Procedure codes

Index


Copyright

Introduction

10 - Endoscopic gastrointestinal procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

17 - Interventional radiology

17.6 - Dilatation

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.4 - Vagina/perineum

2 - Brain, cranium and intracranial organs

2.3 - Meninges

4 - Eye and orbital contents

4.5 - Conjuctiva

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

2 - Brain, cranium and intracranial organs

2.3 - Meninges

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

14 - Female reproductive organs

14.5 - Vulva/labia

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

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

3.6 - Peripheral nerves

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

6.9 - Thyroid and parathyroid glands

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

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

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

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)

11.7 - Other organs (mainly digestive)

15 - Skin and subcutaneous tissue

15.2 - Repair

17 - Interventional radiology

17.11 - Liver

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

14 - Female reproductive organs

14.2 - Suspension

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

14 - Female reproductive organs

14.3 - Cervix uteri

9 - Vascular system

9.2 - Thoracic vessels

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.3 - Inner ear

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

7 - Breast

7.4 - Other

4 - Eye and orbital contents

4.5 - Conjuctiva

4.6 - Cornea

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

5 - Ear, nose and throat

5.3 - Inner ear

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

17 - Interventional radiology

17.3 - Angioplasty

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

5 - Ear, nose and throat

5.7 - Larynx and trachea

9 - Vascular system

9.5 - Ileo-femoral vessels

5 - Ear, nose and throat

5.3 - Inner ear

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.4 - Vagina/perineum

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

5 - Ear, nose and throat

5.5 - Nasal sinuses

14 - Female reproductive organs

14.4 - Vagina/perineum

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

9 - Vascular system

9.8 - Lymphatic system

4 - Eye and orbital contents

4.2 - Eyebrow and lid

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

16 - Bones, joints and connective tissue/tendon muscle

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

14 - Female reproductive organs

14.4 - Vagina/perineum

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

2 - Brain, cranium and intracranial organs

2.5 - Vessels

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

4 - Eye and orbital contents

4.12 - General

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

1.2 - Simple procedures

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.9 - Hip, leg and pelvis

16.11 - Foot

2 - Brain, cranium and intracranial organs

2.4 - Nerves

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

17 - Interventional radiology

17.1 - Biopsy

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

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

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

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)

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

16.8 - Elbow

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

11.4 - Small intestine

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

17 - Interventional radiology

17.13 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

17 - Interventional radiology

17.3 - Angioplasty

5 - Ear, nose and throat

5.1 - External ear

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

4 - Eye and orbital contents

4.5 - Conjuctiva

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

5 - Ear, nose and throat

5.1 - External ear

12 - Urinary system and male reproductive organs

12.4 - Urethra

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

6 - Face, mouth, salivary and thyroid

6.2 - Lips

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.2 - Spinal cord

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

4 - Eye and orbital contents

4.6 - Cornea

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

8.7 - Video assisted thoracic surgery (VATS)

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.4 - Urethra

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

17 - Interventional radiology

17.4 - Embolisation

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

4 - Eye and orbital contents

4.2 - Eyebrow and lid

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

9 - Vascular system

9.6 - Non-specific

5 - Ear, nose and throat

5.7 - Larynx and trachea

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

15 - Skin and subcutaneous tissue

15.2 - Repair

2 - Brain, cranium and intracranial organs

2.6 - Other

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

1.2 - Simple procedures

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

4 - Eye and orbital contents

4.2 - Eyebrow and lid

4.5 - Conjuctiva

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.3 - Lacrimal system

12 - Urinary system and male reproductive organs

12.5 - Prostate

2 - Brain, cranium and intracranial organs

2.4 - Nerves

7 - Breast

7.3 - Reconstruction

17 - Interventional radiology

17.3 - Angioplasty

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

9 - Vascular system

9.7 - Varicose veins

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

1.2 - Simple procedures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

7 - Breast

7.3 - Reconstruction

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

12 - Urinary system and male reproductive organs

12.3 - Bladder

12.6 - Genitalia

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

17 - Interventional radiology

17.8 - Spine

12 - Urinary system and male reproductive organs

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

4 - Eye and orbital contents

4.2 - Eyebrow and lid

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.4 - Palate

6.8 - Neck

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.11 - Foot

16.11 - Foot

15 - Skin and subcutaneous tissue

15.2 - Repair

17 - Interventional radiology

17.8 - Spine

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.8 - Elbow

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

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

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

8 - Thorax and intra-thoracic organs

8.11 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.7 - Larynx and trachea

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

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

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

9 - Vascular system

9.5 - Ileo-femoral vessels

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

12.4 - Urethra

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.10 - Great Vessels

5 - Ear, nose and throat

5.1 - External ear

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

14 - Female reproductive organs

14.1 - Uterus/adnexa

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

9 - Vascular system

9.6 - Non-specific

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

4 - Eye and orbital contents

4.3 - Lacrimal system

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)

11.10 - Peritoneum

16 - Bones, joints and connective tissue/tendon muscle

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

11 - Abdomen (excluding urinary and reproductive organs)

11.8 - Major vessels

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

1.3 - General procedures

6 - Face, mouth, salivary and thyroid

6.4 - Palate

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

5.8 - Fibreoptic endoscopic procedures (GA or LA)

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

4 - Eye and orbital contents

4.11 - Retina

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

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

1.3 - General procedures

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

4 - Eye and orbital contents

4.3 - Lacrimal system

6 - Face, mouth, salivary and thyroid

6.2 - Lips

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

2 - Brain, cranium and intracranial organs

2.1 - Brain

5 - Ear, nose and throat

5.1 - External ear

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

7 - Breast

7.3 - Reconstruction

2 - Brain, cranium and intracranial organs

2.1 - Brain

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

6 - Face, mouth, salivary and thyroid

6.8 - Neck

7 - Breast

7.4 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

9 - Vascular system

9.7 - Varicose veins

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

5 - Ear, nose and throat

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

17 - Interventional radiology

17.12 - Urinary

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

9 - Vascular system

9.6 - Non-specific

12 - Urinary system and male reproductive organs

12.2 - Ureter

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

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

6.1 - Face and jaws

5 - Ear, nose and throat

5.7 - Larynx and trachea

12 - Urinary system and male reproductive organs

12.5 - Prostate

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

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

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

14 - Female reproductive organs

14.1 - Uterus/adnexa

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

17 - Interventional radiology

17.4 - Embolisation

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

12 - Urinary system and male reproductive organs

12.3 - Bladder

9 - Vascular system

9.1 - Head and neck

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

9 - Vascular system

9.2 - Thoracic vessels

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

9 - Vascular system

9.5 - Ileo-femoral vessels

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

4 - Eye and orbital contents

4.4 - Muscles

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

9 - Vascular system

9.5 - Ileo-femoral vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

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

8.7 - Video assisted thoracic surgery (VATS)

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

12 - Urinary system and male reproductive organs

12.3 - Bladder

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

4 - Eye and orbital contents

4.2 - Eyebrow and lid

4.4 - Muscles

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

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

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

12 - Urinary system and male reproductive organs

12.4 - Urethra

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

5 - Ear, nose and throat

5.3 - Inner ear

4 - Eye and orbital contents

4.6 - Cornea

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

4 - Eye and orbital contents

4.3 - Lacrimal system

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

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

9 - Vascular system

9.2 - Thoracic vessels

12 - Urinary system and male reproductive organs

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.9 - Hip, leg and pelvis

5 - Ear, nose and throat

5.6 - Throat

9 - Vascular system

9.1 - Head and neck

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

9 - Vascular system

9.6 - Non-specific

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

5 - Ear, nose and throat

5.6 - Throat

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

9 - Vascular system

9.7 - Varicose veins

4 - Eye and orbital contents

4.4 - Muscles

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

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)

4 - Eye and orbital contents

4.2 - Eyebrow and lid

6 - Face, mouth, salivary and thyroid

6.8 - Neck

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

4 - Eye and orbital contents

4.6 - Cornea

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

9 - Vascular system

9.8 - Lymphatic system

17 - Interventional radiology

17.12 - Urinary

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.4 - Urethra

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

4 - Eye and orbital contents

4.9 - Lens

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

9 - Vascular system

9.6 - Non-specific

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

2 - Brain, cranium and intracranial organs

2.4 - Nerves

15 - Skin and subcutaneous tissue

15.2 - Repair

7 - Breast

7.1 - Excision/biopsy codes

17 - Interventional radiology

17.6 - Dilatation

14 - Female reproductive organs

14.1 - Uterus/adnexa

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

14 - Female reproductive organs

14.1 - Uterus/adnexa

12 - Urinary system and male reproductive organs

12.5 - Prostate

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.1 - External ear

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

12 - Urinary system and male reproductive organs

12.3 - Bladder

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

12 - Urinary system and male reproductive organs

12.5 - Prostate

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

5 - Ear, nose and throat

5.6 - Throat

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

9 - Vascular system

9.5 - Ileo-femoral vessels

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

11.9 - Abdominal wall

14 - Female reproductive organs

14.4 - Vagina/perineum

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

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)

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.3 - Bladder

17 - Interventional radiology

17.13 - Other

12 - Urinary system and male reproductive organs

12.5 - Prostate

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

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

5 - Ear, nose and throat

5.5 - Nasal sinuses

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.4 - Urethra

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

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

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

7 - Breast

7.3 - Reconstruction

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

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

1.3 - General procedures

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

9 - Vascular system

9.7 - Varicose veins

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

17 - Interventional radiology

17.1 - Biopsy

17.12 - Urinary

2 - Brain, cranium and intracranial organs

2.2 - Cranium

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

4 - Eye and orbital contents

4.3 - Lacrimal system

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.7 - Larynx and trachea

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.11 - Foot

16.12 - External fixation/traction

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

7 - Breast

7.4 - Other

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

3.8 - Other procedures

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.12 - External fixation/traction

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

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

16.12 - External fixation/traction

12 - Urinary system and male reproductive organs

12.4 - Urethra

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

9 - Vascular system

9.8 - Lymphatic system

12 - Urinary system and male reproductive organs

12.6 - Genitalia

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

12 - Urinary system and male reproductive organs

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

9 - Vascular system

9.5 - Ileo-femoral vessels

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

8.11 - Other

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

9 - Vascular system

9.6 - Non-specific

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

4 - Eye and orbital contents

4.1 - Globe and orbit

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

12 - Urinary system and male reproductive organs

12.2 - Ureter

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)

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

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

9.6 - Non-specific

12 - Urinary system and male reproductive organs

12.3 - Bladder

5 - Ear, nose and throat

5.7 - Larynx and trachea

2 - Brain, cranium and intracranial organs

2.6 - Other

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.9 - Hip, leg and pelvis

4 - Eye and orbital contents

4.9 - Lens

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

12 - Urinary system and male reproductive organs

12.2 - Ureter

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

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

1.1 - Investigations

12 - Urinary system and male reproductive organs

12.5 - Prostate

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

12 - Urinary system and male reproductive organs

12.3 - Bladder

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

4 - Eye and orbital contents

4.12 - General

12 - Urinary system and male reproductive organs

12.5 - Prostate

9 - Vascular system

9.2 - Thoracic vessels

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.4 - Muscles

17 - Interventional radiology

17.1 - Biopsy

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

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

1.3 - General procedures

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

15 - Skin and subcutaneous tissue

15.2 - Repair

6 - Face, mouth, salivary and thyroid

6.4 - Palate

14 - Female reproductive organs

14.1 - Uterus/adnexa

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

9 - Vascular system

9.6 - Non-specific

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

3.5 - Sympathetic nerves

2 - Brain, cranium and intracranial organs

2.2 - Cranium

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.11 - Other

5 - Ear, nose and throat

5.6 - Throat

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.6 - Rectum/anus

9 - Vascular system

9.6 - Non-specific

4 - Eye and orbital contents

4.3 - Lacrimal system

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

4 - Eye and orbital contents

4.2 - Eyebrow and lid

5 - Ear, nose and throat

5.5 - Nasal sinuses

4 - Eye and orbital contents

4.4 - Muscles

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

14 - Female reproductive organs

14.1 - Uterus/adnexa

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

12 - Urinary system and male reproductive organs

12.3 - Bladder

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.3 - Trachea

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

17 - Interventional radiology

17.3 - Angioplasty

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

17 - Interventional radiology

17.13 - Other

2 - Brain, cranium and intracranial organs

2.1 - Brain

12 - Urinary system and male reproductive organs

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

12 - Urinary system and male reproductive organs

12.2 - Ureter

5 - Ear, nose and throat

5.5 - Nasal sinuses

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

8 - Thorax and intra-thoracic organs

8.11 - Other

9 - Vascular system

9.7 - Varicose veins

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

12 - Urinary system and male reproductive organs

12.4 - Urethra

17 - Interventional radiology

17.8 - Spine

12 - Urinary system and male reproductive organs

12.2 - Ureter

4 - Eye and orbital contents

4.10 - Vitreous

16 - Bones, joints and connective tissue/tendon muscle

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

9 - Vascular system

9.6 - Non-specific

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.3 - Bladder

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

14 - Female reproductive organs

14.2 - Suspension

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

2 - Brain, cranium and intracranial organs

2.1 - Brain

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

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)

14 - Female reproductive organs

14.5 - Vulva/labia

4 - Eye and orbital contents

4.10 - Vitreous

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

12 - Urinary system and male reproductive organs

12.3 - Bladder

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

16.8 - Elbow

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

9 - Vascular system

9.6 - Non-specific

17 - Interventional radiology

17.13 - Other

7 - Breast

7.3 - Reconstruction

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

4 - Eye and orbital contents

4.2 - Eyebrow and lid

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

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

7 - Breast

7.4 - Other

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

17 - Interventional radiology

17.1 - Biopsy

17.2 - Drainage

5 - Ear, nose and throat

5.1 - External ear

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

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

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

9 - Vascular system

9.7 - Varicose veins

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

8.1 - Oesophagus

8.3 - Trachea

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

7 - Breast

7.4 - Other

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

8.11 - Other

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

4 - Eye and orbital contents

4.2 - Eyebrow and lid

17 - Interventional radiology

17.3 - Angioplasty

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

14 - Female reproductive organs

14.1 - Uterus/adnexa

12 - Urinary system and male reproductive organs

12.6 - Genitalia

9 - Vascular system

9.4 - Abdominal vessels

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

1.2 - Simple procedures

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

9 - Vascular system

9.5 - Ileo-femoral vessels

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

5 - Ear, nose and throat

5.6 - Throat

16 - Bones, joints and connective tissue/tendon muscle

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

16.6 - Hand

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

9 - Vascular system

9.6 - Non-specific

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

9 - Vascular system

9.7 - Varicose veins

6 - Face, mouth, salivary and thyroid

6.4 - Palate

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

14 - Female reproductive organs

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.5 - Nasal sinuses

7 - Breast

7.3 - Reconstruction

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

1.1 - Investigations

4 - Eye and orbital contents

4.3 - Lacrimal system

5 - Ear, nose and throat

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.4 - Urethra

5 - Ear, nose and throat

5.5 - Nasal sinuses

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

2 - Brain, cranium and intracranial organs

2.2 - Cranium

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

9 - Vascular system

9.2 - Thoracic vessels

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

9 - Vascular system

9.7 - Varicose veins

2 - Brain, cranium and intracranial organs

2.1 - Brain

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

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

1.1 - Investigations

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

14 - Female reproductive organs

14.4 - Vagina/perineum

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

16 - Bones, joints and connective tissue/tendon muscle

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

4 - Eye and orbital contents

4.7 - Sclera

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

12 - Urinary system and male reproductive organs

12.5 - Prostate

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.6 - Genitalia

6 - Face, mouth, salivary and thyroid

6.2 - Lips

5 - Ear, nose and throat

5.5 - Nasal sinuses

17 - Interventional radiology

17.11 - Liver

9 - Vascular system

9.4 - Abdominal vessels

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

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

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

12 - Urinary system and male reproductive organs

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

15 - Skin and subcutaneous tissue

15.2 - Repair

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

2 - Brain, cranium and intracranial organs

2.1 - Brain

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

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)

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

4 - Eye and orbital contents

4.2 - Eyebrow and lid

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

9 - Vascular system

9.8 - Lymphatic system

7 - Breast

7.3 - Reconstruction

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

8 - Thorax and intra-thoracic organs

8.3 - Trachea

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

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

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.5 - Prostate

18 - Chemotherapy

18.0. - Chemotherapy

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

9 - Vascular system

9.8 - Lymphatic system

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

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

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

12 - Urinary system and male reproductive organs

12.3 - Bladder

5 - Ear, nose and throat

5.6 - Throat

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

12 - Urinary system and male reproductive organs

12.2 - Ureter

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.10 - Vitreous

14 - Female reproductive organs

14.4 - Vagina/perineum

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

4 - Eye and orbital contents

4.4 - Muscles

2 - Brain, cranium and intracranial organs

2.2 - Cranium

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

4 - Eye and orbital contents

4.7 - Sclera

7 - Breast

7.1 - Excision/biopsy codes

9 - Vascular system

9.6 - Non-specific

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

2 - Brain, cranium and intracranial organs

2.3 - Meninges

7 - Breast

7.4 - Other

12 - Urinary system and male reproductive organs

12.4 - Urethra

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

5.7 - Larynx and trachea

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

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

9 - Vascular system

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

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

3 - Spine, spinal cord and peripheral nerves

3.9 - 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

16.10 - Knee

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

9 - Vascular system

9.8 - Lymphatic system

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.10 - Peritoneum

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

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)

16.6 - Hand

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

12 - Urinary system and male reproductive organs

12.3 - Bladder

9 - Vascular system

9.2 - Thoracic vessels

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

4 - Eye and orbital contents

4.3 - Lacrimal system

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

12 - Urinary system and male reproductive organs

12.4 - Urethra

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

4 - Eye and orbital contents

4.4 - Muscles

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

2 - Brain, cranium and intracranial organs

2.1 - Brain

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.9 - Hip, leg and pelvis

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

9 - Vascular system

9.6 - Non-specific

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

11.4 - Small intestine

11.6 - Rectum/anus

11.7 - Other organs (mainly digestive)

17 - Interventional radiology

17.9 - Thorax

12 - Urinary system and male reproductive organs

12.5 - Prostate

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.4 - Small intestine

5 - Ear, nose and throat

5.1 - External ear

5.4 - Nose and nasal cavity

4 - Eye and orbital contents

4.5 - Conjuctiva

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

9 - Vascular system

9.6 - Non-specific

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

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

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

2 - Brain, cranium and intracranial organs

2.1 - Brain

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

7 - Breast

7.1 - Excision/biopsy codes

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

9 - Vascular system

9.5 - Ileo-femoral vessels

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

4 - Eye and orbital contents

4.5 - Conjuctiva

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

1.3 - General procedures

12 - Urinary system and male reproductive organs

12.2 - Ureter

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

4 - Eye and orbital contents

4.4 - Muscles

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

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)

7 - Breast

7.4 - Other

4 - Eye and orbital contents

4.1 - Globe and orbit

4.2 - Eyebrow and lid

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

6.9 - Thyroid and parathyroid glands

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

9 - Vascular system

9.5 - Ileo-femoral vessels

12 - Urinary system and male reproductive organs

12.3 - Bladder

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

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)

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

12 - Urinary system and male reproductive organs

12.4 - Urethra

12.5 - Prostate

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

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

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

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

5 - Ear, nose and throat

5.5 - Nasal sinuses

15 - Skin and subcutaneous tissue

15.2 - Repair

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

14 - Female reproductive organs

14.5 - Vulva/labia

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.6 - Throat

17 - Interventional radiology

17.11 - Liver

12 - Urinary system and male reproductive organs

12.5 - Prostate

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

12 - Urinary system and male reproductive organs

12.6 - Genitalia

4 - Eye and orbital contents

4.10 - Vitreous

17 - Interventional radiology

17.4 - Embolisation

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

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

12.5 - Prostate

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.2 - Eyebrow and lid

12 - Urinary system and male reproductive organs

12.4 - Urethra

5 - Ear, nose and throat

5.5 - Nasal sinuses

11 - Abdomen (excluding urinary and reproductive organs)

11.8 - Major vessels

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.9 - Lens

14 - Female reproductive organs

14.3 - Cervix uteri

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

14 - Female reproductive organs

14.5 - Vulva/labia

16 - Bones, joints and connective tissue/tendon muscle

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

16.11 - Foot

14 - Female reproductive organs

14.1 - Uterus/adnexa

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

11.9 - Abdominal wall

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.7 - Other organs (mainly digestive)

2 - Brain, cranium and intracranial organs

2.2 - Cranium

17 - Interventional radiology

17.13 - Other

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

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)

16 - Bones, joints and connective tissue/tendon muscle

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

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

14 - Female reproductive organs

14.3 - Cervix uteri

14.4 - Vagina/perineum

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

2 - Brain, cranium and intracranial organs

2.5 - Vessels

6 - Face, mouth, salivary and thyroid

6.2 - Lips

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

6 - Face, mouth, salivary and thyroid

6.4 - Palate

14 - Female reproductive organs

14.1 - Uterus/adnexa

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

5 - Ear, nose and throat

5.3 - Inner ear

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)

3.3 - Paraspinal injections

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

2 - Brain, cranium and intracranial organs

2.1 - Brain

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

16.6 - Hand

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.2 - Ureter

17 - Interventional radiology

17.4 - Embolisation

14 - Female reproductive organs

14.3 - Cervix uteri

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.2 - Ureter

4 - Eye and orbital contents

4.9 - Lens

12 - Urinary system and male reproductive organs

12.6 - Genitalia

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

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

1.3 - General procedures

9 - Vascular system

9.6 - Non-specific

2 - Brain, cranium and intracranial organs

2.2 - Cranium

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

16.10 - Knee

4 - Eye and orbital contents

4.2 - Eyebrow and lid

5 - Ear, nose and throat

5.7 - Larynx and trachea

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

17 - Interventional radiology

17.13 - Other

14 - Female reproductive organs

14.1 - Uterus/adnexa

9 - Vascular system

9.8 - Lymphatic system

14 - Female reproductive organs

14.1 - Uterus/adnexa

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.1 - Globe and orbit

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

17 - Interventional radiology

17.13 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

12 - Urinary system and male reproductive organs

12.3 - Bladder

18 - Chemotherapy

18.0. - Chemotherapy

4 - Eye and orbital contents

4.11 - Retina

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

9 - Vascular system

9.4 - Abdominal vessels

4 - Eye and orbital contents

4.1 - Globe and orbit

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

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

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

2 - Brain, cranium and intracranial organs

2.5 - Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

2 - Brain, cranium and intracranial organs

2.1 - Brain

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

9 - Vascular system

9.6 - Non-specific

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

9 - Vascular system

9.8 - Lymphatic system

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.2 - Eyebrow and lid

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

4 - Eye and orbital contents

4.3 - Lacrimal system

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.5 - Prostate

5 - Ear, nose and throat

5.5 - Nasal sinuses

5.6 - Throat

4 - Eye and orbital contents

4.1 - Globe and orbit

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

14 - Female reproductive organs

14.1 - Uterus/adnexa

9 - Vascular system

9.5 - Ileo-femoral vessels

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

8.10 - Great Vessels

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)

17 - Interventional radiology

17.13 - Other

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

12 - Urinary system and male reproductive organs

12.3 - Bladder

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

4 - Eye and orbital contents

4.1 - Globe and orbit

12 - Urinary system and male reproductive organs

12.4 - Urethra

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)

4 - Eye and orbital contents

4.11 - Retina

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

12 - Urinary system and male reproductive organs

12.5 - Prostate

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

9 - Vascular system

9.1 - Head and neck

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

4 - Eye and orbital contents

4.12 - General

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

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

2 - Brain, cranium and intracranial organs

2.2 - Cranium

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

9 - Vascular system

9.7 - Varicose veins

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

2 - Brain, cranium and intracranial organs

2.1 - Brain

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

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

16.6 - Hand

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

4 - Eye and orbital contents

4.6 - Cornea

9 - Vascular system

9.2 - Thoracic vessels

12 - Urinary system and male reproductive organs

12.3 - Bladder

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

2 - Brain, cranium and intracranial organs

2.1 - Brain

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.10 - Knee

15 - Skin and subcutaneous tissue

15.2 - Repair

4 - Eye and orbital contents

4.6 - Cornea

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

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

9 - Vascular system

9.6 - Non-specific

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

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

16.9 - Hip, leg and pelvis

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

1.3 - General procedures

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

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

1.1 - Investigations

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

4 - Eye and orbital contents

4.5 - Conjuctiva

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

4 - Eye and orbital contents

4.6 - Cornea

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

12 - Urinary system and male reproductive organs

12.6 - Genitalia

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

9 - Vascular system

9.5 - Ileo-femoral vessels

17 - Interventional radiology

17.4 - Embolisation

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)

16.12 - External fixation/traction

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)

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

4 - Eye and orbital contents

4.5 - Conjuctiva

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

2 - Brain, cranium and intracranial organs

2.4 - Nerves

9 - Vascular system

9.5 - Ileo-femoral vessels

9.8 - Lymphatic system

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

12 - Urinary system and male reproductive organs

12.4 - Urethra

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

2 - Brain, cranium and intracranial organs

2.4 - Nerves

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

14 - Female reproductive organs

14.1 - Uterus/adnexa

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

17 - Interventional radiology

17.1 - Biopsy

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

4 - Eye and orbital contents

4.1 - Globe and orbit

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.5 - Prostate

5 - Ear, nose and throat

5.1 - External ear

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.8 - Major vessels

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

4 - Eye and orbital contents

4.6 - Cornea

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

7 - Breast

7.4 - Other

17 - Interventional radiology

17.3 - Angioplasty

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

16.7 - Shoulder

16.10 - Knee

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

18 - Chemotherapy

18.0. - Chemotherapy

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

4 - Eye and orbital contents

4.1 - Globe and orbit

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

5 - Ear, nose and throat

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.11 - Foot

9 - Vascular system

9.4 - Abdominal vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.2 - Suspension

6 - Face, mouth, salivary and thyroid

6.2 - Lips

4 - Eye and orbital contents

4.9 - Lens

14 - Female reproductive organs

14.2 - Suspension

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

15 - Skin and subcutaneous tissue

15.2 - Repair

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

5 - Ear, nose and throat

5.7 - Larynx and trachea

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

12.5 - Prostate

2 - Brain, cranium and intracranial organs

2.1 - Brain

14 - Female reproductive organs

14.2 - Suspension

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

12 - Urinary system and male reproductive organs

12.4 - Urethra

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

4 - Eye and orbital contents

4.9 - Lens

8 - Thorax and intra-thoracic organs

8.3 - Trachea

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

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

1.3 - General procedures

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

9 - Vascular system

9.7 - Varicose veins

5 - Ear, nose and throat

5.7 - Larynx and trachea

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

7 - Breast

7.4 - Other

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

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

1.2 - Simple procedures

9 - Vascular system

9.7 - Varicose veins

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

5 - Ear, nose and throat

5.6 - Throat

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

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

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.9 - Abdominal wall

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.3 - Lacrimal system

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

17 - Interventional radiology

17.4 - Embolisation

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

4 - Eye and orbital contents

4.5 - Conjuctiva

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

7 - Breast

7.3 - Reconstruction

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

14 - Female reproductive organs

14.2 - Suspension

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

4 - Eye and orbital contents

4.2 - Eyebrow and lid

2 - Brain, cranium and intracranial organs

2.1 - Brain

2.2 - Cranium

4 - Eye and orbital contents

4.11 - Retina

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

12 - Urinary system and male reproductive organs

12.6 - Genitalia

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

12 - Urinary system and male reproductive organs

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.8 - Elbow

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

7 - Breast

7.3 - Reconstruction

9 - Vascular system

9.6 - Non-specific

5 - Ear, nose and throat

5.7 - Larynx and trachea

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

4 - Eye and orbital contents

4.2 - Eyebrow and lid

17 - Interventional radiology

17.13 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

9 - Vascular system

9.8 - Lymphatic system

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

17 - Interventional radiology

17.13 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.7 - Shoulder

16.7 - Shoulder

6 - Face, mouth, salivary and thyroid

6.4 - Palate

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.5 - Nasal sinuses

17 - Interventional radiology

17.8 - Spine

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

12 - Urinary system and male reproductive organs

12.4 - Urethra

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

9 - Vascular system

9.1 - Head and neck

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.1 - Globe and orbit

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.7 - Other organs (mainly digestive)

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

17 - Interventional radiology

17.1 - Biopsy

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

9 - Vascular system

9.8 - Lymphatic system

14 - Female reproductive organs

14.1 - Uterus/adnexa

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

17 - Interventional radiology

17.13 - Other

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)

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

4 - Eye and orbital contents

4.10 - Vitreous

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

17 - Interventional radiology

17.10 - Gastrointestinal

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

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

1.1 - Investigations

1.3 - General procedures

1.4 - Consultations and Physicians’ fees

1.5 - Practitioner and Therapist fees

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.10 - Vitreous

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.7 - Shoulder

16.8 - Elbow

16.9 - Hip, leg and pelvis

16.10 - Knee

16.11 - Foot

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.10 - Knee

14 - Female reproductive organs

14.1 - Uterus/adnexa

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)

3.2 - Spinal cord

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

6 - Face, mouth, salivary and thyroid

6.2 - Lips

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

2 - Brain, cranium and intracranial organs

2.5 - Vessels

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

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)

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

17 - Interventional radiology

17.7 - Head and neck

5 - Ear, nose and throat

5.6 - Throat

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

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)

11.2 - Stomach

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

5 - Ear, nose and throat

5.5 - Nasal sinuses

5.7 - Larynx and trachea

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

16.4 - Nerves

7 - Breast

7.3 - Reconstruction

9 - Vascular system

9.2 - Thoracic vessels

7 - Breast

7.1 - Excision/biopsy codes

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

5.7 - Larynx and trachea

7 - Breast

7.1 - Excision/biopsy codes

18 - Chemotherapy

18.0. - Chemotherapy

15 - Skin and subcutaneous tissue

15.2 - Repair

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

14 - Female reproductive organs

14.1 - Uterus/adnexa

4 - Eye and orbital contents

4.10 - Vitreous

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

12 - Urinary system and male reproductive organs

12.3 - Bladder

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

12 - Urinary system and male reproductive organs

12.3 - Bladder

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

4 - Eye and orbital contents

4.2 - Eyebrow and lid

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

1.2 - Simple procedures

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

7 - Breast

7.1 - Excision/biopsy codes

9 - Vascular system

9.8 - Lymphatic system

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.5 - Prostate

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

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

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.5 - Nasal sinuses

5.7 - Larynx and trachea

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.3 - Duodenum

15 - Skin and subcutaneous tissue

15.2 - Repair

16 - Bones, joints and connective tissue/tendon muscle

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

9 - Vascular system

9.7 - Varicose veins

12 - Urinary system and male reproductive organs

12.4 - Urethra

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.3 - Bladder

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

9 - Vascular system

9.7 - Varicose veins

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

2 - Brain, cranium and intracranial organs

2.2 - Cranium

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

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

1.2 - Simple procedures

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

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)

11.7 - Other organs (mainly digestive)

7 - Breast

7.3 - Reconstruction

9 - Vascular system

9.6 - Non-specific

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

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

16.11 - Foot

14 - Female reproductive organs

14.4 - Vagina/perineum

14.5 - Vulva/labia

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

17 - Interventional radiology

17.4 - Embolisation

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

9 - Vascular system

9.6 - Non-specific

12 - Urinary system and male reproductive organs

12.3 - Bladder

4 - Eye and orbital contents

4.2 - Eyebrow and lid

7 - Breast

7.3 - Reconstruction

17 - Interventional radiology

17.1 - Biopsy

4 - Eye and orbital contents

4.9 - Lens

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

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)

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

12 - Urinary system and male reproductive organs

12.6 - Genitalia

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

12 - Urinary system and male reproductive organs

12.4 - Urethra

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)

14 - Female reproductive organs

14.4 - Vagina/perineum

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.8 - Lymphatic system

12 - Urinary system and male reproductive organs

12.4 - Urethra

19 - Haematology (Hospital Use Only)

19.1 - Bone Marrow

19.2 - Stem Cell

19.2 - Stem Cell

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

12 - Urinary system and male reproductive organs

12.6 - Genitalia

4 - Eye and orbital contents

4.5 - Conjuctiva

4.7 - Sclera

4.8 - Iris and anterior chamber

2 - Brain, cranium and intracranial organs

2.4 - Nerves

5 - Ear, nose and throat

5.3 - Inner ear

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

9 - Vascular system

9.2 - Thoracic vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

7 - Breast

7.3 - Reconstruction

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

12 - Urinary system and male reproductive organs

12.5 - Prostate

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

17 - Interventional radiology

17.9 - Thorax

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

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

9 - Vascular system

9.5 - Ileo-femoral vessels

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

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

4 - Eye and orbital contents

4.9 - Lens

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.4 - Urethra

19 - Haematology (Hospital Use Only)

19.2 - Stem Cell

7 - Breast

7.3 - Reconstruction

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

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

1.1 - Investigations

1.2 - Simple procedures

14 - Female reproductive organs

14.5 - Vulva/labia

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

17 - Interventional radiology

17.11 - Liver

18 - Chemotherapy

18.0. - Chemotherapy

7 - Breast

7.3 - Reconstruction

17 - Interventional radiology

17.1 - Biopsy

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

1.3 - General procedures

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

17 - Interventional radiology

17.4 - Embolisation

9 - Vascular system

9.7 - Varicose veins

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

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

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

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

1.2 - Simple procedures

14 - Female reproductive organs

14.1 - Uterus/adnexa

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

14 - Female reproductive organs

14.1 - Uterus/adnexa

14.2 - Suspension

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

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

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

14 - Female reproductive organs

14.1 - Uterus/adnexa

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

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

14 - Female reproductive organs

14.2 - Suspension

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

9 - Vascular system

9.6 - Non-specific

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

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

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

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

16.9 - Hip, leg and pelvis

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

9 - Vascular system

9.1 - Head and neck

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

14 - Female reproductive organs

14.1 - Uterus/adnexa

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

17 - Interventional radiology

17.13 - Other

14 - Female reproductive organs

14.1 - Uterus/adnexa

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

17 - Interventional radiology

17.12 - Urinary

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

16.11 - Foot

17 - Interventional radiology

17.13 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

15 - Skin and subcutaneous tissue

15.2 - Repair

17 - Interventional radiology

17.4 - Embolisation

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

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

5 - Ear, nose and throat

5.6 - Throat

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)

3.1 - Spinal column (including intervertebral discs)

3.8 - Other procedures

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

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

12 - Urinary system and male reproductive organs

12.4 - Urethra

17 - Interventional radiology

17.13 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

9 - Vascular system

9.8 - Lymphatic system

5 - Ear, nose and throat

5.6 - Throat

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.7 - Other organs (mainly digestive)

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

1.2 - Simple procedures

4 - Eye and orbital contents

4.6 - Cornea

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

4 - Eye and orbital contents

4.11 - Retina

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

12 - Urinary system and male reproductive organs

12.3 - Bladder

17 - Interventional radiology

17.1 - Biopsy

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

14 - Female reproductive organs

14.1 - Uterus/adnexa

4 - Eye and orbital contents

4.2 - Eyebrow and lid

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.5 - Prostate

12.6 - Genitalia

20 - Radiotherapy

20.0 - Radiotherapy

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

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

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

20 - Radiotherapy

20.0 - Radiotherapy

2 - Brain, cranium and intracranial organs

2.1 - Brain

20 - Radiotherapy

20.0 - Radiotherapy

14 - Female reproductive organs

14.3 - Cervix uteri

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

10 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

11 - Abdomen (excluding urinary and reproductive organs)

11.0 - Abdomen (excluding urinary and reproductive organs)

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

17 - Interventional radiology

17.4 - Embolisation

7 - Breast

7.3 - Reconstruction

14 - Female reproductive organs

14.3 - Cervix uteri

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

12 - Urinary system and male reproductive organs

12.3 - Bladder

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.6 - Non-specific

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.4 - Muscles

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.6 - Cornea

4.9 - Lens

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

7 - Breast

7.4 - Other

4 - Eye and orbital contents

4.2 - Eyebrow and lid

5 - Ear, nose and throat

5.1 - External ear

14 - Female reproductive organs

14.4 - Vagina/perineum

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

11.9 - Abdominal wall

5 - Ear, nose and throat

5.1 - External ear

2 - Brain, cranium and intracranial organs

2.5 - Vessels

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

4 - Eye and orbital contents

4.4 - Muscles

12 - Urinary system and male reproductive organs

12.6 - Genitalia

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

12 - Urinary system and male reproductive organs

12.5 - Prostate

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

5 - Ear, nose and throat

5.7 - Larynx and trachea

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

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

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.7 - Varicose veins

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

20 - Radiotherapy

20.0 - Radiotherapy

4 - Eye and orbital contents

4.9 - Lens

20 - Radiotherapy

20.0 - Radiotherapy

4 - Eye and orbital contents

4.9 - Lens

18 - Chemotherapy

18.0. - Chemotherapy

4 - Eye and orbital contents

4.9 - Lens

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

9 - Vascular system

9.6 - Non-specific

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

5 - Ear, nose and throat

5.6 - Throat

20 - Radiotherapy

20.0 - Radiotherapy

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

1.2 - Simple procedures

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

20 - Radiotherapy

20.0 - Radiotherapy

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

2 - Brain, cranium and intracranial organs

2.1 - Brain

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

7 - Breast

7.3 - Reconstruction

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

20 - Radiotherapy

20.0 - Radiotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

4 - Eye and orbital contents

4.11 - Retina

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

20 - Radiotherapy

20.0 - Radiotherapy

7 - Breast

7.3 - Reconstruction

20 - Radiotherapy

20.0 - Radiotherapy

5 - Ear, nose and throat

5.7 - Larynx and trachea

20 - Radiotherapy

20.0 - Radiotherapy

9 - Vascular system

9.6 - Non-specific

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

12.5 - Prostate

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

2 - Brain, cranium and intracranial organs

2.2 - Cranium

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

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)

3.9 - Neurophysiological procedures

4 - Eye and orbital contents

4.4 - Muscles

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.4 - Palate

12 - Urinary system and male reproductive organs

12.5 - Prostate

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

8.10 - Great Vessels

9 - Vascular system

9.6 - Non-specific

14 - Female reproductive organs

14.1 - Uterus/adnexa

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

1.1 - Investigations

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

9 - Vascular system

9.8 - Lymphatic system

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.2 - Spinal cord

3.3 - Paraspinal injections

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

12 - Urinary system and male reproductive organs

12.3 - Bladder

17 - Interventional radiology

17.3 - Angioplasty

2 - Brain, cranium and intracranial organs

2.2 - Cranium

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

9 - Vascular system

9.3 - Renal vessels

2 - Brain, cranium and intracranial organs

2.2 - Cranium

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

14 - Female reproductive organs

14.2 - Suspension

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.7 - Varicose veins

4 - Eye and orbital contents

4.2 - Eyebrow and lid

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

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

4 - Eye and orbital contents

4.2 - Eyebrow and lid

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

7 - Breast

7.1 - Excision/biopsy codes

9 - Vascular system

9.6 - Non-specific

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

14 - Female reproductive organs

14.1 - Uterus/adnexa

12 - Urinary system and male reproductive organs

12.4 - Urethra

14 - Female reproductive organs

14.4 - Vagina/perineum

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

9 - Vascular system

9.7 - Varicose veins

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.10 - Knee

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

11.9 - Abdominal wall

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

4 - Eye and orbital contents

4.1 - Globe and orbit

5 - Ear, nose and throat

5.1 - External ear

12 - Urinary system and male reproductive organs

12.6 - Genitalia

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

6.8 - Neck

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.10 - Great Vessels

2 - Brain, cranium and intracranial organs

2.1 - Brain

4 - Eye and orbital contents

4.1 - Globe and orbit

14 - Female reproductive organs

14.2 - Suspension

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.5 - Nasal sinuses

4 - Eye and orbital contents

4.9 - Lens

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

7 - Breast

7.4 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

4 - Eye and orbital contents

4.9 - Lens

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

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

8.1 - Oesophagus

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

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

2 - Brain, cranium and intracranial organs

2.6 - Other

16 - Bones, joints and connective tissue/tendon muscle

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

12 - Urinary system and male reproductive organs

12.5 - Prostate

9 - Vascular system

9.6 - Non-specific

4 - Eye and orbital contents

4.2 - Eyebrow and lid

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

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

1.3 - General procedures

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

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

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

9 - Vascular system

9.7 - Varicose veins

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.11 - Foot

4 - Eye and orbital contents

4.1 - Globe and orbit

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

16.12 - External fixation/traction

15 - Skin and subcutaneous tissue

15.2 - Repair

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

9 - Vascular system

9.6 - Non-specific

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

4 - Eye and orbital contents

4.2 - Eyebrow and lid

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

4 - Eye and orbital contents

4.2 - Eyebrow and lid

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

4 - Eye and orbital contents

4.3 - Lacrimal system

8 - Thorax and intra-thoracic organs

8.11 - Other

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

7 - Breast

7.3 - Reconstruction

17 - Interventional radiology

17.12 - Urinary

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

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

5.6 - Throat

9 - Vascular system

9.2 - Thoracic vessels

5 - Ear, nose and throat

5.1 - External ear

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

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

9 - Vascular system

9.4 - Abdominal vessels

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

5 - Ear, nose and throat

5.3 - Inner ear

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

5 - Ear, nose and throat

5.1 - External ear

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

7 - Breast

7.3 - Reconstruction

7.4 - Other

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

4 - Eye and orbital contents

4.11 - Retina

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

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)

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

9 - Vascular system

9.4 - Abdominal vessels

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

17 - Interventional radiology

17.7 - Head and neck

2 - Brain, cranium and intracranial organs

2.6 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

6 - Face, mouth, salivary and thyroid

6.8 - Neck

9 - Vascular system

9.5 - Ileo-femoral vessels

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

9 - Vascular system

9.4 - Abdominal vessels

4 - Eye and orbital contents

4.6 - Cornea

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

17 - Interventional radiology

17.12 - Urinary

5 - Ear, nose and throat

5.1 - External ear

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.4 - Vagina/perineum

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

16.10 - Knee

16.12 - External fixation/traction

17 - Interventional radiology

17.3 - Angioplasty

12 - Urinary system and male reproductive organs

12.2 - Ureter

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

5 - Ear, nose and throat

5.3 - Inner ear

5.8 - Fibreoptic endoscopic procedures (GA or LA)

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

4.11 - Retina

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

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)

16.12 - External fixation/traction

4 - Eye and orbital contents

4.1 - Globe and orbit

5 - Ear, nose and throat

5.3 - Inner ear

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.10 - Vitreous

18 - Chemotherapy

18.0. - Chemotherapy

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

6 - Face, mouth, salivary and thyroid

6.2 - Lips

15 - Skin and subcutaneous tissue

15.4 - Flaps and free skin grafts

9 - Vascular system

9.5 - Ileo-femoral vessels

9.6 - Non-specific

2 - Brain, cranium and intracranial organs

2.6 - Other

15 - Skin and subcutaneous tissue

15.2 - Repair

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

17 - Interventional radiology

17.13 - Other

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

11.10 - Peritoneum

2 - Brain, cranium and intracranial organs

2.1 - Brain

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

11.7 - Other organs (mainly digestive)

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

7 - Breast

7.3 - Reconstruction

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

17 - Interventional radiology

17.13 - Other

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

12 - Urinary system and male reproductive organs

12.3 - Bladder

12.6 - Genitalia

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

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

4 - Eye and orbital contents

4.3 - Lacrimal system

5 - Ear, nose and throat

5.1 - External ear

7 - Breast

7.1 - Excision/biopsy codes

4 - Eye and orbital contents

4.2 - Eyebrow and lid

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

2 - Brain, cranium and intracranial organs

2.4 - Nerves

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

7 - Breast

7.1 - Excision/biopsy codes

4 - Eye and orbital contents

4.9 - Lens

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

17 - Interventional radiology

17.13 - Other

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

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

14.4 - Vagina/perineum

12 - Urinary system and male reproductive organs

12.2 - Ureter

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

3.8 - Other procedures

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

9 - Vascular system

9.1 - Head and neck

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

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

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

5 - Ear, nose and throat

5.6 - Throat

9 - Vascular system

9.8 - Lymphatic system

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

16 - Bones, joints and connective tissue/tendon muscle

16.12 - External fixation/traction

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

9 - Vascular system

9.4 - Abdominal vessels

17 - Interventional radiology

17.5 - Thrombolysis

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.7 - Varicose veins

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

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

4 - Eye and orbital contents

4.6 - Cornea

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

17 - Interventional radiology

17.4 - Embolisation

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

6 - Face, mouth, salivary and thyroid

6.2 - Lips

12 - Urinary system and male reproductive organs

12.2 - Ureter

14 - Female reproductive organs

14.1 - Uterus/adnexa

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

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

1.1 - Investigations

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

12 - Urinary system and male reproductive organs

12.5 - Prostate

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

11.8 - Major vessels

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

17 - Interventional radiology

17.11 - Liver

12 - Urinary system and male reproductive organs

12.4 - Urethra

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

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

4.9 - Lens

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

5 - Ear, nose and throat

5.5 - Nasal sinuses

9 - Vascular system

9.3 - Renal vessels

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

7 - Breast

7.4 - Other

9 - Vascular system

9.8 - Lymphatic system

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

5 - Ear, nose and throat

5.1 - External ear

12 - Urinary system and male reproductive organs

12.5 - Prostate

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

8.6 - Mediastinum

6 - Face, mouth, salivary and thyroid

6.8 - Neck

12 - Urinary system and male reproductive organs

12.6 - Genitalia

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

4 - Eye and orbital contents

4.6 - Cornea

6 - Face, mouth, salivary and thyroid

6.2 - Lips

4 - Eye and orbital contents

4.2 - Eyebrow and lid

4.6 - Cornea

12 - Urinary system and male reproductive organs

12.6 - Genitalia

5 - Ear, nose and throat

5.5 - Nasal sinuses

17 - Interventional radiology

17.8 - Spine

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.3 - Bladder

14 - Female reproductive organs

14.1 - Uterus/adnexa

9 - Vascular system

9.5 - Ileo-femoral vessels

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

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

9 - Vascular system

9.7 - Varicose veins

17 - Interventional radiology

17.13 - Other

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

17 - Interventional radiology

17.1 - Biopsy

16 - Bones, joints and connective tissue/tendon muscle

16.10 - Knee

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

12 - Urinary system and male reproductive organs

12.5 - Prostate

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

14 - Female reproductive organs

14.3 - Cervix uteri

12 - Urinary system and male reproductive organs

12.3 - Bladder

2 - Brain, cranium and intracranial organs

2.4 - Nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

17 - Interventional radiology

17.3 - Angioplasty

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

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

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

17 - Interventional radiology

17.2 - Drainage

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

12 - Urinary system and male reproductive organs

12.6 - Genitalia

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

5 - Ear, nose and throat

5.7 - Larynx and trachea

9 - Vascular system

9.3 - Renal vessels

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

9 - Vascular system

9.6 - Non-specific

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

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

9 - Vascular system

9.2 - Thoracic vessels

8 - Thorax and intra-thoracic organs

8.2 - Chest wall

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

5 - Ear, nose and throat

5.7 - Larynx and trachea

4 - Eye and orbital contents

4.2 - Eyebrow and lid

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

6 - Face, mouth, salivary and thyroid

6.3 - Tongue

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

2 - Brain, cranium and intracranial organs

2.1 - Brain

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

9 - Vascular system

9.6 - Non-specific

12 - Urinary system and male reproductive organs

12.3 - Bladder

3 - Spine, spinal cord and peripheral nerves

3.4 - Nerve roots

7 - Breast

7.3 - Reconstruction

15 - Skin and subcutaneous tissue

15.2 - Repair

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

4 - Eye and orbital contents

4.9 - Lens

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

16.6 - Hand

17 - Interventional radiology

17.13 - Other

4 - Eye and orbital contents

4.11 - Retina

14 - Female reproductive organs

14.1 - Uterus/adnexa

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

14 - Female reproductive organs

14.2 - Suspension

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

4 - Eye and orbital contents

4.2 - Eyebrow and lid

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

14 - Female reproductive organs

14.2 - Suspension

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

6 - Face, mouth, salivary and thyroid

6.4 - Palate

11 - Abdomen (excluding urinary and reproductive organs)

11.3 - Duodenum

12 - Urinary system and male reproductive organs

12.5 - Prostate

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.7 - Varicose veins

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

7 - Breast

7.3 - Reconstruction

4 - Eye and orbital contents

4.3 - Lacrimal system

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

17 - Interventional radiology

17.4 - Embolisation

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

2 - Brain, cranium and intracranial organs

2.1 - Brain

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

3 - Spine, spinal cord and peripheral nerves

3.3 - Paraspinal injections

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

14 - Female reproductive organs

14.1 - Uterus/adnexa

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

5 - Ear, nose and throat

5.7 - Larynx and trachea

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

1.2 - Simple procedures

5 - Ear, nose and throat

5.6 - Throat

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

9 - Vascular system

9.6 - Non-specific

4 - Eye and orbital contents

4.2 - Eyebrow and lid

14 - Female reproductive organs

14.3 - Cervix uteri

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)

12 - Urinary system and male reproductive organs

12.5 - Prostate

6 - Face, mouth, salivary and thyroid

6.2 - Lips

4 - Eye and orbital contents

4.1 - Globe and orbit

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

7 - Breast

7.1 - Excision/biopsy codes

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

2 - Brain, cranium and intracranial organs

2.1 - Brain

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

2 - Brain, cranium and intracranial organs

2.4 - Nerves

9 - Vascular system

9.5 - Ileo-femoral vessels

2 - Brain, cranium and intracranial organs

2.4 - Nerves

12 - Urinary system and male reproductive organs

12.2 - Ureter

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.3 - Paraspinal injections

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

2 - Brain, cranium and intracranial organs

2.2 - Cranium

16 - Bones, joints and connective tissue/tendon muscle

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

7 - Breast

7.3 - Reconstruction

14 - Female reproductive organs

14.5 - Vulva/labia

7 - Breast

7.3 - Reconstruction

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

11.7 - Other organs (mainly digestive)

12 - Urinary system and male reproductive organs

12.2 - Ureter

7 - Breast

7.2 - Mastectomy (excluding implant/reconstruction)

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

7 - Breast

7.3 - Reconstruction

5 - Ear, nose and throat

5.8 - Fibreoptic endoscopic procedures (GA or LA)

14 - Female reproductive organs

14.2 - Suspension

17 - Interventional radiology

17.4 - Embolisation

12 - Urinary system and male reproductive organs

12.2 - Ureter

12.3 - Bladder

15 - Skin and subcutaneous tissue

15.3 - Burns, scars and contractures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

9 - Vascular system

9.7 - Varicose veins

2 - Brain, cranium and intracranial organs

2.3 - Meninges

5 - Ear, nose and throat

5.6 - Throat

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

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

16.9 - Hip, leg and pelvis

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

17 - Interventional radiology

17.8 - Spine

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

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

7 - Breast

7.3 - Reconstruction

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

5 - Ear, nose and throat

5.5 - Nasal sinuses

17 - Interventional radiology

17.11 - Liver

5 - Ear, nose and throat

5.1 - External ear

5.8 - Fibreoptic endoscopic procedures (GA or LA)

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)

11.10 - Peritoneum

17 - Interventional radiology

17.1 - Biopsy

17.4 - Embolisation

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

16.11 - Foot

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

2 - Brain, cranium and intracranial organs

2.3 - Meninges

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

12 - Urinary system and male reproductive organs

12.6 - Genitalia

4 - Eye and orbital contents

4.11 - Retina

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

8 - Thorax and intra-thoracic organs

8.3 - Trachea

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

9 - Vascular system

9.8 - Lymphatic system

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

8.9 - Heart – cardiology

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

5 - Ear, nose and throat

5.7 - Larynx and trachea

7 - Breast

7.4 - Other

3 - Spine, spinal cord and peripheral nerves

3.7 - Other nerve blocks

9 - Vascular system

9.1 - Head and neck

9.7 - Varicose veins

8 - Thorax and intra-thoracic organs

8.6 - Mediastinum

11 - Abdomen (excluding urinary and reproductive organs)

11.10 - Peritoneum

9 - Vascular system

9.6 - Non-specific

6 - Face, mouth, salivary and thyroid

6.7 - Teeth

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

5 - Ear, nose and throat

5.5 - Nasal sinuses

14 - Female reproductive organs

14.1 - Uterus/adnexa

4 - Eye and orbital contents

4.3 - Lacrimal system

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

9 - Vascular system

9.8 - Lymphatic system

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

12 - Urinary system and male reproductive organs

12.6 - Genitalia

15 - Skin and subcutaneous tissue

15.2 - Repair

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

2 - Brain, cranium and intracranial organs

2.5 - Vessels

17 - Interventional radiology

17.8 - Spine

8 - Thorax and intra-thoracic organs

8.4 - Fibreoptic endoscopic procedures (GA or LA)

5 - Ear, nose and throat

5.7 - Larynx and trachea

12 - Urinary system and male reproductive organs

12.2 - Ureter

5 - Ear, nose and throat

5.6 - Throat

8 - Thorax and intra-thoracic organs

8.3 - Trachea

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

5 - Ear, nose and throat

5.1 - External ear

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

9 - Vascular system

9.6 - Non-specific

6 - Face, mouth, salivary and thyroid

6.9 - Thyroid and parathyroid glands

5 - Ear, nose and throat

5.2 - Middle ear and mastoid

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

4 - Eye and orbital contents

4.6 - Cornea

2 - Brain, cranium and intracranial organs

2.1 - Brain

12 - Urinary system and male reproductive organs

12.6 - Genitalia

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.2 - Stomach

14 - Female reproductive organs

14.3 - Cervix uteri

4 - Eye and orbital contents

4.5 - Conjuctiva

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

9 - Vascular system

9.8 - Lymphatic system

5 - Ear, nose and throat

5.3 - Inner ear

6 - Face, mouth, salivary and thyroid

6.5 - Mouth cavity

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

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

15 - Skin and subcutaneous tissue

15.2 - Repair

12 - Urinary system and male reproductive organs

12.3 - Bladder

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

16 - Bones, joints and connective tissue/tendon muscle

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

5 - Ear, nose and throat

5.5 - Nasal sinuses

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

5 - Ear, nose and throat

5.7 - Larynx and trachea

8 - Thorax and intra-thoracic organs

8.9 - Heart – cardiology

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

16 - Bones, joints and connective tissue/tendon muscle

16.11 - Foot

12 - Urinary system and male reproductive organs

12.3 - Bladder

7 - Breast

7.1 - Excision/biopsy codes

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

14 - Female reproductive organs

14.1 - Uterus/adnexa

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

17 - Interventional radiology

17.2 - Drainage

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

7 - Breast

7.1 - Excision/biopsy codes

9 - Vascular system

9.6 - Non-specific

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

12 - Urinary system and male reproductive organs

12.6 - Genitalia

4 - Eye and orbital contents

4.5 - Conjuctiva

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

9 - Vascular system

9.3 - Renal vessels

3 - Spine, spinal cord and peripheral nerves

3.5 - Sympathetic nerves

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

5 - Ear, nose and throat

5.7 - Larynx and trachea

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

4 - Eye and orbital contents

4.9 - Lens

14 - Female reproductive organs

14.3 - Cervix uteri

9 - Vascular system

9.8 - Lymphatic system

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

5 - Ear, nose and throat

5.7 - Larynx and trachea

4 - Eye and orbital contents

4.7 - Sclera

5 - Ear, nose and throat

5.7 - Larynx and trachea

11 - Abdomen (excluding urinary and reproductive organs)

11.9 - Abdominal wall

2 - Brain, cranium and intracranial organs

2.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.2 - Spinal cord

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

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

4 - Eye and orbital contents

4.4 - Muscles

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

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

4 - Eye and orbital contents

4.1 - Globe and orbit

4.8 - Iris and anterior chamber

12 - Urinary system and male reproductive organs

12.6 - Genitalia

3 - Spine, spinal cord and peripheral nerves

3.8 - Other procedures

16 - Bones, joints and connective tissue/tendon muscle

16.9 - Hip, leg and pelvis

16.11 - Foot

5 - Ear, nose and throat

5.5 - Nasal sinuses

3 - Spine, spinal cord and peripheral nerves

3.6 - Peripheral nerves

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

5 - Ear, nose and throat

5.3 - Inner 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

3.2 - Spinal cord

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

12 - Urinary system and male reproductive organs

12.3 - Bladder

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

3 - Spine, spinal cord and peripheral nerves

3.9 - Neurophysiological procedures

5 - Ear, nose and throat

5.5 - Nasal sinuses

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

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

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

4 - Eye and orbital contents

4.9 - Lens

2 - Brain, cranium and intracranial organs

2.1 - Brain

4 - Eye and orbital contents

4.6 - Cornea

15 - Skin and subcutaneous tissue

15.2 - Repair

6 - Face, mouth, salivary and thyroid

6.4 - Palate

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

8 - Thorax and intra-thoracic organs

8.5 - Bronchi/lungs/pleura

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

8 - Thorax and intra-thoracic organs

8.7 - Video assisted thoracic surgery (VATS)

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

14 - Female reproductive organs

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.1 - External ear

14 - Female reproductive organs

14.4 - Vagina/perineum

5 - Ear, nose and throat

5.4 - Nose and nasal cavity

8 - Thorax and intra-thoracic organs

8.10 - Great Vessels

16 - Bones, joints and connective tissue/tendon muscle

16.6 - Hand

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)

2 - Brain, cranium and intracranial organs

2.3 - Meninges

5 - Ear, nose and throat

5.5 - Nasal sinuses

16 - Bones, joints and connective tissue/tendon muscle

16.7 - Shoulder

16.9 - Hip, leg and pelvis

6 - Face, mouth, salivary and thyroid

6.6 - Salivary glands

4 - Eye and orbital contents

4.1 - Globe and orbit

4.6 - Cornea

11 - Abdomen (excluding urinary and reproductive organs)

11.5 - Large intestine

5 - Ear, nose and throat

5.6 - Throat

11 - Abdomen (excluding urinary and reproductive organs)

11.2 - Stomach

8 - Thorax and intra-thoracic organs

8.8 - Heart – cardiac surgery

8.9 - Heart – cardiology

14 - Female reproductive organs

14.4 - Vagina/perineum

11 - Abdomen (excluding urinary and reproductive organs)

11.7 - Other organs (mainly digestive)

7 - Breast

7.3 - Reconstruction

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

4 - Eye and orbital contents

4.6 - Cornea

17 - Interventional radiology

17.3 - Angioplasty

11 - Abdomen (excluding urinary and reproductive organs)

11.4 - Small intestine

4 - Eye and orbital contents

4.8 - Iris and anterior chamber

5 - Ear, nose and throat

5.5 - Nasal sinuses

11 - Abdomen (excluding urinary and reproductive organs)

11.6 - Rectum/anus

17 - Interventional radiology

17.13 - Other

14 - Female reproductive organs

14.5 - Vulva/labia

5 - Ear, nose and throat

5.5 - Nasal sinuses

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.

This work is based on the CCSD Schedule of Procedures © The Clinical Coding and Schedule Development Group.

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.

  • 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 as a meeting between patient and provider to:
  • evaluate the nature and progress of an active condition
  • establish a diagnosis, prognosis and treatment plan.

Consultations should be face-to-face, unless you have an agreement with us for remote or telephone consultations. We allow Mental Health Practitioners to perform remote consultations if this is within their scope of practice. 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, which includes room and other charges, regardless of time taken or complexity. 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 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.

Please see Section 2.3 of these Principles for guidance on submitting an exception to this principle.


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, in line with national guidelines and evidence-based practice and where the tests are required to direct and manage a patient's treatment plan.

For example, we would expect to see patients managed for sepsis according to the NICE sepsis quality standards https://www.nice.org.uk/guidance/qs161/chapter/Quality-statement-2-Senior-review-and-antibiotic-treatment

We would therefore expect, for example, to see a hospital charge for a lactate blood test, but not for a D-dimer blood test (unless this was also indicated by other relevant clinical symptoms).

We will not generally pay you separately for diagnostic tests, pathology or diagnostic radiology 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 with the facility.

You may bill for therapeutic interventional radiology following our Schedule of Procedures and Fees https://provider.axahealth.co.uk/schedule-of-procedures-and-fees/

For diagnostic tests you perform in your private consulting rooms you should submit invoices using CCSD coding and narratives published on the CCSD website https://www.ccsd.org.uk/

We will accept invoices for specimens taken in your private consulting rooms from any recognised pathology facility which has an agreement with us.


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.

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:


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:

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.


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:

    Pre-Operative Uplift Request

    Where you anticipate a procedure will be more complex than expected, for a specific clinical reason, we will estimate the fee. We will need:
    • an explanation of why an enhanced fee is appropriate
    • the estimated time in theatre
    • an indication of what you are likely to charge
    • a full description of the procedure being performed and
    • associated procedure codes.

    Please note we will periodically audit the pre-operative requests we receive, and may request operation notes and anaesthetic charts post-operatively.


    Post-Operative Uplift Request

    We understand that complications can arise during surgery and we will consider paying an enhanced fee if this occurs. Please send us any information you think will help us decide whether an increased fee is appropriate. As a minimum we will need:
    • a copy of the original operation notes (please also submit typed notes if handwritten notes are unclear)
    • anaesthetic charts
    • an indication of the fee requested.


    Multiple Specialist Requests

    We will consider requests for two or more surgeons during a patient's operation, either because:
    • more than one specialism is clinically necessary (a gynaecological surgeon and a colorectal surgeon, for example), or
    • clinical guidance from a UK professional body (or another medical entity we recognise) indicates that two or more specialists from the same specialism need to be present during the surgery.

    You must agree these requests before going ahead with the procedure. Please send us the following information to support this request:
    • details of each specialist
    • an explanation of why each specialist needs to be in surgery
    • the anticipated procedure length and an indication of time in theatre for each specialist
    • an explanation of what each specialist will do
    • an indication of fees for each specialist and any supporting clinical guidance.

    When agreeing treatment we will provide an estimate of fees paid for each specialist. If, after treatment, you would like us to adjust our estimate, please send us your operation notes and anaesthetic charts, so we can understand:
    • your role in the procedure
    • the time spent in theatre and
    • the complexities faced.


We will then confirm the fee we will pay you for the treatment.

Please submit your bespoke request using the specialist fees enquiry form on our Provider website https://provider.axahealth.co.uk/individual/individual-provider-support/

We review all requests individually using the evidence you provide.

We want to make sure your patients can confidently book treatment without worrying about what we will pay. To support with this, please allow at least five working days' notice for any pre-operative requests, including coding queries and requests for multiple specialists. We need this time to review the information you send us and make a decision.

Otherwise, we'll review your request post-operatively, at your own risk. Please note we do not pay for surgical assistants or for you to supervise services provided by others.


Ethical Guidance For Bespoke Requests

We expect you to follow the ethical guidance provided by your regulatory body. An example of such guidance from the GMC can be found here: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/duties-of-a-doctor

This guidance states, in paragraph 78, domain 4, under the section "Honesty in financial dealings", that: "You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients."

We do not expect you to redirect a patient's care or cancel treatment if you are unable to agree your preferred fee with us. We will take situations like this seriously and we may withdraw your recognition in these circumstances.


3.2 - Unproven Treatment

We do not provide benefit for experimental or unproven treatments. These are treatments which do not meet our definition of conventional treatment, as defined below. These treatments include those using new technology or drugs, where safety and effectiveness have not been established or generally accepted. We may make a contribution to unproven treatment if there is a suitable, equivalent conventional treatment.

Please contact our Medical Support Team (medicalsupportteam.health@axahealth.co.uk) before undertaking treatment which might be considered unproven. Please send us:
  • your details
  • the appropriate CCSD code
  • a description of what you will be doing during surgery
  • date of surgery
  • the hospital where the treatment will take place
  • who will be present during surgery, including the anaesthetist's name and provider number
  • the patients name, date of birth and membership details.

You should not use codes covering existing procedures for new and as yet uncoded procedures.


Conventional Treatment

We define conventional treatment as treatment that:
  • is established as best medical practice, is practised widely within the UK and
  • is clinically appropriate in terms of necessity, type, frequency, extent, duration and the facility or location where the treatment is provided; and has either
  • been shown to be safe and effective for the treatment of the medical condition through substantive peer reviewed clinical evidence in published authoritative medical journals or
  • been approved by the National Institute for Health and Care Excellence (NICE) as a treatment which may be used in routine practice.

If the treatment is a drug, the drug must be:
  • licensed for use by the European Medicines Agency or
  • the Medicines and Healthcare products Regulatory Agency and
  • used according to that licence.


4: Specific Provisions





4.1 - Anaesthesia Provisions

Anaesthesia reimbursement includes:
  • pre-operative assessment, on the ward or at a clinic
  • the anaesthetic itself, including all intra-operative and post-operative care and any care in an ITU or high dependency unit (HDU) expected during the procedure
  • inserting and removing all lines and catheters, including central venous pressure (CVP), arterial (ART), continuous cardiac output (CCO), hemofiltration vascaths, nasogastric and urinary tubes
  • monitoring and
  • analgesia, including nerve blockage, neuroaxial blockade or patient controlled analgesia.

You should not list any of these items as additional charges.

Following the Guidelines for the Provision of Intensive Care Services jointly published by the Faculty of Intensive Care Medicine (FICM) and the Intensive Care Society (ICS) (Edition 1.1 2016), we will pay a daily fee as listed in our Schedule of Procedures and Fees https://provider.axahealth.co.uk/schedule-of-procedures-and-fees/ to the intensivist caring for a patient in an ITU. This pays for all ITU care including, but not limited to:
  • insertion and care of CVP/ART/vascath/pulmonary artery catheters
  • dialysis/haemofiltration
  • chest drains and
  • tracheostomy insertion or endotracheal tube changes.

We will not pay this fee to the anaesthetist present during the surgery.


4.2 - Injections And Infusions

As they are not separate surgical procedures, we do not accept separate charges for:
  • subcutaneous, intramuscular or intravenous injections, including vaccinations where eligible
  • drug/electrolyte infusions, including blood/fresh frozen plasma/platelets.

We include injections and infusions within our standard consultation or hospital fee, whether given during a planned consultation or by appropriate nursing staff during a hospital stay.


4.3 - Chemotherapy And Radiotherapy

Charges for the prescribing and supervision of chemotherapy should be made in accordance with the schedule set out in Chapter 18 of our Schedule of Procedures and Fees https://provider.axahealth.co.uk/schedule-of-procedures-and-fees/


Consultation

A fee for consultation may be charged before treatment commences. Further consultation fees should not be charged during the course of treatment.


Chemotherapy

The coding covers all care relating to the clinical supervision and planning of the delivery of chemotherapy (only ONE of the following: X0001 OR X0002 OR X0003 OR X0004) regimens and the engagement and management of patients, including but not limited to:
  • regime prescription
  • supervision of planning and treatment delivery
  • expected side effects management and the prescription of an alternative regimen
  • supervision of all outpatient, day patient, and inpatient care.

Only one supervision fee will be paid for any course of treatment regardless of whether a single or multiple drug combination is used. We expect that invoices for chemotherapy and biological supervision should be made at the end of the cycle of treatment.


Radiotherapy

Charges for the prescribing and supervision of radiotherapy should be made in accordance with the schedule set out in Chapter 20.

As per CCSD guidance, it is intended that planning codes (X6000-X6099) are to be used by both consultants and hospital providers. Delivery codes (X7000-X7099) are to be used by hospital providers only and clinical supervision codes (X0007-X0012) are to be used by consultants only for delivery. Please see the CCSD Schedule for more information: https://www.ccsd.org.uk/ccsdschedule/CCSDScheduleCode?Chapter=20&Section=0&subsection=0&ctype=0&numitems=100&page=0

A fee for consultation may be charged before treatment commences. Further consultation fees should not be charged during the course of treatment. These codes cover all care relating to the clinical supervision and planning of the delivery of radiotherapy regimens and the engagement and management of patients, including but not limited to:
  • regime prescription
  • supervision of planning and treatment delivery
  • expected side effects management and the prescription of an alternative regimen
  • supervision of all outpatient, day patient, and inpatient care, including any transfusion of blood/blood products.

We expect that invoices for radiotherapy supervision and treatment delivery should be made at the end of the cycle of treatment.


5: Administration And Governance





5.1 - Submitting Invoices

You must submit all invoices to us for eligible claims within six months of treatment. Please do not send patients invoices or seek payment from them directly.

To help us to pay you promptly, please submit invoices electronically via our e-billing provider Healthcode https://www.healthcode.co.uk/medical-billing/billing. When you open this link you should select the option to "register for ePractice".


5.2 - Payment

We send you remittance advice telling you the total amount we are paying you for treatment, which patient the payment relates to and any reasons the invoice wasn't paid in full (for example, if there was a membership limitation).

Your patients receive similar statements advising them of any costs their membership doesn't cover, which they must settle with you.

To ensure patients can pay you quickly, please let us share your bank details with your patients by filling out this consent form on our Provider website https://provider.axahealth.co.uk/specialist-opt-in-form/. This lets us share your bank details when needed.

We will also send your patients the invoice address you gave us when you became recognised. Please ensure it is an address you are happy for your patients to know (a business, rather than a home address, for example). If you would like us to use a different address, please update your details on the Private Practice Register PPR: https://www.theppr.org.uk/


5.3 - Requests For Medical Documentation

During your patient's treatment we may request medical information or documentation to make a decision about a claim. We will let you know where to send this information when we request it.

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 agree treatment for patients and settle their claims quickly.

We expect you to comply with the good practice guidance of your regulatory authority when submitting this information.

For example, the general medical record keeping standards of the Royal College of Physicians expect "every entry in the medical record should be dated, timed (24 hour clock), legible and signed by the person making the entry. The name and designation of the person making the entry should be legibly printed against their signature. Deletions and alterations should be countersigned, dated and timed". https://www.rcplondon.ac.uk/projects/outputs/generic-medical-record-keeping-standards

We expect your documents to be complete, accurate, clear and signed by you. 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 you submit documents or information that do not adhere to these standards, we will not be able to review them and we cannot consider your request. If in doubt, please supply typed notes with the original copies.

Please note:
  • we will ask for this information to be submitted as soon as possible, but no later than 28 days after we have asked for it
  • it is your responsibility to gain your patient's consent to share this information
  • without this consent, we may not be able to review the information you have sent us
  • we try to request the minimum appropriate information needed to make a decision
  • under the General Data Protection Regulation (GDPR), you are the controller of this information and you are responsible for ensuring you send the correct information to us.

We do not pay you for providing this information or for completing reports.

We may audit medical notes as part of our quality control procedures. Once the member signs a consent form authorising this disclosure, we will ask you to provide us this information.


5.4 - Fraud And Misrepresentation

The Fraud Act 2006 sets out the legal definition of fraud and creates offences of fraud by false misrepresentation, fraud by omission and fraud by abuse of position. A person who makes a false statement, omits material facts or misuses a position of trust with the intention of causing loss to a third party is guilty of fraud even if he or she does not personally gain and even if the deception fails. The law includes false statement made to any device capable of receiving information. Home Office guidance on the application of the Act states that it is intended to cover false statements made to insurance companies at underwriting.

Our business is conducted on the basis of good faith. We monitor claims using data mining software and routinely audit claims by reference to medical records. We will not tolerate fraud and misrepresentation and will cease doing business with any provider who provides false, misleading or selective information. We will also refer cases of fraud to the GMC and to the police as appropriate. We consider the following examples constitute fraudulent billing:
  • exaggerating the complexity of the procedure. For example, coding a diagnostic procedure as if it were therapeutic
  • misrepresenting the medical history or the procedure performed
  • omitting material facts
  • using jargon or technical information which, while strictly correct, is presented in a way likely to mislead a non-medically qualified claims assessor: a claim for laser in situ keratomileusis (LASIK), for example, coded as keratoplasty
  • unbundling (see section 2.5 on Unbundling, above).

We may share your details under Article 2 of the GDPR for the purposes of the prevention, investigation, detection or prosecution of criminal offences or the execution of criminal penalties, including the safeguarding against and the prevention of threats to public security.


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.
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
  Q0950 Plastic reconstruction of uterus Major
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
  XR565 Percutaneous dilatation of biliary stricture under imaging control Xmajor
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
  W4542 Open reduction, internal fixation and revision of femoral component for peri-prosthetic fracture Complex
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
  H5400 Anorectal stretch Minor
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
  P2450 Sacrospinous fixation Major
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
  A3900 Repair of dura Complex
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
  C3910 Excision/biopsy of conjunctival lesion Minor
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)
  J0310 Resection of liver tumour(s) Complex
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
  A3810 Excision of lesion of meninges of brain Complex
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
  22000 Routine electroencephalography (EEG) in adult or child aged over 5 (Including reporting)
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
  P0580 Radical vulvectomy (including block dissection of inguinal gland) Complex
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
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
  X0720 Disarticulation of shoulder Xmajor
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
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
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
  G2430 Transabdominal anti-reflux operations Complex
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
  A6080 Neurectomy (major nerve) Intermediate
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
  6.9 Thyroid and parathyroid glands
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
  W0464 Complex procedure to mid foot and hind foot with autogenous graft (including osteotomy, fusion +/? tendon transfers, fixation) Complex
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
  H5640 Excision of anal fissure Minor
1 Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

  1.2 Simple procedures
  25022 Stellate ganglion block (local anaesthetic) +/- Image Guidance
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)
  J5610 Pancreatoduodenectomy and excision of surrounding tissue (Whipple's procedure) Complex
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
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)
  V3181 Prosthetic intervertebral disc replacement in the thoracic spine including spinal cord monitoring Complex
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
  W5710 Excision arthroplasty of first metatarso-phalangeal joint, (e.g. Keller, Bonney-Kessel procedures) including cheilectomy Intermediate
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)
  J2800 Excision of lesion of bile duct Major
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
  W0960 Excision of benign tumour of bone with bone grafting Xmajor
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
  XR580 Percutaneous cholecystostomy Major
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
  A6302 Graft to major nerve Xmajor
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
  M5300 Vaginal operations to support outlet of female bladder (including cystoscopy) Major
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
  H1000 Excision of sigmoid colon Xmajor
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
  W3090 Core decompression of knee Major
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
  K1100 Closure of defect of interventricular septum Complex
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
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
  W8580 Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or microfracture) ? bilateral Complex
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
  Q1010 Dilation of cervix uteri and curettage of retained products of conception following miscarriage Intermediate
9 Vascular system
  9.2 Thoracic vessels
  L1890 Repair of leaking aneurysm of thoracic aorta Complex
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
  T6461 Tendon transfer of toe – bilateral Major
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
  A2952 Excison of acoustic neuroma (vestibular schwannoma) - tumours less than 2.5cm (performed by single surgeon) Complex
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
7 Breast
  7.4 Other
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
  4.6 Cornea
  C4520 Excision of lesion of cornea Minor
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
  W7810 Open arthrolysis of shoulder contracture +/- manipulation/injection Major
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
  A8480 Transtympanic electrocochleography Intermediate
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
  A6510 Carpal tunnel release (open) Intermediate
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
  XR252 Venoplasty Major
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
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
  E4030 Tracheoplasty Major
9 Vascular system
  9.5 Ileo-femoral vessels
  L5180 Aorto-bifemoral bypass Complex
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
  A2954 Excision of acoustic neuroma (vestibular schwannoma) - tumours managed by combined oto-neurosurgical team irrespective of tumour size Complex
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
  H3332 Anterior resection - high (i.e. colorectal anastomosis above the peritoneal reflection) Complex
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
  P1300 Operations on female perineum Minor
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
  W0300 Multiple procedures on forefoot, distal to and including the tarsometatarsal joints, which involves at least two distinct procedures not intrinsic to each other Xmajor
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
  K4600 Off-pump coronary artery bypass (OPCAB) Complex
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
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
  E1432 FESS Uncinectomy, ethmoidectomy, antrostomy or antral puncture inc polypectomy and attention to turbinates etc Major
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
  P1920 Excision of septum of vagina Intermediate
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
  G3100 Laparoscopic biliary gastric bypass Complex
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
  A6710 Cubital tunnel release (open) (without transposition) Intermediate
9 Vascular system
  9.8 Lymphatic system
  T8700 Excision biopsy of lymph node for diagnosis (cervical, inguinal, axillary) Intermediate
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
  C1040 Suture of eyebrow Minor
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
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)
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
  P2510 Repair of vesicovaginal fistula (including cystoscopy) Major
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
  G2400 Transthoracic fundoplication and gastroplasty Xmajor
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
  S2503 Local flap ? 9cm2 or more (including graft/flap to secondary defect) Xmajor
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
  X0880 Amputation through mid-carpal/transmetacarpal Intermediate
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
  V1930 Alveolar bone graft - unilateral Intermediate
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
  A0260 Excision of arteriovenous malformation from vessels of brain Complex
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
  Q0740 Total abdominal hysterectomy (+/- oophorectomy) +/- ureterolysis Major
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
  T0810 Resection of rib and open drainage of pleural cavity Major
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
  C8650 Fluorescein angiography of eye (including ocular photography) Minor
1 Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

  1.2 Simple procedures
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
  V2110 Temporomandibular meniscectomy Major
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
  W4930 Revisional shoulder hemiarthroplasty Xmajor
  16.9 Hip, leg and pelvis
  T7930 Repair of abductor mechanism of hip Major
  16.11 Foot
  W7880 Open or arthroscopic release of ankle joint contracture (excluding Achilles tendon lengthening) Major
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
  A3200 Decompression of cranial nerve (craniotomy) Complex
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
  F1810 Enucleation of cyst of jaw Intermediate
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
  D2050 Tympanic neurectomy Xmajor
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
  XR142 Bilateral stereotactic core biopsy of breasts Intermediate
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
  A5110 Excision of intradural lesion Complex
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
  S5533 Dressing of burn of skin or subcutaneous tissue - 2% - 10% Minor
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
  H5020 Repair of anal sphincter (including sigmoidoscopy) Major
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
  X2262 Complex open reduction for congenital dislocation of hip (i.e. pelvic and femoral or Pemberton osteotomy or revision of open reduction) Complex
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
  G2320 Transthoracic repair of diaphragmatic hernia (acquired) Xmajor
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
  T7620 Free functioning muscle transfer (as sole procedure) including closure of secondary defect Complex
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
  K5710 Ablation of atrio-ventricular junction (including mapping) Xmajor
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
  H4430 Examination of rectum under anaesthetic (as sole procedure) Minor
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)
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
  M7340 Repair of urethrorectal fistula Major
9 Vascular system
  9.8 Lymphatic system
  T8520 Block dissection of axillary lymph nodes (axillary clearance levels 1-3) Major
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
  W5560 OK (Outerbridge and Kashiwagi) procedure Major
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
  G5010 Open excision of congenital lesion of duodenum including malrotation Complex
  11.4 Small intestine
  G6100 Bypass of jejunum Major
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)
  V4000 Combined anterior and posterior correction and instrumentation, +/- fusion of idiopathic juvenile scoliosis (including spinal monitoring) Complex
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
  F2650 Suture of tongue Intermediate
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
  G7900 Ileoscopy via stoma with therapy Minor
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
  W7420 Autograft anterior cruciate ligament reconstruction (including arthroscopic and meniscectomy) Xmajor
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
  XR910 Insertion of central venous catheter - non-tunnelled (X-ray guided) Intermediate
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
  G4010 Pyloromyotomy Major
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
  XR254 Angioplasty of other arteries (e.g. sub-clavian, tibial, femoro-popliteal) including peripheral angiogram +/- insertion of stent Major
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
  D0140 Excision of preauricular sinus Intermediate
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
  G6082 Open resectionof small intestine tumour Major
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
  J6730 Endoscopic upper gastrointestinal ultrasound, eg for pancreaticobiliary diagnosis/transmucosal biopsy Intermediate
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
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
  K5740 Ablation of ventricular arrhythmia (including mapping) Complex
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
  H3365 Laparascopic anterior resection - low (ie colorectal anastomosis at or below the peritoneal reflection) Complex
  H5100 Haemorrhoidectomy (including sigmoidoscopy) Intermediate
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
  D0210 Excision of lesion of pinna Intermediate
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
  M5600 Therapeutic endoscopic operations on outlet of female bladder (including cystoscopy) Intermediate
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
  S3622 Full thickness graft, trunk and limbs – up to 9cm2 in area Intermediate
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
  F0312 Primary closure of cleft lip - unilateral Major
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
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)
  V3102 Revisional combined anterior discectomy and posterior fusion (thoracic region) Including Spinal Cord Monitoring Complex
  3.2 Spinal cord
  A4832 Implantation of spinal cord stimulator Major
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
  V1150 Removal of internal fixation and/or inter-maxillary fixation from jaw Minor
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
13 Pregnancy and confinement
  13.1 Pregnancy and confinement
  R2510 Caesarean hysterectomy Xmajor
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
  M2080 Unilateral replantation of ureter into bladder (including cystoscopy) Major
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
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
  M0610 Open removal of calculi from kidney Major
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
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
  E0260 Rhinoplasty following trauma or excision of tumour (including attention to turbinates) Major
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
  W6030 Revision or conversion to arthrodesis of shoulder Xmajor
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
  T0320 Exploratory thoracotomy Major
  8.7 Video assisted thoracic surgery (VATS)
  G0922 VATS oesophageal / oesophagogastric myotomy Major
7 Breast
  7.3 Reconstruction
  B2988 Reconstruction of breast using ALT (anteriolateral thigh) flap including delayed reconstruction Complex
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
  M0814 Open biopsy of native kidney Major
  12.4 Urethra
  M7330 Closure of fistula of urethra (including cystoscopy) Intermediate
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
  H3362 Hartmann's procedure Xmajor
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
  XR352 Embolisation of artery/vein Major
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
  S2500 Local flap ? less than 9cm2 Major
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
  C1420 Graft of skin to eyelid Intermediate
13 Pregnancy and confinement
  13.1 Pregnancy and confinement
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)
  V4302 Combined anterior vertebrectomy with posterior fusion and instrumentation Complex
9 Vascular system
  9.6 Non-specific
  L9113 Percutaneous insertion of central venous dialysis line Intermediate
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
  E4230 Mini-tracheostomy (percutaneous) Minor
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
  N2840 Repair of avulsion of penis Major
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
  W6600 Closed reduction of dislocated hip prosthesis Intermediate
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
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
  Y3810 Insertion of indwelling pleural catheter Intermediate
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
  S4812 Insertion of skin expander into tissue (not related to breast reconstruction) Intermediate
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.
  2.6 Other
  B0610 Excision of pineal gland Complex
1 Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

  1.2 Simple procedures
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
  T1620 Plication of paralysed diaphragm Xmajor
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
  A7010 Implantation of neurostimulator to peripheral nerve Major
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
  C1140 Correction of telecanthus Intermediate
  4.5 Conjuctiva
  C3950 Radiotherapy to conjunctival lesion Minor
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
  K2540 Replacement of mitral valve with sub-valve preservation (including biopsies) Complex
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
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
  BT222 Insertion and removal of high dose rate radioactive agent (brachytherapy) into prostate tumour
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
  A2954 Excision of acoustic neuroma (vestibular schwannoma) - tumours managed by combined oto-neurosurgical team irrespective of tumour size Complex
7 Breast
  7.3 Reconstruction
  B2987 Reconstruction of breast using Transverse Upper Gracilis (TUG) flap (including delayed reconstruction and nipple reconstruction) Complex
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
  XR516 Angioplasty of iliac artery, +/- insertion of stent Major
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
  S6400 Excision of nail bed (Zadik's) (including anaesthetic) Intermediate
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
  W8602 Therapeutic arthroscopy of wrist joint (sole procedure) Major
9 Vascular system
  9.7 Varicose veins
1 Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

  1.2 Simple procedures
  X4810 Change of cast without general anaesthetic (as sole procedure)
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
  K2613 Revision of aortic valve replacement Complex
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
  H5620 Lateral sphincterotomy of anus Minor
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
  J3900 Therapeutic ERCP with insertion of biliary or pancreatic stent(s), sphincterotomy or stone extraction Major
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
  W0432 Isolated sub talar fusion or mid foot fusion with autogenous graft (adult) Major
7 Breast
  7.3 Reconstruction
  B3180 Implantation of prosthesis into breast as sole procedure Intermediate
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
  K0700 Correction of total anomalous pulmonary venous connection Complex
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
  M3420 Laparoscopic cystectomy (with construction of intestinal conduit or bladder) (including cystoscopy) Complex
  12.6 Genitalia
  N0680 Orchidectomy and excision of spermatic cord (+/- insertion of prosthesis) Intermediate
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
  T1220 Drainage of pleural cavity Minor
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
  XR530 Fluoroscopically guided percutaneous vertebroplasty Major
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
  M7314 Repair of distal hypospadia Major
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
  T6213 Soft tissue operations in the region of the greater trochanter (trochanteric bursitis, snapping hip) Major
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
  C1710 Suture of eyelid (laceration) (as sole procedure) Minor
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
  M0800 Other open operations on kidney Major
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
  6.8 Neck
  T9400 Operations on branchial cyst Intermediate
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
  A6810 Neurolysis and transposition of peripheral nerve (excludes carpal tunnel release) Intermediate
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
  A2720 Proximal gastric vagotomy Major
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
  P2530 Repair of rectovaginal fistula Xmajor
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
  T6914 Tenolysis of extensor tendon of hand Intermediate
  16.11 Foot
  T6763 Repair of tendon of foot – extensor Minor Minor
  16.11 Foot
  W7530 Repair of lateral collateral ligament complex Major
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
  S4930 Removal of skin expander or valve (not related to breast reconstruction) Intermediate
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
  XR500 Chemonucleolysis Intermediate
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
  25100 Coeliac plexus block, splanchnic nerve block, hypogastric block - diagnostic +/- Image Guidance Intermediate
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
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
  A6402 Repair of major nerve Major
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
  G7530 Closure of ileostomy (as sole procedure) Intermediate
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
  BT210 Oral introduction of liquid radioactive agent (brachytherapy) for thyroid tumour ablation
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
  A5530 Lumbar puncture (including spinal manometry) Minor
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
  W9111 Manipulation of joint (including intra-articular injection) for “Frozen Shoulder” (as sole procedure) – bilateral Intermediate
  16.8 Elbow
  W5502 Interposition arthroplasty of elbow Xmajor
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
  G2331 Laparoscopic repair of hiatus hernia with anti-reflux procedure (eg fundoplication) Major
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)
  V2430 Revisional posterior decompression with fusion (thoracic region) Including Spinal Cord Monitoring Complex
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)
  W9017 Yttrium joint injection (with radioactive precautions) Minor
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
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
  X5020 External cardioversion Minor
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
  W6017 Ankle arthrodesis with internal fixation (arthroscopic) Intermediate
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
  E2910 Total laryngectomy Complex
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
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)
  W7881 Release of contracture of interphalangeal joint of finger (excluding trigger finger or Dupuytren's disease) Intermediate
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
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
  W3180 Free composite (ie including bone) vascularised grafts Complex
9 Vascular system
  9.5 Ileo-femoral vessels
  L5300 Open operations on iliac artery Complex
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
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
  L1890 Repair of leaking aneurysm of thoracic aorta Complex
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
  M7620 Removal of foreign body from urethra Minor
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
  K2310 Excision of cardiac tumour Complex
  K3100 Open valvotomy Complex
  8.10 Great Vessels
  L1910 Elective repair of aneurysm of ascending aorta Complex
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
  D0410 Drainage of haematoma/abscess of pinna Minor
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
  W8240 Meniscal allograft transplantation Xmajor
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
  M2202 Ureterostomy - formation Major
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
  W0283 Total excision of trapezium with spacer Xmajor
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
  Q3900 Laparoscopy (including e.g. puncture of ovarian cysts, +/- biopsy, minor endometriosis, +/- ureterolysis) Intermediate
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
  S0642 Excision of lesion of skin or subcutaneous tissue - four or more, Head & Neck (excluding lipoma) Intermediate
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.
  3.3 Paraspinal injections
  25020 Intravenous regional sympathetic block (guanethidine block) - 1 injection Minor
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
  S5534 Dressing of burn of skin or subcutaneous tissue - 10% - 25% Minor
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
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
  W1700 Shelf augmentation of acetabulum, eg Wainwright or Trillat Xmajor
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
  F2660 Tongue flap - first stage and second stage Major
9 Vascular system
  9.6 Non-specific
  L9181 Removal of Portacath/vasoport unit Minor
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
  X3770 Intramuscular injection(s) with X-ray control (eg piriformis block) Minor
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
  T7981 Extensive, greater than 2cm tear repair of large muscle including arthroscopic (excluding rotator cuff) Major
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
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
  F4230 Removal of excess mucosa from mouth Intermediate
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
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
  25030 Stellate ganglion block (neurolytic) +/- Image Guidance Minor
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
  M1380 Percutaneous tru-cut needle biopsy of lesion of kidney Intermediate
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
  T4130 Freeing of adhesions of peritoneum Major
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)
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
  L7920 Plication of vena cava Xmajor
1 Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

  1.3 General procedures
  22000 Routine electroencephalography (EEG) in adult or child aged over 5 (including reporting)
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
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
  W6018 Ankle arthrodesis – revision, including converstion from total ankle replacement Intermediate
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
  S3530 Split autograft of skin, trunk and limbs – over 25cm2 and up to 5% of body surface area Major
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.
  5.8 Fibreoptic endoscopic procedures (GA or LA)
  E4800 Therapeutic bronchoscopy (including laser, cryotherapy, lavage, snare, dilatation of stricture, insertion of stent) Minor
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
  A6030 Transection of peripheral nerve for neuroma Intermediate
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
  T6820 Secondary repair or reconstruction of extensor of hand/forearm Major
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.
  4.11 Retina
  C8440 Retinal examination under anaesthetic including retinopexy if necessary Minor
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.
  8.6 Mediastinum
1 Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures

  1.3 General procedures
  25010 Paravertebral block up to two levels (without X-ray control)
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
  T1300 Introduction of substance into pleural cavity with chest drain Minor
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
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
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)
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
  F4830 Therapeutic sialendoscopy (including washout) Intermediate
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
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
  D0730 Removal of foreign body from external auditory canal (and bilateral) Minor
7 Breast
  7.2 Mastectomy (excluding implant/reconstruction)
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
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
  F5110 Open extraction of calculus from parotid duct Intermediate
7 Breast
  7.3 Reconstruction
  B2984 Reconstruction of breast using pedicled TRAM (including delayed reconstruction) Complex
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
  A1300 Maintenance of cerebroventricular shunt Major
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
  S0520 Microscopically controlled excision of lesion of skin or subcutaneous tissue (Mohs micrographic surgery) with immediate reconstruction Xmajor
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
  T8723 Selective dissection of cervical lymph nodes, levels 1 to 5 (+/- 6) Complex
7 Breast
  7.4 Other
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
  H1700 Intra abdominal manipulation of colon for intussusception (as sole procedure) Major
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
  L2303 Coarctation repair involving prosthetic graft Complex
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
  A7500 Lumbar sympathectomy diagnostic (local anaesthetic under X-ray control) Intermediate
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
  A6710 Cubital tunnel release (open) (without transposition) Intermediate
9 Vascular system
  9.7 Varicose veins
  L8621 Ultrasound-guided foam Sclerotherapy for varicose vein(s) ? bilateral Intermediate
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
  L0900 Formation of cavo-pulmonary shunt (Glenn) Complex
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
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
  M6620 Endoscopic incision of outlet of male bladder (with cystoscopy) Intermediate
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
  T1410 Needle biopsy of pleura Minor
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
  XR630 Percutaneous nephrostomy Intermediate
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
  A6402 Repair of major nerve Major
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
9 Vascular system
  9.6 Non-specific
  L7420 Creation of arteriovenous fistula (including subsequent closure) Intermediate
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
  M2920 Endoscopic insertion/removal of prosthesis into ureter (including bilateral and cystoscopy, +/- pyelography) Major
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
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
  A6900 Revision of release of peripheral nerve Major
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
  M0910 Endoscopic fragmentation of calculi of kidney (including cystoscopy and insertion/removal of stent) Major
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
  V1082 Partial maxillectomy for malignancy Xmajor
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
  E2952 Laryngofissure Major
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
  M6180 Radical prostatectomy, reconstruction of bladder neck including bilateral pelvic lymphadenectomy (including cystoscopy) Complex
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
  H4080 Injection of bulking agents for faecal incontinence Intermediate
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
  M0680 Drainage of pyonephrosis Intermediate
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)
  W8300 Therapeutic arthroscopy operation on articular cartilage (other than W8200 and W8230) (as sole procedure) Intermediate
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
  K5120 Intravascular ultrasound of coronary arteries (as sole procedure) Major
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
  T8580 Block dissection of pelvic lymph nodes (as sole procedure) Major
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
  W1870 Drainage of petrous apex for sepsis Complex
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
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
  V1330 Biopsy of lesion of facial bone Minor
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
  M3602 Enterocystoplasty (including cystoscopy) Complex
9 Vascular system
  9.1 Head and neck
  L3710 Bypass of subclavian artery from the arch Complex
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
  S5535 Dressing of burn of skin or subcutaneous tissue - greater than 25% Minor
9 Vascular system
  9.2 Thoracic vessels
  L1990 Elective repair of aneurysm of thoracic aorta Complex
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
  S3100 Re-exploration of free flap Xmajor
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.
  8.6 Mediastinum
  E6310 Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal masses Major
16