"CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association."

2011 CPT CODE CHANGES


Also see the list of new and Deleted CPT codes effective for the year 2012

Evaluation and Management – 3 New Codes

99224 - Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.

99225 - Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit

99226 - Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient’s hospital floor or unit.

Integumentary System – 3 New & 2 Deleted codes

New CPT codes (Add-on Codes)

11045 - Debridement Subcutaneous Tissue, each additional 20 sq cm
11046 - Debridement Muscle/Fascia, each additional 20 sq cm
11047 - Debridement Bone, each additional 20 sq cm

Deleted codes

11040 & 11041 Debridement; skin; partial & full thickness

Musculoskeletal System – 5 New Codes

22551 - ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
22552 - ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
29914 - ARTHROSCOPY HIP W/FEMOROPLASTY
29915 - ARTHROSCOPY HIP W/ACETABULOPLASTY
29916 - ARTHROSCOPY HIP W/LABRAL REPAIR

Respiratory System – 4 New Codes

31295 - NSL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS
31296 - NSL/SINUS NDSC SURG W/DILAT FRONTAL SINUS
31297 - NSL/SINUS NDSC SURG W/DILAT SPHENOID SINUS
31634 - BRONCHOSCOPY BALLOON OCCLUSION

Cardiovascular System – 20 New & 23 Deleted

New CPT codes

33620 - APPLICATION RIGHT & LEFT PULMONARY ARTERY BANDS
33621 - TTHRC CATHETER INSERT FOR STENT PLACEMENT
33622 - RECONSTRUCTION COMPLEX CARDIAC ANOMALY
37220 - REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL
37221 - REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOP UNI
37222 - REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL
37223 - REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSI VSL
37224 - REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
37225 - REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
37226 - REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
37227 - REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
37228 - REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
37229 - REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
37230 - REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
37231 - REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL
37232 - REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
37233 - REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
37234 - REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
37235 - REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL
38900 - INTRAOP SENTINEL LYMPH ID W/DYE NJX

Deleted Codes

35454 – 35474 Transluminal balloon angioplasty
35480 - 35495 Transluminal peripheral atherectomy
39520 - 39531 Repair, diaphragmatic hernia

Digestive System – 18 New & 4 Deleted

New CPT codes

43283 - LAPS ESOPHAGEAL LENGTHENING ADDL
43327 - ESOPG/GSTR FUNDOPLASTY W/LAPT
43328 - ESOPG/GSTR FUNDOPLASTY W/THORCOM
43332 - RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH
43333 - LAPT RPR PARAESOPH HIATAL HERNIA W/ MESH
43334 - RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH
43335 - RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH
43336 - RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH
43337 - RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH
43338 - ESOPHAGUS LENGTHENING
43753 - GASTRIC TUBE PLMT W/ASPIR & LAVAGE
43754 - GASTRIC TUBE DX PLMT W/ASPIR 1 SPECIMEN
43755 - GASTRIC TUBE DX PLMT W/ASPIR MULT SPECIMENS
43756 - DUODENAL TUBE DX PLMT W/IMG GID 1 SPECIMEN
43757 - DUODENAL TUBE DX PLMT W/IMG GID MULT SPECIMEN
49327 - LAPS W/INSERTION NTRSTL DEV W/IMG GID 1+
49412 - PLMT INTRSTL DEV OPN W/IMG GID 1+
49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID

Deleted Codes

43324 - Esophagogastric fundoplasty (eg, Nissen, Belsey IV, Hill procedures)
43325 - Esophagogastric fundoplasty; with fundic patch (Thal-Nissen procedure)
43600 - Biopsy of stomach; by capsule, tube, peroral (1 or more specimens)
49420 - Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary

Urinary System – 1 New Code

53860 - Transurethral Radiofrequency Treatment for Stress Incontinence

Female Genitourinary System – 1 New Code

57156 - Insertion of Vaginal Brachytherapy Device

Nervous System – 8 New & 2 Deleted codes

New CPT Codes

61781 - Stereotactic Computer Assisted PX IDRL CRNL
61782 - Stereotactic Computer Assisted PX XDRL CRNL
61783 - Stereotactic Computer Assisted PX SPINAL
64566 - POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
64568 - INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER
64569 - REVISION/REPLMT NSTIM CRNL ELTRDS
64570 - REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATOR
64611 - CHEMODENERV PAROTID & SUBMANDIBL SALIVARY GLANDS BI

Deleted CPT codes

61795 - Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure)
64573 - Incision for implantation of neurostimulator electrodes; cranial nerve

Eye and Ocular Adnexa – 4 New Codes

65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN
65779 - PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED
66174 - TRLUML DILAT AQUEOUS CANAL W/O DEV/STNT
66175 - TRLUML DILAT AQUEOUS CANAL W/DEV/STNT

Radiology – 5 New Codes

74176 - CT ABD & PELVIS W/O CONTRAST
74177 - CT ABD & PELVIS W/CONTRAST
74178 - CT ABD & PELVIS W/O CONTRST 1+ BODY REGNS
76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL
76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD

Pathology & Laboratory–15 New & 13 Deleted codes

New CPT codes

80104 - DRUG SCRN QUAL 1+ CLASS NONCHROMOTOGRAPHIC EA
82930 - GASTRIC ACID ANALYIS W/PH EA SPECIMEN
83861 - MICROFLUID ANALYSIS TEAR OSMOLARITY
84112 - PLACENTAL ALPHA MICROGLOBULIN C/V QUAL
85598 - PHOSPHOLIPID NEUTRALIZATION HEXAGONAL
86481 - TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP
86902 - BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA
87501 - INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE
87502 - INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
87503 - NFCT AGENT DNA/RNA INFLUENZA 1+ TYPES EA ADDL
87906 - NFCT GEXYP DNA/RNA HIV 1 OTHER REGION
88120 - CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL
88121 - CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA
88177 - CYTP C/V AUTO THIN LYR PREPJ ADEQUACY EA EVAL
88363 - EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS
88749 - UNLISTED IN VIVO LAB SERVICE

Deleted codes

82926 - Gastric acid, free and total, each specimen
82928 - Gastric acid, free or total, each specimen
86903 - Blood typing; antigen screening for compatible blood unit using reagent serum, per unit screened
89100 - Duodenal intubation and aspiration; single specimen (eg, simple bile study or afferent loop culture) plus appropriate test procedure
89105 - Duodenal intubation and aspiration; collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube
89130 - Gastric intubation and aspiration, diagnostic, each specimen, for chemical analyses or cytopathology;
89132 - Gastric intubation and aspiration, diagnostic, each specimen, for chemical analyses or cytopathology; after stimulation
89135 - Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 1 hour
89136 - Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 2 hours
89140 - Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 2 hours including gastric stimulation (eg, histalog, pentagastrin)
89141 - Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 3 hours, including gastric stimulation
89225 - Starch granules, feces
89235 - Water load test

Medicine – 39 New & 41 Deleted codes


New CPT codes

90460 - IMADM THROUGH 18YR ANY ROUTE 1ST VAC/TOXOID
90461 - IMADM THROUGH 18YR ANY ROUTE EA ADDL VAC/TOXOID
90644 - MENINGOCOCCAL & HIB CONJ VACCINE 4 DOSE IM
90664 - INFLUENZA VAC PANDEMIC FORMULA LIVE INTRANASAL
90666 - INFLUENZA VACCINE PANDEMIC SPLT PRSRV FREE IM
90667 - INFLUENZA VACCINE PANDEMIC SPLT ADJUVANT IM
90668 - INFLUENZA VACCINE PANDEMIC SPLT IM
90867 - TRANSCRANIAL MAG STIMJ TX PLANNING
90868 - TRANSCRANIAL MAG STIMJ TX DLVR & MGMT
91013 - ESOPHGL MOTILITY STD W/I&R STIM/PERFUSION
91117 - COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R
92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI
92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE
92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA
92227 - REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/BI
92228 - REMOTE IMG MGT RETINL DIS W/I&R UNI/BI
93451 - RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
93452 - L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
93453 - R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
93454 - CATH PLMT & NJX CORONARY ART ANGIO IMG S&I
93455 - CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
93456 - CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
93457 - CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I
93458 - CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
93459 - CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
93460 - R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I
93461 - R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I
93462 - LEFT HEART CATH BY TRANSEPTAL PUNCTURE
93463 - MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
93464 - PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE
93563 - NJX SEL HRT ART CONGENITAL HRT CATH W/S&I
93564 - NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I
93565 - NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I
93566 - NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
93567 - NJX SUPRAVALV AORTOG HRT CATH W/S&I
93568 - NJX PULMONARY ANGIO HRT CATH W/S&I
95800 - SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
95801 - SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL
96446 - CHEMOTX ADMN PRTL CAVITY PORT/CATH

Deleted Codes

Immunization Administration

90465 - Immune admin 1 inj,

90466 - Immune admin addl inj,
90467 - Immune admin o or n, 1 inj,
90468 - Immune admin o/n, addl inj,

91000 Esophageal intubation

Manometry

91011 - Esophagus motility study w mechoyl
91012 - Esophagus motility study w acid perfusion studies 91052 - Gastric analysis test

91055 - Gastric intubation for smear
91105 - Gastric intubation treatment
91123 - Irrigate fecal impaction
92135 - Ophth dx imaging post seg

Electrocardiographic services

93012 - Transmission of ecg
93014 - Report on transmitted ecg

Ambulatory ECG Monitoring

CPT codes 93230 - 93237

Heart Catheterization and Injection procedure Codes

93501 - Right heart catheterization
93508 - Cath placement, angiography
93510 - Left heart catheterization; percutaneous
93511 - Left heart catheterization; by cutdown
93514 - Left heart catheterization by ventricular puncture

Combined Heart Catheterization

CPT codes 93524 - 93529

Injection procedures

CPT codes 93539 - 93545

Imaging Supervision

CPT codes 93555 - 93556

Chemotherapy Administration

96445 - Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis

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A complete list of 2012 ICD 9 CM changes includes all New, Deleted and Revised ICD 9 CM codes

2011 New modifiers

2011 New vaccine codes and its full description

2011 New modifiers and its usage


Modifier AY: Item/service not for ESRD treatment
Certain laboratory services and limited drugs and supplies will be subject to Part B consolidated billing and will no longer be separately payable when provided for ESRD beneficiaries by providers other than the renal dialysis facility. Should these lab services, and limited drugs be provided to a beneficiary, but are not related to the treatment for ESRD, the claim lines must be submitted by the laboratory supplier or other provider with the new AY HCPCS modifier to allow for separate payment outside of ESRD PPS. ESRD facilities billing for any labs or drugs will be considered part of the bundled PPS payment unless billed with the HCPCS modifier AY.

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7064.pdf


When claims are received without the AY modifier for items and services that are not separately payable due to the ESRD PPS consolidated billing process, the claims will be returned with claim adjustment reason code (CARC) 109 (Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.), RARC N538 (A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.), and assign Group code CO.

Modifier AZ: Physician service in dental HPSA Long description: “Physician providing a service in a Dental Health Professional Shortage Area for the purpose of an Electronic Health Record Incentive payment.”
In order to allow EPs to report claims rendered in a dental HPSA when the zip code does not fully fall within the dental HPSA, CMS has developed a new EHR HPSA modifier AZ. It is effective for dates of service on and after January 1, 2011. The new modifier will not affect the payment or calculation of the FFS geographic quarterly HPSA bonus.

The Integrated Data Repository will be responsible for determining which EPs are due the EHR HPSA incentive payment increase and determining the amount of the payment.

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7035.pdf


Modifier CS: Gulf Oil 2010 Spill Related Long description: “Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent clean-up activities.”
CMS is requiring that every Medicare Fee-For-Service claim be specifically identified if it is for an item or service furnished to a Medicare beneficiary, where the provision of such item or service is related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico and/or circumstances related to such oil spill, including but not limited to subsequent clean-up activities.

Claims from physicians, other practitioners, and suppliers must be annotated with the modifier “CS” for each line item where the item or service is so related. Similarly, claims from institutional billers must be annotated with a condition code of “BP” when the entire claim is so related or with the “CS” modifier for each relevant line item when only certain line items are so related. The modifier and condition code are to be used for claims with dates of service on or after April 20, 2010.

The title of the BP condition code is “Gulf oil spill related” and its definition is as follows: “This code identifies claims where the provision of all services on the claim are related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico and/or circumstances related to such spill, including but not limited to subsequent clean-up activities.”

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7087.pdf


Modifier-PT - Colorectal Cancer screening test, converted to diagnostic test or other procedure

Modifier PT should be appended for the diagnostic procedure code that is reported instead of the screening colonoscopy or screening flexible sigmoidoscopy HCPCS code, or as a result of the barium enema when the screening test becomes a diagnostic service. This will prompt the claims processing system to waive the deductible for all surgical services on the same date of service as the diagnostic service. Modifier PT should be appended only if the planned screening service becomes a diagnostic service.

Reference:
http://www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf


Other New modifiers w.e.f. Jan 1, 2011 and its short descriptions are as follows

DA Oral health assess, not dent
GU Liability waiver rout notice
GX Voluntary liability notice
NB Drug specific nebulizer

Also refer:


2011 CPT CHANGES


Codes 90465, 90466, 90467,90468 deleted, new replacement codes added for patients 18 years of age and under

New codes to report vaccine administration

90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component

90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component

Deletion of 90663 and 90470

H1N1 products (90663) developed for the 2009 H1N1 pandemic have expired and should not be used.

Reformulated seasonal flu vaccines that incorporate the H1N1 virus and related viruses should be reported with the seasonal influenza vaccine codes (90655) and vaccine administration codes (90460, 90461, 90471-90474) AND NOT 90663 and 90470

New codes to report a pandemic formulation of the influenza virus vaccine

90666 Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use

90667 Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use

90668 Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use.


Florida BCBS - Reimbursement for Lab services


In-Office Laboratory Services

Only the laboratory (“lab”) services listed below are eligible for payment when performed in the office by a participating NetworkBlue or Health Options physician for BlueCare, BlueOptions, BlueMedicare HMO and BlueMedicare PPO members. Other lab services performed in the office will be denied for payment and the member may not be billed.

36415* Collection of venous blood by venipuncture
80048 Basic metabolic panel
80051 Electrolyte panel (CO2, Cl, K, Na)
80076 Hepatic function panel (7)
81000 Urinalysis, by dip stick or tablet reagent, non-automated with microscopy
81001 Urinalysis, by dip stick or tablet reagent, automated with microscopy
81002 Urinalysis, by dip stick or tablet reagent, non-automated without microscopy
81003 Urinalysis, by dip stick or tablet reagent, automated without microscopy
81005 Urinalysis, qualitative or semiquantitative, except immunoassays
81015 Urinalysis; microscopic only
81025 Urine pregnancy test, by visual color comparison methods
82150 Amylase
82247 Bilirubin; total
82270 Blood occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations
82272 Blood occult, by peroxidase activity (e.g., guaiac), qualitative; feces, single specimen
(e.g., from digital rectal exam)
82565 Creatinine; blood
82803 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3
(including calculated 02 saturation)
82946 Glucagon tolerance test
82947 Glucose; quantitative, blood (except reagent strip)
82948 Blood, reagent strip
83036 Hemoglobin; glycosylated (A1C)
84703 Beta hCG, qualitative
85013 Spun microhematocrit
85014 Hematocrit (Hct)
85018 Hemoglobin (Hgb)
85025 Complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
85060 Blood smear, peripheral, interpretation by physician with written report
85097 Bone marrow, smear interpretation
85610 Prothrombin time
86308 Heterophile antibodies; screening
86580 Tuberculosis, intradermal
87210 Wet mount for infection agents (e.g., saline, India ink, KOH preps)
87220 Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites
(e.g., scabies)
87400 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative,
multiple step method; Influenza A or B, each
87420 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative,
multiple step method; respiratory syncytial virus
87425 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative,
multiple step method; rotavirus
87430 Infectious agent antigen detection by enzyme immunoassay technique, Streptococcus, group A
87804 Infectious agent detection by immunoassay with direct optical observation; influenza
87880 Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A
89051 Cell count, miscellaneous body fluids, except blood; with differential count
89060 Crystal identification by light microscopy with or without polarizing lens analysis, any body fluid (except urine)
89190 Nasal smear for eosinophils
89300 Semen analysis; presence and/or motility of sperm including Huhner test

* indicates Draw fees are only eligible for payment when lab services are sent to an outside laboratory.
• If you perform some lab services in the office and send others to an independent laboratory on the same day of service, add a modifier 90 to code 36415.
• The draw fee is not eligible for separate reimbursement for lab tests performed in the office; it is included in the allowance for the lab service(s).

For more details please refer
BCBSFL Manual for Physicians and Providers – Coding and Filing Claims

Florida BCBS bundling edits


BCBSF uses the following code-editing logic; please note that this is a listing of all customized edits from the standard recommended code editing logic. This does not represent a complete list of all procedure code edits. For more information please visit bcbsfl.com

Code 76376 will not be separately reimbursed when submitted with the following:

70450 70460 70470 70480 70481 70482 70486 70487 70488 70490
70491 70492 70540 70542 70543 70551 70552 70553 70557 70558
70559 71250 71260 71270 71550 71551 71552 72125 72126 72127
72128 72129 72130 72131 72132 72133 72141 72142 72146 72147
72148 72149 72156 72157 72158 72192 72193 72194 72195 72196
72197 73200 73201 73202 73218 73219 73220 73221 73222 73223
73700 73701 73702 73718 73719 73720 73721 73722 73723 74150
74160 74170 74181 74182 74183 76093 76094 76380 77058 77059

Code 76377 will not be separately reimbursed when submitted with the following:

70450 70460 70470 70480 70481 70482 70486 70487 70488 70490
70491 70492 70540 70542 70543 70551 70552 70553 70557 70558
70559 71250 71260 71270 71550 71551 71552 72125 72126 72127
72128 72129 72130 72131 72132 72133 72141 72142 72146 72147
72148 72149 72156 72157 72158 72192 72193 72194 72195 72196
72197 73200 73201 73202 73218 73219 73220 73221 73222 73223
73700 73701 73702 73718 73719 73720 73721 73722 73723 74150
74160 74170 74181 74182 74183 76093 76094 76380 77058 77059

Code 76942 will not be separately reimbursed when submitted with the following:

36470 36471

Code 90887 will not be separately reimbursed when submitted with the following:

90802 90849 90862 90870 90880

Code 93970 will not be separately reimbursed when submitted with the following:

36470 36471

Code 93971 will not be separately reimbursed when submitted with the following:

36470 36471

Code 97112 will not be separately reimbursed when submitted with the following:

98943

Code 97124 will not be separately reimbursed when submitted with the following:

98943

Code 97140 will not be separately reimbursed when submitted with the following:

98943

Code 99053 will not be separately reimbursed when submitted with the following:

Any anesthesia, surgery, radiology, lab, or evaluation and management service

Code 99082 will not be separately reimbursed when submitted with the following:

99291 99292

Code 99100 will not be separately reimbursed when submitted with the following:

Any anesthesia code

Code 99116 will not be separately reimbursed when submitted with the following:

Any anesthesia code

Code 99135 will not be separately reimbursed when submitted with the following:

Any anesthesia code

Code 99140 will not be separately reimbursed when submitted with the following:

Any anesthesia code

Code 99358 will not be separately reimbursed when submitted with the following:

99221 99222 99223 99231 99232 99233 99238 99239

Code 99359 will not be separately reimbursed when submitted with the following:

99201 99202 99203 99204 99205 99211 99212 99213 99214 99215
99221 99222 99223 99231 99232 99233 99238 99239

Codes A4206 through A9999 will not be separately reimbursed when submitted with the following:

Any surgical or evaluation and management code

Code Q0091 will not be separately reimbursed when submitted with the following:

P3000 P3001

Code S9083 will not be separately reimbursed when submitted with the following:

99201 99202 99203 99204 99205 99211 99212 99213 99214 99215
99241 99242 99243 99244 99245 99281 99282 99283 99284 99285

Code S9088 will not be separately reimbursed when submitted with the following:

99201 99202 99203 99204 99205 99211 99212 99213 99214 99215
99241 99242 99243 99244 99245 99281 99282 99283 99284 99285

Florida Medicaid reimbursement for Adult Health Screening Services


Medicaid reimburses adult health screening services for recipients age 21 and older with the following procedure codes:

• 99385 for new patient screenings age 21-39;
• 99386 for new patient screenings age 40-64;
• 99387 for new patient screenings age 65 years and older;
• 99395 for established patient screenings age 21-39;
• 99396 for established patient screenings age 40-64; or
• 99397 for established patient screenings age 65 years and older.

Screening Schedule:

Medicaid will reimburse for one adult health screening every 365 days. Adult health screenings are recommended for:


• Age 21 through 39, one screening every five years.
• Age 40 and over, one screening every two years.

Florida Medicaid non-covered services and procedures – a quick review


Service Exclusions from Florida Physician Services Coverage and Limitations Handbook

*Medicaid does not reimburse for immunization services for recipients who are 21 years of age and older.

*Medicaid does not reimburse providers for venipuncture, collection, handling or transportation of specimens. This is considered part of the global fee for the service.

Medicaid does not reimburse for the interpretation of arterial blood gases.

*Medicaid does not reimburse for spirometry.

Analysis of arterial blood gases, 82800-82810, is not covered when performed in addition to anesthesia.

CVP insertion is not covered when performed in conjunction with Swan-Ganz insertion, 93503, unless documented at separate distinct sites.

Intravenous pain management by patient controlled analgesia (PCA) is not reimbursable by Medicaid.

Medicaid does not reimburse for mobile cardiovascular services

Medicaid does not reimburse for any technical component reimbursements for procedure codes other than radiology codes

Medicaid does not reimburse for procedure codes that provide diagnostic data that are duplicative of another more comprehensive procedure code performed on the same date of service.

Medicaid does not reimburse radiology and ultrasound services to mobile providers.

*Florida Medicaid will not reimburse for procedures when submitted with Modifier 76 other than the radiology codes (70000-79999)
Medicaid does not reimburse for insertion of intracatheters, PICC lines, infusea-ports, heparin locks or other such methods for delivering intravenous infusions in addition to the prolonged intravenous infusion therapy procedure codes.

*Medicaid does not reimburse visits for second opinions.

Medicaid does not reimburse services furnished to Florida Medicaid recipients when they are out of the country.

Medicaid does not reimburse for telephonic communication to other providers, caregivers, or recipients.

*Medicaid does not reimburse services related to acupuncture.

*Medicaid does not reimburse anesthesiology supervision of CRNAs performing monitored anesthesia care (MAC) or conscious sedation

Medicaid does not reimburse for organ transplant procedures involving living donor organs except for kidney transplants

Medicaid does not reimburse home health services solely due to age, environment, convenience or lack of transportation.

Newborn visits

Medicaid does not reimburse for visit services for a normal newborn who remains in the hospital after three days.

*Medicaid does not reimburse for discharge day management for a normal newborn.

Medicaid does not reimburse for a newborn visit and Child Health Check-Up screening for the same provider, same recipient, and same day of service.

Psychiatric services

Medicaid does not reimburse for any psychiatric services, including pharmacologic management of medications, provided in nursing facilities, skilled nursing facilities,
domiciliary homes, or assisted living facilities.

Medicaid does not reimburse for telephonic psychiatric consultations or services. This includes telephonic communication to other providers, caregivers or recipients.

Medicaid does not reimburse psychiatric services rendered at any other place of service including nursing facilities or custodial care facilities

Non-reimbursable Consultation Visits

Medicaid does not reimburse for a consultation visit in addition to an office, home, nursing facility, custodial care facility or hospital visit on the same day of service, by the same provider.

*Medicaid does not reimburse for consultations rendered in nursing or custodial care facilities.

Medicaid does not reimburse for the following:

• Consultations for a second opinion, or

• Consultations and surgical procedures on the same day.

Ophthalmological Services

*Medicaid does not reimburse for both an evaluation and management visit and a general ophthalmological visit on the same day for the same recipient.

Medicaid does not reimburse for eyeglasses or eyeglass repairs for recipients age 21 and older.

Medicaid does not reimburse for routine vision re-examinations, which includes CPT evaluation and management codes and general ophthalmological visits, performed exclusively for checking an eyeglasses prescription dispensed by the same provider within the previous 30 days.

A routine eye exam in the absence of a reported vision problem, an illness, disease, or injury is not reimbursable

Non-FDA Approved Medications

*Medicaid does not reimburse for non-FDA approved medications.

Medicaid does not reimburse procedures that are experimental or when non-FDA approved medications are included in the procedures.

Provider Write off

*Medicaid does not reimburse copayments, coinsurance, or deductibles for any services provided under a Medicare Advantage Plan.

Medicaid does not reimburse for services provided to recipients when they are out of the United States.

Medicaid does not reimburse for services rendered by providers who are not in the United States.

Medicaid does not cover any of the coinsurance days for inpatient hospital stays.

Medicaid does not reimburse a claim because:

1. Medicare’s payment is the same or more than Medicaid’s fee for the service;

2. The service is not covered by Medicaid;

3. The recipient is eligible as a Qualified Medicare Beneficiary (QMB) or QMB with full Medicaid coverage (QMB+) for the Medicare coinsurance or deductible.

A provider who bills Medicaid for reimbursement of a Medicaid-covered service may not bill the recipient, the recipient’s relatives, or any person or persons acting as the recipient’s designated representative.

Please click here to know more about Florida Medicaid Physician Services Coverage and Limitations

Coding for closed treatments of fractures


By Mary LeGrand, RN, MA, CCS-P, CPC; Margaret Maley, BSN, MS; Robert H. Haralson III, MD, MBA; M. Bradford Henley, MD, MBA; Matthew Twetten, MA

Coding for closed treatment of fractures is controversial; this article provides suggestions on how to code for this form of treatment. Closed treatments are either with or without manipulation. An orthopaedic surgeon has the following two ways of coding closed treatment of a fracture under Current Procedural Terminology (CPT):

“Global” reporting of the services by using the 90-day, global fracture code with or without reporting the initial evaluation and management (E&M) service that resulted in the decision for closed treatment, or “Itemized” reporting of the services by reporting each patient encounter separately. The physician reports each service independently and does not enter into a 90-day global period. The AAOS position is that the orthopaedist must have the option of coding these services either way to enable the treating surgeon to address the specific situation and to meet the physician’s contractual obligations with payors.

Charging a single, all-inclusive large global fee may seem excessive to a patient, especially if the patient doesn’t understand that the charge includes 90 days of physician E&M services related to the fracture. Other times, insurance companies may pay for emergency visits (for example, a global fee with limited patient financial responsibility) but may not pay for office visits, or vice versa. Some insurers require high copayments for office visits, while others apply a coinsurance to the global fracture service. In these situations, a patient may express concern about the financial cost of one method or the other. The physician should report the method that best addresses the situation, meets the physician’s contractual obligations, and complies with coding rules.

The Centers for Medicare and Medicaid Services (CMS) does not have a preference for coding closed nonmanipulative fracture services. Processing a single global claim for 90 days of care may be less expensive for the government, insurance companies, and physician offices than submitting and processing multiple claims (during 90 days of fracture care) and adjudicating disputes resulting from appeals to claim denials.

Because CMS does not give coding advice, it has not given specific directions for reporting closed treatment of fractures. In 2003, however, CMS issued a directive about adjudication of claims stating that carriers will not allow the total compensation for fragmented (eg, itemized) coding to exceed the total compensation for comparable global coding.
Additionally, in recent years, CMS carriers (such as Rhode Island and Kentucky) have asked for a refund when investigating a patient complaint resulting from a large financial responsibility after a physician had charged for nonmanipulative fracture “surgery.”

Global and itemized options

When using the global method, code for the procedure, which invokes a 90-day global period. All subsequent E&M services related to the fracture are covered by the global fee as well as the application of the first cast or splint. The original E&M service may be coded with a modifier (such as 57 or 25), depending on the level of the encounter. If the encounter is minimal, which it may be for evaluation of an isolated injury, do not code for the encounter. Many payors will not pay for an encounter code in this situation.

When using the itemized method, report the initial services by the physician or nonphysician provider (physician assistant, nurse practitioner, or clinical nurse specialist) with the appropriate codes, as follows:

E&M for the first visit—9920x-25 for a new patient office visit, 9921x-25 for an established patient office visit, or 9924x-25 for a consultation provided in the emergency department (ED) or in the physician office. The modifier 25 is necessary to show that the E&M service is a significant and separately identifiable service because it is associated with a procedure (application of a cast or splint). If the service is provided in a setting other than the office or ED, report the appropriate category and level based on the place of service and append modifier 25.

Application of an initial cast or splint (assuming that the physician or supervised staff employed by or under contract to the physician applies the cast or splint)

Supplies for casting/splinting, if applicable, depending on the place of service

Subsequent services are reported as follows:

E&M services using established patient visit codes if the services are provided in the office (9921x), or other E&M code that is specific to the service setting

Application of replacement cast(s) or splint(s), assuming the physician or supervised employed or contracted staff applies the cast or splint). Add modifier 25 to the appropriate E&M code if it is a “significant and separate service” provided in addition to the procedural service (such as application of the cast/splint).

Supplies, if applicable, depending on the place of service

When is closed treatment of fractures reported?

Closed treatment of fractures is commonly reported in two scenarios. One is when the injury requiring nonmanipulative treatment is the only procedural service performed by the physician (Example 1 and Example 2).

As these examples show, the reimbursement is about the same, but different methods are advantageous for different situations. Itemized reporting requires the physician to have supporting documentation and medical necessity for the E&M service at each subsequent visit. No specific E&M documentation is required for subsequent visits when fractures are reported using the global fracture codes. The orthopaedic surgeon should have the flexibility to vary the way fracture care is coded to allow what is best for the patient and society.

Closed treatment of fractures may also be reported within the global period of another procedural or surgical treatment (for example, during the same hospitalization as the open treatment of another fracture or injury such as anterior cruciate ligament [ACL] repair). This commonly occurs when a patient has sustained multiple injuries or fractures or has sustained a new fracture within the global period of a prior service (patient slipped and fell while using crutches after an ACL repair).

Situations involving the closed treatments of fractures that occur concurrently or within the global period of another procedure or surgical treatment most commonly arise when caring for patients with multiple injuries, one of which is a fracture requiring a closed treatment.

Example 3 shows reporting for an elderly patient who fell and sustained an intertrochanteric proximal femur fracture (treated with an intramedullary implant) and a clavicular fracture (treated closed without manipulation). It assumes that the patient was evaluated in the emergency department (ED) on the same day that both her intertrochanteric fracture was stabilized surgically and her clavicle fracture was treated without manipulation.

Reporting by an ED physician

Another problem in reporting the closed treatment of fractures is the confusion about how an ED physician should code for nonmanipulative fracture care when he or she was the only physician who saw the patient in the ED. On occasion, the ED physician has used a global fracture care code for the application of a splint/cast, and then referred the patient to an orthopaedist for follow-up care. In such a situation, the orthopaedist is unable to receive reimbursement for the care provided.

CPT suggests that only the physician who provides the “restorative” treatment and is “responsible for the initial cast, follow-up evaluation(s) and the management of the fracture until healed” should use the global code. The proper coding is for the ED physician to code for the ED visit and application of a splint if appropriate.

If manipulative fracture care that meets the definition of “restorative treatment” is provided by an ED physician and the ED physician has provided a “significant portion of the global fracture care,” the ED physician may use the global code with modifier 54 (surgical care only). However, this treatment must meet the “restorative” care definition and should not be merely splinting a fracture after straightening the limb.

According to CPT, the following reference supports reporting the services using an E&M code and the appropriate cast/splint application code as applicable. “If cast application or strapping is provided as an initial service (eg, casting of a sprained ankle or knee) in which no other procedure or treatment (eg, surgical repair, reduction of a fracture or joint dislocation) is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping and/or supply code (99070) in addition to an evaluation and management code as appropriate.” Supplies would be reported using the appropriate A (nonMedicare) or Q (Medicare and other payors requiring Q) codes.

Mary LeGrand, RN, MA, CCS-P, CPC, and Margaret Maley, BSN, MS, are consultants with KarenZupko & Associates. Robert H. Haralson III, MD, MBA, is AAOS director of medical affairs. M. Bradford Henley, MD, MBA, is a member of the AAOS Coding, Coverage, and Reimbursement Committee; Matthew Twetten, MA, is senior policy analyst in the AAOS department of health policy and governance initiatives.

If you have coding questions or would like to see a coding column on a specific topic, e-mail
aaoscomm@aaos.org


Coding mental disorders


Mental retardation (MR) is a generalized disorder, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors that appears before adulthood. It has historically been defined as an Intelligence Quotient score under 70.

Coding mental disorders is complicated by the availability of another set of widely used codes, the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). According to this latest edition three criteria must be met for a diagnosis of mental retardation:

1. an IQ below 70,
2. significant limitations in two or more areas of adaptive behavior (as measured by an adaptive behavior rating scale, i.e. communication, self-help skills, interpersonal skills, and more), and
3. evidence that the limitations became apparent before the age of 18.

Coders are advised to use DSM-IV as a reference aid to arrive at a diagnosis, but ICD-9-CM should be used for the actual coding. The Mental Disorders section of ICD-9-CM was developed with the assistance of the American Psychiatric Association in an effort to help coders apply these diagnostic codes accurately. The codes are recognized by payers and help avoid confusion and claim denials.

ICD – 9 – CM codes for Mental disorders (290 – 319)

Please refer Inpatient Psychiatric Benefit Days Reduction and Lifetime Limitation from Medicare Benefit Policy manual.

Standard ICD-9-CM Coding Conventions

Each space, typeface, indentation, and punctuation mark determines how you must interpret ICD-9-CM codes. These conventions were developed to help match correct codes to the diagnoses you encounter.

Standard ICD-9-CM coding conventions affect:
1. Terms and Instructions
2. Instructional Notes
3. ICD-9-CM Notes

I. Terms and Instructions


See
See directs coder to a more specific index term under which the correct code can be found.

Example: Cancerous- see Neoplasm, by site, malignant

See Also
See also refers to other index terms that may provide additional information for selecting a diagnostic code.

Example: Hematoma- see also Contusion

See Category
See category indicates that you should review the category specified in the index before selecting a code.

Example: Psychosis - see categories 295-298

Code Also
This instruction is used in the tabular list for two purposes:

1. To code components of a procedure that are performed at the same time, and
2. To code the use of special adjunctive procedures or equipment.

Example: 03.90 Insertion of catheter into spinal canal, Code also any implantation of infusion pump (86.06)

Synchronous Procedures
For some operative procedures (listed in Volume 3), it is necessary to record the individual components of the procedure. In these instances, the alphabetic index lists both codes.

Example: 02.02 Elevation of skull fracture fragments, Code also any synchronous debridement of brain (01.59)

Omit Code
Terms that identify incisions are listed as main terms in the index. If the incision was made only for the purpose of performing further surgery, the omit code instruction is given.

NEC
As the abbreviation for "Not Elsewhere Classified", NEC identifies codes and index terms that specify a condition or disease for which there is no other separate, more specific, code available to identify it.

Example: 518.82 Other pulmonary insufficiency, not elsewhere classified, Adult Respiratory Distress Syndrome NEC.

NOS
As the abbreviation for "Not Otherwise Specified," NOS indicates the code is unspecified and, if possible, you should continue looking for a specific code, or you lack the information necessary to code the diagnosis to a more specific category.

Example: 558.9 Other and unspecified noninfectious gastroenteritis and colitis,
Colitis - NOS, dietetic, or noninfectious
Enteritis - NOS, dietetic, or noninfectious
Gastroenteritis - NOS, dietetic, or noninfectious
Ileitis - NOS, dietetic, or noninfectious
Jejunitis - NOS, dietetic, or noninfectious
Sigmoiditis - NOS, dietetic, or noninfectious

[] Brackets enclose synonyms, alternate wording, or explanatory phrases.

Example: 286.5 Hemorrhagic disorder due to intrinsic circulating anticoagulants
Systemic Lupus Erythematous [SLE] inhibitor

() Parentheses enclose supplementary words that may be present or absent in the statement of a disease or procedure, without affecting the code number to which it is assigned.

Example: 780.64 Chills (without fever)

II. Instructional Notes
To assign diagnostic codes at the highest level of specificity, you must follow four kinds of instructional notes. These notes affect code descriptions in the Code Detail.

Includes
This note appears immediately under a three-digit code in the tabular list to further define or give an example of the contents of the category.

Example: 600 Hyperplasia of prostate, Includes - Enlarged Prostate

Excludes
This note identifies terms in the tabular list that should not be coded under the referenced term. This note does not prevent you from using the excluded code in addition to the code from which it was excluded when both conditions are present.

Example: 600.1 Nodular prostate, Excludes – Malignant neoplasm of prostate (185)

Use additional code
This note appears in categories in the tabular list where you may add further information (by using an additional code) to give a more complete picture of the diagnosis from the available information.

Example: 281.2 Folate-deficiency anemia, Use additional E code to identify drug

Code first underlying disease
This instruction is used with codes in the tabular list that are not intended to be the principal diagnosis. The note requires that the underlying disease (etiology) be recorded first, and the particular manifestation second. Some possible underlying disease choices are listed following the instructional note with code references in parentheses. Always refer to the underlying disease in its own tabular section before coding it as the principal diagnosis to ensure that all other coding instructions are followed and the code is reported to its highest specificity level.

Example: 357.2 Polyneuropathy in diabetes, Code first underlying disease (249.6, 250.6)

ICD-9-CM Notes
ICD-9-CM notes affect both index terms in the Tabular Results window and code descriptions in the Code Detail. Notes in Volume 1 are indented and printed in plain type, while those in Volume 2 are boxed and italicized. The placement of these notes is as important as their content. Notes at the beginning of a section apply to all categories within the section. Those at the beginning of a subsection apply to all categories within the subsection. Notes preceding three digit categories apply to all fourth-digit and fifth-digit codes within that category.

CMS Guidelines for Diagnostic Coding


In the March 4, 1994 Federal Register, the Centers for Medicare and Medicaid Services announced all claims for physician services under Medicare Part B must include proper ICD-9-CM diagnostic coding on the CMS-1500 (formerly known as HCFA) claim form. For physicians who accept payment in an assignment related basis, failure to do so may result in denial of payment.

The Centers for Medicare and Medicaid Services provides specific guidelines to aid in standardizing U.S. coding practices. The guidelines for outpatient facilities, physician offices, and ancillary care are summarized below:

1. Identify each service, procedure, or supply with an ICD-9-CM code to describe the diagnosis, symptom, complaint, condition, or problem.

2. Identify services or visits for circumstances other than disease or injury, such as follow-up care after chemotherapy, with V codes provided for this purpose.

3. Code the primary diagnosis first, followed by the secondary, tertiary, and so on. Code any coexisting conditions that affect the treatment of the patient for that visit or procedure as supplementary information. Do not code a diagnosis that is no longer applicable.

4. Code to the highest degree of specificity. Carry the numerical code to the fourth or fifth digit when available. Remember, there are only approximately 100 valid three-digit codes; all other ICD-9-CM codes require additional digits.

5. Code a chronic diagnosis when it is applicable to the patient's treatment.

6. When only ancillary services are provided, list the appropriate V code first and the problem second. For example, if a patient is receiving only ancillary therapeutic services, such as physical therapy, use the V code first, followed by the code for the condition.


7. When surgical procedures are performed, code the diagnosis applicable to the procedure. If, after the procedure has been done, the condition necessitating the surgery is more specifically identified, or even determined to be different than the preoperative diagnosis, code the most specific diagnosis determined to be the reason for the surgery.

MEDICAL TERMS

Medical Terms that are commonly found in patient medical records

Anterior: Situated on the front surface of the body; ventral.

Bilateral: On both sides, having two sides.
Caudal: Denoting the lower half of the body; inferior.
Contraction: A shortening and/or tensioning of muscle tissue.
Coronal: Pertaining to an imaginary longitudinal plane at right angle to the medial plane and dividing the body into ventral and dorsal components.
Cranial: Denoting the upper half of the body; nearer the head, relating to the head; superior.
Diaphysis: The shaft portion of long bones, between the ends or extremities (epiphyses).
Distal: Situated away from the center of the body, usually applied to the extremity or most distant part of a limb or organ.
Dorsal: Situated on the back surface of the body; back of the hand; top surface of the foot; posterior.
Epiphysis: The end, or extremity, of a long bone.
Extension: The movement that brings a limb into a forward or straight position.
Fascia: The fibrous sheet enveloping the body underneath the skin.
Flexion: The bending of a joint; a joint in the position of being bent.
Inferior: Situated below the center of the body or directly downward, nearer the feet; caudal.
Joint: The junction between two or more bones of the body, and classified as fibrous (i.e., sutures of skull), cartilaginous (i.e., intervertebral discs), and synovial (i.e., elbow).
Lateral: On the side, farther from the median or midsagittal plane.
Medial: Relating to the middle or center, nearer the midsagittal plane.
Midsagittal: An imaginary plane starting at the top of the head, running down through the center of the nose, etc., and dividing the body vertically into two halves, left and right.
Muscle: The movement producing material of the body; consisting of three types: skeletal (voluntary control and having two attachments, an origin and an insertion); cardiac (the myocardium forming the middle of the heart, contracts spontaneously); smooth muscle (generally two-layered, circular and longitudinal, and found in walls of many visceral organs, and contracts rhythmically).
Oblique: Slanting; inclined; a plane between horizontal and vertical.
Palmar: Referring to the palm of the hand.
Plantar: Referring to the sole of the foot.
Posterior: Denoting the back surface of the body; dorsal.
Proximal: Nearer the trunk or center of the body; usually applied to closest part of a limb or organ.
Relaxation: A lessening of muscle tension.
Sagittal: A plane or section parallel to the medial plane, usually identified as left or right of medial sagittal.
Sesamoid: Small bones embedded in tendons or joints, principally the hands and feet.
Superior: Situated above the center of the body or directly upwards; closer to the head; cranial.
Transverse: Lying across the long axis of the body or organ.
Unilateral: Confined to one side only.
Ventral: Pertaining to the belly or front surface of the body; anterior.

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