Download Internal Medicine Superbill - Millennium Medical Billing

Medical Care
LAST NAME:
Dr. Medical Billing
205 Superbill Dr.
DOS:
New York, NY 10012
ADDRESS:
212-484-2800
FIRST NAME:
SSN:
MALE
DOB:
FEMALE
CELL PHONE:
COPAY AMOUNT:
HOME PHONE:
OFFICE SERVICES
ESTABLISHED
99204

99211

99214
99205

99212

99215

99213
PREVENTATIVE MEDICINE
OFFICE CONSULTS
NEW
NEW
AGE
ESTABLISHED
 99241 LEVEL 1

99201

 99384
12 - 17
 99394
 99242 LEVEL 2

99202

 99385
18 - 39
 99395
 99243 LEVEL 3

99203
 99386
40 - 64
 99396
 99244 LEVEL 4
 99387
65 +
 99397
 99245 LEVEL 5
ADMINISTRATION FEES
---------------------------------------------------INJECTIONS/VACCINES----------------------------------------- 90471 Admin Of First Vac.
 90471 Imm admin, one
 90702 DT < 7 YEARS
 90649 HPV
 J0170 Epinephrine
 90472 Admin Of Additional Vac.  90472 Imm admin, 2+
 90701 DTP
 90713 IPV
 J0290 Ampicillin, Up To 500mg
 G0008 Admin Of Flu Vac.
 20600 Inj. joint, small
 90700 DtaP, <7 y
 90707 MMR
 J0696 Rocephin, 250mg
 G0009 Admin Of Pneumo Vac.  20605 Inj., joint, medium
 90658 Flu, 3 y +
 90732 Pneumonia, >2y  J1200 Benadryl 50mg Inj
 96372 Admin Of Im/Sc Med.
 20610 Inj., joint, major
 90632 Hep A, adult
 90718 TD, >7 Y
 J1885 Toradol 60mg Inj
 95115 Allergen, one
 20552 Inj. , tendon sheath  90633 Hep A, minor, 2 dose
 90716 Varicella
 J2001 Lidocaine, 10mg
 95117 Allergen, multiple
 90746 Hep B, adult
 90665 Lyme Vaccine
 J2550 Phenergan, Up To 50mg
 90744 Hep B, minor 3 dose
 J2930 Solumedrol 125mg Inj
 J3301 Kenalog 40
NOTES:
 J3420 B-12
LABORATORY / PROCEDURES / TESTING
 36410 Venipuncture
 83014 H.Pylori Test
 94150 Peak Flow
 A4460 Elastic Bandage Ace
 36415 Medicare Venipuncture
 85610 Pt/Inr
 94640 Nebulizer
 69210 Ear Irrigation/Wax Removal
 81002 Urinalysis Dipstick
 86580 Mantoux
 94060 Spirometry
 Echo (Macro)
 81025 Pregnancy Test
 87880 Strep Test
 94760 Pulse Oxymetry
 VNG/Balance Test (Macro)
 82270 Hemoccult
 93000 Ekg
 97597 Wound Care >= 20cmp
 Urodynamics (Macro)
 82962 Glucose Test/Finger Stick
 94060 Complete Spirometry
 97598 Wound Care < 20cmp
 Nerve Conduction
 82947-QW Assay,Glucose,Blood Quant
 ______________________________  _____________________________  ____________________________
DIAGNOSIS
Signs & Symptoms
Endocrine, Nutritional & Metabolic Disorders
 789.00 Abdominal pain, unspec.
 250.01 Diabetes I, uncomplicated
 795.01 Abnormal Pap, ASC-US
 250.91 Diabetes, I, w/ unspec. Complic.
 719.40 Arthralgia, unspec.
 250.00 Diabetes II/unspec., w/o comp,
 569.3 Bleeding, rectal
 250.90 Diabetes II, w/ unspec. Complic.
 786.50 Chest pain, unspec.
 242.90 Hyperthyroidism, NOS
 786.2 Cough
 244.2 Hypothyroidism, unspec.
 787.91 Diarrhea, NOS
 274.9 Gout, unspec.
 780.4 Dizziness/vertigo, NOS
 272.0 Hypercholesterolemia
 787.2 Dysphagia
 272.2 Hyperlipidemia, mixed
 788.1 Dysuria
 272.1 Hypertriglyceridemia
 782.3 Edema, localized, NOS
 278.01 Obesity, morbid
Circulatory System
 780.6 Fever, nonperinatal
 427.31 Atrial fibrillation
 271.9 Glucose intolerance
 428.0 Heart failure, congestive, unspec.
 784.0 Headache, unspec.
 414.9 Ischemic heart dis., chronic, unspec.
 788.30 Incontinence/enuresis, NOS
 782.2 Localized swelling/mass, superficial  424.1 Valvular disorder, aortic, NOS
 796.2 Elevated BP w/o hypertension
 785.6 Lymph nodes, enlarged
 401.1 Hypertension, benign
 780.71 Chronicfatigue Syndrome
 458.0 Hypotension, orthostatic
 787.02 Nausea, alone
 443.9 Peripheral vascular disease, unspec.
 787.01 Nausea w/ vomiting
 451.9 Thrombophlebitis, unspec.
 719.46 Pain, knee
 459.81 Venous insufficiency, unspec.
 724.2 Pain, low back
Digestive System
 785.1 Palpitations
 564.00 Constipation, unspec.
 788.42 Polyuria
 562.11 Diverticulitis of colon, NOS
 782.1 Rash, nonvesicular, unspec.
 535.50 Gastritis, unspec. w/o hemorrhage
 782.0 Sensory disturbance skin
 558.9 Gastroenteritis, noninfect, unspec.
 786.05 Shortness of breath
 530.81 Gastroesophageal ref, no esophag
 780.2 Syncope
 455.6 Hemorrhoids, NOS
 788.41 Urinary frequency
 564.1 Irritable bowel syndrome
 787.03 Vomiting, alone
 578.1 Melena
 783.21 Weight loss
Nervous System & Sense Organ Disorders
Infectious & Parasitic Diseases
Nervous System Diseases
 053.9 Herpes zoster, NOS
 054.9 Herpetic disease, uncomplicated  354.0 Carpal tunnel
 346.90 Migraine, unspec., not intractable
 034.0 Strep throat
Eye Diseases
 079.99 Viral infection, unspec.
 372.30 Conjunctivitis, unspec.
 078.10 Warts, all sites
 368.10 Visual disturbance, unspec.
Neoplasms
Ear Diseases
 239.2 Skin, soft tissue neoplasm,
 380.4 Cerumen impaction
unspec.
 389.9 Hearing loss, unspec.
 216.9 Skin, unspec.
 381.02 Acute Mucoid Otitis Media
Respiratory System
 493.01 Asthma w/ Status Asthmaticus
 466.0 Bronchitis, acute
 496 COPD, NOS
 486 Pneumonia, unspec.
 462 Pharyngitis, acute
 477.0 Rhinitis, allergic, due to pollen
 461.0 Sinusitis, acute Maxillary
 465.0 Acute Laryngopharyngitis
Skin, Subcutaneous Tissue
 706.1 Acne
 702.0 Actinic keratosis
 682.9 Cellulitis/abscess, unspec.
 691.8 Eczema, atopic dermatitis
 703.0 Ingrown nail
 110.1 Onychomycosis
 696.1 Psoriasis, other
 695.3 Rosacea
 706.2 Sebaceous cyst
 702.19 Seborrheic keratosis, NOS
 708.9 Urticaria, unspec.
Musculoskeletal & Connective Tissue
General
 716.90 Arthropathy, unspec.
 729.1 Fibromyositis
 715.09 Osteoarthrosis, Generalized
 733.01 Osteoporosis Senile.
 714.0 Rheumatoid arthritis
Lower Extremity
 729.5 Pain in limb
 728.71 Plantar fascitis
Spine/Torso
 724.4 Back pain w/ radiation, unspec.
 723.9 Cervical disorder, NOS
Upper Extremity
 726.32 Lateral epicondylitis
 726.10 Rotator cuff syndrome, NOS
Blood Diseases
 285.9 Anemia, other, unspec.
 281.1 B12 Deficit Anemia
Mental Disorders
 300.02 Generalized Anxiety Disorder
 314.00 Attention deficit, w/o hyperactivity
 294.10 Dementia w/o Disturbance
 311 Depression, NEC
Injuries & Adverse Effects
 845.00 Sprain/strain: ankle, unspec.
 845.10 Sprain/strain: foot, unspec.
 842.10 Sprain/strain: hand, unspec.
 844.9 Sprain/strain: knee/leg, unspec.
 847.0 Sprain/strain: neck, unspec.
 840.9 Sprain/strain: shoulder/up arm, unspec.
 842.00 Sprain/strain: wrist, unspec.
 919.0 Abrasion, unspec.
 924.9 Contusion, unspec.
 919.4 Insect bite
 894.0 Open wound, lower limb, unspec.
 884.0 Open wound, upper limb, unspec.
Supplemental Classification
 V72.32 Confirm norm Pap after initial abn
 V25.01 Contraception, oral
 V25.02 Contraception, other (diaphragm,etc.)
 V25.2 Contraception, sterilization
 V58.30 Dressing change, nonsurgical
 V01.9 Exposure, infectious disease, unspec.
 V72.31 Gynecological exam
 V06.8 Immunization, combination, other
 V06.1 Immunization, DTP
 V04.81 Immunization, influenza
 V70.0 Well adult check
 V20.2 Well child check
Genitourinary System
Urinary System Diseases
 592.9 Calculus, urinary, unspec.
 599.70 Hematuria
 593.9 Renal insufficiency, acute
 599.0 Urinary tract infection, unspec./pyuria
Male
 607.84 Impotence, organic
 302.72 Impotence, psychosexual dysfunc.
 601.9 Prostatitis, NOS
 257.2 Testicular hypofunction
Female
 616.0 Cervicitis
 622.10 Dysplasia, cervix, unspec.
 625.9 Pelvic pain, unspec. female disease
 616.10 Vaginitis/vulvitis, unspec.
 626.0 Amenorrhea
 627.9 Menopausal disorders, unspec.
 626.6 Metrorrhagia
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MD Signature:
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