AXA Health | Chapter 7 Details

Chapter 7 / Breast

7.1 - Excision/biopsy codes

Code

Description

Hospital Complexity

Procedure Fees

Fee For General Anaesthesia

Unacceptable Combinations

Additional Information

B2800

Excision of breast lump/fibroadenoma

Intermediate

Show


Unacceptable Combinations

Code	Description

B2752	Subcutaneous mastectomy

B2760	Skin/nipple sparing mastectomy (including axillary node biopsy)

B2780	Simple mastectomy (including axillary node biopsy) - unilateral

B2782	Prophylactic mastectomy - unilateral

B2783	Prophylactic mastectomy - bilateral

B2820	Wide local excision of breast +/- local mobilisation of glandular breast tissue to fill surgical cavity

B2830	Re-excision of lesion of breast if resection margins are not clear (as sole procedure)

B2831	Re-excision of lesion of breast if resection margins are not clear with local mobilisation

B2880	Excision biopsy of breast lesion after localisation

B2890	Ultrasound guided interstitial laser ablation of breast lesion

B2921	Lumpectomy and immediate partial reconstruction of breast using pedicled perforator flap (eg. Lateral Intercostal Artery Perforator (LICAP) or Thoraco-Dorsal Artery Perforator (TDAP))

B3180	Implantation of prosthesis into breast (as sole procedure)

S2500	Local flap - less than 9cm2

S5210	Injection into subcutaneous tissue/painful trigger point under local anaesthetic

T8700	Excision biopsy of lymph node for diagnosis (cervical, inguinal, axillary)

XR121	Image-guided vacuum assisted excision biopsy of breast lesions (mammotome may be used - refer to spine breast cancer guidelines)

XR160	Percutaneous image guided fine needle aspiration (FNA)

XR161	Percutaneous image guided fine needle aspiration(s) (FNA) ? bilateral

GA303	Chest Reconstruction For Gender Affirmation (As Sole Procedure)


Additional Information

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B2820

WIDE LOCAL EXCISION OF BREAST LOCAL MOBILISATION OF GLANDULAR BREAST TISSUE TO FILL SURGICAL CAVITY

Intermediate

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Unacceptable Combinations

Code	Description

B2710	Radical mastectomy (including block dissection)

B2742	Modified radical mastectomy (including lymph node sampling)

B2743	Modified radical mastectomy excluding lymph node sampling

B2744	Modified radical mastectomy (including lymph node clearance)

B2752	Subcutaneous mastectomy

B2782	Prophylactic mastectomy - unilateral

B2783	Prophylactic mastectomy - bilateral

B2800	Excision of breast lump/fibroadenoma

B2830	Re-excision of lesion of breast if resection margins are not clear (as sole procedure)

B2831	Re-excision of lesion of breast if resection margins are not clear with local mobilisation

B2880	Excision biopsy of breast lesion after localisation

B2890	Ultrasound guided interstitial laser ablation of breast lesion

B2916	Mastectomy and immediate reconstruction of breast using extended latissimus dorsi flap

B2921	Lumpectomy and immediate partial reconstruction of breast using pedicled perforator flap (eg. Lateral Intercostal Artery Perforator (LICAP) or Thoraco-Dorsal Artery Perforator (TDAP))

B2981	Local mobilisation of glandular breast tissue to fill surgical cavity

B3016	Mastectomy and immediate reconstruction of breast using fat transfer

B3021	Mastectomy and immediate reconstruction of breast including laparoscopic mobilisation of the greater omentum for breast reconstruction

B3140	Therapeutic mammoplasty for breast cancer

B3180	Implantation of prosthesis into breast (as sole procedure)

B3440	Microdochotomy

B3593	Microdochectomy or mammodochectomy (Hadfield's procedure)

B3595	Excision of mammary fistula

B2830

Re-excision of lesion of breast if resection margins are not clear (as sole procedure)

Intermediate

Show

B2831

Re-excision of lesion of breast if resection margins are not clear with local mobilisation

Intermediate

Show

B2880

Excision biopsy of breast lesion after localisation

Intermediate

Show

B3212

Percutaneous suction core biopsy

Minor

Show

B3220

Core biopsy of lesion of breast ? unilateral

Minor

Show

T9000

Sentinel node mapping and sampling with blue dye or radioactive probe for breast cancer

Intermediate

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T9020

Sentinel node mapping and sampling with blue dye and radioactive probe for breast cancer

Intermediate

Show

T9021

Injection of magnetic lymphatic tracer and subsequent sentinel node mapping +/- sampling for breast cancer

Intermediate

T9030

Intraoperative sentinel node mapping, using One Step Nucleic Acid Amplification (OSNA), for breast cancer

Intermediate

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7.2 - Mastectomy (excluding implant/reconstruction)

Code

Description

Hospital Complexity

Procedure Fees

Fee For General Anaesthesia

Unacceptable Combinations

Additional Information

B2710

Radical mastectomy including block dissection

Major

Show

B2742

Modified radical mastectomy including lymph node sampling

Major

Show

B2743

Modified radical mastectomy excluding lymph node sampling

Major

Show

B2760

Skin/Nipple sparing mastectomy (including axillary node biopsy)

Major

Show

B2744

Modified radical mastectomy including lymph node clearance

Major

Show

B2752

Subcutaneous mastectomy

Major

Show

B2780

Simple mastectomy (including axillary node biopsy) ? unilateral

Major

Show

B3042

Mastectomy and immediate reconstruction of breast using expandable prosthesis - bilateral

Extra Major

Show

B3043

Mastectomy and immediate reconstruction of breast using fixed prosthesis - bilateral

Extra Major

Show

7.3 - Reconstruction

Code

Description

Hospital Complexity

Procedure Fees

Fee For General Anaesthesia

Unacceptable Combinations

Additional Information

B2700

Subcutaneous mastectomy with immediate implant

Major

Show

B2818

Mastectomy and immediate reconstruction of breast using expandable prosthesis and acellular dermal matrix (ADM) - unilateral

Extra Major

Show

B2819

Mastectomy and immediate reconstruction of breast using expandable prosthesis and acellular dermal matrix (ADM) - bilateral

Extra Major

Show

B2912

Mastectomy and immediate reconstruction of breast using latissimus dorsi

Xmajor

Show

B2913

Reconstruction of breast using latissimus dorsi including implantation of prosthesis (including delayed reconstruction)

Xmajor

Show

B2914

Mastectomy followed by immediate Deep Inferior Epigastric Flap (DIEP) reconstruction - bilateral

Complex

Show

B2915

Reconstruction of breast using extended latissimus dorsi flap (including delayed reconstruction)

Complex

Show

B2916

Mastectomy and immediate reconstruction of breast using extended latissimus dorsi flap

Xmajor

Show

B2917

Reconstruction of breast using fixed prosthesis and acellular dermal matrix (ADM) (including delayed reconstruction)

Major

Show

B2918

Mastectomy and immediate reconstruction of breast using fixed prosthesis and acellular dermal matrix (ADM) - unilateral

Xmajor

Show

B2984

Reconstruction of breast using pedicled TRAM (including delayed reconstruction)

Complex

Show

B2985

Reconstruction of breast using free TRAM (including delayed reconstruction

Complex

Show

B2994

Reconstruction of breast using stacked flap (including delayed reconstruction) not elsewhere classified - unilateral (2 flaps)

Complex

Show

B2995

Reconstruction of breast using stacked flap (including delayed reconstruction) not elsewhere classified - bilateral (2 flaps per breast)

complex

Show

B2986

Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - unilateral (Single Flap)

Complex

Show

B2996

Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - bilateral (single flap per breast)

Complex

Show

B2989

Mastectomy followed by immediate Deep Inferior Epigastric Flap (DIEP) reconstruction - unilateral

Complex

Show

B2987

Reconstruction of breast using Transverse Upper Gracilis (TUG) flap (including delayed reconstruction and nipple reconstruction)

Complex

Show

B2988

Reconstruction of breast using ALT (anteriolateral thigh) flap including delayed reconstruction

Complex

Show

B2921

Lumpectomy and immediate partial reconstruction of breast using pedicled perforator flap (eg. Lateral Intercostal Artery Perforator (LICAP) or Thoraco-Dorsal Artery Perforator (TDAP))

Xmajor

Show

B2922

Partial reconstruction of breast using pedicled perforator flap (eg. Lateral Intercostal Artery Perforator (LICAP) or Thoraco-Dorsal Artery Perforator (TDAP) including delayed reconstruction)

Xmajor

Show

B2999

Reconstruction of breast using stacked deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - unilateral (2 flaps)

Complex

Show

B2991

Laparoscopic mobilisation of the greater omentum for reconstruction of breast (including delayed reconstruction)

Major

Show

B3012

Mastectomy and immediate reconstruction of breast using expandable prosthesis - unilateral

Xmajor

Show

B3013

Mastectomy and immediate reconstruction of breast using fixed prosthesis - unilateral

Xmajor

Show

B3014

Reconstruction of breast using expandable prosthesis (including delayed reconstruction)

Major

Show

B3015

Reconstruction of breast using fixed prosthesis (including delayed reconstruction)

Major

Show

B3016

Mastectomy and immediate reconstruction of breast using fat transfer

Xmajor

Show

B3020

Fat transfer, including extraction and transfer for volume adjustment following mastectomy and reconstruction (as sole procedure)

Major

Show

B3180

Implantation of prosthesis into breast as sole procedure

Intermediate

Show

B3580

Nipple areola complex reconstruction +/- liposuction and fat transfer

Major

Show

B3810

Reconstruction of breast using SGAP (superior gluteal artery perforator) flap including delayed reconstruction.

Complex

Show

B2981

LOCAL MOBILISATION OF GLANDULAR BREAST TISSUE TO FILL SURGICAL CAVITY

INT

Show

B3039

Removal And Reinsertion Of Existing Prosthesis Into The Breast (Including Capsulectomy) - Bilateral

Major

B3700

Removal of port or valve from permanent expandable breast prosthesis +/- image guidance

Minor

7.4 - Other

Code

Description

Hospital Complexity

Procedure Fees

Fee For General Anaesthesia

Unacceptable Combinations

Additional Information

B3310

Drainage of breast abscess including haematoma and seroma

Minor

Show

B3440

Microdochotomy

Intermediate

Show

B3592

Micropigmentation (tattooing) of nipple areola complex

Minor

Show

B3593

Microdochectomy or mammodochectomy (Hadfield’s procedure)

Intermediate

Show

B3594

Plastic procedures on nipple

Intermediate

Show

B3595

Excision of mammary fistula

Intermediate

Show

B3100

Reduction mammoplasty - unilateral

Major

Show

B3120

Augmentation Mammoplasty - Unilateral

Major

Show

B3130

Unilateral Mastopexy

Extra Major

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S2502	Local flap - 9cm2 or more (excluding graft/flap to secondary defect)

T8520	Block dissection of axillary lymph nodes (axillary clearance levels 1-3)

XR916*	Surgical removal of cuffed central venous catheter - tunnelled (X-ray guided)

S3530	Split autograft of skin, trunk and limbs ? over 25cm2 and up to 5% of body surface area

Q1800	Hysteroscopy (including biopsy, dilatation, curettage and resection of polyp(s) +/- Mirena coil insertion)

S0633	Excision of lesion of skin or subcutaneous tissue - up to three, Trunk & Limbs (excluding lipoma)

S5524	Burn excision (wound/scar) trunk & limbs (not more than 2% of body area)

GA300	Subcutaneous Mastectomy With Related Chest Reconstruction For Gender Affirmation - Unilateral

GA301	Subcutaneous Mastectomy With Related Chest Reconstruction For Gender Affirmation - Bilateral

GA302	Chest Reconstruction For Gender Affirmation (As Sole Procedure) - Unilateral

GA305	Augmentation Mammoplasty For Gender Affirmation +/- Implant, +/- Fat Transfer - Bilateral

GA304	Augmentation Mammoplasty For Gender Affirmation +/- Implant, +/- Fat Transfer - Unilateral

S1750	Large muscle flap (9cm2 or more) including skin graft and closure of secondary defect

T7602	Microvascular free tissue transfer (when added to other codes) (including closure of secondary defect)

S1740	Large myocutaneous (muscular/cutaneous) flap (9cm2 or more) (including closure of secondary defect)

S1750	Large muscle flap (9cm2 or more) (including skin graft and closure of secondary defect)

S1900	Distant pedicle flap - elevation including transfer (including closure/grafting to secondary defect)

S3532	Split autograft of skin, trunk and limbs - each additional 5% of body surface area

S3622	Full thickness graft, trunk and limbs - up to 9cm2 in area

S3623	Full thickness graft, trunk and limbs - each additional 25cm2 in area

T7603	Microvascular free tissue transfer (as sole procedure including closure of secondary defect)

S2000	Large island skin flap (9cm2 or more) (e.g. radial forearm) (including closure of secondary defect)

T7620	Free functioning muscle transfer (as sole procedure) (including closure of secondary defect)

W3180	Free composite (i.e. including bone) vascularised grafts

S2503	Local flap - 9cm2 or more (including graft/flap to secondary defect)

S1900	Distant pedicle flap ? elevation including transfer (including closure/grafting to secondary defect)

S2502	Local flap ? 9cm2 or more (excluding graft/flap to secondary defect)

S2503	Local flap ? 9cm2 or more (including graft/flap to secondary defect)

S3500	Split autograft of skin, trunk and limbs ? up to 25cm2 in area

S3622	Full thickness graft, trunk and limbs ? up to 9cm2 in area