AXA Health | Specialist Procedure Codes

Procedure codes

Index

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Introduction

14 - Female reproductive organs

14.4 - Vagina/perineum

12 - Urinary system and male reproductive organs

12.3 - Bladder

15 - Skin and subcutaneous tissue

15.2 - Repair

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

17 - Interventional radiology

17.6 - Dilatation

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.7 - Shoulder

9 - Vascular system

9.5 - Ileo-femoral vessels

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

4 - Eye and orbital contents

4.6 - Cornea

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.1 - External ear

12 - Urinary system and male reproductive organs

12.6 - Genitalia

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

14 - Female reproductive organs

14.4 - Vagina/perineum

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

4 - Eye and orbital contents

4.5 - Conjuctiva

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

16.13 - Amputation

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.6 - Peripheral nerves

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

10 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

14 - Female reproductive organs

14.1 - Uterus/adnexa

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

17 - Interventional radiology

17.11 - Liver

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

12 - Urinary system and male reproductive organs

12.2 - Ureter

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

4 - Eye and orbital contents

4.2 - Eyebrow and lid

2 - Brain, cranium and intracranial organs

2.3 - Meninges

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.7 - Shoulder

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.5 - Vulva/labia

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.8 - Major vessels

17 - Interventional radiology

17.4 - Embolisation

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

3.6 - Peripheral nerves

2 - Brain, cranium and intracranial organs

2.5 - Vessels

4 - Eye and orbital contents

4.12 - General

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

12 - Urinary system and male reproductive organs

12.4 - Urethra

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

4 - Eye and orbital contents

4.2 - Eyebrow and lid

4.6 - Cornea

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

9 - Vascular system

9.6 - Non-specific

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

4 - Eye and orbital contents

4.2 - Eyebrow and lid

17 - Interventional radiology

17.3 - Angioplasty

17.8 - Spine

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

14 - Female reproductive organs

14.4 - Vagina/perineum

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

17 - Interventional radiology

17.1 - Biopsy

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

6 - Face, mouth, salivary and thyroid

6.4 - Palate

5 - Ear, nose and throat

5.1 - External ear

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

9 - Vascular system

9.1 - Head and neck

9.2 - Thoracic vessels

5 - Ear, nose and throat

5.6 - Throat

17 - Interventional radiology

17.12 - Urinary

7 - Breast

7.3 - Reconstruction

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

14 - Female reproductive organs

14.3 - Cervix uteri

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

2 - Brain, cranium and intracranial organs

2.3 - Meninges

6 - Face, mouth, salivary and thyroid

6.2 - Lips

12 - Urinary system and male reproductive organs

12.4 - Urethra

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

16.13 - Amputation

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

4 - Eye and orbital contents

4.3 - Lacrimal system

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

5 - Ear, nose and throat

5.3 - Inner ear

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

12 - Urinary system and male reproductive organs

12.3 - Bladder

12.4 - Urethra

12.6 - Genitalia

5 - Ear, nose and throat

5.7 - Larynx and trachea

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

17 - Interventional radiology

17.13 - Other

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

2 - Brain, cranium and intracranial organs

2.1 - Brain

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

2 - Brain, cranium and intracranial organs

2.1 - Brain

4 - Eye and orbital contents

4.4 - Muscles

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

9 - Vascular system

9.1 - Head and neck

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

16.13 - Amputation

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

9 - Vascular system

9.2 - Thoracic vessels

17 - Interventional radiology

17.3 - Angioplasty

9 - Vascular system

9.8 - Lymphatic system

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

5 - Ear, nose and throat

5.3 - Inner ear

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.6 - Throat

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

16.11 - Foot

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

12 - Urinary system and male reproductive organs

12.2 - Ureter

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.4 - Small intestine

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

9 - Vascular system

9.7 - Varicose veins

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

14 - Female reproductive organs

14.1 - Uterus/adnexa

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

5 - Ear, nose and throat

5.7 - Larynx and trachea

7 - Breast

7.4 - Other

9 - Vascular system

9.8 - Lymphatic system

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

8.11 - Other

2 - Brain, cranium and intracranial organs

2.1 - Brain

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.4 - Palate

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.11 - Foot

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

14 - Female reproductive organs

14.2 - Suspension

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.7 - Larynx and trachea

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

2 - Brain, cranium and intracranial organs

2.4 - Nerves

14 - Female reproductive organs

14.1 - Uterus/adnexa

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

16.11 - Foot

5 - Ear, nose and throat

5.3 - Inner ear

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

5 - Ear, nose and throat

5.5 - Nasal sinuses

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

4 - Eye and orbital contents

4.2 - Eyebrow and lid

4.5 - Conjuctiva

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.6 - Rectum/anus

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

12 - Urinary system and male reproductive organs

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

8 - Thorax and intra-thoracic organs

8.11 - Other

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.8 - Neck

7 - Breast

7.4 - Other

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

2 - Brain, cranium and intracranial organs

2.4 - Nerves

12 - Urinary system and male reproductive organs

12.4 - Urethra

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

17 - Interventional radiology

17.3 - Angioplasty

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

5 - Ear, nose and throat

5.7 - Larynx and trachea

17 - Interventional radiology

17.8 - Spine

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.6 - Cornea

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

12 - Urinary system and male reproductive organs

12.3 - Bladder

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

9 - Vascular system

9.5 - Ileo-femoral vessels

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

5 - Ear, nose and throat

5.1 - External ear

15 - Skin and subcutaneous tissue

15.2 - Repair

17 - Interventional radiology

17.12 - Urinary

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

12 - Urinary system and male reproductive organs

12.4 - Urethra

4 - Eye and orbital contents

4.1 - Globe and orbit

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.4 - Muscles

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

12 - Urinary system and male reproductive organs

12.2 - Ureter

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.5 - Prostate

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

9 - Vascular system

9.2 - Thoracic vessels

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.5 - Prostate

9 - Vascular system

9.7 - Varicose veins

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.7 - Larynx and trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

4 - Eye and orbital contents

4.6 - Cornea

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

7 - Breast

7.1 - Excision/biopsy codes

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

2 - Brain, cranium and intracranial organs

2.2 - Cranium

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

4 - Eye and orbital contents

4.5 - Conjuctiva

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

4 - Eye and orbital contents

4.5 - Conjuctiva

2 - Brain, cranium and intracranial organs

2.4 - Nerves

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

9 - Vascular system

9.5 - Ileo-femoral vessels

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.5 - Prostate

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

4 - Eye and orbital contents

4.4 - Muscles

6 - Face, mouth, salivary and thyroid

6.8 - Neck

4 - Eye and orbital contents

4.9 - Lens

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.11 - Other

5 - Ear, nose and throat

5.7 - Larynx and trachea

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.7 - Shoulder

16.8 - Elbow

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

4 - Eye and orbital contents

4.12 - General

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

14 - Female reproductive organs

14.1 - Uterus/adnexa

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

4 - Eye and orbital contents

4.11 - Retina

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

4 - Eye and orbital contents

4.3 - Lacrimal system

7 - Breast

7.3 - Reconstruction

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

12 - Urinary system and male reproductive organs

12.5 - Prostate

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

7 - Breast

7.4 - Other

17 - Interventional radiology

17.12 - Urinary

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

4 - Eye and orbital contents

4.2 - Eyebrow and lid

12 - Urinary system and male reproductive organs

12.3 - Bladder

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.12 - External fixation/traction

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

14 - Female reproductive organs

14.5 - Vulva/labia

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.6 - Hand

16.7 - Shoulder

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

6.7 - Teeth

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

8 - Thorax and intra-thoracic organs

8.3 - Trachea

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

8 - Thorax and intra-thoracic organs

8.11 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

16.12 - External fixation/traction

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

17 - Interventional radiology

17.4 - Embolisation

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.9 - Hip, leg and pelvis

2 - Brain, cranium and intracranial organs

2.1 - Brain

12 - Urinary system and male reproductive organs

12.6 - Genitalia

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.1 - Investigations

9 - Vascular system

9.2 - Thoracic vessels

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

5 - Ear, nose and throat

5.5 - Nasal sinuses

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

9 - Vascular system

9.5 - Ileo-femoral vessels

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

5 - Ear, nose and throat

5.5 - Nasal sinuses

9 - Vascular system

9.6 - Non-specific

12 - Urinary system and male reproductive organs

12.2 - Ureter

12.6 - Genitalia

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

2 - Brain, cranium and intracranial organs

2.6 - Other

5 - Ear, nose and throat

5.5 - Nasal sinuses

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.7 - Other organs (mainly digestive)

9 - Vascular system

9.6 - Non-specific

7 - Breast

7.3 - Reconstruction

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

5.6 - Throat

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

15 - Skin and subcutaneous tissue

15.2 - Repair

12 - Urinary system and male reproductive organs

12.3 - Bladder

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

5 - Ear, nose and throat

5.1 - External ear

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

9 - Vascular system

9.6 - Non-specific

4 - Eye and orbital contents

4.2 - Eyebrow and lid

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

12 - Urinary system and male reproductive organs

12.2 - Ureter

17 - Interventional radiology

17.1 - Biopsy

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

15 - Skin and subcutaneous tissue

15.2 - Repair

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

11.7 - Other organs (mainly digestive)

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

4 - Eye and orbital contents

4.3 - Lacrimal system

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

7 - Breast

7.3 - Reconstruction

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

14 - Female reproductive organs

14.1 - Uterus/adnexa

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

12 - Urinary system and male reproductive organs

12.4 - Urethra

9 - Vascular system

9.2 - Thoracic vessels

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

4 - Eye and orbital contents

4.4 - Muscles

17 - Interventional radiology

17.13 - Other

12 - Urinary system and male reproductive organs

12.2 - Ureter

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

9 - Vascular system

9.6 - Non-specific

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

4 - Eye and orbital contents

4.2 - Eyebrow and lid

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

9 - Vascular system

9.2 - Thoracic vessels

12 - Urinary system and male reproductive organs

12.5 - Prostate

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

4 - Eye and orbital contents

4.10 - Vitreous

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

12 - Urinary system and male reproductive organs

12.4 - Urethra

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

8 - Thorax and intra-thoracic organs

8.3 - Trachea

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

4 - Eye and orbital contents

4.10 - Vitreous

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.6 - Peripheral nerves

5 - Ear, nose and throat

5.1 - External ear

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

16.3 - Fractures

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

17 - Interventional radiology

17.3 - Angioplasty

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

8.2 - Chest wall

12 - Urinary system and male reproductive organs

12.2 - Ureter

12.5 - Prostate

5 - Ear, nose and throat

5.7 - Larynx and trachea

2 - Brain, cranium and intracranial organs

2.1 - Brain

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.3 - Fractures

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

14 - Female reproductive organs

14.4 - Vagina/perineum

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

9 - Vascular system

9.4 - Abdominal vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

9 - Vascular system

9.6 - Non-specific

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

5 - Ear, nose and throat

5.5 - Nasal sinuses

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.4 - Small intestine

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

9 - Vascular system

9.6 - Non-specific

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

9 - Vascular system

9.2 - Thoracic vessels

12 - Urinary system and male reproductive organs

12.5 - Prostate

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

6 - Face, mouth, salivary and thyroid

6.8 - Neck

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

4 - Eye and orbital contents

4.2 - Eyebrow and lid

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.10 - Peritoneum

9 - Vascular system

9.6 - Non-specific

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

2 - Brain, cranium and intracranial organs

2.5 - Vessels

9 - Vascular system

9.5 - Ileo-femoral vessels

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

9 - Vascular system

9.6 - Non-specific

9.7 - Varicose veins

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

15.2 - Repair

15.3 - Burns, scars and contractures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

9 - Vascular system

9.7 - Varicose veins

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

7 - Breast

7.4 - Other

12 - Urinary system and male reproductive organs

12.6 - Genitalia

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

17 - Interventional radiology

17.4 - Embolisation

11 - Abdomen (excluding urinary and reproductive organs)

11.8 - Major vessels

14 - Female reproductive organs

14.5 - Vulva/labia

9 - Vascular system

9.6 - Non-specific

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.3 - Bladder

7 - Breast

7.3 - Reconstruction

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

16.12 - External fixation/traction

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.10 - Knee

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

11.7 - Other organs (mainly digestive)

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

4 - Eye and orbital contents

4.10 - Vitreous

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

12 - Urinary system and male reproductive organs

12.4 - Urethra

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

12 - Urinary system and male reproductive organs

12.4 - Urethra

2 - Brain, cranium and intracranial organs

2.2 - Cranium

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

18 - Chemotherapy

18.0 - Chemotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

5 - Ear, nose and throat

5.5 - Nasal sinuses

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

12 - Urinary system and male reproductive organs

12.4 - Urethra

9 - Vascular system

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.10 - Knee

17 - Interventional radiology

17.9 - Thorax

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.4 - Vagina/perineum

9 - Vascular system

9.4 - Abdominal vessels

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

17 - Interventional radiology

17.6 - Dilatation

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.4 - Urethra

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

9 - Vascular system

9.8 - Lymphatic system

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

12 - Urinary system and male reproductive organs

12.5 - Prostate

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

17 - Interventional radiology

17.13 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

17 - Interventional radiology

17.2 - Drainage

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

8.5 - Bronchi/lungs/pleura

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

6 - Face, mouth, salivary and thyroid

6.4 - Palate

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.11 - Other

14 - Female reproductive organs

14.1 - Uterus/adnexa

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.3 - Bladder

2 - Brain, cranium and intracranial organs

2.5 - Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

15 - Skin and subcutaneous tissue

15.2 - Repair

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

17 - Interventional radiology

17.11 - Liver

2 - Brain, cranium and intracranial organs

2.3 - Meninges

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

4 - Eye and orbital contents

4.11 - Retina

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.6 - Genitalia

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

4 - Eye and orbital contents

4.10 - Vitreous

7 - Breast

7.1 - Excision/biopsy codes

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

4 - Eye and orbital contents

4.5 - Conjuctiva

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

12 - Urinary system and male reproductive organs

12.2 - Ureter

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

4 - Eye and orbital contents

4.3 - Lacrimal system

4.9 - Lens

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

5 - Ear, nose and throat

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.3 - Bladder

9 - Vascular system

9.7 - Varicose veins

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

5 - Ear, nose and throat

5.3 - Inner ear

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.8 - Lymphatic system

5 - Ear, nose and throat

5.1 - External ear

17 - Interventional radiology

17.4 - Embolisation

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.9 - Lens

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.1 - Globe and orbit

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

12 - Urinary system and male reproductive organs

12.6 - Genitalia

9 - Vascular system

9.7 - Varicose veins

5 - Ear, nose and throat

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.5 - Prostate

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

17 - Interventional radiology

17.8 - Spine

7 - Breast

7.3 - Reconstruction

2 - Brain, cranium and intracranial organs

2.1 - Brain

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.8 - Major vessels

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.6 - Hand

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

12 - Urinary system and male reproductive organs

12.2 - Ureter

5 - Ear, nose and throat

5.7 - Larynx and trachea

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

9 - Vascular system

9.8 - Lymphatic system

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

18 - Chemotherapy

18.0 - Chemotherapy

9 - Vascular system

9.7 - Varicose veins

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

14 - Female reproductive organs

14.2 - Suspension

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

7.4 - Other

17 - Interventional radiology

17.1 - Biopsy

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.3 - Bladder

17 - Interventional radiology

17.3 - Angioplasty

2 - Brain, cranium and intracranial organs

2.6 - Other

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

12 - Urinary system and male reproductive organs

12.3 - Bladder

15 - Skin and subcutaneous tissue

15.2 - Repair

4 - Eye and orbital contents

4.6 - Cornea

5 - Ear, nose and throat

5.3 - Inner ear

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

5 - Ear, nose and throat

5.6 - Throat

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

2 - Brain, cranium and intracranial organs

2.1 - Brain

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

6 - Face, mouth, salivary and thyroid

6.2 - Lips

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

9 - Vascular system

9.5 - Ileo-femoral vessels

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.12 - External fixation/traction

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.2 - Lips

15 - Skin and subcutaneous tissue

15.2 - Repair

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.2 - Spinal cord

3.9 - Neurophysiological procedures

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

12 - Urinary system and male reproductive organs

12.2 - Ureter

9 - Vascular system

9.6 - Non-specific

12 - Urinary system and male reproductive organs

12.3 - Bladder

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.9 - Hip, leg and pelvis

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

4 - Eye and orbital contents

4.1 - Globe and orbit

4.5 - Conjuctiva

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

14 - Female reproductive organs

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.6 - Throat

14 - Female reproductive organs

14.3 - Cervix uteri

14.4 - Vagina/perineum

6 - Face, mouth, salivary and thyroid

6.4 - Palate

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.9 - Lens

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

2 - Brain, cranium and intracranial organs

2.3 - Meninges

12 - Urinary system and male reproductive organs

12.2 - Ureter

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

17 - Interventional radiology

17.13 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

14 - Female reproductive organs

14.1 - Uterus/adnexa

2 - Brain, cranium and intracranial organs

2.1 - Brain

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.10 - Knee

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

4 - Eye and orbital contents

4.3 - Lacrimal system

5 - Ear, nose and throat

5.5 - Nasal sinuses

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

9 - Vascular system

9.8 - Lymphatic system

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

17 - Interventional radiology

17.8 - Spine

2 - Brain, cranium and intracranial organs

2.2 - Cranium

12 - Urinary system and male reproductive organs

12.6 - Genitalia

9 - Vascular system

9.8 - Lymphatic system

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

7 - Breast

7.4 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

16.9 - Hip, leg and pelvis

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

9 - Vascular system

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

9 - Vascular system

9.8 - Lymphatic system

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

5 - Ear, nose and throat

5.7 - Larynx and trachea

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

9 - Vascular system

9.6 - Non-specific

12 - Urinary system and male reproductive organs

12.5 - Prostate

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

2 - Brain, cranium and intracranial organs

2.4 - Nerves

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

17 - Interventional radiology

17.3 - Angioplasty

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

5 - Ear, nose and throat

5.7 - Larynx and trachea

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

7 - Breast

7.4 - Other

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

4 - Eye and orbital contents

4.3 - Lacrimal system

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

1.3 - General procedures

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

14 - Female reproductive organs

14.2 - Suspension

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

2 - Brain, cranium and intracranial organs

2.1 - Brain

9 - Vascular system

9.7 - Varicose veins

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.2 - Eyebrow and lid

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

14 - Female reproductive organs

14.1 - Uterus/adnexa

2 - Brain, cranium and intracranial organs

2.2 - Cranium

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

17 - Interventional radiology

17.7 - Head and neck

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

4 - Eye and orbital contents

4.7 - Sclera

9 - Vascular system

9.6 - Non-specific

4 - Eye and orbital contents

4.3 - Lacrimal system

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

4 - Eye and orbital contents

4.9 - Lens

19 - Haematology (Hospital Use Only)

19.2 - Stem Cell

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

3.9 - Neurophysiological procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.11 - Foot

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

5 - Ear, nose and throat

5.6 - Throat

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

9 - Vascular system

9.7 - Varicose veins

14 - Female reproductive organs

14.1 - Uterus/adnexa

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.4 - Consultations and Physicians’ fees

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

17 - Interventional radiology

17.11 - Liver

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

18 - Chemotherapy

18.0 - Chemotherapy

4 - Eye and orbital contents

4.4 - Muscles

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.6 - Genitalia

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

18 - Chemotherapy

18.0 - Chemotherapy

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.13 - Amputation

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

9 - Vascular system

9.1 - Head and neck

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.1 - Investigations

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

2 - Brain, cranium and intracranial organs

2.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

3.7 - Other nerve blocks

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.7 - Other nerve blocks

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

17 - Interventional radiology

17.1 - Biopsy

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

9 - Vascular system

9.7 - Varicose veins

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.2 - Ureter

4 - Eye and orbital contents

4.4 - Muscles

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

5 - Ear, nose and throat

5.6 - Throat

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

17 - Interventional radiology

17.13 - Other

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

2 - Brain, cranium and intracranial organs

2.1 - Brain

2.2 - Cranium

9 - Vascular system

9.2 - Thoracic vessels

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

9 - Vascular system

9.8 - Lymphatic system

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.5 - Practitioner and Therapist fees

4 - Eye and orbital contents

4.10 - Vitreous

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.12 - External fixation/traction

4 - Eye and orbital contents

4.1 - Globe and orbit

9 - Vascular system

9.5 - Ileo-femoral vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

9 - Vascular system

9.6 - Non-specific

5 - Ear, nose and throat

5.6 - Throat

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

17 - Interventional radiology

17.13 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

9 - Vascular system

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.6 - Hand

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

14 - Female reproductive organs

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.7 - Larynx and trachea

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

14 - Female reproductive organs

14.1 - Uterus/adnexa

9 - Vascular system

9.6 - Non-specific

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

12 - Urinary system and male reproductive organs

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

9 - Vascular system

9.7 - Varicose veins

17 - Interventional radiology

17.11 - Liver

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

16.11 - Foot

7 - Breast

7.1 - Excision/biopsy codes

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

17 - Interventional radiology

17.9 - Thorax

12 - Urinary system and male reproductive organs

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

9 - Vascular system

9.5 - Ileo-femoral vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

5 - Ear, nose and throat

5.7 - Larynx and trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

19 - Haematology (Hospital Use Only)

19.1 - Bone Marrow

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.1 - External ear

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

2 - Brain, cranium and intracranial organs

2.1 - Brain

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

17 - Interventional radiology

17.1 - Biopsy

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

12 - Urinary system and male reproductive organs

12.5 - Prostate

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.2 - Ureter

12.6 - Genitalia

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

9 - Vascular system

9.5 - Ileo-femoral vessels

17 - Interventional radiology

17.1 - Biopsy

4 - Eye and orbital contents

4.1 - Globe and orbit

4.9 - Lens

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

4 - Eye and orbital contents

4.11 - Retina

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

14 - Female reproductive organs

14.2 - Suspension

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

14 - Female reproductive organs

14.2 - Suspension

14.5 - Vulva/labia

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

9 - Vascular system

9.4 - Abdominal vessels

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

14 - Female reproductive organs

14.4 - Vagina/perineum

12 - Urinary system and male reproductive organs

12.4 - Urethra

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

14 - Female reproductive organs

14.1 - Uterus/adnexa

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

9 - Vascular system

9.6 - Non-specific

5 - Ear, nose and throat

5.7 - Larynx and trachea

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

7 - Breast

7.4 - Other

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

9 - Vascular system

9.5 - Ileo-femoral vessels

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.1 - Investigations

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.3 - Cervix uteri

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

7 - Breast

7.4 - Other

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

7 - Breast

7.3 - Reconstruction

2 - Brain, cranium and intracranial organs

2.1 - Brain

12 - Urinary system and male reproductive organs

12.3 - Bladder

9 - Vascular system

9.6 - Non-specific

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

4 - Eye and orbital contents

4.7 - Sclera

9 - Vascular system

9.2 - Thoracic vessels

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

12 - Urinary system and male reproductive organs

12.3 - Bladder

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

7 - Breast

7.3 - Reconstruction

17 - Interventional radiology

17.10 - Gastrointestinal

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

17 - Interventional radiology

17.13 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

19 - Haematology (Hospital Use Only)

19.2 - Stem Cell

5 - Ear, nose and throat

5.3 - Inner ear

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

19 - Haematology (Hospital Use Only)

19.2 - Stem Cell

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

14 - Female reproductive organs

14.2 - Suspension

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

7 - Breast

7.3 - Reconstruction

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.12 - External fixation/traction

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

12 - Urinary system and male reproductive organs

12.5 - Prostate

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.9 - Lens

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

16.11 - Foot

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

4 - Eye and orbital contents

4.1 - Globe and orbit

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

2 - Brain, cranium and intracranial organs

2.1 - Brain

4 - Eye and orbital contents

4.7 - Sclera

6 - Face, mouth, salivary and thyroid

6.2 - Lips

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.10 - Peritoneum

15 - Skin and subcutaneous tissue

15.2 - Repair

4 - Eye and orbital contents

4.2 - Eyebrow and lid

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

5 - Ear, nose and throat

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.11 - Foot

12 - Urinary system and male reproductive organs

12.4 - Urethra

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

20 - Radiotherapy

20.0 - Radiotherapy

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

13 - Pregnancy and confinement

13.0 - Pregnancy and confinement

9 - Vascular system

9.7 - Varicose veins

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

12 - Urinary system and male reproductive organs

12.4 - Urethra

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

16.11 - Foot

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

7 - Breast

7.3 - Reconstruction

5 - Ear, nose and throat

5.5 - Nasal sinuses

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

17 - Interventional radiology

17.13 - Other

9 - Vascular system

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.1 - Investigations

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

7 - Breast

7.1 - Excision/biopsy codes

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

19 - Haematology (Hospital Use Only)

19.1 - Bone Marrow

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

7 - Breast

7.3 - Reconstruction

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

4 - Eye and orbital contents

4.5 - Conjuctiva

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

17 - Interventional radiology

17.13 - Other

12 - Urinary system and male reproductive organs

12.6 - Genitalia

17 - Interventional radiology

17.13 - Other

12 - Urinary system and male reproductive organs

12.4 - Urethra

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

4 - Eye and orbital contents

4.6 - Cornea

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

5 - Ear, nose and throat

5.1 - External ear

4 - Eye and orbital contents

4.5 - Conjuctiva

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

4 - Eye and orbital contents

4.2 - Eyebrow and lid

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

9 - Vascular system

9.6 - Non-specific

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.6 - Rectum/anus

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

16.11 - Foot

2 - Brain, cranium and intracranial organs

2.1 - Brain

8 - Thorax and intra-thoracic organs

8.3 - Trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

5 - Ear, nose and throat

5.6 - Throat

2 - Brain, cranium and intracranial organs

2.2 - Cranium

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

15 - Skin and subcutaneous tissue

15.2 - Repair

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

9 - Vascular system

9.6 - Non-specific

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

20 - Radiotherapy

20.0 - Radiotherapy

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

7 - Breast

7.4 - Other

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

19 - Haematology (Hospital Use Only)

19.1 - Bone Marrow

19.2 - Stem Cell

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

20 - Radiotherapy

20.0 - Radiotherapy

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

18 - Chemotherapy

18.0 - Chemotherapy

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

19 - Haematology (Hospital Use Only)

19.2 - Stem Cell

12 - Urinary system and male reproductive organs

12.3 - Bladder

17 - Interventional radiology

17.13 - Other

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

9 - Vascular system

9.1 - Head and neck

4 - Eye and orbital contents

4.1 - Globe and orbit

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

9 - Vascular system

9.7 - Varicose veins

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

14 - Female reproductive organs

14.2 - Suspension

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

2 - Brain, cranium and intracranial organs

2.1 - Brain

4 - Eye and orbital contents

4.4 - Muscles

6 - Face, mouth, salivary and thyroid

6.2 - Lips

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

17 - Interventional radiology

17.7 - Head and neck

9 - Vascular system

9.4 - Abdominal vessels

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

4 - Eye and orbital contents

4.2 - Eyebrow and lid

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

9 - Vascular system

9.8 - Lymphatic system

12 - Urinary system and male reproductive organs

12.5 - Prostate

14 - Female reproductive organs

14.4 - Vagina/perineum

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.1 - Investigations

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

20 - Radiotherapy

20.0 - Radiotherapy

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

9 - Vascular system

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.2 - Eyebrow and lid

4.9 - Lens

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

2 - Brain, cranium and intracranial organs

2.1 - Brain

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

7 - Breast

7.1 - Excision/biopsy codes

9 - Vascular system

9.5 - Ileo-femoral vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

9 - Vascular system

9.6 - Non-specific

14 - Female reproductive organs

14.1 - Uterus/adnexa

9 - Vascular system

9.7 - Varicose veins

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

7 - Breast

7.1 - Excision/biopsy codes

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

17 - Interventional radiology

17.12 - Urinary

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.9 - Hip, leg and pelvis

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

20 - Radiotherapy

20.0 - Radiotherapy

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

13 - Pregnancy and confinement

13.0 - Pregnancy and confinement

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

11.10 - Peritoneum

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

17 - Interventional radiology

17.3 - Angioplasty

9 - Vascular system

9.6 - Non-specific

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

9 - Vascular system

9.4 - Abdominal vessels

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

4 - Eye and orbital contents

4.5 - Conjuctiva

4.9 - Lens

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

7 - Breast

7.3 - Reconstruction

19 - Haematology (Hospital Use Only)

19.2 - Stem Cell

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

12 - Urinary system and male reproductive organs

12.5 - Prostate

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

5 - Ear, nose and throat

5.6 - Throat

14 - Female reproductive organs

14.1 - Uterus/adnexa

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

4 - Eye and orbital contents

4.9 - Lens

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

4 - Eye and orbital contents

4.6 - Cornea

14 - Female reproductive organs

14.2 - Suspension

4 - Eye and orbital contents

4.11 - Retina

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

20 - Radiotherapy

20.0 - Radiotherapy

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

2 - Brain, cranium and intracranial organs

2.2 - Cranium

9 - Vascular system

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.3 - Bladder

9 - Vascular system

9.7 - Varicose veins

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

17 - Interventional radiology

17.4 - Embolisation

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

12 - Urinary system and male reproductive organs

12.4 - Urethra

20 - Radiotherapy

20.0 - Radiotherapy

5 - Ear, nose and throat

5.5 - Nasal sinuses

6 - Face, mouth, salivary and thyroid

6.2 - Lips

6.8 - Neck

4 - Eye and orbital contents

4.2 - Eyebrow and lid

17 - Interventional radiology

17.3 - Angioplasty

4 - Eye and orbital contents

4.2 - Eyebrow and lid

14 - Female reproductive organs

14.4 - Vagina/perineum

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

9 - Vascular system

9.2 - Thoracic vessels

4 - Eye and orbital contents

4.11 - Retina

20 - Radiotherapy

20.0 - Radiotherapy

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

12 - Urinary system and male reproductive organs

12.5 - Prostate

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

4 - Eye and orbital contents

4.3 - Lacrimal system

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

11.7 - Other organs (mainly digestive)

11.10 - Peritoneum

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

20 - Radiotherapy

20.0 - Radiotherapy

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

12 - Urinary system and male reproductive organs

12.3 - Bladder

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

17 - Interventional radiology

17.10 - Gastrointestinal

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

12 - Urinary system and male reproductive organs

12.5 - Prostate

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

2 - Brain, cranium and intracranial organs

2.1 - Brain

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

12 - Urinary system and male reproductive organs

12.6 - Genitalia

9 - Vascular system

9.4 - Abdominal vessels

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

14 - Female reproductive organs

14.4 - Vagina/perineum

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

13 - Pregnancy and confinement

13.0 - Pregnancy and confinement

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

2 - Brain, cranium and intracranial organs

2.2 - Cranium

9 - Vascular system

9.6 - Non-specific

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.3 - Bladder

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

5 - Ear, nose and throat

5.6 - Throat

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.6 - Peripheral nerves

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

5 - Ear, nose and throat

5.7 - Larynx and trachea

4 - Eye and orbital contents

4.11 - Retina

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.2 - Lips

9 - Vascular system

9.5 - Ileo-femoral vessels

5 - Ear, nose and throat

5.1 - External ear

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

9 - Vascular system

9.7 - Varicose veins

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

17 - Interventional radiology

17.4 - Embolisation

4 - Eye and orbital contents

4.2 - Eyebrow and lid

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

9 - Vascular system

9.1 - Head and neck

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

9 - Vascular system

9.4 - Abdominal vessels

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.11 - Foot

9 - Vascular system

9.2 - Thoracic vessels

4 - Eye and orbital contents

4.10 - Vitreous

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

14 - Female reproductive organs

14.2 - Suspension

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

4 - Eye and orbital contents

4.6 - Cornea

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

5 - Ear, nose and throat

5.6 - Throat

6 - Face, mouth, salivary and thyroid

6.4 - Palate

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

12 - Urinary system and male reproductive organs

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

12 - Urinary system and male reproductive organs

12.5 - Prostate

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

2 - Brain, cranium and intracranial organs

2.2 - Cranium

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

6 - Face, mouth, salivary and thyroid

6.2 - Lips

2 - Brain, cranium and intracranial organs

2.2 - Cranium

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

20 - Radiotherapy

20.0 - Radiotherapy

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

7 - Breast

7.1 - Excision/biopsy codes

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

2 - Brain, cranium and intracranial organs

2.2 - Cranium

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

14 - Female reproductive organs

14.4 - Vagina/perineum

12 - Urinary system and male reproductive organs

12.4 - Urethra

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

2 - Brain, cranium and intracranial organs

2.5 - Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

2 - Brain, cranium and intracranial organs

2.5 - Vessels

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

18 - Chemotherapy

18.0 - Chemotherapy

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

5 - Ear, nose and throat

5.3 - Inner ear

4 - Eye and orbital contents

4.1 - Globe and orbit

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

12 - Urinary system and male reproductive organs

12.6 - Genitalia

17 - Interventional radiology

17.13 - Other

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

14 - Female reproductive organs

14.1 - Uterus/adnexa

14.4 - Vagina/perineum

11 - Abdomen (excluding urinary and reproductive organs)

11.8 - Major vessels

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

6.9 - Thyroid and parathyroid glands

5 - Ear, nose and throat

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.3 - Bladder

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

12 - Urinary system and male reproductive organs

12.3 - Bladder

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

12 - Urinary system and male reproductive organs

12.6 - Genitalia

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

9 - Vascular system

9.4 - Abdominal vessels

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

5 - Ear, nose and throat

5.1 - External ear

4 - Eye and orbital contents

4.9 - Lens

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

17 - Interventional radiology

17.1 - Biopsy

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.10 - Great Vessels

6 - Face, mouth, salivary and thyroid

6.8 - Neck

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

5 - Ear, nose and throat

5.3 - Inner ear

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

9 - Vascular system

9.5 - Ileo-femoral vessels

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.2 - Lips

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

5 - Ear, nose and throat

5.5 - Nasal sinuses

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

9 - Vascular system

9.4 - Abdominal vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

5 - Ear, nose and throat

5.7 - Larynx and trachea

20 - Radiotherapy

20.0 - Radiotherapy

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

11 - Abdomen (excluding urinary and reproductive organs)

11.0 - Abdomen (excluding urinary and reproductive organs)

7 - Breast

7.4 - Other

4 - Eye and orbital contents

4.2 - Eyebrow and lid

14 - Female reproductive organs

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.5 - Prostate

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

11.6 - Rectum/anus

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

9 - Vascular system

9.5 - Ileo-femoral vessels

9.8 - Lymphatic system

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

4 - Eye and orbital contents

4.9 - Lens

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

9 - Vascular system

9.6 - Non-specific

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

4 - Eye and orbital contents

4.1 - Globe and orbit

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.5 - Conjuctiva

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

6 - Face, mouth, salivary and thyroid

6.4 - Palate

4 - Eye and orbital contents

4.10 - Vitreous

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.3 - Bladder

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

14 - Female reproductive organs

14.2 - Suspension

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.7 - Shoulder

17 - Interventional radiology

17.3 - Angioplasty

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.9 - Hip, leg and pelvis

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

9 - Vascular system

9.8 - Lymphatic system

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

4 - Eye and orbital contents

4.2 - Eyebrow and lid

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

4 - Eye and orbital contents

4.1 - Globe and orbit

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

8 - Thorax and intra-thoracic organs

8.3 - Trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

14 - Female reproductive organs

14.4 - Vagina/perineum

17 - Interventional radiology

17.13 - Other

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

20 - Radiotherapy

20.0 - Radiotherapy

4 - Eye and orbital contents

4.6 - Cornea

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.6 - Hand

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

17 - Interventional radiology

17.4 - Embolisation

12 - Urinary system and male reproductive organs

12.3 - Bladder

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

4 - Eye and orbital contents

4.3 - Lacrimal system

7 - Breast

7.1 - Excision/biopsy codes

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.1 - Investigations

9 - Vascular system

9.3 - Renal vessels

9.6 - Non-specific

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

20 - Radiotherapy

20.0 - Radiotherapy

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

10 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

14 - Female reproductive organs

14.4 - Vagina/perineum

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

2 - Brain, cranium and intracranial organs

2.4 - Nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

4 - Eye and orbital contents

4.11 - Retina

5 - Ear, nose and throat

5.7 - Larynx and trachea

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.9 - Heart – cardiology

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.1 - Investigations

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

4 - Eye and orbital contents

4.9 - Lens

7 - Breast

7.3 - Reconstruction

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.3 - Bladder

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

6 - Face, mouth, salivary and thyroid

6.2 - Lips

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

17 - Interventional radiology

17.4 - Embolisation

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

5 - Ear, nose and throat

5.1 - External ear

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.11 - Foot

15 - Skin and subcutaneous tissue

15.2 - Repair

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

20 - Radiotherapy

20.0 - Radiotherapy

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

7 - Breast

7.3 - Reconstruction

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

4 - Eye and orbital contents

4.3 - Lacrimal system

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

14 - Female reproductive organs

14.3 - Cervix uteri

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.10 - Knee

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

5 - Ear, nose and throat

5.5 - Nasal sinuses

4 - Eye and orbital contents

4.1 - Globe and orbit

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

3 - Spine, spinal cord and peripheral nerves

3.4 - Nerve roots

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

4 - Eye and orbital contents

4.3 - Lacrimal system

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

5 - Ear, nose and throat

5.6 - Throat

20 - Radiotherapy

20.0 - Radiotherapy

17 - Interventional radiology

17.4 - Embolisation

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

8 - Thorax and intra-thoracic organs

8.3 - Trachea

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

17 - Interventional radiology

17.3 - Angioplasty

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.8 - Other procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

4 - Eye and orbital contents

4.9 - Lens

7 - Breast

7.3 - Reconstruction

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.3 - Bladder

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

14 - Female reproductive organs

14.1 - Uterus/adnexa

9 - Vascular system

9.6 - Non-specific

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

17 - Interventional radiology

17.13 - Other

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

19 - Haematology (Hospital Use Only)

19.1 - Bone Marrow

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

7 - Breast

7.3 - Reconstruction

2 - Brain, cranium and intracranial organs

2.3 - Meninges

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

9 - Vascular system

9.7 - Varicose veins

9.8 - Lymphatic system

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

5 - Ear, nose and throat

5.5 - Nasal sinuses

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

16.10 - Knee

12 - Urinary system and male reproductive organs

12.5 - Prostate

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.13 - Amputation

4 - Eye and orbital contents

4.5 - Conjuctiva

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

2 - Brain, cranium and intracranial organs

2.6 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

5 - Ear, nose and throat

5.1 - External ear

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

14 - Female reproductive organs

14.4 - Vagina/perineum

15 - Skin and subcutaneous tissue

15.2 - Repair

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

12 - Urinary system and male reproductive organs

12.3 - Bladder

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

5 - Ear, nose and throat

5.5 - Nasal sinuses

14 - Female reproductive organs

14.3 - Cervix uteri

4 - Eye and orbital contents

4.4 - Muscles

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

9 - Vascular system

9.6 - Non-specific

20 - Radiotherapy

20.0 - Radiotherapy

14 - Female reproductive organs

14.4 - Vagina/perineum

12 - Urinary system and male reproductive organs

12.2 - Ureter

20 - Radiotherapy

20.0 - Radiotherapy

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

9 - Vascular system

9.3 - Renal vessels

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

3.8 - Other procedures

2 - Brain, cranium and intracranial organs

2.1 - Brain

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

20 - Radiotherapy

20.0 - Radiotherapy

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

5 - Ear, nose and throat

5.7 - Larynx and trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.3 - Paraspinal injections

3.9 - Neurophysiological procedures

15 - Skin and subcutaneous tissue

15.2 - Repair

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

2 - Brain, cranium and intracranial organs

2.1 - Brain

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

12 - Urinary system and male reproductive organs

12.4 - Urethra

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.1 - Investigations

17 - Interventional radiology

17.4 - Embolisation

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

7 - Breast

7.4 - Other

5 - Ear, nose and throat

5.6 - Throat

9 - Vascular system

9.8 - Lymphatic system

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

20 - Radiotherapy

20.0 - Radiotherapy

14 - Female reproductive organs

14.4 - Vagina/perineum

12 - Urinary system and male reproductive organs

12.5 - Prostate

2 - Brain, cranium and intracranial organs

2.2 - Cranium

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

20 - Radiotherapy

20.0 - Radiotherapy

12 - Urinary system and male reproductive organs

12.5 - Prostate

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

2 - Brain, cranium and intracranial organs

2.1 - Brain

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.3 - Lacrimal system

17 - Interventional radiology

17.12 - Urinary

18 - Chemotherapy

18.0 - Chemotherapy

7 - Breast

7.3 - Reconstruction

17 - Interventional radiology

17.13 - Other

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

17 - Interventional radiology

17.8 - Spine

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

17 - Interventional radiology

17.11 - Liver

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

9 - Vascular system

9.1 - Head and neck

5 - Ear, nose and throat

5.6 - Throat

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.6 - Cornea

14 - Female reproductive organs

14.1 - Uterus/adnexa

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

20 - Radiotherapy

20.0 - Radiotherapy

14 - Female reproductive organs

14.3 - Cervix uteri

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.10 - Great Vessels

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

12 - Urinary system and male reproductive organs

12.6 - Genitalia

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

16.13 - Amputation

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

4 - Eye and orbital contents

4.1 - Globe and orbit

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.3 - Bladder

20 - Radiotherapy

20.0 - Radiotherapy

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

7.4 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

9 - Vascular system

9.6 - Non-specific

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

4 - Eye and orbital contents

4.6 - Cornea

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

17 - Interventional radiology

17.4 - Embolisation

2 - Brain, cranium and intracranial organs

2.1 - Brain

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

14 - Female reproductive organs

14.1 - Uterus/adnexa

17 - Interventional radiology

17.13 - Other

14 - Female reproductive organs

14.3 - Cervix uteri

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

2 - Brain, cranium and intracranial organs

2.6 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

4 - Eye and orbital contents

4.1 - Globe and orbit

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

12 - Urinary system and male reproductive organs

12.5 - Prostate

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

5 - Ear, nose and throat

5.7 - Larynx and trachea

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

9 - Vascular system

9.6 - Non-specific

17 - Interventional radiology

17.4 - Embolisation

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

9 - Vascular system

9.5 - Ileo-femoral vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

14 - Female reproductive organs

14.1 - Uterus/adnexa

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

4 - Eye and orbital contents

4.2 - Eyebrow and lid

9 - Vascular system

9.7 - Varicose veins

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.9 - Abdominal wall

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

18 - Chemotherapy

18.0 - Chemotherapy

20 - Radiotherapy

20.0 - Radiotherapy

5 - Ear, nose and throat

5.7 - Larynx and trachea

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

5 - Ear, nose and throat

5.1 - External ear

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

6 - Face, mouth, salivary and thyroid

6.4 - Palate

14 - Female reproductive organs

14.4 - Vagina/perineum

9 - Vascular system

9.1 - Head and neck

12 - Urinary system and male reproductive organs

12.5 - Prostate

5 - Ear, nose and throat

5.1 - External ear

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

2 - Brain, cranium and intracranial organs

2.2 - Cranium

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

7 - Breast

7.3 - Reconstruction

14 - Female reproductive organs

14.2 - Suspension

5 - Ear, nose and throat

5.5 - Nasal sinuses

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

9 - Vascular system

9.6 - Non-specific

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.11 - Foot

4 - Eye and orbital contents

4.1 - Globe and orbit

7 - Breast

7.3 - Reconstruction

17 - Interventional radiology

17.13 - Other

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.5 - Nasal sinuses

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

14 - Female reproductive organs

14.4 - Vagina/perineum

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.7 - Other organs (mainly digestive)

17 - Interventional radiology

17.2 - Drainage

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

9 - Vascular system

9.7 - Varicose veins

12 - Urinary system and male reproductive organs

12.3 - Bladder

2 - Brain, cranium and intracranial organs

2.4 - Nerves

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

2 - Brain, cranium and intracranial organs

2.1 - Brain

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.3 - Bladder

17 - Interventional radiology

17.13 - Other

7 - Breast

7.3 - Reconstruction

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

8.10 - Great Vessels

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

5 - Ear, nose and throat

5.1 - External ear

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

5 - Ear, nose and throat

5.3 - Inner ear

5.7 - Larynx and trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

15 - Skin and subcutaneous tissue

15.2 - Repair

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

6.9 - Thyroid and parathyroid glands

14 - Female reproductive organs

14.4 - Vagina/perineum

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

17 - Interventional radiology

17.5 - Thrombolysis

6 - Face, mouth, salivary and thyroid

6.2 - Lips

12 - Urinary system and male reproductive organs

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.13 - Amputation

12 - Urinary system and male reproductive organs

12.4 - Urethra

6 - Face, mouth, salivary and thyroid

6.8 - Neck

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

14 - Female reproductive organs

14.1 - Uterus/adnexa

4 - Eye and orbital contents

4.2 - Eyebrow and lid

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

7 - Breast

7.3 - Reconstruction

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

14 - Female reproductive organs

14.5 - Vulva/labia

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

4 - Eye and orbital contents

4.6 - Cornea

4.11 - Retina

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

17 - Interventional radiology

17.13 - Other

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.10 - Knee

2 - Brain, cranium and intracranial organs

2.2 - Cranium

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

9 - Vascular system

9.7 - Varicose veins

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.2 - Thoracic vessels

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

9 - Vascular system

9.3 - Renal vessels

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.4 - Muscles

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

15 - Skin and subcutaneous tissue

15.2 - Repair

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

16.6 - Hand

16.9 - Hip, leg and pelvis

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

7 - Breast

7.1 - Excision/biopsy codes

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

4 - Eye and orbital contents

4.1 - Globe and orbit

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

7 - Breast

7.3 - Reconstruction

7.4 - Other

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.2 - Eyebrow and lid

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

12 - Urinary system and male reproductive organs

12.5 - Prostate

12.6 - Genitalia

20 - Radiotherapy

20.0 - Radiotherapy

5 - Ear, nose and throat

5.1 - External ear

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

12 - Urinary system and male reproductive organs

12.5 - Prostate

17 - Interventional radiology

17.1 - Biopsy

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

12 - Urinary system and male reproductive organs

12.2 - Ureter

17 - Interventional radiology

17.4 - Embolisation

4 - Eye and orbital contents

4.11 - Retina

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

14 - Female reproductive organs

14.1 - Uterus/adnexa

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

9 - Vascular system

9.6 - Non-specific

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

17 - Interventional radiology

17.2 - Drainage

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

4 - Eye and orbital contents

4.7 - Sclera

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.4 - Palate

12 - Urinary system and male reproductive organs

12.2 - Ureter

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.9 - Hip, leg and pelvis

16.11 - Foot

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.8 - Elbow

14 - Female reproductive organs

14.1 - Uterus/adnexa

6 - Face, mouth, salivary and thyroid

6.2 - Lips

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

20 - Radiotherapy

20.0 - Radiotherapy

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.10 - Knee

16.11 - Foot

16.12 - External fixation/traction

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

5 - Ear, nose and throat

5.6 - Throat

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.4 - Urethra

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

5 - Ear, nose and throat

5.5 - Nasal sinuses

4 - Eye and orbital contents

4.4 - Muscles

4.6 - Cornea

4.9 - Lens

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

4 - Eye and orbital contents

4.11 - Retina

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.9 - Abdominal wall

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

9 - Vascular system

9.6 - Non-specific

2 - Brain, cranium and intracranial organs

2.3 - Meninges

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

12 - Urinary system and male reproductive organs

12.6 - Genitalia

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

9 - Vascular system

9.8 - Lymphatic system

2 - Brain, cranium and intracranial organs

2.5 - Vessels

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

12 - Urinary system and male reproductive organs

12.6 - Genitalia

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.1 - External ear

5.7 - Larynx and trachea

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

14 - Female reproductive organs

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

5 - Ear, nose and throat

5.5 - Nasal sinuses

5.7 - Larynx and trachea

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

14 - Female reproductive organs

14.2 - Suspension

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

15 - Skin and subcutaneous tissue

15.2 - Repair

5 - Ear, nose and throat

5.7 - Larynx and trachea

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

9 - Vascular system

9.3 - Renal vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

17 - Interventional radiology

17.8 - Spine

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.6 - Throat

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

4 - Eye and orbital contents

4.3 - Lacrimal system

17 - Interventional radiology

17.12 - Urinary

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

12 - Urinary system and male reproductive organs

12.3 - Bladder

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

5 - Ear, nose and throat

5.6 - Throat

7 - Breast

7.4 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

11.9 - Abdominal wall

17 - Interventional radiology

17.10 - Gastrointestinal

7 - Breast

7.1 - Excision/biopsy codes

12 - Urinary system and male reproductive organs

12.5 - Prostate

12.6 - Genitalia

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

3.8 - Other procedures

12 - Urinary system and male reproductive organs

12.6 - Genitalia

9 - Vascular system

9.6 - Non-specific

4 - Eye and orbital contents

4.1 - Globe and orbit

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.3 - General procedures

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

9 - Vascular system

9.6 - Non-specific

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.9 - Hip, leg and pelvis

14 - Female reproductive organs

14.5 - Vulva/labia

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

17 - Interventional radiology

17.8 - Spine

7 - Breast

7.1 - Excision/biopsy codes

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

16.11 - Foot

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

5 - Ear, nose and throat

5.6 - Throat

15 - Skin and subcutaneous tissue

15.2 - Repair

12 - Urinary system and male reproductive organs

12.3 - Bladder

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

5 - Ear, nose and throat

5.1 - External ear

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

2 - Brain, cranium and intracranial organs

2.1 - Brain

9 - Vascular system

9.5 - Ileo-femoral vessels

2 - Brain, cranium and intracranial organs

2.2 - Cranium

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

7 - Breast

7.4 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

5 - Ear, nose and throat

5.6 - Throat

2 - Brain, cranium and intracranial organs

2.6 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

2 - Brain, cranium and intracranial organs

2.4 - Nerves

4 - Eye and orbital contents

4.9 - Lens

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

4 - Eye and orbital contents

4.6 - Cornea

19 - Haematology (Hospital Use Only)

19.2 - Stem Cell

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

12 - Urinary system and male reproductive organs

12.3 - Bladder

19 - Haematology (Hospital Use Only)

19.1 - Bone Marrow

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.9 - Hip, leg and pelvis

16.11 - Foot

12 - Urinary system and male reproductive organs

12.6 - Genitalia

4 - Eye and orbital contents

4.5 - Conjuctiva

5 - Ear, nose and throat

5.5 - Nasal sinuses

14 - Female reproductive organs

14.5 - Vulva/labia

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

4 - Eye and orbital contents

4.9 - Lens

7 - Breast

7.1 - Excision/biopsy codes

5 - Ear, nose and throat

5.7 - Larynx and trachea

2 - Brain, cranium and intracranial organs

2.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.7 - Larynx and trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

4 - Eye and orbital contents

4.9 - Lens

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

9 - Vascular system

9.6 - Non-specific

17 - Interventional radiology

17.13 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

14 - Female reproductive organs

14.3 - Cervix uteri

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.5 - Nasal sinuses

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.4 - Small intestine

9 - Vascular system

9.6 - Non-specific

20 - Radiotherapy

20.0 - Radiotherapy

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

14 - Female reproductive organs

14.1 - Uterus/adnexa

20 - Radiotherapy

20.0 - Radiotherapy

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

16.7 - Shoulder

16.12 - External fixation/traction

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

17 - Interventional radiology

17.1 - Biopsy

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

12 - Urinary system and male reproductive organs

12.4 - Urethra

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.3 - Paraspinal injections

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

9 - Vascular system

9.8 - Lymphatic system

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

4 - Eye and orbital contents

4.9 - Lens

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

12 - Urinary system and male reproductive organs

12.6 - Genitalia

4 - Eye and orbital contents

4.9 - Lens

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

4 - Eye and orbital contents

4.4 - Muscles

5 - Ear, nose and throat

5.7 - Larynx and trachea

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.4 - Small intestine

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

4 - Eye and orbital contents

4.2 - Eyebrow and lid

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.9 - Heart – cardiology

9 - Vascular system

9.7 - Varicose veins

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.11 - Other

9 - Vascular system

9.5 - Ileo-femoral vessels

17 - Interventional radiology

17.13 - Other

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

12 - Urinary system and male reproductive organs

12.2 - Ureter

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.2 - Ureter

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

14 - Female reproductive organs

14.1 - Uterus/adnexa

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

14 - Female reproductive organs

14.3 - Cervix uteri

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

7 - Breast

7.1 - Excision/biopsy codes

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

9 - Vascular system

9.7 - Varicose veins

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.6 - Hand

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.3 - Bladder

20 - Radiotherapy

20.0 - Radiotherapy

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

20 - Radiotherapy

20.0 - Radiotherapy

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.5 - Prostate

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

5 - Ear, nose and throat

5.7 - Larynx and trachea

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.5 - Prostate

20 - Radiotherapy

20.0 - Radiotherapy

17 - Interventional radiology

17.4 - Embolisation

12 - Urinary system and male reproductive organs

12.5 - Prostate

14 - Female reproductive organs

14.2 - Suspension

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

2 - Brain, cranium and intracranial organs

2.1 - Brain

4 - Eye and orbital contents

4.1 - Globe and orbit

12 - Urinary system and male reproductive organs

12.2 - Ureter

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.1 - Connective tissue/tendon muscle

9 - Vascular system

9.6 - Non-specific

5 - Ear, nose and throat

5.1 - External ear

5.3 - Inner ear

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

5 - Ear, nose and throat

5.5 - Nasal sinuses

5.7 - Larynx and trachea

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.3 - Lacrimal system

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

15.2 - Repair

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

3.6 - Peripheral nerves

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

2 - Brain, cranium and intracranial organs

2.4 - Nerves

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

14 - Female reproductive organs

14.3 - Cervix uteri

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

2 - Brain, cranium and intracranial organs

2.4 - Nerves

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

6 - Face, mouth, salivary and thyroid

6.4 - Palate

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

14 - Female reproductive organs

14.1 - Uterus/adnexa

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

17 - Interventional radiology

17.1 - Biopsy

8 - Thorax and intra-thoracic organs

8.3 - Trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

2 - Brain, cranium and intracranial organs

2.1 - Brain

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

4 - Eye and orbital contents

4.3 - Lacrimal system

9 - Vascular system

9.8 - Lymphatic system

17 - Interventional radiology

17.13 - Other

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

14 - Female reproductive organs

14.5 - Vulva/labia

16 - Bones, joints and connective tissue/tendon muscle

16.3 - Fractures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.3 - Bladder

12.6 - Genitalia

4 - Eye and orbital contents

4.6 - Cornea

5 - Ear, nose and throat

5.5 - Nasal sinuses

9 - Vascular system

9.7 - Varicose veins

12 - Urinary system and male reproductive organs

12.4 - Urethra

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.4 - Vagina/perineum

4 - Eye and orbital contents

4.4 - Muscles

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

14 - Female reproductive organs

14.1 - Uterus/adnexa

4 - Eye and orbital contents

4.12 - General

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

2 - Brain, cranium and intracranial organs

2.2 - Cranium

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

17 - Interventional radiology

17.1 - Biopsy

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

4 - Eye and orbital contents

4.9 - Lens

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

4 - Eye and orbital contents

4.2 - Eyebrow and lid

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.5 - Nasal sinuses

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

16 - Bones, joints and connective tissue/tendon muscle

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

16.6 - Hand

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.2 - Ureter

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

20 - Radiotherapy

20.0 - Radiotherapy

4 - Eye and orbital contents

4.9 - Lens

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

20 - Radiotherapy

20.0 - Radiotherapy

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

7 - Breast

7.3 - Reconstruction

20 - Radiotherapy

20.0 - Radiotherapy

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

19 - Haematology (Hospital Use Only)

19.2 - Stem Cell

2 - Brain, cranium and intracranial organs

2.1 - Brain

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

1 - Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

1.2 - Simple procedures

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.2 - Bone (non-specific)

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

4 - Eye and orbital contents

4.10 - Vitreous

2 - Brain, cranium and intracranial organs

2.1 - Brain

12 - Urinary system and male reproductive organs

12.6 - Genitalia

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

17 - Interventional radiology

17.11 - Liver

4 - Eye and orbital contents

4.6 - Cornea

12 - Urinary system and male reproductive organs

12.3 - Bladder

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

8.8 - Heart – cardiac surgery

2 - Brain, cranium and intracranial organs

2.4 - Nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

17 - Interventional radiology

17.4 - Embolisation

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

4 - Eye and orbital contents

4.6 - Cornea

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

15 - Skin and subcutaneous tissue

15.2 - Repair

2 - Brain, cranium and intracranial organs

2.3 - Meninges

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

Copyright

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means (including photocopying and recording) without the written permission of AXA Health limited. The written permission of AXA Health limited must also be obtained before any part of this publication is stored in a retrieval system of any nature. Applications for written permission to reproduce, transmit or store in a retrieval system any part of this publication should be addressed to Group General Counsel, 5 Old Broad Street, London EC2N 1AD.

Warning: the doing of an unauthorised act in relation to copyright work may result in both a civil claim or damages and criminal prosecution.

Material contained in the Office of Population Censuses and Surveys Classification of Operations and Surgical Procedures Consolidated Fourth Revision, is © Crown Copyright 1990 and has been reproduced by kind permission of the Controller of Her Majesty’s Stationery Office and the NHSIA.

Billing Principles: Introduction

These Billing Principles will give you clarity in your work with us and support for your patients' care.

In these Principles we tell you what services and treatment we will and will not pay for. The information will guide you on when you need to contact us, helps in paying your invoices quickly, and ensures our work together runs smoothly.

Following these Principles also means giving us the information we need, at the right time. This helps ensure we can best support your patient's care and that commercial discussions don't get in the way of treatment.

We do expect you to adhere to these Principles, which support your recognition and form part of your contract. Failure to adhere to these principles may affect your recognition with us.

Important Points

We will pay eligible fees in full when you charge up to the level shown within the Schedule of Procedures and Fees https://provider.axahealth.co.uk/schedule-of-procedures-and-fees/ for treatment you have provided. We will not pay for you to supervise services provided by others. Publication of a code in the Schedule does not guarantee eligibility for every member therefore you should ensure that all treatment has been pre-authorised in advance of any treatment taking place.
Please do not bill for any service or treatment that is not listed in the Schedule of Procedures and Fees, outlined in these Billing Principles or outlined in your contract, without first seeking approval from AXA Health.
In line with the good practice guidelines of your regulatory authority, any medical records or information you send us should be complete, accurate, clear and signed by the treating provider. They should include details of procedures, treatments or consultations as appropriate and include the patient's name, relevant dates and treatment start and end times. If in any doubt, please send us typed copies of medical records, with copies of the originals.
Our memberships are designed to cover the costs of the short-term treatment of acute medical conditions. Generally they do not cover treatments and procedures that are considered primarily cosmetic in nature. There are some exceptions, for example, following treatment for cancer. If in doubt, please contact us in advance by submitting a copy of your clinic letter using our specialist fees enquiry form https://provider.axahealth.co.uk/individual/individual-provider-support/ We will then consider your request.
As the treating provider, we hold you responsible for ensuring the information you provide, such as coding or medical notes, is accurate. This is important as we use this information to assess eligibility and to settle claims.
We need time to consider pre-operative requests which may affect your fees or the way you carry out a procedure. Please send us the relevant information at least five working days before the scheduled treatment.
We expect you to follow the ethical guidance provided by your regulatory body. An example of such guidance from the General Medical Council (GMC) can be found here: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/duties-of-a-doctor
Please do not consider the provisions of any sections of these Billing Principles in isolation. Each section should be considered in relation to the others.

1: Pre-Treatment And Pre-Authorisation Provisions

1.1 - Consultations

We define a consultation, whether face-to-face or remote, as a meeting between patient and provider to:

evaluate the nature and progress of an active condition
establish a diagnosis, prognosis and treatment plan.

An email exchange with a patient is not classed as a remote consultation. Remote consultation charges should only be made where a face-to-face consultation would previously have occurred. Short consultations, for example to inform patients about results or for largely administrative matters, should not be charged for.

We set the consultation fee,

to include all charges relating to that consultation, whether face-to-face or remote (for example, room fees or IT costs)
to accommodate all consultations, including those which may be longer or be more complex than the norm.

We expect you to see each patient for the appropriate time to treat their individual condition. We do not expect to be invoiced for additional time or double sessions when treatment has overrun the scheduled time.

We expect to be billed for only one consultation for each patient on any given day.

You may perform certain unplanned minor operations during face-to-face consultations. Please bill for these using the codes listed in our Schedule of Procedures and Fees https://provider.axahealth.co.uk/schedule-of-procedures-and-fees/

We will pay for in-patient consultations if you:
- are the physician in charge of the patient's care,
- have visited them in hospital and
- are not providing routine post-operative care.
These will be paid at the daily attendance fee rate.

We would not expect you to bill for a consultation if you:
- are on call, or
- have performed a procedure on or provided anaesthesia to the patient in question within the past 10 days, or
- are performing a planned procedure for that patient on the day of the consultation.
For further information regarding remote consultations please refer to the Remote consulting provisions on our provider information centre.

1.2 - Tests, Pathology And Diagnostic Radiology

You should only request diagnostic tests or pathology tests when you have reasonable suspicion of a medical condition. This should be in line with national guidelines and evidence-based practice, and where the tests are required to direct and manage a patient's treatment plan. Screening tests are generally excluded from coverage.

Please ensure patients are directed to a facility in our network for diagnostic tests (diagnostic tests are investigations, such as x-rays or blood tests, to find or to help to find the cause of a patients' symptoms. This does not include procedures).

We will not pay you separately for diagnostic tests at facilities in our network, or for reporting on the results of these diagnostics. We pay the hospital, clinic or facility directly for these services. If required, you should negotiate appropriate payment for your services directly with the facility.

If the test you need to perform is not available at a recognised facility, please contact the Specialist Fees and Contracting Team here .

For any specimens taken in your consulting rooms on behalf of a recognised pathology facility, we would expect the invoices to come from the facility directly.

We reserve the right to refuse or recover money for any charges which are outside your agreed contract.

You may bill for therapeutic interventional radiology following our Schedule of Procedures and Fees Schedule of Procedures and Fees

1.3 - Information You Should Provide Before And After A Consultation

We expect you to comply with the Private Healthcare Market Investigation Order 2014, published by the Competition and Markets Authority (CMA).

Before confirming an outpatient consultation appointment, you should give your patient the following information:
- the estimated cost of the consultation
- details of any financial interests you may have in the facility or its equipment
- a list of all insurers who recognise you
- a statement that insured patients should check with their insurers the cover they have
- a reason for further tests or treatment
- an estimate of the cumulative cost of the treatment pathway which has been recommended. This should include:
  - all fees you charge separately from hospital fees
  - contact details for any other consultants whose fees are not included in the quote
  - a statement of services which have not been included in the estimate, such as those resulting from unforeseeable complications. Where alternative treatments are available but the appropriate treatment can only be decided during surgery, the estimate should set out the relevant options and associated fees.
Please also provide this information to the Private Healthcare Information Network (PHIN)www.phin.org.uk which provides patients with information to help them make their private healthcare choices.

After the consultation, you should provide your patient with all relevant CCSD coding for any proposed treatment so they may gain pre-authorisation from our Personal Advisers. If a patient doesn?t have the correct code to hand this may delay pre-authorisation.

1.4 - Treatment At A Facility Outside Our Network

The majority of our members have chosen a policy requiring them to receive treatment at one of our network facilities.

We pay all charges for eligible treatment at any hospital listed as a network facility in line with our agreements. In normal circumstances, we pay only a small daily benefit for treatment at a facility that is outside of our network and is not listed in our directory.

In exceptional circumstances, if a patient needs facilities or treatments which are not available at one of our network facilities, we may pay the charges.

You must agree this specific exemption with us before treatment or, in an emergency, as soon as possible after admission. Where we have agreed, we will pay all charges for eligible treatment at the relevant facility which is best placed to provide the necessary care.

To request an exemption, please complete the Hospital Exemption Request form on our Provider website https://www.axahealth.co.uk/network-exemption

The Network Development team will review your clinical reasons and let you know if we will accept treatment outside our network.

2: Treatment Provisions

2.1 - Coding

Please provide our members with all relevant CCSD coding in advance of their treatment so that this can be added to their claim. Without this information being provided upfront there may be delays in pre-authorisation being given. Pre-authorisation for any proposed treatment is needed in advance of the treatment taking place. Your patients need to confirm they?re eligible for any proposed treatment plan by calling our Personal Advisory Team. We give our members this telephone number on their policy documents. If you need assistance with identifying the appropriate CCSD code then you can contact our Specialist Fees Team using this link https://provider.axahealth.co.uk/individual/individual-provider-support/

We work with the Clinical Coding and Schedule Development (CCSD) group to help create industry standard procedure codes. We publish any codes we introduce in the "Important information" section of our Schedule of Procedures and Fees. Please use these codes when billing us for treatment. They should be reasonable and within their intended purpose, as defined by the CCSD: https://www.ccsd.org.uk/

Procedure narratives and codes are protected by copyright and may not be altered or used in any way other than as published in the Schedule of Procedures and Fees.

If you believe there is no appropriate code for the treatment you wish to carry out or that the narrative does not reflect what you are doing, please contact the CCSD directly and request a new code. We review requests and possible changes with them regularly.

2.2 - Our Fees

We list the majority of procedures we pay for in our Schedule of Procedures and Fees https://provider.axahealth.co.uk/schedule-of-procedures-and-fees/

We will pay eligible fees in full when you charge up to the level shown within the Schedule of Procedures and Fees https://provider.axahealth.co.uk/schedule-of-procedures-and-fees/ for treatment you have provided. We will not pay for you to supervise services provided by others.

Your AXA provider code is for your personal use and should only be used for services that you have provided yourself. It should not be used for billing on behalf of others.

Our fees include all component parts, for example:
- pre-operative assessment
- the procedure itself, including local anaesthetic and/or intravenous (IV) sedation by the main operator
- all routine aftercare, including any consultations within 10 days of the procedure.
Please see Section 2.3 of these Principles for guidance on submitting an exception to this principle.

We pay the hospital, facility or clinic directly for the in-patient services listed below. We do not pay you separately for these services:
- consumables, including drug costs
- equipment charges
- in-patient therapies.
If required, you should negotiate appropriate payment for your services with the facility.

2.3 - Our Fees: Exceptions

Please do not bill for any service or treatment not listed in the Schedule of Procedures and Fees, outlined in these Billing Principles or outlined in your contract, without first seeking approval from AXA Health. If you believe an additional fee is appropriate, for example where you have to see a patient within 10 days of their surgical procedure because the wound has reopened, please:
- tell us what fees you would like us to reconsider and why
- submit a copy of your clinic letter using our specialist fees enquiry form https://provider.axahealth.co.uk/individual/individual-provider-support/. We will then consider your request.
2.4 - Unsure What Code To Use For Surgery?

We may still cover procedures which are not listed by code in our Schedule of Procedures and Fees. We'll need additional information from you to help us consider your proposed treatment.
If you can't find the code you need, please:
- give us a detailed analysis of what you're planning
- include the nearest appropriate code from our Schedule of Procedures and Fees and/or the CCSD website and
- submit a copy of your clinic letter using our specialist fees enquiry form https://provider.axahealth.co.uk/individual/individual-provider-support/
- make sure we have this information at least five working days before the procedure is due to take place.
We'll use this information to help find the correct code and we'll tell you the corresponding fee.
When there is no appropriate procedure code, we will allocate the nearest code and may also review the fee independently, considering any additional complexities.
Once you have the right code, please share this with your patient so they can authorise their treatment. This will also help avoid any doubt when you invoice us.

2.5 - Unbundling

We take a common-sense approach to unbundling and will list the most frequently occurring procedures together. The list is not exhaustive, but we do not expect procedures to be broken down into their component steps.

Here are some examples of unbundling which show what we would consider unreasonable combinations or billing:
- charging for two procedures where one is part and parcel of the other or is so frequently performed that it is in effect part and parcel, for example suturing to close an operation wound
- charging for in-patient care or intensive treatment unit (ITU) care routinely considered part of the procedure, for example with a complex procedure such as a Whipples procedure
- charging for pre-operative or post-operative assessment or analgesia, including local anaesthetic or IV sedation by the specialist performing the procedure
- using procedure combinations whose primary purpose is to increase reimbursement. An example of this would be charging for wound infiltration with local anaesthesia or a Whipples procedure with a gallbladder removal code, as these elements are integral to the operation
- charging for an anaesthetic when an anaesthetist has provided anaesthetic services
- charging for a multidisciplinary team meeting
- consultations during a course of chemotherapy.
In most cases, we will outline which procedures we don't expect to see billed together on our Schedule of Procedures and Fees and publish these on our "Important changes" document on our website.

2.6 - Sole Procedures

A code has "sole procedure" in the narrative when it is usually performed by itself. Otherwise it is part and parcel of another procedure in the same area of the body. You should normally bill sole procedures in isolation, but there may be times that it is appropriate to bill a sole procedure code alongside another code. Please tell us about these exceptions by following the guidance below.

2.7 - Unbundling/Sole Procedures: Exceptions

Our unbundling or sole procedure rules may not apply if you perform procedures on a separate area of the body in a single session. If this applies in a specific case please:
- complete the specialist fees enquiry form on our Provider website https://provider.axahealth.co.uk/individual/individual-provider-support/, selecting "query about our billing principles", at least five working days before the procedure
- supply the relevant codes and areas of the body to support your request.
We'll tell you whether you can bill separately for these codes. If you submit an invoice without contacting us we will not pay all the separate charges or we may recoup money paid by mistake.

2.8 - Provider Code

Your Provider Code is your unique identifying code. Your Provider Code should be used solely to bill for treatment that you have carried out yourself for a member. You must not use your Provider Code to invoice for any treatment or services provided by anyone else. The only exception is where AXA Health has approved the appointment of a secondary specialist who has not been recognised by AXA Health to provide additional support in the treatment of a member by you (please see the 'Multiple Specialist Requests' section below).

3: Bespoke Requests

3.1 - Fee Uplifts and Multiple Specialist Requests

On occasion you may need to submit more than one code for surgery. When this happens we will pay the full amount for the procedure with the highest complexity and 50% of the fee for the second procedure.

We appreciate that we can't address every medical situation or surgical complication in setting fees. If you are planning a complex series of procedures which are not covered in the principle outlined in the paragraph above, we may consider a bespoke request.

This may include pre-operative or post-operative uplift requests and multiple specialist requests.

We define these here:

14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.4	Vagina/perineum		Contracted Procedure Fee	Contracted Anaesthetist Fee
	P2450	Sacrospinous fixation	Major	£600.00	£285.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.3	Bladder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M3410	Robot assisted laparoscopic cystectomy without prostatectomy (with construction of intestinal conduit or bladder)	Complex	£1,600.00	£642.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.2	Repair		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W0960	Excision of benign tumour of bone with bone grafting	Xmajor	£750.00	£357.00
1	Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

	1.2	Simple procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.6	Dilatation		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR565	Percutaneous dilatation of biliary stricture under imaging control	Xmajor	£650.00	£428.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.3	Fractures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W1646	Open reduction/internal fixation of sacro-iliac joint	Complex	£1,000.00	£571.00
	16.7	Shoulder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W4930	Revisional shoulder hemiarthroplasty	Xmajor	£700.00	£285.00
9	Vascular system

	9.5	Ileo-femoral vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L5180	Aorto-bifemoral bypass	Complex	£1,300.00	£642.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.2	Middle ear and mastoid		Contracted Procedure Fee	Contracted Anaesthetist Fee
	D2050	Tympanic neurectomy	Xmajor	£400.00	£213.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.6	Cornea		Contracted Procedure Fee	Contracted Anaesthetist Fee
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.5	Prostate		Contracted Procedure Fee	Contracted Anaesthetist Fee
	BT222	Insertion and removal of high dose rate radioactive agent (brachytherapy) into prostate tumour		£800.00	£571.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.4	Nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A6402	Repair of major nerve	Major	£300.00	£213.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.8	Heart – cardiac surgery		Contracted Procedure Fee	Contracted Anaesthetist Fee
	K1100	Closure of defect of interventricular septum	Complex	£1,900.00	£1,285.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.1	External ear		Contracted Procedure Fee	Contracted Anaesthetist Fee
	D0210	Excision of lesion of pinna	Intermediate	£200.00	£213.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.6	Genitalia		Contracted Procedure Fee	Contracted Anaesthetist Fee
	N2840	Repair of avulsion of penis	Major	£600.00	£285.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.5	Bronchi/lungs/pleura		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T1220	Drainage of pleural cavity	Minor	£200.00	£142.00
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.4	Vagina/perineum		Contracted Procedure Fee	Contracted Anaesthetist Fee
	P2530	Repair of rectovaginal fistula	Xmajor	£700.00	£357.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.1	Kidney/renal pelvic		Contracted Procedure Fee	Contracted Anaesthetist Fee
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.5	Conjuctiva		Contracted Procedure Fee	Contracted Anaesthetist Fee
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.4	Vagina/perineum		Contracted Procedure Fee	Contracted Anaesthetist Fee
	P1920	Excision of septum of vagina	Intermediate	£200.00	£213.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.9	Hip, leg and pelvis		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W4542	Open reduction, internal fixation and revision of femoral component for peri-prosthetic fracture	Complex	£750.00	£285.00
	16.13	Amputation		Contracted Procedure Fee	Contracted Anaesthetist Fee
	X0880	Amputation through mid-carpal/transmetacarpal	Intermediate	£300.00	£213.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.9	Neurophysiological procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	22000	Routine electroencephalography (EEG) in adult or child aged over 5 (Including reporting)		£75.00	£0.00
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.4	Vagina/perineum		Contracted Procedure Fee	Contracted Anaesthetist Fee
	P1300	Operations on female perineum	Minor	£150.00	£142.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.13	Amputation		Contracted Procedure Fee	Contracted Anaesthetist Fee
	X0720	Disarticulation of shoulder	Xmajor	£800.00	£571.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.1	Spinal column (including intervertebral discs)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V3181	Prosthetic intervertebral disc replacement in the thoracic spine including spinal cord monitoring	Complex	£1,300.00	£1,071.00
	3.6	Peripheral nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A6080	Neurectomy (major nerve)	Intermediate	£400.00	£213.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.4	Flaps and free skin grafts		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T7620	Free functioning muscle transfer (as sole procedure) including closure of secondary defect	Complex	£1,000.00	£857.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.10	Knee		Contracted Procedure Fee	Contracted Anaesthetist Fee
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.1	Oesophagus		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.4	Nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A7010	Implantation of neurostimulator to peripheral nerve	Major	£550.00	£142.00
10	Endoscopic gastrointestinal procedures
The benefit for endoscopic therapeutic procedures includes an amount for diagnostic endoscopy. This should therefore not be charged for separately. The benefit for gastroscopy and sigmoidoscopy includes an amount for sedation. Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.2	Bone (non-specific)		Contracted Procedure Fee	Contracted Anaesthetist Fee
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.1	Uterus/adnexa		Contracted Procedure Fee	Contracted Anaesthetist Fee
	Q0740	Total abdominal hysterectomy, +/- oophorectomy, +/- ureterolysis	Major	£600.00	£357.00
1	Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

	1.2	Simple procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	25022	Stellate ganglion block (local anaesthetic) +/- Image Guidance		£150.00	£142.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.7	Other organs (mainly digestive)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	J5610	Pancreatoduodenectomy and excision of surrounding tissue (Whipple's procedure)	Complex	£1,900.00	£714.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.11	Liver		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR580	Percutaneous cholecystostomy	Major	£550.00	£0.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.10	Great Vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.2	Ureter		Contracted Procedure Fee	Contracted Anaesthetist Fee
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.8	Heart – cardiac surgery		Contracted Procedure Fee	Contracted Anaesthetist Fee
	K2540	Replacement of mitral valve with sub-valve preservation (including biopsies)	Complex	£2,000.00	£1,285.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.9	Thyroid and parathyroid glands		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.10	Knee		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W3090	Core decompression of knee	Major	£700.00	£357.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.1	Oesophagus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G2400	Transthoracic fundoplication and gastroplasty	Xmajor	£800.00	£357.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.1	Face and jaws		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V1930	Alveolar bone graft - unilateral	Intermediate	£400.00	£285.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.2	Eyebrow and lid		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C1710	Suture of eyelid (laceration) (as sole procedure)	Minor	£150.00	£194.00
2	Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required. These should not be charged separately. Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
	2.3	Meninges		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A3810	Excision of lesion of meninges of brain	Complex	£1,900.00	£1,071.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.4	Nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A6510	Carpal tunnel release (open)	Intermediate	£250.00	£213.00
	16.7	Shoulder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W7810	Open arthrolysis of shoulder contracture +/- manipulation/injection	Major	£600.00	£285.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.6	Rectum/anus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H5400	Anorectal stretch	Minor	£100.00	£129.00
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.5	Vulva/labia		Contracted Procedure Fee	Contracted Anaesthetist Fee
	P0580	Radical vulvectomy (including block dissection of inguinal gland)	Complex	£1,200.00	£428.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.1	Face and jaws		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W5710	Excision arthroplasty of first metatarsophalangeal joint, (e.g. Keller, Bonney-Kessel procedures) including cheilectomy	Intermediate	£350.00	£213.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.8	Other procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	X3770	Intramuscular injection(s) with X-ray control (eg piriformis block)	Minor	£150.00	£213.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.8	Major vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L7920	Plication of vena cava	Xmajor	£650.00	£357.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.4	Embolisation		Contracted Procedure Fee	Contracted Anaesthetist Fee
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.4	Flaps and free skin grafts		Contracted Procedure Fee	Contracted Anaesthetist Fee
	S3100	Re-exploration of free flap	Xmajor	£1,000.00	£857.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.5	Sympathetic nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A7600	Lumbar sympathectomy therapeutic (neurolytic under X-ray control)	Intermediate	£400.00	£213.00
	3.6	Peripheral nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A6302	Graft to major nerve	Xmajor	£650.00	£357.00
2	Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required. These should not be charged separately. Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
	2.5	Vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A0260	Excision of arteriovenous malformation from vessels of brain	Complex	£1,900.00	£857.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.12	General		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C8650	Fluorescein angiography of eye (including ocular photography)	Minor	£100.00	£129.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.7	Teeth		Contracted Procedure Fee	Contracted Anaesthetist Fee
	F1810	Enucleation of cyst of jaw	Intermediate	£200.00	£142.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.4	Urethra		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M7340	Repair of urethrorectal fistula	Major	£500.00	£285.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.1	Oesophagus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G2430	Transabdominal anti-reflux operations	Complex	£800.00	£499.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.2	Eyebrow and lid		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C1040	Suture of eyebrow (as sole procedure)	Minor	£100.00	£129.00
	4.6	Cornea		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C4520	Excision of lesion of cornea	Minor	£150.00	£194.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.6	Rectum/anus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H5020	Repair of anal sphincter (including sigmoidoscopy)	Major	£450.00	£285.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.10	Knee		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W7420	Autograft Anterior Cruciate Ligament Reconstruction +/- Meniscectomy	Xmajor	£750.00	£499.00
9	Vascular system

	9.6	Non-specific		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L9113	Percutaneous insertion of central venous dialysis line	Intermediate	£200.00	£142.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.2	Chest wall		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T1620	Plication of paralysed diaphragm	Xmajor	£650.00	£428.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.2	Eyebrow and lid		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C1140	Correction of telecanthus	Intermediate	£350.00	£213.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.3	Angioplasty		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR516	Angioplasty of iliac artery, +/- insertion of stent	Major	£500.00	£285.00
	17.8	Spine		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR530	Fluoroscopically guided percutaneous vertebroplasty	Major	£650.00	£428.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T6763	Repair of tendon of foot – extensor Minor	Minor	£150.00	£194.00
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.4	Vagina/perineum		Contracted Procedure Fee	Contracted Anaesthetist Fee
	P2510	Repair of vesicovaginal fistula (including cystoscopy)	Major	£600.00	£357.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.2	Chest wall		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T0810	Resection of rib and open drainage of pleural cavity	Major	£450.00	£357.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.1	Biopsy		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR142	Bilateral stereotactic core biopsy of breasts	Intermediate	£300.00	£213.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.3	Tongue		Contracted Procedure Fee	Contracted Anaesthetist Fee
	F2650	Suture of tongue (as sole procedure)	Intermediate	£100.00	£129.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.6	Rectum/anus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H5100	Haemorrhoidectomy (including sigmoidoscopy)	Intermediate	£300.00	£213.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.9	Hip, leg and pelvis		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T6213	Soft tissue operations in the region of the greater trochanter (trochanteric bursitis, snapping hip)	Major	£200.00	£213.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.4	Palate		Contracted Procedure Fee	Contracted Anaesthetist Fee
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.1	External ear		Contracted Procedure Fee	Contracted Anaesthetist Fee
	D0410	Drainage of haematoma/abscess of pinna	Minor	£200.00	£213.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.6	Hand		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W0283	Total excision of trapezium with spacer	Xmajor	£700.00	£357.00
9	Vascular system

	9.1	Head and neck		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L3710	Bypass of subclavian artery from the arch	Complex	£1,300.00	£642.00
	9.2	Thoracic vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L2290	Excision of infected aortic graft with bypass	Complex	£1,900.00	£1,429.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.6	Throat		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E1910	Total pharyngectomy	Complex	£1,600.00	£714.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.12	Urinary		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR640	Percutaneous creation of track to kidney for nephrolithotomy +/- insertion of stent	Xmajor	£800.00	£213.00
7	Breast

	7.3	Reconstruction		Contracted Procedure Fee	Contracted Anaesthetist Fee
	B2915	Reconstruction of breast using extended latissimus dorsi flap (including delayed reconstruction)	Complex	£1,400.00	£714.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.8	Iris and anterior chamber		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C6450	Removal of foreign body from iris	Major	£550.00	£285.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.7	Other nerve blocks		Contracted Procedure Fee	Contracted Anaesthetist Fee
	AA460	Destruction of branch of trigeminal nerve (neurolytic/RF/cryoprobe)	Intermediate	£600.00	£285.00
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.3	Cervix uteri		Contracted Procedure Fee	Contracted Anaesthetist Fee
	Q1010	Dilation of cervix uteri and curettage of retained products of conception following miscarriage	Intermediate	£200.00	£142.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.5	Joints, including replacement/reconstruction (not listed elsewhere)		Contracted Procedure Fee	Contracted Anaesthetist Fee
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.1	Oesophagus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G2320	Transthoracic repair of diaphragmatic hernia (acquired)	Xmajor	£650.00	£357.00
2	Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required. These should not be charged separately. Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
	2.3	Meninges		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A3900	Repair of dura	Complex	£1,000.00	£571.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.2	Lips		Contracted Procedure Fee	Contracted Anaesthetist Fee
	F0312	Primary closure of cleft lip - unilateral	Major	£500.00	£357.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.4	Urethra		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M7314	Repair of distal hypospadia	Major	£550.00	£285.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.6	Peripheral nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A6810	Neurolysis and transposition of peripheral nerve (excludes carpal tunnel release)	Intermediate	£300.00	£213.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.4	Small intestine		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G7530	Closure of ileostomy (as sole procedure)	Intermediate	£450.00	£285.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.8	Heart – cardiac surgery		Contracted Procedure Fee	Contracted Anaesthetist Fee
	K2310	Excision of cardiac tumour	Complex	£1,900.00	£1,429.00
10	Endoscopic gastrointestinal procedures
The benefit for endoscopic therapeutic procedures includes an amount for diagnostic endoscopy. This should therefore not be charged for separately. The benefit for gastroscopy and sigmoidoscopy includes an amount for sedation. Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	10.1	Endoscopic gastrointestinal procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.8	Elbow		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W8880	Arthroscopy of elbow (as sole procedure)	Major	£550.00	£285.00
	16.13	Amputation		Contracted Procedure Fee	Contracted Anaesthetist Fee
	X0750	Amputation of arm	Major	£400.00	£285.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.1	Oesophagus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G2331	Laparoscopic repair of hiatus hernia with anti-reflux procedure (eg fundoplication)	Major	£800.00	£571.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.3	Lacrimal system		Contracted Procedure Fee	Contracted Anaesthetist Fee
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.10	Great Vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L2303	Coarctation repair involving prosthetic graft	Complex	£1,300.00	£714.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.7	Other organs (mainly digestive)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	J0210	Hemihepatectomy (resection of four or more segments) +/- cholecystectomy	Complex	£1,900.00	£857.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.6	Hand		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W5930	Fusion of digit joint(s) of hand with or without graft and with or without internal fixation	Intermediate	£300.00	£285.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.3	Inner ear		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A8480	Transtympanic electrocochleography	Intermediate	£200.00	£0.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.3	Fractures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W1920	Primary open reduction of long bone with fixation	Major	£600.00	£357.00
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W6017	Ankle arthrodesis with internal fixation	Intermediate	£750.00	£285.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.9	Abdominal wall		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T1640	Repair of congenital diaphragmatic hernia	Xmajor	£750.00	£642.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.3	Bladder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M3900	Open removal of calculus from bladder (including cystoscopy)	Intermediate	£400.00	£213.00
	12.4	Urethra		Contracted Procedure Fee	Contracted Anaesthetist Fee
	12.6	Genitalia		Contracted Procedure Fee	Contracted Anaesthetist Fee
	N1000	Prosthesis of testis (insertion or removal)	Intermediate	£200.00	£213.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.7	Larynx and trachea		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E4030	Tracheoplasty	Major	£1,000.00	£285.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.6	Peripheral nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A6710	Cubital tunnel release (open) (without transposition)	Intermediate	£250.00	£213.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W7880	Open or arthroscopic release of ankle joint contracture (excluding Achilles tendon lengthening)	Major	£550.00	£357.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.3	Bladder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M6620	Endoscopic incision of outlet of male bladder (with cystoscopy)	Intermediate	£400.00	£213.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.8	Iris and anterior chamber		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T6810	Delayed or Secondary Repair Of Achilles Tendon Without Tendon Or Fascial Graft	Major	£550.00	£194.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.13	Other		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR910	Insertion of central venous catheter - non-tunnelled (X-ray guided)	Intermediate	£200.00	£142.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.1	Spinal column (including intervertebral discs)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V4302	Combined anterior vertebrectomy with posterior fusion and instrumentation	Complex	£2,500.00	£1,429.00
2	Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required. These should not be charged separately. Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
	2.1	Brain		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.1	Connective tissue/tendon muscle		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T6800	Delayed or secondary repair of tendon (including graft, transfer and/or prosthesis) (not otherwise specified)	Major	£550.00	£213.00
2	Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required. These should not be charged separately. Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
	2.1	Brain		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A1300	Maintenance of cerebroventricular shunt	Major	£430.00	£253.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.4	Muscles		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C3180	Revision of squint surgery	Xmajor	£650.00	£285.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.3	Tongue		Contracted Procedure Fee	Contracted Anaesthetist Fee
	F2210	Total glossectomy	Xmajor	£700.00	£357.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.1	Kidney/renal pelvic		Contracted Procedure Fee	Contracted Anaesthetist Fee
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.1	Spinal column (including intervertebral discs)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V2542	Posterior excision of disc prolapse with undercutting facetectomy +/- decompression - lumbar region (1 or 2 levels)	Xmajor	£900.00	£470.00
9	Vascular system

	9.1	Head and neck		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L3711	Bypass of subclavian artery - extra-thoracic	Complex	£800.00	£571.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.8	Elbow		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W7860	Arthroscopic arthrolysis of elbow (as sole procedure)	Major	£550.00	£285.00
	16.13	Amputation		Contracted Procedure Fee	Contracted Anaesthetist Fee
	X0930	Amputation of leg above the knee	Major	£550.00	£285.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.1	Oesophagus		Contracted Procedure Fee	Contracted Anaesthetist Fee
9	Vascular system

	9.2	Thoracic vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L1890	Repair of leaking aneurysm of thoracic aorta	Complex	£1,900.00	£1,429.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.3	Angioplasty		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR252	Venoplasty	Major	£500.00	£0.00
9	Vascular system

	9.8	Lymphatic system		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T8700	Excision biopsy of lymph node for diagnosis (cervical, inguinal, axillary)	Intermediate	£200.00	£213.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.1	Face and jaws		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V2110	Temporomandibular meniscectomy	Major	£350.00	£213.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.9	Hip, leg and pelvis		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T7930	Repair of abductor mechanism of hip	Major	£200.00	£259.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.3	Inner ear		Contracted Procedure Fee	Contracted Anaesthetist Fee
	D2630	Osseous labyrinthectomy	Xmajor	£700.00	£357.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.4	Flaps and free skin grafts		Contracted Procedure Fee	Contracted Anaesthetist Fee
	S1740	Large myocutaneous (muscular/cutaneous) flap (9cm2 or more) including closure of secondary defect	Xmajor	£800.00	£571.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.2	Bone (non-specific)		Contracted Procedure Fee	Contracted Anaesthetist Fee
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.3	Duodenum		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G5010	Open excision of congenital lesion of duodenum including malrotation	Complex	£650.00	£357.00
10	Endoscopic gastrointestinal procedures
The benefit for endoscopic therapeutic procedures includes an amount for diagnostic endoscopy. This should therefore not be charged for separately. The benefit for gastroscopy and sigmoidoscopy includes an amount for sedation. Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	10.1	Endoscopic gastrointestinal procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	J6730	Endoscopic upper gastrointestinal ultrasound, eg for pancreaticobiliary diagnosis/transmucosal biopsy	Intermediate	£500.00	£213.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.4	Urethra		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M7330	Closure of fistula of urethra (including cystoscopy)	Intermediate	£250.00	£213.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W7530	Repair of lateral collateral ligament complex	Major	£550.00	£285.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.6	Throat		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E2480	Endoscopic operation(s) on pharyngeal pouch (e.g. Dohlman's procedure)	Major	£550.00	£285.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.8	Heart – cardiac surgery		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.5	Joints, including replacement/reconstruction (not listed elsewhere)		Contracted Procedure Fee	Contracted Anaesthetist Fee
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.2	Chest wall		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T0212	Secondary correction of scolios-related chest wall deformity (posterior costoplasty) (as sole procedure)	Complex	£800.00	£357.00
7	Breast

	7.3	Reconstruction		Contracted Procedure Fee	Contracted Anaesthetist Fee
	B2988	Reconstruction of breast using ALT (anteriolateral thigh) flap including delayed reconstruction	Complex	£2,750.00	£1,429.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.1	Kidney/renal pelvic		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M0814	Open biopsy of native kidney	Major	£550.00	£285.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.4	Flaps and free skin grafts		Contracted Procedure Fee	Contracted Anaesthetist Fee
	S2500	Local flap ? less than 9cm2	Major	£500.00	£213.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.2	Bone (non-specific)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W2700	Fixation of epiphysis, including epiphysiodesis, correction of angular deformity	Intermediate	£350.00	£285.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.4	Fibreoptic endoscopic procedures (GA or LA)		Contracted Procedure Fee	Contracted Anaesthetist Fee
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.1	Face and jaws		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V1150	Removal of internal fixation and/or inter-maxillary fixation from jaw	Minor	£200.00	£285.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.6	Rectum/anus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H3362	Hartmann's procedure	Xmajor	£750.00	£642.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.2	Ureter		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.10	Knee		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W8240	Meniscal allograft transplantation	Xmajor	£800.00	£389.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.10	Peritoneum		Contracted Procedure Fee	Contracted Anaesthetist Fee
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.6	Peripheral nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A6030	Transection of peripheral nerve for neuroma	Intermediate	£250.00	£213.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.4	Fibreoptic endoscopic procedures (GA or LA)		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.8	Elbow		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W5560	OK (Outerbridge and Kashiwagi) procedure	Major	£550.00	£357.00
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W7910	Metatarsal Osteotomy (Eg Scarf) For Hallux Valgus, +/- Internal Fixation +/- Soft Tissue Correction - Unilateral	Major	£550.00	£357.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.4	Flaps and free skin grafts		Contracted Procedure Fee	Contracted Anaesthetist Fee
	S3622	Full thickness graft, trunk and limbs – up to 9cm2 in area	Intermediate	£350.00	£285.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.2	Ureter		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M2080	Unilateral replantation of ureter into bladder (including cystoscopy)	Major	£550.00	£357.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.2	Stomach		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G4010	Pyloromyotomy	Major	£550.00	£285.00
	11.4	Small intestine		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G6082	Open resectionof small intestine tumour	Major	£600.00	£285.00
13	Pregnancy and confinement

	13.1	Pregnancy and confinement		Contracted Procedure Fee	Contracted Anaesthetist Fee
	R2510	Caesarean hysterectomy	Xmajor	£750.00	£499.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.1	Kidney/renal pelvic		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M0610	Open removal of calculi from kidney	Major	£650.00	£285.00
9	Vascular system

	9.7	Varicose veins		Contracted Procedure Fee	Contracted Anaesthetist Fee
10	Endoscopic gastrointestinal procedures
The benefit for endoscopic therapeutic procedures includes an amount for diagnostic endoscopy. This should therefore not be charged for separately. The benefit for gastroscopy and sigmoidoscopy includes an amount for sedation. Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	10.1	Endoscopic gastrointestinal procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	J3900	Therapeutic ERCP with insertion of biliary or pancreatic stent(s), sphincterotomy or stone extraction	Major	£550.00	£213.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.4	Flaps and free skin grafts		Contracted Procedure Fee	Contracted Anaesthetist Fee
	S2503	Local flap ? 9cm2 or more (including graft/flap to secondary defect)	Xmajor	£500.00	£213.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.2	Spinal cord		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A5110	Excision of intradural lesion	Complex	£1,300.00	£642.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.6	Rectum/anus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H4430	Examination of rectum under anaesthetic (as sole procedure)	Minor	£100.00	£129.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.1	Spinal column (including intervertebral discs)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V4000	Combined anterior and posterior correction and instrumentation, +/- fusion of idiopathic juvenile scoliosis (including spinal monitoring)	Complex	£2,500.00	£1,429.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.7	Shoulder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W6030	Revision or conversion to arthrodesis of shoulder	Xmajor	£600.00	£285.00
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.1	Uterus/adnexa		Contracted Procedure Fee	Contracted Anaesthetist Fee
	Q0950	Plastic reconstruction of uterus	Major	£650.00	£285.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.7	Other organs (mainly digestive)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	J0310	Resection of liver tumour(s)	Complex	£1,600.00	£649.00
	J2800	Excision of lesion of bile duct	Major	£600.00	£357.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.7	Video assisted thoracic surgery (VATS)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G0922	VATS oesophageal / oesophagogastric myotomy	Major	£600.00	£428.00
1	Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

	1.2	Simple procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	X4810	Change of cast without general anaesthetic (as sole procedure)		£75.00	£0.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.3	Tongue		Contracted Procedure Fee	Contracted Anaesthetist Fee
	F2660	Tongue flap - first stage and second stage	Major	£500.00	£357.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.7	Larynx and trachea		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E2930	Vertical hemi-laryngectomy	Complex	£1,000.00	£428.00
7	Breast

	7.4	Other		Contracted Procedure Fee	Contracted Anaesthetist Fee
9	Vascular system

	9.8	Lymphatic system		Contracted Procedure Fee	Contracted Anaesthetist Fee
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.10	Great Vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L0620	Creation of communication between pulmonary artery and aorta	Complex	£1,600.00	£857.00
	8.11	Other		Contracted Procedure Fee	Contracted Anaesthetist Fee
	64302	Transoesophageal echocardiography (including reporting) (as sole procedure)	Intermediate	£320.00	£213.00
2	Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required. These should not be charged separately. Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
	2.1	Brain		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A0200	Excision of lesion of tissue of brain	Complex	£1,600.00	£1,071.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.1	Oesophagus		Contracted Procedure Fee	Contracted Anaesthetist Fee
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.4	Palate		Contracted Procedure Fee	Contracted Anaesthetist Fee
	F3240	Operations on uvula	Intermediate	£200.00	£213.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.1	Spinal column (including intervertebral discs)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V2430	Revisional posterior decompression with fusion (thoracic region) Including Spinal Cord Monitoring	Complex	£1,300.00	£571.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.1	Lesions of skin		Contracted Procedure Fee	Contracted Anaesthetist Fee
	S0642	Excision of lesion of skin or subcutaneous tissue - four or more, Head & Neck (excluding lipoma)	Intermediate	£250.00	£142.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.4	Nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A6710	Cubital tunnel release (open) (without transposition)	Intermediate	£250.00	£213.00
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W0464	Complex Procedure To Mid Foot And Hindfoot With Autogenous Bone Graft (Osteotomy/Fusion +/- Tendon Transfers, Fixation)	Complex	£1,000.00	£499.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.3	Burns, scars and contractures		Contracted Procedure Fee	Contracted Anaesthetist Fee
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.2	Suspension		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M5300	Vaginal operations to support outlet of female bladder (including cystoscopy)	Major	£550.00	£285.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.8	Heart – cardiac surgery		Contracted Procedure Fee	Contracted Anaesthetist Fee
	K2613	Revision of aortic valve replacement	Complex	£1,900.00	£1,285.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W0432	Isolated Subtalar Fusion Or Midfoot Fusion With Autogenous Graft	Major	£650.00	£285.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.7	Larynx and trachea		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E2910	Total laryngectomy	Complex	£2,000.00	£714.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W6018	Ankle arthrodesis – revision, including converstion from total ankle replacement	Intermediate	£600.00	£285.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.4	Nose and nasal cavity		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E0380	Nasal septum cauterisation (and bilateral)	Minor	£100.00	£142.00
2	Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required. These should not be charged separately. Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
	2.4	Nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A2952	Excison of acoustic neuroma (vestibular schwannoma) - tumours less than 2.5cm (performed by single surgeon)	Complex	£1,900.00	£1,285.00
14	Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy. The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra. Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures. We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure. The benefit for colposcopy includes an amount for punch biopsy. The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy. The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable. The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation. Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
	14.1	Uterus/adnexa		Contracted Procedure Fee	Contracted Anaesthetist Fee
	Q4400	Ovarian cystectomy +/- omental biopsy (as sole procedure and including bilateral)	Major	£520.00	£285.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.4	Flaps and free skin grafts		Contracted Procedure Fee	Contracted Anaesthetist Fee
	S3532	Split autograft of skin, trunk and limbs – each additional 5% of body surface area	Major	£550.00	£285.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.10	Knee		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W8580	Multiple arthroscopic operations on knee (including meniscectomy, chondroplasty, drilling or microfracture) - bilateral	Complex	£800.00	£499.00
	16.11	Foot		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T6461	Tendon transfer of toe – bilateral	Major	£450.00	£285.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.3	Inner ear		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A2952	Excison of acoustic neuroma (vestibular schwannoma) - tumours less than 2.5cm (performed by single surgeon)	Complex	£1,900.00	£1,285.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.6	Rectum/anus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H3332	Anterior resection - high (i.e. colorectal anastomosis above the peritoneal reflection)	Complex	£1,300.00	£714.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.9	Hip, leg and pelvis		Contracted Procedure Fee	Contracted Anaesthetist Fee
	X2262	Complex open reduction for congenital dislocation of hip (i.e. pelvic and femoral or Pemberton osteotomy or revision of open reduction)	Complex	£1,300.00	£1,071.00
1	Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

	1.2	Simple procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.6	Peripheral nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.5	Nasal sinuses		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E1432	FESS Uncinectomy, ethmoidectomy, antrostomy or antral puncture inc polypectomy and attention to turbinates etc	Major	£550.00	£285.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.6	Rectum/anus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H3365	Laparoscopic anterior resection - low (ie colorectal anastomosis at or below the peritoneal reflection)	Complex	£1,300.00	£642.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.2	Chest wall		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T0320	Exploratory thoracotomy	Major	£550.00	£357.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.2	Eyebrow and lid		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C1420	Graft of skin to eyelid	Intermediate	£300.00	£213.00
	4.5	Conjuctiva		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C3910	Excision/biopsy of conjunctival lesion	Minor	£150.00	£194.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.5	Large intestine		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H1000	Excision of sigmoid colon	Xmajor	£800.00	£428.00
	11.6	Rectum/anus		Contracted Procedure Fee	Contracted Anaesthetist Fee
	H5640	Excision of anal fissure	Minor	£150.00	£194.00
10	Endoscopic gastrointestinal procedures
The benefit for endoscopic therapeutic procedures includes an amount for diagnostic endoscopy. This should therefore not be charged for separately. The benefit for gastroscopy and sigmoidoscopy includes an amount for sedation. Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	10.1	Endoscopic gastrointestinal procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	G7900	Ileoscopy via stoma with therapy	Minor	£200.00	£142.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.1	Spinal column (including intervertebral discs)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V3102	Revisional combined anterior discectomy and posterior fusion (thoracic region) Including Spinal Cord Monitoring	Complex	£1,600.00	£1,429.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.9	Hip, leg and pelvis		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W6600	Closed reduction of dislocated hip prosthesis	Intermediate	£300.00	£213.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.6	Genitalia		Contracted Procedure Fee	Contracted Anaesthetist Fee
	N0680	Orchidectomy and excision of spermatic cord (+/- insertion of prosthesis)	Intermediate	£400.00	£213.00
11	Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
	11.2	Stomach		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A2720	Proximal gastric vagotomy	Major	£550.00	£285.00
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.11	Other		Contracted Procedure Fee	Contracted Anaesthetist Fee
	X5020	External cardioversion	Minor	£150.00	£142.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.1	Kidney/renal pelvic		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M1380	Percutaneous tru-cut needle biopsy of lesion of kidney	Intermediate	£250.00	£213.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.8	Neck		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T8723	Selective dissection of cervical lymph nodes, levels 1 to 5 (+/- 6)	Complex	£800.00	£428.00
7	Breast

	7.4	Other		Contracted Procedure Fee	Contracted Anaesthetist Fee
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.9	Heart – cardiology		Contracted Procedure Fee	Contracted Anaesthetist Fee
2	Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required. These should not be charged separately. Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
	2.4	Nerves		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A3200	Decompression of cranial nerve (craniotomy)	Complex	£1,600.00	£714.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.4	Urethra		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M5600	Therapeutic endoscopic operations on outlet of female bladder (including cystoscopy)	Intermediate	£300.00	£213.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.4	Nose and nasal cavity		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E0260	Rhinoplasty following trauma or excision of tumour (including attention to turbinates)	Major	£550.00	£285.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.3	Angioplasty		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR254	Angioplasty of other arteries (e.g. sub-clavian, tibial, femoro-popliteal) including peripheral angiogram +/- insertion of stent	Major	£500.00	£285.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.2	Spinal cord		Contracted Procedure Fee	Contracted Anaesthetist Fee
	A4832	Implantation of spinal cord stimulator	Major	£1,300.00	£428.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.7	Teeth		Contracted Procedure Fee	Contracted Anaesthetist Fee
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.7	Larynx and trachea		Contracted Procedure Fee	Contracted Anaesthetist Fee
	E4230	Mini-tracheostomy (percutaneous)	Minor	£200.00	£213.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.8	Spine		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR500	Chemonucleolysis	Intermediate	£350.00	£0.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.3	Bladder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M3602	Enterocystoplasty (including cystoscopy)	Complex	£1,600.00	£642.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.6	Cornea		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C4650	Revision of corneal graft/wound	Major	£500.00	£285.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.9	Hip, leg and pelvis		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W8620	Therapeutic arthroscopy examination of hip joint, +/- biopsy	Xmajor	£700.00	£357.00
13	Pregnancy and confinement

	13.1	Pregnancy and confinement		Contracted Procedure Fee	Contracted Anaesthetist Fee
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.8	Other procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	Y3810	Insertion of indwelling pleural catheter	Intermediate	£200.00	£0.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.3	Bladder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M3420	Laparoscopic cystectomy (with construction of intestinal conduit or bladder) (including cystoscopy)	Complex	£1,600.00	£642.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.1	Face and jaws		Contracted Procedure Fee	Contracted Anaesthetist Fee
8	Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure. Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
	8.10	Great Vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L1910	Elective repair of aneurysm of ascending aorta	Complex	£1,900.00	£1,285.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.1	Kidney/renal pelvic		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.5	Joints, including replacement/reconstruction (not listed elsewhere)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W9017	Yttrium joint injection (with radioactive precautions)	Minor	£100.00	£0.00
9	Vascular system

	9.5	Ileo-femoral vessels		Contracted Procedure Fee	Contracted Anaesthetist Fee
	L5300	Open operations on iliac artery	Complex	£1,000.00	£642.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.5	Mouth cavity		Contracted Procedure Fee	Contracted Anaesthetist Fee
	F4230	Removal of excess mucosa from mouth	Intermediate	£250.00	£213.00
5	Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders. Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea. FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra. Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose. Packing of the nose should not be charged as extra with nasal surgery. The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
	5.1	External ear		Contracted Procedure Fee	Contracted Anaesthetist Fee
	D0730	Removal of foreign body from external auditory canal (and bilateral)	Minor	£100.00	£129.00
15	Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account. Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection. The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.
	15.2	Repair		Contracted Procedure Fee	Contracted Anaesthetist Fee
	S4230	Secondary suture of skin	Minor	£100.00	£129.00
17	Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place. We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule. The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound. If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
	17.12	Urinary		Contracted Procedure Fee	Contracted Anaesthetist Fee
	XR650	Percutaneous pyelolysis	Xmajor	£800.00	£0.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.8	Other procedures		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T7290	Trigger point injection/Enthesis - one injection	Minor	£100.00	£129.00
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.7	Shoulder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	W5030	Revision total shoulder replacement	Complex	£1,000.00	£642.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.4	Urethra		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M7380	Repair of rupture of urethra (including cystoscopy)	Major	£550.00	£285.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.1	Globe and orbit		Contracted Procedure Fee	Contracted Anaesthetist Fee
	C0110	Exenteration of orbit	Major	£550.00	£357.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.3	Bladder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M4510	Diagnostic endoscopic examination of bladder (flexible cystoscopy) including any biopsy	Minor	£200.00	£213.00
4	Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately. When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure. Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery. Removal of sutures. This code is for use after keratoplasty only. We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
	4.4	Muscles		Contracted Procedure Fee	Contracted Anaesthetist Fee
16	Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances). We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant. Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures. EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice. Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure. Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service. There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression. Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3). Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas. The following definitions are used throughout this section: Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna Small bones – all bones of hand, wrist, foot, ankle and also the patella Large joints – ankle, elbow, hip, knee, shoulder and wrist Small joints – all other joints of the hand and foot Child Aged 0-15 Adult Aged 16 and over
	16.7	Shoulder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	T7981	Extensive, greater than 2cm tear repair of large muscle including arthroscopic (excluding rotator cuff)	Major	£650.00	£428.00
6	Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth. When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances. Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
	6.6	Salivary glands		Contracted Procedure Fee	Contracted Anaesthetist Fee
	F5110	Open extraction of calculus from parotid duct	Intermediate	£250.00	£213.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
	12.2	Ureter		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M2730	Ureteroscopic extraction of calculus of ureter (including cystoscopy and insertion/removal of stent)	Intermediate	£500.00	£213.00
	12.3	Bladder		Contracted Procedure Fee	Contracted Anaesthetist Fee
	M4310	Endoscopic transection of bladder (including cystoscopy)	Major	£550.00	£285.00
3	Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances. Spinal fusion includes bone grafting and this should not be charged separately. Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately. Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region. Chemonucleolysis includes discography and this should not be charged separately. Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis. The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
	3.1	Spinal column (including intervertebral discs)		Contracted Procedure Fee	Contracted Anaesthetist Fee
	V4100	Posterior correction of idiopathic juvenile scoliosis with instrumentation, +/- fusion (including spinal cord monitoring)	Complex	£2,500.00	£1,299.00
12	Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc. M4510 Diagnostic endoscopic examination of bladder (including any biopsy) M7700 Diagnostic endoscopic examination of urethra (as sole procedure) M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made. M7920 Dilatation of urethra (including cystoscopy) M7940 Internal urethrotomy (including cystoscopy) M5820 Dilatation of outlet of female bladder (with cystoscopy) Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available

Specialist Procedure Codes

Procedure codes

Index

Copyright

Billing Principles: Introduction

Important Points

1: Pre-Treatment And Pre-Authorisation Provisions

2: Treatment Provisions

3: Bespoke Requests

4: Specific Provisions

5: Administration And Governance

6: Robotic Procedures