Ambulatory/Outpatient Procedures Collected
Ambulatory/outpatient facilities are required to submit specific data to PHC4 for use in our reports. A complete list of reporting requirements can be found here.
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. Emergency room records are not submitted.
Effective 2007Q3 to Present as Noted
HCPCS Level I CPT-4 Procedure Code Ranges*
Surgery / Endoscopy
- All procedures within the range of 10021 – 69990 (effective 2007Q3 – 2018Q4)
- All procedures within the range of 10004 – 69990 (effective 2019Q1)
Chemotherapy
- All procedures within the range of 96401 – 96549 (effective 2007Q3)
Cardiovascular
- Cardiac catheterization procedures:
- within the range of 93501 – 93581 (effective 2007Q3 – 2010Q4)
- within the range of 93451 – 93581 (effective 2011Q1 – 2013Q4)
- within the range of 93451 – 93583 (effective 2014Q1 – 2016Q4)
- within the range of 93451 – 93592 (effective 2017Q1 – 2021Q4)
- within the range of 93451 – 93598 (effective 2022Q1)
- Cardiovascular therapeutic procedures:
- within the range of 92950 – 92998 (effective 2007Q3 – 2012Q4)
- within the range of 92920 – 92998 (effective 2013Q1)
HCPCS Level II Procedure Code Ranges
All procedures (effective 2007Q3)
*If the only qualifying CPT-4 code in the claim was 36415 -Collection of venous blood by venipuncture (i.e., the claim was for an outpatient laboratory encounter), the claim was not required.
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
