Types of Surgeries:
Outpatient surgery encounters include open procedures, endoscopy procedures, catherization procedures, pain management procedures, lithotripsy and injection procedures such as myelogram, arthrograms, etc.
Surgery encounter:
A surgery encounter indicates an outpatient surgery discharge record and may consist of more than one procedure. Encounter statistics are based on surgery encounters.
Procedures:
Procedure statistics count individual procedures. There may be multiple procedures per surgery encounter.
Patients:
Patient statistics count unique patients. Patients may have multiple encounters and procedures.
Charges:
Total charges reflect the total billed charges and do not necessarily refer to the costs nor are they synonymous with reimbursements associated with the surgical visit.
25th percentile /1st quartile for total charges is the charge below which 25 percent of the charges fall.
75th percentile /3rd quartile for total charges is the charge below which 75 percent of the charges fall.
CPT Codes:
The CPT (Current Procedural Terminology) code set accurately describes medical, surgical, and diagnostic services and is designed to communicate uniform information
about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
CPT codes are developed, maintained and copyrighted by the AMA (American Medical Association.)
| Body System | CPT Range |
|---|---|
| Integumentary | 10021-19499 |
| Musculoskeletal | 20000-29999 |
| Respiratory | 30000-32999 |
| Cardiovascular | 33010-39599 |
| Digestive | 40490-49999 |
| Urinary | 50010-53899 |
| Male Genital | 54000-55980 |
| Female Genital | 56405-58999 |
| Maternity Care and Delivery | 59000-59998 |
| Endocrine | 60000-60699 |
| Nervous | 61000-64999 |
| Eye | 65091-68899 |
| Ear | 69000-69990 |
| Cardiac Catheterization | 93451-93572 |
| Non-Surgical Procedures | Outside above ranges |
For 2016 onwards, the Groupings were developed as part of the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality (AHRQ).
The following link contains detail explanations and codes for the outpatient principal diagnosis categories.
Clinical Classification Software (CCS)| Groupings | CPT Codes |
|---|---|
| Abdominal paracentesis | See |
| Abortion (termination of pregnancy) | link |
| Alcohol and drug rehabilitation/detoxification | above |
| Amputation of lower extremity | for |
| Ancillary Services | CPT |
| Anesthesia | coding |
| Aortic resection, replacement or anastomosis | |
| Appendectomy | |
| Arterial blood gases | |
| Arterio- or venogram (not heart and head) | |
| Arthrocentesis | |
| Arthroplasty knee | |
| Arthroplasty other than hip or knee | |
| Arthroscopy | |
| Biopsy of liver | |
| Blood transfusion | |
| Bone marrow biopsy | |
| Bone marrow transplant | |
| Breast biopsy and other diagnostic procedures on breast | |
| Bunionectomy or repair of toe deformities | |
| Cancer chemotherapy | |
| Cardiac stress tests | |
| Cerebral arteriogram | |
| Cesarean section | |
| Cholecystectomy and common duct exploration | |
| Circumcision | |
| Colonoscopy and biopsy | |
| Colorectal resection | |
| Colostomy, temporary and permanent | |
| Computerized axial tomography (CT) scan head | |
| Contrast aortogram | |
| Contrast arteriogram of femoral and lower extremity arteries | |
| Control of epistaxis | |
| Conversion of cardiac rhythm | |
| Corneal transplant | |
| Coronary artery bypass graft (CABG) | |
| Coronary thrombolysis | |
| Creation, revision and removal of arteriovenous fistula or vessel-to-vessel cannula for dialysis | |
| CT scan abdomen | |
| CT scan chest | |
| Debridement of wound, infection or burn | |
| Decompression peripheral nerve | |
| Destruction of lesion of retina and choroid | |
| Diagnostic amniocentesis | |
| Diagnostic bronchoscopy and biopsy of bronchus | |
| Diagnostic cardiac catheterization, coronary arteriography | |
| Diagnostic dilatation and curettage (D and C) | |
| Diagnostic endocrine procedures | |
| Diagnostic physical therapy | |
| Diagnostic procedures on ear | |
| Diagnostic procedures on eye | |
| Diagnostic procedures on nose, mouth and pharynx | |
| Diagnostic procedures, male genital | |
| Diagnostic spinal tap | |
| Diagnostic ultrasound of abdomen or retroperitoneum | |
| Diagnostic ultrasound of gastrointestinal tract | |
| Diagnostic ultrasound of head and neck | |
| Diagnostic ultrasound of heart (echocardiogram) | |
| Diagnostic ultrasound of urinary tract | |
| Dilatation and curettage (D and C), aspiration after delivery or abortion | |
| Division of joint capsule, ligament or cartilage | |
| DME and supplies | |
| Electrocardiogram | |
| Electroencephalogram (EEG) | |
| Electrographic cardiac monitoring | |
| Embolectomy and endarterectomy of lower limbs | |
| Endarterectomy, vessel of head and neck | |
| Endoscopic retrograde cannulation of pancreas (ERCP) | |
| Endoscopy and endoscopic biopsy of the urinary tract | |
| Enteral and parenteral nutrition | |
| Esophageal dilatation | |
| Excision of semilunar cartilage of knee | |
| Excision of skin lesion | |
| Excision, lysis peritoneal adhesions | |
| Exploratory laparotomy | |
| Extracorporeal circulation auxiliary to open heart procedures | |
| Extracorporeal lithotripsy, urinary | |
| Extracorporeal shock wave, other than urinary | |
| Fetal monitoring | |
| Forceps, vacuum, and breech delivery | |
| Gastrectomy, partial and total | |
| Gastric bypass and volume reduction | |
| Gastrostomy, temporary and permanent | |
| Genitourinary incontinence procedures | |
| Glaucoma procedures | |
| Hearing devices and audiology supplies | |
| Heart valve procedures | |
| Hemodialysis | |
| Hemorrhoid procedures | |
| Hip replacement, total and partial | |
| Home Health Services | |
| Hysterectomy, abdominal and vaginal | |
| Ileostomy and other enterostomy | |
| Incision and drainage, skin and subcutaneous tissue | |
| Incision and excision of CNS | |
| Incision of pleura, thoracentesis, chest drainage | |
| Indwelling catheter | |
| Infertility Services | |
| Inguinal and femoral hernia repair | |
| Injection or ligation of esophageal varices | |
| Injections and aspirations of muscles, tendons, bursa, joints and soft tissue | |
| Insertion of catheter or spinal stimulator and injection into spinal canal | |
| Insertion, replacement, or removal of extracranial ventricular shunt | |
| Insertion, revision, replacement, removal of cardiac pacemaker or cardioverter/defibrillator | |
| Intraoperative cholangiogram | |
| Intravenous pyelogram | |
| Kidney transplant | |
| Laboratory - Chemistry and Hematology | |
| Laminectomy, excision intervertebral disc | |
| Laparoscopy | |
| Lens and cataract procedures | |
| Ligation of fallopian tubes | |
| Lobectomy or pneumonectomy | |
| Local excision of large intestine lesion (not endoscopic) | |
| Lower gastrointestinal X-ray | |
| Lumpectomy, quadrantectomy of breast | |
| Magnetic resonance imaging | |
| Mammography | |
| Mastectomy | |
| Mastoidectomy | |
| Medications (Injections, infusions and other forms) | |
| Microscopic examination (bacterial smear, culture, toxicology) | |
| Myelogram | |
| Myringotomy | |
| Nasogastric tube | |
| Nephrectomy, partial or complete | |
| Nephrotomy and nephrostomy | |
| Nonoperative removal of foreign body | |
| Nonoperative urinary system measurements | |
| Oophorectomy, unilateral and bilateral | |
| Open prostatectomy | |
| Ophthalmologic and otologic diagnosis and treatment | |
| Oral and Dental Services | |
| Other | |
| Other bowel diagnostic procedures | |
| Other CT scan | |
| Other diagnostic cardiovascular procedures | |
| Other diagnostic nervous system procedures | |
| Other diagnostic procedures (interview, evaluation, consultation) | |
| Other diagnostic procedures of respiratory tract and mediastinum | |
| Other diagnostic procedures of urinary tract | |
| Other diagnostic procedures on lung and bronchus | |
| Other diagnostic procedures on musculoskeletal system | |
| Other diagnostic procedures on skin and subcutaneous tissue | |
| Other diagnostic procedures, female organs | |
| Other diagnostic radiology and related techniques | |
| Other diagnostic ultrasound | |
| Other excision of cervix and uterus | |
| Other extraocular muscle and orbit therapeutic procedures | |
| Other fracture and dislocation procedure | |
| Other gastrointestinal diagnostic procedures | |
| Other hernia repair | |
| Other intraocular therapeutic procedures | |
| Other Laboratory | |
| Other non-OR gastrointestinal therapeutic procedures | |
| Other non-OR lower GI therapeutic procedures | |
| Other non-OR or closed therapeutic nervous system procedures | |
| Other non-OR therapeutic cardiovascular procedures | |
| Other non-OR therapeutic procedures of urinary tract | |
| Other non-OR therapeutic procedures on musculoskeletal system | |
| Other non-OR therapeutic procedures on nose, mouth and pharynx | |
| Other non-OR therapeutic procedures on respiratory system | |
| Other non-OR therapeutic procedures on skin and breast | |
| Other non-OR therapeutic procedures, female organs | |
| Other non-OR therapeutic procedures, male genital | |
| Other non-OR upper GI therapeutic procedures | |
| Other operations on fallopian tubes | |
| Other operations on ovary | |
| Other OR gastrointestinal therapeutic procedures | |
| Other OR heart procedures | |
| Other OR lower GI therapeutic procedures | |
| Other OR procedures on vessels of head and neck | |
| Other OR procedures on vessels other than head and neck | |
| Other OR therapeutic nervous system procedures | |
| Other OR therapeutic procedures of urinary tract | |
| Other OR therapeutic procedures on bone | |
| Other OR therapeutic procedures on joints | |
| Other OR therapeutic procedures on musculoskeletal system | |
| Other OR therapeutic procedures on nose, mouth and pharynx | |
| Other OR therapeutic procedures on respiratory system | |
| Other OR therapeutic procedures on skin and breast | |
| Other OR therapeutic procedures, female organs | |
| Other OR therapeutic procedures, male genital | |
| Other OR upper GI therapeutic procedures | |
| Other organ transplantation | |
| Other physical therapy and rehabilitation | |
| Other procedures to assist delivery | |
| Other radioisotope scan | |
| Other respiratory therapy | |
| Other therapeutic ear procedures | |
| Other therapeutic endocrine procedures | |
| Other therapeutic obstetrical procedures | |
| Other therapeutic procedures | |
| Other therapeutic procedures on eyelids, conjunctiva, cornea | |
| Other therapeutic procedures on muscles and tendons | |
| Other therapeutic procedures, hemic and lymphatic system | |
| Other vascular bypass and shunt, not heart | |
| Other vascular catheterization, not heart | |
| Partial excision bone | |
| Pathology | |
| Percutaneous transluminal coronary angioplasty (PTCA) | |
| Peripheral vascular bypass | |
| Peritoneal dialysis | |
| Physical therapy exercises, manipulation, and other procedures | |
| Plastic procedures on nose | |
| Procedures on spleen | |
| Procedures on the urethra | |
| Proctoscopy and anorectal biopsy | |
| Prophylactic vaccinations and inoculations | |
| Psychological and psychiatric evaluation and therapy | |
| Radioisotope bone scan | |
| Radioisotope pulmonary scan | |
| Radioisotope scan and function studies | |
| Removal of ectopic pregnancy | |
| Repair of current obstetric laceration | |
| Repair of cystocele and rectocele, obliteration of vaginal vault | |
| Repair of retinal tear, detachment | |
| Respiratory intubation and mechanical ventilation | |
| Routine chest X-ray | |
| Skin graft | |
| Small bowel resection | |
| Spinal fusion | |
| Suture of skin and subcutaneous tissue | |
| Swan-Ganz catheterization for monitoring | |
| Therapeutic radiology | |
| Thyroidectomy, partial or complete | |
| Tonsillectomy and/or adenoidectomy | |
| Tracheoscopy and laryngoscopy with biopsy | |
| Tracheostomy, temporary and permanent | |
| Traction, splints, and other wound care | |
| Transportation - patient, provider, equipment | |
| Transurethral excision, drainage, or removal urinary obstruction | |
| Transurethral resection of prostate (TURP) | |
| Treatment, facial fracture or dislocation | |
| Treatment, fracture or dislocation of hip and femur | |
| Treatment, fracture or dislocation of lower extremity (other than hip or femur) | |
| Treatment, fracture or dislocation of radius and ulna | |
| Tympanoplasty | |
| Upper gastrointestinal endoscopy, biopsy | |
| Upper gastrointestinal X-ray | |
| Ureteral catheterization | |
| Varicose vein stripping, lower limb | |
| Visual aids and other optical supplies |