CPT Worksheet - Inspira Health Network
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Mammo Mammo Procedure Description PUNCTURE ASP CUST BREAST PUNCTURE ASP CUST BREAST ADD CPT 19000 19001 19000 19001 GALACTOGRAM INJ. PROC 19030 19030 BX BREAST, OPEN, INCISIONAL 19101 19101 BX, BREAST NEEDLE CORE,PERC W/IMG 19102 19102 BX, BREAST, AUTO VACUUM, PERC. 19103 19103 BX, BREAST, INCISIONAL, VAC 19103 NEEDLE LOCAL BREAST PRE-OP 19103 19290 19290 NEEDLE LOC EACH ADD LESION 19291 19291 CLIP, PLACEMENT, BREAST BX 19295 19295 COMP - AID DETECT DIAG 77051 COMP - AID DETECT MAMMO, SCREEN 77052 GALACTOGRAM 77053 77051 77052 77053 GALACTOGRAM, MILTI DUCTS 77054 77054 MAMMOGRAPHY, DIAG UNILAT 77055 77055 MAMMOGRAPHY BILATERAL DIAG 77056 77056 MAMMOGRAPHY SCREEN ING 77057 77057 STEREOTACTIC BREAST LOC 77031 77031 STEREOTACTIC LOC BREAST BX 77031* 77031 NEEDLE LOCAL BREAST LESION 77032 77032 SURGICAL SPECIMEN, X-RAY 76098 76098 SURGICAL SPECIMRN, BREAST,X-RAY 76098* 76098 TISSUE MARKER, IMPLANTABLE C1879 C1879 SUPPLY/MATERIALS-BREAST BX CONSULTATION FOR MAMMO A4550 76140 DIGITAL MAMMO, Dx BILAT DIGITAL MAMMO, Dx UNIILAT DIGITAL MAMMO, SCREENING SOUTH JERSEY HEALTHCARE 76140 G0204 G0206 G0202 Nuc Med Nuc Med Procedure Description SENTINAL NODE INJECTION ID SPINAL PUNCTURE, LUMBAR, DX THYROID UPTAKE SINGLE DET THYROID UPTAKE, MULTI DET THYROID UPTAKE STIM/SUPP THYROID IMAGE W/UPTAKE SNG THYROID UPTAKE, MULTI DET. THYROID UPTAKE W/ MULT DET. THYROID IMAGE ONLY THYROID IMAGE W/VASC FLOW THYROID CA METS IMAGE LTD THYROID METS W/ADD STDYS THYROID METS W/ADD STDYS THYROID WHOLE BODY I-131 THYROID WHOLE BODY I-131 THYROID UPTAKE PRIME CODE PARATHYROID SCAN PARATHYROID SCAN ADRENAL IMG CORTEX/MEDULLA BONE MARROW IMAGE, LTD BNE MARROW IMAGE, MULTI BONE MARROW IMAGE WHOLE PLASMA VOLUME SINGLE SAMPL PLASMA VOLUME SINGLE SAMPL PLASMA VOLUME MULTI SAMPLE RED CELL VOLUME SINGLE SAM RED CELL VOLUME MULTI SAMP BLOOD VOLUME RC (RED CELL) BLOOD VOLUME RC (RED CELL) RED CELL SURVIVAL STUDY RED CELL SURVIVAL KINETICS RED CELL SEQUESTRATION SPLEEN IMAGING ONLY LYMPH GLAND IMAGING LYMPH GLAND IMGING LIVER IMAGING STATIC ONLY LIVER IMAGE W/ VASCULAR FL LIVER IMAGING SPECT LIVER IMAGE SPECT VASC FLO LIVER AND SPLEEN SCAN LIVER SPLEEN FLOW SCAN HIDA (CCK) W/WO QUANT / EJF LIVER FUNCT W / IMG (IDA) SALIVARY GLAND IMAGING ESOPHAGEAL MOTILITY GASTRIC MUCOSAL IMAGING GASTROESOPHAGEAL REFLUX GASTROESOPHAGEAL REFLUX GASTRIC EMPTYING SOUTH JERSEY HEALTHCARE CPT 38792 62270 78000 78001 78003 78006 78007 78007 78010 78011 78015 78016 78016 78018 78018 78020 78070 78070 78075 78102 78103 78104 78110 78110 78111 78120 78121 78122 78122 78130 78135 78140 78185 78195 78195 78201 78202 78205 78206 78215 78216 78223 78220 78230 78258 78261 78262 78262 78264 Procedure Description CPT RADIOCOBALT B12 SCHILLINGS SCHILLINGS B12 GASTROINTESTINAL BLOOD LOS BOWEL IMAGING MECKEL SCAN SHUNT PATENCY BONE IMAGE LIMITED BONE IMAGE MULTIPLE AREAS BONE SCAN WHOLE BODY BONE SCAN THREE PHASE BONE SCAN SPECT CARDIAC SHUNT STUDY NON CARDIAC VASC FLOW IMAG VENOUS THROMBO IMAGE, UNILAT VENOUS THROMBO IMAGE BILAT MYOCARD IMAGE SINGLE PLANAR PLANAR MYOCARD SINGLE IMAGE MYOCARD IMG, MULT, PLANAR MYOCARD, SINGLE, SPECT MYOCARD PERF (SPECT) W/PERSANT MYOCARD PERF (SPECT) MULTI STDY MYOCARDIAL INFARCT PYP MYOCARD IMG, INFAR, PLR W/EJECT MYOCARD IM SPCTW-W/O QUAN MYOCARD INFARCT SPECT MUGA (CARDIO BLOOD POOL) MUGA, MULTIPLE STUDIES MYOCARD PERF, W/WAL MOT, Q/Q MYOCARD IMG W/EJECT FR, ADD CARDIAC BLOOD POOL 1ST PAS CARDIAC BLOOD POOL 1 PASS CARDIAC GATED SPECT REST CARDIAC GATED REST 1ST PAS CARDIAC GATED RT VENT REST UNLISTED CV PROC, DX LUNG SCAN PERFUSION PULMONARY PERF/VENT REBR LUNG SCAN VENT. DTPA PULM PERFUS W/VENT AEROSOL LUNG VENT IMG, W/REBREATH LUNG SCAN VENTILATE XENON LUNG SCAN QUANTITATIVE UNLISTED RESP PROCEDURE, DIAG BRAIN IMAGE STATIC LIMITED BRAIN IMAGE W/VASC FLOW LTD BRAIN IMG, COMP, STATIC BRAIN SCAN VASCULAR FLOW BRAIN IMAGING SPECT BRAIN IMAGE VASC FLOW ONLY CEREBRAL BLOOD FLOW 78271 78272 78278 78290 78291 78300 78305 78306 78315 78320 78428 78445 78457 78458 78460 78460 78461 78464 78465 78465 78466 78468 78469 78469 78472 78473 78478 78480 78481 78483 78494 78496 78496 78499 78580 78585 78587 78588 78593 78594 78596 78599 78600 78601 78605 78606 78607 78610 78615 Page 3 Nuc Med B 12 ABSORPTION W/O FACTOR Procedure Description CSF STUDY SHUNT EVALUATION CSF FLOW STUDY SPECT CNS LEAK STUDY KIDNEY IMAGE, MORPHOLOGY KIDNEY IMG W/VASC FLOW KIDNEY IMG, VASC F/F W/O PHARM KIDNEY IMG, VASC F/F W/ PHARM 1 KIDNEY IMG VAS F/F W/WO PHARM KIDNEY IMAGE SPECT KIDNEY FUNCTION ONLY URINARY BLADDER RESIDUAL URINARY REFLUX STUDY TESTICULAR IMAGE, W/ VAS FLOW TUMOR LOCALIZATION LIMITED TUMOR LOC MULTI AREAS TUMOR LOCALIZE WHOLE BODY, 1 DAY TUMOR LOCAL SPECT TUMOR LOC.WH BOD=> 2 DAYS ABSCESS LOCALIZATION LIMIT ABSCESS LOCAL WHOLE BODY ABSCESS LOCAL SPECT ADDED CURVE STUDY RADIOPHARM Rx, ORAL ADM RADIOPHARM Rx, IV INTRACAVITARY RADIO COLLOID THPY INTERSTITIAL COLLOID THPY RADIOPHARM, THPY, MONOC ANTI, IV RADIOPHARM Rx, INT ART PARTIC UNLISTED Dx CV PROC 78270 CPT CSF FLOW IMAGE, CISTERNOG SOUTH JERSEY HEALTHCARE 78645 78647 78650 78700 78701 78707 78708 78709 78710 78725 78730 78740 78761 78800 78801 78802 78803 78804 78805 78806 78807 78890 79005 79101 79200 79300 79403 79445 78499 GEN AUTO DATA SIMPLE <=30 MIN 78890 GEN AUTO DATA COMPLX >30 MIN 78891 UNLISTED NERVOUS SYS PROC 78699 Page 4 78630 Specials Specials SOUTH JERSEY HEALTHCARE Procedure Description FINE NEEDLE ASPIRAT IMAG GUID BONE BIOPSY STERNUM, OTHER BIOPSY BONE, DEEP (FEMUR) CPT Procedure Description CPT 10022 10022 INTRO NEEDLE EXTREMITY ART 20220 20220 INTRO NEEDLE AV SHUNT DIAL 36145 36145 20225 INTRO NEEDLE AORTA TRANSLUM 36160 36160 36200 20225 36140 36120 SINUS TRACT INJ, THPY 20500 20500 INTRODUCE CATHETER AORTA 36200 INJ TENDON/LIGAMENT/GANGLION CYST 20550 20550 SEL CATH ART 1ST THOR BRACH 36215 36215 20600 SEL CATH ART 2ND THOR BRACH 36216 36216 ARTHROCENTESIS SMALL JNT 20600 20605 SEL CATH ART 3RD THOR BRACH 36217 36217 20610 20610 SEL CATH ART ADD THOR BRACH 36218 36218 VETEBROPLASTY,THORACIC, 1 BDY, PERC 22520 22520 SEL ART 1ST ORD ABD, PELV 36245 36245 VETEBROPLASTY,LUMBAR, 1 BDY, PERC 22521 22521 SEL ARTERY 2ND ORD ABD, PEL 36246 36246 VETEBROPLASTY, EA ADD, PERC. 22522 ARTHROCENTESIS MEDIUM JNT ARTHROCENTESIS LARGE JNT KYPHOPLASTY, THORACIC, EA VERT KYPHOPLASTY, LUMBAR, EA VERT KYPHOPLASTY, EA ADD VERT 20605 22522 SEL ART 3RD ORD ABD, PEL 36247 36247 22523 22523 SEL ART >3 ORD ABD, PEL 36248 36248 22524 +22525 22524 INSERT INTER INFUSION PUMP 36262 36262 36260 36260 22525 REMOVE INTER INFUSE PUMP ARTHROGRAM SHOULDER INJECT 23350 23350 UNLISTED VASCULAR INJECT 36299 36299 ARTHROGRAM ELBOW INJECT 24220 24220 VENIPUNCTURE <3 FEM JUGUL 36400 36400 ARTHROGRAM WRIST INJECT 25246 25246 VENIPUNCTURE <3 YR SCALP 36405 36405 ARTHROGRAM HIP INJECT 27093 27093 VENIPUNCTURE <3 OTHER VEIN 36406 36406 27096 VENIPUNCTURE >3 YR DIAG TH 36410 36410 SI JNT INJ PROC, ARTHROGRAM 27096 27096 VENIPUNCTURE CUTDOWN < 1YR 36420 36420 ARTHROGRAM KNEE INJECT 27370 27370 VENIPUNCTURE CUTDOWN > 1YR 36425 36425 ARTHROGRAM ANKLE INJECT 27648 27648 PORTAL VEIN CATH, PERC. 36481 36481 32550 VENOUS CATH FOR BLOOD SAMPL36500 32551 INSERT NON-TUNNELED CV CATH 32400 INSERT TUNNELED CV CATH 32405 INSERT TUNNELED CV ACC DEVICE 36561 36561 36563 36563 SI JNT INJ PROC, THERAPY INSRT TUNLD CATH, PLEURAL W CUFF THOROCOSTOMY W/H2O SEAL BIOPSY PLEURA PERCUTANEOUS BX, LUNG/MEDIASTINUM, PERC 27096 32550 32551 32400 32405 36500 36556 36558 36556 36558 EXT CANNULA DECLOT/BALLOON 36861 36861 INSERT TUNLD CV ACC DEV W/PUMP AAA, ENDOVAS RPR, W / MOD BILAT 34802 34802 INSRT TUNLD CV DEVICE W/2 CATHS WO port 36565 36565 36566 ABD, ENDOVAS RPR W / DEVICE 34804 34804 INSRT TUNLD CV DEVICE W/2 CATHS W/PORT 36565 ENDOVAS GRAFY REPAIR, ILIAC ART 34900 34900 INSRT TUNLD CV-DEV W/2 CATHS W/PORT 36566 36566 36569 36569 ANGIOPLASTY PERC TIBIO PER 35470 35470 INSERT PICC LINE WO P/P =>5yrs ANGIOPLASTY PERC RENAL VISC 35471 35471 INSERT PICC ACC DEVICE W/PORT 35472 REPAIR TUNLD / NON-TUN CV CATH 36575 36575 35473 REPAIR CV ACC DEV W PORT/PUMP 36576 36576 36578 ANGIOPLASTY, AORTIC, PERC. 35472 ANGIOPLASTY PERC ILIAC 35473 ANGIOPLASTY, PERC, FEM-POP 35474 ANGIOPLASTY, UPPER EXT ART PERC 35475 35474 REPLC CATH,CV ACC DEV W/PORT/PUMP 35475 REPLAC PICC WO PORT / PUMP COMP 36571 36584 36571 36578 36584 ANGIOPLASTY, PERC, VENOUS 35476 35476 REPLAC PICC ACC DEVICE W / PORT 36585 36585 INTRO NEEDLE OR CATH VEIN 36000 36000 REM TUNLD CV CATH W/O PORT/PUMP 36589 36589 36002 REMOV OBST MATRL CV DEV,SEPARATE 36595 36595 36005 REMOV OBST MATRL CV DEV,DEV LUMEN 36596 36596 36010 REPOSITION CV DEV, FLUORO 36597 36597 INJ PROC FOR TREAT PSEUDOANU INJ PROC VENOGRAM, EXTREM INTRO CATHETER SVC OR IVC 36002 36005 36010 CATH SELECT VENOUS 1ST ORD 36011 36011 CV CATH CHECK W/FLUORO S&I CATH SELECT VENOUS 2ND ORD 36012 36012 ART CATH PROLONG INFUS THER36640 36640 36598 36598 INTRO CATH, RT HEART OR PULM 36013 36013 EXT CANNULA DECLOT W/O BAL 36860 36860 CATH SELECT PULMONARY ART 36014 36014 THROMBECTOMY PERC A/V FIST 36870 36870 36015 VENOUS ANASTOMOSIS, PORTOCAVAL 37140 CATH PLACE SEG PULM ART 36015 INTRO CATH CAROTID VERTEB 36100 36100 FISTULA, SINUS TRACT, INJ Dx INTRO CATH RETROBRACH ART 36120 36120 TIPS, INITIAL PLACE W/STENT Page 5 37140 20501 37182 20501 37182 Specials SJH Procedure Description TIPS, REVISION W/STENT CPT 37183 SJH Procedure Description CPT 37183 ASPIR/INJ RENAL CYST RT/LR THROMB, ART/BYPAS, INT, PRIM W/FLUORO 37184 37184 ASPIRATION RENAL CYST THROMB, ART/BYPAS,2ND ORD, PRIM W/FLUOR 37184 37185 INTRO CATH RENAL DRAIN 50392 50392 THROMB, SECON, ART/BYPAS W/FLUOR 37186 INTRO CATH STENT URETER DR 50393 50393 37187 INJ PROC NEPHROSTOGRAM 37188 NEPHROSTOMY DILATE PERCUT 50395 37186 THROMBECTOMY, VEIN (s) 37187 THROMB, VEIN (s) SUBSEQ DAY 37188 TRANSCATHETER BX 37200 TRANSCATH INFUSION THROMBO 37201 50390-50 50390 50394 50390-50 50390 50394 50395 37200 NEPHROM TUBE CHANGE 50398 37201 ENDO,RENAL,EXIST NEPHROSTOMY TBE 50551 50551 TRANSCATH THPY (SPASMOLYTIC) 37202 37202 INJ PROCEDURE URETEROGRAPHY50684 50684 TRANSCATH RETREIVAL OF FB 37203 37203 URETEROSTOMY TUBE CHANGE 50688 50688 37204 INJ PROC, LOOPAGRAM STENT(S) PLACE INIT VESSEL 37205 37205 SUPRAPUBIC CATH W/BLDR ASP TRANSCATH PLACE STENT ADD 37206 37206 INJ PROC URETHRO CYSTO VOID51600 37209 INJECT PROC RETROGR CYSTO 51610 37210 CATH,BLADDER,NON-INDWEIIING 51701 51701 37215 37215 CATH,BLADDER, INDWEIIING, TEMP 51702 51702 STENT PLACE, CAROTID ART W/O EMB PROT 37216 37216 UNLISTED PROC, URINARY INTERUPT IVC, ANY METHOD 37620 37620 PROSTATE BIOPSY UNLISTED PROC, VASC SURGERY 37799 37799 THYROID CYST ASPIR/INJ SPLENOPORTOGRAPHY INJECTION 38200 38200 PUNCTUR SHUNT TBE/RESEVOR for INJ 42550 BALOON OCCLUS, HEAD/NECK, TEMP 61623 43260 ENDOVAS ART COOLUSION, H / N, TEMP 61623 GASTROSCOPY TUBE PLACE PERC43750 43750 TRANSCATH EMBOL PERC CNS 61624 GASTROSTOMY TUBE CHANGE 43760 EMBOL, TUMOR DESTRUCT, CNS H/N perc 43761 SPINAL PUNCTURE LUMBAR DX 43999 INJECTION PROC MYELOGRAPHY 62284 62284 44015 INJ PROC DISCOGRAPHY LUMBAR62290 62290 44799 INJ PROC DISCOGRAPHY CERVIC62291 47000 EPIDURAL, INJ, C/T SPINE, SINGLE 62310 62310 BILIARY STENT INTRODUCTION 47011 47011 EPIDURAL, INJ, L-SPINE, SINGLE 62311 62311 CHOLECYSTOTOMY PERUCTAN 47490 C/T SPINE PRVRT/FACT JNT INJ UNI 64470 64470 47500 C/T SPINE PRVRT/FACT JNT INJ UNI ea add 64472 64472 TRANSCATH EMBOL PERC NON-CNS 37204 EXCH PREV ART CATH-THROMBTH 37209 UFE/UAE COMPLETE PROC RS&I 37210 STENT PLACE, CAROTID ART W EMB PROT SIALOGRAPHY, INJ PROC 42550 ERCP W/WO SPECIMEN, BRUSH 43260 43760 REPOSITION GI FEEDING TUBE 43761 UNLISTED STOMACH PROC. 43999 JEJUNOSTOMY TUBE INSERTION 44015 UNLISTED PROC, INTESTINE 44799 LIVER BIOPSY 47000 47490 PTC INJECTION 47500 50690 50690 51102 51102 51600 51610 53899 55700 53899 55700 60300 61070 60300 61070 61623 61623 61624 61626 62270 61626 62270 62291 CHOLANGIO INJ W/EXIST CATH 47505 47505 L SPINE PARVRT/FACT JNT INJ UNI 64475 64475 PT CATH INTRO, - BILIARY DRAIN 47510 47510 L SPINE PARVRT/FACT JNT INJ UNI ea add 64476 64476 PT STENT INTRO, INT/EXT DRAIN 47511 INJ ANES/STERIOD, CERV ,THORACIC, SINGLE 64479 64479 47525 INJ ANES/ STER, CERV/THOR EA ADD 64480 64480 47530 INJ ANES/STERIOD, LUMB, SINGLE 64483 BILIARY ENDO T-TBE W/DILA W/O STENT 47555 47555 INJ PROC DACRYCYSTOGRAPHY BILIARY ENDO TTB W/DIL ST 47556 47556 DACRYOCYSTO, NASOLACRIMAL 70170 47630 SIALOGRAPHY COMPLETE 70390 PANCREAS BIOPSY 48102 48102 PACEMAKER INSERT ABSCESS DRAIN SUBDIAPHRAGM 49041 49041 EPIDUROGRAPHY ABSCESS DRAIN RETROPERITON 49061 49061 VERT/KYOPLASTY,PERC,PER. VERT BIOPSY ABD OR RETOPERITON 49180 49180 ARTHROGRAM SHOULDER 73040 INJECT AIR CONT PERITONEAL 49400 49400 ARTHROGRAM ELBOW 73085 73085 INS INTRAPER DIAL CATH TEMP49420 49420 ARTHROGRAM WRIST 73115 73115 49421 ARTHROGRAM HIP 73525 73525 49424 ARTHROGRAM KNEE 73580 73580 73615 73615 BILIARY DR CATH CHANGE, PERC 47511 47525 REVISE/REINSERT TRANSHEP TB47530 BILIARY STONE EXTRACTION 47630 INS INTRAPER DIAL CATH PERM49421 ASSESS CYST/ABSCESS, INJ PROC 49424 PERITONEAL-VENOUS SHUNT, INSERT 49425 49425 ARTHROGRAM ANKLE INJ PROC EVAL PER VNT SHUNT 49427 49427 PERITONEOGRAM Page 6 68850 64483 68850 70170 70390 71090 72275 71090 72275 72291 74190 72291 73040 74190 Specials DRAIN PERI/RENAL ABSCESS 50021 SJH Procedure Description RENAL BIOPSY 74305 PERC. TRANS. CHOLANG BILE STONE REMOVAL POST OP ERCP BILIARY 50200 74235 CPT ANGIO PULMONARY NON SEL 75746 74305 ANGIO, INTERNAL MAMMARY 74320 ANGIO,SEL,EA ADD VESSEL 74327 74327 ANGIO, AV SHUNT ( DIALYSIS) 74328 SPLENOPORTOGRAPHY 74329 VENOGRAM EXTREMITY UNILAT 75820 74329 74235 SJH Procedure Description 74320 74328 ERCP PANCREATIC REM FB ESOPHAGUS W/ BALLOON CPT 50200 POST OP CHOLANG/PAN 50021 75746 75756 75756 75774 75774 75790 75790 75810 75810 75820 ERCP BILIARY & PANCREATIC 74330 74330 VENOGRAM EXTREMITY BILAT 75822 75822 GASTROSTOMY TBE PLACE, PERC 74350 74350 INFERIOR VENOCAVAGRAM 75825 75825 DILATE GI STRICT/OBSTRUCT 74360 DILATE BILE DUCT W/WO STENT 74363 NEPHROSTOGRAM / LOOPOGRAM 74425 CYSTOGRAM =>3 VIEWS 74430 RENAL CYST STDY, TRANSLUMBAR 74470 NEPHROSTOMY,PERC. 74475 INTRODUCE CATH/STENT, URETER 74480 CATH RENAL PELVIS DR/INJ RT/LT 50392-50 DILATION NEPHROST,URETER/URETHRA CATH/STENT URETER DR RT/LT AORTAGRAM THORACIC W/O SER 74485 50393-50 75600 AORTA THORACIC 75605 AORTA ABDOMEN CATH 75625 C/T SPN FACT JNT INJ RT/LT 64470-50 AORTA ABD AND BOTH LEGS 75630 AORTIC ARCH/ CERVICOCEREB AORTIC ARCH/CERVICOCERB 75650 SUPERIOR VENOCAVAGRAM 75827 75827 RENAL VENOGRAM UNILATERAL 75831 75831 74425 RENAL VENOGRAM BILAT 75833 75833 74430 ADRENAL VENOGRAM UNILAT 75840 75840 74470 ADRENAL VENOGRAM BILATERAL 75733 75842 74475 TRANSHEP PORTOG W/HEMO EVAL,PERC 75885 75885 74480 TRANSHEP PORTOG W/O HEMO EVAL,PERC 75887 75887 50392-50 HEPATIC VENOG. W/HEMO EVAL 74485 VENOGRAPHY, HEPATIC W/O HEMO 75894 TRANSCATH THERAPY INFUSION 75896 75896 75625 POST THERAPY ANGIO 75898 75630 PERICATH OBST MATERIAL REMAVAL 75901 75901 INTRALUM OBST MATERIAL REMOVAL 75902 75902 75660 INFRARENAL / ILIAC ART RPR CAROTID EXTERNAL 2S SELECT 75662 75662 ILIAC ANEURYSM, ENDOVAS REPAIR 75665 ILIAC ART ENDOVAS RPR 75671 TRANSCATHETER RETREIVAL 75961 CAROTID CERVICAL SELECT 1 75676 75676 ANGIOPLASTY PERIPH ART EPIDURAL L-SPN UNI ANGIO VETEB,CERV,/INTRACRAN 75680 64484 75685*** 75940 75952 75953 75954 75954 64472-50 TRANSCATHET INTRO OF STENT 75960 CAROTID SELECTIVE BILAT 75671 CAROTID, CERVICAL BILAT 75900 75650 CAROTID EXTERNAL 1S SELECT 75660 50551-50 75898 64470-50 EXCHANGE ART CATH THROMBEC 75900 PERCUTANEOUS IVC FILTER ENDO,RENAL,EXIST NEPHRO TBE RT/LT 75893 75605 AAA, RPR ABD AORTA 64472-50 75891 TRANSCATH EMBOLIZE, ANGIO 75894 75650 75665 75889 75891 75600 75658 C/T SPN FACT JNT INJ EA ADD RT/LT 75889 50393*50 VENOUS SAMPLING THRU CATH 75893 BRACHIAL RETROGRADE 75658 ANGIO CAROTID CERV, CEREB UNILAT 75650 74360 74363 50551-50 ANGIOPLASTY PERIPH ART ADD 75940 75952 75953 75954 75954 75960 75961 75962 75962 75964 75964 75680 ANGIOPLASTY VISCERT ART 75966 75966 64484 ANGIOPLASTY VISC ART ADDED 75968 75968 75978 75685 ANGIOPLASTY VENOUS 75705 TRANSHEPATIC BILIARY DRAIN INSERTION BILIARY DRAIN 75982 75982 75710 PTC CATHETER CHANGE 75984 75984 ANGIOGRAM EXTREMITY BILAT 75716 75716 ABSCESS DRAIN FLUORO GUIDE RENAL AORTIC FLUSH UNILAT 75722 75722 ARTERECTOMY,PERPH ART 75992 RENAL AORTIC FLUSH BILAT 75724 75724 ARTERECTOMY,PERPH ART EA ADD 75993 75726 FLUORO <= 1 HOUR SPINAL, SELECT EACH VESSEL 75705 EPIDURAL L-SPN BILAT RT/LT 64484-50 ANGIOGRAM EXTREMITY UNILAT 75710 VISCERAL ANGIO SELECTSUPER HEPATIC VENOGRAM W/HEMO EVAL 75726 75889-52 75731 FISTULA, SINUS TRACT STDY ADRENAL SELECTIVE BILAT 75733 75733 TENCKHOFFOGRAM ANGIO PELVIC,SELECT/ SUPRASELECT PULMONARY ANGIO UNILAT 75741 64479-50 75736 75989 64479-50 SPECIAL PROC. CONSULT 75736 SUBTRACTION PROCESS 75741 FLUORO, UNLISTED PROCEDURE Page 7 75980 75989 75992 75993 76000 75889-52 FLUORO > 1 HOUR ADRENAL SELECTIVE UNILAT 75731 INJ ANES/STEROD C/T SPN RT/LT 75978 75980 76001 76080 76080 76080 76080 76140 76140 76350 76496 76350 76496 Specials ANGIO PULMONARY BILAT SEL 75743 75743 SJH Procedure Description ANGIO, AV SHUNT ( DIALYSIS) SPLENOPORTOGRAPHY INJ PROC URETEROGRAPHY RT/LT CPT 75790 75790 75810 50684-50 SJH Procedure Description INJ PROC NEPHROSTOGRAM RT/LT 50684-50 CPT 50394-50 50394-50 75810 INJ ANES/STEROD C/T SPN EA ADD RT/LT 64480-50 64480-50 75820 INJ ANES/STEROD L-SPN RT/LT 64483-50 64483-50 VENOGRAM EXTREMITY BILAT 75822 75822 SEDATION, CONSCIOUS,=>5yr, <=30 MIN 99144 99144 INFERIOR VENOCAVAGRAM 75825 75825 SEDATION, CONSCIOUS,=>5yr, EA ADD 15 99145 99145 SUPERIOR VENOCAVAGRAM 75827 75827 AFV / PTA, ART, DIALYSIS G0392 G0392 RENAL VENOGRAM UNILATERAL 75831 75831 AVF / PTA, VENOUS, DIALYSIS G0393 G0393 VENOGRAM EXTREMITY UNILAT 75820 RENAL VENOGRAM BILAT 75833 75833 L-SPN FACT JT INJ RT/LT 64475-50 64475-50 ADRENAL VENOGRAM UNILAT 75840 75840 L-SPN FACT JT INJ RT/LT EA ADD 64476-50 64476-50 ADRENAL VENOGRAM BILATERAL 75733 75842 NEPHRO DILATE, PERC RT/LT TRANSHEP PORTOG W/HEMO EVAL,PERC 75885 75885 NEPHRO TBE CHANGE RT/LT TRANSHEP PORTOG W/O HEMO EVAL,PERC 75887 75887 CATH, TRANSLUM ANGIOPLASTY HEPATIC VENOG. W/HEMO EVAL 75889 75889 CATH, BALLOON DILITATION, NON-VAS VENOGRAPHY, HEPATIC W/O HEMO 75891 75891 CATH, DRAINAGE VENOUS SAMPLING THRU CATH 75893 75893 TRANSCATH EMBOLIZE, ANGIO 75894 75894 CATH,HEMODIAL/PER LONG-TERM CATH, CENTRAL / MIDLINE (PICC LINE) TRANSCATH THERAPY INFUSION 75896 75896 CATH, THROMBECTOMY/EMBOLECTOMY POST THERAPY ANGIO 75898 75898 CATH, URETERAL C1758 EXCHANGE ART CATH THROMBEC 75900 50395-50 50398-50 C1726 C1729 C1750 C1751 C1757 75900 GUIDE WIRE C1769 75901 75901 CATH RETRIEVAL DEVICE C1773 INTRALUM OBST MATERIAL REMOVAL 75902 75902 PORT, INDWELLING(IMPLANTABLE) C1788 75940 STENTCOATED/COV.W/DELIVERY SYS C1874 AAA, RPR ABD AORTA INFRARENAL / ILIAC ART RPR ILIAC ANEURYSM, ENDOVAS REPAIR ILIAC ART ENDOVAS RPR 75940 75952 75953 75954 75954 TRANSCATHETER RETREIVAL 75961 ANGIOPLASTY PERIPH ART 75962 75952 STENT,COATED/CPV,WO/DELIVERY SYS C1875 75953 STENT,NON-COAT/NON-COV,W/DELIV C1876 75954 75954 STENT,NON-CAOT/NON-COV,WO/DELIV FILTER, VENA CAVA 75961 CATH, GUIDING, W/INF/PERF CAP C1887 75962 SHEATH, INTRODUCER C1894 C1877 C1880 ANGIOPLASTY PERIPH ART ADD 75964 75964 STENT,NON-CORONARY,TEMP,WO/DELIV C2617 ANGIOPLASTY VISCERT ART 75966 75966 STENT,NON-CORONARY,TEMP,W/DELIV C2625 ANGIOPLASTY VISC ART ADDED 75968 75968 CATH, SUORAPUBIC/CYSTOSCOPIC ANGIOPLASTY VENOUS 75978 75978 CATH, OCCLUSION TRANSHEPATIC BILIARY DRAIN 75980 75980 LOCM =>400 MG/ML, per ML INSERTION BILIARY DRAIN 75982 75982 MRI CONTRAST (GAD) PER ML PTC CATHETER CHANGE 75984 75984 EMBO GOLD, PER 2ML 75989 PARAVERT FACT INJ L-SPN ABSCESS DRAIN FLUORO GUIDE 75989 50398-50 C1725 PERICATH OBST MATERIAL REMAVAL PERCUTANEOUS IVC FILTER 50395-50 C2627 C2628 A9579 64622 64622 64622-50 64622-50 ARTERECTOMY,PERPH ART 75992 75992 PARAVERT FACT INJ L-SPN RT/LT ARTERECTOMY,PERPH ART EA ADD 75993 75993 PATAFACT INJ L-SPN EA ADD 76000 PARAFACT INJ L-SPN EA ADD RT/LT 76001 REMOV INT URETERAL STENT RT/LT 50384-50 50384-50 76080 REMOV & REP IND URETER STENT RT/LT 50382-50 50382-50 FLUORO <= 1 HOUR FLUORO > 1 HOUR FISTULA, SINUS TRACT STDY 76080 64623 64623 64623-50 64623-50 TENCKHOFFOGRAM 76080 76080 REPLC EXT URET STENT RT/LT 50387-50 SPECIAL PROC. CONSULT 76140 76140 REMOV NEPHRO TUBE W/FLU RT/LT 50389-50 ` 76350 TRANSFORAM EPI INJ L-SPN 64484 64484 76496 TRANSFORAM EPI INJ L-SPN RT/LT SUBTRACTION PROCESS FLUORO, UNLISTED PROCEDURE INJ PROC URETEROGRAPHY RT/LT FLUORO GIIDE,CV ACC DEV PLC FLUORO GUIDE, NEEDLE PLACEMENT FLUORO GUIDE 4 EPIDURAL 76350 76496 50684-50 77001 77002 77003 50684-50 URETEROSTOMY TUBE CHANGE RT/LT 64484-50 64484-50 50688-50 50688-50 77001 DISCOGRAM L-SPN 72295 77002 LOCM 100-199 MG/ML, PER ML Q9965 77003 LOCM 200-299 MG/ML, PER ML Q9966 Page 8 50387-50 72295 Specials INSERT SWAN-GANZ CATH 93503 Procedure Description CLOSURE ADHESIVE, TISSUE 51100 BLADDER ASP, INTRACATH/TROCAR 51101 ARTERECTOMY, PERPH ART, EA ADD LOCM 300-399 MG/ML, PER ML CPT SOUTH JERSEY HEALTHCARE G0168 BLADDER ASP, NEEDLE BLADDER ASP, SUPRAPUB CATH INSRT 93503 51102 75993 GASTRO TBE PLC W/FLUORO COMPLETE 49440 D - J TBE PLC W/FLUORO,PERC COMPLET 51100 51101 51102 75993 49440 49441 49441 C - COLONIC TBE PLC W/FLUORO COMPLET 49442 49442 G - GJ TBE CONVERSION W/FLUORO COMP 49446 49446 G - C TBE REPLACE W/FLUORO COMP 49450 49450 D - J TBE REPLACE W/FLUORO COMP 49451 49451 GJ TBE REPLACE W/FLUORO COMP 49452 49452 REMOV OBST MAT, G,D,J,GJ TBE W/FLUORO 46460 49460 BLOOD PATCH, INJ PROC 62273 62273 G,D,J,GJ,C TBE CHECK W/IMG COMP 49465 49465 US GUIDE CATH/NEEDLE PLACE GASTRIC BAND ADJUST INJ or ASP 76942 76942 S2083 VASC CLOSURE DEVICE C1760 CATH, HEMODIAL, SHORT TERM C1752 CYSTOSTOMY TBE CHG COMPLEX 51710 51710 CYSTOSTOMY TBE CHG SIMPLE 51705 51705 Page 9 Q9967 Ultrasound US SOUTH JERSEY HEALTHCARE Procedure Description CPT FINE NEEDLE ASPIRATION / W IMG 10022 US DR HEMATOMA/SEROMA 10140 Procedure Description 10022 U/S BLADDER CAPACITY, NON-IMG CPT 76857 51798 10140 US, UNLISTED URINARY PROC 53899 53899 US PUNCT, ASPIR, ABSCES, CYST 10160 10160 US BX EPIDIDYMIS NEEDLE 54800 54800 TISSUE EXPANDER, NON-BREAST 11960 11960 US ABSC DR SKIN/SUBQ 10060 19000 US PROSTATE BIOPSY 55700 55700 19001 INJECTION PROC HYSTERO 58340 58340 PUNCTURE ASP CYST BREAST 19000 US EACH ADDITL CYST, BREAST 19001 BIOPSY BREAST, NEEDLE 19102 US NEEDLE LOC, pre OP, breast 19290 US NEEDLE LOC, BREAST, EA ADDITION 19291 TISSUE EXPANDER, BREAST 19357 US Bx MUSCLE / SOFT TISSUE 20206 US BX BONE, SUPERFIC(STERMUN) 20220 US, BX BONE DEEP (FEMUR) 20225 19102 US DRAIN OVARIAN CYST(S) 19290 DRAIN OVARIAN CYST ABD 58800 58805 10060 58800 58805 19291 US DRAIN OVARIAN ABS ABD 58822 58822 19357 DRAIN PELVIC ABSCESS PERC 58823 58823 20206 AMNIOCENTESIS 20220 ATU AMNIOCENTESIS, DIAG 20225 US THYROID CYST ASPIRATION 60300 59000 59000 59000 59000 60300 20550 BIOPSY THYROID CORE PERCUT 60100 60100 20610 20610 US,UNLISTED ENDOCRIN PROC. 60699 60699 US ABSCESS DR NECK / THORAX, SOFT 21501 21501 US ASPIR SPINALCORD CYST,PERC US BX SOFT TISSUE NECK/THORAX 21550 21550 US RENAL CYST STDY W/CONT 32421 US HIPS INFANT LTD STATIC 76886 75886 US ABSCESS DRAIN COLLECT 75989 75989 INJ TENDON/LIGAMENT/GANGLION CYST ARTHROCENTESIS, LARGE JOINT THORCENTESIS FOR ASPIRAT 20550 32421 62268 74470 62268 74470 THORACENTES W/WO H20 SEAL 32422 32422 THORACOSTOMY W/H20 SEAL 32551 32551 US 3-D W/O POSTPROCESSING 76376 76376 76377 76377 US BX PLEURA, PERC 32400 BX LUNG/MEDIASTINUM 32405 INJ PROC FOR TREAT PSEUDOANUR 36002 32400 US 3-D W POSTPROCESSING 32405 US NEONATAL BRAIN 76506 76506 36002 US OCULAR A SCAN UNILAT 76511 76511 76536 76536 US Bx, LYMPH NODE, perc, super 38505 38505 US HEAD / NECK SOFT TISSUE BIOPSY INT MAMMO LYMPH NODE 38530 38630 US THYROID GASTROSTOMY TUBE PLACE PERC 43750 43750 US CHEST W/MEDIASTINUM BIOPSY LIVER 47000 76536 76604 47000 US BREAST (s) US BX LIVER W/OTHER PERC 47001 47001 ATU ABD COMPLETE 76700 76700 DRAIN ABSCESS/CYST LIVER 47011 47011 US ABDOMEN COMPLETE 76700 76700 47490 76705 CHOLECYSTOTOMY PERCUTAN 76645 76536 76604 47490 ATU ABD LTD 76705 BILIARY ENDO TTUBE W,W/O SP 47552 47552 US ABDOMEN LIMITED 76705 BILIARY ENDO TTB STONE REM 47554 47554 ATU RETROPER COMP. BIOPSY PANCREAS US EXT DRAIN PSEUDOCYST PANC, perc DRAIN PERITONEAL ABSC PERC 48102 48511 49021 76770 76770 48102 US RETROPERITONEAL COMP (KUB) US AORTA 76775 76775 49021 US BLADDER 76775 76775 49041 49041 ATU RETROPER LTD. DRAIN RETROPERIT ABSC PERC 49061 49061 US RETROPERITONEAL LTD 76775 76776 PARACENTESIS ABDOMEN, INIT 49080 49080 US TRANSPLANT KIDNEY US PAPACENTESIS, ABD, SUBSEQ 49081 49081 US SPINAL CANAL + CONTENTS BX ABD/RETROPERITONEAL MASS 49180 49180 ATU OB < 14 WKS 1st GEST. US EXCHANGE ABSCESS DRAIN CATH 49423 49423 US OB <14 WKS, ABD, 1ST GEST. 50021 50021 ATU OB < 14 WKS ea add GEST. 50200 50200 US OB <14 WKS, ABD, EA ADDIT. 50390 ATU OB => 14 WKS 1st GEST BIOPSY RENAL PERCUTANEOUS ASP/INJ RENAL CYST PELVIS 50390 INTRO CATH RENAL PEL DRAIN 50392 50392 US OB => 14 WKS, 1ST PERC GUIDE NEPHROST W/DIL 50395 50395 ATU OB => 14 WKS ea add GEST NEPHROSTOMY TUBE CHANGE 50398 50398 US OB => 14 WKS, EA ADD 51010 ATU OB W/DETAIL FETAL ANATOMY SUPRAPUBIC CATH W/BLDR ASP 51010 76705 76770 48511 DRAIN SUBDIAPHRAGMTIC ABS DRAIN PERI/RENAL ABSCESS 76645 Page 10 76775 76770 76775 76775 76776 76800 76800 76801 76801 76801 76802 76802 76805 76805 76810 76810 76811 76801 76802 76802 76805 76805 76810 76810 76811 Ultrasound PERIVESICAL ABSCESS DRAIN 51080 SJH Procedure Description 51080 CPT SJH Procedure Description CPT US OB W/DETAIL FETAL ANATOMIC 76811 76811 US EXTRACRAN ART, NON-INV ATU OB W/DETAIL FETAL ANAT ea add 76812 76812 US CAROTID ART COMP 93880 93880 76812 US CAROTID ART COMP 93880* 93880 US OB W/DET FET ANATOMIC EA ADD 76812 93875 93875 NUCHAL TRANSLUCENCY 76813 76813 US CAROTID, IMG, LTD. 93882 93882 ATU NUCHAL TRANSLUCENCY 76813 76813 US CAROTID, IMG, LTD. 93882* 93882 76814 76814 US TRANSCRANIAL, BILAT 93886 93886 ATU NUCHAL TRANSLUCENCY EA ADD 76814 76814 US TRANSCRANIAL, BILAT. 93886* 93886 NUCHAL TRANSLUCENCY EA ADD ATU PREGNANCY LTD. 76815 76815 US TRANSCRANIAL, LTD 93888 93888 US PREGNANCY LIMITED 76815 76815 US TRANSCRANIAL, LTD 93888* 93888 ATU GESTATIONAL FOLLOW-UP 76816 76816 US ANKLE BRACHIAL INDEX 93922 US GESTATIONAL FOLLOW UP 76816 76816 US ANKLE/BRACHEAL INDEX ATU OB TRANSVAG W/IMG DOC 76817 76817 US UP/LOWR EXT ART, BILAT 93923 93923 76817 US UP/LOWR EXT ART, BILAT 93923* 93923 76818 US NON-INV LOW EXT ART W/STRESS 93924 93924 76818 US NON-INV LOW EXT ART W/STRESS 93924* 93924 US OB TRANSVAG W/IMG DOC ATU BIOPYS PROFILE W/STRESS US BIOPHYSICAL PROF W/ STRES 76817 76818 76818 93922* 93922 93922 76819 US LOWER EXT ART BILAT 93925 93925 76819 76819 US LOWER EXT ART BILAT 93925* 93925 76820 76820 US LOWER EXT ART LTD 93926 93926 76820 US LOWER EXT ART, LTD 93926* 93926 76821 76821 US UPPER EXT ART BILAT 93930 93930 DOP VELOCITY, FETAL MID CERB ART 76821 76821 US UPPER EXT ART BILAT 93930* 93930 ATU TRANSVAG, NON-OB 76830 76830 US UPPER EXT ART LTD 93931 93931 76830 US UPPER EXT ART LTD 93931* 93931 ATU BIOPYS PROFILE W/O STRESS US BIOPHYS PROF W/O STRESS ATU DOP VELOCITY, FETAL UMB ART DOP VELOCITY, FETAL UMB ART ATU VELOCITY FETAL MID CERB ART US TRANSVAG, NON-OB 76819 76820 76830 US HYSTEROSONOGRAPHY 76831 76831 US EXT VEIN NON-INV 93965 93965 ATU PELVIC, NON-OB COMP US PELVIC NON OB COMPLETE 76856 76856 76856 76856 US EXT VEIN NON-INV US VENOUS EXT BILAT 93965* 93970 93965 93970 93970 ATU PELVIC, NON-OB LTD/FU US PELVIC NON- OB LTD / F-U US SCROTUM AND CONTENTS US TRANSRECTAL 76857 76857 76870 US VENOUS EXT BILAT 93970* US VENOUS EXT LTD 93971 93971 76870 US VENOUS EXT LTD 93971* 93971 76872 ATU VASCULAR/VISCERAL COMP 93975 93975 76873* 76873 US VASCULAR VISCERAL COMP 93975 93975 US EXTREMITY NON-VASCULAR 76880 76880 ATU VASCULAR/VISCERAL LTD 93976 93976 US HIPS INFANT W/MANIPULATE 76885 76885 US VASCULAR/VISCERAL, LTD 93976 93976 76930 US AORTA/IVC/ILIAC COMP 76934 76934 US AORTA/IVC/ILIAC COMP 76936 76936 US AORTA/IVC/ILIAC LTD. 93979 93979 76937 US AORTA/IVC/ILIAC LTD. 93979* 93979 US VOL PROSTATE BRACHYTHER GUIDANCE PERICARDIOCENTES US PARACENTESIS GUIDED US PSEUDO-ANEURYSM COMPRESS US GUIDE, VASC ACCESS 76872 76857 76857 76930 76937 93978 93978* 93978 93978 US GUID/ MONITOR VISC TISSUE ABL 76940 76940 PENILE ARTERY IN VENOUS OUT 93980 93980 ATU US GUIDED NEEDLE Bx 76942 76942 PENILE ART INFLO/ OUT LTD 93981 93981 76942 93981 US NEEDLE BIOPSY GUIDE 76942 US PENILE ART INFLO/ OUT LTD. 93981* ATU US GUIDED AMNIOCENTESIS 76946 76946 US HEMODIALYSIS ACCESS 93990 93990 US guided AMNIOCENTESIS 76946 76946 US HEMODIALYSIS ACCESS 93990* 93990 ASPIRATION of OVA, US GUIDED 76948 76948 US OCULAR A SCAN BILAT 76511-50 76511-50 US GUIDE RAD THERAPY FLD PLACE 76950 76950 US GUIDE INTER RADIOELEM 76965 76965 ATU GESTATIONAL F/U EA ADD US GESTATIONAL F/U EA ADD 76816-59 76816-59 76816-59 76816-59 US FOLLOW UP SPECIFY NEEDED 76970 76970 US AAA SCREEN W/IMG DOC G0389 G0389 US INTRAOPERATIVE PROCEDURE 76986 76986 US VESSEL MAP,PRE OP, HEMODIAL G0365 G0365 76998 BLADDER ASP, NEEDLE 51100 51100 76999 BLADDER ASP, INTRACATH/TROCAR 51101 51101 US INTRAOPERATIVE US UNLISTED PROC, DIAG / INTER 76998 76999 Page 11 Ultrasound ATU UNLISTED PROC, DIAG 76999 76999 BLADDER ASP, SUPRAPUB CATH INSRT 51102 51102 US EXTRACRAN ART, NON-INV 93875* 93875 APPENDICEAL ABSCESS DR, PERC 44901 Page 12 44901 X-Ray X - Ray SOUTH JERSEY HEALTHCARE Procedure Description CPT PUNCT, ASPIR-SOFT TISSUE, FLUORO 10160 Procedure Description 10160 NEPHRO TUBE CHANGE CPT 50398 50398 BIOPSY BREAST NEEDLE CORE 19102 19102 URETROGRAPHY INJ PROC 50684 50684 BONE BX SPINE/FEMUR 20225 20225 LOOPOGRAM, INJECTION PROC 50690 50690 SINUS TRACT INJ, THPY 20500 FISTULA, SINUS TRACT INJ 20501 20500 PERIVESICAL ABSCESS DRAIN 51080 51080 20501 CYSTOGRAM INJ PROC 51600 51600 51600 ARTHROCENTESIS MAJOR JOINT 20610 20610 URETHRO CYSTO VOID IN TMJ ARTHROGRAPHY INJ PROC 21116 21116 URETHRO CYSTO, RETROGRADE, INJ PROC 51610 51610 51600 ARTHROGRAM SHOULDER INJ PROC 23350 23350 CATH,BLADDER,NON-INDWELLING 51701 51701 ARTHROGRAM ELBOW INJ PROC 24220 24220 CATH,BLADDER,INDWELLING, TEMP 51702 51702 ARTHROGRAM WRIST INJ PROC 25246 25246 CAVERNOSOGRAPHY INJ PROC 54230 ARTHROGRAM HIP INJ PROC 27093 27093 BIOPSY EPIDIDYMIS NEEDLE 54800 27095 HYSTEROSALPING INJ ARTHROGRAM HIP W/ ANESTHES 27095 58340 SI JNT INJ PROC ARTHROGRAM 27096 27096 TRANSCERV INTRO FALLOP TUBE SI JNT INJ PROC THERAPY 27096 27096 DRAIN OVARIAN ABSCESS ABD 58345 ARTHROGRAM KNEE INJ PROC 27370 27370 THYROID BX ARTHROGRAM ANKLE INJ PROC 27648 27648 SPINAL PUNCTURE, LUMBAR, DX 62270 58822 60100 54230 54800 58340 58345 58822 60100 62270 BRONCHOSCOPY W/, FIBERSCOPE31656 31656 MYELOGRAM INJECTION PROC 62284 62284 BRONCHOSCOPY W/O CATHETER 31708 31708 DISKOGRAPHY LUMB, INJ PROC 62290 62290 62291 BRONCHOSCOPY W W/O CONT 31710 DISCKOGRAPHY CERVICAL,INJ PROC 62291 BRONCHOSCOPY TRANSTRACHEAL 31715 31710 31715 C/T SPINE PRVRT/FACT INJ UNI 64470 64470 THORACENTESIS 32000 32421 C/T SPINE PRVRT/FACT ea add uni 64472 64472 INJ PROC VENOGRAM, EXTREM 36005 LYMPH NODE BX 38500 URETOGRAPHY, INJ. PROC. 39436 36005 L-SPINE PRVT/FACT UNI 64475 64475 38500 L-SPINE PRVT/FACT ea add uni 64476 64476 39436 INJECTION DACRYOCYSTOGRAPH 68850 68850 *REQUEST SPECIAL PROCEDURE 39999 39999 EYE FOR FOREIGN BODY 70030 70030 DRAINAGE OF SALIVARY GLAND 42300 42300 MANDIBLE < 4 VIEWS 70100 70100 SIALOGRAPHY INJECTION 42550 42550 MANDIBLE =>4 VIEWS GASTROSTOMY TUBE PLACE PERC43750 43750 MASTOIDS < 3 VIEWS EA SIDE 70120 43752 MASTOIDS =>3 VIEWS EA SIDE 70130 43752 INTERNAL AUDITORY CANAL 70134 70134 43760 FACIAL BONES < 3 VIEWS 70140 70140 43761 ZYGOMATIC ARCH 70140 70140 NASO/ORO-GASTRIC TUBE PLACE 42752 NASO-GASTRIC TUBE, PLACE GASTROSTOMY TUBE CHANGE G/J TIBE, REPOSITION 43752 43760 43761 STOMACH,UNLISTED PROC. 70110 70120 70130 43999 FACIAL BONES COMPLETE 70150 44500 NASAL BONES 70160 70160 45400 OPTIC FORAMINA 70190 70190 47000 ORBITS => 4 VIEWS 70200 47500 SINUSES < 3 VIEWS 70210 70210 CHOLANGIO INJ W/EXIST CATH 47505 47505 SINUSES => 3 VIEWS 70220 70220 REVISE/REINSERT TRANSHEP TB47530 47530 SELLA TURCICA 70240 70240 BIL END TTUBE DIL W/O STENT47555 47555 SKULL < 4 VIEWS 70250 70250 47630 SKULL, => 4 VIEWS, COMP 70260 48400 TEETH COMPLETE FULL MOUTH 70320 70320 48511 TMJ UNILATERAL 70328 70328 49180 TMJ BILATERAL 70330 49400 ARTHROGRAM TM JOINTS INTRO LONG G/J TUBE 43999 70110 44500 BIOPSY SALIVARY GLAND NEEDL45400 BIOPSY LIVER FLUORO GUIDED 47000 INJ PROC FOR PTC 47500 BILIARY STONE EXTRACTION 47630 INTRA-OP PANCREATOG INJ PRC 48400 EXT DRAIN PSEUDOCYST PANCR 48511 BX ABD/RETROPERITONEAL MASS 49180 INJECT AIR CONT PERITONEAL 49400 EXCGANG PRE PLAC ABS/DR CATH INJ EXIST CATH. CYST/ABSC (PEG TBE) BIOPSY RENAL 49423 49424 50200 ASPIR/INJ RENAL CYST/PELVIS 50390 70200 70260 70330 70332 49423 ORTHOPANTOGRAM 70355 49424 SOFT TISSUE NECK 70360 50200 PHARYNX/LARYNX W/ FLUORO 50390 SPEECH EVALUATION VCR Page 13 70150 70332 70355 70360 70371 70370 70370 70371 X-Ray INJ PROCEDURE NEPHROSTOGRAM 50394 SJH Procedure Description SALIVARY GLAND FOR STONE 70380 SIALOGRAPHY LARYNGOGRAPHY CONTRAST CPT 70380 70390 70373 70373 SJH Procedure Description MYELOGRAM LUMBAR SPINE CPT 72265 72265 70390 MYELOGRAM, => 2 REGIONS 72270 72270 71010 DISCOGRAM, CERV/THORACIC 72285 72285 71010 CLAVICLE 73000 71020 SCAPULA 73010 73010 71020 71020 SHOULDER 1 VIEW 73020 73020 CHEST 3 VIEWS (LORDOTIC) 71021 71021 SHOULDER => 2 VIEWS CHEST 4 VIEWS 71022 71022 ACROMIOCLAVICULAR JOINTS 73050 CHEST 1 VIEW PORTABLE 71010 CHEST ONE VIEW 71010 CHEST 2 VIEWS 71020 CHEST, 2 VIEW (B-READER) CHEST 2 VIEWS AND FLUORO 71023 71023 HUMERUS => 2 VIEWS CHEST => 4 VIEWS 71030 71030 ELBOW 2 VIEWS 73070 73000 73030 73030 73050 73060 73060 73070 CHEST => 4 VIEWS W/ FLUORO 71034 71034 ELBOW => 3 VIEWS 73080 73080 CHEST, EXP, DECUB 71035 71035 FOREARM 2 VIEWS 73090 73090 BRONCHOGRAM UNILATERAL 71040 UPPER EXTREMITY 2 VIEWS 73092 BRONCHOGRAM BILATERAL 71060 71060 WRIST 2 VIEWS 73100 PACEMAKER INSERT FLUORO 71090 71090 WRIST >= 3 VIEWS, COMP RIBS UNILAT 2 VIEWS 71100 71100 HAND 2 VIEWS 73120 RIBS UNILAT W/PA CHEST =>3 VIEWS 71040 71101 RIBS BILATERAL THREE VIEWS 71110 RIBS BILAT W/PA CHEST => 4 VIEWS 71111 STERNUM 2 VIEWS 71120 STERNOCLAVICULAR JTS => 71130 ENTIRE SPINE AP + LATERAL 72010 CERVICAL SPINE 1 VIEW 72020 ER C-SPINE, 1VIEW 72020 LUMBAR SPINE 1 VIEW 72020 THORACIC SPINE ONE VIEW 72020 73100 73110 71101 HAND => 3 VIEWS 73130 73130 71110 FINGER (s) 2 VIEWS 73140 73140 71111 HIP 1 VIEW 73500 71120 HIP => 2 VIEWS 73500 73510 71130 HIPS BILAT, =>2 VIEWS EA, W/ PELVIS HIP IN O.R. 73530 73530 72020 PELVIS & HIP CHILD => 2 VIEWS 73540 73540 72020 FEMUR 2 VIEWS 72020 KNEE <=2 VIEWS 72020 KNEE, THREE VIEWS 73550 73560 73562 72040 72040 KNEE, COMPLETE => FOUR VWS 75809 75809 KNEES BILATERAL STAND AP ER C-SPINE, 2-3 VIEW 72040 72040 ARTHROGRAM KNEE C-SPINE => 4 VIEWS 72050 72050 TIBIA/FIBULA 2 VIEWS 73590 72052 LOWER EXT., CHILD, 2 VIEWS 72069 ER T-SPINE 2 VIEWS 72070 THORACIC SPINE 2 VIEWS 72070 72069 ANKLE 2 VIEWS 73600 72070 ANKLE -> 3 VIEWS 72070 FOOT 2 VIEWS 73620 73520 73564 73565 73580 72072 FOOT => 3 VIEWS CALCANEUS 2 VIEWS 73650 72080 TOE (s) 2 VIEW 73660 72080 ABD (KUB) 74000 72090 ABDOMEN 1 VIEW 74000 72100 ABD, AP, OBL, AND CONE VIEWS 74010 72100 ABD, COMP., W/DECUB AND/OR ERECT 72100 LUMBOSACRAL SPINE 2 VIEW 72100 L-SPINE => 4 VIEW 72110 LUMBAR SPINE W/ BENDING VW 72114 LUMBAR SPINE BENDING ONLY 72120 PELVIS <= 2 VIEW PELVIS 3 VIEWS 72170 72190 SACROILIAC JOINTS 2 VIEWS 72200 SACROILIAC JOINTS => 3 VIEWS SACRUM AND COCCYX 72220 72202 73592 73610 73620 72074 ER L-SPINE 2-3 VIEWS 73564 73565 73600 73610 72072 72080 73560 73590 73592 72074 SCOLIOSIS SUPINE AND ERECT 72090 73550 73580 T- SPINE W / OBL => 4 views THORACO LUMBAR SPINE 2 VWS 73520 73562 T-SPINE 3 VIEWS THORACO LUMBAR 2 VIEWS 72080 73510 72010 SHUNTOGRAM, NON-VASCULAR SCOLIOSIS SERIES 73110 73120 CERVICAL SPINE 2 -3 VIEWS CERVICAL SPINE W/ FLEX+EX 72052 73092 73630 72110 OBSTRUCTION SERIES W/PA CHEST 72114 UPPER G.I. W/O K.U.B. 72120 PHARYNX AND/OR CERO ESOPH 74210 72170 ESOPHAGUS 73630 73650 74020 74022 74040 73660 74000 74000 74010 74020 74022 74040 74210 74220 74220 72190 VIDEO SWALLOWING FUNCTION-74230 74230 72200 REM FB ESOPH W/ BALLOON CTH74235 74235 72202 U.G.I. 72220 UPPER G. I. SMALL BOWEL 74245 Page 14 74241 74241 74245 X-Ray MYELOGRAM CERVICAL SPINE 72240 72240 UGI W/AIR CONTRAST MYELOGRAM THORACIC SPINE 72255 72255 U. G. I.,AIR CONTRAST SJH Procedure Description CPT 74246 74246 74247 SJH Procedure Description 74247 CPT AIR CONTRAST UGI SM BOWEL 74249 74249 BONE AGE SMALL BOWEL SERIES 74250 74250 BONE LENTH STUDY SMALL BOWEL VIA ENTEROCLYS 74251 74251 OSSEOUS SURVEY LIMITED 77074 77074 DUODENOGRAPHY HYPOTONIC 74260 OSSEOUS SURVEY COMPLETE 77075 77075 BARIUM ENEMA 74270 74270 OSSEOUS SURVEY INFANT 77076 77076 BARIUM ENEMA AIR CONTRAST 74280 74280 JOINT SURVEY => 2 JOINTS 77077 77077 BARIUM ENEMA THERAPEUTIC 74283 74283 DXA (BONE DENSITY STDY) 77080 GALL BLADDER ORAL CONT 74290 74290 DXA => 1 SITE,VERT,FX ASSESSMENT 74260 G.B., ORAL CONT., REPEAT/ADDITIONAL 74291 77072 77073 77082 77073 77080 77082 74291 ELBOW 2 VIEWS RT / LT CHOLANGIOGRAPHY OR 74300 74300 CLAVICLE COMP RT LT 73000-50 73000-50 O.R. CHOLANG/PANC/ADD SET 74301 74301 SCAPULA COMP RT LT 73010-50 73010-50 CHOLANGIOGRAM T TUBE 74305 73070-50 77072 7030-50 74305 SHOULDER 1 VIEW RT/ LT 73020-50 73020-50 74305 SHOULDER COMP =>2 RT/ LT 73030-50 73030-50 74320 HUMERUS => 2 VW RT/ LT 73060-50 73060-50 74328 ELBOW, 2 VIEW, RT-LT 73070-50 73070-50 74329 ELBOW COMP =>3 VW RT- LT 73080-50 73080-50 ERCP BILIARY AND PANCREATIC74330 74330 FOREARM AP LAT RT- LT 73090-50 73090-50 INTRO LONG GI TUBE MILLRABT74340 74340 UPPER EXTREMITY LT-RT 73092-50 ENTEROCLYSIS TUBE PL PERC 74355 74355 WRIST 2 VIEWS, RT-LT PANCREATO; THROU EXIST CATH CHOLANG PERC TRANSHEP ERCP BILIARY DUCTS 74320 74328 ERCP PANCREATIC DUCTS 74329 73100-50 73092-50 73100-50 IVP W/WO KUB ,W/WO TOMO 74400 74400 WRIST COMP =>3VW RT- LT 73110-50 UROGRAM RETROGRADE 74420 74420 HAND 2 VIEWS RT- LT 73120-50 73110-50 73120-50 UROGRAM ANTEGRADE NEPHROSTOGRAM 74425 74425 HAND =>3 VIEWS RT- LT 73130-50 73130-50 CYSTOGRAPHY => 3 VIEWS 74430 74430 FINGER(S) =>2 VIEW RT-LT 73140-50 73140-50 CAVERNOSOGRAPHY 74445 74445 HIP, ONE VIEW, LT-RT 73500-50 URETHRO CYSTOGRAPHY RETRO 74450 74450 HIPS BILAT,=> 2 VIEWS EA, RT/LT 73520 - 52 73520-52 URETHRO CYSTOGRAPHY VOID 74455 74455 FEMUR 2 VIEW, RT-LT 73550-50 73550-50 PELVIMETRY 74710 74710 KNEE, <=2 VIEWS RT-LT 73560-50 73560-50 73500-50 HYSTEROSALPINGOGRAM 74740 74740 KNEE 3 VIEWS RT- LT 73562-50 73562-50 TRANSCERVICAL CATH FALLOP 74742 74742 KNEE COMP =>4 VW RT- LT 73564-50 73564-50 PERINIOGRAM FOR SEX DETERM 74775 74775 TIBIA/FIBULA 2 VWS RT- LT 73590-50 73590-50 BILIARY TBE CHG W / CONT 75984 75984 LOWER EXT., CHILD, 2 VIEWS RT/LT NEPHRO TUBE CHANGE 75984 75984 ANKLE 2 VIEW, RT-LT FLUORO GUID/ABS DR/SPEC COL75989 73592-50 73592-50 73600-50 73600-50 75989 ANKLE COMP =>3 VW RT- LT 73610-50 73610-50 FLUORO <= 1 HR 76000 76000 FOOT AP LAT RT- LT 73620-50 73620-50 FLUORO > 1 HOUR 76001 76001 FOOT COMP =>3 VW RT- LT 73630-50 73630-50 FOREIGN BODY CHILD 76010 76010 CALCANEUS 2 VW RT- LT 73650-50 73650-50 FISTULA, SINUS TRACT (teneckhoffogram) 76080 76080 TOES => 2VIEWS RT- LT SURGICAL SPECIMEN, X-RAY 76098 ABD, 2 VIEWS 76100 76098 TOMOGRAPHY 76100 TOMOGRAPHY NON UROLOG UNI 76101 76101 LOCM => 400 MG/ML, per ML MRI CONT. (GAD), per ML TOMOGRAPHY NON UROLOG BILAT76102 76102 HOCM <=149 MG/ML, per ML CONSULTATION FOR MAMMO 76140 76140 HOCM 150-199 MG/ML, per ML CONSULTATION,OUTSIDE X-RAY(S) 76140 76140 HOCM 200-249 MG/ML, per ML 76496 HOCM 250-299 MG/ML, per ML FLUORO, UNLISTED PROCEDURE 76496 73660-50 74010-52 UNLISTED DIAGNOSTIC PROC. 76499 76499 HOCM 300 - 349 MG/ML, per ML FLUORO GUIDE CV ACC DEV PLC 77001 77001 HOCM 350-399 MG/ML, per ML 77002 HOCM =>400 MG/ML, per ML 77003 BX BREAST PERC VAC/ROTAT BX DEV FLUORO GUIDE NEEDLE PLACE FLUORO GUID NEED PLC DX/RX 77002 77003 Page 15 A9579 73660-50 74010-52 X-Ray STEREOTACTIC LOC BREAST BX 77031* 77031 IMG GUIDE PLACE LOC CLIP ADD ON GALACTOGRAM MULTI DUCTS 77054 77054 ARTHROCENTESIS LRG JT 20610 77071 ARTHROCENTESIS LRG JT 20610-50 STRESS VIEWS ANY JOINT PHYS 77071 Procedure Description CPT SOUTH JERSEY HEALTHCARE ARTHROCENTESIS INTRMED JT 20605 ARTHROCENTESIS INTRMED JT 20605-50 20605-50 20600 20600-50-52 20600 20600-50 ARTHROCENTESIS SM JT ARTHROCENTESIS SM JT C/T SPN PRVERT/FACT INJ-UNI 64470-52 C/T SPN PRVERT/FACT INJ BILAT RT/LT64470-50-52 C/T SPN PR/VRT/FACT EA ADD 64472-52 C/T SPN PR/VRT/FACT EA ADD RT/LR 64472-50-52 L-SPN PR/VRT-FACT UNI 64475-52 20605 64470 64470-50 64472 64472-50 64475 L-SPN PR/VRT-FACT BILAT RT/LT 64475-50-52 64475-50 L-SPN PR/VRT-FACT EA ADD L-SPN PR/VRT-FACT EA ADD BIL 64476-52 64476-50-52 64476 64476-50 PARAVERT FACT INJ L-SPN PARAVERT FACT INJ L-SPN RT/LR PARAFACT INJ L-SPN EA ADD PARAFACT INJ L-SPN EA ADD RT/LT TRANSFORAM EPI INJ L-SPN 64622 64622 64622-50 64622-50 64623 64623-50 64623 64623-50 64484 64484 64484-50 64484-50 DISCOGRAM L-SPN 72295 72295 LOCM 100-199 MG/ML,PER ML Q9965 LOCM 200-299 MG/ML,PER ML Q9966 TRANSFORAM EPI INJ L-SPN RT/LR LOCM 300-399 MG/ML,PER ML Q9967 REMOV OBST G,D,J,GJ TBE W/IMG 49460 GJ TBE, REPLACE W/IMG 49452 49452 D - J TBE, REPLACE W/IMG 49451 49451 G - C TBE, REPLACE W/IMG 49450 49450 G, GJ TBE CONVERSION W/IMG 49446 49446 C - COLONIC TBE PLC W/FLUORO 49442 49442 D - J TBE, PLC W/FLUORO, PERC COMP 49441 49441 GASTRO TBE PLC W/IMG COMP 49440 49440 G,D,J,GJ,C TBE CHECK W/IMG COMP 49465 49465 49460 Page 16 20610 20610-50
