APPENDIX S4: The CPT3 Score
SYSTEM
Integumentary
Musculoskeletal
1ST THREE
NUMBERS
OF CPT
CODE
101
110
119
143
151
152
155
156
157
158
159
190
191
192
193
194
200
201
206
208
209
210
211
212
213
214
215
216
DESCRIPTION
I+D abcess, fluid, hematoma
Debridement: skin, subcutanoeuos tissue, muscle, bone
Tissue expander insertion
Shaving of Epidermal / dermal lesion
Epidermal graft
Free Full thickness graft
Formation of pedicle
Delay / sectioning of flap
Muscle/Myocutaneous/Fasciocutaneous Flap
Graft for Facial Nerve paralysis, Excision excessive tissue
Excision, pressure ulcer
Mastotomy, drainage of abcsess
Excision of breast/nipple lesion identified by radiological marker
Excision chest wall tumor, or placement of radiotherapy catheter
Mastectomy (partial/total), Mammoplasty, or Breast Reconstruction
Breast Surgery NOS
Incision of Soft Tissue Abcsess
Exploration of Penetrating Wound
Application/Exchange of External Fixation
Replantation of Limb/Digit
Tissue Grafts (Bone, Cartilage, Other), unlisted MSK Procedure
TMJ Arthrotomy, Excision of Bone/Tumor of Mandible/Facial Bones
Repair/Reconstruction of Facial/Mandible Bone Fracture/Dislocation
Reconstruction of Mandible/Maxilla with Graft/Implane, Osteotomy/Osteoplasty Facial/Orbital Bones,
Open Treatment Zygomatic/Malar/Nasomaxillary/Orbital Blowout Fracture
Open Treatment of Orbital (non-blowout)/Palatal/Maxillary/Mandibular/Hyoid Fracture or Craniofacial Separation
Incision and Drainage of Neck/Thorax
Resection of Rib/Sternum, Hyoid Myotomy
CPT3
SCORE
1.67
1.04
2.98
3.36
1
1.94
1
1
1.13
1.82
0.48
1.62
1.91
0.89
1.07
1
0.71
1.64
1
4.06
1.25
1.24
1.27
0.50
1.81
0.27
0.76
1.06
217
218
219
220
221
222
223
225
226
228
229
230
231
232
233
234
235
236
238
239
240
241
242
243
244
245
246
248
249
250
251
252
253
Repair of Rib/Sternum Defect (including pectus excavatum/carinatum)
Repair of Rib/Sternum Fracture
Excision, tumor, soft tissue of back or flank
Incision and Drainage of Deep Abcess, Posterior Spine
Partial Excision, Vertabrae
Osteotomy, Spine
Repair of Verterbral/Odontoid Fracture/Dislocation
Percutaneous Vertebroplasty and Vertebral Arthrodesis
Single Posterior Vertebral Arthrodesis Below C2
Multiple Vertebral Arthrodesis, Spinal Instrumentation/Fixation, Total Disc Arthroplasty
Unlisted Procedure of Abdomen/MSK System
Shoulder joint exploration, I&D
Acriomio/sternoclavicular/Glenohumerol Arthrotomy, Excision, or Curretage
Radical Resection Tumor, Clavicle/Scapula/Proximal Humerus
Removal of Foreign Body or Muscle Transfer, Shoulder
Soft Tissue Repair, Osteotomy, and Prophylactic Treatment of Shoulder Area
Open Treatment of Shpoulder Area Fracture/Dislocation
Open Treatment of Shpoulder Area Fracture/Dislocation
Arthrodesis, Glenohumeral Joint
Other Procedure, Shoulder
Elbow Arthrotomy or Soft Tissue Tumor Excision of Upper Arm/Elbow Area
Excision/Sequestrectomy of Bone/Tumor of Distal Humerus/Radial Head, Or Resection of Elbow Joint
Removal of Foreign Body, Upper Arm/Elbow
Soft Tissue Repair/Arthroplasty, Upper Arm/Elbow Area
Osteotomy/Repair/Prophylactic Treatment of Humeral Shaft
Open Treatment of Humeral Shaft/Elbow Fracture/Dislocation
Open Treatment of Radial/Ulnar Fracture or Elbow Dislocation
Arthrodesis, Elbow Joint
Amputation at Humerus or Unlisted Humerus/Elbow Procedure
Forearm Fasciotomy/Tendon Incision/Arthrotomy/Tumor Excision
Arthrotomy or Soft Tissue Procedure/Tumor Excision of Wrist/Forearm
Soft Tissue Repair, Forearm/Wrist
Tenodesis/Osteotomy/Osteoplasty, Forearm/Wrist
0.52
1.16
*
0.50
1
0.49
1
0.33
0.47
0.67
1
2.99
0
1
1
0.21
0
0.54
0
0
1.41
0
0
1.41
0
0.74
0
*
0
3.53
1.80
0
0
Respiratory
254
255
256
259
261
263
264
265
266
267
269
270
271
272
273
274
275
276
277
278
280
284
288
298
299
313
314
315
316
317
318
320
321
Repair of Non/Malunion, Arthroplasty, Prohylactic Treatment of Forearm/Wrist
Open Treatment of Radial/Ulnar Shaft Fracture
Open Treatment of Distal Radial/Ulnar/Wrist Intra/Extra Articular Fractures
Amputation or Disarticulation of Forearm/Wrist
Radical Resection of Tumor, Soft Tissue, Hand/Finger
Repair/Excision of Flexor Tendon, Hand
Other Flexor/Extensor Procedure, Hand
Muscle/Ligament/Joint Procedure, Hand
Open Treatment of Carpo/Metacarpal Fracture/Dislocation
Open Treatment of Phalngeal/Metacarpophalangeal Fracture/Dislocation
Amputation of Finger/Thumb, I&D of Pelvis/Hip Joint Area
Soft Tissue Procedure or Tumor Excision of Pelvis/Hip Joint Area
Other Procedure, Pelvis/Hip Joint Area
Open/Closed Treatment of Fracture/Dislocation in Pelvis/Hip Joint Area
Tumor Excision or Soft Tissue Repair of Thigh/Knee Joint Area
Osteotomy/Arthroplasty/Soft Tissue Repair of Distal Femur/Knee Joint
Open Treatment of Thigh/Knee Fracture/Dislocation
Tumor Excision/Arthrotomy/Soft Tissue Repair of Distal Leg/Ankle Joint
Open Treatment of Distal Tibia/Fibula Fracture, Ankel Arthroplasty
Open Treatment of Ankle Fracture, Below Knee Amputation, and Lower Leg Fasciotomy
Incision & Drainage of Foot
Open Treatment of Talar/Calcaneous Fracture, and Osteochondral Autograft of Talus
Amupation Foot, Midtarsal or Transmetatarsal
Joint Arthroscopy
Arthroscopy, Ankle/Hip
Partial/Total Excision of Pharynx/Larynx
Arytenoidectomy, arytenoidopexy, eppiglotectomy
Laryngoplasty or Other Procedure of Larynx
Insertion of Laryngeal Speech Prosthesis, or Tracheostoma Revision
Tracheoplasty, Bronchoplasty, or Excision of Tracheal Stenosis/Tumor
Tracheostomy Repair/Closure, or Other Tracheal Procedure
Thoracostomy for Rib Resection/Empyema, or Thoracotomy, Minor
Thoracotomy, Major
0
0
0.27
1
1
0.95
1.53
0.99
3.06
0
0.25
0.92
0.68
1.07
0.91
0.61
1.20
1.48
0.71
1.26
0
1
1.05
0.43
1
0.82
1
0.85
1
0
1.34
0
0.35
Cardiovascular
322
323
324
325
326
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
344
345
348
349
350
351
352
353
354
355
356
357
358
Pneumonostomy, Pulmonary Decortication
Parietal Pleurectomy +/- Decortication
Pleural Biopsy or Lung Resection
Lung Wedge Resection, Bronchoplasty, Resection of Pancoast Tumor, Empyemectomy, or Pleuredesis
Thoracoscopy, Surgical
Repair of Lung Hernia/Chest Wall Defect
Other Procedure, Lung/Pleura
Pericardiotomy/Pericardiectomy, Excision of Pericardial Mass
Excision of Cardiac Tumor, Transmyocardial laser revascularization
Ablation Procedure, Cardiac
Exploratory Cardiotomy, Repair of Cardiac Wound/Great Vessels
Repair/Replacement of Cardiac Valve
Coronary Artery Repair/Bypass
Repair of Cardiac Anomalies/Congenital Defects
Repair of Cardiac Anomalies/Congenital Defects
Repair of Great Vessel Stenosis/Stricture/Anomoly +/- Bypass Graft
Pulmonary Artery Repair, Other procedure Cardiac Surgery
Arterial Embolectomy/Thrombectomy by Neck/Thoracic Incision
Arterial Embolectomy/Thrombectomy by Arm/Abdominal Incision
Arterial Embolectomy/Thrombectomy by Leg Incision
Venous Embolectomy/Thrombectomy
Venous Graft/Valvular Repair
Endovascular/Open Repair of Infrarenal AAA/Brachial/Iliac/Femoral Artery
Endovascular Graft Placement for Repair of Iliac Artery
Direct Repair of Aneurysm/Pseudoaneurysm and Graft Insertion
Direct Repair of Aneurysm/Pseudoaneurysm and Graft Insertion, or Repair of AVF
Repair of Blood Vessel With/Without Graft
Thromboendarterectomy
Percutaneous Balloon Angioplasty, Renal Artery/Visceral Arter/Aorta
Bypass Graft with Vein
Bypass Graft Without Vein
Exploration/Reoperation of Vessels
Postoperative Exploration for Hemmorhage/Thrombosis/Infection, Revision/Repair of Arterial Bypass/Graft
0
0.96
0.21
0.49
0.24
2.03
1.52
0.96
1
1
0
0.52
0.73
1
1
0.45
0
1
0.54
0.82
2.91
0
0.53
0.60
0.32
1.09
1.78
0.54
*
1.29
1.20
0.38
1.04
Lymphatic
Mediastinum
Digestive
359
364
368
371
372
375
376
377
381
383
385
387
389
390
392
394
395
405
406
407
408
410
411
415
418
421
422
423
424
425
426
427
428
Excision of Infected Graft
Endovenous Ablation
DRIL, and Upper Extremity Hemodyalsis Access (STEAL Syndrome)
Venous Anastamosis (Open)
Arterial Revascularization Procedure, Endovascular or Open
Vascular Endoscopy with Ligation of Perforator Veins
Ligation of Major Artery/Vein
Vericose Vein procedure, penile revascularization, or other vascular surgery procedure NOS
Surgical Procedure of Spleen
I&D of Lymph Node Abscess, Lymphangiotomy, or Ligation of Thoracic Duct
Pelvic/Peritoneal Lymphadenectomy, Excision of Cystic Hygroma, or other Unlisted Lymphatic Surgery
Lymohadenectomy, Other
Unlisted Procedure Hemic/Lymohatic System
Mediastinotomy
Excision of Mediastinal Cyst/Tumor
Mediastinoscopy, Unlisted Mediastinal Procedure
Diaphragm Surgery
Lip Excision +/- Reconstruction
Lip Repair
Plastic Repair of Cleft Lip/Nasal Deformity
Surgical Procedure on Vestibule of Mouth
I&D of Tongue or Floor of Mouth
Excision of Lesion of Tongue or Floor of Mouth
Other Procedure of Tongue or Floor of Mouth
Repair/Resection of Dentoalveolar Structures
Excision of Lesion or Resection of Palate/Uvula
Palatoplasty, Repair of Nasolabial Fistula, or Unlisted Procedure of Palate/Uvula
Abscess Drainage or Sialolithotomy of Salivary Glands
Excision of Salivary Glands
Plastic Repair or Diversion of Salivary Duct
Ligation of Salivary Duct, or Unlisted Procedure of Salivary Glands/Ducts
I&D of Peritonsilar/Retropharyngeal Abscess
Laryngeal/Pharyngeal Repair or Resection
0.26
0.90
0.49
1
*
1
0.50
0.76
1.03
3.23
0.89
0.61
2.52
1.01
2.17
0.16
0.95
1.47
1
1
0
1
0.47
0
1
0.40
1
1
0.35
1
1
0
0.34
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
446
447
448
449
450
451
453
454
455
458
459
460
467
469
470
471
473
474
Laryngeal/Pharyngeal Repair or Resection
Esophagotomy or Cricopharyngeal Myotomy
Excision of Lesion/Diverticulectomy of Esophagus, or Esophagectomy
Laparoscopic Surgery of Esophagus
Esophagoplasty or Repair of PEH
Repair of Esophageal Wound/Injury/Varices
Gastrotomy or Pyloromyotomy
Local Excision/Total/Partial Gastrectomy, Vagotomy or Laparoscopic Gastric Bypass Procedure
Laparoscopic Removal/Replacement of Gastric Restrive Device or Laparoscopic Sleeve Gastrectomy
Open Gastric Restrictive Procedure, or Formation/Revision of Gastric Anastamosis/Gastrostomy
Laparoscopic, Endoscopic or Open Gastric Procedure
Enterolysis/Enterotomy/Colotomy/Reduction of Volvulus
Enterectomy/Colectomy, Laparoscopic Enterolysis/Enterostomy/Colostomy
Laparoscopic Enterectomy/Colectomy/Closure Enterostomy/Colostomy
Open Formation/Revision of Enterostomy/Colostomy
Enterorrhaphy/Colorrhaphy/Inestinal Stricturoplasty/Closure of Enterostomy or Enteric Fistula
Pelvic Exclusion of Small Intestine or Intraoperative Colonic Lavage, Other Unlisted Intestinal Procedure
Excision/Repair of Meckel's Diverticulum or Mesenteric Lesion
Appendectomy or Other Appendiceal Procedure
I&D of Rectal Abscess
Open Repair/Excision of Rectum (Partial/Total), Destruction of Rectal Tumor
Laparoscopic Proctectomy
Laparoscopic Proctopexy, or Unlisted Laparoscopic Procedure of Rectum
Open Proctoplasty/Proctopexy, Exploration/Repair of Rectal Injury/Rectocele
Closure of Rectovesical/Rectourethral Fistula, Open
Unlisted Procedure, Rectum
I&D of Ischiorectal Abscess +/- Fistulotomy
Plastic Operation/Repair of Defect in Anus/Sphincter Mechanism
Curretage/Cautery of Anal Fissure, Hemorrhoidopexy, or other unlisted anal procedure
Open Drainage of Hepatic Abscess or Cyst
Partial/Total Hepatectomy
Other Surgical Procedure of Live
Choledotomy/Cholecysotomy/Cholecystomy/Sphincterotomy +/- Removal of Calculus
0.42
0
0.98
0.27
0.64
0
1.56
0.60
0.58
1.11
1.43
1.56
1.53
1.34
1.52
1.82
1.79
1.82
0.96
0.80
1.53
1.57
0.61
0.99
0
1.53
0.62
1.00
0.29
1.22
0.98
0.85
0.70
Urinary
475
476
477
478
479
480
481
485
489
490
492
493
494
495
496
499
500
501
502
503
504
505
506
507
508
509
510
515
518
519
522
523
524
Laparoscopic Procedure of Biliary Tract
Open Cholecystectomy +/- Biliary Duct Exploration
Excision Bile Duct Tumor/Choledocal Cyst, Cholecysto/Cheldocoenerostomy, Exploration Biliary Atresia
Reconstruction of Extrahepatic Biliary Ducts, U-Tube Hepaticoenterostomy
Suture of Extrahepatic Biliary Duct, Unlisted Procedure of Biliary Tract
Placement of peripancreatic Drains, Removal of Pancreatic Calculus
Open Total/Partial Pancreatectomy or Excision of Pancreatic Mass
Surgical Treatment of Pancreatic Cyst/Pseudocyst/Stricture
Unlisted Procedure of Pancreas
Exploratory Laparotomy +/- Drainage of Intra/Extraperitoneal Abscess
Open Excision or Destruction of Abdominal Tumor/Cyst, or Staging Laparotomy
Laparoscopic Procedure of Abdomen, Peritoneum and Omentum
Insertion/Revision of Peritoneal Venous Shunt/Catheter
Hernia Repair +/- Mesh, Open
Omphalocele/Gastroschesis Repair, or Laparoscopic Hernia Repair +/- Mesh
Repair of Abdominal Dehischence, Omental Flap Procedure
Nephrolithotomy or I&D of Renal/Perirenal Abscess
Repair of Aberrant Renal Vessels, or Pyelotomy
Partial/Total Nephrectomy, Excision/Ablation of Renal Mass/Cyst
Instillation/Removal of Nephrostomy Tube
Pyeloplasty
Repair of Renal Fistula, or any Laparoscopic Procedure of the Kidney
Ureterolithotomy/Ureterectomy
Ureteroplasty/Ureterolysis/Ureteroneocystostomy/Ureteropyelostomy/Ureterocalycostomy, or Revision of Urostomy
Ureteroenterostomy, Creation of Ileal Conduit or other Urinary Diversion
Ureterorrhaphy, Closure of Ureteric Fistula, or Laparoscopic Procedure of Ureter
Cystotomy or Drainage of Perivescical Space Abscess
Excision of Bladder Tumor, or Partial/Total Cystectomy, or Pelvic Exenteration
Cystoplasty, Vesicourethropexy, Cystorrhapy
Surgical Repair of Bladder Fistula, or Laparoscopic repair of stress incontinence
Cystourethroscopy, with Fulgeration
Cystourethroscopy, with treatment of Ureteric Defect
Cystourethroscopy with urethral valve repair, or Transurethral Incision of Prostate
0.33
1.07
1.35
1.28
0
1
1.56
1.41
0.91
1.32
1.02
0.88
0.90
1.59
0.59
1.42
0
1
0.41
1
1
0.22
1
1.33
1.72
1
1.18
0.75
0.83
0.28
0
0
0
Male Genital
Female Genital
525
526
527
530
532
534
535
536
538
540
541
543
544
545
546
548
549
550
551
552
555
556
557
558
559
564
566
567
568
570
571
572
573
Transurethral Resection of Bladder Neck
Transurethral Resection or Laser Treatment of Prostate
Transurethral Drainage of Prostatic Abscess
Urethrotomy or Drainage of Periurethral/Perinel Collection
Urethrectomy or Excision/Fulguration of Urethral Lesion
Urethroplasty, Insertion/Removal of Urethral/Bladder Neck Sphincter
Urethrolysis, Urethrorrhaphy, Urethrostomy
Dilation of Female Urethra
Transurethral Destruction of Prostate Tissue or Other, Unlisted Urinary Procedure
I&D, Penis
Excision Penile Plaque/Foreign Body, Partial/Total Penile Amputation
Plastic Operation, Penis
Penile Shunt/Fistulization or Repair of injury
Orchioectomy, Exploration for Undescended Testicles
Laparoscopic Orchiectomy/Orchipexy, Insertion Testicular Prosthesis, Repair Torsioned Testes
Excision Spermatocele +/- Epidymectomy
Epididymovasostomy
Excision/Repair, Hydrocele
Scrotal Procedure
Vasotomy
Excision/Ligation for Varicocele, Open or Laparoscopic
Vesiculotomy, Vesiculectomy, Excision of Mullerian Duct Cyst
Prostatotomy
Prostatectomy or other Prostate Surgery using abdominal approach
Intersex Surgery
I&D Female Genital Abscess, Marsupialization of Bartholin's Gland Cyst
Total/Partial/Radical Vulvectomy
Excision of Bartholin's Grland Cyst
Plastic Repair of Introitus/Clitoris/Female Perineum
Colpotomy +/- Destruction of Vaginal Lesions
Vaginectomy or Excision of Vaginal Lesion
Plastic Repair of Femal Genitourinary Tract
Closure of Vaginal Fistula, Vaginoplasty for Intersex State
0
0
1
1
0
0.18
1
*
0
1
1.34
0
1
0.64
3.62
0.97
1
1.83
1.48
1
0
*
1
0.14
1
0.40
1.51
3.44
1
3.26
1.34
0.27
1.46
Maternity Care
and Delivery
Endocrine
Nervous
Auditory
574
575
577
581
582
583
584
585
587
588
589
591
593
602
605
606
613
614
615
616
617
618
620
621
630
631
632
633
637
647
648
649
695
Laparoscopic Colpopexy or Paravaginal Defect Repair
Conization of Cervix, Cervicectomy, Excision of Cervical Stump
Trachelorrhaphy
Myomectomy, Excision of Fibroid Tumors, TAH,
Radical TAH, or Vaginal Hysterectomy
Endometrial Cryoablation
Uterine Suspension
Laparoscopic Hysterectomy or other, unlisted uterine procedure
Salpingectomy, Salpingo-oophrectomy, Salpingostomy, or Tubo-tubal anastamosis
I&D Ovarian Cyst/Abscess, or Transposition of Ovaries
Radical BSO, Resection/Debulking of Ovarian Mass, oophrectomy, Staging Laparotomy
Surgical Treatment of Ectopic Pregnancy, Open/Laparoscopic
Hysterorrhaphy of Ruptured Uterus
Excision of Thyroid or Thyroglassal Duct Cyst
Parathyroidectomy +/- Transplantation, Thymectomy, Adrenalectomy
Excision of Carotid Body Tumor, or Laparoscopic Procedure of Endocrine System
CraniectomyCraniotomy for Evacuation of Hematoma or Exploration of Orbit
Craniectomy/Craniotomy Subtemporal/Subocciptal or for Lobotomy
Other Craniectomy/Craniotomy
Excision of Intracranial Neoplasm, Transection/Ligation of Carotid Artery, Repair of AVM/Aneurysm
Repair of Intracranial Aneurysm
Surgery for Intracranial Neurostimulator
Elevation of Depressed Skull Fracture
Craniotomy for Repair of CSF Leak/Emphalocele, Reduction of Craniomegalic Skull
Laminectomy, Discectomy, Vertebral Corpectomy
Vertebral Corpectomy, Laminectomy with Cordotomy
Laminectomy for Spinal Neoplasm/AVM
Vertebral Corpectomy for Intraspinal Lesion
Repair of Meningocele or Dural/CSF Leak +/- Laminectomy, Dural Spinal Graft
Neuroplasty, Nerve Decompression, Internal Neurolysis
Surgical Repair of Peripheral/Sympathetic Nerve Structure
Nerve Graft/Pedicle Transfer
Radical Mastoidectomy +/- Petrous Apicectomy
0
0
1
0.81
0.50
1
1
0.52
0.84
1
0.81
0.54
1
0.13
0.30
0.65
0.68
0
0.37
0.35
0.53
0
1
0
0.65
1.78
0.42
0
0
1.54
0
1
1
696
698
Revision of Mastoidectomy, Tympanoplasty
Labrynthotomy
The unique combinations for the first 3 numbers of CPT codes for without any surgeries in the study cohort are indicated with an
asterisk; categories with no observed SSIs but with an expected number of SSIs (based on the initial model) exceeding 0.5 are
indicated with a CPT3 Score of “0”; categories with no observed SSIs but with an expected number of SSIs (based on the initial
model) lower than 0.5 are indicated with a CPT3 Score of “1”.
1.03
1