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Triggering and Grouping Codes			Table of Contents	
PNEUMONIA				
Code	Code Type	Used in Trigger Rule	Code Description	
481	ICD-9 Diagnosis	Y	Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]	 
483	ICD-9 Diagnosis	Y	Pneumonia due to other specified organism	 
485	ICD-9 Diagnosis	Y	"Bronchopneumonia, organism unspecified"	 
486	ICD-9 Diagnosis	Y	"Pneumonia, organism unspecified"	 
480.0	ICD-9 Diagnosis	Y	Pneumonia due to adenovirus	 
480.1	ICD-9 Diagnosis	Y	Pneumonia due to respiratory syncytial virus	 
480.2	ICD-9 Diagnosis	Y	Pneumonia due to parainfluenza virus	 
480.8	ICD-9 Diagnosis	Y	Pneumonia due to other virus not elsewhere classified	 
480.9	ICD-9 Diagnosis	Y	"Viral pneumonia, unspecified"	 
482.0	ICD-9 Diagnosis	Y	Pneumonia due to Klebsiella pneumoniae	 
482.1	ICD-9 Diagnosis	Y	Pneumonia due to Pseudomonas	 
482.2	ICD-9 Diagnosis	Y	Pneumonia due to Hemophilus influenzae [H. influenzae]	 
482.3	ICD-9 Diagnosis	Y	Other bacterial pneumonia - Pneumonia due to Streptococcus	 
482.30	ICD-9 Diagnosis	Y	"Pneumonia due to Streptococcus, unspecified"	 
482.31	ICD-9 Diagnosis	Y	"Pneumonia due to Streptococcus, group A"	 
482.32	ICD-9 Diagnosis	Y	"Pneumonia due to Streptococcus, group B"	 
482.39	ICD-9 Diagnosis	Y	Pneumonia due to other Streptococcus	 
482.4	ICD-9 Diagnosis	Y	Other bacterial pneumonia - Pneumonia due to Staphylococcus	 
482.40	ICD-9 Diagnosis	Y	"Pneumonia due to Staphylococcus, unspecified"	 
482.41	ICD-9 Diagnosis	Y	Methicillin susceptible pneumonia due to Staphylococcus aureus	 
482.42	ICD-9 Diagnosis	Y	Methicillin resistant pneumonia due to Staphylococcus aureus	 
482.49	ICD-9 Diagnosis	Y	Other Staphylococcus pneumonia	 
482.8	ICD-9 Diagnosis	Y	Other bacterial pneumonia - Pneumonia due to other specified bacteria	 
482.82	ICD-9 Diagnosis	Y	Pneumonia due to escherichia coli [E. coli]	 
482.83	ICD-9 Diagnosis	Y	Pneumonia due to other gram-negative bacteria	 
482.89	ICD-9 Diagnosis	Y	Pneumonia due to other specified bacteria	 
482.9	ICD-9 Diagnosis	Y	"Bacterial pneumonia, unspecified"	 
483.0	ICD-9 Diagnosis	Y	Pneumonia due to mycoplasma pneumoniae	 
483.8	ICD-9 Diagnosis	Y	Pneumonia due to other specified organism	 
484.8	ICD-9 Diagnosis	Y	Pneumonia in other infectious diseases classified elsewhere	 
487.0	ICD-9 Diagnosis	Y	Influenza with pneumonia	 
00520	CPT-4	No data	Anesthesia for closed chest procedures; (including bronchoscopy) not otherwise specified	 
0251T	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe"	 
0252T	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure)"	 
0276T	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe"	 
0277T	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes"	 
31615	CPT-4	No data	Tracheobronchoscopy through established tracheostomy incision	 
31622	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)"	 
31623	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings"	 
31624	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage"	 
31625	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites"	 
31626	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple"	 
31627	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s])"	 
31630	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture"	 
31631	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required)"	 
31632	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)"	 
31633	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary"	 
31634	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (eg, fibrin glue), if"	 
31635	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body"	 
31636	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus"	 
31637	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; each additional major bronchus stented (List separately in addition to code for primary procedure)"	 
31638	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as req"	 
31645	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial (eg, drainage of lung abscess)"	 
31646	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, subsequent"	 
31647	CPT-4	No data	"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), in"	 
31659	CPT-4	No data	"Bronchoscopic, Procedures"	 
32000	CPT-4	No data	"Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent"	 
32002	CPT-4	No data	"Thoracentesis with insertion of tube with or without water seal (eg, for pneumothorax) (separate procedure)"	 
32020	CPT-4	No data	"Tube thoracostomy with or without water seal (eg, for abscess, hemothorax, empyema) (separate procedure)"	 
32421	CPT-4	No data	"Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent"	 
32422	CPT-4	No data	"Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure)"	 
32550	CPT-4	No data	Insertion of indwelling tunneled pleural catheter with cuff	 
32551	CPT-4	No data	"Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure)"	 
32552	CPT-4	No data	Removal of indwelling tunneled pleural catheter with cuff	 
32554	CPT-4	No data	"Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance"	 
32555	CPT-4	No data	"Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance"	 
32556	CPT-4	No data	"Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance"	 
32557	CPT-4	No data	"Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance"	 
36410	CPT-4	No data	"Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for"	 
36415	CPT-4	No data	Collection of venous blood by venipuncture	 
36600	CPT-4	No data	"Arterial puncture, withdrawal of blood for diagnosis"	 
71010	CPT-4	No data	"Radiologic examination, chest; single view, frontal"	 
71015	CPT-4	No data	"Radiologic examination, chest; stereo, frontal"	 
71020	CPT-4	No data	"Radiologic examination, chest, 2 views, frontal and lateral;"	 
71021	CPT-4	No data	"Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure"	 
71022	CPT-4	No data	"Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections"	 
71023	CPT-4	No data	"Radiologic examination, chest, 2 views, frontal and lateral; with fluoroscopy"	 
71030	CPT-4	No data	"Radiologic examination, chest, complete, minimum of 4 views;"	 
71034	CPT-4	No data	"Radiologic examination, chest, complete, minimum of 4 views; with fluoroscopy"	 
71035	CPT-4	No data	"Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)"	 
71250	CPT-4	No data	"Computed tomography, thorax; without contrast material"	 
71260	CPT-4	No data	"Computed tomography, thorax; with contrast material(s)"	 
71270	CPT-4	No data	"Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections"	 
78579	CPT-4	No data	"Pulmonary ventilation imaging (eg, aerosol or gas)"	 
78580	CPT-4	No data	"Pulmonary perfusion imaging (eg, particulate)"	 
78581	CPT-4	No data	"Nuclear, Scan, of, Lung"	 
78582	CPT-4	No data	"Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging"	 
78584	CPT-4	No data	"Pulmonary perfusion imaging, particulate, with ventilation; single breath"	 
78585	CPT-4	No data	"Pulmonary perfusion imaging, particulate, with ventilation; rebreathing and washout, with or without single breath"	 
78586	CPT-4	No data	"Pulmonary ventilation imaging, aerosol; single projection"	 
78587	CPT-4	No data	"Pulmonary ventilation imaging, aerosol; multiple projections (eg, anterior, posterior, lateral views)"	 
78588	CPT-4	No data	"Pulmonary perfusion imaging, particulate, with ventilation imaging, aerosol, 1 or multiple projections"	 
78591	CPT-4	No data	"Pulmonary ventilation imaging, gaseous, single breath, single projection"	 
78593	CPT-4	No data	"Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; single projection"	 
78594	CPT-4	No data	"Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; multiple projections (eg, anterior, posterior, lateral views)"	 
78596	CPT-4	No data	Pulmonary quantitative differential function (ventilation/perfusion) study	 
78597	CPT-4	No data	"Quantitative differential pulmonary perfusion, including imaging when performed"	 
78598	CPT-4	No data	"Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed"	 
78599	CPT-4	No data	"Unlisted respiratory procedure, diagnostic nuclear medicine"	 
78990	CPT-4	No data	"Provide, Diag, Radionuclide(s)"	 
80002	CPT-4	No data	"1-2, Clinical, Chem, Tests"	 
80003	CPT-4	No data	"3, Clinical, Chemistry, Tests"	 
80004	CPT-4	No data	"4, Clinical, Chemistry, Tests"	 
80005	CPT-4	No data	"5, Clinical, Chemistry, Tests"	 
80006	CPT-4	No data	"6, Clinical, Chemistry, Tests"	 
80007	CPT-4	No data	"7, Clinical, Chemistry, Tests"	 
80008	CPT-4	No data	"8, Clinical, Chemistry, Tests"	 
80009	CPT-4	No data	"9, Clinical, Chemistry, Tests"	 
80010	CPT-4	No data	"10, Clinical, Chemistry, Tests"	 
80011	CPT-4	No data	"11, Clinical, Chemistry, Tests"	 
80012	CPT-4	No data	"12, Clinical, Chemistry, Tests"	 
80047	CPT-4	No data	"Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potass"	 
80048	CPT-4	No data	"Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium"	 
80049	CPT-4	No data	"Metabolic, Panel, Basic"	 
80050	CPT-4	No data	"General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004)"	 
80051	CPT-4	No data	Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295)	 
80053	CPT-4	No data	"Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (8"	 
80054	CPT-4	No data	"Comprehen, Metabolic, Panel"	 
80069	CPT-4	No data	"Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus i"	 
80150	CPT-4	No data	Amikacin	 
80200	CPT-4	No data	Tobramycin	 
80202	CPT-4	No data	Vancomycin	 
80299	CPT-4	No data	"Quantitation of drug, not elsewhere specified"	 
82792	CPT-4	No data	"Blood, Oxygen, Saturation"	 
82800	CPT-4	No data	"Gases, blood, pH only"	 
82801	CPT-4	No data	"Blood, Gases:, Pco2"	 
82802	CPT-4	No data	"Blood, Gases:, Ph, &, Pco2"	 
82803	CPT-4	No data	"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);"	 
82804	CPT-4	No data	"Blood, Gases:, Electrode, Po2"	 
82805	CPT-4	No data	"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry"	 
82810	CPT-4	No data	"Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry"	 
82812	CPT-4	No data	"Blood, Gases:, Manometry, Po2"	 
82817	CPT-4	No data	"Blood, Gases:, Ph, Pco2"	 
82820	CPT-4	No data	Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen)	 
85004	CPT-4	No data	Blood count; automated differential WBC count	 
85007	CPT-4	No data	"Blood count; blood smear, microscopic examination with manual differential WBC count"	 
85008	CPT-4	No data	"Blood count; blood smear, microscopic examination without manual differential WBC count"	 
85009	CPT-4	No data	"Blood count; manual differential WBC count, buffy coat"	 
85013	CPT-4	No data	Blood count; spun microhematocrit	 
85014	CPT-4	No data	Blood count; hematocrit (Hct)	 
85018	CPT-4	No data	Blood count; hemoglobin (Hgb)	 
85025	CPT-4	No data	"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count"	 
85027	CPT-4	No data	"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)"	 
85041	CPT-4	No data	"Blood count; red blood cell (RBC), automated"	 
85048	CPT-4	No data	"Blood count; leukocyte (WBC), automated"	 
86060	CPT-4	No data	Antistreptolysin 0; titer	 
86063	CPT-4	No data	Antistreptolysin 0; screen	 
86156	CPT-4	No data	Cold agglutinin; screen	 
86157	CPT-4	No data	Cold agglutinin; titer	 
86603	CPT-4	No data	Antibody; adenovirus	 
86609	CPT-4	No data	"Antibody; bacterium, not elsewhere specified"	 
86684	CPT-4	No data	Antibody; Haemophilus influenza	 
86710	CPT-4	No data	Antibody; influenza virus	 
86713	CPT-4	No data	Antibody; Legionella	 
86756	CPT-4	No data	Antibody; respiratory syncytial virus	 
87070	CPT-4	No data	"Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates"	 
87071	CPT-4	No data	"Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool"	 
87072	CPT-4	No data	"Culture, of, Specimen, by, Kit"	 
87073	CPT-4	No data	"Culture, bacterial; quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool"	 
87075	CPT-4	No data	"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates"	 
87076	CPT-4	No data	"Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate"	 
87077	CPT-4	No data	"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate"	 
87081	CPT-4	No data	"Culture, presumptive, pathogenic organisms, screening only;"	 
87083	CPT-4	No data	"Culture, of, Specimen, by, Kit"	 
87084	CPT-4	No data	"Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart"	 
87085	CPT-4	No data	"Culture, of, Specimen, by, Kit"	 
87109	CPT-4	No data	"Culture, mycoplasma, any source"	 
87163	CPT-4	No data	"Special, Microbiology, Culture"	 
87176	CPT-4	No data	"Homogenization, tissue, for culture"	 
87178	CPT-4	No data	"Microbe, Identification"	 
87179	CPT-4	No data	"Microbe, Identification"	 
87181	CPT-4	No data	"Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip)"	 
87184	CPT-4	No data	"Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)"	 
87185	CPT-4	No data	"Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme"	 
87186	CPT-4	No data	"Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate"	 
87187	CPT-4	No data	"Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure)"	 
87188	CPT-4	No data	"Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent"	 
87190	CPT-4	No data	"Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent"	 
87192	CPT-4	No data	"Antibiotic, Sensitivity, Each"	 
87197	CPT-4	No data	Serum bactericidal titer (Schlicter test)	 
87205	CPT-4	No data	"Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types"	 
87206	CPT-4	No data	"Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types"	 
87207	CPT-4	No data	"Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses)"	 
87208	CPT-4	No data	"Smear, Stain, &, Interpret"	 
87209	CPT-4	No data	"Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites"	 
87210	CPT-4	No data	"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)"	 
87211	CPT-4	No data	"Smear, Stain, &, Interpret"	 
87260	CPT-4	No data	Infectious agent antigen detection by immunofluorescent technique; adenovirus	 
87275	CPT-4	No data	Infectious agent antigen detection by immunofluorescent technique; influenza B virus	 
87276	CPT-4	No data	Infectious agent antigen detection by immunofluorescent technique; influenza A virus	 
87501	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, reverse transcription and amplified probe technique, each type or subtype"	 
87502	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, first 2 types or sub-types"	 
87503	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, each additional influenza viru"	 
87640	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique"	 
87641	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique"	 
87650	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, direct probe technique"	 
87651	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique"	 
87652	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, quantification"	 
87653	CPT-4	No data	"Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique"	 
87809	CPT-4	No data	Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus	 
A4559	HCPCS	No data	"Coupling gel or paste, for use with ultrasound device, per oz"	 
A4641	HCPCS	No data	"Radiopharmaceutical, diagnostic, not otherwise classified"	 
A4642	HCPCS	No data	"Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries"	 
A4643	HCPCS	No data	"supply of additional high dose contrast material(s) during magnetic resonance imaging, e.g., gadoteridol injection"	 
A4644	HCPCS	No data	supply of low osmolar contrast material (100-199 mgs of iodine)	 
A4645	HCPCS	No data	supply of low osmolar contrast material (200-299 mgs of iodine)	 
A4646	HCPCS	No data	supply of low osmolar contrast material (300-399 mgs of iodine)	 
A4647	HCPCS	No data	"supply of paramagnetic contrast material, eg., gadolinium"	 
A9507	HCPCS	No data	"Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries"	 
A9511	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m, depreotide, per mci"	 
A9512	HCPCS	No data	"Technetium tc-99m pertechnetate, diagnostic, per millicurie"	 
A9514	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc-99m pyrophosphate, per mci"	 
A9519	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc-99m macroaggregated albumin, per mci"	 
A9520	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc-99m sulfur colloid, per mci"	 
A9521	HCPCS	No data	"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries"	 
A9525	HCPCS	No data	"supply of low or iso-osmolar contrast material, 10 mg of iodine"	 
A9536	HCPCS	No data	"Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries"	 
A9538	HCPCS	No data	"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries"	 
A9540	HCPCS	No data	"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries"	 
A9541	HCPCS	No data	"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries"	 
A9547	HCPCS	No data	"Indium in-111 oxyquinoline, diagnostic, per 0. 5 millicurie"	 
A9549	HCPCS	No data	"technetium tc-99m arcitumomab, diagnostic, per study dose, up to 25 millicuries"	 
A9550	HCPCS	No data	"Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie"	 
A9552	HCPCS	No data	"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries"	 
A9553	HCPCS	No data	"Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries"	 
A9556	HCPCS	No data	"Gallium ga-67 citrate, diagnostic, per millicurie"	 
A9558	HCPCS	No data	"Xenon xe-133 gas, diagnostic, per 10 millicuries"	 
A9560	HCPCS	No data	"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries"	 
A9565	HCPCS	No data	"INDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER MILLICURIE"	 
A9566	HCPCS	No data	"Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries"	 
A9568	HCPCS	No data	"Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries"	 
A9572	HCPCS	No data	"Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries"	 
A9576	HCPCS	No data	"Injection, gadoteridol, (prohance multipack), per ml"	 
A9577	HCPCS	No data	"Injection, gadobenate dimeglumine (multihance), per ml"	 
A9578	HCPCS	No data	"Injection, gadobenate dimeglumine (multihance multipack), per ml"	 
A9579	HCPCS	No data	"Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml"	 
A9580	HCPCS	No data	"Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries"	 
A9581	HCPCS	No data	"Injection, gadoxetate disodium, 1 ml"	 
A9582	HCPCS	No data	"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries"	 
A9583	HCPCS	No data	"Injection, gadofosveset trisodium, 1 ml"	 
A9585	HCPCS	No data	"Injection, gadobutrol, 0. 1 ml"	 
A9698	HCPCS	No data	"Non-radioactive contrast imaging material, not otherwise classified, per study"	 
C1024	HCPCS	No data	"quinopristin/dalfopristin, 10ml, synercid iv"	 
C1045	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, i-131 mibg [iobenguane sulfate i-131], per 0.5 mci"	 
C1066	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, indium 111 satumomab pendetide, per vial"	 
C1090	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, indium in 111 chloride, per mci"	 
C1091	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, indium 111 oxyquinoline, per 0.5 millicurie"	 
C1093	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m fanolesomab, per dose (10 - 20 mci)"	 
C1094	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m albumin aggregated, per 1.0 millicurie"	 
C1095	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m depreotide, per vial"	 
C1096	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m exametazime, per dose"	 
C1099	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m pyrophosphate, per vial"	 
C1122	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m arcitumomab, per vial"	 
C1200	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m sodium glucoheptonate, per vial"	 
C1202	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m sulfur colloid, per dose"	 
C1775	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, fluorodeoxyglucose f18 (2-deoxy-2-[18f]fluoro-d-glucose), per dose (4-40 mci/ml)"	 
C9001	HCPCS	No data	"linezolid injection, per 200mg"	 
C9013	HCPCS	No data	"supply of co 57 cobaltous chloride, radiopharmaceutical diagnostic imaging agent"	 
C9102	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, 51 sodium chromate, per 50 mci"	 
C9116	HCPCS	No data	"injection, ertapenem sodium, per 1 gram vial"	 
C9246	HCPCS	No data	"Injection, gadoxetate disodium, per ml"	 
C9258	HCPCS	No data	"Injection, telavancin, 10 mg"	 
C9282	HCPCS	No data	"Injection, ceftaroline fosamil, 10 mg"	 
G0001	HCPCS	No data	routine venipuncture for collection of specimen(s)	 
G0096	HCPCS	No data	basic metabolic panel	 
G0097	HCPCS	No data	electrolytes panel	 
G0098	HCPCS	No data	comprehensiv metabolic panel	 
G0306	HCPCS	No data	"Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count"	 
G0307	HCPCS	No data	"Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)"	 
J0120	HCPCS	No data	"Injection, tetracycline, up to 250 mg"	 
J0278	HCPCS	No data	"Injection, amikacin sulfate, 100 mg"	 
J0290	HCPCS	No data	"Injection, ampicillin sodium,  500 mg"	 
J0295	HCPCS	No data	"Injection, ampicillin sodium/sulbactam sodium, per 1. 5 gm"	 
J0456	HCPCS	No data	"Injection, azithromycin, 500 mg"	 
J0530	HCPCS	No data	"Injection, penicillin g benzathine and penicillin g procaine, up to 600,000 units"	 
J0540	HCPCS	No data	"Injection, penicillin g benzathine and penicillin g procaine, up to 1,200,000 units"	 
J0550	HCPCS	No data	"Injection, penicillin g benzathine and penicillin g procaine, up to 2,400,000 units"	 
J0558	HCPCS	No data	"Injection, penicillin g benzathine and penicillin g procaine, 100,000 units"	 
J0559	HCPCS	No data	"Injection, penicillin g benzathine and penicillin g procaine, 2500 units"	 
J0560	HCPCS	No data	"Injection, penicillin g benzathine, up to 600,000 units"	 
J0561	HCPCS	No data	"Injection, penicillin g benzathine, 100,000 units"	 
J0570	HCPCS	No data	"Injection, penicillin g benzathine, up to 1,200,000 units"	 
J0580	HCPCS	No data	"Injection, penicillin g benzathine, up to 2,400,000 units"	 
J0690	HCPCS	No data	"Injection, cefazolin sodium, 500 mg"	 
J0692	HCPCS	No data	"Injection, cefepime hydrochloride, 500 mg"	 
J0694	HCPCS	No data	"Injection, cefoxitin sodium, 1 gm"	 
J0695	HCPCS	No data	"injection, cefonicid sodium, 1 gram"	 
J0696	HCPCS	No data	"Injection, ceftriaxone sodium, per 250 mg"	 
J0697	HCPCS	No data	"Injection, sterile cefuroxime sodium, per 750 mg"	 
J0698	HCPCS	No data	"Injection, cefotaxime sodium, per gm"	 
J0710	HCPCS	No data	"Injection, cephapirin sodium, up to 1 gm"	 
J0712	HCPCS	No data	"Injection, ceftaroline fosamil, 10 mg"	 
J0713	HCPCS	No data	"Injection, ceftazidime, per 500 mg"	 
J0715	HCPCS	No data	"Injection, ceftizoxime sodium, per 500 mg"	 
J0743	HCPCS	No data	"Injection, cilastatin sodium; imipenem, per 250 mg"	 
J0744	HCPCS	No data	"Injection, ciprofloxacin for intravenous infusion, 200 mg"	 
J0770	HCPCS	No data	"Injection, colistimethate sodium, up to 150 mg"	 
J1335	HCPCS	No data	"Injection, ertapenem sodium, 500 mg"	 
J1350	HCPCS	No data	erythromycin-im inj	 
J1360	HCPCS	No data	erythromycin-iv inj	 
J1362	HCPCS	No data	"injection, erythromycin gluceptate, per 250 mg"	 
J1364	HCPCS	No data	"Injection, erythromycin lactobionate, per 500 mg"	 
J1580	HCPCS	No data	"Injection, garamycin, gentamicin, up to 80 mg"	 
J1590	HCPCS	No data	"Injection, gatifloxacin, 10mg"	 
J1840	HCPCS	No data	"Injection, kanamycin sulfate, up to 500 mg"	 
J1850	HCPCS	No data	"Injection, kanamycin sulfate, up to 75 mg"	 
J1890	HCPCS	No data	"Injection, cephalothin sodium, up to 1 gram"	 
J1956	HCPCS	No data	"Injection, levofloxacin, 250 mg"	 
J2010	HCPCS	No data	"Injection, lincomycin hcl, up to 300 mg"	 
J2020	HCPCS	No data	"Injection, linezolid, 200mg"	 
J2185	HCPCS	No data	"Injection, meropenem, 100 mg"	 
J2265	HCPCS	No data	"Injection, minocycline hydrochloride, 1 mg"	 
J2280	HCPCS	No data	"Injection, moxifloxacin, 100 mg"	 
J2460	HCPCS	No data	"Injection, oxytetracycline hcl, up to 50 mg"	 
J2510	HCPCS	No data	"Injection, penicillin g procaine, aqueous, up to 600,000 units"	 
J2540	HCPCS	No data	"Injection, penicillin g potassium, up to 600,000 units"	 
J2543	HCPCS	No data	"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0. 125 grams (1. 125 grams)"	 
J2545	HCPCS	No data	"Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg"	 
J2700	HCPCS	No data	"Injection, oxacillin sodium, up to 250 mg"	 
J2770	HCPCS	No data	"Injection, quinupristin/dalfopristin, 500 mg (150/350)"	 
J2970	HCPCS	No data	"injection, methicillin sodium, up to 1 gm"	 
J3000	HCPCS	No data	"Injection, streptomycin, up to 1 gm"	 
J3095	HCPCS	No data	"Injection, telavancin, 10 mg"	 
J3243	HCPCS	No data	"Injection, tigecycline, 1 mg"	 
J3260	HCPCS	No data	"Injection, tobramycin sulfate, up to 80 mg"	 
J3305	HCPCS	No data	"Injection, trimetrexate glucuronate, per 25 mg"	 
J3320	HCPCS	No data	"Injection, spectinomycin dihydrochloride, up to 2 gm"	 
J3370	HCPCS	No data	"Injection, vancomycin hcl, 500 mg"	 
J7676	HCPCS	No data	"Pentamidine isethionate, inhalation solution, compounded product, administered through dme, unit dose form, per 300 mg"	 
J7682	HCPCS	No data	"Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams"	 
J7685	HCPCS	No data	"Tobramycin, inhalation solution, compounded product, administered through dme, unit dose form, per 300 milligrams"	 
P9605	HCPCS	No data	routine venipuncture	 
Q0105	HCPCS	No data	lo osmol contr(100-199 mg i)	 
Q0106	HCPCS	No data	lo osmol contr(200-299 mg i)	 
Q0107	HCPCS	No data	lo osmol contr(300-399 mg i)	 
Q0135	HCPCS	No data	high dose inj contrast mri	 
Q0144	HCPCS	No data	"Azithromycin dihydrate, oral, capsules/powder, 1 gram"	 
Q3002	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, gallium ga 67, per mci"	 
Q3004	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, xenon xe 133, per 10 mci"	 
Q3006	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m glucepatate, per 5 mci"	 
Q3007	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, sodium phosphate p32, per mci"	 
Q3008	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, indium 111-in pentetreotide, per 3 mci"	 
Q3011	HCPCS	No data	"supply of radiopharmaceutical diagnostic imaging agent, chromic phosphate p32 suspension, per mci"	 
Q9945	HCPCS	No data	"LOW OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML"	 
Q9946	HCPCS	No data	"LOW OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML"	 
Q9947	HCPCS	No data	"LOW OSMOLAR CONTRAST MATERIAL, 200-249 MG/ML IODINE CONCENTRATION, PER ML"	 
Q9948	HCPCS	No data	"LOW OSMOLAR CONTRAST MATERIAL, 250-299 MG/ML IODINE CONCENTRATION, PER ML"	 
Q9949	HCPCS	No data	"LOW OSMOLAR CONTRAST MATERIAL, 300-349 MG/ML IODINE CONCENTRATION, PER ML"	 
Q9950	HCPCS	No data	"LOW OSMOLAR CONTRAST MATERIAL, 350-399 MG/ML IODINE CONCENTRATION, PER ML"	 
Q9951	HCPCS	No data	"Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml"	 
Q9952	HCPCS	No data	"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, PER ML"	 
Q9953	HCPCS	No data	"Injection, iron-based magnetic resonance contrast agent, per ml"	 
Q9954	HCPCS	No data	"Oral magnetic resonance contrast agent, per 100 ml"	 
Q9958	HCPCS	No data	"High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml"	 
Q9959	HCPCS	No data	"High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml"	 
Q9960	HCPCS	No data	"High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml"	 
Q9961	HCPCS	No data	"High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml"	 
Q9962	HCPCS	No data	"High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml"	 
Q9963	HCPCS	No data	"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml"	 
Q9964	HCPCS	No data	"High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml"	 
Q9965	HCPCS	No data	"Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml"	 
Q9966	HCPCS	No data	"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml"	 
Q9967	HCPCS	No data	"Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml"	 
Q9969	HCPCS	No data	"Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose"	 
S0016	HCPCS	No data	"injection, amikacin sulfate, 500 mg"	 
S0021	HCPCS	No data	"Injection, cefoperazone sodium, 1 gram"	 
S0024	HCPCS	No data	"injection, ciprofloxacin, 200 mg"	 
S0030	HCPCS	No data	"Injection, metronidazole, 500 mg"	 
S0032	HCPCS	No data	"Injection, nafcillin sodium, 2 grams"	 
S0034	HCPCS	No data	"Injection, ofloxacin, 400 mg"	 
S0040	HCPCS	No data	"Injection, ticarcillin disodium and clavulanate potassium, 3. 1 grams"	 
S0072	HCPCS	No data	"injection, amikacin sulfate, 100 mg"	 
S0073	HCPCS	No data	"Injection, aztreonam, 500 mg"	 
S0074	HCPCS	No data	"Injection, cefotetan disodium, 500 mg"	 
S0077	HCPCS	No data	"Injection, clindamycin phosphate, 300 mg"	 
S0080	HCPCS	No data	"Injection, pentamidine isethionate, 300 mg"	 
S0081	HCPCS	No data	"Injection, piperacillin sodium, 500 mg"	 
S0085	HCPCS	No data	"injection, gatifloxacin, 200 mg"	 
S0143	HCPCS	No data	"AZTREONAM, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER GRAM"	 
S8002	HCPCS	No data	"supply of diagnostic radiopharmaceutical, indium-111"	 
S8085	HCPCS	No data	Fluorine-18 fluorodeoxyglucose (f-18 fdg) imaging using dual-head coincidence detection system (non-dedicated pet scan)	 
S9061	HCPCS	No data	"Home administration of aerosolized drug therapy (e. G. , pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursi"	 
S9529	HCPCS	No data	"Routine venipuncture for collection of specimen(s), single home bound, nursing home, or skilled nursing facility patient"	 
038.0	ICD-9 Diagnosis	No data	Streptococcal septicemia	 
038.1	ICD-9 Diagnosis	No data	Septicemia - Staphylococcal septicemia	 
038.10	ICD-9 Diagnosis	No data	"Staphylococcal septicemia, unspecified"	 
038.11	ICD-9 Diagnosis	No data	Methicillin susceptible Staphylococcus aureus septicemia	 
038.12	ICD-9 Diagnosis	No data	Methicillin resistant Staphylococcus aureus septicemia	 
038.19	ICD-9 Diagnosis	No data	Other staphylococcal septicemia	 
038.2	ICD-9 Diagnosis	No data	Pneumococcal septicemia [Streptococcus pneumoniae septicemia]	 
038.3	ICD-9 Diagnosis	No data	Septicemia due to anaerobes	 
038.40	ICD-9 Diagnosis	No data	"Septicemia due to gram-negative organism, unspecified"	 
038.41	ICD-9 Diagnosis	No data	Septicemia due to hemophilus influenzae [H. influenzae]	 
038.42	ICD-9 Diagnosis	No data	Septicemia due to escherichia coli [E. coli]	 
038.43	ICD-9 Diagnosis	No data	Septicemia due to pseudomonas	 
038.44	ICD-9 Diagnosis	No data	Septicemia due to serratia	 
038.49	ICD-9 Diagnosis	No data	Other septicemia due to gram-negative organisms	 
038.8	ICD-9 Diagnosis	No data	Other specified septicemias	 
038.9	ICD-9 Diagnosis	No data	Unspecified septicemia	 
288.60	ICD-9 Diagnosis	No data	"Leukocytosis, unspecified"	 
288.62	ICD-9 Diagnosis	No data	Leukemoid reaction	 
288.66	ICD-9 Diagnosis	No data	Bandemia	 
288.69	ICD-9 Diagnosis	No data	Other elevated white blood cell count	 
511.0	ICD-9 Diagnosis	No data	Pleurisy without mention of effusion or current tuberculosis	 
511.1	ICD-9 Diagnosis	No data	"Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis"	 
511.8	ICD-9 Diagnosis	No data	pleural effus nec not tb	 
511.89	ICD-9 Diagnosis	No data	"Other specified forms of effusion, except tuberculous"	 
511.9	ICD-9 Diagnosis	No data	Unspecified pleural effusion	 
518.0	ICD-9 Diagnosis	No data	Pulmonary collapse	 
518.81	ICD-9 Diagnosis	No data	Acute respiratory failure	 
518.84	ICD-9 Diagnosis	No data	Acute and chronic respiratory failure	 
780.6	ICD-9 Diagnosis	No data	fever	 
780.60	ICD-9 Diagnosis	No data	"Fever, unspecified"	 
785.50	ICD-9 Diagnosis	No data	"Shock, unspecified"	 
785.52	ICD-9 Diagnosis	No data	Septic shock	 
786.00	ICD-9 Diagnosis	No data	"Respiratory abnormality, unspecified"	 
786.01	ICD-9 Diagnosis	No data	Hyperventilation	 
786.04	ICD-9 Diagnosis	No data	Cheyne-Stokes respiration	 
786.05	ICD-9 Diagnosis	No data	Shortness of breath	 
786.06	ICD-9 Diagnosis	No data	Tachypnea	 
786.09	ICD-9 Diagnosis	No data	Other respiratory abnormalities	 
786.1	ICD-9 Diagnosis	No data	Stridor	 
786.2	ICD-9 Diagnosis	No data	Cough	 
786.4	ICD-9 Diagnosis	No data	Abnormal sputum	 
786.7	ICD-9 Diagnosis	No data	Abnormal chest sounds	 
786.9	ICD-9 Diagnosis	No data	Other symptoms involving respiratory system and chest	 
790.7	ICD-9 Diagnosis	No data	Bacteremia	 
790.91	ICD-9 Diagnosis	No data	Abnormal arterial blood gases	 
793.1	ICD-9 Diagnosis	No data	Nonspecific (abnormal) findings on radiological and other examination of lung field	 
793.19	ICD-9 Diagnosis	No data	Other nonspecific abnormal finding of lung field	 
799.1	ICD-9 Diagnosis	No data	Respiratory arrest	 
995.90	ICD-9 Diagnosis	No data	"Systemic inflammatory response syndrome, unspecified"	 
995.91	ICD-9 Diagnosis	No data	Sepsis	 
995.92	ICD-9 Diagnosis	No data	Severe sepsis	 
995.93	ICD-9 Diagnosis	No data	Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction	 
995.94	ICD-9 Diagnosis	No data	Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction	 
997.31	ICD-9 Diagnosis	No data	Ventilator associated pneumonia	 
999.32	ICD-9 Diagnosis	No data	Bloodstream infection due to central venous catheter	 
999.33	ICD-9 Diagnosis	No data	Local infection due to central venous catheter	 
V12.61	ICD-9 Diagnosis	No data	Personal history of pneumonia (recurrent)	 
324	Revenue Center	No data	Radiology diagnostic-chest x-ray	 
End of Worksheet				
