| API Endpoint | Method | You send to API | API responds with |
|---|---|---|---|
| apiFreeText | POST | Natural language, free text | Coding candidates: medical terms that have at least one CPT or ICD10 code |
| apiSinglePhrase | GET | Single phrase made of up to 250 chracters or a code (CPT or ICD10) for reverse search | CPT, ICD10 Diagnosis or ICD10 Procedure codes |
| apiCPTDiagLCD | GET | Location, CPT code and ICD10 Diagnosis code | Any LCD supporting the medical necessity of the CPT procedure with an ICD10 Diagnosis code in a specific jurisdiction. Any LCD explicitly NOT supporting the CPT code with the ICD10 Diagnosis code at your location. |
| apiCPTCodeDetails | GET | CPT code | Details about the CPT code: Physician Medicare fees in your region, LCD supporting or NOT supporting this code, ICD10 Diagnosis codes that are considered medical necessity for the CPT, relevant modifiers, indicators, E/M, etc. |
| apiDiagCodeDetails | GET | ICD10 Diagnosis code | Details about the ICD10 Diagnosis code, relevant CPT codes and LCD for a specific jurisdiction. |
| apiProcCodeDetails | GET | ICD10 Procedure code | Details about the ICD10 Procedure code. |
| apiLCDCodeDetails | GET | LCD code | Details about the LCD code: CPT supporting it and their RVUs, ICD10 Diagnosis supporting medical necessity and ICD10 Diagnosis that explicitly do NOT support a CPT in a jurisdiction. |
| apiStaticModifiers | GET | Nothing | Details about all the Modifiers, Indicators, Factors that impact fees, Anesthesia modifiers, etc. |
| HTTP Error | Error details you may find in the HTTP response |
|---|---|
| 400 - Bad request | Text for NLP analysis must have between 5 and 10,000 characters |
| Not a CPT code | |
| Not an ICD10 Diagnosis code | |
| Not an LCD code | |
| Not an ICD10 Procedure code | |
| The server cannot or will not process the request due to an apparent client error | |
| 401 - Unauthorized | See Authentication |
| 402 - Payment required | Subscription expired. Please renew your subscription at Text2Codes.com |
| You have passed the number of free text documents NLP analysis per day allowed by your current account settings. You can increase the number of documents you analyze per day at Text2Codes.com |
|
| 405 - Method not allowed | You're trying GET instead of POST or vice versa |
| 500 - Server error | Problem on our side. Whoops...a slight distortion in our space time continuum... |
| Basic Authentication | Your username, which is your email address and your password for the account with Text2Codes The authorization header with your Basic Auth will be automatically generated when you send the request. Postman details how to send the username and password as Basic Auth. |
| Purpose | Extract Coding Candidates: medical terms that have at least one CPT or ICD10 code, from free text, natural language documents |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiFreeText.json |
| Body | ********** YOUR OWN TEXT / MEDICAL TERMS or CODES HERE ********* ***** FREE TEXT Natural Language ***** Patient suffers from acute on chronic diastolic congestive heart failure since 2012. He was recently diagnosed with arthropatic psoriasis, mild chronic kidney disease, asthma and pulmonary hypertension. ***** TERMS or PARTIAL terms on separate lines ***** Chr atr fib Hip osteoarth Lap Chole ***** Codes for REVERSE SEARCH on separate lines ***** I48.2 27134 |
| API Response |
{ "CodingCandidates": [ " Lap Chole", " Hip osteoarth", " Chr atr fib", "psoriasis", "chronic kidney disease", "asthma", "pulmonary hypertension", "congestive heart failure", "acute on chronic", "27134", "I48.2" ], "HitsLeftToday": 16, "DaysLeft": 1, "SubscriptionEnds": "2018-02-15 00:00:00" } |
| Body | Text with no coding candidates |
| API Response | { "TodayHitsNLP": 10, "HitsNLPDaylyAllow": 31, "CodingCandidates": [], "SubscriptionEnds": "2018-01-10 05:17:04", "DaysLeft": 7 } |
| Purpose | Search for CPT or ICD9 and ICD10 diagnosis or procedure codes with a single phrase, up to 250 characters, or Reverse search with a code - CPT, ICD9, ICD10, Diagnosis, Procedure code Please send ICD Diagnosis codes without the dot. ex: Code I48.2 should be sent for search as I482 |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiSinglePhrase/lap cholecy.json |
| API Response |
{ "CPThcpcs": [ { "AnesBaseUnit": 0, "NonFacTotal": "32.14", "FacTotal": "32.14", "LongDesc": "Laparoscopy, surgical; cholecystectomy with exploration of common duct", "CPTcode": "47564", "Modifier": "", "id": 14304 }, { "AnesBaseUnit": 0, "NonFacTotal": "22.44", "FacTotal": "22.44", "LongDesc": "Laparoscopy, surgical; cholecystoenterostomy", "CPTcode": "47570", "Modifier": "", "id": 14305 }, { "AnesBaseUnit": 0, "NonFacTotal": "20.63", "FacTotal": "20.63", "LongDesc": "Laparoscopy, surgical; cholecystectomy with cholangiography", "CPTcode": "47563", "Modifier": "", "id": 14303 }, { "AnesBaseUnit": 0, "NonFacTotal": "19.00", "FacTotal": "19.00", "LongDesc": "Laparoscopy, surgical; cholecystectomy", "CPTcode": "47562", "Modifier": "", "id": 14302 } ], "ICD10ProcRev": [], "CPThcpcsRev": [], "ICD10Procedure": [ { "ProcDesc": "Medical and Surgical. Hepatobiliary System and Pancreas. Resection. Gallbladder. Percutaneous Endoscopic. No Device. No Qualifier", "id": 35351, "ProcCode": "0FT44ZZ" }, { "ProcDesc": "Medical and Surgical. Hepatobiliary System and Pancreas. Excision. Gallbladder. Percutaneous Endoscopic. No Device. No Qualifier", "id": 34694, "ProcCode": "0FB44ZZ" }, { "ProcDesc": "Medical and Surgical. Hepatobiliary System and Pancreas. Destruction. Gallbladder. Percutaneous Endoscopic. No Device. No Qualifier", "id": 34471, "ProcCode": "0F544ZZ" } ], "DaysLeft": 7, "ICD9DiagRev": [], "ICD10DiagRev": [], "ICD9ProcRev": [], "SearchWith": "lap_cholecy", "ICD10Diagnosis": [], "SubscriptionEnds": "2018-01-10 05:17:04" } |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiSinglePhrase/47564.json |
| API Response |
{ "CPThcpcs": [], "ICD10ProcRev": [], "CPThcpcsRev": [ { "AnesBaseUnit": 0, "NonFacTotal": "32.14", "FacTotal": "32.14", "LongDesc": "Laparoscopy, surgical; cholecystectomy with exploration of common duct", "CPTcode": "47564", "Modifier": "", "id": 14304 } ], "ICD10Procedure": [], "DaysLeft": 6, "ICD9DiagRev": [], "ICD10DiagRev": [], "ICD9ProcRev": [], "SearchWith": "47564", "ICD10Diagnosis": [], "SubscriptionEnds": "2018-01-10 05:17:04" } |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiSinglePhrase/Text with no coding candidates.json |
| API Response | { "CPThcpcs": [], "ICD10ProcRev": [], "CPThcpcsRev": [], "ICD10Procedure": [], "DaysLeft": 7, "ICD9DiagRev": [], "ICD10DiagRev": [], "ICD9ProcRev": [], "SearchWith": "Text_with_no_coding_candidates", "ICD10Diagnosis": [], "SubscriptionEnds": "2018-01-10 05:17:04" } |
| Purpose | You send the API as named variables: LocId - the US location (see below) CPTcode ICD10DiagCodeNoPoint code and the API response will include: SupportLCD - LCD supporting the medical necessity of the CPT procedure with the ICD10 Diagnosis code in a specific jurisdiction. NOTSupportLCD - LCD explicitly NOT supporting the combination of CPT code with the ICD10 Diagnosis code at that location. |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiCPTDiagLCD/?CPTcode=29105&ICD10DiagCodeNoPoint=G8191&LocId=12 |
| API Response | {"NOTSupportLCD": [], "SupportLCD": [{"ICD10DiagSupMedNec": "G81.91", "StateName": "Florida", "SupportingLCD": 34560, "CPTcode": "29105"}, {"ICD10DiagSupMedNec": "G81.91", "StateName": "Florida", "SupportingLCD": 34564, "CPTcode": "29105"}], "SearchWithICD10DiagCode": "G8191", "SearchWithLocId": "12", "SearchWithCPTcode": "29105"} |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiCPTDiagLCD/?CPTcode=36471&LocId=12&ICD10DiagCodeNoPoint=I789 |
| API Response | {"NOTSupportLCD": [{"NOTSupportLCD": 33762, "StateName": "Florida", "ICD10DiagNOTSupMedNec": "I78.9", "CPTcode": "36471"}], "SupportLCD": [], "SearchWithICD10DiagCode": "I789", "SearchWithLocId": "12", "SearchWithCPTcode": "36471"} |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiCPTDiagLCD/?CPTcode=123&ICD10DiagCodeNoPoint=123&LocId=123 |
| API Response | {"NOTSupportLCD": [], "SupportLCD": [], "SearchWithICD10DiagCode": "123", "SearchWithLocId": "123", "SearchWithCPTcode": "123"} |
| LocId and State names for apiCPTDiagLCD |
1 Alaska 2 Alabama 3 Arkansas 4 American Samoa 5 Arizona 6 California - Entire State 8 Colorado 9 Connecticut 10 District of Columbia 11 Delaware 12 Florida 14 Georgia 15 Guam 16 Hawaii 17 Iowa 18 Idaho 19 Illinois 20 Indiana 21 Kansas 22 Kentucky 23 Louisiana 24 Massachusetts 25 Maryland 26 Maine 27 Michigan 28 Minnesota 29 Missouri - Entire State 31 Mississippi 32 Montana 34 North Carolina 35 North Dakota 36 Nebraska 37 New Hampshire 38 New Jersey 39 New Mexico 40 Nevada 41 New York - Entire State 42 Ohio 43 Oklahoma 44 Oregon 45 Pennsylvania 46 Puerto Rico 47 Rhode Island 48 South Carolina 49 South Dakota 50 Tennessee 51 Texas 52 Utah 53 Virginia 54 Virgin Islands 55 Vermont 56 Washington 57 Wisconsin 58 West Virginia 59 Wyoming 60 Northern Mariana Islands 61 Missouri - Northeastern & Southern 62 Missouri - Northwestern 63 New York - Downstate 64 New York - Queens 65 New York - Upstate 66 California - Northern 67 California - Southern |
| Purpose | You send the API one CPT code and the API response will include all the information related to the CPT code Note the Location can be set from your Text2Codes account, NOT from the API call. |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiCPTCodeDetails/66172.json |
| API Response | { "DiagSupLCD": [], "DiagNoSupLCD": [], "CPTAbbrev": [ { "AnesBaseUnit": 0, "NonFacTotal": "42.80", "FacTotal": "42.80", "CPTcode": "66172", "CodeType": "CPTCategory1", "ShortDesc": "INCISION OF EYE", "Modifier": "", "LongDesc": "Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)" } ], "DaysLeft": 5, "CPTLocs": [ { "RegPERVU": "0.960", "Area": "REST OF STATE ", "Locality": "99", "RegWorkRVU": "1.000", "RegMPRVU": "1.315", "State": "FLORIDA ", "Carrier": "09102", "Location": "FLORIDA REST OF STATE ALL OTHER COUNTIES ", "id": 21, "Counties": "ALL OTHER COUNTIES " } ], "LCDSupCPT": [], "CPTClinDesc": [ { "ClinDesc": "Fistulization of sclera for glaucoma by trabeculectomy ab externo with injection of antifibrotic agent" } ], "CPTLocsLCD": [ { "StateName": "Florida", "StateID": 12 } ], "SearchWith": "66172", "SubscriptionEnds": "2018-01-10 05:17:04", "CPTDetails": [ { "ConvFactor": "35.7547", "PreOp": "0.10", "IntraOp": "0.70", "CodeType": "CPTCategory1", "id": 19687, "StatusCode": "A - Active Code.\nThese codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an \"A\" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.", "AsstSurg": "2 - Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid.", "CPTcode": "66172", "CalcFlag": "0", "ClinDesc": "Fistulization of sclera for glaucoma by trabeculectomy ab externo with injection of antifibrotic agent", "GlobDays": "090 - Major surgery with a 1-day preoperative period and 90-day postoperative period included in the fee schedule amount.", "MediumDesc": "FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING", "ShortDesc": "INCISION OF EYE", "BilatSurg": "1 - 150% payment adjustment for bilateral procedures applies.\nIf the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers, or with a 2 in the units field), base the payment for these codes when reported as bilateral procedures on the lower of:\n(a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code. If the code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any multiple procedure rules.", "SupervisionDiagProc": "09 - Concept does not apply.", "FacPEOpps": "0.00", "LongDesc": "Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)", "AnesBaseUnit": 0, "NonFacTotal": "42.80", "MPRVU": "1.36", "FacPERVU": "22.58", "MultProc": "2 - Standard payment adjustment rules for multiple procedures apply.\nIf procedure is reported on the same day as another procedure with an indicator of 1, 2, or 3, rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100%, 50%, 50%, 50%, 50% and by report). Base the payment on the lower of (a) the actual charge, or (b) the fee schedule amount reduced by the appropriate percentage.", "WorkRVU": "18.86", "NonFacPEOpps": "0.00", "TeamSurg": "0 - Team surgeons not permitted for this procedure.", "NonFacPERVU": "22.58", "Modifier": "", "PCTCInd": "0 - Physician Service Codes\nIdentifies codes that describe physician services. Examples include visits, consultations, and surgical procedures. \nThe concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 and TC cannot be used with these codes. The RVUS include values for physician work, practice expense and malpractice expense. There are some codes with no work RVUs.", "MPOpps": "0.00", "FacNA": "", "FacTotal": "42.80", "PostOp": "0.20", "CoSurg": "1 - Co-surgeons could be paid, though supporting documentation is required to establish the medical necessity of two surgeons for the procedure.", "ImagingFamIndic": "99 - Concept does not apply", "NotForMedicarePay": "", "NonFacNA": "NA", "EndoBase": 0 } ] } |
| Purpose | You send the API one ICD10 Diagnosis code - WITHOUT the dot - ex: K353 and not K35.3 and the API response will include all the information related to the ICD10 Diagnosis code Note The Location can be set from your Text2Codes account, NOT from the API call. |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiDiagCodeDetails/K353.json |
| API Response | { "exclude2s": [], "sevenchrdefs": [], "Diag9from10": [ { "ICD9DiagDesc": "Acute appendicitis with peritoneal abscess", "id": 5686, "ICD9DiagCodeWithPoint": "540.1", "ICD9DiagCode": "5401" } ], "encounterD": [], "encounterA": [], "CPTSupDiag": [], "codefirsts": [], "encounterS": [], "codealsos": [], "diag": { "ICD10Code": "K35.3", "ICD10CodeNoPoint": "K353", "ICD10Diagnosis": "Acute appendicitis with localized peritonitis", "id": 12372 }, "useadditionalcodes": [], "includess": [], "CPTLocsLCD": [ { "StateName": "Florida", "StateID": 12 } ], "SearchWith": "k353", "notess": [], "exclude1s": [], "inclusionterms": [ { "ICD10Code": "K35.3", "InclusionTerm": "Acute appendicitis with or without perforation or rupture NOS", "id": 4291 }, { "ICD10Code": "K35.3", "InclusionTerm": "Acute appendicitis with or without perforation or rupture with localized peritonitis", "id": 4292 }, { "ICD10Code": "K35.3", "InclusionTerm": "Acute appendicitis with peritoneal abscess", "id": 4293 } ], "sevenchrnotes": [] } |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiDiagCodeDetails/K35.3.json |
| API Response | Not an ICD10 Diagnosis code. |
| Purpose | You send the API one ICD10 Procedure code and the API response will include all the information related to the ICD10 Procedure code Note ICD10 Procedure codes are currently used in the USA for INPATIENTS only |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiProcCodeDetails/0DTJ4ZZ.json |
| API Response | { "DaysLeft": 5, "procICD9": [ { "ICD9ProcCodeWithPoint": "47.01", "ICD9ProcDesc": "Laparoscopic appendectomy", "id": 1530, "ICD9ProcCode": "4701" }, { "ICD9ProcCodeWithPoint": "47.11", "ICD9ProcDesc": "Laparoscopic incidental appendectomy", "id": 1532, "ICD9ProcCode": "4711" } ], "SubscriptionEnds": "2018-01-10 05:17:04", "SearchWith": "0DTJ4ZZ", "RevProcRow": [ { "ProcDesc": "Medical and Surgical. Gastrointestinal System. Resection. Appendix. Percutaneous Endoscopic. No Device. No Qualifier", "id": 33595, "ProcCode": "0DTJ4ZZ" } ] } |
| Purpose | You send the API one LCD code and the API response will include all the information related to the LCD Note The Location can be set from your Text2Codes account, NOT from the API call. |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiLCDCodeDetails/34563.json |
| API Response | { "ICD10DsupN": [], "CPTcodes": [ { "ConvFactor": "35.7547", "PreOp": "0.00", "IntraOp": "0.00", "CodeType": "CPTCategory1", "id": 25515, "StatusCode": "A - Active Code.\nThese codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an \"A\" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.", "AsstSurg": "0 - Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.", "CPTcode": "92523", "CalcFlag": "0", "ClinDesc": "Evaluation of sound production with evaluation of language comprehension and expression", "GlobDays": "XXX - The global concept does not apply to the code.", "MediumDesc": "EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION", "ShortDesc": "SPEECH SOUND LANG COMPREHEN", "BilatSurg": "0 - 150% payment adjustment for bilateral procedures does not apply.\nIf procedure is reported with modifier -50 or with modifiers RT and LT, base the payment for the two sides on the lower of:\n(a) the total actual charge for both sides or (b) 100% of the fee schedule amount for a single code. \nExample: The fee schedule amount for code XXXXX is $125. The physician reports code XXXXX-LT with an actual charge of $100 and XXXXX-RT with an actual charge of $100. Payment should be based on the fee schedule amount ($125) since it is lower than the total actual charges for the left and right sides ($200).\nThe bilateral adjustment is inappropriate for codes in this category (a) because of physiology or anatomy, or (b) because the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure.", "SupervisionDiagProc": "09 - Concept does not apply.", "FacPEOpps": "0.00", "LongDesc": "Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)", "AnesBaseUnit": 0, "NonFacTotal": "5.30", "MPRVU": "0.15", "FacPERVU": "2.15", "MultProc": "5 - Subject to 20% of the practice expense component for certain therapy services.\n25% reduction for services rendered in an institutional setting - effective for services January 1, 2013 and after.", "WorkRVU": "3.00", "NonFacPEOpps": "0.00", "TeamSurg": "0 - Team surgeons not permitted for this procedure.", "NonFacPERVU": "2.15", "Modifier": "", "PCTCInd": "7 - Physical therapy service, for which payment may not be made\nPayment may not be made if the service is provided to either a patient in a hospital outpatient department or to an inpatient of the hospital by an independently practicing physical or occupational therapist.", "MPOpps": "0.00", "FacNA": "NA", "FacTotal": "5.30", "PostOp": "0.00", "CoSurg": "0 - Co-surgeons not permitted for this procedure.", "ImagingFamIndic": "99 - Concept does not apply", "NotForMedicarePay": "", "NonFacNA": "", "EndoBase": 0 }, { "ConvFactor": "35.7547", "PreOp": "0.00", "IntraOp": "0.00", "CodeType": "CPTCategory1", "id": 26195, "StatusCode": "A - Active Code.\nThese codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an \"A\" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.", "AsstSurg": "0 - Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity.", "CPTcode": "96111", "CalcFlag": "0", Response is abbreviated here for making the page reasonable in length, as it can have hundreds of codes related to a LCD |
| Purpose | You send the API nothing and the API response will include all the information related to modifiers |
| Endpoint | https://www.text2codes.com/T2C/home2api/apiStaticModifiers/.json |
| API Response | { "HCPCSModifiers": [ { "ModifierDesc": "", "ModifierTitle": "Upper left, eyelid ", "Modifier": "E1", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Lower left, eyelid ", "Modifier": "E2", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Upper right, eyelid ", "Modifier": "E3", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Lower right, eyelid ", "Modifier": "E4", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left hand, second digit ", "Modifier": "F1", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left hand, third digit ", "Modifier": "F2", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left hand, fourth digit ", "Modifier": "F3", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left hand, fifth digit ", "Modifier": "F4", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right hand, thumb ", "Modifier": "F5", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right hand, second digit ", "Modifier": "F6", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right hand, third digit ", "Modifier": "F7", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right hand, fourth digit ", "Modifier": "F8", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right hand, fifth digit ", "Modifier": "F9", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left hand, thumb ", "Modifier": "FA", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day", "Modifier": "GG", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Diagnostic mammogram converted from screening mammogram on same day", "Modifier": "GH", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left circumflex coronary artery", "Modifier": "LC", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left anterior descending coronary artery", "Modifier": "LD", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left main coronary artery", "Modifier": "LM", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "LT Left side (used to identify procedures performed on the left side of the body)", "Modifier": "LT", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Ambulance service provided under arrangement by a provider of services", "Modifier": "QM", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Ambulance service furnished directly by a provider of services", "Modifier": "QN", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right coronary artery", "Modifier": "RC", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Ramus intermedius coronary artery ", "Modifier": "RI", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right side (used to identify procedures performed on the right side of the body) ", "Modifier": "RT", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left foot, second digit ", "Modifier": "T1", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left foot, third digit ", "Modifier": "T2", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left foot, fourth digit ", "Modifier": "T3", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left foot, fifth digit ", "Modifier": "T4", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right foot, great toe ", "Modifier": "T5", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right foot, second digit ", "Modifier": "T6", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right foot, third digit ", "Modifier": "T7", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right foot, fourth digit ", "Modifier": "T8", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Right foot, fifth digit ", "Modifier": "T9", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Left foot, great toe ", "Modifier": "TA", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Separate Encounter * (*HCPCS modifiers for selective identification of subsets of Distinct Procedural Services [-59 modifier])", "Modifier": "XE", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Separate Structure * (*HCPCS modifiers for selective identification of subsets of Distinct Procedural Services [-59 modifier])", "Modifier": "XS", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Separate Practitioner * (*HCPCS modifiers for selective identification of subsets of Distinct Procedural Services [-59 modifier])", "Modifier": "XP", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Unusual Non-Overlapping Service * (*HCPCS modifiers for selective identification of subsets of Distinct Procedural Services [-59 modifier])", "Modifier": "XU", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "CRNA service: with medical direction by a physician", "Modifier": "QX", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Medical direction of one CRNA by an anesthesiologist", "Modifier": "QY", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Physician provided service in a rural HPSA", "Modifier": "QB", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals", "Modifier": "QK", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": "", "ModifierTitle": "Monitored anesthesia care service (MAC)", "Modifier": "QS", "ModifierType": "HCPCS Level 2 Modifier" }, { "ModifierDesc": null, "ModifierTitle": "CRNA service: without medical direction by a physician", "Modifier": "QZ", "ModifierType": "HCPCS Level 2 Modifier" } ], "ASCModifiers": [ { "ModifierDesc": "For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E/M encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department E/M code(s). This modifier provides a means of reporting circumstances involving evaluation and management services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (eg, hospital emergency department, clinic). Note: This modifier is not to be used for physician reporting of multiple E/M services performed by the same physician on the same date. For physician reporting of all outpatient evaluation and management services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital emergency department, clinic), see Evaluation and Management, Emergency Department, or Preventive Medicine Services codes.", "ModifierTitle": "Multiple Outpatient Hospital E/M Encounters on the Same Date", "Modifier": "27", "ModifierType": "ASC Modifier" }, { "ModifierDesc": "Due to extenuating circumstances or those that threaten the well being of the patient, the physician may cancel a surgical or diagnostic procedure subsequent to the patient's surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia (local, regional block(s) or general). Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure number and the addition of modifier 73. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.", "ModifierTitle": "Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia", "Modifier": "73", "ModifierType": "ASC Modifier" }, { "ModifierDesc": "(local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.", "ModifierTitle": "Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia", "Modifier": "74", "ModifierType": "ASC Modifier" } ], "CPTModifiers": [ { "ModifierDesc": "When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service.", "ModifierTitle": "Increased Procedural Services", "Modifier": "22", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia. This circumstance may be reported by adding modifier 23 to the procedure code of the basic service.", "ModifierTitle": "Unusual Anesthesia", "Modifier": "23", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "The physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service.", "ModifierTitle": "Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period", "Modifier": "24", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery. See modifier 57 For significant, separately identifiable non-E/M services, see modifier 59.", "ModifierTitle": "Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service", "Modifier": "25", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Certain procedures are a combination of a physician or other qualified health care professional component and a technical component. When the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.", "ModifierTitle": "Professional Component", "Modifier": "26", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure.", "ModifierTitle": "Mandated Services", "Modifier": "32", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "When the primary purpose of the service is the delivery of an evidence based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.", "ModifierTitle": "Preventive Services", "Modifier": "33", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Regional or general anesthesia provided by the surgeon may be reported by adding modifier 47 to the basic service. (This does not include local anesthesia.) Note: Modifier 47 would not be used as a modifier for the anesthesia procedures.", "ModifierTitle": "Anesthesia by Surgeon", "Modifier": "47", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code.", "ModifierTitle": "Bilateral Procedure", "Modifier": "50", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "When multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). Note: This modifier should not be appended to designated \"add-on\" codes (see Appendix D).", "ModifierTitle": "Multiple Procedures", "Modifier": "51", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. Note: For hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).", "ModifierTitle": "Reduced Services", "Modifier": "52", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. Note: This modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).", "ModifierTitle": "Discontinued Procedure", "Modifier": "53", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "When 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.", "ModifierTitle": "Surgical Care Only", "Modifier": "54", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "When 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number.", "ModifierTitle": "Postoperative Management Only", "Modifier": "55", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "When 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number.", "ModifierTitle": "Preoperative Management Only", "Modifier": "56", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.", "ModifierTitle": "Decision for Surgery", "Modifier": "57", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "It may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure. Note: For treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.", "ModifierTitle": "Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period:", "Modifier": "58", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25. See also page 684, Level II HCPCS/National Modifiers listing.", "ModifierTitle": "Distinct Procedural Service", "Modifier": "59", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "When 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. Note: If a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.", "ModifierTitle": "Two Surgeons", "Modifier": "62", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician or other qualified health care professional work commonly associated with these patients. This circumstance may be reported by adding modifier 63 to the procedure number. Note: Unless otherwise designated, this modifier may only be appended to procedures/services listed in the 20005-69990 code series. Modifier 63 should not be appended to any CPT codes listed in the Evaluation and Management Services, Anesthesia, Radiology, Pathology/Laboratory, or Medicine sections.", "ModifierTitle": "Procedure Performed on Infants less than 4 kg", "Modifier": "63", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the \"surgical team\" concept. Such circumstances may be identified by each participating individual with the addition of modifier 66 to the basic procedure number used for reporting services.", "ModifierTitle": "Surgical Team", "Modifier": "66", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "It may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service. Note: This modifier should not be appended to an E/M service.", "ModifierTitle": "Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional", "Modifier": "76", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "It may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 77 to the repeated procedure or service. Note: This modifier should not be appended to an E/M service.", "ModifierTitle": "Repeat Procedure by Another Physician or Other Qualified Health Care Professional", "Modifier": "77", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (For repeat procedures, see modifier 76.)", "ModifierTitle": "Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period", "Modifier": "78", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "The individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using modifier 79. (For repeat procedures on the same day, see modifier 76.)", "ModifierTitle": "Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period", "Modifier": "79", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).", "ModifierTitle": "Assistant Surgeon", "Modifier": "80", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.", "ModifierTitle": "Minimum Assistant Surgeon", "Modifier": "81", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "The unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).", "ModifierTitle": "Assistant Surgeon (when qualified resident surgeon not available)", "Modifier": "82", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "When laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.", "ModifierTitle": "Reference (Outside) Laboratory", "Modifier": "90", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. Note: This modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.", "ModifierTitle": "Repeat Clinical Diagnostic Laboratory Test", "Modifier": "91", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "When laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (HIV testing 86701-86703, and 87389). The test does not require permanent dedicated space, hence by its design may be hand carried or transported to the vicinity of the patient for immediate testing at that site, although location of the testing is not in itself determinative of the use of this modifier.", "ModifierTitle": "Alternative Laboratory Platform Testing", "Modifier": "92", "ModifierType": "CPT Modifier" }, { "ModifierDesc": "Under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. In such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service.", "ModifierTitle": "Multiple Modifiers", "Modifier": "99", "ModifierType": "CPT Modifier" } ], "AnesModifiers": [ { "ModifierDesc": null, "ModifierTitle": "A normal healthy patient", "Modifier": "P1", "ModifierType": "Anesthesia Modifier" }, { "ModifierDesc": null, "ModifierTitle": "A patient with mild systemic disease", "Modifier": "P2", "ModifierType": "Anesthesia Modifier" }, { "ModifierDesc": null, "ModifierTitle": "A patient with severe systemic disease", "Modifier": "P3", "ModifierType": "Anesthesia Modifier" }, { "ModifierDesc": null, "ModifierTitle": "A patient with severe systemic disease that is a constant threat to life", "Modifier": "P4", "ModifierType": "Anesthesia Modifier" }, { "ModifierDesc": null, "ModifierTitle": "A moribund patient who is not expected to survive without the operation", "Modifier": "P5", "ModifierType": "Anesthesia Modifier" }, { "ModifierDesc": null, "ModifierTitle": "A declared brain-dead patient whose organs are removed for donor purposes", "Modifier": "P6", "ModifierType": "Anesthesia Modifier" } ], "SubscriptionEnds": "2018-01-10 05:17:04", "DaysLeft": 5 } |