WELL VISIT CODING AND BILLING FREQUENTLY ASKED QUESTIONS If you directly pay any portion of your child’s health care costs (co-pay, deductible, HSA, etc), then it is important to have a general understanding of medical coding and billing. It’s a confusing, boring area but Kidz1st offers the following explanations and examples to help you understand your potential financial responsibilities. What are medical billing codes? Medical billing codes started in the late 1970s and were originally called Healthcare Common Procedure Coding System (HCPCS) Level 1 codes. In the mid-1990’s, the core set of codes were further expanded and refined and became known as Current Procedural Terminology, or CPT, codes. CPT codes are a standardized, numerical coding system that defines every possible service, procedure, test, product, and device that can be provided in the delivery of health care. The codes fill an 800 page book! A small subset of CPT codes, called Evaluation and Management, or E/M, codes are used to define office visits. Why do we need CPT codes? Consistency in the definitions of what is performed, documented, and billed has two purposes: 1) To make sure that there is adequate and consistent payment to health care providers 2) To minimize the chance of fraud by providers and insurance companies. What do CPT E/M codes tell us? CPT E/M codes tell us what is typically done at office visits or the “typical resources” needed. Resources include office expenses, provider training/skills/experience, performing the history and physical exam, decision making complexity and risk, coordination of care, evaluating outside records, counseling, and time. E/M codes are divided into codes for well visits and codes for acute, chronic, and follow-up visits. Who determines which CPT codes to use for an office visit? The health care provider who performs the services is ultimately responsible for the accuracy of the codes billed. Larger offices may employ professional coders. It’s actually a good field to go into! However, Kidz1st does not delegate this very important responsibility. We believe that the person who actually did the work, the health care provider, has the best knowledge of what was actually done. So we train our providers in the gory details of coding. And we do detailed, daily internal auditing so that patients and insurers alike can be confident that we provide the most accurate coding possible. Why would I want to know about billing codes? With the country’s economic woes, we are seeing a rapidly spreading trend of employers shifting more health care expenses, both premiums and direct costs, to employees. Ignorance may be bliss when someone else is paying the bills but if you are paying, all of this coding information becomes relevant. So what is included in a “typical” acute visit? For acute, chronic, and follow-up visits, increasing levels of resources required.

1. WELL VISIT CODING AND BILLING
FREQUENTLY ASKED QUESTIONS
If you directly pay any portion of your child’s health care costs
(co-pay, deductible, HSA, etc), then it is
important to have a general understanding of medical coding
and billing. It’s a confusing, boring area but
Kidz1st offers the following explanations and examples to help
you understand your potential financial
responsibilities.
What are medical billing codes?
Medical billing codes started in the late 1970s and were
originally called Healthcare Common Procedure

2. Coding System (HCPCS) Level 1 codes. In the mid-1990’s, the
core set of codes were further expanded
and refined and became known as Current Procedural
Terminology, or CPT, codes. CPT codes are a
standardized, numerical coding system that defines every
possible service, procedure, test, product, and
device that can be provided in the delivery of health care. The
codes fill an 800 page book! A small subset
of CPT codes, called Evaluation and Management, or E/M,
codes are used to define office visits.
Why do we need CPT codes?
Consistency in the definitions of what is performed,
documented, and billed has two purposes:
1) To make sure that there is adequate and consistent payment
to health care providers
2) To minimize the chance of fraud by providers and insurance
companies.
What do CPT E/M codes tell us?
CPT E/M codes tell us what is typically done at office visits or
the “typical resources” needed. Resources
include office expenses, provider training/skills/experience,
performing the history and physical exam,
decision making complexity and risk, coordination of care,
evaluating outside records, counseling, and

3. time. E/M codes are divided into codes for well visits and
codes for acute, chronic, and follow-up visits.
Who determines which CPT codes to use for an office visit?
The health care provider who performs the services is ultimately
responsible for the accuracy of the codes
billed. Larger offices may employ professional coders. It’s
actually a good field to go into! However,
Kidz1st does not delegate this very important responsibility. We
believe that the person who actually did
the work, the health care provider, has the best knowledge of
what was actually done. So we train our
providers in the gory details of coding. And we do detailed,
daily internal auditing so that patients and
insurers alike can be confident that we provide the most
accurate coding possible.
Why would I want to know about billing codes?
With the country’s economic woes, we are seeing a rapidly
spreading trend of employers shifting more
health care expenses, both premiums and direct costs, to
employees. Ignorance may be bliss when
someone else is paying the bills but if you are paying, all of this
coding information becomes relevant.

4. So what is included in a “typical” acute visit?
For acute, chronic, and follow-up visits, increasing levels of
resources required for a “typical” visit are
assigned to increasing “levels” of codes. You will see these
codes billed with the numbers 9920x and
9921x, where x is a number 1-5 depending on the level of
resources needed. If a lab test or other
procedure is done, that is billed separately because it is NOT
“typically” done on everybody.
What’s included in a “typical” well visit?
Coding for well visits is much trickier. Well visit codes will be
shown as 9938x or 9939x, where x is
again 1-5 but now represents the age of the patient. “Typical”
resources needed are fairly consistent from
age to age so CPT E/M codes define a “typical minimum” that
must be done. There are, however, two
general scenarios in which “additional” resources are needed
and, therefore, coded and billed:
1) When there are “expert recommendations” that certain
procedures are necessary as the
“standard of care.” There are MANY of these, such as
immunizations, developmental
assessment, hearing and visions screening tests, anemia and

5. cholesterol blood tests, and screening
for health and behavior problems. Each of these
“recommendations” has their own unique CPT
codes as they require a different set and level of resources.
These CAN be predicted ahead of time.
2) When there are “additional concerns” during the well visit
NOT “typically” part of a well visit.
a. The concern may be expressed by the parent/patient or
identified during the visit by the
provider or by screening tests/questionnaires.
b. The concern may be a new problem or follow-up on an
existing problem.
c. Since the resources required to deal with the concern are
similar in nature to those needed
for a separate acute, chronic, and follow-up visits, the acute
visit codes 9920x and 9921x
are used.
d. The “-25 modifier” is added to the end of the acute code to
show that, while at a well visit,
a potential concern was identified that required extra resources.
e. The appropriate “level” of acute code is chosen that matches
the amount of additional
“resources” required.
f. The modified code is only billed if the concern and the extra
work meet certain strict
criteria so that this modified code is not misused/overused.

6. g. Most of the time you CAN NOT predict ahead if a “-25
modifier” code will be used.
Is this new, especially these -25 modifier codes?
Codes for various “expert recommendations” have been used for
many years. The -25 modifier was
approved in 2007 to recognize the extra resources needed in
certain situations. Kidz1st has been using
them since 2009. You may not have previously noticed if your
insurance paid the these codes.
So, which of these codes will I be expected to pay and how
much?
That question is best answered by your health insurance
company. Take advantage of the Kidz1st
Insurance Worksheet to help you understand what is covered
100%, what is not covered at all, what has a
co-pay or co-insurance, and what will apply to your deductible.
I called my insurance company and they said these codes should
be
included in the well visit code and not billed separately.
This process is called “bundling” and, in the above situations, is
unethical and potentially illegal.
Bundling is used as an excuse for insurers to not pay what they
are contractually obligated to pay. While

7. there are some CPT codes that supposed to be bundled, none of
the above coding examples are included.
If I only knew this ahead of time, I could plan my health care
spending
budget better!
You are absolutely correct! That is why we created and offered
the Kidz1st Insurance Worksheet for your
use. In addition, if we have your email address, we will soon be
sending you the expected codes and
charges for your child’s next well visit along with our email
reminder of your child’s appointment time
and date. You may also call at any time and ask which codes
and charges may be applicable for a visit.
WELL VISIT BILLING AND CODING EXAMPLE
SCENARIOS
SCENARIO #1
Jacob comes in for his 4 month well baby visit. Mom has no
concerns. History and physical exam reveal
no potential concerns. Mom completes the development and
postpartum depression screening

8. questionnaires which reveal no concerns. Jacob receives his
recommended immunizations.
BILLING CODES
99391 Established patient, well visit 0-11 months old
96110 Developmental screening questionnaire
96110 Postpartum depression screening questionnaire
90698/90460/90461x4 Pentacel (DTaP-IPV-Hib) vaccine and
its administration
90670/90460 Prevnar (PCV7) vaccine and its
administration
90680/90460 Rotavirus (RV5) vaccine and its
administration
SCENARIO #2
Mom states that Jacob has mild cough and congestion for 2 days
with no fever and no other symptoms.
History and physical exam reveal only mild nasal congestion.
The provider discusses basic treatment for
the cold. Jacob receives his recommended immunizations. The
rest of the visit is as in #1above.
BILLING CODES

9. 99391 Established patient, well visit 0-11
months old
96110 Developmental screening
questionnaire
96110 Postpartum depression screening
questionnaire
90698/90460/90461x4 Pentacel (DTaP-IPV-Hib) vaccine and
its administration
90670/90460 Prevnar (PCV7) vaccine and its
administration
90680/90460 Rotavirus (RV5) vaccine and its
administration
99212-25 is NOT billed because the extra resources required did
NOT meet the strict
criteria to bill this code
SCENARIO #3
Mom states that Jacob has had an itchy red rash on his face,
elbows, and knees for a couple weeks. Mom
expresses no other concerns. Physical exam reveals mild
inflammatory eczema affecting the above areas
and is otherwise normal. Jacob is diagnosed with mild eczema.
The provider discusses basic skin care
with mom and recommends the use of over the counter
moisturizing cream and hydrocortisone cream.

10. The rest of the visit is as in #1above.
BILLING CODES
99391 Established patient, well visit 0-11 months old
96110 Developmental screening questionnaire
96110 Postpartum depression screening questionnaire
90698/90460/90461x4 Pentacel (DTaP-IPV-Hib) vaccine and
its administration
90670/90460 Prevnar (PCV7) vaccine and its
administration
90680/90460 Rotavirus (RV5) vaccine and its
administration
99212-25 Acute visit – new problem, OTC
medications, followup as needed
SCENARIO #4
Mom states that Jacob has mild cough and congestion for 2 days
with no fever and no other symptoms.
History and physical exam reveal nasal congestion and a right

11. ear infection. The provider discusses the
ear infection, home care, prescribes an antibiotic, and
recommends follow-up in 10 days. The rest of the
visit is as in #1above.
BILLING CODES
99391 Established patient, well visit 0-11
months old
96110 Developmental screening
questionnaire
96110 Postpartum depression screening
questionnaire
90698/90460/90461x4 Pentacel (DTaP-IPV-Hib) Vaccine and
Administration
90670/90460 Prevnar (PCV7) Vaccine and
Administration
90680/90460 Rotavirus (RV5) Vaccine and
Administration
99213-25 Acute visit – new problem,
prescription medication, followup
SCENARIO #5
Mom states that Jacob has mild cough and congestion for 2 days

12. with no fever and no other symptoms.
History and physical exam reveal nasal congestion and a right
ear infection. Screening questionnaires
reveal possible developmental delay but no postpartum
depression. The provider discusses the ear
infection, prescribes an antibiotic, recommends follow-up in 10
days, and discusses Jacob’s possible
developmental delay. Jacob is referred to Early Intervention for
further evaluation. The rest of the visit is
as in #1above.
BILLING CODES
99391 Established patient, well visit 0-11
months old
96110 Developmental screening
questionnaire
96110 Postpartum depression screening
questionnaire
90698/90460/90461x4 Pentacel (DTaP-IPV-Hib) Vaccine and
Administration
90670/90460 Prevnar (PCV7) Vaccine and
Administration
90680/90460 Rotavirus (RV5) Vaccine and
Administration

13. 99214-25 Acute visit – multiple new
problems, prescription medication,
followup needed, referral recommended
SCENARIO #6
Jacob has a history of congenital hypothyroidism. He is
followed by a pediatric endocrinologist. Mom
states that he has been completely well. She has a followup
appointment in 1 week but wants the lab tests
done at Crittenton Hospital before the visit. After questioning,
mom states that she has missed some doses
of his medication. The provider discusses the importance of
consistent treatment, reads the last consultant
report and labs, and writes an order for the next set of labs. Two
days later, the provider checks the new
labs and determines that Jacob’s thyroid level is low. The
results are faxed to the specialist and the mother
is called to remind her to keep the specialist followup
appointment. The rest of the visit is as in #1above.
BILLING CODES
99391 Established patient, well visit 0-11
months old

14. 96110 Developmental screening
questionnaire
96110 Postpartum depression screening
questionnaire
90698/90460/90461x4 Pentacel (DTaP-IPV-Hib) Vaccine and
Administration
90670/90460 Prevnar (PCV7) Vaccine and
Administration
90680/90460 Rotavirus (RV5) Vaccine and
Administration
99215-25 Chronic Followup visit – followup
existing chronic problem,
patient education, lab test ordered, consultant report and labs
reviewed
TOP 500 CPT® CODES for PEDIATRIC
42830 ADENOIDECTOMY, PRIMARY; < AGE 12
99420 ADMINISTRATION & INTERPRETATION HEALTH
RISK ASSESSMENT INSTRUMENT
82107 AFP-L3 FRACTION ISOFORM AND TOTAL AFP
82043 ALBUMIN; URINE, MICROALBUMIN,
QUANTITATIVE
99408 ALCOHOL/SUBSTANCE SCREEN & INTERVENTION
15-30 MIN
95004 ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC
EXTRACTS, INCL INTERP & REPORT, SPECIFY NUMBER

15. 82105 ALPHA-FETOPROTEIN; SERUM
82150 AMYLASE
01920 ANESTHESIA, CARDIAC CATHETERIZATION
W/CORONARY ARTERIOGRAPHY &
VENTRICULOGRAPHY
00635 ANESTHESIA, PROC, LUMBAR REGION;
DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE
59425 ANTEPARTUM CARE ONLY; 4 TO 6 VISITS
59426 ANTEPARTUM CARE ONLY; 7+ VISITS
86631 ANTIBODY; CHLAMYDIA
86663 ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY
ANTIGEN (EA)
86696 ANTIBODY; HERPES SIMPLEX, TYPE 2
86701 ANTIBODY; HIV-1
86703 ANTIBODY; HIV-1 & HIV-2, SINGLE ASSAY
86689 ANTIBODY; HTLV/HIV ANTIBODY,
CONFIRMATORY TEST
86710 ANTIBODY; INFLUENZA VIRUS
86756 ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS
86759 ANTIBODY; ROTAVIRUS
86762 ANTIBODY; RUBELLA
97016 APPLICATION, MODALITY TO 1+ AREAS;
VASOPNEUMATIC DEVICES
29125 APPLICATION, SHORT ARM SPLINT (FOREARM TO
HAND); STATIC
92586 AUDITORY EVOKED POTENTIALS, EVOKED
RESPONSE AUDIOMETRY, &/OR CNS TESTING; LIMITED
80047 BASIC METABOLIC PANEL (CALCIUM, IONIZED)
80048 BASIC METABOLIC PANEL (CALCIUM, TOTAL)
88720 BILIRUBIN TOTAL TRANSCUTANEOUS
82248 BILIRUBIN; DIRECT
82247 BILIRUBIN; TOTAL
92504 BINOCULAR MICROSCOPY (SEP DX PROC)
90911 BIOFEEDBACK, PERINEAL
MUSCLES/ANORECTAL/URETHRAL SPHINCTER, W/EMG
TRAINING &/OR MANOMETRY

16. 85007 BLOOD COUNT; BLOOD SMEAR, MICROSCOP
EXAM W/MANUAL DIFFERENTIAL WBC COUNT
85027 BLOOD COUNT; COMPLETE CBC, AUTOMATED
(HGB, HCT, RBC, WBC, & PLATELET)
85025 BLOOD COUNT; COMPLETE CBC, AUTOMATED
(HGB, HCT, RBC, WBC, & PLATELET) & AUTOMATED
DIFFERENTIAL WBC
85014 BLOOD COUNT; HEMATOCRIT
85018 BLOOD COUNT; HEMOGLOBIN
85045 BLOOD COUNT; RETICULOCYTE, AUTOMATED
85013 BLOOD COUNT; SPUN MICROHEMATOCRIT
86900 BLOOD TYPING; ABO
86901 BLOOD TYPING; RH (D)
82272 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY
QUAL FECES 1-3 SIMUL DETERMINATIONS
82270 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY,
QUALITATIVE; FECES, CONSEC SPECIMENS
77072 BONE AGE STUDIES
94060 BRONCHODILAT RESPONSE/SPIROMETRY
PRE/POST BRONCHODILATOR ADMIN
11100 BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE
LESION
17250 CHEMICAL CAUTERIZATION, GRANULATION
TISSUE (PROUD FLESH, SINUS/FISTULA)
17360 CHEMICAL EXFOLIATION, ACNE
96450 CHEMOTHERAPY ADMINISTRATION, CNS,
REQUIRING, W/LUMBAR PUNCTURE
96422 CHEMOTHERAPY ADMINISTRATION, INTRA-
ARTERIAL; INFUSION, UP TO 1 HR
96415 CHEMOTHERAPY ADMINISTRATION, IV NFS TQ EA
HR
96413 CHEMOTHERAPY ADMINISTRATION, IV NFS TQ UP
1 HR 1/1ST SBST/DRUG
82465 CHOLESTEROL, SERUM/WHOLE BLOOD, TOTAL
54160 CIRCUMCISION, SURGICAL EXCISION OTHER
THAN CLAMP/DEVICE/DORSAL SLIT; NEONATE (<=28

17. DAYS OLD)
54150 CIRCUMCISION, USING CLAMP/OTHER DEVICE
W/REGIONAL DORSAL PENILE OR RING BLOCK
33675 CLOSURE MULTIPLE VENTRICULAR SEPTAL
DEFECTS
44144 COLECTOMY, PARTIAL; W/RESECTION,
W/COLOSTOMY/ILEOSTOMY & CREATION,
MUCOFISTULA
36591 COLLECTION OF BLOOD SPECIMEN FROM A
COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE
36592 COLLECTION OF BLOOD SPECIMEN USING
ESTABLISHED CENTRAL OR PERIPHERAL CATHETER,
VENOUS, NOS
36416 COLLECTION, CAPILLARY BLOOD SPECIMEN
36415 COLLECTION, VENOUS BLOOD, VENIPUNCTURE
57452 COLPOSCOPY, CERVIX W/UPPER ADJACENT
VAGINA
57454 COLPOSCOPY, CERVIX W/UPPER ADJACENT
VAGINA; W/BIOPSY(S), CERVIX & ENDOCERVICAL
CURETTAGE
80418 COMBINED RAPID ANTERIOR PITUITARY EVAL
PANEL
51741 COMPLEX UROFLOWMETRY
92557 COMPREHENSIVE AUDIOMETRY THRESHOLD
EVAL & SPEECH RECOGNITION
80053 COMPREHENSIVE METABOLIC PANEL
94644 CONTINUOUS INHALATION TREATMENT 1ST HR
94660 CONTINUOUS POSITIVE AIRWAY PRESSURE
VENTILATION (CPAP), INITIATION & MANAGEMENT
86140 C-REACTIVE PROTEIN
99291 CRITICAL CARE, EVALUATION & MANAGEMENT
99292 CRITICAL CARE, EVALUATION & MANAGEMENT,
ADD'L 30 MIN
17340 CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR
ACNE
74160 CT SCAN, ABDOMEN; W/CONTRAST MATL(S)

18. 70460 CT SCAN, HEAD/BRAIN; W/CONTRAST MATL(S)
70450 CT SCAN, HEAD/BRAIN; W/O CONTRAST MATL
72193 CT SCAN, PELVIS; W/CONTRAST MATL(S)
70491 CT SCAN, SOFT TISSUE NECK; W/CONTRAST
MATL(S)
70490 CT SCAN, SOFT TISSUE NECK; W/O CONTRAST
MATL
87070 CULTURE, BACTERIAL; ANY OTHER SOURCE
EXCEPT URINE/BLOOD/STOOL, AEROBIC,
W/ISOLATN/PRESUMPTIVE ID
87075 CULTURE, BACTERIAL; ANY SOURCE, EXCEPT
BLOOD, ANAEROBIC W/ISOLATN/PRESUMPTIVE ID,
ISOLATES
87040 CULTURE, BACTERIAL; BLOOD, AEROBIC, W/
ISOLATN/PRESUMPTIVE ID, ISOLATES (W/ ANAEROBIC
CULTURE)
87071 CULTURE, BACTERIAL; QUANTIT, AEROBIC
W/ISOLATN & ID ISOLATES, ANY SOURCE EXCEPT
URINE/BLOOD/STOOL
87086 CULTURE, BACTERIAL; QUANTITATIVE COLONY
COUNT, URINE
87046 CULTURE, BACTERIAL; STOOL, AEROBIC, ADD’L
PATHOGENS, ISOLATN/PRESUMPTIVE ID, EA PLATE
87045 CULTURE, BACTERIAL; STOOL, AEROBIC, W/
ISOLATN/PRELIMINARY EXAM, SALMONELLA &
SHIGELLA SPECIES
87088 CULTURE, BACTERIAL; W/ISOLATION &
PRESUMPTIVE ID OF EACH ISOLATE, URINE
87110 CULTURE, CHLAMYDIA, ANY SOURCE
87101 CULTURE, FUNGI (MOLD/YEAST) ISOLATION,
W/PRESUMPTIVE ID OF ISOLATES; SKIN/HAIR/NAIL
87081 CULTURE, PRESUMPTIVE, PATHOGENIC
ORGANISMS, SCREENING ONLY
87158 CULTURE, TYPING; OTHER METHODS
88175 CYTOPATHOLOGY, CERVICAL/VAGINAL, AUTO
THIN LAYER PREP; AUTO SCREEN & MANUAL

19. RESCREEN, W/PHYS
88142 CYTOPATHOLOGY, CERVICAL/VAGINAL,
PRESERVATIVE FLUID, AUTO THIN LAYER PREP;
MANUAL SCREEN
88143 CYTOPATHOLOGY, CERVICAL/VAGINAL,
PRESERVATIVE FLUID, AUTO THIN LAYER PREP;
MANUAL SCREEN/RESCREEN
88164 CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL,
BETHESDA; MANUAL SCREEN
88150 CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL;
MANUAL SCREEN
11000 DEBRIDEMENT, EXTENSIVE
ECZEMATOUS/INFECTED SKIN; UP TO 10PCT BODY
SURFACE
99465 DELIVERY/BIRTHING ROOM RESUSCITATION
94664 DEMONSTRATE &/OR EVAL, PT USE, AEROSOL
GENERATOR/NEBULIZER/INHALER/IPPB DEVICE
17110 DESTRUCTION, BENIGN LESIONS, EXCEPT SKIN
TAGS/CUTANEOUS VASC LESIONS; UP TO 14 LESIONS
17111 DESTRUCTION, FLAT WARTS, MOLLUSCUM
CONTAGIOSUM/MILIA; 15 +
54050 DESTRUCTION, PENILE LESION, SIMPLE;
CHEMICAL
17000 DESTRUCTION, PREMALIG LESIONS; 1ST LESION
92015 DETERMINATION, REFRACTIVE STATE
96111 DEVELOPMENTAL TESTING; EXTENDED,
W/INTERPRETATION & REPORT
96110 DEVELOPMENTAL TESTING; LIMITED,
W/INTERPRETATION & REPORT, PER HR
90700 DIPHTHERIA, TETANUS TOXOIDS, & ACELLULAR
PERTUSSIS VACCINE (DTAP), < 7 YEARS, IM USE
90701 DIPHTHERIA, TETANUS TOXOIDS, & WHOLE CELL
PERTUSSIS VACCINE (DTP), IM USE
93320 DOPPLER ECHOCARDIOGRAPHY; COMPLETE
15852 DRESSING CHANGE (FOR OTHER THAN BURNS)
UNDER ANESTHESIA (OTHER THAN LOCAL)

20. 16020 DRESSINGS &/OR DEBRIDEMENT,
INITIAL/SUBSEQUENT; SMALL
80100 DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG
CLASSES CHROMATOGRAPHIC METHOD, EACH PROC
90698 DTAP - HIB - IPV VACCINE, IM USE
90723 DTAP/HEPB & POLIO VIRUS, INACTIVATED (DTAP-
HEPB-IPV) IM USE
90721 DTAP/HIB VACCINE, IM
90696 DTAP-IPV INACTIVATED IF ADMIN PTS AGE 4-6
YRS IM
76827 ECHOCARDIOGRAPHY, FETAL, DOPPLER;
COMPLETE
93312 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, 2D;
W/PROBE, IMAGE ACQUISITION, INTERPRETATION &
REPORT
93306 ECHOCARDIOGRAPHY, TRANSTHORACIC R-T 2D -
+M-MODE COMPL SPEC&COLOR DOP
93307 ECHOCARDIOGRAPHY, TRANSTHORACIC, 2D, M-
MODE; COMPLETE
93308 ECHOCARDIOGRAPHY, TRANSTHORACIC, 2D, M-
MODE; FOLLOW-UP/LIMITED STUDY
76604 ECHOGRAPHY, CHEST (INCLUDES MEDIASTINUM)
REAL TIME W/IMAGE DOCUMENTATION
76856 ECHOGRAPHY, PELVIC (NONOBSTETRIC), REAL
TIME W/IMAGE DOCUMENTATION; COMPLETE
76830 ECHOGRAPHY, TRANSVAGINAL
98960 EDUCATION & TRAINING F/PT SELF-MGMT BY
NONPHYS 1 PT
98961 EDUCATION & TRAINING F/PT SELF-MGMT BY
NONPHYS 2-4 PT
93010 ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12
LEADS; INTERPRETATION & REPORT ONLY
93005 ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12
LEADS; TRACING ONLY W/O INTERPRETATION &
REPORT
93000 ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12

21. LEADS; W/INTERPRETATION & REPORT
95813 ELECTROENCEPHALOGRAM (EEG) EXTENDED
MONITORING; > ONE HOUR
95812 ELECTROENCEPHALOGRAM (EEG) EXTENDED
MONITORING; 41-60 MINUTES
80051 ELECTROLYTE PANEL
51784 ELECTROMYOGRAPHY STUDIES, ANAL/URETHRAL
SPHINCTER, OTHER THAN NEEDLE, ANY TECHNIQUE
99284 EMERGENCY DEPT VISIT, 3 KEY COMPONENTS:
DETAILED HX; DETAILED EXAM; MED DECISION MOD
COMPLEXITY
99281 EMERGENCY DEPT VISIT, 3 KEY COMPONENTS:
PROB FOCUS HX; PROB FOCUS EXAM; STRTFWD MED
DECISION
99285 EMERGENCY DEPT VISIT, 3 KEY
COMPONENTS:COMPREHENSIVE HX; COMPREHENSIVE
EXAM; MED DECISN HIGH
99282 EMERGENCY DEPT VISIT,3 KEY
COMPONENTS:EXPAND PROB FOCUS HX;EXPAND PROB
FOCUS EXAM;MED DEC LOW
99283 EMERGENCY DEPT VISIT,3 KEY
COMPONENTS:EXPAND PROB FOCUS HX;EXPAND PROB
FOCUS EXAM;MED DEC MOD
58100 ENDOMETRIAL BX W/WO ENDOCERVICAL BX, W/O
DILATION, ANY METHOD (SEP PROC)
93505 ENDOMYOCARDIAL BX
82657 ENZYME ACTIVITY, CELLS/TISSUE NOT
ELSEWHERE SPECIFIED; NONRADIOACTIVE SUBSTRATE,
EACH SPECIMEN
87449 ENZYME IMMUNOASSAY (EIA)
QUALITATIVE/SEMIQUANTITATIVE; MULTIPLE STEP,
NOS, EA ORGANISM
87400 ENZYME IMMUNOASSAY (EIA),
QUALITATIVE/SEMIQUANTITATIVE, MULTI STEP;
INFLUENZA, A OR B, EA
87340 ENZYME IMMUNOASSAY (EIA),

22. QUALITATIVE/SEMIQUANTITATIVE, MULTIPLE STEP;
HEPATITIS B SURFACE ANTIGEN
87390 ENZYME IMMUNOASSAY (EIA),
QUALITATIVE/SEMIQUANTITATIVE, MULTIPLE STEP;
HIV-1
87420 ENZYME IMMUNOASSAY (EIA),
QUALITATIVE/SEMIQUANTITATIVE, MULTIPLE STEP;
RSV
87430 ENZYME IMMUNOASSAY (EIA),
QUALITATIVE/SEMIQUANTITATIVE, MULTIPLE STEP;
STREPTOCOCCUS, GROUP A
82670 ESTRADIOL
82677 ESTRIOL
82672 ESTROGENS; TOTAL
92506 EVAL,
SPEECH/LANGUAGE/VOICE/COMMUNICATION/AUDITOR
Y
92588 EVOKED OTOACOUSTIC EMISSIONS;
COMPREHENSIVE/DX
92587 EVOKED OTOACOUSTIC EMISSIONS; LIMITED
36455 EXCHANGE TRANSFUSION, BLOOD; OTHER THAN
NEWBORN
96567 EXTERNAL PHOTODYNAMIC THERAPY, EACH
PHOTOTHERAPY EXPOSURE SESSION
82728 FERRITIN
59025 FETAL NON-STRESS TEST
82735 FLUORIDE
54450 FORESKIN MANIPULATION W/LYSIS, PREPUTIAL
ADHESIONS & STRETCHING
82784 GAMMAGLOBULIN; IGA, IGD, IGG, IGM, EACH
80050 GENERAL HEALTH PANEL
82962 GLUCOSE, BLOOD, GLUCOSE MONITORING
DEVICE(S) CLEARED BY FDA SPECIFICALLY FOR HOME
USE
82948 GLUCOSE; BLOOD, REAGENT STRIP
82947 GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT

23. REAGENT STRIP)
82951 GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS
(INCLUDES GLUCOSE)
84704 GONADOTROPIN, CHORIONIC (HCG); FREE BETA
CHAIN
84703 GONADOTROPIN, CHORIONIC (HCG);
QUALITATIVE
84702 GONADOTROPIN, CHORIONIC (HCG);
QUANTITATIVE
83001 GONADOTROPIN; FOLLICLE STIMULATING
HORMONE (FSH)
83002 GONADOTROPIN; LUTEINIZING HORMONE (LH)
80428 GROWTH HORMONE STIMULATION PANEL
90470 H1N1 IMMUNIZATION ADMINISTRATION
(INTRAMUSCULAR, INTRANASAL), W/WO COUNSELING
99000 HANDLING &/OR CONVEYANCE, SPECIMEN
TRANSFER, PHYSICIAN'S OFFICE TO LAB
96150 HEALTH & BEHAVIOR ASSESSMENT, EA 15
MINUTES; INITIAL ASSESSMENT
96151 HEALTH & BEHAVIOR ASSESSMENT, EA 15
MINUTES; RE-ASSESSMENT
96152 HEALTH & BEHAVIOR INTERVENTION, EA 15
MINUTES; INDIVIDUAL
83020 HEMOGLOBIN FRACTIONATION & QUANTITATION;
ELECTROPHORESIS
83036 HEMOGLOBIN; GLYCOSYLATED (A1C)
83037 HEMOGLOBIN; GLYCOSYLATED (A1C) BY DEVICE
CLEARED BY FDA FOR HOME USE
83051 HEMOGLOBIN; PLASMA
90645 HEMOPHILUS INFLUENZA B VACCINE (HIB), HBOC
CONJUGATE (4 DOSE SCHEDULE), IM USE
90646 HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-D
CONJUGATE, BOOSTER USE ONLY, IM USE
90648 HEMOPHILUS INFLUENZA B VACCINE (HIB),PRP-T
CONJUGATE (4 DOSE SCHEDULE), IM USE
90647 HEMOPHILUS INFLUENZA B VACCINE, PRP-OMP, 3

24. DOSE SCHEDULE, IM USE
80076 HEPATIC FUNCTION PANEL
86708 HEPATITIS A ANTIBODY (HAAB); TOTAL
90632 HEPATITIS A VACCINE, ADULT DOSAGE, IM USE
90633 HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT
DOSAGE-2 DOSE SCHEDULE, IM USE
90634 HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT
DOSAGE-3 DOSE SCHEDULE, IM USE
90748 HEPATITIS B & HEMOPHILUS INFLUENZA B
VACCINE (HEPB-HIB), IM USE
86704 HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL
90743 HEPATITIS B VACCINE, ADOLESCENT (2-DOSE
SCHEDULE), IM USE
90746 HEPATITIS B VACCINE, ADULT DOSAGE, IM USE
90744 HEPATITIS B VACCINE, PEDIATRIC/ADOLESCENT,
(3-DOSE SCHEDULE), IM USE
86803 HEPATITIS C ANTIBODY
86308 HETEROPHILE ANTIBODIES; SCREENING
99349 HOME VISIT EST PT 2+ KEY COMPONENTS:
DETAILED INTRVL HX; DETAILED EXAM; MED DECISION
MOD COMPLEXITY
99239 HOSPITAL DISCHARGE DAY MANAGEMENT; > 30
MIN
99238 HOSPITAL DISCHARGE DAY MANAGEMENT; UP TO
30 MIN
90649 HPV TYP 6 11 16 18 QUADRIV 3 DOSE SCHED IM
90650 HPV VACCINE BIVALENT 3 DOSE IM
90460 IMMUNIZATION ADMINISTRATION THROUGH
18YR ANY ROUTE 1ST VAC/TOXOID
90461 IMMUNIZATION ADMINISTRATION THROUGH
18YR ANY ROUTE EA ADDL VAC/TOXOID
90473 IMMUNIZATION ADMINISTRATION,
INTRANASAL/ORAL; 1 SINGLE/COMBINATION
VACCINE/TOXOID
90474 IMMUNIZATION ADMINISTRATION,
INTRANASAL/ORAL; EA ADD'L SINGLE/COMBINATION

25. VACCINE/TOXOID
90471 IMMUNIZATION ADMINISTRATION; 1
SINGLE/COMBINATION VACCINE/TOXOID
90472 IMMUNIZATION ADMINISTRATION; EACH ADD'L
SINGLE/COMBINATION VACCINE/TOXOID
86318 IMMUNOASSAY, INFECTIOUS AGENT ANTIBODY,
QUALITATIVE, SEMIQUANTITATIVE, SINGLE STEP
83518 IMMUNOASSAY, NON-ANTIBODY/INFECTIOUS
ANTIGEN QUAL/SEMIQUANT; SINGLE STEP METHOD
86304 IMMUNOASSAY, TUMOR ANTIGEN,
QUANTITATIVE; CA 125
10061 INCISION & DRAINAGE, ABSCESS;
COMPLICATED/MULTIPLE
10060 INCISION & DRAINAGE, ABSCESS; SIMPLE/SINGLE
10120 INCISION & REMOVAL, FB, SUBQ TISSUES; SIMPLE
90875 INDIVIDUAL PSYCHOPHYSIOLOGICAL THERAPY
W/BIOFEEDBACK TRAINING; APPROXIMATELY 20-30
MIN
87276 INFECTIOUS AGENT ANTIGEN DETECTION BY
IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA A
VIRUS
87275 INFECTIOUS AGENT ANTIGEN DETECTION BY
IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B
VIRUS
87280 INFECTIOUS AGENT ANTIGEN DETECTION BY
IMMUNOFLUORESCENT TECHNIQUE; RSV
87265 INFECTIOUS AGENT ANTIGEN DETECTION,
IMMUNOFLUOR TECHNIQUE; BORDETELLA
PERTUSSIS/PARAPERTUSSIS
87804 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT
OBSERVATION; INFLUENZA
87850 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT
OBSERVATION; NEISSERIA GONORRHOEAE
87899 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT
OBSERVATION; NOS
87807 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT

26. OBSERVATION; RESPIRATORY SYNCYTIAL VIRUS
87880 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT
OBSERVATION; STREPOCOCCUS GROUP A
87802 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT
OBSERVATION; STREPTOCOCCUS GROUP B
87800 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA),
MULTIPLE ORGANISMS; DIRECT PROBE(S) TECHNIQUE
87491 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE
87490 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
CHLAMYDIA TRACHOMATIS, DIRECT PROBE
87492 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
CHLAMYDIA TRACHOMATIS, QUANTIFICATION
87534 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
HIV-1, DIRECT PROBE
87536 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
HIV-1, QUANTIFICATION
87621 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
HUMAN PAPILLOMAVIRUS, AMPLIFIED PROBE
87620 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
HUMAN PAPILLOMAVIRUS, DIRECT PROBE
87591 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
NEISSERIA GONORRHOEAE, AMPLIFIED PROBE
87590 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
NEISSERIA GONORRHOEAE, DIRECT PROBE
87592 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
NEISSERIA GONORRHOEAE, QUANTIFICATION
87650 INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA);
STREPTOCOCCUS GROUP A, DIRECT PROBE
90661 INFLUENZA VIRUS VACCINE, CELL CULTURES,
PRESERVATIVE FREE IM
90660 INFLUENZA VIRUS VACCINE, LIVE, INTRANASAL
USE
90663 INFLUENZA VIRUS VACCINE, PANDEMIC
FORMULATION, H1N1
90658 INFLUENZA VIRUS VACCINE, SPLIT, 3 YEARS +, IM

27. USE
90657 INFLUENZA VIRUS VACCINE, SPLIT, 6-35 MONTHS,
IM USE
90662 INFLUENZA VIRUS VACCINE, SPLIT,
PRESERVATIVE FREE INC ANTIGEN IM
90656 INFLUENZA VIRUS VACCINE, SPLIT,
PRESERVATIVE FREE, 3+YRS, IM USE
90655 INFLUENZA VIRUS VACCINE, SPLIT,
PRESERVATIVE FREE, 6-35 MONTHS, IM USE
95075 INGESTION CHALLENGE TEST
95071 INHALATION BRONCHIAL CHALLENGE TESTS;
W/ANTIGENS/GASES, SPECIFY
95070 INHALATION BRONCHIAL CHALLENGE TESTS;
W/HISTAMINE/METHACHOLINE
86336 INHIBIN A
99461 INITIAL CARE PER DAY NORMAL NEWBORN XCPT
HOSP/BIRTHING CENTER
99384 INITIAL COMPREHENSIVE PREVENTIVE MEDICINE
E&M W/HX/EXAM, NEW PT; 12-17 YR
99382 INITIAL COMPREHENSIVE PREVENTIVE MEDICINE
E&M W/HX/EXAM, NEW PT; 1-4 YR
99385 INITIAL COMPREHENSIVE PREVENTIVE MEDICINE
E&M W/HX/EXAM, NEW PT; 18-39 YR
99383 INITIAL COMPREHENSIVE PREVENTIVE MEDICINE
E&M W/HX/EXAM, NEW PT; 5-11 YR
99381 INITIAL COMPREHENSIVE PREVENTIVE MEDICINE
E&M W/HX/EXAM, NEW PT; INFANT < 1 YR
99223 INITIAL HOSP CARE 3 KEY COMPONENTS:
COMPREHENSIVE HX; COMPREHENSIVE EXAM; MED
DECISION HIGH
99222 INITIAL HOSP CARE 3 KEY COMPONENTS:
COMPREHENSIVE HX; COMPREHENSIVE EXAM; MED
DECISION MOD
99221 INITIAL HOSP CARE 3 KEY
COMPONENTS:DETAIL/COMPREHENSV HX;DETAIL/COMP
EXAM;MED DEC STR/LOW

28. 99477 INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY
ILL
99460 INITIAL HOSP/BIRTHING CENTER CARE PER DAY
NORMAL NEWBORN
99219 INITIAL OBSV CARE, 3 KEY COMPONENTS:
COMPREHENSIVE HX;COMPREHENSIVE EXAM;MED
DECISION MOD
99471 INITIAL PEDIATRIC CRITICAL CARE 29 D THRU 24
MO
99218 INITL OBSV CARE, 3 KEY COMPONENTS:
DETAIL/COMPREHENSV HX;DETAIL/COMP EXAM;MED
DEC STRTFWD/LOW
99253 INPATIENT CONSULT, 3 KEY COMPONENTS:
DETAILED HX; DETAILED EXAM; MED DECISION LOW
COMPLEX
99251 INPATIENT CONSULT, 3 KEY COMPONENTS: PROB
FOCUS HX; PROB FOCUS EXAM; STRTFWD MED
DECISION
99254 INPATIENT CONSULT, 3 KEY
COMPONENTS:COMPREHENSIVE HX;COMPREHENSIVE
EXAM; MED DECISION MOD
99255 INPATIENT CONSULT, 3 KEY
COMPONENTS:COMPREHENSIVE HX;COMPREHENSIVE
EXAM;MED DECISION HIGH
99252 INPATIENT CONSULT, 3 KEY
COMPONENTS:EXPAND PROB FOCUS HX;EXPAND PROB
FOCUS EXAM;STRTFWD MED
11975 INSERTION, IMPLANTABLE CONTRACEPTIVE
CAPSULES
58300 INSERTION, INTRAUTERINE DEVICE
51701 INSERTION, NON-INDWELLING BLADDER
CATHETER
36568 INSERTION, PERIPHERAL CENTRAL VENOUS
CATHETER, W/O SUBQ PORT/PUMP,
36560 INSERTION, TUNNELED CENTRALLY INSERTED
VENOUS ACCESS DEVICE, W/SUBQ PORT;

29. 83525 INSULIN; TOTAL
90802 INTERACTIVE PSYCHIATRIC DX EXAM, USING
PLAY EQUIPMENT/PX DEVICES/LANGUAGE
INTERPRETER/OTHER
31500 INTUBATION, ENDOTRACHEAL, EMERGENCY
PROC
83540 IRON
96361 IV INFUSION HYDRATION EACH ADDITIONAL
HOUR
96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
96365 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST >1
HOUR
83655 LEAD
83690 LIPASE
80061 LIPID PANEL
78220 LIVER FUNCTION STUDY W/HEPATOBILIARY
AGENTS, W/SERIAL IMAGES
83735 MAGNESIUM
77056 MAMMOGRAPHY BILATERAL
94200 MAXIMUM BREATHING CAPACITY, MAXIMAL
VOLUNTARY VENTILATION
90707 MEASLES, MUMPS AND RUBELLA VIRUS VACCINE
(MMR), LIVE, SUB-Q USE
90710 MEASLES, MUMPS, RUBELLA, & VARICELLA
VACCINE (MMRV), LIVE, SUBQ USE
51798 MEASUREMENT, POST-VOIDING RESIDUAL URINE
&/OR BLADDER CAPACITY, US, NON-IMAGING
94011 MEASUREMENT, SPIROMETRIC FORCED
EXPIRATORY FLOWS, < 2 YRS
97802 MEDICAL NUTRITION THERAPY; INITIAL
ASSESSMENT & INTERVENTION, FACE-TO-FACE W/PT, 15
MIN
97803 MEDICAL NUTRITION THERAPY; RE-ASSESSMENT
& INTERVENTION, FACE-TO-FACE W/PT, EACH 15 MIN
99605 MEDICATION THERAPY 1ST 15 MIN NEW PATIENT
99606 MEDICATION THERAPY F2F 1ST 15 MIN

30. ESTABLISHED PT
99607 MEDICATION THERAPY F2F EA ADDITIONAL 15
MIN
90734 MENINGOCOCCAL CONJUGATE VACCINE,
SEROGROUPS A, C, Y & W-135 (4-VALENT), IM USE
90733 MENINGOCOCCAL POLYSACCHARIDE VACCINE
(ANY GROUP(S)), SUB-Q USE
99143 MODERATE SEDATION SERVICES BY SM PHYS
PERFRMG SVC
99144 MODERATE SEDATION SERVICES BY SM PHYS
PERFRMG SVC 5+ YR
83896 MOLECULAR DX; NUCLEIC ACID PROBE, EACH
92611 MOTION FLUOROSCOPIC EVAL, SWALLOW
FUNCTION, CINE/VIDEO RECORD
70552 MRI, BRAIN; W/CONTRAST MATL (S)
70551 MRI, BRAIN; W/O CONTRAST MATL
70553 MRI, BRAIN; W/O CONTRAST MATL, THEN
W/CONTRASTMATL (S) & FURTHER SEQUENCES
69421 MYRINGOTOMY W/ASPIRATION &/OR
EUSTACHIAN TUBE INFLATION REQUIRING GENERAL
ANESTHESIA
89190 NASAL SMEAR, EOSINOPHILS
97605 NEGATIVE PRESSURE WOUND THERAPY, PER
SESSION; TOT WOUND SURF 50 SQ CM/<
94762 NONINVASIVE EAR/PULSE OXIMETRY, OXYGEN
SATURATION; CONTINUOUS OVERNIGHT MONITORING
94761 NONINVASIVE EAR/PULSE OXIMETRY, OXYGEN
SATURATION; MULTIPLE DETERMINATIONS
94760 NONINVASIVE EAR/PULSE OXIMETRY, OXYGEN
SATURATION; SINGLE DETERMINATION
93923 NON-INVASIVE STUDY, EXTREMITY ARTERY,
COMPLETE BILATERAL
99217 OBSERVATION CARE DISCHARGE DAY MGT
80055 OBSTETRIC PANEL
99236 OBSV/INPT HOSP CARE 3 KEY COMPONENTS:
COMPREHENSIVE HX; COMPREHENSIVE EXAM; MED

31. DECISION HIGH
99235 OBSV/INPT HOSP CARE 3 KEY COMPONENTS:
COMPREHENSIVE HX; COMPREHENSIVE EXAM; MED
DECISION MOD
99234 OBSV/INPT HOSP CARE 3 KEY COMPONENTS:
DETAIL/COMPR HX; DETAIL/COMPR EXAM;MED DEC
STRTFWD/LOW
97004 OCCUPATIONAL THERAPY RE-EVAL
99245 OFFICE CONSULTATION, 3 KEY COMPONENTS:
COMPREHENSIVE HX;COMPREHENSIVE EXAM;MED
DECISION HIGH
99243 OFFICE CONSULTATION, 3 KEY COMPONENTS:
DETAILED HX; DETAILED EXAM; MED DECISION LOW
COMPLEXITY
99241 OFFICE CONSULTATION, 3 KEY COMPONENTS:
PROB FOCUS HX; PROB FOCUS EXAM; STRTFWD MED
DECISION
99244 OFFICE CONSULTATION, 3 KEY
COMPONENTS:COMPREHENSIVE HX; COMPREHENSIVE
EXAM; MED DECISION MOD
99242 OFFICE CONSULTATION, 3 KEY
COMPONENTS:EXPAND PROB FOCUS HX;EXPAND PROB
FOCUS EXAM;STRTFWD MED
99214 OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS:
DETAILED HX; DETAILED EXAM; MED DECISION MOD
COMPLEXITY
99213 OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS:
EXPAND PROB HX; EXPAND PROB EXAM;MED DECISION
LOW
99212 OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS:
PROB FOCUS HX; PROB FOCUS EXAM; STRTFWD MED
DECISION
99215 OFFICE/OP VISIT, EST PT, 2 KEY
COMPONENTS:COMPREHENSIVE HX;COMPREHENSIV
EXAM;MED DECISN HIGH
99211 OFFICE/OP VISIT, EST PT, NOT REQUIRING

32. PHYSICIAN PRESENCE, TYPICALLY 5 MIN
99203 OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS:
DETAILED HX; DETAILED EXAM; MED DECISION LOW
COMPLEXITY
99202 OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS:
EXPAND PROB FOCUS HX; EXPAND PROB FOCUS EXAM;
STRTFWD
99201 OFFICE/OP VISIT, NEW PT, 3 KEY COMPONENTS:
PROB FOCUS HX; PROB FOCUS EXAM; STRTFRWD MED
DECISION
99205 OFFICE/OP VISIT, NEW PT, 3 KEY
COMPONENTS:COMPREHENSIVE HX;COMPREHENSIV
EXAM;MED DECISN HIGH
99204 OFFICE/OP VISIT, NEW PT, 3 KEY
COMPONENTS:COMPREHENSIVE HX;COMPREHENSIVE
EXAM;MED DECISN MOD
92012 OPHTHALMOLOGICAL MEDICAL EXAM & EVAL;
INTERMEDIATE, ESTABLISHED PATIENT
87177 OVA & PARASITES, DIRECT SMEARS,
CONCENTRATION & IDENTIFICATION
86403 PARTICLE AGGLUTINATION; SCREEN, EACH
ANTIBODY
99071 PATIENT EDUCATION MATLS PROVIDED BY
PHYSICIAN
94776 PEDIATRIC APNEA MONITOR ANALYSES
COMPUTER
99394 PERIODIC COMPREHENSIVE PREVENTIVE
MEDICINE E&M W/HX/EXAM, EST PT; 12-17 YR
99392 PERIODIC COMPREHENSIVE PREVENTIVE
MEDICINE E&M W/HX/EXAM, EST PT; 1-4 YR
99395 PERIODIC COMPREHENSIVE PREVENTIVE
MEDICINE E&M W/HX/EXAM, EST PT; 18-39 YR
99396 PERIODIC COMPREHENSIVE PREVENTIVE
MEDICINE E&M W/HX/EXAM, EST PT; 40-64 YR
99393 PERIODIC COMPREHENSIVE PREVENTIVE
MEDICINE E&M W/HX/EXAM, EST PT; 5-11 YR

33. 99391 PERIODIC COMPREHENSIVE PREVENTIVE
MEDICINE E&M W/HX/EXAM, EST PT; INFANT < 1 YR
84030 PHENYLALANINE (PKU), BLOOD
84100 PHOSPHORUS INORGANIC (PHOSPHATE)
97001 PHYSICAL THERAPY EVAL
97002 PHYSICAL THERAPY RE-EVAL
99378 PHYSICIAN SUPERVISION, HOSPICE PATIENT; 30+
MIN
90670 PNEUMOCOCCAL CONJUGATE VACCINE, 13
VALENT, IM USE
90669 PNEUMOCOCCAL CONJUGATE VACCINE, 7
VALENT, IM USE
90732 PNEUMOCOCCAL POLYSACCHARIDE VACCINE, 23-
VALENT, ADULT/IMMUNOSUPPRESSED PATIENT
DOSAGE, SUBQ/IM
90713 POLIOVIRUS VACCINE, INACTIVATED, (IPV), SUBQ
OR IM USE
99024 POSTOPERATIVE FOLLOW-UP VISIT, INCLUDED
SURGICAL PACKAGE, E/M PERFORMED
59430 POSTPARTUM CARE ONLY (SEP PROC)
94640 PRESSURIZED/NONPRESSURIZED INHALATION RX,
AIRWAY OBSTRUCTION/DX SPUTUM INDUCTION
99401 PREVENTIVE MEDICINE COUNSELING, INDIV; 15
MIN
84144 PROGESTERONE
84146 PROLACTIN
99354 PROLONGED PHYSICIAN SERVICE, OFFICE/OP
W/DIRECT CONTACT; 1ST HR
85610 PROTHROMBIN TIME
90862 PSYCHIATRIC MEDICATION MANAGEMENT
W/MINIMAL PSYCHOTHERAPY
78596 PULMONARY QUANTITATIVE DIFFERENTIAL
FUNCTION (VENTILATION/PERFUSION) STUDY
92552 PURE TONE AUDIOMETRY (THRESHOLD); AIR
ONLY
74020 RADIOLOGIC EXAM, ABDOMEN; COMPLETE,

34. W/DECUBITUS &/OR ERECT VIEWS
74000 RADIOLOGIC EXAM, ABDOMEN; SINGLE
ANTEROPOSTERIOR VIEW
73600 RADIOLOGIC EXAM, ANKLE; 2 VIEWS
73610 RADIOLOGIC EXAM, ANKLE; COMPLETE, 3+ VIEWS
71020 RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL &
LATERAL
71010 RADIOLOGIC EXAM, CHEST; SINGLE VIEW,
FRONTAL
73070 RADIOLOGIC EXAM, ELBOW; 2 VIEWS
73080 RADIOLOGIC EXAM, ELBOW; COMPLETE, 3+
VIEWS
73140 RADIOLOGIC EXAM, FINGER(S), 2+ VIEWS
73620 RADIOLOGIC EXAM, FOOT; 2 VIEWS
73630 RADIOLOGIC EXAM, FOOT; COMPLETE, 3+ VIEWS
73120 RADIOLOGIC EXAM, HAND; 2 VIEWS
73130 RADIOLOGIC EXAM, HAND; 3+ VIEWS
73560 RADIOLOGIC EXAM, KNEE; 1/2 VIEWS
73562 RADIOLOGIC EXAM, KNEE; 3 VIEWS
70210 RADIOLOGIC EXAM, SINUSES, PARANASAL,
72010 RADIOLOGIC EXAM, SPINE, ENTIRE, SURVEY
STUDY, ANTEROPOSTERIOR & LATERAL
74241 RADIOLOGIC EXAM, UPPER GI TRACT; W/WO
DELAYED FILMS, W/KUB
74240 RADIOLOGIC EXAM, UPPER GI TRACT; W/WO
DELAYED FILMS, W/O KUB
73100 RADIOLOGIC EXAM, WRIST; 2 VIEWS
73110 RADIOLOGIC EXAM, WRIST; COMPLETE, 3+ VIEWS
73090 RADIOLOGIC EXAM; FOREARM, 2 VIEWS
73590 RADIOLOGIC EXAM; TIBIA & FIBULA, TWO VIEWS
95990 REFILLING & MAINTENANCE, IMPLANT
PUMP/RESERVOIR, DRUG DELIVERY, SPINAL/BRAIN;
69200 REMOVAL FB, EXT AUDITORY CANAL; W/O
GENERAL ANESTHESIA
69210 REMOVAL IMPACTED CERUMEN (SEP PROC),
ONE/BOTH EARS

35. 58301 REMOVAL, INTRAUTERINE DEVICE
80069 RENAL FUNCTION PANEL
33615 REPAIR, COMPLEX CARD ANOMALIES, CLOSURE,
ATRIASEPTL DEFECT, ANASTOMOSIS ATRIA/VENA
CAVA-PULM ART
33619 REPAIR, SINGLE VENTRICLE W/AORTIC OUTFLOW
OBSTRUCTION & ARCH HYPOPLASIA
49450 REPLACE GASTROSTOMY/CECOSTOMY TUBE
PERCUTANEOUS
90378 RESPIRATORY SYNCYTIAL VIRUS MONOCLONAL
ANTIBODY, RECOMBINANT, IM USE, 50 MG, EACH
90681 ROTAVIRUS VACCINE HUMAN ATTENUATED 2
DOSE LIVE ORAL
90680 ROTAVIRUS VACCINE, PENTAVALENT, 3 DOSE
SCHED, LIVE, ORAL USE
59400 ROUTINE OBSTETRIC CARE, ANTEPARTUM CARE,
VAGINAL DELIVERY, & POSTPARTUM CARE
77057 SCREENING MAMMOGRAPHY BILATERAL
92551 SCREENING TEST, PURE TONE, AIR ONLY
99173 SCREENING, VISUAL ACUITY, QUANTITATIVE,
BILAT
85652 SEDIMENTATION RATE, ERYTHROCYTE;
AUTOMATED
85651 SEDIMENTATION RATE, ERYTHROCYTE; NON-
AUTOMATED
92583 SELECT PICTURE AUDIOMETRY
33767 SHUNT; SUPERIOR VENA CAVA TO PULMONARY
ARTERY, FLOW TO BOTH LUNGS
85660 SICKLING, RBC, REDUCTION
12011 SIMPLE REPAIR, SUPERFICIAL WOUNDS,
FACE/EARS/EYELIDS/NOSE/LIPS/MUCOUS MEMBRANES;
2.5 CM/<
12001 SIMPLE REPAIR, SUPERFICIAL WOUNDS,
SCALP/NECK/AXILLAE/GENITALIA/TRUNK/EXTREMITIES
; 2.5 CM/<
12002 SIMPLE REPAIR, SUPERFICIAL WOUNDS,

36. SCALP/NECK/AXILLAE/GENITALIA/TRUNK/EXTREMITIES
; 2.6-7.5 CM
51736 SIMPLE UROFLOWMETRY
86580 SKIN TEST; TUBERCULOSIS, INTRADERMAL
95807 SLEEP STUDY, ATTENDED
87205 SMEAR, PRIMARY SOURCE W/INTERPRETATION;
GRAM OR GIEMSA STAIN, BACTERIA/FUNGI/CELL TYPES
87210 SMEAR, PRIMARY SOURCE W/INTERPRETATION;
WET MOUNT, FOR INFECTIOUS AGENTS
92555 SPEECH AUDIOMETRY THRESHOLD
92508 SPEECH/HEARING/VOICE/COMMUNICATION
THERAPY; GROUP, 2+ INDIVIDUALS
92507 SPEECH/HEARING/VOICE/COMMUNICATION
THERAPY; INDIVIDUAL
62270 SPINAL PUNCTURE, LUMBAR, DX
94010 SPIROMETRY W/GRAPHIC RECORD/VITAL
CAPACITY/FLOW RATE W/WO MAXIMAL VOLUNTARY
VENTILATION
67312 STRABISMUS SURGERY, RECESSION/RESECTION
PROC; 2 HORIZONTAL MUSCLES
86590 STREPTOKINASE, ANTIBODY
99233 SUBSEQUENT HOSP CARE 2+ KEY COMPONENTS:
DETAILED INTERVL HX; DETAILED EXAM;MED
DECISION HIGH
99232 SUBSEQUENT HOSP CARE 2+ KEY
COMPONENTS:EXPAND PROB FOCUS INT HX;EXPAND
PROB EXAM;MED DEC MOD
99231 SUBSEQUENT HOSP CARE 2+ KEY
COMPONENTS:PROB FOCUS INT HX;PROB FOCUS
EXAM;MED DEC STRTFWD/LOW
99462 SUBSEQUENT HOSPITAL CARE PER DAY E/M
NORMAL NEWBORN
99469 SUBSEQUENT I/P CRITICAL CARE PER DAY AGE 28
DAYS/<
99478 SUBSEQUENT INTENSIVE CARE INFANT < 1500
GRAMS

37. 99479 SUBSEQUENT INTENSIVE CARE INFANT 1500-2500
GRAMS
99480 SUBSEQUENT INTENSIVE CARE INFANT 2501-5000
GRAMS
99309 SUBSEQUENT NSG FACILITY CARE PER DAY E/M
NEW PROBLEM
99307 SUBSEQUENT NSG FACILITY CARE PER DAY E/M
STABLE
99310 SUBSEQUENT NSG FACILITY CARE PER DAY E/M
UNSTABLE/NEW PROBLEM
99226 SUBSEQUENT OBS CARE PER DAY HIGH SEVERITY
99225 SUBSEQUENT OBS CARE PER DAY MODERATE
SEVERITY
99476 SUBSEQUENT PEDIATRIC CRITICAL CARE 2 THRU
5 YEARS
99472 SUBSEQUENT PEDIATRIC CRITICAL CARE 29 D
THRU 24 MO
99070 SUPPLIES PROVIDED BY PHYSICIAN OVER &
ABOVE THOSE INCLUDED IN THE SERVICE
99050 SVC PRV AFTER OFFICE REG SCHEDD OFFICE
HOURS, + BASIC SERVICE
99051 SVC PRV OFFICE REG SCHEDD EVN
WKEND/HOLIDAY HRS
74230 SWALLOWING FUNCTION, W/CINERADIOGRAPHY
&/OR VIDEORADIOLOGY
86592 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY;
QUALITATIVE
86593 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY;
QUANTITATIVE
86360 T CELLS; ABSOLUTE CD4 & CD8 COUNT, W/RATIO
84402 TESTOSTERONE; FREE
84403 TESTOSTERONE; TOTAL
90718 TETANUS & DIPHTHERIA TOXOIDS (TD)
ADSORBED, >7, IM USE
90715 TETANUS, DIPHTHERIA TOXOIDS AND
ACELLULAR PERTUSIS VACCINE (TDAP), >7 YEARS, IM

38. USE
96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION
SUBQ/IM
77261 THERAPEUTIC RADIOLOGY TREATMENT
PLANNING; SIMPLE
84479 THYROID HORMONE (T3/T4) UPTAKE/THYROID
HORMONE BINDING RATIO (THBR)
84443 THYROID STIMULATING HORMONE (TSH)
84439 THYROXINE; FREE
87220 TISSUE EXAM BY KOH SLIDE OF SAMPLES FROM
SKIN/HAIR/NAILS, FUNGI/ECTOPARASITE OVA/MITES
42820 TONSILLECTOMY & ADENOIDECTOMY; < AGE 12
36430 TRANSFUSION, BLOOD/BLOOD COMPONENTS
93303 TRANSTHORACIC ECHOCARDIOGRAPHY,
CONGENITAL CARDIAC ANOMALIES; COMPLETE
93304 TRANSTHORACIC ECHOCARDIOGRAPHY,
CONGENITAL CARDIAC ANOMALIES; FOLLOW-
UP/LIMITED STUDY
92526 TREATMENT, SWALLOWING DYSFUNCTION &/OR
ORAL FUNCTION, FEEDING
32551 TUBE THORACOSTOMY, INCLUDES WATER SEAL
92567 TYMPANOMETRY (IMPEDANCE TESTING)
69436 TYMPANOSTOMY (REQUIRING INSERTION,
VENTILATING TUBE), GENERAL ANESTHESIA
76705 ULTRASOUND, ABDOMINAL, B-SCAN &/OR REAL
TIME W/IMAGE DOCUMENTATION; LIMITED
76700 ULTRASOUND, ABDOMINAL, REAL TIME W/IMAGE
DOCUMENTATION; COMPLETE
76506 ULTRASOUND, HEAD/BRAIN
76770 ULTRASOUND, RETROPERITONEUM, REAL TIME;
COMPLETE
84999 UNLISTED CHEMISTRY PROC
76499 UNLISTED DX RADIOGRAPHIC PROCEDURE
99499 UNLISTED EVALUATION & MANAGEMENT
SERVICE
87999 UNLISTED MICROBIOLOGY PROC

39. 92499 UNLISTED OPHTHALMOLOGICAL SERVICE/PROC
97799 UNLISTED PHYSICAL MEDICINE/REHABILITATION
SERVICE/PROC
99429 UNLISTED PREVENTIVE MEDICINE SERVICE
41899 UNLISTED PROC, DENTOALVEOLAR STRUCTURES
90749 UNLISTED VACCINE/TOXOID
43234 UPPER GI ENDOSCOPY; SIMPLE PRIMARY EXAM
(SEP PROC)
43242 UPPER GI ENDOSCOPY; W/ TRANSENDOSCOPIC U/S
-GUIDED NEEDLE ASPIRATION/BX, ESOPHAGUS W/ U/S
EGD EXAM
81001 URINALYSIS, DIP STICK/TABLET REAGENT;
AUTOMATED W/MICROSCOPY
81003 URINALYSIS, DIP STICK/TABLET REAGENT;
AUTOMATED, W/O MICROSCOPY
81000 URINALYSIS, DIP STICK/TABLET REAGENT; NON-
AUTOMATED W/MICROSCOPY
81002 URINALYSIS, DIP STICK/TABLET REAGENT; NON-
AUTOMATED, W/O MICROSCOPY
81007 URINALYSIS; BACTERIURIA SCREEN, EXCEPT BY
CULTURE/DIPSTICK
81015 URINALYSIS; MICROSCOPIC ONLY
81005 URINALYSIS; QUALITATIVE/SEMIQUANTITATIVE,
EXCEPT IMMUNOASSAYS
81025 URINE PREGNANCY TEST, VISUAL COLOR
COMPARISON METHODS
76816 US, PREGNANT UTERUS, REAL TIME W/IMAGE
DOCUMENT, FOLLOW-UP, TRANSABD APPROACH, PER
FETUS
76815 US, PREGNANT UTERUS, REAL TIME W/IMAGE
DOCUMENT, LIMITED, 1/> FETUSES
76817 US, PREGNANT UTERUS, REAL TIME W/IMAGE
DOCUMENT, TRANSVAGINAL
90716 VARICELLA VIRUS VACCINE, LIVE, SUBQ USE
90396 VARICELLA-ZOSTER IMMUNE GLOBULIN, HUMAN,
IM USE

40. 36406 VENIPUNCTURE, < AGE 3; OTHER VEIN
36410 VENIPUNCTURE, AGE 3/>, REQ PHYSICIAN SKILL,
(SEP PROC), DX/TX (EXCEPT ROUTINE)
36500 VENOUS CATHETERIZATION, SELECTIVE ORGAN
BLOOD SAMPLING
94003 VENTILATION ASSIST & MGMT INPATIENT EA
SBSQ DAY
92083 VISUAL FIELD EXAM, UNILAT/BILAT
W/INTERPRETATION & REPORT; EXTENDED
92081 VISUAL FIELD EXAM, UNILAT/BILAT
W/INTERPRETATION & REPORT; LIMITED
99172 VISUAL FUNCTION SCREENING, AUTOMATED,
SEMI-AUTOMATED BILAT QUANTITATIVE
DETERMINATION
92579 VISUAL REINFORCEMENT AUDIOMETRY (VRA)
94150 VITAL CAPACITY, TOTAL (SEP PROC)
82306 VITAMIN D; 25 HYDROXY, INCL FRACTION(S) IF
PERFORMED
84597 VITAMIN K
TOP 500 CPT® CODES for PEDIATRIC
42830 ADENOIDECTOMY, PRIMARY; < AGE 12
99420 ADMINISTRATION & INTERPRETATION HEALTH
RISK ASSESSMENT
INSTRUM
ENT
82107 AFP
-
L3 FRACTION ISOFORM AND TOTAL AFP
82043 ALBUMIN; URINE, MICROALBUMIN,
QUANTITATIVE

41. 99408 ALCOHOL/SUBSTANCE SCREEN & INTERVENTION
15
-
30 MIN
95004 ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC
EXTRACTS, INCL INTERP &
REPORT, SPECIFY NUMBER
82105 ALPH
A
-
FETOPROTEIN; SERUM
82150 AMYLASE
01920 ANESTHESIA, CARDIAC CATHETERIZATION
W/CORONARY
ARTERIOGRAPHY & VENTRICULOGRAPHY
00635 ANESTHESIA, PROC, LUMBAR REGION;
DIAGNOSTIC/THERAPEUTIC
LUMBAR PUNCTURE
59425 ANTEPARTUM CARE ONLY; 4 TO 6 VISITS
59426 ANTEPARTU
M CARE ONLY; 7+ VISITS
86631 ANTIBODY; CHLAMYDIA
86663 ANTIBODY; EPSTEIN
-
BARR (EB) VIRUS, EARLY ANTIGEN (EA)

42. 86696 ANTIBODY; HERPES SIMPLEX, TYPE 2
86701 ANTIBODY; HIV
-
1
86703 ANTIBODY; HIV
-
1 & HIV
-
2, SINGLE ASSAY
86689 ANTIBODY; HTLV/HIV ANTIBODY, CONFIRM
ATORY TEST
86710 ANTIBODY; INFLUENZA VIRUS
86756 ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS
86759 ANTIBODY; ROTAVIRUS
86762 ANTIBODY; RUBELLA
97016 APPLICATION, MODALITY TO 1+ AREAS;
VASOPNEUMATIC DEVICES
TOP 500 CPT® CODES for PEDIATRIC
42830 ADENOIDECTOMY, PRIMARY; < AGE 12
99420 ADMINISTRATION & INTERPRETATION HEALTH
RISK ASSESSMENT
INSTRUMENT
82107 AFP-L3 FRACTION ISOFORM AND TOTAL AFP
82043 ALBUMIN; URINE, MICROALBUMIN,
QUANTITATIVE
99408 ALCOHOL/SUBSTANCE SCREEN & INTERVENTION

43. 15-30 MIN
95004 ALLERGY TESTS, PERCUTANEOUS, ALLERGENIC
EXTRACTS, INCL INTERP &
REPORT, SPECIFY NUMBER
82105 ALPHA-FETOPROTEIN; SERUM
82150 AMYLASE
01920 ANESTHESIA, CARDIAC CATHETERIZATION
W/CORONARY
ARTERIOGRAPHY & VENTRICULOGRAPHY
00635 ANESTHESIA, PROC, LUMBAR REGION;
DIAGNOSTIC/THERAPEUTIC
LUMBAR PUNCTURE
59425 ANTEPARTUM CARE ONLY; 4 TO 6 VISITS
59426 ANTEPARTUM CARE ONLY; 7+ VISITS
86631 ANTIBODY; CHLAMYDIA
86663 ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY
ANTIGEN (EA)
86696 ANTIBODY; HERPES SIMPLEX, TYPE 2
86701 ANTIBODY; HIV-1
86703 ANTIBODY; HIV-1 & HIV-2, SINGLE ASSAY
86689 ANTIBODY; HTLV/HIV ANTIBODY,
CONFIRMATORY TEST
86710 ANTIBODY; INFLUENZA VIRUS
86756 ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS
86759 ANTIBODY; ROTAVIRUS
86762 ANTIBODY; RUBELLA
97016 APPLICATION, MODALITY TO 1+ AREAS;
VASOPNEUMATIC DEVICES
TOP 400 ICD-10 CODES for PEDIATRIC
R63.5 ABNORMAL WEIGHT GAIN
R63.4 ABNORMAL WEIGHT LOSS
L83 ACANTHOSIS NIGRICANS
L70.2 ACNE VARIOLIFORMIS
H04.55 ACQUIRED STENOSIS OF NASOLACRIMAL DUCT

44. H65.11 ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA
(MUCOID) (SANGUINOUS) (SEROUS)
H10.13 ACUTE ATOPIC CONJUNCTIVITIS, BILATERAL
J21.8 ACUTE BRONCHIOLITIS DUE TO OTHER SPECIFIED
ORGANISMS
J21.0 ACUTE BRONCHIOLITIS DUE TO RESPIRATORY
SYNCYTIAL VIRUS
J20.9 ACUTE BRONCHITIS, UNSPECIFIED
N30.00 ACUTE CYSTITIS WITHOUT HEMATURIA
J01.10 ACUTE FRONTAL SINUSITIS, UNSPECIFIED
K29.00 ACUTE GASTRITIS WITHOUT BLEEDING
J04.0 ACUTE LARYNGITIS
J06.0 ACUTE LARYNGOPHARYNGITIS
J04.2 ACUTE LARYNGOTRACHEITIS
L04.9 ACUTE LYMPHADENITIS, UNSPECIFIED
J01.00 ACUTE MAXILLARY SINUSITIS, UNSPECIFIED
J00 ACUTE NASOPHARYNGITIS [COMMON COLD]
J05.0 ACUTE OBSTRUCTIVE LARYNGITIS [CROUP]
J01.40 ACUTE PANSINUSITIS, UNSPECIFIED
J02.9 ACUTE PHARYNGITIS, UNSPECIFIED
H65.00 ACUTE SEROUS OTITIS MEDIA, UNSPECIFIED EAR
J01.90 ACUTE SINUSITIS, UNSPECIFIED
H66.01 ACUTE SUPPURATIVE OTITIS MEDIA WITH
SPONTANEOUS RUPTURE OF EAR DRUM
H66.00 ACUTE SUPPURATIVE OTITIS MEDIA WITHOUT
SPONTANEOUS RUPTURE OF EAR DRUM
J03.90 ACUTE TONSILLITIS, UNSPECIFIED
J06.9 ACUTE UPPER RESPIRATORY INFECTION,
UNSPECIFIED
F10.20 ALCOHOL DEPENDENCE, UNCOMPLICATED
E87.3 ALKALOSIS
J30.1 ALLERGIC RHINITIS DUE TO POLLEN
J30.9 ALLERGIC RHINITIS, UNSPECIFIED
L50.0 ALLERGIC URTICARIA
T78.40 ALLERGY, UNSPECIFIED
N91.2 AMENORRHEA, UNSPECIFIED

45. P61.2 ANEMIA OF PREMATURITY
D64.9 ANEMIA, UNSPECIFIED
R63.0 ANOREXIA
F41.9 ANXIETY DISORDER, UNSPECIFIED
Q21.1 ATRIAL SEPTAL DEFECT
F90.9 ATTENTION-DEFICIT HYPERACTIVITY DISORDER,
UNSPECIFIED TYPE
F84.0 AUTISTIC DISORDER
P36.9 BACTERIAL SEPSIS OF NEWBORN, UNSPECIFIED
F31.9 BIPOLAR DISORDER, UNSPECIFIED
W54.0 BITTEN BY DOG
W57 BITTEN OR STUNG BY NONVENOMOUS INSECT AND
OTHER NONVENOMOUS ARTHROPODS
J40 BRONCHITIS, NOT SPECIFIED AS ACUTE OR
CHRONIC
J18.0 BRONCHOPNEUMONIA, UNSPECIFIED ORGANISM
H73.01 BULLOUS MYRINGITIS
B37.0 CANDIDAL STOMATITIS
B37.2 CANDIDIASIS OF SKIN AND NAIL
B37.3 CANDIDIASIS OF VULVA AND VAGINA
B37.9 CANDIDIASIS, UNSPECIFIED
R01.1 CARDIAC MURMUR, UNSPECIFIED
L03.21 CELLULITIS AND ACUTE LYMPHANGITIS OF FACE
L03.01 CELLULITIS OF FINGER
H05.01 CELLULITIS OF ORBIT
L03.11 CELLULITIS OF OTHER PARTS OF LIMB
L03.03 CELLULITIS OF TOE
L03.31 CELLULITIS OF TRUNK
L03.90 CELLULITIS, UNSPECIFIED
G80.9 CEREBRAL PALSY, UNSPECIFIED
M54.2 CERVICALGIA
H00.19 CHALAZION UNSPECIFIED EYE, UNSPECIFIED
EYELID
R07.9 CHEST PAIN, UNSPECIFIED
T76.22 CHILD SEXUAL ABUSE, SUSPECTED
M94.0 CHONDROCOSTAL JUNCTION SYNDROME

46. [TIETZE]
J44.1 CHRONIC OBSTRUCTIVE PULMONARY DISEASE
WITH (ACUTE) EXACERBATION
J44.9 CHRONIC OBSTRUCTIVE PULMONARY DISEASE,
UNSPECIFIED
J31.0 CHRONIC RHINITIS
H65.20 CHRONIC SEROUS OTITIS MEDIA, UNSPECIFIED
EAR
J32.9 CHRONIC SINUSITIS, UNSPECIFIED
J35.01 CHRONIC TONSILLITIS
Q35.9 CLEFT PALATE, UNSPECIFIED
S06.0X CONCUSSION
F91.9 CONDUCT DISORDER, UNSPECIFIED
Q40.0 CONGENITAL HYPERTROPHIC PYLORIC STENOSIS
K59.00 CONSTIPATION, UNSPECIFIED
S90.11 CONTUSION OF GREAT TOE WITHOUT DAMAGE
TO NAIL
S00.93 CONTUSION OF UNSPECIFIED PART OF HEAD
R05 COUGH
B97.11 COXSACKIEVIRUS AS THE CAUSE OF DISEASES
CLASSIFIED ELSEWHERE
E84.0 CYSTIC FIBROSIS WITH PULMONARY
MANIFESTATIONS
E86.0 DEHYDRATION
K02.9 DENTAL CARIES, UNSPECIFIED
Z99.11 DEPENDENCE ON RESPIRATOR [VENTILATOR]
STATUS
L27.2 DERMATITIS DUE TO INGESTED FOOD
B35.9 DERMATOPHYTOSIS, UNSPECIFIED
F81.9 DEVELOPMENTAL DISORDER OF SCHOLASTIC
SKILLS, UNSPECIFIED
L22 DIAPER DERMATITIS
R19.7 DIARRHEA, UNSPECIFIED
J39.9 DISEASE OF UPPER RESPIRATORY TRACT,
UNSPECIFIED
E80.7 DISORDER OF BILIRUBIN METABOLISM,

47. UNSPECIFIED
L98.9 DISORDER OF THE SKIN AND SUBCUTANEOUS
TISSUE, UNSPECIFIED
D72.9 DISORDER OF WHITE BLOOD CELLS, UNSPECIFIED
R42 DIZZINESS AND GIDDINESS
M54.9 DORSALGIA, UNSPECIFIED
Q90.9 DOWN SYNDROME, UNSPECIFIED
L30.1 DYSHIDROSIS [POMPHOLYX]
N94.6 DYSMENORRHEA, UNSPECIFIED
R30.0 DYSURIA
B00.0 ECZEMA HERPETICUM
R60.9 EDEMA, UNSPECIFIED
F98.1 ENCOPRESIS NOT DUE TO A SUBSTANCE OR
KNOWN PHYSIOLOGICAL CONDITION
Z00.3 ENCOUNTER FOR EXAMINATION FOR
ADOLESCENT DEVELOPMENT STATE
Z01.00 ENCOUNTER FOR EXAMINATION OF EYES AND
VISION WITHOUT ABNORMAL FINDINGS
Z09 ENCOUNTER FOR FOLLOW-UP EXAMINATION AFTER
COMPLETED TREATMENT, NOT MALIGNANT NEOPLASM
Z08 ENCOUNTER FOR FOLLOW-UP EXAMINATION AFTER
COMPLETED TREATMENT FOR MALIGNANT NEOPLASM
O80 ENCOUNTER FOR FULL-TERM UNCOMPLICATED
DELIVERY
Z00.00 ENCOUNTER FOR GENERAL ADULT MEDICAL
EXAMINATION WITHOUT ABNORMAL FINDINGS
Z76.1 ENCOUNTER FOR HEALTH SUPERVISION AND
CARE OF FOUNDLING
Z76.2 ENCOUNTER FOR HEALTH SUPERVISION AND
CARE OF OTHER HEALTHY INFANT AND CHILD
Z23 ENCOUNTER FOR IMMUNIZATION
Z02.89 ENCOUNTER FOR OTHER ADMINISTRATIVE
EXAMINATIONS
Z00.8 ENCOUNTER FOR OTHER GENERAL EXAMINATION
Z01.81 ENCOUNTER FOR PREPROCEDURAL
EXAMINATIONS

48. Z41.2 ENCOUNTER FOR ROUTINE AND RITUAL MALE
CIRCUMCISION
Z00.12 ENCOUNTER FOR ROUTINE CHILD HEALTH
EXAMINATION
Z01.41 ENCOUNTER FOR ROUTINE GYNECOLOGICAL
EXAMINATION
Z12.83 ENCOUNTER FOR SCREENING FOR MALIGNANT
NEOPLASM OF SKIN
Z13.89 ENCOUNTER FOR SCREENING FOR OTHER
DISORDER
Z34.00 ENCOUNTER FOR SUPERVISION OF NORMAL
FIRST PREGNANCY, UNSPECIFIED TRIMESTER
Z34.80 ENCOUNTER FOR SUPERVISION OF OTHER
NORMAL PREGNANCY, UNSPECIFIED TRIMESTER
R59.9 ENLARGED LYMPH NODES, UNSPECIFIED
B80 ENTEROBIASIS
B08.5 ENTEROVIRAL VESICULAR PHARYNGITIS
B08.4 ENTEROVIRAL VESICULAR STOMATITIS WITH
EXANTHEM
M77.9 ENTHESOPATHY, UNSPECIFIED
F98.0 ENURESIS NOT DUE TO A SUBSTANCE OR KNOWN
PHYSIOLOGICAL CONDITION
R10.13 EPIGASTRIC PAIN
G40.90 EPILEPSY, UNSPECIFIED, NOT INTRACTABLE
R04.0 EPISTAXIS
B08.3 ERYTHEMA INFECTIOSUM [FIFTH DISEASE]
I10 ESSENTIAL (PRIMARY) HYPERTENSION
N92.0 EXCESSIVE AND FREQUENT MENSTRUATION WITH
REGULAR CYCLE
F80.1 EXPRESSIVE LANGUAGE DISORDER
P07.03 EXTREMELY LOW BIRTH WEIGHT NEWBORN, 750-
999 GRAMS
R62.51 FAILURE TO THRIVE (CHILD)
R63.3 FEEDING DIFFICULTIES
M21.40 FLAT FOOT [PES PLANUS] (ACQUIRED),
UNSPECIFIED FOOT

49. R14.3 FLATULENCE
T16.9 FOREIGN BODY IN EAR, UNSPECIFIED EAR
T17.1 FOREIGN BODY IN NOSTRIL
S62.50 FRACTURE OF UNSPECIFIED PHALANX OF THUMB
R35.0 FREQUENCY OF MICTURITION
K30 FUNCTIONAL DYSPEPSIA
R68.12 FUSSY INFANT (BABY)
K29.70 GASTRITIS, UNSPECIFIED, WITHOUT BLEEDING
K52.0 GASTROENTERITIS AND COLITIS DUE TO
RADIATION
K21.0 GASTRO-ESOPHAGEAL REFLUX DISEASE WITH
ESOPHAGITIS
K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE
WITHOUT ESOPHAGITIS
R10.84 GENERALIZED ABDOMINAL PAIN
F41.1 GENERALIZED ANXIETY DISORDER
I70.91 GENERALIZED ATHEROSCLEROSIS
G40.30 GENERALIZED IDIOPATHIC EPILEPSY AND
EPILEPTIC SYNDROMES, NOT INTRACTABLE
L27.0 GENERALIZED SKIN ERUPTION DUE TO DRUGS
AND MEDICAMENTS TAKEN INTERNALLY
R51 HEADACHE
I50.9 HEART FAILURE, UNSPECIFIED
R12 HEARTBURN
D18.01 HEMANGIOMA OF SKIN AND SUBCUTANEOUS
TISSUE
B00.2 HERPESVIRAL GINGIVOSTOMATITIS AND
PHARYNGOTONSILLITIS
B00.9 HERPESVIRAL INFECTION, UNSPECIFIED
H00.01 HORDEOLUM EXTERNUM
H00.02 HORDEOLUM INTERNUM
N43.3 HYDROCELE, UNSPECIFIED
E78.5 HYPERLIPIDEMIA, UNSPECIFIED
E87.0 HYPEROSMOLALITY AND HYPERNATREMIA
L91.9 HYPERTROPHIC DISORDER OF THE SKIN,
UNSPECIFIED

50. N62 HYPERTROPHY OF BREAST
J35.1 HYPERTROPHY OF TONSILS
J35.3 HYPERTROPHY OF TONSILS WITH HYPERTROPHY
OF ADENOIDS
E87.1 HYPO-OSMOLALITY AND HYPONATREMIA
Q54.9 HYPOSPADIAS, UNSPECIFIED
I95.9 HYPOTENSION, UNSPECIFIED
E03.9 HYPOTHYROIDISM, UNSPECIFIED
L50.1 IDIOPATHIC URTICARIA
H61.23 IMPACTED CERUMEN, BILATERAL
L01.00 IMPETIGO, UNSPECIFIED
A09 INFECTIOUS GASTROENTERITIS AND COLITIS,
UNSPECIFIED
B27.90 INFECTIOUS MONONUCLEOSIS, UNSPECIFIED
WITHOUT COMPLICATION
J11.89 INFLUENZA DUE TO UNIDENTIFIED INFLUENZA
VIRUS WITH OTHER MANIFESTATIONS
J11.1 INFLUENZA DUE TO UNIDENTIFIED INFLUENZA
VIRUS WITH OTHER RESPIRATORY MANIFESTATIONS
L60.0 INGROWING NAIL
S05.00 INJURY OF CONJUNCTIVA AND CORNEAL
ABRASION WITHOUT FOREIGN BODY, UNSPECIFIED EYE
T14.90 INJURY, UNSPECIFIED
S30.86 INSECT BITE (NONVENOMOUS) OF ABDOMEN,
LOWER BACK, PELVIS AND EXTERNAL GENITALS
S00.06 INSECT BITE (NONVENOMOUS) OF SCALP
G47.00 INSOMNIA, UNSPECIFIED
P52.22 INTRAVENTRICULAR (NONTRAUMATIC)
HEMORRHAGE, GRADE 4, OF NEWBORN
D50.9 IRON DEFICIENCY ANEMIA, UNSPECIFIED
N92.6 IRREGULAR MENSTRUATION, UNSPECIFIED
K58.9 IRRITABLE BOWEL SYNDROME WITHOUT
DIARRHEA
L24.0 IRRITANT CONTACT DERMATITIS DUE TO
DETERGENTS
L24.81 IRRITANT CONTACT DERMATITIS DUE TO

51. METALS
M92.50 JUVENILE OSTEOCHONDROSIS OF TIBIA AND
FIBULA, UNSPECIFIED LEG
R10.32 LEFT LOWER QUADRANT PAIN
L08.9 LOCAL INFECTION OF THE SKIN AND
SUBCUTANEOUS TISSUE, UNSPECIFIED
M54.5 LOW BACK PAIN
R10.30 LOWER ABDOMINAL PAIN, UNSPECIFIED
F33.9 MAJOR DEPRESSIVE DISORDER, RECURRENT,
UNSPECIFIED
F32.0 MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE,
MILD
F32.9 MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE,
UNSPECIFIED
K92.1 MELENA
B95.61 METHICILLIN SUSCEPTIBLE STAPHYLOCOCCUS
AUREUS INFECTION CAUSING DISEASES CLASSIFIED
ELSEWHERE
G43.10 MIGRAINE WITH AURA, NOT INTRACTABLE
G43.00 MIGRAINE WITHOUT AURA, NOT INTRACTABLE
G43.90 MIGRAINE, UNSPECIFIED, NOT INTRACTABLE
F70 MILD INTELLECTUAL DISABILITIES
J45.21 MILD INTERMITTENT ASTHMA WITH (ACUTE)
EXACERBATION
J45.20 MILD INTERMITTENT ASTHMA, UNCOMPLICATED
L74.0 MILIARIA RUBRA
E78.2 MIXED HYPERLIPIDEMIA
B08.1 MOLLUSCUM CONTAGIOSUM
E66.01 MORBID (SEVERE) OBESITY DUE TO EXCESS
CALORIES
M62.83 MUSCLE SPASM
M60.9 MYOSITIS, UNSPECIFIED
R11.0 NAUSEA
R11.2 NAUSEA WITH VOMITING, UNSPECIFIED
P29.12 NEONATAL BRADYCARDIA
P37.5 NEONATAL CANDIDIASIS

52. P59.0 NEONATAL JAUNDICE ASSOCIATED WITH
PRETERM DELIVERY
P59.8 NEONATAL JAUNDICE FROM OTHER SPECIFIED
CAUSES
P59.9 NEONATAL JAUNDICE, UNSPECIFIED
H04.53 NEONATAL OBSTRUCTION OF NASOLACRIMAL
DUCT
I78.1 NEVUS, NON-NEOPLASTIC
P04.41 NEWBORN (SUSPECTED TO BE) AFFECTED BY
MATERNAL USE OF COCAINE
P05.04 NEWBORN LIGHT FOR GESTATIONAL AGE, 1000-
1249 GRAMS
P05.05 NEWBORN LIGHT FOR GESTATIONAL AGE, 1250-
1499 GRAMS
P05.06 NEWBORN LIGHT FOR GESTATIONAL AGE, 1500-
1749 GRAMS
P05.07 NEWBORN LIGHT FOR GESTATIONAL AGE, 1750-
1999 GRAMS
P05.08 NEWBORN LIGHT FOR GESTATIONAL AGE, 2000-
2499 GRAMS
P05.03 NEWBORN LIGHT FOR GESTATIONAL AGE, 750-
999 GRAMS
P05.00 NEWBORN LIGHT FOR GESTATIONAL AGE,
UNSPECIFIED WEIGHT
N39.44 NOCTURNAL ENURESIS
N34.1 NONSPECIFIC URETHRITIS
E66.9 OBESITY, UNSPECIFIED
F91.3 OPPOSITIONAL DEFIANT DISORDER
H92.09 OTALGIA, UNSPECIFIED EAR
R06.89 OTHER ABNORMALITIES OF BREATHING
L70.8 OTHER ACNE
H65.19 OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA
J30.89 OTHER ALLERGIC RHINITIS
L63.8 OTHER ALOPECIA AREATA
P28.4 OTHER APNEA OF NEWBORN
J45.99 OTHER ASTHMA

53. L20.89 OTHER ATOPIC DERMATITIS
D23.9 OTHER BENIGN NEOPLASM OF SKIN, UNSPECIFIED
R01.2 OTHER CARDIAC SOUNDS
R07.89 OTHER CHEST PAIN
H10.45 OTHER CHRONIC ALLERGIC CONJUNCTIVITIS
P27.8 OTHER CHRONIC RESPIRATORY DISEASES
ORIGINATING IN THE PERINATAL PERIOD
Q31.8 OTHER CONGENITAL MALFORMATIONS OF
LARYNX
K59.09 OTHER CONSTIPATION
F80.89 OTHER DEVELOPMENTAL DISORDERS OF SPEECH
AND LANGUAGE
R53.83 OTHER FATIGUE
R68.89 OTHER GENERAL SYMPTOMS AND SIGNS
M41.20 OTHER IDIOPATHIC SCOLIOSIS, SITE
UNSPECIFIED
H60.39 OTHER INFECTIVE OTITIS EXTERNA
T14.8 OTHER INJURY OF UNSPECIFIED BODY REGION
D50.8 OTHER IRON DEFICIENCY ANEMIAS
Z79.89 OTHER LONG TERM (CURRENT) DRUG THERAPY
P07.15 OTHER LOW BIRTH WEIGHT NEWBORN, 1250-1499
GRAMS
P07.17 OTHER LOW BIRTH WEIGHT NEWBORN, 1750-1999
GRAMS
P07.10 OTHER LOW BIRTH WEIGHT NEWBORN,
UNSPECIFIED WEIGHT
H10.02 OTHER MUCOPURULENT CONJUNCTIVITIS
H60.59 OTHER NONINFECTIVE ACUTE OTITIS EXTERNA
F84.8 OTHER PERVASIVE DEVELOPMENTAL DISORDERS
R35.8 OTHER POLYURIA
L40.8 OTHER PSORIASIS
D64.89 OTHER SPECIFIED ANEMIAS
Q89.8 OTHER SPECIFIED CONGENITAL MALFORMATIONS
Q55.8 OTHER SPECIFIED CONGENITAL MALFORMATIONS
OF MALE GENITAL ORGANS
Q82.8 OTHER SPECIFIED CONGENITAL MALFORMATIONS

54. OF SKIN
H69.80 OTHER SPECIFIED DISORDERS OF EUSTACHIAN
TUBE, UNSPECIFIED EAR
H57.8 OTHER SPECIFIED DISORDERS OF EYE AND
ADNEXA
L98.8 OTHER SPECIFIED DISORDERS OF THE SKIN AND
SUBCUTANEOUS TISSUE
L53.8 OTHER SPECIFIED ERYTHEMATOUS CONDITIONS
L73.8 OTHER SPECIFIED FOLLICULAR DISORDERS
A08.8 OTHER SPECIFIED INTESTINAL INFECTIONS
N92.5 OTHER SPECIFIED IRREGULAR MENSTRUATION
L08.89 OTHER SPECIFIED LOCAL INFECTIONS OF THE
SKIN AND SUBCUTANEOUS TISSUE
K52.89 OTHER SPECIFIED NONINFECTIVE
GASTROENTERITIS AND COLITIS
Z65.8 OTHER SPECIFIED PROBLEMS RELATED TO
PSYCHOSOCIAL CIRCUMSTANCES
B37.49 OTHER UROGENITAL CANDIDIASIS
B97.89 OTHER VIRAL AGENTS AS THE CAUSE OF
DISEASES CLASSIFIED ELSEWHERE
B30.8 OTHER VIRAL CONJUNCTIVITIS
A08.39 OTHER VIRAL ENTERITIS
B34.8 OTHER VIRAL INFECTIONS OF UNSPECIFIED SITE
B07.8 OTHER VIRAL WARTS
H66.90 OTITIS MEDIA, UNSPECIFIED, UNSPECIFIED EAR
H92.10 OTORRHEA, UNSPECIFIED EAR
E66.3 OVERWEIGHT
M25.57 PAIN IN ANKLE AND JOINTS OF FOOT
M25.55 PAIN IN HIP
M25.56 PAIN IN KNEE
M79.60 PAIN IN LIMB, UNSPECIFIED
M25.51 PAIN IN SHOULDER
R07.0 PAIN IN THROAT
M25.53 PAIN IN WRIST
R00.2 PALPITATIONS
Q25.0 PATENT DUCTUS ARTERIOSUS

55. B85.0 PEDICULOSIS DUE TO PEDICULUS HUMANUS
CAPITIS
J36 PERITONSILLAR ABSCESS
R10.33 PERIUMBILICAL PAIN
Z71.1 PERSON WITH FEARED HEALTH COMPLAINT IN
WHOM NO DIAGNOSIS IS MADE
Z85.82 PERSONAL HISTORY OF MALIGNANT NEOPLASM
OF SKIN
N47.1 PHIMOSIS
L42 PITYRIASIS ROSEA
B36.0 PITYRIASIS VERSICOLOR
J15.0 PNEUMONIA DUE TO KLEBSIELLA PNEUMONIAE
J15.7 PNEUMONIA DUE TO MYCOPLASMA PNEUMONIAE
J15.8 PNEUMONIA DUE TO OTHER SPECIFIED BACTERIA
J13 PNEUMONIA DUE TO STREPTOCOCCUS PNEUMONIAE
J18.9 PNEUMONIA, UNSPECIFIED ORGANISM
F07.81 POSTCONCUSSIONAL SYNDROME
E30.1 PRECOCIOUS PUBERTY
L98.0 PYOGENIC GRANULOMA
R21 RASH AND OTHER NONSPECIFIC SKIN ERUPTION
K12.0 RECURRENT ORAL APHTHAE
J98.9 RESPIRATORY DISORDER, UNSPECIFIED
P22.0 RESPIRATORY DISTRESS SYNDROME OF NEWBORN
B97.4 RESPIRATORY SYNCYTIAL VIRUS AS THE CAUSE
OF DISEASES CLASSIFIED ELSEWHERE
J12.1 RESPIRATORY SYNCYTIAL VIRUS PNEUMONIA
R10.31 RIGHT LOWER QUADRANT PAIN
R10.11 RIGHT UPPER QUADRANT PAIN
A08.0 ROTAVIRAL ENTERITIS
B86 SCABIES
A38.9 SCARLET FEVER, UNCOMPLICATED
L72.3 SEBACEOUS CYST
L21.0 SEBORRHEA CAPITIS
L21.9 SEBORRHEIC DERMATITIS, UNSPECIFIED
L21.1 SEBORRHEIC INFANTILE DERMATITIS
R06.02 SHORTNESS OF BREATH

56. R56.00 SIMPLE FEBRILE CONVULSIONS
Z38.01 SINGLE LIVEBORN INFANT, DELIVERED BY
CESAREAN
Z38.00 SINGLE LIVEBORN INFANT, DELIVERED
VAGINALLY
G47.30 SLEEP APNEA, UNSPECIFIED
G47.9 SLEEP DISORDER, UNSPECIFIED
K59.01 SLOW TRANSIT CONSTIPATION
S63.63 SPRAIN OF INTERPHALANGEAL JOINT OF OTHER
AND UNSPECIFIED FINGER(S)
S13.8 SPRAIN OF JOINTS AND LIGAMENTS OF OTHER
PARTS OF NECK
S33.5 SPRAIN OF LIGAMENTS OF LUMBAR SPINE
S93.49 SPRAIN OF OTHER LIGAMENT OF ANKLE
S23.8 SPRAIN OF OTHER SPECIFIED PARTS OF THORAX
S96.91 STRAIN OF UNSPECIFIED MUSCLE AND TENDON
AT ANKLE AND FOOT LEVEL
S86.91 STRAIN OF UNSPECIFIED MUSCLE AND TENDON
AT LOWER LEG LEVEL
S66.91 STRAIN OF UNSPECIFIED MUSCLE, FASCIA AND
TENDON AT WRIST AND HAND LEVEL
J02.0 STREPTOCOCCAL PHARYNGITIS
B95.3 STREPTOCOCCUS PNEUMONIAE AS THE CAUSE OF
DISEASES CLASSIFIED ELSEWHERE
B95.0 STREPTOCOCCUS, GROUP A, AS THE CAUSE OF
DISEASES CLASSIFIED ELSEWHERE
N76.3 SUBACUTE AND CHRONIC VULVITIS
L55.9 SUNBURN, UNSPECIFIED
H60.33 SWIMMER'S EAR
R55 SYNCOPE AND COLLAPSE
M32.10 SYSTEMIC LUPUS ERYTHEMATOSUS, ORGAN OR
SYSTEM INVOLVEMENT UNSPECIFIED
K00.7 TEETHING SYNDROME
G44.20 TENSION-TYPE HEADACHE, UNSPECIFIED
Q21.3 TETRALOGY OF FALLOT
B35.0 TINEA BARBAE AND TINEA CAPITIS

57. B35.5 TINEA IMBRICATA
B35.3 TINEA PEDIS
B35.1 TINEA UNGUIUM
M43.6 TORTICOLLIS
P61.0 TRANSIENT NEONATAL THROMBOCYTOPENIA
N12 TUBULO-INTERSTITIAL NEPHRITIS, NOT SPECIFIED
AS ACUTE OR CHRONIC
Z38.31 TWIN LIVEBORN INFANT, DELIVERED BY
CESAREAN
E10.65 TYPE 1 DIABETES MELLITUS WITH
HYPERGLYCEMIA
E10.9 TYPE 1 DIABETES MELLITUS WITHOUT
COMPLICATIONS
E11.8 TYPE 2 DIABETES MELLITUS WITH UNSPECIFIED
COMPLICATIONS
E11.9 TYPE 2 DIABETES MELLITUS WITHOUT
COMPLICATIONS
K42.9 UMBILICAL HERNIA WITHOUT OBSTRUCTION OR
GANGRENE
R63.6 UNDERWEIGHT
K40.90 UNILATERAL INGUINAL HERNIA, WITHOUT
OBSTRUCTION OR GANGRENE, NOT SPECIFIED AS
RECURRENT
R10.9 UNSPECIFIED ABDOMINAL PAIN
R26.9 UNSPECIFIED ABNORMALITIES OF GAIT AND
MOBILITY
H10.33 UNSPECIFIED ACUTE CONJUNCTIVITIS,
BILATERAL
J45.90 UNSPECIFIED ASTHMA
I48.91 UNSPECIFIED ATRIAL FIBRILLATION
J15.9 UNSPECIFIED BACTERIAL PNEUMONIA
H10.9 UNSPECIFIED CONJUNCTIVITIS
L25.8 UNSPECIFIED CONTACT DERMATITIS DUE TO
OTHER AGENTS
L25.3 UNSPECIFIED CONTACT DERMATITIS DUE TO
OTHER CHEMICAL PRODUCTS

58. L25.5 UNSPECIFIED CONTACT DERMATITIS DUE TO
PLANTS, EXCEPT FOOD
L25.9 UNSPECIFIED CONTACT DERMATITIS,
UNSPECIFIED CAUSE
R56.9 UNSPECIFIED CONVULSIONS
H69.90 UNSPECIFIED EUSTACHIAN TUBE DISORDER,
UNSPECIFIED EAR
H91.90 UNSPECIFIED HEARING LOSS, UNSPECIFIED EAR
N13.30 UNSPECIFIED HYDRONEPHROSIS
S09.90 UNSPECIFIED INJURY OF HEAD
S89.90 UNSPECIFIED INJURY OF UNSPECIFIED LOWER
LEG
R17 UNSPECIFIED JAUNDICE
M08.00 UNSPECIFIED JUVENILE RHEUMATOID
ARTHRITIS OF UNSPECIFIED SITE
N63 UNSPECIFIED LUMP IN BREAST
T07 UNSPECIFIED MULTIPLE INJURIES
H65.90 UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA,
UNSPECIFIED EAR
S31.00 UNSPECIFIED OPEN WOUND OF LOWER BACK
AND PELVIS
H72.90 UNSPECIFIED PERFORATION OF TYMPANIC
MEMBRANE, UNSPECIFIED EAR
S43.40 UNSPECIFIED SPRAIN OF SHOULDER JOINT
R29.91 UNSPECIFIED SYMPTOMS AND SIGNS INVOLVING
THE MUSCULOSKELETAL SYSTEM
R32 UNSPECIFIED URINARY INCONTINENCE
B09 UNSPECIFIED VIRAL INFECTION CHARACTERIZED
BY SKIN AND MUCOUS MEMBRANE LESIONS
N39.0 URINARY TRACT INFECTION, SITE NOT SPECIFIED
L50.9 URTICARIA, UNSPECIFIED
B01.9 VARICELLA WITHOUT COMPLICATION
Q21.0 VENTRICULAR SEPTAL DEFECT
B30.9 VIRAL CONJUNCTIVITIS, UNSPECIFIED
J12.9 VIRAL PNEUMONIA, UNSPECIFIED
B07.9 VIRAL WART, UNSPECIFIED

59. R11.10 VOMITING, UNSPECIFIED
R06.2 WHEEZING
Q82.1 XERODERMA PIGMENTOSUM
B02.9 ZOSTER WITHOUT COMPLICATIONS
TOP 400 ICD
-
10 CODES for PEDIATRIC
R63.5 ABNORMAL WEIGHT GAIN
R63.4 ABNORMAL WEIGHT LOSS
L83 ACANTHOSIS NIGRICANS
L70.2 ACNE VARIOLIFORMIS
H04.55 ACQUIRED STENOSIS OF NASOLACRIMAL DUCT
H65.11 ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA
(MUCOID)
(SANGUINOUS) (SEROUS)
H10.13 ACUTE ATOPIC CONJUNCTIVITIS, BILATERAL
J21.8 ACUTE BRONCHIOLITIS DUE TO OTHER SPECIFIED
ORGANISMS
J21.0 ACUTE BRONCHIOLITIS DUE TO RESPIRATORY
SYNCYTIAL VIRUS
J20.9 ACUTE BRONCHITIS, UNSPECIFIED
N30.00 ACUTE CYSTITIS WITHOUT HEMATURIA

60. J01.10 ACUTE FRONTAL SINUSITIS, UNSPECIFIED
K29.00 ACUTE GAS
TRITIS WITHOUT BLEEDING
J04.0 ACUTE LARYNGITIS
J06.0 ACUTE LARYNGOPHARYNGITIS
J04.2 ACUTE LARYNGOTRACHEITIS
L04.9 ACUTE LYMPHADENITIS, UNSPECIFIED
J01.00 ACUTE MAXILLARY SINUSITIS, UNSPECIFIED
J00 ACUTE NASOPHARYNGITIS [COMMON COLD]
J05.0 ACUTE OBSTRUCTIVE
LARYNGITIS [CROUP]
J01.40 ACUTE PANSINUSITIS, UNSPECIFIED
J02.9 ACUTE PHARYNGITIS, UNSPECIFIED
H65.00 ACUTE SEROUS OTITIS MEDIA, UNSPECIFIED EAR
J01.90 ACUTE SINUSITIS, UNSPECIFIED
H66.01 ACUTE SUPPURATIVE OTITIS MEDIA WITH
SPONTANEOUS RUPTURE OF
EAR DRUM
TOP 400 ICD-10 CODES for PEDIATRIC
R63.5 ABNORMAL WEIGHT GAIN

61. R63.4 ABNORMAL WEIGHT LOSS
L83 ACANTHOSIS NIGRICANS
L70.2 ACNE VARIOLIFORMIS
H04.55 ACQUIRED STENOSIS OF NASOLACRIMAL DUCT
H65.11 ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA
(MUCOID)
(SANGUINOUS) (SEROUS)
H10.13 ACUTE ATOPIC CONJUNCTIVITIS, BILATERAL
J21.8 ACUTE BRONCHIOLITIS DUE TO OTHER SPECIFIED
ORGANISMS
J21.0 ACUTE BRONCHIOLITIS DUE TO RESPIRATORY
SYNCYTIAL VIRUS
J20.9 ACUTE BRONCHITIS, UNSPECIFIED
N30.00 ACUTE CYSTITIS WITHOUT HEMATURIA
J01.10 ACUTE FRONTAL SINUSITIS, UNSPECIFIED
K29.00 ACUTE GASTRITIS WITHOUT BLEEDING
J04.0 ACUTE LARYNGITIS
J06.0 ACUTE LARYNGOPHARYNGITIS
J04.2 ACUTE LARYNGOTRACHEITIS
L04.9 ACUTE LYMPHADENITIS, UNSPECIFIED
J01.00 ACUTE MAXILLARY SINUSITIS, UNSPECIFIED
J00 ACUTE NASOPHARYNGITIS [COMMON COLD]
J05.0 ACUTE OBSTRUCTIVE LARYNGITIS [CROUP]
J01.40 ACUTE PANSINUSITIS, UNSPECIFIED
J02.9 ACUTE PHARYNGITIS, UNSPECIFIED
H65.00 ACUTE SEROUS OTITIS MEDIA, UNSPECIFIED EAR
J01.90 ACUTE SINUSITIS, UNSPECIFIED
H66.01 ACUTE SUPPURATIVE OTITIS MEDIA WITH
SPONTANEOUS RUPTURE OF
EAR DRUM

62. Coding for Pediatric Preventive Care
NOTE: This resource contains comprehensive listings of codes
that may not be used by your practice
on a regular basis. We recommend that you identify the codes
most relevant to your practice and
include those on your encounter form/billing sheet.
Following are the Current Procedural Terminology (CPT®),
Healthcare Common Procedure Coding
System (HCPCS) Level II, and International Classification of
Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM) codes most commonly reported by
pediatricians in providing preventive
care services. It is strongly recommended that the pediatrician,
not the staff, select the appropriate
code(s) to report.
[A]Preventive Medicine Service Codes
first determine if the patient
qualifies as new or established (defined in the next 2 sections),
then select the appropriate
code within the new or established code family based on patient
age.
-based;
therefore, time spent during the visit is
not relevant in selecting the appropriate code.
r abnormality is encountered or a preexisting
problem is addressed in the
process of performing the preventive medicine service, and if

63. the illness, abnormality, or
problem is significant enough to require additional work to
perform the key components of a
problem-oriented evaluation and management (E/M) service
(history, physical examination,
medical decision-making), the appropriate office or other
outpatient service code (99201–
99215) should be reported in addition to the preventive
medicine service code. Modifier 25
should be appended to the office or other outpatient service
code to indicate that a significant,
separately identifiable E/M service was provided by the same
physician on the same day as
the preventive medicine service.
ificant or trivial illness, abnormality, or problem
encountered in the process of
performing the preventive medicine service that does not
require additional work and
performance of the key components of a problem-oriented E/M
service should not be
reported.
codes reflects an age- and
gender-appropriate history and physical examination and is not
synonymous with the
comprehensive examination required for some other E/M codes
(eg, 99204, 99205,
99215).
radiology, or other procedures, or
screening tests (eg, vision and hearing screening) identified
with a specific CPT code, are
reported separately from the preventive medicine service code.

64. [B]Preventive Medicine Services: New Patients
Initial comprehensive preventive medicine E/M of an individual
includes an age- and gender-
appropriate history; physical examination; counseling,
anticipatory guidance, or risk factor
reduction interventions; and the ordering of laboratory or
diagnostic procedures.
CPT Codes ICD-9-CM Codes
07/01/2013
99381 Infant (younger than 1 year) V20.31 Health supervision
for newborn under 8 days old
V20.32 Health supervision for newborns 8 to 28 days old
V20.2 Routine infant or child health check
99382 Early childhood (age 1–4 years) V20.2 Routine infant or
child health check
99383 Late childhood (age 5–11 years) V20.2 Routine infant
or child health check
99384 Adolescent (age 12–17 years) V20.2 Routine infant or
child health check
99385 18 years or older V70.0 Routine general medical
examination
at a health care facility
A new patient is defined as one who has not received any

65. professional services (face-to-face services
rendered by a physician and reported by a specific CPT code[s])
from a physician, or another
physician of the same specialty who belongs to the same group
practice, within the past 3 years.
[B]Preventive Medicine Services: Established Patients
Periodic comprehensive preventive medicine reevaluation and
management of an individual
includes an age- and gender-appropriate history; physical
examination; counseling, anticipatory
guidance, or risk factor reduction interventions; and the
ordering of laboratory or diagnostic
procedures.
CPT Codes ICD-9-CM Codes
99391 Infant (younger than 1 year) V20.31 Health supervision
for newborn under 8 days old
V20.32 Health supervision for newborns 8 to 28 days old
V20.2 Routine infant or child health check
99392 Early childhood (age 1–4 years) V20.2 Routine infant or
child health check
99393 Late childhood (age 5–11 years) V20.2 Routine infant
or child health check
99394 Adolescent (age 12–17 years) V20.2 Routine infant or
child health check
99395 18 years or older V70.0 Routine general medical
examination
at a health care facility
[A]Counseling, Risk Factor Reduction, and Behavior Change
Intervention
Codes

66. he purpose of promoting
health and preventing illness or
injury.
reported separately when performed.
family dynamics, diet and exercise,
sexual practices, injury prevention, dental health, and
diagnostic or laboratory test results
available at the time of the encounter.
-based, where the appropriate code is selected
based on the approximate time
spent providing the service.
must be documented in the patient
chart to qualify the service based on time.
specific illness for which the
counseling might otherwise be used as part of treatment.
established illness.
established illness, report an office or
other outpatient service code (99201–99215) instead.
established illness, report 99078
(physician educational services rendered to patients in a group
setting) instead.

67. [B]Preventive Medicine, Individual Counseling
99401 Preventive medicine counseling or risk factor reduction
intervention(s) provided to an
individual; approximately 15 minutes
99402 approximately 30 minutes
99403 approximately 45 minutes
99404 approximately 60 minutes
[B]Behavior Change Interventions, Individual
(99406–99407).
cessation, do not report these codes
(99406–99407) under the patient; instead, refer to preventive
medicine counseling codes
(99401–99404) if the patient is not currently experiencing
adverse effects (eg, illness) or
include under the problem-related E/M service (99201–99215).
99406 Smoking and tobacco use cessation counseling visit;
intermediate, greater than 3 minutes up
to 10 minutes
99407 intensive, greater than 10 minutes
99408 Alcohol or substance (other than tobacco) abuse

68. structured screening (eg, Alcohol Use
Disorder Identification Test [AUDIT], Drug Abuse Screening
Test [DAST]) and brief
intervention (SBI) services; 15 to 30 minutes
99409 greater than 30 minutes
[B]Preventive Medicine, Group Counseling
99411 Preventive medicine counseling or risk factor reduction
intervention(s) provided to
individuals in a group setting; approximately 30 minutes
99412 approximately 60 minutes
[C]ICD-9-CM Codes for Counseling Risk Factor Reduction and
Behavior Change
Interventions
reduction and behavior change
intervention codes will vary depending on the reason for the
encounter.
established illness; therefore, the
diagnosis code(s) reported cannot reflect symptom(s) or
illness(es).
codes include
o V15.82 History of tobacco use
o V15.83 Underimmunized status (Lapsed immunization
schedule)
o V15.89 Other specific personal history presenting as hazards
to health

69. o V25.09 Encounter for contraceptive management; general
counseling and
advice; other
o V65.3 Dietary surveillance and counseling
o V65.40 Counseling not otherwise specified
o V65.41 Exercise counseling
o V65.42 Counseling on substance use and abuse
o V65.43 Counseling on injury prevention
o V65.49 Other specified counseling
[A]Other Preventive Medicine Services
[B]Pelvic Examination
–99385 and 99391–
99395) include a pelvic
examination as part of the age- and gender-appropriate
examination.
the patient is having a problem, the physician
can report an office or other
outpatient E/M service code (99212–99215) for the visit and
attach modifier 25, which
identifies that the problem-oriented pelvic visit is a separately
identifiable E/M service by the
same physician on the same date of service.
-9-CM code V20.2 to the preventive medicine

70. service code, but link a different
diagnosis code (eg, 623.5 [vaginal discharge], 625.3
[dysmenorrhea]) to the office or other
outpatient E/M service code.
“problem” and therefore is
included in the preventive medicine service code; however, if
contraception creates a problem
(eg, breakthrough bleeding, vomiting), the service can be
reported separately with an office or
other outpatient service code.
[C]ICD-9-CM Codes
o V25.11 Encounter for insertion of intrauterine contraceptive
device
o V25.12 Encounter for removal of intrauterine contraceptive
device
o V25.13 Encounter for removal and reinsertion of intrauterine
contraceptive device
o V25.40 Surveillance of previously prescribed contraceptive
methods; contraceptive
surveillance, unspecified
o V25.41 Surveillance of previously prescribed contraceptive
methods; contraceptive pill
o V25.42 Surveillance of previously prescribed contraceptive
methods; intrauterine
contraceptive device
o V25.43 Surveillance of previously prescribed contraceptive
methods; implantable
subdermal contraceptive

71. o V25.49 Surveillance of previously prescribed contraceptive
methods; other
contraceptive method
o V72.31 Routine gynecologic examination
o V72.32 Encounter for Papanicolaou cervical smear to confirm
findings of recent normal
smear following initial abnormal smear
[B]Health Risk Assessment
[C]CPT Code
99420 Administration and interpretation of health risk
assessment instrument (eg, health hazard
appraisal)
NOTE: This code can be reported for a postpartum screening
administered to a mother as part of a
routine newborn check, but can be billed under the baby’s name.
Link to ICD-9-CM code V20.2 for
a normal screen. Check with your payers.
[C]ICD-9-CM Codes
V20.2 Routine infant or child health check (eg, for postpartum
depression screening)
V79.8 Special screening for other specified mental disorders
and developmental handicaps
[B]Unlisted Preventive Medicine Service
99429 Unlisted preventive medicine service

72. Report code 99429 only when a more specific preventive
medicine service code does not exist.
[A]Case Management or Care Plan Oversight Services
[B]Telephone Services
[C]CPT Codes
99441 Telephone E/M service by a physician or other qualified
health care professional who may
report E/M services provided to an established patient, parent,
or guardian not originating
from a related E/M service provided within the previous 7 days
nor leading to an E/M
service or procedure within the next 24 hours or soonest
available appointment; 5 to 10
minutes of medical discussion
99442 11 to 20 minutes of medical discussion
99443 21 to 30 minutes of medical discussion
[B]Online Medical Evaluation
[C]CPT Code
99444 Online E/M service provided by a physician or other
qualified health care professional who
may report E/M services provided to an established patient or
guardian not originating from
a related E/M service provided within the previous 7 days, using
the Internet or similar
electronic communications network

73. [B]Care Plan Oversight
[C]CPT Codes
99339 Individual physician supervision of a patient (patient not
present) in home, domiciliary, or
rest home (eg, assisted living facility) requiring complex and
multidisciplinary care
modalities involving regular physician development or revision
of care plans; review of
subsequent reports of patient status; review of related
laboratory and other studies;
communication (including telephone calls) for purposes of
assessment or care decisions
with health care professional(s), family member(s), surrogate
decision maker(s) (eg, legal
guardian), or key caregiver(s) involved in patient’s care;
integration of new information into
medical treatment plan; or adjustment of medical therapy;
within a calendar month; 15 to
29 minutes
99340 30 minutes or more
t (CPO) codes are reported once per
calendar month.
telephone call made or received from
a patient or parent, excluding those that occur 7 days after or 24
hours before a face-to-face
visit.
The online medical evaluation code is reported only once for
the same episode of care during a

74. 7-day period, although multiple physicians can report their
exchanges with the same patient.
previously performed and reported
by a physician within the previous 7 days (physician requested
or unsolicited patient follow-
up) or within the postoperative period of the previously
completed procedure, the service is
considered covered by the previous E/M service or procedure.
encompasses the sum of
communication (eg, related telephone calls, prescription
provision, laboratory orders)
pertaining to the online patient encounter.
CPO codes include telephone calls and online medical
evaluations; therefore, if you
include time spent on a telephone call or an online medical
evaluation toward your monthly
CPO billing, you cannot also separately report that service.
[A]Complex Chronic Care Coordination Services
99487 Complex chronic care coordination services; first hour of
clinical staff time directed by a
physician or other qualified health care professional with no
face-to-face visit, per calendar
month

75. 99488 first hour of clinical staff time directed by a physician or
other qualified health care
professional with one face-to-face visit, per calendar month
99489 each additional 30 minutes of clinical staff time directed
by a physician or other
qualified health care professional, per calendar month
[A]Transitional Care Management Services
99495 Transitional care management services with the
following required elements:
the patient and/or caregiver
within 2 business days of discharge
-making of at least moderate complexity
during the service period
-to-face visit, within 14 calendar days of discharge
99496 Transitional care management services with the
following required elements:
the patient and/or caregiver
within 2 business days of discharge
-making of high complexity during the
service period
-to-face visit, within 7 calendar days of discharge

76. [A]Screening Codes
[B]Vision Screening
CPT Codes ICD-9-CM Codes
99173 Screening test of visual acuity V20.2 Routine infant or
child health check
quantitative, bilateral
99174 Instrument-based ocular screening V20.2 Routine infant
or child health check
(eg, photoscreening, automated-
refraction), bilateral
V72.0 (examination of eyes and vision) is reported for
diagnostic vision examinations only.
acuity stimuli that allow a
quantitative estimate of visual acuity (eg, Snellen chart).
-based ocular screening
for esotropia, exotropia,
anisometropia, cataracts, ptosis, hyperopia, and myopia.
y (99173) or instrument-based ocular screening
(99174) is measured as part of a
general ophthalmologic service or an E/M service of the eye
(eg, for an eye-related problem or

77. symptom), it is considered part of the diagnostic examination of
the office or other outpatient
service code (99201–99215) and is not reported separately.
provided at the same time are
reported separately (eg, preventive medicine services).
will most likely result in a follow-up
office visit (eg, 99212–99215)
linked to the diagnosis code for the reason for the failure (eg,
367.1 [myopia]); when a specific
code cannot be identified, report 368.8 (other specified visual
disturbance).
[B]Hearing Screening
CPT Codes ICD-9-CM Codes
92551 Screening test, pure tone, air only V20.2 Routine infant
or child health check
92552 Pure tone audiometry (threshold); air only V20.2 Routine
infant or child health check
92567 Tympanometry (impedance testing) V20.2 Routine infant
or child health check
Codes V72.11 (encounter for hearing examination following
failed hearing screening) and V72.19
(other examination of ears and hearing) are reported for
diagnostic hearing examinations only.
other methods (eg, whispered
voice, tuning fork) are not reported separately.

78. is applied to only one ear.
le services unrelated to the screening test
provided at the same time are
reported separately (eg, preventive medicine services).
-
up office visit (eg, 99212–99215)
linked to the diagnosis code for the reason for the failure; when
a specific code cannot be
identified, report 389.8 (other specified forms of hearing loss).
[B]Developmental Screening
CPT Code ICD-9-CM Code
96110 Developmental screening, per instrument, V79.3 Special
screening for developmental
with interpretation and report handicaps in early childhood
screening instruments of a
limited nature.
of preventive
medicine services but may also be
reported when screening is performed with other E/M services
such as acute illness or follow-
up office visits.
scores the completed instrument
while the physician incorporates the interpretation component

79. into the accompanying E/M
service.
along with any E/M service (eg,
preventive medicine service), both services should be reported
and modifier 25 (significant,
separately identifiable E/M service by the same physician on the
same day of the procedure or
other service) should be appended to the E/M code to show the
E/M service was distinct and
necessary at the same visit.
Examples of 96110 instruments include, but are not limited to
(ASQ). 2nd ed. Baltimore, MD:
Paul H. Brookes Publishing Co, Inc; 1999 and Squires J,
Bricker D, Twombly E. Ages & Stages
Questionnaires: Social-Emotional (ASQ:SE). Baltimore, MD:
Paul H. Brookes Publishing Co,
Inc; 2002
Asperger’s Syndrome: A Guide for
Parents and Professionals. London, England: Jessica Kingsley
Publishers; 1997
-2: Behavior Assessment
Scale for Children. 2nd ed. Upper
Saddle River, NJ: Pearson School Publishing; 2004

80. Rating Inventory of Executive
Functioning (BRIEF). Lutz, FL: Psychological Assessment
Resources, Inc; 2000
MN: Behavior Science Systems, Inc
Behavior Scales Developmental
Profile (CSBS DP). Baltimore, MD: Paul H. Brookes Publishing
Co, Inc; 2002
Nashville, TN: Ellsworth &
Vandermeer Press LLC; 2006
http://www.massgeneral.org/psychiatry/services/psc_home.aspx.
Accessed January 30, 2013
of Pediatrics. Caring for Children
With ADHD: A Resource Toolkit for Clinicians [CD-ROM]. 2nd
ed. Elk Grove Village, IL:
American Academy of Pediatrics; 2012
[A]Immunizations
[B]Immunization Administration
[C]Pediatric Immunization Administration Codes
Report a CPT and an ICD-9-CM code for each component
administered as well as for each vaccine

81. product given during a patient encounter.
90460 Immunization administration (IA) through 18 years of
age via any route of administration,
with counseling by physician or other qualified health care
professional; first or only
component of each vaccine or toxoid administered
+90461 each additional vaccine or toxoid component
administered (List separately in addition
to code for primary procedure.)
Report 90461 in conjunction with 90460.
Component refers to all antigens in a vaccine that prevent
disease(s) caused by one organism.
Multivalent antigens or multiple serotypes of antigens against a
single organism are considered a
single component of vaccines. Combination vaccines are those
vaccines that contain multiple vaccine
components. Conjugates or adjuvants contained in vaccines are
not considered to be component
parts of the vaccine as defined above.
A “qualified health care professional” is an individual who by
education, training,
licensure/regulation, facility credentialing (when applicable),
and payer policy is able to perform a
professional service within his or her scope of practice and
independently report a professional
service. These professionals are distinct from “clinical staff.” A
clinical staff member is a person who
works under the supervision of a physician or other qualified
health care professional and who is
allowed by law, regulation, facility, and payer policy to perform

82. or assist in the performance of
specified professional services but who does not individually
report any professional services.
Code 90460 is used to report the first or only component in a
single vaccine given during an
encounter. You can report more than one 90460 during a single
office encounter. Code 90461 is
considered an add-on code to 90460 (hence the + symbol next to
it). This means that the provider
will use 90461 in addition to 90460 if more than one component
is contained within a single
vaccine administered. CPT codes 90460 and 90461 are reported
regardless of route of
administration.
Pediatric IA codes (90460–90461) are reported only when both
of the following requirements are
met:
1) The patient must be 18 years or younger.
2) The physician or other qualified health care professional
must perform face-to-face
vaccine counseling associated with the administration. (Note:
The clinical staff can do the
actual administration of the vaccine.)
If both of these requirements are not met, report a nonage-
specific IA code(s) (90471–90474)

83. instead.
[C]Nonage-Specific Immunization Administration Codes
Report a CPT and an ICD-9-CM code for each vaccine
administration as well as for each vaccine
product given during a patient encounter.
90471 IA (includes percutaneous, intradermal, subcutaneous, or
intramuscular injections); one
vaccine (single or combination vaccine/toxoid)
Do not report 90471 in conjunction with 90473.
+90472 each additional vaccine (single or combination
vaccine/toxoid) (List separately to
code for primary procedure.)
Use 90472 in conjunction with 90460, 90471, or 90473.
90473 IA (includes intranasal or oral administration); one
vaccine (single or combination
vaccine/toxoid)
Do not report 90473 in conjunction with 90471.
+90474 each additional vaccine (single or combination
vaccine/toxoid) (List separately to
code for primary procedure.)
Use 90474 in conjunction with 90460, 90471, or 90473.
Codes 90471 and 90473 are used to code for the first
immunization given during a single office
visit. Codes 90472 and 90474 are considered add-on codes
(hence the + symbol next to them) to
90460, 90471, and 90473. This means that the provider will use
90472 or 90474 in addition to
90460, 90471, or 90473 if more than one vaccine is
administered during a visit. Note that there

84. can only be one first administration during a given visit. (See
vignettes #3 and 4 on pages 24 and 25.)
If during a single encounter for a patient 18 years or younger, a
physician or other qualified health
care professional only counsels on some of the vaccines, report
code 90460 (and 90461 when
applicable) for those counseled on and defer to codes 90472 or
90474 as appropriate for those that
are not counseled on.
The following vignettes may help illustrate their correct use
(please note that these coding vignettes
are for teaching purposes and do not necessarily follow every
payer’s reporting requirements):
[D]Vignette #1
A 5-year-old established patient is at a physician’s office for
her annual well-child examination. The
patient is scheduled to receive her first hepatitis A vaccine; her
fifth diphtheria, tetanus, and
acellular pertussis (DTaP) vaccine; and the intranasal influenza
vaccine. After distributing the
Vaccine Information Statements and discussing the risks and
benefits of immunizations with her
parents, the physician administers the vaccines.
How are the appropriate code(s) for this service selected?
[E]Step 1: Select appropriate E/M code.

85. 99393 Preventive medicine service, established patient, age 5 to
11 years
[E]Step 2: Select appropriate vaccine product code(s).
90633 Hepatitis A vaccine, pediatric/adolescent dosage (2-dose
schedule), for intramuscular
use
90700 DTaP, for use in individuals younger than 7 years, for
intramuscular use
90672 Influenza virus vaccine, quadrivalent, live, for intranasal
use
[E]Step 3: Select appropriate immunization administration
code(s) by considering the
following questions:
other qualified health care
professional perform the face-to-face vaccine counseling,
discussing the specific risks and
benefits of the vaccine(s)?
If the answer to both questions is “yes,” select a code(s) from
the pediatric IA code family (90460–
90461). If the answer to one of the questions is “no,” select a
code from the nonage-specific IA code
family (90471–90474).
In this vignette, the answer to both questions is “yes.”
Therefore, the following IA codes will be
reported:

86. 90460 IA through 18 years of age via any route of
administration, with counseling by physician or
other qualified health care professional; first or only component
of each vaccine or toxoid
administered
+90461 each additional vaccine or toxoid component
administered (List separately in
addition to code for primary procedure.)
[E]Step 4: Select the appropriate ICD-9-CM diagnosis code(s).
Diagnosis codes are used along with CPT codes to reflect the
outcome of a visit. CPT codes tell a
carrier what was done and ICD-9-CM codes tell a carrier why it
was done.
The vaccine product CPT code and its corresponding IA CPT
code are always linked to the same ICD-
9-CM code. This is because the vaccine product and the work
that goes into administering that
product are intended to provide prophylactic vaccination against
a certain type of disease.
ICD-9-CM does list specific codes to describe an encounter in
which a patient does receive a certain
vaccine (ie, codes V03–V05); however, when immunizations are
administered during a routine
well-child visit, ICD-9-CM code V20.2 should be linked to the
individual vaccine product and
administration code(s). This is due to ICD-9-CM guidelines that
allow for the linkage of age-
appropriate vaccines to be reported under V20.2 during a

87. routine well-baby or well-child encounter.
The diagnosis codes for the 3 vaccines and the 3 IA codes used
in this vignette are as follows:
CPT Codes ICD-9-CM Codes
99393 Preventive medicine service, established patient, 5–11
years V20.2
90633 Hepatitis A vaccine product V20.2
90460 Pediatric IA (hepatitis A vaccine), first component
V20.2
90700 DTaP vaccine product V20.2
90460 Pediatric IA (DTaP vaccine), first component V20.2
90461 (x2) Pediatric IA (DTaP vaccine), each additional
component V20.2
90672 Influenza virus vaccine, quadrivalent, live product
V20.2
90460 Pediatric IA (influenza vaccine), first component V20.2
Alternative Coding
CPT Codes ICD-9-CM Codes
90633 Hepatitis A vaccine product V20.2
90700 DTaP vaccine product V20.2
90672 Influenza virus vaccine, quadrivalent, live product
V20.2
90460 (x3) Pediatric IA (hepatits A, DTaP, influenza vaccines),
first component V20.2
90461 (x2) Pediatric IA (DTaP vaccine), second and third
components V20.2
Please note that most payers do not want multiple line items of
codes 90460 or 90461; therefore,

88. follow the alternative coding.
Rationale
Because the patient is younger than 18 years of age and there is
physician counseling, pediatric IA
codes are reported (90460, 90461). Each vaccine administered
will be reported with its own
90460 (hepatitis A, DTaP, influenza). The only vaccine with
multiple components is DTaP. Because
the first component (ie, diphtheria) was counted in 90460, only
the second and third components
(tetanus and acellular pertussis) are reported with 90461 with 2
units.
[D]Vignette #2
A 2-month-old established patient presents for her checkup. The
following vaccines are ordered:
DTaP-Haemophilus influenzae type b (Hib)-inactivated
poliovirus (IPV) (Pentacel), pneumococcal,
and rotavirus. The physician counsels the parents on all of them
and the nurse administers them all.
CPT Codes ICD-9-CM Codes
99391 Preventive medicine service, established patient, <1 year
V20.2
90698 DTaP-Hib-IPV (Pentacel) product V20.2
90670 Pneumococcal product V20.2
90680 Rotavirus vaccine V20.2
90460 (x3) Pediatric IA (Pentacel, pneumococcal, rotavirus),
first component V20.2
90461 (x4) Pediatric IA (Pentacel), each additional component
V20.2
Rationale
Because the patient is younger than 18 years and there is

89. physician counseling, pediatric IA codes are
reported (90460, 90461). Clinical staff may administer the
vaccine. The vaccines are administered
during the patient’s routine well-baby visit; therefore, code
V20.2 is the appropriate ICD-9-CM code
for all vaccines.
[D]Vignette #3
A 19-year-old patient presents to the office for his annual
checkup and to complete a college physical
examination (in college the patient will be living in a dorm). He
is due for a tetanus-diphtheria-
acellular pertussis (Tdap) booster, meningococcal vaccine, and
intranasal influenza vaccine. The
physician counsels the patient on each and the nurse administers
each.
CPT Codes ICD-9-CM Codes
99395 Preventive medicine service, established patient, 18–39
years V70.0 and V70.3
90715 Tdap product V06.1
90471 IA, first injection V06.1
90734 Meningococcal (MCV4) product V03.89
90472 IA, each additional injection V03.89
90672 Influenza virus vaccine, quadrivalent, live product
V04.81
90474 IA, each additional oral or intranasal V04.81
Rationale
The patient is older than 18 years; therefore, despite physician
counseling, pediatric IA codes cannot

90. be reported. Instead, codes 90471–90474 must be used. Because
the patient received 2 injections
and 1 intranasal vaccine, code 90471 is reported for the first
injection, 90472 for the second
injection, and 90474 for the intranasal vaccine. It is important
to remember that a first injection
code (90471) cannot be reported in addition to a first oral or
intranasal code (90473); therefore,
code 90474 must be used. The patient’s age also requires the
reporting of ICD-9-CM code V70.0;
therefore, the vaccine product and IA codes must be linked to
their appropriate ICD-9-CM codes (eg,
V06.1).
[D]Vignette #4
A 17-year-old patient presents to the office for her annual
checkup and to complete a college physical
examination (in college the patient will be living in a dorm).
The patient is due for a Tdap booster,
meningococcal vaccine, and intranasal influenza vaccine. The
physician counsels the patient only on
the meningococcal vaccine and the nurse administers each.
CPT Codes ICD-9-CM Codes
99394 Preventive medicine service, established patient, 12–17
years V20.2 and V70.3
90734 Meningococcal (MCV4) product V03.89
90460 Pediatric IA (meningococcal), first component V03.89
90715 Tdap product V06.1
90472 IA, each additional injection (Tdap) V06.1
90672 Influenza virus vaccine, quadrivalent, live product
V04.81
90474 IA, each additional oral or intranasal V04.81
Rationale
Because the physician only documents counseling for the

91. meningococcal vaccine, code 90460 can
only be reported for that vaccine. For the Tdap and intranasal
influenza vaccines, defer to non-
pediatric IA codes (90471–90474). In this case, however, a first
vaccine code is already reported
with code 90460, so the additional IA codes (90472, 90474)
have to be reported based on route of
administration. Because the encounter was also related to an
examination for administrative
purpose (eg, college examination), link the appropriate ICD-9-
CM code to the vaccine product and
IA codes (eg, V04.81).
[D]Vignette #5
A 6-month-old patient presents to the office for her routine
checkup and to receive vaccines. The
patient is due for DTaP, pneumococcal, and hepatitis B
vaccines. During the examination the
physician finds an upper respiratory infection and fever. The
physician counsels the parent on the
vaccines but decides to defer for 2 weeks. The physician
completes the well-baby check on that day.
Two weeks later the patient returns. The patient is afebrile and
asymptomatic and is only seen by the
nurse. The DTaP, pneumococcal, and hepatitis vaccines are
administered.
First Visit:
CPT Codes ICD-9-CM Codes
99391 Preventive medicine service, established patient, <1 year

92. V20.2
(An appropriate acute sick visit (eg, 99213) may be reported in
addition with modifier 25 and linked
to an appropriate ICD-9-CM code.)
CPT Codes ICD-9-CM Codes
90700 DTaP product V06.1
90670 Pneumococcal product V03.82
90744 Hepatitis B vaccine product V05.3
90471 IA (DTaP), first vaccine V06.1
90472 (x2) IA (pneumococcal, hepatitis B), each additional
component V03.82 and V05.3
Rationale
If counseling occurs outside of the IA service, there is no way
to report it separately. Therefore, in
this vignette, there is nothing separate to report during the well-
child visit, and when the patient
returns and sees the nurse only, pediatric IA codes cannot be
reported; defer to codes 90471–
90474. During the preventive medicine service, when an acute
illness is detected, a code from
99212–99215 can be reported if the service is significant and
separately identifiable. Code 9921x is
reported with modifier 25. When the patient returns for vaccines
only, an E/M service is not
reported because one is not completed or documented.
For more information on IA codes, see “Frequently Asked
Questions for the Pediatric Immunization
Administration Codes” and the Vaccine Coding Table at
http://coding.aap.org/codingresources.aspx
[B]How to Code When Immunizations Are Not Administered
during routine preventive medicine