Healthcare Code Lookup User Guide
You can search by a code and/or any word from the code’s description. A whitespace is interpreted as a logical “AND.” E.g., the query “knee drainage” (without quotes) will search for procedures with the description containing these two words in any order.
The procedure “0L9Q0ZX Drainage of Right Knee Tendon, Open Approach, Diagnostic” will be one of the results.
A comma is interpreted as a logical “OR.” E.g., the query “right knee drainage, right tendon excision” will search for descriptions containing “right knee drainage” or “right tendon excision.” So you will see “0L9Q0ZX” and “0LB10ZX Excision of Right Shoulder Tendon, Open Approach, Diagnostic” in the result set.
Our search is not case-sensitive, e.g., “Knee” and “knee” will produce identical results.
You can also search by a codeset name, such as “HCPCS” (for HCPCS level 2), “CPT”, “ICD-10”, or “diagnosis.”
Search by Initial Characters
Each word from a search query is used as a prefix. This means we will try to find all items containing any word (or a code) that starts with a word from the query. For example, searching for “endo” will find procedures containing any word starting with “endo”, such as “endoscopic” and “endoscope”.
This also applies to codes. Diagnosis, procedures, NDC codes all have a built-in implicit hierarchy. For example, all HCPCS Level 2 codes that start with “00924” deal with “Drainage of dura mater.”
To find these codes, we can search for “hcpcs 00924” (we had to specify “HCPCS” to filter out CPT codes).
You can suppress search by initial characters by appending “$” to your search terms. E.g., the query “endo$” will only find procedures containing this exact word; it will no longer match “endoscopic”.
You can explicitly limit the search to only codes, as opposed to codes, descriptions, types, etc. For example, if you want to see all procedures where the code starts with “J” (injection-related procedures), you can use this query: “code:J”. This will exclude procedures containing words that start with “J” in their description.
For example, to see the J-code for adrenaline, query for “code:j adrenalin”. “J” will only match codes, and “Adrenalin” will match descriptions.
There are also prefixes for categories (“cat:”) and edits (“edit:”) described below.
By default, the prefix only applies to the word next to it. The word must follow the colon without any spaces. You can also relate prefix to multiple words by using the colon separator.
For example, “edit:ptp:mue” will match codes that have PTP and MUE edits.
Search by Categories
Certain healthcare code sets, such as procedures and provider taxonomies, can be grouped by categories and subcategories. CMS maintains Restructured BETOS Classification System for procedure codes. NUCC groups providers specialties (taxonomy codes) using a multi-level classification system.
You can use our lookup tool to find codes that belong to a particular category. For example, to see all procedures classified as “Molecular Testing”, simply enter “molecular testing” into the search field.
To make the search more specific, use the prefix “cat:”, e.g., “cat:molecular”.
To see all procedures with categories, use the prefix “cat:” without any values. E.g., the query “cat:” will display all procedures with assigned RBCS/BETOS categories and subcategories.
Search by Edits
Many procedures and some diagnosis have so-called “edits” developed by CMS as part of their National Correct Coding Initiative (NCCI). An edit is a rule restricting the use of certain procedures and diagnosis codes.
For example, “Medically Unnecessary Edits” (MUE) edits define “the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service”.
You can view edits for a given code in the code details popup.
You can search for codes with edits using the “edit:” prefix. The “edit:” query will match all codes with edits.
You can also search for specific edit types. Our code lookup tool provides information on the following edit types:
- MUE (Medically Unnecessary Edits)
- PTP (Procedure to Procedure). Edits that prevent improper payment when certain codes are submitted together for Part B-covered services.
- Age. Inconsistencies between a patient’s age and a diagnosis or a procedure on the patient’s record.
- Gender. Inconsistencies between a patient’s sex and a diagnosis or a procedure on the patient’s record.
You can search for codes with these edits by specifying the edit type prefixed by the “edit:”. E.g., the query “edit:MUE, edit:gender” will match procedures with MUE edits or gender-related edits.
“edit:MUE:gender” will match procedures that have both MUE and gender edits.
Search by Specific PTP Procedures
“Procedure-to-Procedure” edits define procedure pairs that cannot be reported together on the same date of service unless a modifier is used.
For example, the repair of an organ that can be performed by two different methods. Only one method can be chosen to repair the organ.
You can use our search to see if a given code has specific PTP edits associated with it.
For example, you may want to check if G0102 (Prostate cancer screening; digital rectal examination) is reimbursable when billed together with 99215 (Office or other outpatient visit).
You can use the query “code:99215 PTP:G0102” to perform this check. This query can be translated into plain English as “Find the procedure with the code 99215 and with the PTP edit for the code G0102”.
When you run the query, the procedure 99215 will be shown in the result set. This means that “99215” indeed has an edit prohibiting the use of “G0102” on the same day.
Conversely, the empty result set will indicate that “99215” does not have such and edit and “G0102” can be used.
You can also search for multiple PTP edits with a single query, e.g., “code:99215 PTP:G0102:0359T”.
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