Surgical Procedures CPT Codes and Descriptions

1 Surgical Procedures CPT Codes and Descriptions This list of Codes applies to Anthem clinical guideline CG-Surg-52: Site of Care: Hospital- Based Ambulatory Surgical Procedures and Endoscopic Services. The following Codes for treatments and Procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. CPT Codes Body System Description ANESTHESIA FOR UPPER GI. 00731 OTHER - ANESTHESIA SERVICES.

2 Procedures . ANESTHESIA FOR UPPER GI. 00732 OTHER - ANESTHESIA SERVICES. Procedures - ERCP. ANESTHESIA FOR LOWER GI. 00811 OTHER - ANESTHESIA SERVICES Procedures - DIAGNOSTIC. COLONOSCOPY. ANESTHESIA FOR LOWER GI. 00812 OTHER - ANESTHESIA SERVICES Procedures - SCREENING. COLONOSCOPY. ANESTHESIA FOR COMBINED UPPER. 00813 OTHER - ANESTHESIA SERVICES. AND LOWER GI Procedures . 0652T DIGESTIVE SYSTEM EGD DIAGNOSTIC TRANSNASAL. 0653T DIGESTIVE SYSTEM EGD TRANSNASAL W/BIOPSY. 0654T DIGESTIVE SYSTEM EGD TRANSNASAL/CATH INSERTION. CPT Codes Body System Description 10060 INTEGUMENTARY SYSTEM DRAINAGE OF SKIN ABSCESS. 10061 INTEGUMENTARY SYSTEM DRAINAGE OF SKIN ABSCESS. 10080 INTEGUMENTARY SYSTEM DRAINAGE OF PILONIDAL CYST.

3 10081 INTEGUMENTARY SYSTEM DRAINAGE OF PILONIDAL CYST. 10120 INTEGUMENTARY SYSTEM REMOVE FOREIGN BODY. 10121 INTEGUMENTARY SYSTEM REMOVE FOREIGN BODY. 10140 INTEGUMENTARY SYSTEM DRAINAGE OF HEMATOMA/FLUID. 10160 INTEGUMENTARY SYSTEM PUNCTURE DRAINAGE OF LESION. 10180 INTEGUMENTARY SYSTEM COMPLEX DRAINAGE WOUND. 11000 INTEGUMENTARY SYSTEM DEBRIDE INFECTED SKIN. 11010 INTEGUMENTARY SYSTEM DEBRIDE SKIN AT FX SITE. 11012 INTEGUMENTARY SYSTEM DEB SKIN BONE AT FX SITE. 11042 INTEGUMENTARY SYSTEM DEB SUBQ TISSUE 20 SQ CM/<. CPT Codes Body System Description 11044 INTEGUMENTARY SYSTEM DEB BONE 20 SQ CM/<. 11200 INTEGUMENTARY SYSTEM REMOVAL OF SKIN TAGS <W/15. 11310 INTEGUMENTARY SYSTEM SHAVE SKIN LESION CM/<. 11402 INTEGUMENTARY SYSTEM EXC TR-EXT B9+MARG CM.

4 11403 INTEGUMENTARY SYSTEM EXC TR-EXT B9+MARG 11404 INTEGUMENTARY SYSTEM EXC TR-EXT B9+MARG CM. 11406 INTEGUMENTARY SYSTEM EXC TR-EXT B9+MARG > CM. 11420 INTEGUMENTARY SYSTEM EXC H-F-NK-SP B9+MARG <. 11421 INTEGUMENTARY SYSTEM EXC H-F-NK-SP B9+MARG 11422 INTEGUMENTARY SYSTEM EXC H-F-NK-SP B9+MARG 11423 INTEGUMENTARY SYSTEM EXC H-F-NK-SP B9+MARG 11424 INTEGUMENTARY SYSTEM EXC H-F-NK-SP B9+MARG 11426 INTEGUMENTARY SYSTEM EXC H-F-NK-SP B9+MARG >4 CM. CPT Codes Body System Description 11440 INTEGUMENTARY SYSTEM EXC FACE-MM B9+MARG CM/<. 11441 INTEGUMENTARY SYSTEM EXC FACE-MM B9+MARG CM. 11442 INTEGUMENTARY SYSTEM EXC FACE-MM B9+MARG CM. 11443 INTEGUMENTARY SYSTEM EXC FACE-MM B9+MARG CM. 11444 INTEGUMENTARY SYSTEM EXC FACE-MM B9+MARG CM.

5 11446 INTEGUMENTARY SYSTEM EXC FACE-MM B9+MARG >4 CM. 11450 INTEGUMENTARY SYSTEM REMOVAL SWEAT GLAND LESION. 11451 INTEGUMENTARY SYSTEM REMOVAL SWEAT GLAND LESION. 11462 INTEGUMENTARY SYSTEM REMOVAL SWEAT GLAND LESION. 11463 INTEGUMENTARY SYSTEM REMOVAL SWEAT GLAND LESION. 11470 INTEGUMENTARY SYSTEM REMOVAL SWEAT GLAND LESION. 11471 INTEGUMENTARY SYSTEM REMOVAL SWEAT GLAND LESION. 11601 INTEGUMENTARY SYSTEM EXC TR-EXT MAL+MARG CM. CPT Codes Body System Description 11602 INTEGUMENTARY SYSTEM EXC TR-EXT MAL+MARG CM. 11603 INTEGUMENTARY SYSTEM EXC TR-EXT MAL+MARG CM. 11604 INTEGUMENTARY SYSTEM EXC TR-EXT MAL+MARG CM. 11606 INTEGUMENTARY SYSTEM EXC TR-EXT MAL+MARG >4 CM. 11620 INTEGUMENTARY SYSTEM EXC H-F-NK-SP MAL+MARG <.

6 11621 INTEGUMENTARY SYSTEM EXC S/N/H/F/G MAL+MRG 11622 INTEGUMENTARY SYSTEM EXC S/N/H/F/G MAL+MRG 11623 INTEGUMENTARY SYSTEM EXC S/N/H/F/G MAL+MRG 11624 INTEGUMENTARY SYSTEM EXC S/N/H/F/G MAL+MRG 11626 INTEGUMENTARY SYSTEM EXC S/N/H/F/G MAL+MRG >4 CM. 11640 INTEGUMENTARY SYSTEM EXC F/E/E/N/L MAL+MRG <. 11641 INTEGUMENTARY SYSTEM EXC F/E/E/N/L MAL+MRG 11642 INTEGUMENTARY SYSTEM EXC F/E/E/N/L MAL+MRG CPT Codes Body System Description 11643 INTEGUMENTARY SYSTEM EXC F/E/E/N/L MAL+MRG 11644 INTEGUMENTARY SYSTEM EXC F/E/E/N/L MAL+MRG 11646 INTEGUMENTARY SYSTEM EXC F/E/E/N/L MAL+MRG >4 CM. 11730 INTEGUMENTARY SYSTEM REMOVAL OF NAIL PLATE. 11750 INTEGUMENTARY SYSTEM REMOVAL OF NAIL BED. 11760 INTEGUMENTARY SYSTEM REPAIR OF NAIL BED.

7 11765 INTEGUMENTARY SYSTEM EXCISION OF NAIL FOLD TOE. 11770 INTEGUMENTARY SYSTEM REMOVE PILONIDAL CYST SIMPLE. 11772 INTEGUMENTARY SYSTEM REMOVE PILONIDAL CYST COMPL. 11900 INTEGUMENTARY SYSTEM INJECT SKIN LESIONS </W 7. 12001 INTEGUMENTARY SYSTEM RPR S/N/AX/GEN/TRNK <. 12002 INTEGUMENTARY SYSTEM RPR S/N/AX/ 12011 INTEGUMENTARY SYSTEM RPR F/E/E/N/L/M CM/<. CPT Codes Body System Description 12020 INTEGUMENTARY SYSTEM CLOSURE OF SPLIT WOUND. 12031 INTEGUMENTARY SYSTEM INTMD RPR S/A/T/EXT CM/<. 12032 INTEGUMENTARY SYSTEM INTMD RPR S/A/T/EXT 12034 INTEGUMENTARY SYSTEM INTMD RPR S/TR/EXT 12035 INTEGUMENTARY SYSTEM INTMD RPR S/A/T/EXT 12037 INTEGUMENTARY SYSTEM INTMD RPR S/TR/EXT > CM. 12041 INTEGUMENTARY SYSTEM INTMD RPR N-HF/GENIT <.

8 12042 INTEGUMENTARY SYSTEM INTMD RPR N- 12051 INTEGUMENTARY SYSTEM INTMD RPR FACE/MM CM/<. 12052 INTEGUMENTARY SYSTEM INTMD RPR FACE/MM CM. 13100 INTEGUMENTARY SYSTEM CMPLX RPR TRUNK CM. 13101 INTEGUMENTARY SYSTEM CMPLX RPR TRUNK CM. 13120 INTEGUMENTARY SYSTEM CMPLX RPR S/A/L CM. CPT Codes Body System Description 13121 INTEGUMENTARY SYSTEM CMPLX RPR S/A/L CM. 13131 INTEGUMENTARY SYSTEM CMPLX RPR F/C/C/M/N/AX/G/H/F. 13132 INTEGUMENTARY SYSTEM CMPLX RPR F/C/C/M/N/AX/G/H/F. 13151 INTEGUMENTARY SYSTEM CMPLX RPR E/N/E/L CM. 13152 INTEGUMENTARY SYSTEM CMPLX RPR E/N/E/L CM. 13160 INTEGUMENTARY SYSTEM LATE CLOSURE OF WOUND. 14020 INTEGUMENTARY SYSTEM TIS TRNFR S/A/L 10 SQ CM/<. 14301 INTEGUMENTARY SYSTEM TIS TRNFR ANY SQ CM.

9 15004 INTEGUMENTARY SYSTEM WOUND PREP F/N/HF/G. 15100 INTEGUMENTARY SYSTEM SKIN SPLT GRFT TRNK/ARM/LEG. 15120 INTEGUMENTARY SYSTEM SKN SPLT A-GRFT FAC/NCK/HF/G. 15220 INTEGUMENTARY SYSTEM SKIN FULL GRAFT SCLP/ARM/LEG. 15240 INTEGUMENTARY SYSTEM SKIN FULL GRFT FACE/GENIT/HF. CPT Codes Body System Description 15260 INTEGUMENTARY SYSTEM SKIN FULL GRAFT EEN & LIPS. 15576 INTEGUMENTARY SYSTEM PEDICLE E/N/E/L/NTRORAL. 15760 INTEGUMENTARY SYSTEM COMPOSITE SKIN GRAFT. 15770 INTEGUMENTARY SYSTEM DERMA-FAT-FASCIA GRAFT. 17000 INTEGUMENTARY SYSTEM DESTRUCT PREMALG LESION. 17004 INTEGUMENTARY SYSTEM DESTROY PREMAL LESIONS 15/>. 17110 INTEGUMENTARY SYSTEM DESTRUCT B9 LESION 1-14. 17111 INTEGUMENTARY SYSTEM DESTRUCT LESION 15 OR MORE.

10 19020 INTEGUMENTARY SYSTEM INCISION OF BREAST LESION. 19101 INTEGUMENTARY SYSTEM BIOPSY OF BREAST OPEN. 19110 INTEGUMENTARY SYSTEM NIPPLE EXPLORATION. 19120 INTEGUMENTARY SYSTEM REMOVAL OF BREAST LESION. 19125 INTEGUMENTARY SYSTEM EXCISION BREAST LESION. CPT Codes Body System Description 20220 MUSCULOSKELETAL SYSTEM BONE BIOPSY TROCAR/NEEDLE. 20225 MUSCULOSKELETAL SYSTEM BONE BIOPSY TROCAR/NEEDLE. 20240 MUSCULOSKELETAL SYSTEM BONE BIOPSY OPEN SUPERFICIAL. 20245 MUSCULOSKELETAL SYSTEM BONE BIOPSY OPEN DEEP. 20520 MUSCULOSKELETAL SYSTEM REMOVAL OF FOREIGN BODY. 20525 MUSCULOSKELETAL SYSTEM REMOVAL OF FOREIGN BODY. 20526 MUSCULOSKELETAL SYSTEM THER INJECTION CARP TUNNEL. 20551 MUSCULOSKELETAL SYSTEM INJ TENDON ORIGIN/INSERTION.