Services & Data Requests - Ambulatory/Outpatient Procedures Collected

The Required Procedures and Coding Guidelines:

Claim records that meet all three criterions are included in the quarterly ambulatory/outpatient procedure submission files:

• The Statement Covers Period – Through Date is in the submission quarter.
• Effective with 2007Q3 data, at least one HCPCS Level I - CPT-4 code is within the specified code ranges (see list below) or any HCPCS Level II code is used. Prior to 2007Q3 at least one CPT-4 code or ICD-9-CM procedure code is within the specified code ranges as described below.
• The ambulatory/outpatient procedure was performed in any of the following locations within a hospital-based ambulatory/outpatient unit or freestanding ambulatory surgery center: general operating room, ambulatory surgery room, short-term procedure unit, endoscopy or GI lab/unit, cardiac catheterization laboratory, radiology department, outpatient oncology unit, etc. The names of these locations/units listed are intended to be used as general terms. Location names may differ from facility to facility.

Effective 2007Q3

HCPCS Level I CPT-4 Code Ranges:

Surgery / Endoscopy:

• All procedures within the range of 10021 - 69990

Chemotherapy:

• All procedures within the range of 96401 - 96549

Cardiovascular:

• Cardiac catheterization procedures within the range of 93501 – 93581
• Cardiovascular therapeutic procedures within the range of 92950 - 92998

HCPCS Level II Code Ranges:

• All HCPCS Level II codes

Effective 1996 through 2007Q2

CPT-4 Code Ranges:

Surgery / Endoscopy:

• All procedures within the range of 10000 - 69999

Chemotherapy:

• All procedures within the range of 96400 – 96569

Cardiovascular

• Cardiac catheterization procedures within the range of 93501 - 93599
• Cardiovascular therapeutic procedures within the range of 92950 - 92999

ICD-9-CM Procedure Code Ranges:

Surgery / Endoscopy / Cardiovascular:

All procedures within the range 01.0 - 86.99 EXCEPT:

• 23.0 to 23.99 Removal and restoration of teeth
• 24.1 to 24.19 Diagnostic procedures on teeth, gums, and alveoli
• 29.11 Pharyngoscopy
• 29.19 Other diagnostic procedures on pharynx
• 37.26 Cardiac electrophysiologic stimulation studies
• 39.95 Hemodialysis
• 41.31 Bone marrow biopsy
• 51.1 to 51.19 Diagnostic procedures on the biliary tract
• 52.13 Endoscopic retrograde pancreatography (ERP)
• 84.4 to 84.9 Implantation or fitting of prosthetic limb device

Chemotherapy:

• 99.25 Injection or infusion of cancer chemotherapeutic substance
• 99.29 Injection or infusion of other therapeutic or prophylactic substance

For more information contact the Special Request Unit at .