFHGXUH�DQG�����RI�WKH�UDWH�IRU�WKH�VHFRQG�DQG�DOO�VXEVHTXHQW�SURFHGXUHV��7KHVH�SURFHGXUHV�DUH�PDUNHG�q<�r�+RZHYHU��SURFHGXUHV�PDUNHG�q1r�DUH�QRW�VXEMHFW�WR�WKLV�GLVFRXQWLQJ�DQG�DUH�SDLG�DW������RI�WKH�UDWH�UHJDUGOHVV�RI�ZKHWKHU�WKH\�DUH�VXEPLWWHG�ZLWK�RWKHU�SURFHGXUHV�

�� )RU�0HGLFDUH�ELOOLQJ��$6&V�XVH�D�&06-�����IRUP� �� 0HGLFDUH�GRHV�QRW�UHFRJQL]H�WKH�XVH�RI�ELODWHUDO�PRGLƬHU�-���IRU�SD\PHQW�LQ�WKH�$6&�DQG�LQVWUXFWV�WKDW�ELODWHUDO�SURFHGXUHV�

VKRXOG�HLWKHU�EH�UHSRUWHG�ZLWK�WKH�&37�SURFHGXUH�FRGH�UHSHDWHG�RQ�WZR�VHSDUDWH�OLQHV��RU�UHSRUWHG�RQ�D�VLQJOH�OLQH�ZLWK�XQLWV�RI�q�r���&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV���0HGLFDUH�&ODLPV�3URFHVVLQJ�0DQXDO��&KDSWHU���—$PEXODWRU\�6XUJHU\�&HQWHUV��VHFWLRQ�������KWWS���ZZZ�FPV�JRY�5HJXODWLRQV-DQG-*XLGDQFH�*XLGDQFH�0DQXDOV�GRZQORDGV�FOP���F���SGI���8SGDWHG�0D\������������$FFHVVHG�1RYHPEHU�������������

�� &RGLQJ�IRU�WXUELQRSODVW\�SURFHGXUHV�LV�EDVHG�RQ�ZKHWKHU�ERQH�ZDV�UHPRYHG�GXULQJ�SURFHGXUH��6RIW�WLVVXH�UHGXFWLRQ�RI�WXU�ELQDWHV��ZLWKRXW�UHPRYDO�RI�ERQH��LV�UHSRUWHG�ZLWK�FRGH��������,I�ERQH�LV�UHPRYHG��LW�LV�UHSRUWHG�ZLWK���������7XUELQRSODVW\�DQG�RXWIUDFWXUH�DUH�VRPHWLPHV�SHUIRUPHG�WRJHWKHU��$FFRUGLQJ�WR�1&&,�HGLWV��DQG�RU�&37�GHVFULSWLRQV��&37�FRGH�������VKRXOG�QRW�EH�ELOOHG�ZLWK��������,I�&37�FRGHV�FRGH�������DQG�������DUH�UHSRUWHG�WRJHWKHU��RQO\�RQH�FRGH�LV�SDLG�XQOHVV�SUR�FHGXUHV�DUH�SHUIRUPHG�LQGHSHQGHQWO\�RQ�RSSRVLWH�VLGHV�

�� &37�������LV�XVHG�WR�UHSRUW�D�ELODWHUDO�SURFHGXUH���)RU�XQLODWHUDO�SURFHGXUH��XVH�PRGLƬHU����� ��� <RX�PD\�DOVR�UHSRUW�D�VHSDUDWH�FRGH�ZKHQ�\RX�KDUYHVW�JUDIW�PDWHULDO�WKURXJK�D�VHSDUDWH�LQFLVLRQ��H�J�������-�&DUWLODJH�JUDIW��

QDVDO�VHSWXP���+RZHYHU��LI�D�VHSWRSODVW\��&37��������LV�SHUIRUPHG�DQG�UHSRUWHG�GXULQJ�WKH�VDPH�RSHUDWLYH�VHVVLRQ��WKHQ�\RX�PD\�QRW�VHSDUDWHO\�UHSRUW�JUDIW�KDUYHVW�

��� &37�$VVLVWDQW��-DQXDU\������9ROXPH�����,VVXH����

$6&�&RGLQJ�DQG�3D\PHQW��FRQWLQXHG

0HGWURQLF�,QF�����������������������������������6RXWKSRLQW�'ULYH�1�-DFNVRQYLOOH��)/����������������86$�������������������������������������������������������7HO���-���-���-����

PHGWURQLF�FRP

)RU�IXUWKHU�LQIRUPDWLRQ��SOHDVH�FRQWDFW�0HGWURQLF�(17�DW��������������DQG�RU�FRQVXOW�0HGWURQLF�(17�ZHEVLWH�DW�ZZZ�PHGWURQLFHQW�FRP�

8&���������G(1��������0HGWURQLF�,QF��$OO�ULJKWV�UHVHUYHG��0HGWURQLF��0HGWURQLF�ORJR�DQG�)XUWKHU��7RJHWKHU�DUH�WUDGHPDUNV�RI�0HGWURQLF��$OO�RWKHU�EUDQGV�DUH�WUDGH�PDUNV�RI�D�0HGWURQLF�FRPSDQ\�

8&���������G(1