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S.I. No. 84/1996 - Health Insurance Act (Risk Equalisation Scheme), 1996

S.I. No. 84/1996 - Health Insurance Act (Risk Equalisation Scheme), 1996 Skip to content Disclaimer Feedback Helpdesk Gaeilge Léim go dtí an t-ábhar Séanadh Aiseolas Deasc chabhrach English Gaeilge English Produced by the Office of the Attorney General Táirgthe ag Oifig an Ard-Aighne Home Legislation Acts of the Oireachtas Statutory Instruments Pre-1922 Legislation Constitution External Resources Bills (Houses of the Oireachtas) Iris Oifigiúil / Official Gazette Revised Acts (LRC) Classified List of Legislation (LRC) Translations (acts.

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  3. s)or rangeBliain nó blianta nó raon TypeCineál All Legislation Acts Statutory Instruments Advanced SearchCuardach Casta HomeBaile Statutory InstrumentsIonstraimí Reachtúla 1996 S.I. No. 84/1996 - Health Insurance Act (Risk Equalisation Scheme), 1996 S.I. No. 84/1996 - Health Insurance Act (Risk Equalisation Scheme), 1996 AmendmentsLeasuithe S.I. No. 84 of 1996. HEALTH INSURANCE ACT (RISK EQUALISATION SCHEME), 1996 The Minister for Health in exercise of the powers conferred on him by sections 3 and 12 of the Health Insurance Act, 1994 (No. 16 of 1994) hereby makes the following Scheme— PART I GENERAL 1. This Scheme may be cited as the Health Insurance Act, 1994 (Risk Equalisation) Scheme, 1996. 2. Articles 3 to 6, 9 and 10 of this Scheme shall come into operation on the 28th day of March 1996. Articles 7 and 8 shall come into operation on a day determined in accordance with article 10. 3. In this Scheme— "the Act" means the Health Insurance Act, 1994 ; "appropriate health services" means health services in relation to the diagnosis or treatment of the illness or injury of a patient which would be accepted generally by the medical profession as appropriate and necessary having regard to good standards of medical practice and to the nature and cost of any alternative forms of treatment as well as to all of the circumstances relevant to the patient; "cell" means a group of fully insured persons who belong to both a common gender and a common prescribed age band; "cell day-patient days" has the meaning assigned to it in Schedule D of this Scheme; "cell equalised benefits" has the meaning assigned to it in Schedule D of this Scheme; "cell weighted claim value" has the meaning assigned to it in Schedule D of this Scheme; "claim" means an application by, or on behalf of, a fully insured person to a registered undertaking for the discharge or reimbursement under the terms of a health insurance contract of all or part of the fees or charges due to a health services provider in respect of: (
  4. a)the provision of prescribed health services during a hospital stay: or (
  5. b)the provision of the prescribed health services listed in Table C.2 of Schedule C while that person was in receipt of out-patient services; "corrective payment" means a payment made to, or an amount recovered from, a health services provider or an insured person in respect of prescribed health services for which an incorrect payment, other than one arising from a systematic error in the method of processing claims, has been made; "covered persons" has the meaning assigned to it in Schedule D of this Scheme; "day-patient day" means a day, including a day upon which an in-patient stay commences and ceases, during the course of which a fully insured person is maintained in private hospital accommodation for the purpose of receiving day-patient services; "day-patient services" means health services provided in, or by persons attached to, a hospital where the patient is admitted on an elective basis for care and/or treatment which does not require the use of a hospital bed overnight and who is discharged as scheduled; "data adjustment" has the meaning assigned to it in article 6 of this Scheme; "dependent person" has the meaning assigned to it by section 1 of the Health (Nursing Homes) Act, 1990 ; "equalisation contribution" has the meaning assigned to it in Schedule D of this Scheme; "fully insured person" means an insured person named in a health insurance contract other than a contract which relates solely to one or both of the following— (
  6. a)ancillary health services; or (
  7. b)public hospital daily in-patient charges made under Regulations pursuant to Section 53 of the Health Act, 1970 ; "the fund" means the risk equalisation fund; "gross provider payment" means, in respect of a settled claim, a payment or payments, based on proper and correct accounts, due or nominally due from a registered undertaking to a health services provider or in respect of services rendered by that provider disregarding the effect of (
  8. a)any third party recoveries made in respect of that claim; (
  9. b)any corrective payments in respect of that claim; and (
  10. c)any discounts, overall limits or like reductions or bonuses or other additional compensation which may have been agreed between that provider and that undertaking; "health services provider" means a publicly-funded hospital, private hospital, registered nursing home or hospital consultant, as appropriate; "hospital consultant" means a registered medical practitioner who holds a current full registration with the Irish Medical Council and is engaged in hospital practice and who, by reason of his or her training, skill and experience in a designated speciality, is consulted by other registered medical practitioners and undertakes full clinical responsibility for patients in his or her care, or that aspect of care on which he or she has been consulted, without supervision in professional matters by any other person; "hospital stay" means an in-patient stay or a day-patient day; "in-patient day" means a day during an in-patient stay where the day on which that stay ceased is deemed a whole day and the day on which that stay commenced is disregarded except that if that stay commenced and ceased on the same day then that day shall be deemed a day-patient day; "in-patient services" means in-patient services within the meaning of the Health Act, 1970 , but excluding day-patient services; "in-patient stay" means a continuous period during which a fully insured person is maintained in private hospital accommodation for the purpose of receiving in-patient services, such period (
  11. a)to commence on the later of the occurrence of the following events— (
  12. i)the most recent admission or transfer of that person to private hospital accommodation; or (
  13. ii)the cessation of the most recent previous in-patient stay in respect of that person; and (
  14. b)to cease on the occurrence of the earlier of the following events- (
  15. i)the next subsequent discharge or transfer of that person from private hospital accommodation; (
  16. ii)the death of that person; or (iii) a designation of the cessation of that period by the registered undertaking which effected the health insurance contract under which that person is named provided that the effect of a designation under sub-paragraph (iii) shall not be to cause such a period to comprise less than five in-patient days or a day-patient day; "insured person" means a person named in a health insurance contract as an insured person or an infant born to a person named in a health insurance contract provided that in the case of an infant the person who effected the health insurance contract requests that the health insurance contract be altered to name such infant as an insured person, and pays the appropriate premium in respect of such infant, within 13 weeks of the date of birth of the infant; "market equalised benefits (total)" has the meaning assigned to it in Schedule D of this Scheme; "net provider payment" has the meaning assigned to it in article 5 of this Scheme; "nursing home" has the meaning assigned to it in section 2 of the Health (Nursing Homes) Act, 1990 ; "prescribed age band" means one of the following age groupings (
  17. a)age 17 and under (
  18. b)age 18 to age 29 (
  19. c)age 30 to age 39 (
  20. d)age 40 to age 49 (
  21. e)age 50 to age 59 (
  22. f)age 60 to age 69 (
  23. g)age 70 to age 79 (
  24. h)age 80 and over where age is attained age (in whole years) of the person; "prescribed equalised benefit" has the meaning assigned to it in article 5 of this Scheme; "prescribed health services" means- (
  25. a)in-patient services (
  26. b)day-patient services (
  27. c)out-patient services (
  28. d)health services provided by a hospital consultant whether in a hospital setting or otherwise which are appropriate health services and the sole purpose of which is the medical investigation, treatment, cure or alleviation of the symptoms, of illness or injury but excluding (
  29. i)treatment directly or indirectly arising from or required in connection with male and female birth control, infertility and any form of assisted reproduction; (
  30. ii)dental, orosurgical or orthodontic treatment or consultation with a dental practitioner, other than those services prescribed in Schedule C of this Scheme; (iii) cosmetic services or treatment except the correction of accidental disfigurement or significant congenital disfigurement; (
  31. iv)health services relating to eating disorders or weight reduction; (
  32. v)preventive health services such as check-ups or screenings; (
  33. vi)health services provided by a nursing home other than a registered nursing home; (vii) nursing care, whether provided in an institution or otherwise, to persons who are dependant persons other than such care provided in the course or consequence of the provision of in-patient, day-patient or out-patient services; (viii) health services received overseas; (
  34. ix)health services, provided other than (I) as a result of the patient having been referred to the health services provider by registered medical practitioner, or (II) in an emergency; or (III) in connection with an obstetric condition (
  35. x)health services necessitated directly or indirectly by war or civil disturbance; "private hospital" means a hospital, including a facility registered pursuant to the Mental Treatment Act, 1945 , other than a nursing home, which (
  36. a)provides prescribed health services, and (
  37. b)is not a publicly-funded hospital; "private hospital accommodation" means accommodation in a private hospital or accommodation in a publicly-funded hospital which is designated by the Minister for Health as private or semi-private accommodation; "private psychiatric hospital" means a facility registered pursuant to the Mental Treatment Act, 1945 ; "publicly-funded hospital" means a hospital, other than a nursing home, which provides services to a person pursuant to his or her entitlements under Chapter II of Part IV of the Health Act, 1970 ; "quarterly return" has the meaning assigned to it in article 6 of this Scheme; "registered nursing home" means a nursing home registered pursuant to the Health (Nursing Homes) Act, 1990 ; "registered medical practitioner" means a person whose name appears in the General Register of Medical Practitioners maintained under the Medical Practitioners Acts, 1978 and 1993; "risk equalisation fund" has the meaning assigned to it in article 8 of this Scheme; "scheme commencement day" has the meaning assigned to it in article 10 of this Scheme; "scheme undertakings" has the meaning assigned to it in article 10 of this Scheme; "screening" means a medical examination or test that is not reasonably required for the management of the medical condition of the patient; "settled accommodation claim" means a settled claim under which all or part of the payments relate to the discharge or reimbursement of fees or charges due to a private hospital or a publicly funded hospital in respect of a hospital stay except that a settled claim shall not be so designated if a previous settled accommodation claim relates to the same hospital stay; "settled claim" means a claim in respect of which payments due have been made; "settled hospital claim" means a settled accommodation claim or a settled out-patient claim; "settled out-patient claim" means a settled claim which is not a settled accommodation claim and under which all or part of the payments relate to out-patient services except that a settled claim shall not be so designated if a previous settled out-patient claim relates to out-patient services provided on the same day; "single room" means a hospital bedroom designed for and accommodating only one patient; "special procedure" means a procedure which is listed in Schedule B of this Scheme; "third party recovery" means a payment made to a registered undertaking as a result of the acceptance by a third party of full or partial liability for fees or charges arising from the provision of prescribed health services to an insured person; "undertaking equalised benefits" has the meaning assigned to it in Schedule D of this Scheme. 4. In this Scheme a reference to an article means a reference to an article of this Scheme and a reference to a subarticle means a reference to a subarticle in the article to which it is referred. PART II DETERMINATION OF BENEFITS TO BE EQUALISED 5.

(1)Each scheme undertaking shall calculate and record in respect of each settled claim the amount of prescribed equalised benefits in accordance with the provisions of this article and, where appropriate, the Schedules to this Scheme.
(2)In respect of each settled claim and for each health services provider the undertaking shall determine an amount (herein referred to as the "net provider payment") being the gross provider payment in respect of that claim and that provider multiplied by an amount determined in accordance with the formula where, for the quarter in which that claim was settled, A is the sum of- (
  1. i)the total of actual amounts which that undertaking has paid or is liable to pay, disregarding the effect of any corrective payments and third party recoveries, in respect of all settled claims which acquired that status during that quarter; and (
  2. ii)the net total of corrective payments relating to that undertaking during that quarter provided that this amount shall not exceed 0.5% of B and shall not be less than -0.5% of B reduced by the total of third party recoveries made by that undertaking during that quarter B is the sum of that undertaking's gross provider payments under all settled claims which acquired that status during that quarter.
(3)The prescribed equalised benefits in respect of each settled claim shall be the sum of net provider payments under that claim subject in each case to a maximum limit determined, as appropriate, in accordance with Schedule A (payments in respect of hospital charges (in-patient, day-patient and out-patient)), Schedule B (payments in respect of hospital charges relating to special procedures) or Schedule C (payments in respect of consultants' fees (in-patient, day-patient and out-patient)) as amended from time to time. PART III SPECIFICATION OF RETURNS 6.
(1)Each scheme undertaking shall make a return (to be known for the purposes of this Scheme as the "quarterly return") in accordance with sub section 4 of section 12 of the Act and shall submit a copy of the report of the auditor specified in subarticle
(4)in conjunction with the return.
(2)The first quarterly return to be made by a scheme undertaking shall be in respect of the quarter ending on 30th day of June, 1996 in the case of an undertaking which was registered on the date this Scheme comes into operation and shall be, in the case of an undertaking first registered after the date this scheme comes into operation, in respect of the quarter next following that first registration.
(3)The quarterly return shall be in the format set out in Schedule E and shall contain the details specified herein in respect of each cell and separately in respect of all cells combined— (
  1. a)the number of fully insured persons on the first day of that quarter; (
  2. b)the number of fully insured persons on the first day of the next following quarter; (
  3. c)the cell equalised benefits for that quarter; (
  4. d)the cell weighted claim value for that quarter; (
  5. e)the cell day-patient days for that quarter; (
  6. f)the total number of settled accommodation claims which acquired that status during that quarter in respect of covered persons and the number of those claims which relate to each of the following- (
  7. i)one in-patient day only (
  8. ii)two in-patient days only (iii) three in-patient days only (
  9. iv)four in-patient days only (
  10. v)five in-patient days only (
  11. vi)six in-patient days only (vii) seven in-patient days only (viii) eight in-patient days only (
  12. ix)nine in-patient days only (
  13. x)ten in-patient days only (
  14. xi)not less than eleven and not more than fifteen in-patient days (xii) not less than sixteen and not more than twenty in-patient days (xiii) not less than twenty-one and not more than thirty in-patient days (xiv) thirty-one or more in-patient days. (
  15. g)the total number of settled out-patient claims which acquired that status during the quarter in respect of covered persons.
(4)Each quarterly return for each scheme undertaking shall be confirmed by two officers of that undertaking who are authorised to sign its accounts under the Companies Acts 1963 to 1990, or otherwise, and shall be audited by a qualified auditor to be appointed by the undertaking.
(5)If a scheme undertaking detects or otherwise becomes aware of an error in a quarterly return which has been made under this Scheme, other than errors which have previously been taken into account as corrective payments in the calculation of a net provider payment under article 5
(2), it shall (
  1. a)immediately notify the Authority or the person engaged under sub section 5 of section 12 of the Act; and (
  2. b)within 15 days submit a corrected quarterly return to be known for the purposes of this Scheme as a data adjustment together with a report setting out the reason the error occurred and the steps which have been taken to prevent a recurrence. PART IV DETERMINATION OF PAYMENTS 7.
(1)"contribution" has the meaning assigned to it in subarticle
(6); "current quarter" has the meaning assigned to it in sub-article
(3); "first quarter" has the meaning assigned to it in subarticle
(2); "former equalisation contribution" has the meaning assigned to it in subarticle
(4); "prior quarter adjustment" has the meaning assigned to it in subarticle
(5); "revised equalisation contribution" has the meaning assigned to it in subarticle
(4).
(2)Calculations to determine payments under paragraphs (a) and (b) of subsection
(3)of section 12 of the Act shall be carried out by, or on behalf of the Authority, in respect of each quarter commencing with the quarter (referred to in this article as the "first quarter") next following the scheme commencement date.
(3)Not more than 30 days following receipt of a quarterly return as specified under article 6 of this Scheme for all scheme undertakings, the Authority shall determine, based on those returns, in respect of the corresponding quarter (referred to in this article as the "current quarter"), an equalisation contribution for each scheme undertaking in accordance with Schedule D.
(4)The Authority shall further, for each previous quarter in respect of which a new data adjustment has been submitted, determine for each scheme undertaking in accordance with Schedule D- (
  1. a)the equalisation contribution for that quarter, based on the quarterly returns or the most recent previous data adjustments received for that quarter, increased by the addition of interest at a rate of 15 percent per annum for the period between the last day of that quarter and the last day of the current quarter (referred to in this article as the "former equalisation contribution"); and (
  2. b)the equalisation contribution for that quarter, based on the information specified in paragraph (
  3. a)of this subarticle, but incorporating the newly submitted data adjustment, increased by the addition of interest at a rate of 15 percent per annum for the period between the last day of that quarter and the last day of the current quarter (referred to in this section as the "revised equalisation contribution") provided that no such determination shall be made for any quarter before the first quarter.
(5)The prior quarter adjustment for the current quarter for each scheme undertaking shall be the sum, for each quarter in respect of which a new determination has been made under subarticle
(4), of values determined in accordance with the formula A - B where A is the revised equalisation contribution B is the former equalisation contribution
(6)The contribution for the current quarter for each scheme undertaking shall be determined as the sum of— (
  1. a)a value determined in accordance with the formula 0.25 x 1.04 x C where C is the sum of its equalisation contributions for the current quarter and for the three quarters which immediately preceded the current quarter, provided that if an equalisation contribution has not been determined in respect of a quarter specified because that quarter precedes the first quarter then the equalisation contribution for that quarter shall be deemed to be zero; and (
  2. b)that undertaking's prior quarter adjustment.
(7)If the contribution for a scheme undertaking is greater than zero then that amount shall be the payment by that undertaking to the Authority under paragraph (a) of subsection
(3)of section 12 of the Act. The Authority shall notify that undertaking accordingly and shall specify in the notification the date on or before which the payment is to be made.
(8)Where a scheme undertaking fails to pay the amount due to the Authority in accordance with a notification under subarticle 7 that amount (or such part of that amount which from time to time remains unpaid) shall be increased by the addition of interest at a rate of 15 percent per annum computed from the day upon which that amount first became payable.
(9)If the contribution for a scheme undertaking is less than or equal to zero then the amount, if any, by which such contribution is less than zero shall be the payment to that undertaking from the Authority under paragraph (b) of subsection
(3)of section 12 of the Act. The Authority shall notify that undertaking accordingly.
(10)In the circumstances specified in subarticle 8 the Authority may revise the payment or payments determined under subarticle 9 and notify the scheme undertakings affected accordingly. PART V ESTABLISHMENT AND OPERATION OF RISK EQUALISATION FUND 8.
(1)The Authority shall cause to be established and maintained a fund which shall be known as the risk equalisation fund (referred to in this Scheme as "the fund").
(2)(
  1. a)The fund shall be a current bank account which shall be managed and controlled by the Authority. (
  2. b)Moneys payable into the fund shall be paid into the current account of the fund and moneys payable out of the fund shall be paid out of that account. Any interest accruing on moneys held in the account shall be paid out in direct proportion to current liabilities. (
  3. c)(
  4. i)Payments due to the Authority under paragraph (
  5. a)of subsection
(3)of section 12 of the Act shall be paid into the fund, (
  1. ii)Payments due from the Authority under paragraph (
  2. b)of subsection
(3)of section 12 of the Act shall be paid out of the fund.
(3)The accounts of the fund as audited by the Comptroller and Auditor General together with a copy of the report of the Comptroller and Auditor General thereon shall be furnished by the Authority to the Minister not later than 1 month following the completion of the said report. PART VI EXEMPTED UNDERTAKINGS 9. Each registered undertaking which effects health insurance contracts which relate solely to one or both of the following— (a) ancillary health services, or (b) the public hospital daily in-patient charges made under Regulations pursuant to Section 53 of the Health Act, 1970 shall be excluded from the application of articles 5 to 8 and 10 of this Scheme. PART VII COMMENCEMENT OF RISK EQUALISATION SCHEME 10.
(1)"scheme undertakings" means all registered undertakings excluding those restricted membership undertakings specified in paragraph (b) of sub section 2 of section 12 of the Act.
(2)Articles 7 and 8 shall come into operation with effect from the day (to be known for the purposes of this Scheme as "the scheme commencement day") notified by the Minister to all registered undertakings.
(3)The scheme commencement day shall be the last day of the period of six months next commencing after the last day of the first quarter in respect of which, if the scheme of risk equalisation had been in operation and calculations carried out in accordance with article 7 disregarding the proviso in paragraph (
  1. a)of subarticle 6 of that article, at least one of the following conditions would have been satisfied— (
  2. a)the sum of payments by scheme undertakings under subarticle 7 of article 7, would have exceeded 2% of market equalised benefits (total); or (
  3. b)(
  4. i)the amount payable to any one scheme undertaking under subarticle 9 of article 7 would have exceeded 2.5% of its undertaking equalised benefits or £125,000 if greater, and (
  5. ii)the undertaking equalised benefits for that undertaking would have exceeded 5 % of market equalised benefits (total). Schedule A — Hospital Charges (In-patient, Day-patient and Out-patient Services) 1. The maximum prescribed equalised payments in this Schedule relate to prescribed health services (other than those special procedures listed in Table B.1 of Schedule B of these Regulations) provided by a private hospital, and prescribed health services (other than out-patient services) provided by a publicly funded hospital, to a fully insured person. Maximum prescribed equalised payments shall be determined as follows— In respect of: Maximum Prescribed Equalised Payment 1. Prescribed health services which are in-patient services provided by a publicly funded hospital while the insured person was maintained in accommodation other than private hospital accommodation. The public hospital daily in-patient charges made under regulations pursuant to Section 53 of the Health Act 1970 . 2. Prescribed health services which are in-patient services provided by a public hospital while the insured person was maintained in private hospital accommodation. The amount of the charge payable under Section 55 of the Health Act 1970 plus the amount of the public hospital daily inpatient charges made under regulations pursuant to Section 53 of the Health Act 1970 . 3. Prescribed health services (other than special procedures listed in Table B.1 of Schedule B) which are in-patient services provided by a private hospital other than a private psychiatric hospital. The lesser for each in-patient day of:(
  6. a)£250 for each in-patient day, or(
  7. b)100% of(
  8. i)the charge made by the private hospital; less(
  9. ii)£20 for each day during which the insured person was accommodated in a single room. 4. Prescribed health services which are day-patient services provided by a publicly-funded hospital while the insured person was maintained in private hospital accommodation. The amount of the charge payable under Section 55 of the Health Act, 1970 . 5. Prescribed health services which are day-patient services provided by a private hospital other than a private psychiatric hospital. £250 for each day-patient day. 6. Prescribed health services which are in-patient services provided by a private psychiatric hospital. £100 for each in-patient day. 7. Prescribed health services which are out-patient services listed in Table C.2 of Schedule C provided by a private hospital other than a private psychiatric hospital. £100 for each claim. 2. The amount determined under paragraph 1 in respect of hospital charges relating to childbirth by means of a normal vaginal delivery shall not exceed £300. Schedule B — Special Procedures 1. The maximum prescribed equalised payments in this Schedule relate to prescribed health services which are the special procedures listed herein and which are provided by a private hospital to a fully insured person while that person is maintained in private hospital accommodation for in-patient services or day-patient services. 2. The maximum prescribed equalised payment shall be 90% of the procedure benefit derived from Table B.1 of this Schedule. TABLE B.1 Procedure Code Procedure Description Procedure Benefit (£) 5801 Exploration of mediastinum 940 5802 Endoscopic extirpation of lesion of mediastinum 940 5803 Diagnostic endoscopic examination of mediastinum 940 6675 Angiogram (direct puncture, single vessel study, brachial, femoral) 1,238 5945 Cardiac catheterisation with digital subtraction angiography 1,270 5080 Cardiac catheterisation (left, right or both sides) 1,306 5085 Cardiac angiography (left, right or both sides) 1,306 5090 Cardiac catheterisation and cardiac angiography combined 1,306 2676 Vitroctomy 2,354 5520 Valve shunt (hydrocephalus) - (Brain and Meninges) 2,756 5730 Cervical disc, partial excision of or fusion 2,866 5862 Cardiac Pacemaker System introduced through vein (Single Chamber) 3,032 5067 Cardiac Pacemaker System introduced through vein (Dual Chamber) 3,032 5068 Insertion of antitachycardia pacemaker 3,032 5069 Insertion of automatic implantation cardioverter/defibrillator 3,032 5525 Valve shunt revision - (Brain & Meninges) 3,032 5660 Craniotomy 3,721 3595 Spinal fusion - anterior & posterior 4,410 3596 Spinal fusion, in scoliosis spine, anterior and posterior 4,410 3601 Spinal fusion with instrumentation 4,410 5101 Angioplasty (Coronary) 4,410 5962 Plastic repair of aorta (Coarctation/Interrupted Aortic Arch) 5,181 5957 Revision repair of coarctation of aorta 5,181 5893 Open Operations on pulmonary artery 5,209 5735 Cervical spondylosis, laminectomy, etc. 5,435 5480 Posterior fossa tumours, removal of 5,512 5470 Pituitary gland, hypophysectomy 5,677 5075 Blalock Operation 5,788 5870 Myocardial aneurysmyotomy 5,788 5811 Atrial inversion for transposition of great vessels 5,788 5812 Other correction of transposition of great vessels 5,788 5814 Closure of defect of atrioventricular septum using dual prosthetic patch 5,788 5817 Closure of defect of interventricular septum 5,788 5818 Planned repair of post infraction ventricular septal defect 5,788 5819 Emergency repair of post infraction ventricular septal defect 5,788 5958 Revision closure of defect of intra-ventricular septum 5,788 5813 Correction of total anomalous pulmonary venous connection 5,788 5872 Excision of pericardium 5,788 5809 Correction of tetralogy of fallot 5,788 5871 Open correction of patent ductus arteriosus 5,788 5882 Closed correction of patent ductus arteriosus 5,788 5875 Shoulder replacement prosthesis 6,107 5555 Acoustic neuroma, removal of 6,173 1246 Arterial bypass, popliteal artery 6,284 5865 Repair of ascending aortic aneurysm 6,284 3300 Arthroplasty - (Forearm & Elbow) 7,186 5942 Lobectomy of Lung (including excision of segment) 7,717 5831 Plastic repair of mitral valve 8,268 5833 Replacement of tricuspid valve (includes valvuloplasty) 8,268 5855 Annuloplasty 8,268 5839 Double valves 8,268 5842 Triple valves 8,268 5843 Valve and grafts 8,268 5959 Revision of valve surgery 8,268 5816 Closure of defect of interatrial septum 8,599 5821 Other open operations on the septum of the heart 8,599 5824 Refashioning of atrium (Ebstein'
  10. s)8,599 5826 Operations on wall of atrium 8,599 5832 Replacement of aortic valve (includes valvuloplasty) 9,922 5836 Open Valvotomy 9,922 5055 Aortic endarterectomy 9,922 5829 Replacement of mitral valve (includes valvuloplasty) 9,922 5844 Saphenous vein graft bypass for coronary artery(ies) 9,922 5846 Autograft bypass for coronary artery(ies) 9,922 5847 Allograft bypass for coronary artery(ies) 9,922 5848 Prosthetic bypass for coronary artery(ies) 9,922 5849 Connection of mammary artery(ies) to coronary artery(ies) 9,922 5851 Connection of other thoracic artery(ies) to coronary artery(ies) 9,922 5852 Correction of anomalous coronary arteries 9,922 5853 Other open operation(
  11. s)on coronary artery(ies) 9,922 5904 Revision of prosthesis of aorta 9,922 5956 Revision coronary artery surgery 9,922 5099 Coronary artery bypass grafts and angiogram 10,970 4283 Allogeneic bone marrow transplantation, (complete procedure) 27,560 4284 Autologous bone marrow transplantation (complete procedure) 27,560 Schedule C Consultants' Fees (In-Patient, Day-Patient and Out-Patient Services) 1. Definitions "consultant anaesthetist" means a hospital consultant whose designated speciality is anaesthesia; "consultant pathologist" means a hospital consultant whose designated speciality is pathology; "consultant radiologist" means a hospital consultant whose designated speciality is radiology; "in-patient attendance" means a period during which a hospital consultant is responsible for the care of an insured person; "pathological procedure" means a service, treatment or procedure listed in Table C.4 of this Schedule; "radiological procedure" means a service, treatment or procedure listed in Table C.3 of this Schedule and therapeutic/invasive procedures listed in Table C.2 of this Schedule; "surgical procedure" means a service, treatment or procedure listed in Table C.2 of the Schedule. 2. The maximum prescribed equalised payments in this Schedule relate to prescribed health services which are provided by a hospital consultant to a fully insured person while that person is in receipt of in-patient services, day-patient services or out-patient services. 3. The maximum prescribed equalised payment in respect of the participation by a consultant anaesthetist in a surgical or radiological procedure shall be 90% of the anaesthetic procedure benefit as set out in Table C.2 and C.3 respectively of this Schedule. 4. The maximum prescribed equalised payment in respect of in-patient attendance by a hospital consultant shall be 90% of the in-patient attendance benefit determined in accordance with Table C.1 of this Schedule. 5. The maximum prescribed equalised payment in respect of an in-patient consultation is £63 and arises when the admitting hospital consultant responsible for the care of an insured person refers that person to another hospital consultant for an opinion. 6. The maximum prescribed equalised payment in respect of a surgical procedure performed by a hospital consultant, other than a consultant anaesthetist, shall be 90% of the surgical procedure benefit as set out in Table C.2 of this Schedule. 7. The maximum prescribed equalised payment in respect of a radiological procedure performed by a consultant radiologist shall be 90% of the radiological procedure benefit as set out in Table C.3 of this Schedule or 90% of the surgical procedure benefit set out in Table C.2 of this Schedule as appropriate. 8. The maximum prescribed equalised payment in respect of a pathological procedure performed by a consultant pathologist shall be 90% of the procedure benefit as set out in Table C.4 of this Schedule. Table C.1 Period of Attendance In Patient Attendance Benefit 1 day £ 73 2 days £ 83 3 days £ 94 4 days £100 5 days £107 6 days £107 7 days £122 8 days £122 9 days £135 10 days £135 11 days £148 12 days £158 13 days £168 14 days £179 15 days £189 Periods in excess of 15 days £10 for each day in excess of 15 days plus £189 TABLE C.2 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic GENERAL SURGICAL OPERATIONS ABDOMINAL WALL and PERITONEUM: 5 Abdominal wall, secondary suture of 148 123 15 Laparotomy, division of adhesions 260 133 20 Intra abdominal injury with rupture of viscus 441 256 25 Intra abdominal injury, multiple complicated with rupture of viscus 540 307 30 Laparotomy 196 123 35 Laparoscopy with or without biopsy 148 102 45 Omentopexy (otherwise) 196 154 50 Paracentesis abdominis 49 0 60 Pelvic abscess, drainage of 140 77 61 Percutaneous transabdominal biopsy 89 72 80 Peritoneum, drainage of 196 123 90 Laparotomy, intra-abdominal sepsis 392 184 5835 Peritoneal - venous shunt for ascites 392 184 ADRENAL GLANDS: 95 Adrenalectomy (unilateral) 450 205 100 Adrenalectomy (bilateral) 600 205 101 Adrenalectomy for phaeochromocytoma 600 512 105 Adrenal glands-any other operations 392 205 106 Neuroblastoma, tru cut biopsy 89 72 107 Neuroblastoma, resection 624 307 APPENDIX: 110 Appendicectomy (with or without complications) 196 123 GALL BLADDER and BILE DUCTS: 115 Cholecystojejunostomy 485 205 116 Choledochojejunostomy (Roux - en - Y) 593 205 117 Choledochoduodenostomy 431 205 118 Surgical repair of post-operative bilary stricture 1040 350 129 Hepaticojejunostomy 676 205 132 Cholecystectomy with exploration of common bile duct 540 205 135 Cholecystectomy (including laparoscopic method) and per operative cholangiogram 392 205 136 Percutaneous removal of gallstones from the bile ducts 245 123 140 Cholecystostomy with exploration, drainage or removal of calculus 295 143 145 Hepaticoduodenostomy 490 205 150 Transduodenal sphincteroplasty with or without transduodenal extraction of calculus 539 205 151 Transhepatic insertion of biliary endoprosthesis 294 154 152 Percutaneous insertion of gall bladder catheter for MTBE installation including catheter removal 245 143 153 Insertion of naso biliary tube and administration of CDC/URSO 245 102 GASTRIC OPERATIONS: 155 Antrectomy and drainage 490 184 165 Duodenal diverticula, excision of 441 184 175 Gastrectomy total or revision 638 256 180 Gastrectomy (sub total) 490 205 190 Gastroenterostomy 392 184 195 Gastroscopy or gastroduodenoscopy (fibroscope) 68 41 196 Upper G.I. endoscopy and biopsies 68 41 197 Upper G.I. endoscopy and polypectomy 68 41 200 Gastrostomy 294 123 201 Percutaneous gastrostomy 148 102 205 Gastrotomy/duodenotomy for haemorrhage 456 154 215 Oversewing perforated peptic ulcer 319 154 230 Rammstedt's operation 294 164 235 Stomach transection 490 256 240 Vagotomy and drainage or highly selective vagotomy 490 184 HERNIA: 245 Epigastric/Ventral hernia, repair of 196 113 246 Exomphalos, minor 312 123 247 Exomphalos, major 614 358 248 Exomphalos, delayed 614 358 250 Femoral hernia, repair of (bilateral) 368 164 255 Femoral hernia, repair of (unilateral) 245 113 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 270 Hiatus hernia, abdominal repair of 441 184 271 Laparoscopic repair of hiatus hernia 441 225 275 Hiatus hernia, transthoracic, repair of 441 225 280 Incisional hernia, repair of 392 123 285 Inguinal hernia, repair of (bilateral) 294 174 290 Inguinal hernia, repair of (unilateral) 196 123 291 Strangulated inguinal hernia, unilateral 275 123 295 Patent urachus, closure and repair of abdominal muscles 294 113 305 Recurrent hernia, repair of 294 143 310 Umbilical hernia, repair of 196 113 JEJUNUM and ILEUM: 320 Congenital defects, correction of (including Meckel's diverticulum) 228 123 331 Gastroschisis 728 358 355 Ileostomy 392 123 360 Intestinal obstruction (including bowel resection) 491 154 361 Intestinal atresia, single/multiple 491 236 364 Hydrostatic reduction of intussusception 196 123 370 Jejunostomy 196 123 385 Resection and anastomosis of jejunum or ileum 491 184 LARGE INTESTINE: 389 Anal canal EUA 45 72 390 Anal canal, plastic repair of (for incontinence) 294 143 395 Anal fissure, dilatation of anus for 49 72 396 Anoplasty for low anorectal anomaly 294 143 397 Anorectal anomaly, (posterior sagittal anorectoplasty PSARP), for high/inter 581 358 400 Lateral internal sphincterotomy 196 72 404 Parks' anal sphincter repair 581 358 405 Anal warts or papillae, removal of 74 72 410 Anus, excision of epithelioma of, with colostomy 392 205 415 Anus, excision of epithelioma of, without colostomy 74 82 420 Caecostomy 392 123 425 Caecostomy or colostomy, closure of 392 123 430 Colectomy, partial 491 184 435 Colectomy, total 664 307 436 Total colectomy and ileal pouch construction with temporary ileostomy 834 358 437 Closure of ileostomy 392 123 438 Total colectomy for toxic megacolon 785 358 450 Colonoscopy, one side 68 41 455 Colonoscopy, both sides 179 41 456 Colonoscopy plus polypectomy 89 41 457 Colonoscopy plus polypectomy full colon 179 41 458 Left colonoscopy and laser photocoagulation of rectum 148 41 459 Colonoscopy, full colon and laser photocoagulation of rectum 294 41 460 Colostomy 392 123 465 Resection of bowel and colostomy or anastomosis for diverticulitis 581 256 470 Faecal fistula, closure or resection 581 256 485 Fistula in ano, excision 245 123 490 Haemorrhoidectomy (external) 122 82 495 Haemorrhoidectomy (external, multiple) 148 92 500 Haemorrhoidectomy (internal) 215 123 506 Haemorrhoids, injection and/or banding 49 0 515 Imperforate anus, simple incision 49 82 520 Imperforate anus, with colostomy or pull through operation 392 225 525 Ischio rectal abscess, incision and drainage 148 92 513 Meconium ileus, open reduction with or without stoma 491 205 514 Meconium ileus reduction 148 154 516 Necrotising enterocolitis, percutaneous drainage 104 72 517 Necrotising enterocolitis, laparotomy resection/stoma 491 205 530 Proctoscopy or sigmoidoscopy 45 41 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 535 Proctoscopy or sigmoidoscopy, with biopsy 45 41 536 Diagnostic flexible sigmoidoscopy and biopsies 45 41 540 Proctoscopy or sigmoidoscopy with biopsy of muscle coats of bowel, for megacolon 68 72 545 Prolapse of rectum, abdominal approach involving laparotomy, colostomy or intestinal anastomosis 639 225 549 Delorme procedure 392 225 550 Prolapse of rectum, perineal repair 245 128 555 Rectal fistula, closure or repair 490 205 556 Balloon dilation of the rectum 99 72 560 Rectal or sigmoid polypi (removal by diathermy, etc) 148 82 565 Rectum, excision of (all forms including perineoabdominal, perineal anterior resection) 686 358 570 Rectum, partial excision of 686 307 574 Presacral teratoma, excision 735 358 575 Rectum (combined synchronous resection) 735 358 576 Revision/refashioning of ileostomy and duodenostomy, complicated reconstruction in - depth 431 123 577 Low anterior resection with coloanal anastomosis for cancer 834 358 578 Soave procedure 834 358 580 Sigmoid myotomy (Reilly's operation) 220 123 581 Sigmoidoscopy including dilatation of intestinal strictures 122 72 585 Stricture of rectum (dilation
  12. of)49 72 590 Volvulus (stomach, small bowel or colon, including resection and anastomosis) 490 236 LIVER: 595 Hepatotomy for drainage of abscess or cyst, one or two stages 314 184 600 Biopsy of liver (by laparotomy) 179 123 601 Transjugular liver biopsy 179 102 605 Biopsy of liver (needle) 89 77 610 Haemangioma of liver 196 225 611 Major liver resection 1196 512 612 Kasai type liver resection 624 307 616 Wedge resection of liver 323 307 617 Intrahepatic cholangioenteric anastomosis 780 307 618 Resection of hilar bile duct tumour 1196 512 619 Liver trauma 700 410 622 Insertion of hepatic artery catheter and reservoir pump 312 72 625 Left lateral lobectomy 834 358 630 Excision of hydatid cyst 431 307 MALE GENITAL TRACT: 635 Circumcision (over 6 years) 99 82 640 Circumcision (under 6 years) 99 82 645 Epididymectomy 196 113 650 Hydrocele (tapping) 49 67 655 Hydrocele, radical operation, bilateral 294 123 660 Hydrocele, radical operation, unilateral 196 102 665 Meatotomy 74 72 670 Orchidectomy, bilateral 196 102 675 Orchidectomy, unilateral 148 102 680 Orchidectomy with radical removal of lymph nodes 490 225 681 Injection of corpora cavernosa with pharmacologic agent(
  13. s)(e.g. papaverine, phentolamine) 49 72 685 Penis, amputation of partial 245 123 686 Chordee release of 196 123 690 Penis, amputation of-with block dissection of glands 490 225 691 Transcatheter embolosation for relief of priapism 294 123 695 Prepuce, dorsal incision of 74 72 700 Prostatectomy 392 164 701 Radical retropubic nerve sparing prostatectomy (includes bilateral pelvic lymph adenectomy with bladder neck reconstruction and anastomosis to the urethra). 589 333 702 Transurethral microwave thermotherapy to the prostate (TUMT) 294 154 703 Insertion of an endo urethral stent for prostate obstruction 294 123 705 Spermatocele or spermatic cyst, (simple) excision of 196 113 706 Spermatocele or spermatic cyst, (multiloculate) excision of 196 113 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 710 Testes, agenesis of-bilateral exploration of inguinal canals and pelvis 343 184 711 Electro ejaculation procedure 99 72 715 Testicle, imperfectly descended, orchidopexy 148 102 720 Testicle, imperfectly descended bilateral orchidopexy 196 154 725 Testicle, imperfectly descended, associated with inguinal hernia 196 123 730 Testes, imperfectly descended, associated with bilateral inguinal hernia 294 184 735 Testes, unilateral orchidopexy and exploration of opposite side 294 143 740 Testicular biopsy (needle) 68 72 741 Testicular biopsy 134 77 742 Insertion of testicular prosthesis, unilateral 196 87 745 Reduction of torsion of testicle 99 82 749 Transcatheter management of varicocele, including testicular venography 245 123 750 Varicocele, bilateral removal 343 154 755 Varicocele, unilateral removal 245 123 760 Vasotomy or ligation of vas 99 72 765 Vas, reconstruction of (unilateral) 319 184 770 Vas, reconstruction of (bilateral) 441 225 PANCREAS: 771 ERCP sphincterotomy and extraction of stones 269 123 772 ERCP sphincterotomy and insertion of endoprosthesis 294 102 774 ERCP (endoscopic retrograde cholangiogram of pancreas) 224 123 775 Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (Whipple-type procedure); with pancreatojejunostomy 915 512 776 Pancreatic biopsy 268 154 778 Pancreaticojejunostomy 639 307 780 Distal pancreatectomy 646 256 785 Total pancreatectomy, distal gastrectomy, splenectomy, duodenectomy, cholecystectomy and resection of distal bile duct 915 512 786 Simultaneous pancreas/kidney transplant 1008 563 790 Drainage of pancreatic abscess or pseudocyst 520 307 795 Pancreatotomy for drainage of pancreatitis, abscess or cyst with exploration of biliary and pancreatic duct 589 358 SPLEEN: 800 Splenectomy 392 184 806 Transcatheter ablation of function of spleen 294 128 807 Aspiration of splenic cysts 148 77 URINARY TRACT: 815 Aberrant vessels, division of 490 246 822 Permacath Hickman catheter for dialysis 245 123 823 Home based haemodialysis self dialysis training (max. 18 sessions) 29 0 824 Haemodialysis, chronic, in patient's home or at hospital out patient department, after completion of training sessions (minimum of three dialysis sessions per week inclusive of all consultant care) monthly benefit 184 0 825 Artificial kidney, use of (pre shunt) (haemodialysis, surgical fee) 122 0 826 Chronic haemodialysis (post shunt) 1st 12th treatment 49 0 827 Chronic haemodialysis (post shunt) 13th treatment onwards 49 0 828 Acute intermittent haemodialysis 1st 12th treatment 74 0 829 Acute intermittent haemodialysis 13th treatment onwards 74 0 830 Artificial kidney, use of (peritoneal dialysis) 122 0 831 Chronic peritoneal dialysis, hospital based establishment of therapy (1st 12th day) 49 0 832 Chronic peritoneal dialysis (hospital based after 12th day) 49 0 833 Peritoneal dialysis, chronic, in the patient's home or at hospital out patient department, after completion of training sessions (minimum of three dialysis sessions per week inclusive of all consultant care) monthly benefit 206 0 834 Tenchkoff catheter for CAPD dialysis 196 123 835 Bladder, implantation of radioactive source 245 92 836 Bladder, instillation of anticarcincgenic agent (BCG) 74 72 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 837 Continuous veno venous haemofiltration dialysis (CVVHD), per day 74 0 840 Bladder- rupture of (simple) 294 154 845 Bladder- rupture of (complicated traumatic) 392 256 850 Bladder neck, transurethral resection of 196 102 855 Bladder tumour, diathermy to, primary resection 294 102 860 Bladder tumour, repeat diathermy 99 77 865 Cystectomy, partial 343 154 870 Cystectomy, with re-implantation of ureters 490 307 875 Cystectomy with ileal or sigmoid loop and bowel anastomosis 662 358 876 Cystectomy with ileal or sigmoid loop and bowel anastomosis including continent catheterizable diversion 735 358 877 Cystectomy with ileal or sigmoid loop and bowel anastomosis including neo bladder with urethral re anastomosis 834 358 880 Cystoscopy with or without biopsy 68 72 881 Cystoscopy and removal of JJ stent 148 72 885 Cystoscopy with intravesical operation (diathermy, etc.) 122 77 886 Therapeutic overdistension of the bladder 74 72 890 Cystoscopy with ureteric catheterisation including retrograde pyelography 89 82 895 Cystoscopy with removal of ureteric calculus 196 82 900 Cystoscopy with ureteric dilatation or meatotomy 148 82 905 Cystotomy 196 92 906 Augmentation cystoplasty (ileo caeco cystoplasty, colocystoplasty) 490 358 910 Diverticulum of bladder, excision or obliteration of 392 154 915 Embolisation of haemangioma of kidney 343 184 920 Hemi nephrectomy 343 205 923 Kidney transplant 686 410 924 Litholapaxy: Crushing or fragmentation of calculus by any means, in the bladder, including ultrasonic destruction 294 123 925 Nephrectomy 441 205 926 Nephrectomy and caval extension below liver 540 225 927 Nephrectomy and caval extension of tumour above liver 712 358 928 Nephrectomy with caval invasion 809 410 930 Nephrolithotomy 490 184 931 Percutaneous nephrolithotomy, unilateral 294 205 932 Percutaneous nephrolithotomy, bilateral 441 205 933 Percutaneous nephrolithotomy, staghom 441 225 934 Percutaneous nephrostomy with or without antegrade pyelogram or stent placement 343 123 935 Peri renal tissues, exploration, open biopsy (no abnormality discovered) 294 154 936 Percutaneous tract formation for renal stone removal 196 102 940 Pyelolithotomy 490 184 945 Pyeloplasty 540 184 950 Pyelotomy 294 154 955 Renal biopsy (needle) 89 72 956 Renal cyst puncture and aspiration 148 77 960 Suprapubic cystostomy 148 72 965 Suprapubic fistula, closure of 294 154 966 Transcatheter ablation of function of kidney 294 154 967 Transcatheter ablation of function of adrenal 294 154 970 Ureteric fistula, closure of (including uretero-vaginal and vesico-vaginal) 392 184 975 Ureterolithotomy 294 143 980 Ureterolithotomy (bilateral) 441 134 981 Ureterolysis (unilateral) 392 143 982 Ureterolysis (bilateral) 589 184 984 STING procedure 294 82 985 Ureters, transplantation of, (bilateral) 589 184 990 Ureter, transplantation of, (unilateral) 441 164 991 Stamey Raz urethropexy 294 123 995 Ureterostomy (unilateral) 294 143 1000 Ureterostomy (bilateral) 441 184 1005 Urethral rupture of (straddle injury), repair of 294 133 1010 Urethra rupture, repair of with fractured pelvis (orthopaedic surgeon) 490 256 1015 Urethral dilatation 49 72 1020 Urethroscopy with treatment (diathermy) 99 72 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 1025 Urethrostomy 196 92 1030 Urethrotomy 99 72 1031 Complex urodynamic evaluation involving cineradiology 89 72 1032 Implantation of artificial urinary sphincter 490 225 1033 Whittaker test for evaluation of upper urinary tract obstruction 179 0 1035 Vesicolic fistula, closure of 392 184 5845 Ileal conduit urinary diversion 589 307 5850 Cystoscopy and ureteroscopy 179 92 5910 Lithotripsy, one or more sessions per hospital stay 294 92 5911 Lithotripsy including placement and removal of J stent and/or push ureteroscopy one or more sessions per hospital stay 343 123 HEAD AND NECK ARTERIES: (See also Neurological Section) 1041 Carotid body tumour greater than 4 cms 735 358 1042 Carotid body tumour less than 4 cms 540 358 CHEEK: 1045 Cyst or benign tumour of cheek or mouth, excision of 74 82 1050 Malignant growth of cheek, full thickness/wide excision of 392 154 1051 Malignant growth of cheek, superficial, excision of 172 123 JAWS: See E.N.T. and Plastic Sections. LIPS: (see also Plastic Section) 1055 Cyst or benign tumour on lip, excision of 74 72 1058 Epithelioma of lip, lip shave 99 72 1059 Epithelioma of lip, wedge excision 196 77 1060 Epithelioma of lip, excision and flap reconstruction 392 184 NECK: 1065 Branchial cyst, pouch or fistula, excision of 392 184 1075 Cysts or tuberculous glands of neck (deep to deep fascia) excision of 294 123 1080 Conservative neck dissection 392 225 1082 Radical neck dissection 468 256 1085 Thyroglossal cyst or fistula, excision of 392 184 1090 Torticollis, partial excision, open correction of 245 113 1095 Tuberculous caseous glands or sinuses, curettage of 104 77 PALATE: (See also Plastic Section) 1100 Laceration of palate, repair of 99 92 1105 Radical operation for malignant growth of palate 490 256 1104 Biopsy lesion of palate 47 72 MAXILLA: 1106 Partial maxillectomy including plastic reconstruction 520 256 1107 Total maxillectomy including plastic reconstruction 624 307 PARATHYROID GLANDS: 1110 Parathyroid adenoma, excision of 500 256 1111 Transcatheter ablation of function of parathyroid glands 294 154 1112 Parathyroid hyperplasia, excision of (4 glands-frozen section) 550 256 1113 Total parathyroidectomy with autotransplant or mediastinal exploration/intra-thoracic 650 256 1114 Parathyroid re-exploration 650 256 SALIVARY GLANDS: 1115 Abscess of salivary gland, incision and drainage 74 82 1120 Fistula of salivary duct, repair of 343 184 1125 Parotid or submandibular duct, dilatation of 49 82 1126 Submandibular duct, relocation 490 225 1130 Excision of parotid tumour or parotid gland, lateral lobe, (enucleation
  14. of)302 154 1133 Excision of parotid tumour or parotid gland, lateral lobe (superficial parotidectomy) with dissection and preservation of facial nerve 551 276 1134 Excision of parotid tumour or parotid gland, total, en bloc removal with sacrifice of facial nerve 416 184 1135 Excision of parotid tumour or parotid gland, total with dissection and preservation of facial nerve 624 282 1140 Salivary calculus, removal of 99 92 1150 Submandibular salivary gland, excision of 229 92 1151 Excision of sublingual gland 148 92 THYROID GLAND: 1152 Thyroid cyst(
  15. s)aspiration/fine needle biopsy 40 0 1154 Excision of thyroid cyst 345 184 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 1156 Percutaneous core needle biopsy of thyroid gland (for fine needle biopsy use procedure code 1152) 68 72 1155 Total/revision thyroidectomy 500 205 1157 Partial/subtotal thyroidectomy 471 205 TONGUE: 1165 Excision of epithelioma of tongue with radical operation on glands 490 225 1170 Frenectomy (tongue tie) 49 72 1175 Hemiglossectomy 312 154 1176 Total glossectomy 624 236 1180 Growths of tongue, diathermy to 49 72 1185 Excision biopsy, oral cavity 74 72 1186 Resection of tonsil, tongue base, palate, mandible and radical neck dissection 936 461 BREAST: 1190 Abscess, incision and drainage of 74 72 1191 Breast cyst(
  16. s)aspiration/fine needle biopsy (diagnostic or therapeutic) 40 0 1195 Percutaneous core needle biopsy of breast (for fine needle biopsy use procedure code 1191) 68 92 1200 Cysts or benign tumours, excision of, or segmental resection 142 92 1205 Duct papilloma, excision 148 92 1210 Gynaecomastia (excision for), unilateral 184 102 1211 Gynaecomastia (excision for), bilateral 343 154 1214 Segmental mastectomy with axillary sampling 294 154 1215 Total mastectomy 294 154 1216 Mastectomy with axillary clearance 468 154 1217 Quadrant mastectomy with axillary clearance 468 154 1218 Mammographic wire guided breast biopsy 160 72 LYMPHATICS: 1310 Axillary/inguinal lymph node(
  17. s)superficial dissection of 100 92 1315 Axillary lymph nodes complete dissection of 343 123 1320 Axillary or inguinal lymph nodes, incision of abscess 100 72 1326 Deep cervical node excision biopsy (not needle biopsy) 100 72 1335 Inguinal or pelvic lymph node block dissection, unilateral 368 164 1336 Inguinal or pelvic lymph node block dissection, bilateral 550 256 1355 Lymphatic infusion 245 0 1365 Primary or secondary retroperitoneal, lymphadenectomy complete, transabdominal 589 307 MUSCLES: 1370 Haemangioma of muscle, excision and repair of 294 123 1375 Muscle, manipulation and stretching of 49 0 1380 Muscle, repair and suture of 196 92 1385 Muscle biopsy 68 72 NERVES: (See also E.N.T. and Plastic Sections) 1390 Nerve biopsy 134 72 1395 Nerve repairs (primary) 392 133 1400 Nerve suture (secondary, including grafting and anastomosis) 441 184 1405 Neurectomy or local excision of neuroma 294 92 TENDONS: (See also Orthopaedic and Plastic Sections) 1410 Tendon repairs (primary) single 196 123 1415 Tendon repairs (primary) multiple 392 184 1420 Tendon sheath, incision of 99 77 1425 Tenotomy 99 72 1426 Tenolysis 196 92 VASCULAR: 1427 Supra-renal aneurysm repair 834 410 1428 Repair of super renal aortic aneurysm rupture 1076 410 1429 Tube graft repair of abdominal aorta 754 410 1431 Repair of ruptured abdominal aortic aneurysm 1034 410 1432 Aorto bi-iliac bypass for atherosclerosis or aneurysm 334 410 1433 Aorto-femoral or bifemoral bypass for atherosclerosis or aneurysm 834 410 1434 Endarterectomy of abdominal aorta and iliac vessels 754 410 1436 Repair of ruptured iliac artery aneurysm 754 410 1437 Endarterectomy of iliac vessels alone 646 410 1438 Visceral artery repair, re-anastomosis or endarterectomy 834 410 1439 Renal artery anastomosis, endarterectomy or re-implantation or bypass 834 410 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 1441 Embolectomy of visceral branches, superior mesenteric or renal arteries 592 184 1442 Removal of infected aortic prosthesis 1076 512 1443 Obturator bypass from aorta or iliac to profunda or distal femoral bypass 834 256 1444 Repair of abdominal aortic trauma 592 256 1446 Aortic exclusion by axillo-femoral bypass 700 256 1447 Endarterectomy of internal/external common carotid artery with or without shunt 1076 410 1448 Patch repair of internal carotid artery 323 184 1449 Vertebral artery bypass or repair 700 256 1451 Open repair of subclavian artery 592 256 1454 Translocation of common carotid to subclavian artery 700 256 1456 Carotid subclavian bypass 700 358 1457 Subclavian/subclavian bypass 592 256 1458 Thoracotomy with repair of vessels of arch of aorta 834 410 1285 Intra arterial injection (excluding arteriography) 74 0 1305 Renal stenosis, repair of 490 256 1306 Transcatheter embolisation 294 184 1307 Transcatheter removal of intravascular thrombus or foreign body 294 184 5866 Percutaneous angioplasty 294 205 VASCULAR - HEAD, NECK and UPPER LIMBS: 1459 Subclavian to branchial bypass or endarterectomy 592 358 1461 Repair of subclavian aneurysm 539 358 1462 Brachial embolectomy 323 184 1463 Repair or bypass of brachial to radial or ulnar vessel 700 256 1464 Repair of trauma to brachial artery with endarterectomy patch or bypass 592 256 820 Arterial venous fistula in arm under L.A. 196 164 821 Gortex graft placement for AV access for dialysis 441 164 1290 Ligation of major vessels 245 154 1250 Arterial biopsy (temporal artery biopsy bilateral under L.A.) 89 77 VASCULAR - LOWER LIMBS: 1467 Femoral popliteal bypass, above knee vein 646 256 1468 Femoral to popliteal bypass, above knee synthetic 592 256 1469 Femoral to popliteal bypass, below knee vein 754 256 1471 Femoral to popliteal bypass, below knee synthetic 646 256 1472 Profundaplasty with or without patch or endarterectomy 485 256 1473 Common femoral artery endarterectomy 376 184 1474 Repair of femoral artery aneurysm 539 256 1280 Common femoral artery embolectomy 295 184 1476 Popliteal artery embolectomy 485 256 1477 Tibial artery embolectomy 592 256 1478 Femoral tibial artery bypass, including tibial-peroneal and peroneal artery bypass, or other distal vessels 915 410 1479 Popliteal aneurysm artery repair or bypass 592 256 1481 Femoral/femoral bypass 646 256 1482 Repair of femoral or popliteal vessels due to trauma 700 256 VARICOSE VEINS: 1483 Ligation and division at the sapheno-femoral junction and complete stripping of the long saphenous vein, ligation and division of the short saphenous vein at the sapheno popliteal junction, ligation and avulsion of multiple varicose veins, for both legs 392 154 1484 As 1483 for one leg 269 123 1486 Ligation and division at the sapheno-femoral junction of the long saphenous vein with complete stripping of the long saphenous vein and ligation and avulsion of multiple varicose veins in the leg (both legs) 294 154 1487 Ligation and division at the sapheno-femoral junction of the long saphenous vein with complete stripping of the long saphenous vein with ligation and avulsion of multiple varicose veins in the leg (one leg) 196 123 1488 Ligation and division of the short saphenous vein at the sapheno popliteal junction with ligation and avulsion of multiple varicose veins in the leg (both legs) 294 154 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 1489 Ligation and division of the short saphenous vein at the sapheno popliteal junction plus ligation and avulsion of multiple varicose veins in the leg (one leg) 196 123 1491 Cockett, Linton or Dodd procedure on perforators 392 154 1492 Ligation and division at the sapheno-femoral junction of the long saphenous vein with ligation and avulsion of multiple varicose veins, one or both legs 196 123 1430 Iliac or femoral veins, removal of thrombus from 245 123 1435 Inferior vena cava, ligation or clipping of, with or without removal of thrombus 392 184 1440 Ligation and division of individual perforator 74 77 1450 Portosystemic shunt 646 358 1455 Sclerosing operation on vein(s), one leg 49 0 1460 Sclerosing operation on veins, both legs 74 0 1465 Splenorenal anastomosis 490 307 1490 Varicose veins, exploration and removal of thrombus, unilateral 245 123 1495 Varicose veins, exploration and removal of thrombus, bilateral 294 154 1500 Venous pressure and blood volume studies 45 0 SKIN and SUBCUTANEOUS TISSUES: 1505 Abscess, cyst or tumour, aspiration of 49 72 1506 Angioma cauterisation or injection into, under general anaesthetic 49 72 1507 Angioma of skin and subcutaneous tissue or mucous surfaces, small, excision and repair of, under general anaesthetic 74 72 1508 Angioma of skin and subcutaneous tissue or mucous surfaces, large, excision and repair of, under general anaesthetic 148 82 1509 Biopsy of skin, subcutaneous tissue and/or mucous membrane including simple closure 64 0 1510 Excision and biopsy/curettage of a seborrhoeic keratosis / basal cell papilloma (single or multiple) 74 72 1513 Ellipse biopsy of the skin 86 0 1514 Cryotherapy or curettage to solar or actinic keratosis or warts other than plantar (single or multiple) 74 72 1525 Foreign body, removal of 74 72 1540 Skin abscess, (superficial) incision and drainage of 74 72 1545 Keloid or other scar, excision of 74 72 1546 Enucleation of lipoma 99 87 1550 Malignant melanoma, wide excisional biopsy 148 87 1551 Malignant melanoma, wide excisional biopsy and graft 268 113 (See "LYMPHATICS" for block dissection of glands) 1555 Excision of pigmented naevi 74 72 1560 Incision and drainage of pilonidal abscess 71 72 1561 Pilonidal sinus or cyst, excision of 200 123 1565 Tubed pedicle flap, per stage 294 154 1570 Removal of foreign body from hand or foot under anaesthetic 74 77 1575 Basal cell carcinoma / squamous cell carcinoma, simple excision 148 72 1576 Basal cell carcinoma / squamous cell carcinoma, excision and graft or local flap 294 97 1577 Basal cell carcinoma / squamous cell carcinoma, curettage and/or electrosurgery 172 77 1580 Excision of a sebaceous cyst(
  18. s)(single or multiple} 99 72 1586 Laser treatment to naevi, initial patch test 74 72 1587 Laser treatment to naevi, each subsequent treatment session 148 72 1588 Excision of axillary skin for hyperhidrosis 196 92 1591 Hydradenitis suppurativa, excision and suture 122 72 1592 Hydradenitis suppurativa, excision and graft 294 113 1605 Surgical diathermy under general anaesthetic for any condition other than those listed separately 99 72 1610 Interstitial implant with radioactive source 99 72 1615 Wounds and sinuses, curettage of 74 72 1620 Wounds (multiple), suture or excision and suture 148 87 1625 Simple repair of superficial wounds 72 72 OTHER PROCEDURES 1630 Exchange transfusion 134 0 1635 Exchange transfusion (intra uterine) 196 0 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 1631 Hyperbaric oxygen therapy, initial, including full medical evaluation 148 0 1632 Hyperbaric oxygen therapy, subsequent, per session 49 0 1636 Intravenous immunoglobulin for patients with a haematological malignancy or immune deficiencies 48 0 1637 Blood transfusion for patients with a haematological malignancy or immune deficiencies 48 0 1638 Intravenous antibiotics for patients on cytotoxic chemotherapy regimens for malignant disease 48 0 1639 Electrolyte replacement for patients on cytotoxic chemotherapy regimens for malignant disease 48 0 1641 Therapeutic phlebotomy for patients with polycythemia rubra vera or haemochromatosis 49 0 1642 Isolated limb perfusion including exposure of major limb artery and vein, arteriotomy and venotomy 490 225 1645 Intracaviatory insertion with radioactive source (cranium, chest, abdomen ) 294 143 1646 Plasmapheresis. 49 0 1657 Cytotoxic chemotherapy (combination therapy), infusion, for (
  19. a)initial day's treatment for a new patient, (
  20. b)first day's treatment of a new cycle of therapy, for an established patient, day care or inpatient. 72 0 1658 Succeeding days of cytotoxic chemotherapy (combination therapy) infusion treatment after the first day's treatment, day care or in patient. 48 0 1663 Drainage of abscess or haematoma, (deep tissues) requiring general anaesthetic 99 72 4281 Bone marrow aspiration 45 72 4282 Bone marrow biopsy 68 72 4287 Bone marrow aspiration and biopsy 89 72 4283 Allogeneic bone marrow transplantation, benefit includes all procedures and in-patient care 834 0 4284 Autologous bone marrow transplantation, benefit includes all procedures and in-patient care 686 0 4286 Bone marrow harvesting 148 123 4288 Peripheral blood stem cell harvesting 148 0 4291 Peripheral blood stem re infusion, benefit includes cytotoxic chemotherapy and in patient care 686 0 EAR, NOSE AND THROAT EAR: (See also Plastic Section) 1665 Atresia of auricle, 2 or 3 stages, correction of (per stage) 364 154 1666 Attico antrostomy, unilateral 490 205 1670 Ear polyp, excision of 74 72 1671 Ear toilet requiring use of operating microscope and micro inspection of tympanic membrane with or without general anaesthesia, unilateral or bilateral 74 72 1675 Drainage external ear, abscess or haematoma 74 72 1680 External auditory canal excision of tumour 148 72 1685 External auditory canal removal of exostosis or osteoma 156 72 1686 Reconstruction of external auditory canal (meatoplasty) (e.g. for stenosis due to trauma, infection) 291 143 1690 Facial nerve decompression (in temporal bone) 490 184 1695 Facial nerve graft (in temporal bone) 540 205 1700 Removal of foreign body from ear, under general anaesthetic 99 72 1701 Labyrinthectomy; transcanal 364 184 1710 Mastoidectomy, radical with or without labyrinthectomy 520 239 1715 Mastoidectomy, simple 416 205 1730 Myringoplasty 343 184 1735 Myringotomy 62 72 1740 Myringotomy (bilateral) 104 82 1741 Removal of drain tube(
  21. s)under general anaesthetic 49 72 1751 Pinna, total excision 196 102 1752 Pinna, partial excision with flap reconstruction 294 143 1753 Pinna, partial excision and graft 196 123 1755 Preauricular sinus, excision of 196 102 1760 Saccus endolymphaticus for Meniere's Disease 441 225 1765 Sebaceous cyst of ear, removal of 99 72 1770 Stapedectomy 589 225 1771 Stapedectomy with plastic reconstruction of ossicles 589 225 1790 Tympanoplasty 540 225 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 5980 Combined approach tympanoplasty 639 256 1785 Myringotomy with insertion of grommet 146 72 1786 Myringotomy, bilateral, with insertion of grommets 202 82 1796 Electrocochleography 27 72 NOSE: 1800 Epistaxis anterior packing and/or cautery 99 72 1805 Epistaxis posterior anterior packing and/or cautery 134 82 1810 Epistaxis anterior ethmoid and/or internal maxillary ligation 196 102 1815 Foreign body, removal under general anaesthetic 66 72 1820 Polypectomy, single 55 72 1825 Polypectomy, multiple 148 77 NOSE and ACCESSORY SINUSES: (See also Plastic Section) 1830 Accessory sinuses, open operations on, unilateral (including Caldwell Luc) 245 113 1840 Accessory sinuses, open operations on, bilateral (including Caldwell Luc) 368 164 1850 Antral biopsy 45 77 1855 Antral puncture (antrotomy) and washout unilateral 99 72 1860 Antral puncture (antrotomy) and washout bilateral 148 72 1865 Antral lavage involving insertion of polythene tube (unilateral) 148 72 1870 Antral lavage involving insertion of polythene tubes (bilateral) 196 72 1875 Sinusotomy with or without biopsy, with mucosal stripping or removal of polyp(
  22. s)166 82 1880 Nasal/Sinus endoscopy, surgical, with antrostomy (unilateral) 122 72 1885 Nasal/Sinus endoscopy, surgical, with antrostomy (bilateral) 196 87 1890 Repair of choanal atresia, intranasal 218 102 1895 Repair of choanal atresia, transpalatine 441 205 1896 Crawford tube insertion, unilateral 99 77 1897 Crawford tube insertion, bilateral 148 82 1900 Ethmoid area malignant tumour excision 416 205 1905 Nasal/Sinus endoscopy, with or without biopsy, polypectomy or debridement 94 77 1910 Ethmoidectomy extranasal (unilateral) 196 92 1915 Ethmoidectomy extranasal (bilateral) 364 164 1920 Ethmoidectomy intranasal (unilateral) 239 113 1925 Ethmoidectomy intranasal (bilateral) 231 138 1935 External frontal sinus exploration 490 205 1940 External frontal sinus operation for malignant disease 589 256 1945 External rhinotomy (with drainage of ethmoid frontal, or maxillary sinuses) 490 225 1968 Nasal septum insertion of prosthetic button 122 77 1969 Plastic repair of nasal septum 364 164 1970 Nasal septum, submucous resection of 196 72 1980 Naso pharyngeal tumour, excision of 624 307 1985 Oro antral fistula, closure of 490 205 1990 Cauterisation and/or ablation, mucous of turbinates, unilateral or bilateral, any method, superficial 99 72 1992 Nasal/Sinus endoscopy, surgical with ethmoidectomy (partial or total) 281 133 1993 Nasal/Sinus endoscopy, surgical with frontal sinus exploration with or without removal of tissue from frontal sinus 312 154 1745 Nostril closure for atrophic rhinitis 196 77 4525 Rhinoplasty 441 184 5975 Rhinoplasty, primary, including major septal repair 528 221 THROAT: 1995 Abscess (retropharyngeal), incision and drainage (internal pharyngotomy) 99 154 1996 Bronchoscopy with bronchoalveolar lavage (includes irrigation of bronchial tree) 115 0 1997 Bronchoscopy with transbronchial biopsy of lung 179 41 2003 Bronchoscopy with combined bronchial and/or transbronchial biopsies and bronchoalveolar lavage 201 41 1999 Bronchoscopy with laser ablation/resection of tumour 294 123 2000 Bronchoscopy with brachytherapy or placement of radium source 294 92 2001 Bronchoscopy with selective bronchography 134 41 2002 Bronchial provocation testing (histamine, methacholine etc.) 179 0 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 2011 Bronchoscopy with or without bronchial biopsy 115 41 2012 Bronchoscopy with or without bronchial biopsy (less than 2 years old) 125 125 2020 Bronchoscopy with removal of foreign body (includes foreign body removal by rigid endoscopy) 140 123 2030 Laryngoscopy 68 82 2040 Laryngectomy, all forms including vertical hemi laryngectomy and tracheostomy 759 358 2045 Larynx, microsurgery of 294 123 2050 Laryngofissure, external operation on 490 205 2055 Lateral pharyngotomy 426 201 2056 Direct operative laryngoscopy with operating microscope with or without biopsy, removal of foreign body, removal of lesion etc. 294 92 2057 Vocal cord augmentation (injection of teflon) 220 102 2060 Oesophagoscopy 68 82 2065 Oesophagoscopy with biopsy and dilatation 112 82 2070 Oesophagoscopy with removal of foreign body 140 92 2074 Upper G.I. endoscopy with oesophageal dilatation and lasertherapy 245 82 2075 Operative peroral endoscopy (including biopsy of larynx, trachea, bronchus, pharynx or oesophagus) 74 82 2077 Oesophageal dilation and insertion of endoprosthesis 245 205 2079 Oesophagoscopy with multiple injection of oesophageal varices 148 123 5840 Oesophageal motility study 68 92 2080 Papilloma or cyst of larynx, excision of 196 123 2081 Balloon, dilatation of the oesophagus (includes endoscopy) 152 82 2085 Pharyngeal pouch or diverticulum, excision of 540 225 2090 Pharyngeal pouch or diverticulum endoscopic diathermy division 343 184 2096 Drainage and marsupialisation of cyst 220 102 2100 Pharyngolaryngectomy 832 404 2115 Incision and drainage, abscess; retropharyngeal or parapharyngeal 83 154 2125 Tonsils and/or adenoids (adults), removal of 230 102 2130 Tonsils and/or adenoids, removal of (children under 12 years) 200 92 2131 Tonsils or tonsils and adenoids, arrest of haemorrhage requiring general anaesthetic, following removal 122 154 2132 Tracheoesophageal puncture and insertion of prosthesis 172 123 2136 Transtracheal aspiration 89 0 OTHER PROCEDURES: 2126 Overnight oximetry 45 0 2133 Kveim test including follow up punch biopsy of skin 64 0 2134 Kveim test including follow-up ellipse biopsy of skin 86 0 2137 Mantoux test, injection and follow up interpretation 64 0 5895 Full pulmonary function studies carried out in a pulmonary function laboratory including report 86 0 2141 Prolonged post-exposure evaluation of bronchospasm after exercise, with multiple spirometric determinations as in 5895 including measurement of thoracic gas volume and expired gas determinations 99 0 2139 Full sleep study (polysomnography) 173 0 GYNAECOLOGICAL OPERATIONS CERVIX: 2140 Cervix, amputation of 99 72 2145 Cervix, biopsy of 45 72 2146 Cervix, cone biopsy of 125 72 2150 Cervical polypi, removal of 49 72 2155 Cervix, dilatation of 49 72 2160 Cervix, local excision of lesion of 49 72 2170 Cervix, suture of 74 72 2171 Cervical cerclage 99 72 2175 Cervix, cautery of 49 72 2180 Cervix, examination under anaesthesia 45 72 2181 Colposcopy 62 72 2182 Colposcopy and biopsy including Lletz procedure and/or laser therapy 104 72 OBSTETRICAL: Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 2185 Caesarean hysterectomy 589 256 2190 Caesarean section (grant in aid for obstetrician's fees) 215 154 2200 Ectopic pregnancy, surgical management (laparoscopic or open): salpingectomy and/or salpingo oophorectomy (unilateral or bilateral) 245 205 2205 Hydatidiform mole (hysterotomy) 196 154 2206 Vaginal delivery (grant in aid) 144 0 2207 Epidural anaesthesia for vaginal delivery 0 138 UTERUS and ADNEXA: 2215 Aldridge sling operation 364 123 2220 Broad ligament, excision of cyst of 196 113 2225 Dilatation and curettage (diagnostic or therapeutic) 135 72 2235 Microsurgical repair of extensive tubal and peritubal disease consequent on pelvic inflammatory disease and endometriosis including re-implantation of fallopian tube, unilateral 399 143 2240 Microsurgical repair of extensive tubal and peritubal disease consequent on pelvic inflammatory disease and endometriosis including re-implantation of fallopian tubes, bilateral 598 205 2241 Surgical repair of extensive tubal and peritubal disease consequent on pelvic inflammatory disease or endometriosis, unilateral or bilateral 312 143 2248 Hysteroscopy 74 72 2249 Transcervical endometrial resection 490 123 2250 Total abdominal hysterectomy 489 179 2255 Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(
  23. s)728 205 2256 Total vaginal hysterectomy combined with anterior and posterior pelvic floor repair 645 179 2257 Total abdominal hysterectomy with unilateral or bilateral salpingo oophorectomy 530 179 2258 Resection of ovarian malignancy with total abdominal hysterectomy, complete procedure 728 256 2259 Debulking of ovarian carcinoma with or without omentectomy, complete procedure 520 205 2260 Sub total abdominal hysterectomy 392 179 2264 Total vaginal hysterectomy with urethropexy or urethroplasty 489 184 2265 Total vaginal hysterectomy 489 179 2267 Total vaginal hysterectomy and anterior or posterior pelvic floor repair 593 179 2270 Induction of radiation menopause 99 72 2273 Marlex sling procedure 196 123 2280 Myomectomy (multiple) 392 154 2285 Myomectomy (simple, single) 343 154 2289 Oophorectomy, unilateral or bilateral (complete or partial) 218 128 2300 Ovarian cystectomy, unilateral or bilateral 245 128 2319 Salpingectomy complete or partial, unilateral or bilateral 218 128 2354 Salpingostomy or salpingolysis, unilateral or bilateral 312 128 2364 Microsurgical tuboplasty (salpingostomy or salpingolysis), unilateral or bilateral 354 154 2365 Salpingo oophorectomy, complete or partial, unilateral or bilateral 245 133 2366 Salpingography and cannulisation for unblocking fallopian tubes, unilateral or bilateral 245 0 2370 Uterus, plastic reconstruction of 392 184 2375 Ventrosuspension/Gilliam's operation 196 123 VULVOVAGINAL: 2380 Atresia vaginae, relief of (including dilatation of vulva and vagina) 148 92 2385 Bartholin's gland cyst, excision of 125 72 2390 Bartholin's or Skene's gland, abscess of, incision and drainage 74 67 2391 Burch colposuspension 364 154 2395 Caruncle, vulvovaginal, removal of 74 72 2400 Colporrhaphy with amputation of cervix, anterior and posterior (Manchester or Fothergill operation) 392 164 2410 Colpotomy 148 77 2415 Cystocele. repair of 196 128 2420 Cystocele and rectocele, repair of (including colpoperineorraphy) 245 164 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 2425 Cysts or simple tumours of the vulva or vagina, excision of 99 77 2430 Hymenotomy 74 72 2435 Hymenectomy 74 72 2440 Perineal tear complete repair of 294 128 2441 Partial vaginectomy 490 184 2445 Rectocele, repair of 245 128 2450 Stress incontinence, Marshall Marchetti, urethropexy for 364 164 2460 Vaginal fistulae (recto vaginal), repair of 245 154 2465 Vaginal fistulae (vesico vaginal), repair of 392 154 2470 Vaginal wall, suture of 148 77 2475 Vagina, plastic repair for dyspareunia 196 154 2480 Vulvectomy simple, without glands 392 154 2485 Vulvectomy radical, with glands 540 256 2486 Intracaviatory insertion of radioactive source, cervix, vagina or uterus 294 154 2484 Diagnostic laparoscopy with or without biopsy, with or without tubal irrigation/insufflation 148 113 2488 Diagnostic laparoscopy with or without biopsy. This procedure also includes dilatation and curettage (diagnostic or therapeutic), with or without tubal irrigation/insufflation 200 113 2487 Diagnostic laparoscopy with/without biopsy and one or more of: excision of lesions of ovary;pelvic viscera or peritoneal surface: diathermy of endometriosis;division of adhesions; puncture of cysts. With/without tubal irrigation/insufflation. 172 113 2489 As 2467 but including dilatation and curettage (diagnostic/therapeutic) 234 113 OPHTHALMIC OPERATIONS CONJUNCTIVA: 2490 Conjunctival flap 99 72 2493 Conjunctivectomy 74 72 2495 Conjunctival graft 148 77 2498 Conjunctival tumour with or without graft 197 77 2496 Cryotherapy, unilateral 196 72 2497 Cryotherapy, bilateral 295 82 2500 Cyst/Granuloma- excision of 74 72 2505 Foreign body- removal of, from conjunctiva 74 77 2520 Wounds, repair 99 77 2521 Symblepharon division 99 77 2526 Symblephora - division of (includes conjunctival graft) 197 92 2527 Conjunctival biopsy 74 72 ANTERIOR SEGMENT: 2522 Removal of foreign body from anterior chamber, magnetic 392 184 2523 Removal of foreign body from anterior chamber, non-magnetic 392 184 2524 Removal of implanted material from anterior chamber 392 184 2525 Paracentesis of anterior chamber of eye with or without diagnostic aspiration of aqueous 148 82 2580 Paracentesis of anterior chamber of eye for hyphaema with or without irrigation and/or air injection 245 72 2585 Paracentesis/Saemisch section etc. 245 123 2586 Reform anterior chamber secondary to trabeculectomy or post cataract surgery 245 123 CORNEA and SCLERA: 2530 Corneal grafting- penetrating/lamellar 589 138 2531 Removal of sutures (late Stage) corneal/sclera 74 72 2532 Keratoprosthesis 603 184 2533 Epikeratophakia 603 184 2535 Corneal surface removed and EDTA application 99 77 2510 Pterygium removal 99 77 2511 Pterygium removal and conjunctival graft 197 92 2540 Corneal tattooing 99 77 2548 Ulcer/Recurrent, erosion, surgical treatment/Cautery with or without pricking, with or without debridement, with or without cryotherapy - one or more treatments, per episode of illness 99 77 2546 Corneal scraping 99 77 2547 Corneal biopsy 99 72 2555 Corneal or scleral tumour, excision 245 123 2556 Perforating injury cornea and/or sclera not involving uveal tissue 246 123 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 2565 Perforating injury cornea and/or sclera with reposition or resection of uveal tissue 420 184 2566 Repair of scleral staphyloma with or without graft 589 184 2575 Foreign body, removal of, from cornea 74 72 2577 Keratotomy (Wedge resections, relaxing incisions etc; for the correction of abnormal refractive errors resulting from cataracts, corneal scars or post traumatic corneal astigmatism) 491 123 2579 Excimer laser therapy for corneal pathology, per course 323 133 EYELIDS: 2589 Biopsy of eyelids 67 72 2590 Chalazion - incision and curettage, one or more 99 72 2591 Botulinum injection for blepharospasm or to induce ptosis 122 72 2595 Ectropion 196 82 2600 Entropion 172 82 2596 Blepharophimosis - for pathology (not cosmetic) 258 123 2605 Epilation trichiasis 54 72 2606 Cryo to lash/electrolysis/ Removal lash follicle per course of therapy 108 72 2610 Injury to eyelid - repair (superficial) 74 72 2611 Opening of tarsorrhaphy 74 72 2615 Injury to eyelid - repair (deep) 196 92 2620 Lid papilloma 196 72 2625 Superficial dermoid or cyst - excision of 148 72 2626 Canthotomy 43 0 2630 Tarsorrhaphy 148 72 GLOBE: 2635 Evisceration of eye 295 123 2640 Excision of eye plus implant 343 154 2645 Removal of intraocular foreign body 392 184 2660 Removal of eye 295 143 IRIS, CILIARY BODY and CHOROID OPERATIONS: 2680 Division of anterior synechiae 245 102 2685 Cyclodialysis 343 154 2696 Cyclocryotherapy/Diathermy 343 154 2700 Goniotomy 392 154 2710 Iridectomy 245 123 2711 Pupil reconstruction post trauma, post surgery 392 184 2725 Iris tumour, removal 392 184 2726 Iris biopsy 245 123 2740 Trabeculectomy/Drainage procedure 539 128 2741 Laser trabeculoplasty, one or more treatments 313 143 2845 Local resection of ciliary body or choroidal tumour 603 154 2742 Trabeculectomy and tubes, etc. 581 143 LACRIMAL APPARATUS: 2750 Canaliculus repair with or without tube 343 184 2755 Dacryocystorhinostomy with or without tubes 392 184 2756 Removal of D.C.R. tube 43 0 2760 Lacrimal abscess (dacryocystitis) incision 74 72 2761 Lacrimal sac, syringing and probing 99 72 2764 Intubation of nasolacrimal duct 392 154 2766 Punctal closure with cautery or controller 74 72 2768 3 Snip operation of lacrimal punctum 99 72 2769 Correction of everted punctum : cautery only 74 72 2770 Lacrimal sac excision (dacryocystectomy) 392 154 2771 Lacrimal gland tumour excision 431 184 2772 Conjunctivo - dacryocystorhinostomy with Lester Jones tube 409 184 2775 Lacrimal sac, syringing 74 72 LENS: 2779 Repositioning of intraocular lens 295 128 2780 Intraocular lens insertion not associated with concurrent cataract removal (secondary) 295 128 2785 Capsulotomy, needling (surgical) 148 92 2786 Revision of cataract wound 161 92 2795 Lens extraction 515 164 2802 Cataract extraction plus insertion of artificial lens (includes phacoemulsfication, etc.) 581 164 2803 For cataract extraction operations, all forms, where only monitored anaesthesia care is given, the anaesthetic benefit payable is shown opposite 0 82 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic LASER / LIGHT COAGULATION: 2644 Argon or Diode laser or Xenon Arc - for treatment of retinal or choridal disease, glaucoma, one or more treatments 295 123 2647 YAG laser - for capsulotomy, pupil formation, iridectomy, membranectomy, ciliary body treatment, glaucoma, one or more treatments 295 0 2806 Argon laser therapy for pan- retinal photocoagulation of diabetic retinopathy (per course of therapy) 431 123 MUSCLES: 2870 Routine squint operation, horizontal, vertical or oblique 392 123 2871 Transposition surgery - Jansens, Hummelsheim, Knapp procedure 539 184 2872 Adjustment post strabismus operation 129 72 2873 Botulinum toxin injection to extraocular muscles 122 72 2874 Muscle biopsy 108 72 ORBIT: 2890 Orbit, exenteration of 589 184 2895 Orbit, exploration of, including biopsy 295 143 2900 Orbit, removal of foreign body from 343 154 2905 Orbit, removal of tumour from (Kronlein's operation) 441 205 2910 Orbit, repair of fracture of 392 205 2911 Orbitotomy 603 184 2915 Orbit, repair of fracture of, with plastic implant 491 205 2912 Trans nasal wiring 485 205 2920 Radio Active Source application 196 102 POSTERIOR SEGMENT: 2665 Prophylactic therapy for retinal detachment 409 184 2506 Removal of silicone oil 603 184 2675 Repair of retinal detachment - retinopexy with scleral buckling, scleral resection or scleral implant, etc. (For diathermy, cryotherapy or photocoagulation, use 2665) 735 256 2676 Vitrectomy 735 256 MISCELLANEOUS: 2875 Retrobulbar, orbital floor, subconjunctival, subtenons and facial nerve injections 74 72 2880 Examination of eye under general anaesthetic 97 72 2926 Fluorescein angiography 45 0 DENTAL / ORAL SURGERY 2940 Dental cysts of maxilla or mandible 148 92 2950 Extraction of teeth (more than 6 permanent teeth) with or without alveolectomy 122 92 2980 Labial frenectomy with dissection of tissue 49 72 2985 Odontoma, excision of 122 82 3005 Root resection or apicectomy, single, with or without cyst removal and apical curettage 99 82 3010 Root resection or apicectomy, multiple, with or without cyst removal and apical curettage 148 97 3015 Reimplantation of tooth in socket with splinting 99 82 3020 Simple cysts or epulis, palate or floor of mouth, excision of 99 82 3025 Small tumours of dental origin, removal of, includes biopsy 74 77 3030 Tuberosities, reduction of 99 77 ORTHOPAEDIC OPERATIONS HAND: (See also Plastic Section) 3035 Abscess or infected tendon sheath of palmar spaces, drainage of 104 72 3039 Synovectomy of metacarpophalangeal joints, (more than two joints) with release of ulnar intrinsic tendons 343 154 3040 Arthrodesis of joint 208 92 3045 Arthroplasty using joint prosthesis single 208 92 3050 Arthroplasty using joint prosthesis two joints 309 113 3055 Arthroplasty using joint prosthesis more than two joints 441 143 3060 Bone tumours (benign), excision of 343 154 3070 Bursectomy 104 77 3075 Chondroma, excision of (multiple) with bone graft 343 154 3080 Chondroma, excision (single) with bone graft 245 123 3085 Exostosis, excision of 156 82 3095 Fracture of phalanges and/or metacarpals closed reduction 99 67 3100 Fracture of phalanx single internal fixation 156 82 3105 Fracture of phalanges multiple internal fixation 260 123 3110 Ganglion of hand, surgical removal 148 72 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 3115 Manipulation for treatment of dislocation of metacarpophalangeal joint 78 72 3120 Nail, removal of 49 72 3125 Nails, removal of all 99 72 3130 Application of plaster of Paris casts 49 72 3135 Synovioma, excision of 148 72 3136 Tendon repair - flexor-double (hand) 338 154 3140 Traumatic amputation of finger - single - reconstructive operation 208 102 3145 Amputation of two or more fingers 392 184 3150 Trigger finger, correction of 99 77 3155 Whitlow incision and drainage 49 0 WRIST: 3159 Arthroscopy of the wrist 179 123 3160 Arthrodesis, using bone graft 441 184 3165 Arthroplasty 490 184 3170 Aspiration, wrist joint 49 72 3175 Bone grafting operation on scaphoid 343 123 3176 Herbert screw fixation, scaphoid 260 123 3180 Carpal bone (lunate scaphoid trapezium), excision of 196 92 3181 Trapezial joint replacement 589 225 3185 Carpal tunnel, decompression 148 92 3190 Carpus or peri carpal dislocations, manipulation 156 77 3195 Corrective osteotomy of lower end of radius 294 123 3200 Dislocation open reduction of 294 143 3205 Fracture (Colles') internal fixation of 229 123 3210 Fracture (Colles') manipulation and plaster of Paris 135 87 3211 Fracture of distal radius, external fixation of 148 72 3215 Injection, wrist joint 49 0 3220 Ganglion, removal of aspiration 49 72 3225 Ganglion, removal of surgical 148 72 3229 Intercarpal fusion 260 123 3230 Nerve block for pain control 49 0 3235 Nerve median and ulnar nerve repair of 520 205 3240 Nerve median or ulnar nerve repair of 392 184 3245 Radial styloid, excision of 156 82 3250 Sympathetic block 99 0 3255 Synovectomy of wrist joint 294 123 3260 Tendon repair at wrist single 208 102 3265 Tendons repair at wrist multiple 312 143 3270 Tendon transfer about the wrist, single 258 123 3271 Tendon transfer about the wrist, multiple 387 154 3275 Ulna, lower end of (malunited Colles), excision of 172 87 3276 Smith's or Barton's fractures, internal fixation of 276 143 FOREARM and ELBOW: 3280 Amputation through forearm 392 184 3285 Annular ligament, repair of 294 143 3290 Anterior capsulotomy and excision myositis ossificans 294 143 3295 Arthrodesis 490 205 3296 Arthroscopy, elbow, diagnostic, with or without synovial biopsy, removal of loose body or foreign body, synovectomy, debridement 208 123 3300 Arthroplasty 593 225 3305 Aspiration and injection forearm/elbow 49 72 3315 Drainage of joint 99 72 3316 External fixation, upper limb 148 87 3320 Fracture forearm (complete) closed reduction and plaster of Paris 164 87 3325 Fracture forearm (greenstick) closed reduction and plaster of Paris 135 87 3330 Fracture about elbow, closed manipulation of 166 87 3335 Fracture dislocation, open reduction 392 154 3340 Fracture of forearm bones, open reduction of 446 154 3341 Open reduction, internal fixation and bone grafting (forearm & elbow) 572 225 3345 Fracture of lateral condyle, open reduction of 361 154 3350 Fracture of medial condyle, open reduction of 364 123 3355 Fracture (supracondylar), closed reduction of 229 77 3360 Fracture olecranon, screwing of 260 87 3365 Closed treatment of elbow dislocation 104 72 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 3370 Nerve ulnar transplant 312 123 3375 Olecranon bursa, removal of 148 82 3380 Radius excision of head of 208 92 3381 Silastic interposition of radial head 364 184 3385 Synovectomy of elbow joint 392 184 3390 Tendon transplants about the elbow 260 113 3395 Tendon sheaths, removal of in forearm 245 113 3400 Tennis elbow advancement of extensor muscles 196 102 HUMERUS and SHOULDER: 3401 Arthroscopy, shoulder, surgical, with removal of loose body or foreign body, synovectomy, debridement 294 154 3402 Arthroscopic suture capsulorrhaphy for anterior shoulder instability 589 225 3403 Arthroscopy, shoulder, diagnostic with or without synovial biopsy 192 123 3404 Acromioplasty 294 143 5875 Shoulder replacement prosthesis 589 225 3405 Acromio clavicular joint, excision of 208 102 3410 Acromio clavicular joint, open reduction of 294 143 3411 Arthroscopic subacromial decompression 312 143 3412 Arthroscopic excision outer end clavicle 260 143 3413 Arthroscopic excision outer end of clavicle/subacromial decompression 364 184 3415 Amputation through arm 392 184 3420 Arthrodesis, humerus/shoulder 589 225 3425 Aspiration of joint, humerus/shoulder 49 72 3430 Biopsy, synovial, humerus/shoulder 68 72 3435 Capsulotomy (acute capsulitis) 166 72 3440 Disarticulation, humerus/shoulder 589 282 3445 Dislocation, open reduction, humerus/shoulder 490 225 3450 Dislocation, acute, manipulation under general anaesthetic, humerus/shoulder 125 72 3455 Dislocation recurrent operation for, humerus/shoulder 490 225 3464 Forequarter amputation 624 282 3465 Fractured clavicle, closed reduction 122 77 3470 Fractured clavicle, open reduction 294 123 3475 Fractured humerus, open reduction with internal fixation 392 184 3480 Fractured humerus, open reduction and bone graft 490 184 3485 Fractured humerus, closed reduction 156 77 3490 Injection of joint, humerus/shoulder 49 72 3495 Manipulation of humerus/shoulder under general anaesthetic 78 72 3500 Repair of capsule (in rotator cuff injuries) humerus/shoulder 441 184 3509 Saucerising humerus in chronic osteomyelitis 312 143 3510 Subacromial bursectomy 343 154 3515 Tendon transplant about shoulder 343 154 SPINAL REGION: 3520 Anterior drainage of paravertebral abscess with bone graft 832 256 3521 Anterior release and fusion for scoliosis/kyphosis 1040 461 3525 Antero lateral decompression 540 256 3526 Antero lateral decompression involving two or more levels 1040 307 3530 Coccyx, excision of 294 102 3540 Epidural injection 125 0 3541 Caudal injection 125 0 3545 Epidural infusion with cannula 148 0 3550 Fracture or fracture dislocation of spine traction, reduction and plaster cast 567 256 3555 Fractured spine, open reduction of 936 256 3559 Chemonucleolysis for intervertebral disc 239 102 3560 Intervertebral disc, removal 526 205 3561 Needle aspiration of intervertebral disc 196 102 3563 Excision of thoracic intervertebral disc 735 307 3565 Laminectomy and exploration 490 205 3566 Neuralarch biopsy 125 72 3571 Posterior spinal fusion with instrumentation for scoliosis 1040 451 3580 Spina bifida closure 546 236 3585 Spina bifida lumbar spinal osteotomy 1040 236 3586 Spinal fusion, simultaneous combined anterior and posterior - one level, with instrumentation 1040 461 3587 Spinal fusion, simultaneous combined anterior and posterior - multiple level with instrumentation 1144 461 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 3588 Spinal fusion, simultaneous combined anterior and posterior fusion - one level without instrumentation 832 461 3589 Spinal fusion, simultaneous combined anterior and posterior fusion - multiple level, without instrumentation 1040 461 3590 Spinal manipulation, under general anaesthetic 99 72 3592 External fixature of the spine 437 205 3593 Synthetic fusion (GRAF) one level 728 307 3594 Synthetic fusion (GRAF) two level 936 461 3598 Spinal fusion, multiple level, with internal fixation 1040 461 3595 Spinal fusion 639 256 3596 Spinal fusion, in scoliosis spine, anterior and posterior 639 461 3597 Spinal fusion involving two or more levels 1040 307 3600 Vertebral body biopsy 268 123 3601 Spinal fusion, one level with instrumentation 936 461 3602 Removal of instrumentation 312 184 3603 Spinal stenosis decompression, one level 468 236 3604 Spinal stenosis decompression, two levels 520 236 SACRO - ILIAC JOINT REGION: 3605 Arthrodesis, sacro iliac joint 540 225 3610 Aspiration, sacro iliac joint 49 72 3615 Biopsy of sacro iliac joint region 94 72 3620 Injection, sacro iliac joint region 52 72 3625 Pelvic osteotomy (bilateral) in ectopia vesica 624 225 HIP and FEMUR: 3630 Acetabuloplasty shelf operation 397 164 3631 Internal fixation of acetabular fractures 834 307 3635 Acute dislocation manipulation for 166 77 3636 Congenital dislocation of hip, E.U.A. and P.O.P. 125 77 3640 Acute dislocation or fracture dislocation open reduction, hip/femur 490 225 3645 Above knee amputation 592 205 3650 Arthrodesis, hip/femur 686 307 3660 Arthroplasty of hip using prosthesis 624 225 3661 Revision of total hip arthroplasty, acetablar and femoral components with or without autograft or allograft 832 328 3665 Arthrotomy for loose body 416 164 3670 Colonna's arthroplasty 589 256 3675 Corrective osteotomy with or without internal fixation 520 205 3680 Curetting of greater trochanter and bursectomy 196 102 3685 Decompression operations or hanging hip operations 312 133 3690 Hind quarter amputation 807 358 3695 Drainage of hip joint for acute infection 208 102 3700 Exostosis of femoral neck in slipped femoral epiphysis, excision of 490 205 3705 Femoral condyle, osteotomy of 416 184 3709 Fractured femur, hemiarthroplasty 589 225 3710 Fracture shaft of femur open reduction with internal fixation 520 184 3715 Fracture shaft of femur closed reduction with traction 312 102 3720 Fracture femur (supracondylar) open reduction of 520 184 3723 Fractured shaft of femur, closed intramedullary nailing 489 184 3724 Fractured shaft of femur closed intramedullary - interlocking nail 624 307 3725 Fracture of neck of femur intramedullary nail fixation of 468 184 3730 Fracture of femur (pertrochanteric or introchanteric) intramedullary nail fixation of 489 184 3731 Open treatment of anterior ring fracture and/or dislocation with internal fixation, (includes pubic symphysis and/or rami) 490 184 3732 Open treatment of posterior ring fracture and/or dislocation with internal fixation, (includes ilium, sacroiliac joint and/or sacrum) 645 256 3733 Pelvic fracture, external fixation 208 102 3735 Hip deformity, soft tissue operations for correction of 312 143 3740 Injection or aspiration of the hip 49 72 3745 Manipulation of hip closed, requiring general anaesthetic 62 72 3750 Open reduction and/or rotation osteotomy 520 205 3751 Open reduction, pelvic osteotomy and femoral shortening 686 307 3755 Pelvic osteotomy 490 256 3756 Modified innominate osteotomy including bone graft 686 307 3760 Pseudoarthroplasty of hip (Girdlestone operation) 458 205 3765 Slipped femoral epiphysis intramedullary nail. fixation of 458 184 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 3770 Slipped femoral epiphysis lower end stapling of 294 154 3775 Synovectomy of hip joint and debridement 441 205 3785 Transplantation of psoas muscle to greater trochanter (Mustard's or Sherrard's operation) 441 205 KNEE and LOWER LEG: 3790 Below knee amputation 374 205 3795 Arthrodesis, knee 490 205 3810 Aspiration, knee/lower leg 49 72 3815 Baker's cyst excision of 294 113 3816 Bone transportation 437 205 3817 Removal of fixator device tibia 122 72 3819 Arthroscopy, knee, diagnostic, with or without synovial biopsy 166 123 3820 Cartilage(s), removal of, knee 294 143 3821 Arthroscopy and removal of cartilage, knee 343 154 3822 Arthroscopy of the knee for removal of loose body or foreign body, synovectomy, debridement 269 154 5890 Ligament reconstruction at the knee joint 490 225 5891 Ligament reconstruction of the knee joint using autogenous graft 490 225 3825 Corrective osteotomy of tibia in region of knee 441 184 3830 Corrective osteotomy of tibia in region of ankle 343 164 3835 Cruciate ligaments repair 392 184 3836 Arthroscopic anterior cruciate ligament reconstruction 490 225 3837 Arthroscopic anterior cruciate ligament reconstruction and menisectomy 603 225 3838 Arthroscopic anterior cruciate ligament reconstruction and menisceal repair 645 225 3839 Arthroscopic menisceal repair 385 154 3840 Drainage of joint in acute infection 171 72 3845 Exploration of joint, knee/lower leg 245 123 3850 Fixed flexion of knee soft tissue operations for 392 184 3855 Fracture dislocation of knee joint, operations for 540 225 3860 Fracture of tibia (condylar) open reduction of 490 205 3865 Fracture of tibial shaft open reduction and internal fixation 490 205 3870 Fracture of tibial shaft closed reduction 166 82 3875 Injection of joint, knee/lower leg 49 72 3880 Lateral ligaments, repair 343 154 3885 Manipulation under general anaesthetic, knee/lower leg 62 72 3890 Osteochondritis dissecans Smillies operation for 208 102 3895 Patellectomy or open reduction of fractured patella 343 154 3900 Pre patellar bursa, removal of 196 92 3905 Plication of vastii, etc. 208 92 3910 Prosthetic replacement (total) of knee joint 624 225 3911 Revision of arthroplasty of knee joint with or without allograft one or more components 728 307 3912 Reconstruction of knee, (anterior cruciate) 490 225 3915 Quadriceps mechanism repair 343 164 3920 Slipped epiphysis, stapling of, or epiphysiodesis 453 184 3925 Slipped epiphysis (tibial and femoral combined) stapling of, or epiphysiodesis 490 225 3930 Slipped epiphyses (bilateral tibial), stapling of 416 184 3931 Slocum's or similar procedure 490 225 3935 Synovectomy 392 184 3940 Synovial biopsy, knee/lower leg 78 72 3945 Tendon transplants about knee joint 392 184 3950 Transplant of tibial tubercle 392 184 ANKLE: 3955 Arthrodesis of ankle joint 441 184 3956 Arthroscopy, ankle, with or without removal of loose body or foreign body, with or without synovectomy, debridement 232 123 3957 Arthroplasty (ankle) 291 143 3960 Aspiration and injection, ankle 49 72 3965 Fracture of medial or lateral malleolus (1st degree Pott's fracture) internal fixation of 312 133 3970 Fracture of posterior malleolus (with or without fracture of other malleolus) internal fixation of 343 143 3971 Fracture of medial and lateral malleolus open reduction and internal fixation of 364 154 3975 Fracture Pott's closed reduction 196 102 3980 Synovectomy and debridement 343 154 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 3985 Synovial biopsy, ankle 68 72 3986 Talar fracture, open reduction and internal fixation of 343 143 3990 Tendo achillis, elongation of 294 154 3995 Tendo achillis, repair of 392 154 4000 Tendon transplants about the ankle joint and foot (multiple) 392 179 4005 Tendon transplants about the ankle joint and foot (single) 294 128 4010 Traumatic fracture and dislocation, open reduction of 392 133 4015 Unstable ankle Watson Jones operation for, 392 184 CONGENITAL TALIPES EQUINOVARUS: 4019 Astragalectomy 343 164 4020 Dwyer's Valgus osteotomy 312 143 4025 Manipulation and plaster fixation 74 82 4030 Manipulation and strapping 74 72 4035 Rotation osteotomy of tibia 406 184 4040 Soft tissue release 416 128 4045 Tarsal osteotomy 343 154 4050 Tendon transplant -single 294 143 4051 Tendon transplant -multiple 416 205 FOOT: 4060 Arthrodesis of all inter phalangeal joints (Lambrinudi) unilateral 294 143 4065 Arthrodesis of all inter phalangeal joints (Lambrinudi) bilateral 441 205 4070 Arthrodesis of first metatarso phalangeal joint 196 92 4075 Arthrodesis triple, in all its forms 490 205 4080 Arthrodesis, pantalar 589 225 4085 Claw foot (Steindlar) muscle stripping operations for 196 102 4090 Exostosis of first metatarsal (unilateral), removal of 171 77 4095 Exostosis of first metatarsal (bilateral), removal of 229 92 4100 Flat foot involving joint fusion, operation for 341 143 4101 Flexor tenotomy, single (foot) 104 77 4102 Flexor tenotomy, multiple (foot) 156 92 4103 Fracture of hindfoot, internal fixation, unilateral 312 143 4104 Fracture of hindfoot, internal fixation, bilateral 468 205 4105 Fracture of phalanges and/or metatarsals (closed reduction) 99 77 4110 Fracture of phalanx and/or metatarsal (single) internal fixation of 148 92 4115 Fracture of phalanges and/or metatarsals (multiple) internal fixation of 294 123 4120 Ganglion of foot, excision of 104 72 4125 Hallux valgus and follow up, other than simple removal of exostosis (unilateral) operation for 294 123 4130 Hallux valgus and follow up, other than simple removal of exostosis (bilateral) operation for 392 123 4135 Hammertoe unilateral, correction of 148 92 4140 Hammertoe bilateral, correction of 220 113 4145 Grice's operation, subtalar bone block 148 72 4150 Ingrowing toe nail hemiphalangectomy 148 72 4155 Avulsion of nail plate, partial or complete, simple 48 0 4160 Ingrowing toe nail, removal of nail and nail bed 134 72 4165 Injection and manipulation, foot 49 72 4170 Laprau's operation to correct position of toe 171 92 4175 Metatarsal heads, excision of all, and plastic correction of sole (unilateral) 232 113 4180 Metatarsal heads, excision of all, and plastic correction of sole (bilateral) (Hoffman'
  24. s)364 164 4181 Metatarsal joint replacement with prosthesis 490 205 4182 Metatarsal osteotomy, unilateral 208 113 4183 Metatarsal osteotomies, bilateral 312 164 4184 Chevron osteotomy-single 312 143 4185 Os calcis, osteotomy of (Dwyer) 312 143 4190 Os calcis and bursa, posterior exostosis of (unilateral) removal of 196 92 4195 Os calcis and bursa, posterior exostosis of (bilateral) removal of 294 143 4200 Plantar fascia, excision or division of (unilateral) 196 92 4205 Plantar fascia, excision or division of (bilateral) 294 143 4210 Plantar warts, surgical excision, one or more (not local application, cryotherapy etc.) 72 72 4211 Plantar warts, one or more, local application, per complete course of therapy 16 0 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 4215 Stamm's operation, unilateral 392 164 4220 Stamm's operation, bilateral 441 205 4225 Talectomy 392 184 4230 Tarsal osteotomy 245 113 4235 Tendon transplantation about the foot, multiple 392 184 4240 Tendon transplantation about the foot, single 294 123 4245 Tendon transplantation flexor and extensor all toes, unilateral 441 184 4250 Tendon transplantation flexor and extensor all toes, bilateral . 540 225 4255 Trans metatarsal amputation of foot 295 113 4260 Trans metatarsal amputation of one toe 177 72 4261 Trans metatarsal amputation of two or more toes 295 113 MISCELLANEOUS: 4264 Arthroscopy 104 123 4265 Arthrotomy for removal of loose bodies 196 92 4270 Biopsy of tumour of long bones open 104 82 4271 Costotransversectomy 281 102 4272 Excision of large malignant bone tumours for limb conservation 884 256 4273 Excision of large malignant bone tumours for limb conservation including prosthetic insertion 988 307 4275 Body plaster application 196 92 4270 Bone cysts excision 245 92 4285 Bursectomy large joints 196 92 4290 Chondroma removal 441 184 4295 Exostosis of long bones removal 208 92 4300 Fracture sternum and ribs operative reduction 245 205 4301 Limb lengthening (upper or lower limb) including osteotomy procedure and application of fixator devices 589 225 4305 Long bones, sequestrectomy, decortication or bone graft 441 184 4310 Osteomyelitis drilling of bones 232 92 4315 Osteomyelitis, marsupialisation and bone grafting 490 184 4320 Removal of plates, pins, screws, etc. (superficial) 122 92 4325 Removal of plates, pins, screws, etc. (deep) 268 123 4330 Trimming of stump following amputation of limb 171 77 PLASTIC SURGERY (See also Orthopaedic, E.N.T. and General Sections) Benefit is not payable for cosmetic treatment except the correction of accidental disfigurement or significant congenital disfigurement. BURNS: 4335 Burns and scalds, treatment under anaesthesia, second degree or more (depending on extent) 196 123 4340 Burns, over 10% body surface (equivalent of whole upper limb), excision and graft of 490 184 4350 Graft of extensive areas beyond 10% 589 225 4355 Graft of granulating areas less than 10% 245 123 4360 Major burns of face, excision and graft of 490 164 4365 Major burns of hands, excision and graft of 490 143 4370 Smaller areas, excision and graft of 294 92 BURNS - LATE DEFORMITIES: 4385 Inlay grafts (ankle) 392 184 4390 Inlay grafts (elbow) 245 123 4395 Inlay grafts (fingers) 245 123 4400 Inlay grafts (knee) 392 184 4405 Scar excisions (per scar) flexion, elbows, fingers, groin, knees 196 92 4410 Z plasty (per scar) flexion, fingers, elbows, groin, knees 196 92 CLEFT LIP and PALATE: 4415 Adjustment of lip margin 99 72 4420 Adjustment of scars, secondary 99 72 4425 Cleft palate reconstruction 392 174 4430 Complete cleft tip and anterior palate repair 490 225 4431 Primary repair, unilateral cleft lip 490 174 4432 Primary repair, bilateral cleft lip 515 225 4433 Secondary repair, unilateral cleft lip 490 174 4434 Secondary repair, bilateral cleft lip 515 225 4440 Fistula, secondary closure of 392 174 4460 Maxillary bone graft 490 225 4465 Nostril margin, secondary correction of 294 123 4466 Total cleft rhinoplasty 441 205 4470 Pharyngoplasty (not for snoring) 392 184 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 4475 Soft palate partial cleft, reconstruction of 343 143 BREAST RECONSTRUCTION: 4479 Nipple reconstruction 269 128 4480 Breast reduction 686 225 4481 Breast augmentation (implants) 269 128 4482 Plastic repair of inverted nipple 294 154 4483 Transverse flap (TAIF or TRAM), reconstruction of breast, post mastectomy 589 307 4484 Mastopexy including full thickness graft from other areas 490 225 4485 Breast reconstruction, vertical rectus flap, post mastectomy 565 307 4486 Breast reconstruction, latissimus dorsi flap, with or without implant, post mastectomy 466 256 4487 Breast reconstruction, other flap, with or without implant, post mastectomy 466 256 4488 Breast reconstruction, implant only, post mastectomy 172 128 TISSUE EXPANDERS: 4551 Insertion of expander including any subsequent injections of expander 441 184 4552 Removal of expander 148 92 4553 Removal of expander and inserting of expanded skin 319 154 EYELIDS: 4490 Eyelid bags, repair of 343 123 FACIAL TRAUMA: 4489 Facial trauma, suturing of facial nerve 392 184 4491 Facial trauma, suturing of facial nerve branch 343 154 4492 Facial trauma, grafting of facial nerve, sural nerve, greater auricular nerve 490 225 FACIAL TUMOURS: 4493 Excision of facial nerve and graft, sural nerve, greater auricular nerve 565 256 DELAYED FACIAL REANIMATION - SKIN and DERMAL HITCHES: 4494 Wedge excision of lower lip 343 154 4496 Nasolabial skin/dermal hitch 245 113 STATIC SLINGS: 4497 Temporalis fascial sling, oral, nasolabial, ocular 639 307 4498 Orbicularis oris hitch 639 307 DYNAMIC SLINGS: 4499 Masseter to oral angle, digastric to lower lip or temporalis to fascial slings 639 307 NERVE TRANSFERS: 4500 Facial nerve graft (in face) (see E.N.T. operations for facial nerve graft in facial canal 589 282 4501 Cross facial nerve grafting, hypoglossal/facial nerve reanimation 834 358 COMPLEX FREE TISSUE TRANSFER: 4502 Free muscle transfer, pectoralis minor, gracilis or extensor digitorum brevis as a second stage to 4501 834 358 4510 Facial reanimation in facial paralysis (unilateral) 639 307 OTHER PROCEDURES: 4520 Moles or cysts, excision and suture (Plastic) 99 72 4530 Facial scars, dermabrasion, per scar 99 72 4535 Scars on face excision or Z plasty (3 or more) 343 102 4540 Scars on trunk excision or Z plasty 343 123 4545 Wounds of face suture (per wound) 99 72 EAR: 4555 Accessory auricles, removal 99 72 4560 Epithelioma of ear, excision and reconstruction, lobule placement 196 92 4561 Cartilage graft(s). reconstruction of ear 441 184 4562 Ear reconstruction, further minor procedures 196 92 4575 Protruding ears correction with reconstruction of folds (bilateral) 368 123 4530 Protruding ears, correction of with reconstruction of folds (unilateral) 245 92 EYES: 4585 Contracted socket 539 154 4590 Cyst of eyelids, excision of 99 72 4595 Enophthalmos bone graft 441 205 4605 Decompression, orbit 491 205 Code Surgical Procedure Procedure Benefit IR£ Surgical Anaesthetic 4610 Eyebrow graft 196 92 4615 Eyelids, repair of, for avulsion 196 92 4620 Eyelid, inlay grafts (one lid) 343 154 4625 Eyelid operations in facial paralysis 294 123 4630 Eyelid, total reconstruction of 490 225 4635 Muscle advancement for ptosis (unilateral) 368 164 4640 Naso lacrimal duct, reconstruction of 245 123 GENITO URINARY: 4645 Ectopia vesica (reconstruction of bladder) 490 256 4650 Ectopia vesica (reconstruction of urethra) (per stage) 245 123 4655 Epispadias, correction of dorsal curvature 294 133 4660 Epispadias, reconstruction of urethra 294 133 4665 Hypospadias, correction of ventral curvature or chordee 294 133 4670 Hypospadias, fistula closure 294 133 4675 Hypospadias, reconstruction of urethra 343 154 4676 One stage hypospadias or epispadias repair with or without chordee, urethroplasty with skin graft repair 760 358 4680 Urethra, plastic reconstruction of 392 143 4681 Insertion of Jonas penile prosthesis 294 154 4882 Insertion of inflatable (multi component) penile prosthesis, including placement of pump, cylinders and/or reservoir 416 205 4685 Urethra, second stage, reconstruction of 490 205 4686 Cliteroplasty 416 205 4690 Vaginal reconstruction with skin graft 490 205 4691 Young Dee's Leadbetter operation 735 307 HANDS: 4695 Congenital hand deformities reconstruction on each hand (per stage) 343 164 4700 Congenital hand deformities moderate repairs on each hand (per stage) 196 102 4705 Contractures extensive straightening of hand and inlay grafts 343 164 4710 Contractures, localised, division and graft 196 102 4711 Dermofasciectomy, removal of flexor skin, full thickness skin graft including distal or full palm, one finger 392 184 4712 Dermofasciectomy, removal of flexor skin, full thickness skin graft including distal or full palm, one finger including simple fasciectomy to another finger 540 246 4715 Dupuytren's contracture fasciectomy (one or two fingers) 294 123 4720 Dupuytren's contracture fasciectomy (three or more fingers) 416 154 4721 Dupuytren's contracture, palm and fingers 416 154 4730 Injury to hand major multiple repair of tendons, nerves and skin 540 205 4735 Injury to hand, moderate, wound repair or graft 294 123 4740 Island grafting, for sensory loss, finger and/or thumb 540 256 4745 Neoplasm, major excision and repair with tendon grafts and flaps 589 256 4750 Neoplasm, localised excision and graft 294 143 4760 Nerve repair, primary, single or multiple 343 174 4765 Nerve repair in extensively scarred hand 490 225 4770 Opposition strut graft to thumb 392 205 4775 Palmar ganglion, compound, synovectomy of 392 184 4780 Policisation (finger replacement of lost thumb) 639 307 4785 Syndactyly, repair of (single) 392 154 4790 Syndactyly, repair of (multiple) 392 184 4795 Tendon grafting, single 343 164 4800 Tendon grafting, multiple 490 205 4805 Tendon repair, single 294 92 4810 Tendon repair, multiple 392 184 4815 Tendon transplants, for restoration of opposition 392 184 4820 Tendon transfers for paralysis, multiple 540 256 4825 Tube pedicle or flap reconstructions, first stage 441 205 4830 Tube pedicle or flap reconstructions, second stage 368 184 4835 Tube pedicle or flap reconstructions, final stage 490 225 4840 Wound suture of 99 72 MAXILLA and MANDIBLE: 4845 Facial bone, simple fixation of undisplaced fracture (e.g. jaw sling) 148 102 4850 Facial bones, tumours of, major resection and/or reconstruction 589 307 4855 Fracture of maxilla or mandible, open reduction and fixation 392 184 4860 Fracture of maxilla or mandible, fixation of undisplaced 245 154 4865 Fracture of maxilla or mandible, malar bone or part of these, reduction without fixation 245 123 4870 Hypertelorism correction, sub cranial 686 358 4875 Mandible, excision of 490 256 4880 Maxilla or mandible, advancement or recession osteotomy of 392 256 4881 Maxillary and mandibular osteotomy 589 307 4885 Orbital floor, fracture of, reduction, direct wiring and build up from antrum 490 256 4890 Orbital floor, secondary bone grafting 392 205 4895 Osteomyelitis or abscess of facial bones, operation for 245 123 4900 Temporo mandibular joint, reduction of dislocation under general anaesthetic 99 82 4901 Arthroscopy, temporo mandibular joint for release of adhesions or arthroplasty, with or without biopsy 196 184 4905 Temporo mandibular joint, condylectomy for ankylosis 343 307 NOSE: 4910 Bone graft 441 205 4915 Nasal tip deformities, correction of 343 154 4920 Fracture of nose, digital closed reduction 49 72 4925 Fracture of nose, instrumental closed reduction 74 82 4926 Fracture of nose, instrumental closed reduction with plaster of Paris fixation 99 82 4927 Fracture of nose, instrumental closed reduction with reduction of septum and plaster of Paris fixation 148 82 4930 Fracture of nose, open reduction 99 102 4935 Fracture of nose, open reduction with internal or external fixation 220 123 4940 Fracture of nose, open reduction with open reduction of fractured septum 343 184 4945 Reconstruction with imported flaps, partial 441 205 4950 Reconstruction with imported flaps, total 540 256 4955 Re fracture and open corrective rhinoplasty 490 205 SKIN REPLACEMENT AND RECONSTRUCTIONS LOCAL GRAFTS and FLAPS: 4956 Excision of lesion and split skin graft 196 102 4957 Excision of lesion and full thickness (Wolfe) skin graft 196 102 4958 Excision of lesion, local flap face 294 102 4959 Excision of lesion, local flap hand 294 102 4961 Excision of lesion, local flap limb 245 102 4962 Excision of lesion, local flap trunk 245 102 CUTANEOUS FLAPS: 4963 Excision of lesion including scalp rotation flap 245 102 4964 Excision of lesion including cheek rotation flap 368 154 4966 Excision of lesion including ceivicofacial rotation flap 368 154 4967 Excision of lesion including forehead flap 392 184 4968 Excision of lesion including deltopectoral flap 466 205 4969 Excision of lesion including groin flap 466 205 FASCIOCUTANEOUS FLAPS: 4971 Fasciocutaneous flap upper limb 368 184 4972 Fasciocutaneous flap lower limb 368 184 4973 Fasciocutaneous flap trunk 368 184 (Flap repair is payable in addition to the primary operation for procedures 4974 to 4989 MYOCUTANEOUS FLAPS: 4974 Myocutaneous flap, pectoralis 343 164 4976 Myocutaneous flap, latissimus dorsi 343 164 4977 Myocutaneous flap, latissimus dorsi with serratus and rib 368 184 4978 Myocutaneous flap, vertical rectus 368 184 4979 Myocutaneous flap, transverse rectus (TRAM) 343 164 4981 Myocutaneous flap, tensor fascia lata 368 184 4982 Myocutaneous flap, gluteal 368 184 FREE MICROVASCULAR FLAPS: 4963 Free microvascular flap, radial forearm without bone 565 256 4964 Free microvascular flap, radial forearm with bone 614 256 4966 Free microvascular flap, latissimus dorsi 565 256 4987 Free microvascular flap, latissimus dorsi with serratus and rib 614 256 4988 Free microvascular flap, scapular 565 256 4989 Free microvascular flap, para scapular 565 256 (Flap repair is payable in addition to the primary operation for procedures 4953 and 4954) 4953 Free microvascular flap, fibula 565 256 4954 Free microvascular flap, deep circumflex iliac (DCIA) 565 282 REPLANTATION: 4991 Replantation, per digit 565 256 4992 Replantation, hand (mid palm) 834 358 4993 Replantation, hand (wrist) 712 328 4994 Replantation, forearm 785 358 4996 Replantation, foot 785 358 4997 Replantation, scalp 565 282 4998 Replantation, ear 565 282 TRAUMA: 4990 Major degloving injuries of limbs, excision and graft of 589 256 THORACIC OPERATIONS: LUNGS: 5015 Lung abscess with thoracotomy, drainage of 540 307 5025 Pneumonolysis 343 225 5038 Refilling and maintenance of implantable pump or reservoir including access to pump port (see 5039) 74 0 5039 Implantation of catheter system and reservoir for administration of pain control therapy and/or chemotherapy 245 72 MEDIASTINUM: 5041 Myocardial biopsy 224 205 5055 Aortic endarterectomy 686 358 5065 Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter 110 0 5801 Exploration of mediastinum 313 307 5802 Endoscopic extirpation of lesion of mediastinum 313 307 5803 Diagnostic endoscopic examination of mediastinum 313 179 5804 Operation on lymphatic duct 500 307 5863 Thymectomy 540 358 5075 Blalock operation 589 410 5080 Cardiac catheterisation (left, right or both sides) 179 0 5090 Cardiac catheterisation and coronary angiography with or without ventriculography 301 0 5112 Cardiac catherisation and coronary angiography with or without ventriculography (including

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