Medicos para la Familia
(Rev. 6-5-07)-WMR
OFFICE SURGERY/ENDOSCOPY
Patient Name: ______Date: ______
DIAGNOSIS FOR SERVICES ON THIS SHEET
1.2.
Pulse oximetry[mult readings] 94761 $40
IV infusion first hour 70760 $60
IV infusion each additional hour 90761 $30
IV med injection 90774 $30
IV sedation/analgesia-age>5[cannot bill pulse ox]
Same MD performing the procedure 99144 $120
2nd MD doing sed/analgesia 99148 $120
IV supplies/fluids _____
Surgical tray A4550 $30
Needles A4215 $10
Other _____
Meperidine each amp J22175 $10
Valium each amp J3360 $10
Fentanyl each amp J3010 $20
Narcan 0.4mg J2310 $20
Ketorolac 30-60MG IM $30-60
Bupivicaine 0.25% 1 amp TBA $30
Bupivicaine 0.75% spinal 1 amp TBA $30
Morphine 5mg/2ml spinal 1 amp TBA $20
Ketamine 50mg/ml CPT TBA $30
Surgical pathology (varies) _____ $200-440 per bottle. Misdirected specimens are charged back to us.
Specimen handling 99000 $10
PROCEDURES
Colonoscopy 45378 $600
Colonoscopy w/bx ( 45380 $700
Colonoscopy w/polypectomy 45385 $800
Flex Sig 45330 $200
Flex Sig w/bx 45331 $300
Flex Sig w/polypectomy 45335 $400
UGI Endoscopy 43235 $400
UGI w/bx 43239 $500
H. pylori [CLO test in office] 86677 $ 40
Nasopharyngoscopy 92511 $200
See ENT sheet for other code 92375?
Repair Inguinal Hernia xxxxx $1000Vasectomy $400
Medicos para la Familia offers cancer screening and office surgery services to an underserved community whose psychosocial issues prevent access to the many subspecialists in our urban locations.
This is a required part of the MEDICOS practice management curriculum
1. Equipment maintenance is the responsibility of the physician. Every procedure requires a preflight check prior to putting the IV into the patient.
2. Cleaning and disinfection skills are required of the physician. Once mastered the physician can supervise staff in this critical part of the procedure.
3. Before the procedure begins, the physician must fill out the preprocedure diagnostic probabilities, and summarize the indications for the case on the endoscopy medical record.
4. An IV sedation/analgesia log including the recovery phase must be completed for each case.
5. Medicare and Medicaid[Tenncare] do not allow billing of supplies associated with endoscopy. A4550
6. Pulse oximetry 97461 is “bundled” into the endoscopy and IV sedation charges and cannot be billed separately with Medicaid and Medicare endoscopy unless a second physician administers.
7. Recently passed state regulations governing IV sedation/analgesia require an ACLS trained physician on premises during the endoscopy. Make sure that oxygen and Narcan are available before your start every procedure.
8. Others