Pulmonology Revenue Cycle Management Services
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ICD-10 Pulmonology Superbill Example
| Appointment Date & Time: | Last Seen Date: | ||||
| Patient: | Gender: | DOB: | MR# | Pat Due: | INS Due: |
| Address: | Reason: | ||||
| Home Phone: | Cell Phone: | E-Mail: | |||
| Case Name: | Case No: | Case Type: | Case Date: | ||
| Pr Insurance: | Member ID: | Co-Pay Amount: | Deductible: | ||
| Rendering Provider: | PCP: | Referring Provider: | |||
| CPT CODES | |||||
| CPT Code | Description | CPT Code | Description | CPT Code | Description |
| 0262T | Implantation of catheter delivered prosthetic pulmonary valve,endovascular approach | 33361 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach | 33365 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) |
| 0343T | Transcatheter mitral valve repair percutaneous approach including transseptal puncture when performed; initial prosthesis | 33362 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic with prosthetic valve; open femoral artery approach | 33366 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy) |
| 0344T | Transcatheter mitral valve repair percutaneous approach including transseptal puncture when performed; additional prosthesis (es) during same session | 33363 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach | 33367 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) |
| 0345T | Transcatheter mitral valve repair percutaneous approach via the coronary sinus | 33364 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach | 33368 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannula tion |
| ICD CODES | |||||
| ICD-10 | Description | ICD-10 | Description | ICD-10 | Description |
| Q20 | Congenital malformations of cardiac chambers and connections | Q22.5 | Ebstein’s anomaly | Q25.72 | Congenital pulmonary arteriovenous malformation |
| Q21 | Congenital malformations of cardiac septa | Q22.6 | Hypoplastic right heart syndrome | Q25.79 | Other congenital malformations of pulmonary artery |
| Q22 | Congenital malformations of pulmonary and tricuspid valves | Q22.8 | Other congenital malformations of tricuspid valve | Q25.8 | Other congenital malformations of other great arteries |
| Q23 | Congenital malformations of aortic and mitral valves | Q22.9 | Congenital malformation of tricuspid valve, unspecified | Q25.9 | Congenital malformation of great arteries, unspecified |
| Q24 | Other congenital malformations of heart | Q25 | Congenital malformations of great arteries | Q26 | Congenital malformations of great veins |
| Q25 | Congenital malformations of great arteries | Q25.0 | Patent ductus arteriosus | Q26.0 | Congenital stenosis of vena cava |
| Q26 | Congenital malformations of great veins | Q25.1 | Coarctation of aorta | Q26.1 | Persistent left superior vena cava |
| Q27 | Other congenital malformations of peripheral vascular system | Q25.2 | Atresia of aorta | Q26.2 | Total anomalous pulmonary venous connection |
| Q28 | Other congenital malformations of circulatory system | Q25.3 | Supravalvular aortic stenosis | Q26.3 | Partial anomalous pulmonary venous connection |
| Q22.0 | Pulmonary valve atresia | Q25.4 | Other congenital malformations of aorta | Q26.4 | Anomalous pulmonary venous connection, unspecified |
| Q22.1 | Congenital pulmonary valve stenosis | Q25.5 | Atresia of pulmonary artery | Q26.5 | Anomalous portal venous connection |
| Q22.2 | Congenital pulmonary valve insufficiency | Q25.6 | Stenosis of pulmonary artery | Q26.6 | Portal vein-hepatic artery fistula |
| Q22.3 | Other congenital malformations of pulmonary valve | Q25.7 | Other congenital malformations of pulmonary artery | Q26.8 | Other congenital malformations of great veins |
| Q22.4 | Congenital tricuspid stenosis | Q25.71 | Coarctation of pulmonary artery | Q26.9 | Congenital malformation of great vein, unspecified |
| Q33 | Congenital malformations of lung | Q33.2 | Sequestration of lung | Q33.5 | Ectopic tissue in lung |
| Q33.0 | Congenital cystic lung | Q33.3 | Agenesis of lung | Q33.6 | Congenital hypoplasia and dysplasia of lung |
| Q33.1 | Accessory lobe of lung | Q33.4 | Congenital bronchiectasis | Q33.8 | Other congenital malformations of lung |
| Charges: | CASH | Doctor’s Signature | |||
| Payments: | CHECK: | ||||
| MC | AMX | ||||
| Balance: | VISA | DEBT | |||
| Credit Card# | |||||