ENCOUNTER KEYS - azahcccs.gov

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ENCOUNTER KEYS

January-February 2018

Inside this Edi on

Age Coverage Code End Date Codes (Once in a Life Time) Procedure Daily Limit Adult ER Bene- fits Place of Service

Modifiers

Provider Type

1 2-10

11

12-15

16 17-20

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Age

The minimum and maximum age for the CPT code 90688 (Vaccine for Influenza for Administration into Muscle) has been changed to 000 years ? 999 years. Coverage Code

Effective for dates of service on or after October 1, 2015 the Coverage Code has been changed to 02 (Not Covered Service/Code Available Coverage) for the ICD-10 code N97.9 (Female infertility, unspecified).

Effective for dates of service on or after October 1, 2017 the Coverage Code has been changed to 01 (Covered Service\Code Available) for the ICD-10 code I21.9 (Acute Myocardial Infarction, Unspecified).

End Date

The modifier L1 (Separately Payable Lab Test) has been end dated on RF114 for with the effective date of December 31, 2016.

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Codes The following CPT and HCPCS codes now have a "Once in a Life Time" limit of 1 listed on the reference screen RF113 and a coverage code of 01 (Covered Service/Code Available).

CPT

Code

Description

Excision, coccygeal pressure ulcer, with 15920 coccygectomy; with primary suture

Excision, coccygeal pressure ulcer, with 15922 coccygectomy; with flap closure

27080 Coccygectomy, primary

Laryngoplasty; for laryngeal web, 231580 stage, with keel insertion and removal

Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (eg, voice button, Blom 31611 -Singer prosthesis

33404 Construction of apical-aortic conduit

Replacement, aortic valve; with aortic 33411 annulus enlargement, noncoronary sinus

Replacement, aortic valve; with transventricular aortic annulus enlargement 33412 (Konno procedure)

Resection or incision of subvalvular tissue for discrete subvalvular aortic steno33415 sis

Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, 33427 with or without ring

Valvectomy, tricuspid valve, with cari33460 opulmonary bypass

Anastomosis of pulmonary artery to aorta 33606 (Damus-Kaye-Stansel procedure

Repair of complex cardiac anomaly other than pulmonary atresia with ventricular septal defect by construction or replacement of conduit from right or left ventri33608 cle to pulmonary artery

Repair of complex cardiac anomalies (eg, single ventricle with subaortic obstruction) by surgical enlargement of ventricu33610 lar septal defect

Repair of double outlet right ventricle 33611 with intraventricular tunnel repair;

Repair of double outlet right ventricle with intraventricular tunnel repair; with repair of right ventricular outflow tract 33612 obstruction

Repair of complex cardiac anomalies (eg, tricuspid atresia) by closure of atrial septal defect and anastomosis of atria or vena cava to pulmonary artery (simple 33615 Fontan procedure)

Repair of complex cardiac anomalies (eg, single ventricle) by modified Fontan 33617 procedure

Repair of single ventricle with aortic outflow obstruction and aortic arch hypoplasia (hypoplastic left heart syn33619 drome) (eg, Norwood procedure)

Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or 33641 without patch

Direct or patch closure, sinus venosus, with or without anomalous pulmonary 33645 venous drainage

Repair of atrial septal defect and ventricular septal defect, with direct or patch 33647 closure

Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal defect), with or without atrioventricu33660 lar valve repair

Repair of intermediate or transitional atrioventricular canal, with or without 33665 atrioventricular valve repair

Repair of complete atrioventricular ca33670 nal, with or without prosthetic valve

Complete repair tetralogy of Fallot with33692 out pulmonary atresia

Complete repair tetralogy of Fallot without pulmonary atresia; with transannular 33694 patch

Complete repair tetralogy of Fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular 33697 septal defect

Repair sinus of Valsalva fistula, with 33702 cardiopulmonary bypass;

Repair sinus of Valsalva fistula, with cardiopulmonary bypass; with repair of 33710 ventricular septal defect

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Repair sinus of Valsalva aneurysm, with 33720 cardiopulmonary bypass

33722 Closure of aortico-left ventricular tunnel

Repair of isolated partial anomalous pulmonary venous return (eg, Scimitar Syn33724 drome)

33726 Repair of pulmonary venous stenosis

Complete repair of anomalous pulmonary venous return (supracardiac, intracardiac, 33730 or infracardiac types)

Repair of cor triatriatum or supravalvular mitral ring by resection of left atrial mem33732 brane Atrial septectomy or septostomy; closed 33735 heart (Blalock-Hanlon type operation)

Atrial septectomy or septostomy; open 33736 heart with cardiopulmonary bypass

Atrial septectomy or septostomy; open 33737 heart, with inflow occlusion

Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; without surgical enlarge33770 ment of ventricular septal defect

Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; with surgical enlarge33771 ment of ventricular septal defect

Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary by33774 pass;

Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary by33775 pass; with removal of pulmonary band

Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with closure of ventricular septal 33776 defect Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with repair of subpulmonic obstruc33777 tion

Repair of transposition of the great arteries, aortic pulmonary artery reconstruc33778 tion (eg, Jatene type);

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with removal of 33779 pulmonary band

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with closure of 33780 ventricular septal defect

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with repair of sub33781 pulmonic obstruction

Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure); without 33782 coronary ostium reimplantation

Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure); with reimplantation of 1 or both coronary 33783 ostia

Total repair, truncus arteriosus (Rastelli 33786 type operation)

Reimplantation of an anomalous pulmo33788 nary artery

Aortic suspension (aortopexy) for tracheal decompression (eg, for tracheoma33800 lacia) (separate procedure)

Obliteration of aortopulmonary septal 33813 defect; without cardiopulmonary bypass

Obliteration of aortopulmonary septal 33814 defect; with cardiopulmonary bypass

Repair of patent ductus arteriosus; by 33820 ligation

Repair of patent ductus arteriosus; by 33822 division, younger than 18 years

Repair of patent ductus arteriosus; by 33824 division, 18 years and older

Excision of coarctation of aorta, with or without associated patent ductus arterio33840 sus; with direct anastomosis

Excision of coarctation of aorta, with or without associated patent ductus arterio33845 sus; with graft

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Excision of coarctation of aorta, with or without associated patent ductus arteriosus; repair using either left subclavian artery or prosthetic 33851 material as gusset for enlargement

Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; without cardio33852 pulmonary bypass Donor cardiectomypneumonectomy (including cold 33930 preservation) Heart-lung transplant with recipient 33935 cardiectomy-pneumonectomy Donor cardiectomy (including cold 33940 preservation) Venous anastomosis, open; porto37140 caval Venous anastomosis, open; renopor37145 tal Venous anastomosis, open; caval37160 mesenteric Venous anastomosis, open; 37180 splenorenal, proximal Venous anastomosis, open; splenorenal, distal (selective decompression of esophagogastric varices, 37181 any technique)

Splenectomy; total, en bloc for extensive disease, in conjunction with other procedure (List separately in 38102 addition t

Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal 38780 nodes (separate procedure)

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of 39503 ventral hernia

Imbrication of diaphragm for eventration, transthoracic or trans39545 abdominal, paralytic or nonparalytic Excision of lingual frenum 41115 (frenectomy)

Glossectomy; complete or total, with or without tracheostomy, with41140 out radical neck dissection

Glossectomy; complete or total, with or without tracheostomy, with unilat41145 eral radical neck dissection

Glossectomy; composite procedure with resection floor of mouth and mandibular resection, without radical 41150 neck dissection

Glossectomy; composite procedure with resection floor of mouth, with 41153 suprahyoid neck dissection

Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck 41155 dissection (Commando type)

Suture of tongue to lip for microgna41510 thia (Douglas type procedure)

Frenoplasty (surgical revision of fre41520 num, eg, with Z-plasty) 42140 Uvulectomy, excision of uvula

Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyn42145 goplasty)

Palatoplasty for cleft palate, soft and/ 42200 or hard palate only

Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue 42205 only

Palatoplasty for cleft palate; attach42225 ment pharyngeal flap

Lengthening of palate, and pharyn42226 geal flap

Lengthening of palate, with island 42227 flap

Repair of anterior palate, including 42235 vomer flap

Parotid duct diversion, bilateral 42507 (Wilke type procedure);

Parotid duct diversion, bilateral (Wilke type procedure); with exci42509 sion of both submandibular glands Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) 42510 ducts

Excision or destruction lingual ton42870 sil, any method (separate procedure)

42890 Limited pharyngectomy

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Pharyngoplasty (plastic or reconstructive 42950 operation on pharynx)

Pharyngostomy (fistulization of phar42955 ynx, external for feeding)

Total or near total esophagectomy, without thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty 43107 (transhiatal)

Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, prepa43108 ration and anastomosis(es)

Partial esophagectomy, cervical, with free intestinal graft, including microvascular anastomosis, obtaining the graft 43116 and intestinal reconstruction

Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloro43117 plasty (Ivor Lewis)

Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, prepa43118 ration, and anastomosis(es)

Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without proximal gastrectomy, with thoracic esophagogastrostomy, with or without 43121 pyloroplasty

Total or partial esophagectomy, without reconstruction (any approach), with cer43124 vical esophagostomy Esophagogastric fundoplasty partial or 43327 complete; laparotomy

Esophagogastric fundoplasty partial or 43328 complete; thoracotomy

Esophagomyotomy (Heller type); ab43330 dominal approach

Esophagomyotomy (Heller type); tho43331 racic approach

Esophagojejunostomy (without total 43340 gastrectomy); abdominal approach

Esophagojejunostomy (without total 43341 gastrectomy); thoracic approach

Esophagostomy, fistulization of esopha43351 gus, external; thoracic approach

Esophagostomy, fistulization of esopha43352 gus, external; cervical approach

Transection of esophagus with repair, 43401 for esophageal varices

Vagotomy when performed with partial distal gastrectomy (List separately in addition to code[s] for primary proce43635 dure) Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selec43640 tive Vagotomy including pyloroplasty, with or without gastrostomy; parietal cell 43641 (highly selective)

43810 Gastroduodenostomy Gastrostomy, open; with construction of

43832 gastric tube (eg, Janeway procedure)

Gastric restrictive procedure, without gastric bypass, for morbid obesity; verti43842 cal-banded gastroplasty

Gastric restrictive procedure, without gastric bypass, for morbid obesity; other 43843 than vertical-banded gastroplasty

Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y 43846 gastroenterostomy

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Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit 43847 absorption

Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive de43848 vice (separate procedure)

Revision of gastroduodenal anastomosis (gastroduodenostomy) with recon43850 struction; without vagotomy

Revision of gastroduodenal anastomosis (gastroduodenostomy) with recon43855 struction; with vagotomy

Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without va43860 gotomy

Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; with vagoto43865 my

Colectomy, partial; with colo44145 proctostomy (low pelvic anastomosis)

Colectomy, partial; with coloproctostomy (low pelvic anastomosis), 44146 with colostomy Colectomy, partial; abdominal and 44147 transanal approach Continent ileostomy (Kock procedure) 44316 (separate procedure)

Excision of Meckel's diverticulum (diverticulectomy) or omphalomesen44800 teric duct

Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or 45113 without loop ileostomy Excision of rectal procidentia, with 45130 anastomosis; perineal approach

Excision of rectal procidentia, with anastomosis; abdominal and perineal 45135 approach

Excision of ileoanal reservoir with ileos45136 tomy

Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, 45395 with colostomy

Laparoscopy, surgical; proctectomy, combined abdominoperineal pullthrough procedure (eg, colo-anal anasto45397 mosis), with c Proctopexy (eg, for prolapse); with sig45550 moid resection, abdominal approach

46070 Incision, anal septum (infant)

Repair of high imperforate anus without fistula; perineal or sacroperineal ap46730 proach

Repair of high imperforate anus without fistula; combined transabdominal and 46735 sacroperineal approaches

Repair of high imperforate anus with rectourethral or rectovaginal fistula; per46740 ineal or sacroperineal approach Hepatectomy, resection of liver; total 47125 left lobectomy Hepatectomy, resection of liver; total 47130 right lobectomy Donor hepatectomy (including cold 47133 preservation), from cadaver donor

Donor hepatectomy (including cold preservation), from living donor; left lateral segment only (segments II and 47140 III)

Donor hepatectomy (including cold preservation), from living donor; total 47141 left lobectomy (segments II, III and IV)

Donor hepatectomy (including cold preservation), from living donor; total right lobectomy (segments V, VI, VII 47142 and VIII) Laparoscopy, surgical; cholecystectomy 47563 with cholangiography

Exploration for congenital atresia of bile ducts, without repair, with or without liver biopsy, with or without cholangi47700 ography

47701 Portoenterostomy (eg, Kasai procedure)

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Pancreatectomy, distal subtotal, with or without splenectomy; without pancreati48140 cojejunostomy

Pancreatectomy, total or subtotal, with autologous transplantation of pancreas 48160 or pancreatic islet cells Internal anastomosis of pancreatic cyst 48540 to gastrointestinal tract; Roux-en-Y

Donor pancreatectomy (including cold preservation), with or without duodenal 48550 segment for transplantation

Staging laparotomy for Hodgkins disease or lymphoma (includes splenectomy, needle or open biopsies of both liver lobes, possibly also removal of abdominal nodes, abdominal node and/or bone marrow biopsies, ovarian reposi49220 tioning) Umbilectomy, omphalectomy, excision 49250 of umbilicus (separate procedure) Repair of large omphalocele or gas49605 troschisis; with or without prosthesis

Repair of large omphalocele or gastroschisis; with removal of prosthesis, final reduction and closure, in operating 49606 room Repair of omphalocele (Gross type oper49610 ation); first stage Repair of omphalocele (Gross type oper49611 ation); second stage

Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall 49904 defects)

Omental flap, intra-abdominal (List separately in addition to code for primary 49905 procedure) Cystotomy; for simple excision of vesi51520 cal neck (separate procedure)

Cystectomy, partial, with reimplantation of ureter(s) into bladder 51565 (ureteroneocystostomy)

Abdomino-vaginal vesical neck suspension, with or without endoscopic control 51845 (eg, Stamey, Raz, modified Pereyra)

51940 Closure, exstrophy of bladder

Enterocystoplasty, including intestinal 51960 anastomosis

51980 Cutaneous vesicostomy

Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy 52630 are included)

Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete 52649 (vasectomy, m Urethrotomy or urethrostomy, external 53000 (separate procedure); pendulous urethra

Urethrotomy or urethrostomy, external (separate procedure); perineal urethra, 53010 external Meatotomy, cutting of meatus (separate 53020 procedure); except infant Meatotomy, cutting of meatus (separate 53025 procedure); infant Excision or fulguration of carcinoma of 53220 urethra

Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen 53400 type) Urethroplasty; second stage (formation 53405 of urethra), including urinary diversion

Urethroplasty, transpubic or perineal, 1stage, for reconstruction or repair of 53410 prostatic or membranous urethra

Urethroplasty, transpubic or perineal, 1stage, for reconstruction or repair of 53415 prostatic or membranous urethra

Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous ure53420 thra; first stage

Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous ure53425 thra; second stage

Urethroplasty, reconstruction of female 53430 urethra

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Urethroplasty with tubularization of posterior urethra and/or lower bladder for incontinence (eg, Tenago, 53431 Leadbetter procedure) Urethromeatoplasty, with mucosal 53450 advancement

Urethromeatoplasty, with partial excision of distal urethral segment 53460 (Richardson type procedure) Slitting of prepuce, dorsal or lateral 54000 (separate procedure); newborn Slitting of prepuce, dorsal or lateral (separate procedure); except new54001 born

Excision of penile plaque (Peyronie 54111 disease); with graft to 5 cm in length

Excision of penile plaque (Peyronie disease); with graft greater than 5 54112 cm in length Circumcision, using clamp or other 54150 device; newborn

Circumcision, surgical excision other than clamp, device or dorsal slit; 54161 except newborn Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or 54304 skin flaps

Urethroplasty for second stage hypospadias repair (including urinary 54308 diversion); less than 3 cm

Urethroplasty for second stage hypospadias repair (including urinary 54312 diversion); greater than 3 cm

Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft ob54316 tained from site other than genitalia

Urethroplasty for third stage hypospadias repair to release penis from 54318 scrotum (eg, third stage Cecil repair)

1-stage distal hypospadias repair (with or without chordee or circumcision); with simple meatal advance54322 ment (eg, Magpi, V-flap)

1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps 54324 (eg, flip-flap, prepucial flap) 1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps 54326 and mobilization of urethra

1-stage distal hypospadias repair (with or without chordee or circumcision); with extensive dissection to correct chordee and urethroplasty with local skin flaps, skin graft patch, and/or island 54328 flap

1-stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/ 54332 or island flap

1-stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin 54336 graft tube and/or island flap

Plastic operation on penis for epispadias 54380 distal to external sphincter;

Plastic operation on penis for epispadias distal to external sphincter; with inconti54385 nence

Plastic operation on penis for epispadias distal to external sphincter; with exstro54390 phy of bladder

Insertion of penile prosthesis; non54400 inflatable (semi-rigid)

Insertion of penile prosthesis; inflatable 54401 (self-contained)

Insertion of multi-component, inflatable penile prosthesis, including placement of 54405 pump, cylinders, and reservoir

Transplantation of testis(es) to thigh 54680 (because of scrotal destruction)

Epididymovasostomy, anastomosis of 54901 epididymis to vas deferens; bilateral

Prostatectomy, perineal, subtotal (including control of postoperative bleeding, vasectomy, meatotomy, ure55801 thral calibrati

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