Survey Page

Inpatient Surgical Services [Report inpatient procedures only]

Procedure/Services C-Section Delivery - Code DRG-371
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Procedure/Services Vaginal Deliveries (normal) - Code DRG-373
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Procedure/Services Hip Replacement - Code DRG-544 [ICD-9 81.51, 81.52]
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Procedure/Services Knee Replacements - Code DRG-544 [ICD-9 81.54]
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Procedure/Services Laminectomy - Inpatient - Code DRG-500
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Procedure/Services Laparoscopic Gall Bladder Removal - Code DRG-494
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Procedure/Services Spinal Fusion (Anterior) - Code DRG-520
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Procedure/Services Spinal Fusion (Posterior) - Code DRG-498
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Outpatient Surgical Services [Report outpatient procedures only]

Procedure/Services ACL Repair by Arthroscopy - Code CPT 29888
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Procedure/Services Breast Biopsy Percutaneous w/Imaging - Code CPT 19102
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Procedure/Services Breast Biopsy w/Device - Code CPT 19103
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Procedure/Services Carpal Tunnel - Code CPT 64721
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Procedure/Services Cataract Removal - Code CPT 66984
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Procedure/Services Colonoscopy with biopsy - Code CPT 45380
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Procedure/Services Hernia Inguinal Repair 5 Years and Older - Code CPT 49505
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Procedure/Services Knee Arthroscopy with Cartilage Repair - Code CPT 29881
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Procedure/Services Laparoscopic Gall Bladder Removal - Code CPT 47562
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Procedure/Services Left Heart Catheterization - Code CPT 93510
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Procedure/Services Screening Colonoscopy - Code CPT 45378
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Procedure/Services Shoulder Arthroscopy - Code CPT 29826
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Procedure/Services Shoulder Arthroscopy with Rotator Cuff Repair - Code CPT 29827
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Procedure/Services Tonsilectomy and Adenectomy, under age 12 - Code CPT 42820
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Procedure/Services Tympanostomy - Code CPT 69436
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Outpatient Radiology Services [Report outpatient procedures only]

Mammography

Procedure/Services Mammogram, one breast - Code CPT 76090¹
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Procedure/Services Mammogram, both breasts - Code CPT 76091¹
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Procedure/Services Mammogram, screening - Code CPT 76092¹
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Procedure/Services Mammogram, screening - Code CPT 77055²
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Procedure/Services Mammogram, screening - Code CPT 77056²
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Procedure/Services Mammogram, screening - Code CPT 77057²
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Procedure/Services Mammogram, one breast - Code G0206
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Procedure/Services Mammogram, both breasts - Code G0204
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Procedure/Services Mammogram, screening - Code G0202
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¹ Deleted Code; ² New Code

CT Scan Abdomen

Procedure/Services CT abdomen without dye - Code CPT 74150
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Procedure/Services CT abdomen with dye - Code CPT 74160
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Procedure/Services CT abdomen with & without dye - Code CPT 74170
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Procedure/Services CT angio abdomen with & without dye - Code CPT 74175
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CT Scan Head

Procedure/Services CT head/brain without dye - Code CPT 70450
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Procedure/Services CT head/brain with dye - Code CPT 70460
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Procedure/Services CT head/brain with & without dye - Code CPT 70470
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Procedure/Services CT angiography, head - Code CPT 70496
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CT Scan Pelvis

Procedure/Services CT pelvis without dye - Code CPT 72192
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Procedure/Services CT pelvis with dye - Code CPT 72193
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Procedure/Services CT pelvis with & without dye - Code CPT 72194
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Procedure/Services CT angiograph pelvis w/ dye - Code CPT 72191
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Upper GI

Procedure/Services Upper GI Endoscopy - Code CPT 43235
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Procedure/Services Upper GI Endoscopy with Biopsy - Code CPT 43239
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MRI Brain

Procedure/Services MRI brain with dye - Code CPT 70558
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Procedure/Services MRI brain with dye - Code CPT 70552
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Procedure/Services MRI brain with & without dye - Code CPT 70559
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Procedure/Services MRI brain without dye - Code CPT 70557
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Procedure/Services MRI brain without dye - Code CPT 70551
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Procedure/Services MRI brain with & without dye - Code CPT 70553
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MRI Lower Limb

Procedure/Services MRI lower extremity with dye - Code CPT 73719
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Procedure/Services MRI lower extremity without dye - Code CPT 73718
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Procedure/Services MRI lower extremity with & without dye - Code CPT 73720
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MRI Spine

Procedure/Services MRI lumbar spine with dye - Code CPT 72149
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Procedure/Services MRI lumbar spine without dye - Code CPT 72148
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Procedure/Services MRI lumbar spine with & without dye - Code CPT 72158
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Procedure/Services MRI neck spine with dye - Code CPT 72142
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Procedure/Services MRI neck spine without dye - Code CPT 72141
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Procedure/Services MRI neck spine with & without dye - Code CPT 72156
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Procedure/Services MRI orbit/face/neck with dye - Code CPT 70542
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Procedure/Services MRI orbit/face/neck without dye - Code CPT 70540
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Procedure/Services MRI orbit/face/neck with & without dye - Code CPT 70543
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MRI Upper Limb

Procedure/Services MRI upper extremity with dye - Code CPT 73219
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Procedure/Services MRI upper extremity without dye - Code CPT 73218
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Procedure/Services MRI upper extremity with dye - Code CPT 73220
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MRI lower extremity joint

Procedure/Services MRI lower extremity joint without dye - Code CPT 73721
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Procedure/Services MRI lower extremity joint with dye - Code CPT 73722
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Procedure/Services MRI lower extremity joint with & without dye - Code CPT 73723
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Questions marked with an asterisk (*) are mandatory.