Confidential Screening/Billing Report (PM 160) Claim Form ...
08 Hemoglobin or Hematocrit. 09 Urine Dipstick. 10 Complete Urinalysis. 12 TB Mantoux. ... Elevated blood lead levels. ... Enter the International Classification of Diseases code in the Diagnosis Codes area for each condition or problem suspected. (No ICD indicator is required on the standard PM 160 claim or PM 160 Information Only). ................
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