Outpatient
Outpatient Methodology
Virginia Health Information receives information on the outpatient procedures below. The information comes from Hospital Outpatient Departments, Licensed Ambulatory Surgical Centers and Physician Offices. Charges are based on claims forms submitted for payment to health insurance companies, government programs and individuals paying for services out of pocket.
After editing, VHI makes this information available to the public on VHI.org. VHI displays information by health care provider, including how often they performed the procedure and their median charge. Cases with total charges equal to $0 are included in a provider’s totals, but excluded from median calculations for the provider and statewide. Procedures were chosen based on frequency and real or perceived risk to the patient. Detailed descriptions of the procedure explain why you may have the procedure and related information.
Click procedure name to view procedure codes collected by each procedure.
Breast Surgery
| Sub Group | CPT Code | Description | ICD-9 Procedure |
|---|---|---|---|
| Diagnostic | 19102 | Biopsy of breast; percutaneous, needle core, using imaging guidance | 8511 |
| 19103 | Percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance | 8511 | |
| 19110 | Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct | 850 | |
| Repair/ Reconstruction/ Cosmetic Pxs. | 19499 | Unlisted procedure, breast | 8599 |
| 19316 | Mastopexy | 856 | |
| 19318 | Reduction mammaplasty | 8531 | |
| 19324 | Mammaplasty, augmentation; without prosthetic implant | 8550 | |
| 19325 | with prosthetic implant | 8553U 8554B |
|
| 19328 | Removal of intact mammary implant | 8594 | |
| 19330 | Removal of mammary implant material | 8594 | |
| 19340 | Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction | 8553U 8554B |
|
| 19342 | Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction | 8553U 8554B |
|
| 19350 | Nipple/areola reconstruction | 8587 | |
| 19355 | Correction of inverted nipples | 8587 | |
| 19357 | Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion | 8595 | |
| 19361 | Breast reconstruction with latissimus dorsi flap, with or without prosthetic implant | 8585 8554B |
|
| 19364 | Breast reconstruction with free flap | 8581 8582 8583 8584 8586 |
|
| 19366 | Breast reconstruction with other technique | 8589 | |
| 19367 | Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site; | 857 | |
| 19368 | with microvascular anastomosis (supercharging) | 857 | |
| 19369 | Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor site | 857 | |
| 19370 | Open periprosthetic capsulotomy, breast | 850 | |
| 19371 | Periprosthetic capsulectomy, breast | 8594 | |
| 19380 | Revision of reconstructed breast | 8589 | |
| 19396 | Preparation of moulage for custom breast implant | CPT only | |
| Therapeutic | 19112 | Excision of lactiferous duct fistula | 8520 |
| 19120 | Excision of cyst, fibroadenoma or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19140), open, male or female, one or more lesions | 8521 | |
| 19125 | Excision of breast lesion identified by preoperative placement of radiological marker, open, single lesion | 8521 | |
| 19126 | Each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure) | 8521 | |
| 19140 | Mastectomy for gynecomastia | 8534 | |
| 19160 | Mastectomy, partial; | 8523 | |
| 19290 | Preoperative placement of needle localization wire, breast | 8519 | |
| 19291 | each additional lesion (List separately in addition to code for primary procedure) | 8519 |
Colonoscopy
| Sub Group | CPT Code | Description | ICD-9 Procedure |
|---|---|---|---|
| Diagnostic | 45355 | Colonoscopy, rigid or flexible, transabdominal via colostomy, single or multiple. | 4525 4521 4824 |
| 45378 | Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) | 4685 4523 |
|
| Therapeutic | 45379 | with removal of foreign body | 4523 9805 |
| 45380 | with biopsy, single or multiple | 4525 4824 |
|
| 45382 | with control of bleeding, any method | 4543 | |
| 45383 | with ablation of tumor(s), polyp(s) or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique | 4543 4835 |
|
| 45384 | with removal of tumor(s), polyp(s) or other lesion(s) by hot biopsy forceps or bipolar cautery | 4543 4832 |
|
| 45385 | with removal of tumor(s), polyp(s) or other lesion(s) by snare technique | 4542 4836 |
Facial Surgery
| Sub Group | CPT Code | Description | ICD-9 Procedure |
|---|---|---|---|
| Eyes Only | 15820 | Blepharoplasty, lower eyelid; | 0886 |
| 15821 | with extensive herniated fat pad | 0886 | |
| 15822 | Blepharoplasty, upper eyelid | 0887 | |
| 15823 | with excessive skin weighing down lid | 0887 | |
| Facial | 15825 | Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap) | 8682 |
| 15828 | cheek, chin and neck | 8682 | |
| Face and Eyes | Face codes & Eye codes**** |
Gallbladder Removal
| CPT Code | Description | ICD-9 Procedure |
|---|---|---|
| 47562 | Laparoscopy, surgical; cholecystectomy | 5123 |
| 47563 | cholecystectomy with cholangiography | 5123 8753 |
| 47564 | cholecystectomy with exploration of common duct | 5123 5151 5183 |
| 47570 | cholecysto-enterostomy | 5132 5421 |
| 47579 | Unlisted laparoscopy procedure, biliary tract | 5199 5421 |
General laparoscopic procedures
| CPT Code | Description | ICD-9 Procedure |
|---|---|---|
| 49320 | Laparoscopy, abdomen, peritoneum and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) | 5421 |
| 49321 | Laparoscopy, surgical: with biopsy (single or multiple) | 5424 5421 |
| 49322 | with aspiration of cavity or cyst (e.g. Ovarian cyst) single or multiple | 5424 6591 5421 |
| 49323 | with drainage of lymphocele to peritoneal cavity | 5421 540 |
| 49329 | Unlisted laparoscopy procedure, abdomen, peritoneum and omentum | 5421 5499 |
| 58578 | Unlisted laparoscopy procedure, uterus | 6999 5421 |
| 58579 | Unlisted hysteroscopy procedure, uterus | 6812 |
| 58679 | Unlisted laparoscopy procedure, oviduct, ovary | 6599 5421 |
Hernia Repair
| Sub Group | CPT Code | Description | ICD-9 Procedure |
|---|---|---|---|
| Children | 49500 | Repair initial inguinal hernia, age 6 months to under 5 years, with or without hydrocelectomy; reducible | 5300 |
| 49501 | incarcerated or strangulated | 5300 | |
| 49580 | Repair umbilical hernia, under age 5 years; reducible | 5359 | |
| 49582 | incarcerated or strangulated | 5359 | |
| Infants | 49495 | Repair initial inguinal hernia, under age 6 months, with or without hydrocelectomy; reducible | 5300 |
| 49496 | incarcerated or strangulated | 5300 | |
| 49605 | Repair of large omphalocele or gastroschisis; with or without prosthesis | 5341 | |
| 49606 | with removal of prosthesis, final reduction and closure, in operating room | 5341 | |
| 49610 | Repair of omphalocele (Gross type operation); first stage | 5349 | |
| 49611 | second stage | 5349 | |
| Unspecified Age | 49505 | Repair initial inguinal hernia, age 5 years or over; reducible | 5300 |
| 49507 | incarcerated or strangulated | 5300 | |
| 49520 | Repair recurrent inguinal hernia, any age; reducible | 5300 | |
| 49521 | incarcerated or strangulated | 5300 | |
| 49525 | Repair inguinal hernia; sliding, any age | 5300 | |
| 49540 | Repair lumbar hernia | 539 | |
| 49550 | Repair initial femoral hernia, any age; reducible | 5329 | |
| 49553 | incarcerated or strangulated | 5329 | |
| 49555 | Repair recurrent femoral hernia; reducible | 5329 | |
| 49557 | incarcerated or strangulated | 5329 | |
| 49560 | Repair initial incisional or ventral hernia; reducible | 5351 | |
| 49561 | incarcerated or strangulated | 5351 | |
| 49565 | Repair recurrent incisional or ventral hernia; reducible | 5351 | |
| 49566 | incarcerated or strangulated | 5351 | |
| 49568 | Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List separately in addition to code for the incisional or ventral hernia repair) | 5351 (49565) |
|
| 49570 | Repair epigastric hernia (e.g. Preperitoneal fat); reducible (separate procedure) | 5359 | |
| 49572 | incarcerated or strangulated | 5359 | |
| 49585 | Repair umbilical hernia, age 5 years or over; reducible | 5349 | |
| 49587 | incarcerated or strangulated | 5349 | |
| 49590 | Repair spigelian hernia | 5359 | |
| 49600 | Repair of small omphalocele, with primary closure | 5349 | |
| 49650 | Laparoscopy, surgical: repair initial inguinal hernia | 5300 5421 |
|
| 49651 | Repair recurrent inguinal hernia | 5300 5421 |
|
| 49659 | Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy | 539 5421 |
Hysterectomy
| CPT Code | Description | ICD-9 Procedure |
|---|---|---|
| 58550 | Laparoscopy, surgical: with vaginal hysterectomy with or without removal of tube(s), with or without removal of ovary(s) (laparoscopic assisted vaginal hysterectomy) | 6851 |
| 58551 | with removal of leiomyomata (single or multiple) | 6829 5421 |
Knee Anthroscopy
| CPT Code | Description | ICD-9 Procedure |
|---|---|---|
| 29871 | Arthroscopy, knee, surgical; for infection, lavage and drainage | 8016 |
| 29874 | for removal of loose body or foreign body (e.g. Osteochondritis dissecans fragmentation, chondral fragmentation) | 8016 |
| 29875 | synovectomy, limited (e.g. Plica or shelf resection) (separate procedure) | 8076 |
| 29876 | synovectomy, major, two or more compartments (e.g. medial or lateral) | 8076 |
| 29877 | debridement/shaving of articular cartilage (chondroplasty) | 8086 |
| 29879 | abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture | 8147 |
| 29880 | with meniscectomy (medial AND lateral, including any meniscal shaving) | 806 |
| 29881 | with meniscectomy (medial OR lateral, including any meniscal shaving) | 806 |
| 29882 | with meniscus repair (medial OR lateral) | 8147 |
| 29883 | with meniscus repair (medial AND lateral) | 8147 |
| 29884 | with lysis of adhesions, with or without manipulation (separate procedure) | 8046 |
| 29885 | drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion) | 8147 |
| 29886 | drilling for intact osteochondritis dissecans lesion | 8147 |
| 29887 | drilling for intact osteochondritis dissecans lesion with internal fixation | 8147 |
| 29888 | Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction | 8145 |
| 29889 | Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction | 8145 |
Liposuction
| Sub Group | CPT Code | Description | ICD-9 Procedure |
|---|---|---|---|
| Head neck | 15876 | Suction assisted lipectomy; head and neck | 8683 |
| Lower Extremity | 15879 | lower extremity | 8683 |
| Upper Extremity | 15878 | upper extremity | 8683 |
| Trunk Ext. | 15877 | trunk | 8683 |
Other Gynecological Procedures
| Sub Group | CPT Code | Description | ICD-9 Procedure |
|---|---|---|---|
| Birth Control | 58671 | with occlusion of oviducts by device (e.g. band, clip or Falope ring) | 6629 |
| D&C/Removal Fabroids | 58559 | with lysis of intrauterine adhesions (any method) | 6821 6812 |
| 58561 | with removal of leiomyomata | 6829 6812 |
|
| 58563 | with endometrial ablation (any method) | 6823 | |
| 58661 | with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) | 6541 | |
| 58670 | with fulguration of oviducts (with or without transection) | 6629 | |
| Fertility related | 58560 | with division or resection of intrauterine septum (any method) | 6822 6812 |
| 58672 | with fimbrioplasty | 6679 5421 |
|
| 58673 | with salpingostomy (salpingoneostomy) | 6602 5421 |
|
| Removal adhesions | 58660 | Laparoscopy, surgical with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) | 6581 |
| 58662 | with fulguration or excision of lesions of the ovary, pelvic viscera or peritoneal surface by any method | 6525 |
Updated on: 3/6/2019