IE
S.I. No. 83/1996 - Health Insurance Act, 1994 (Minimum Benefit) Regulations, 1996
Table of Provisions (16)
Statutory Text (16 Articles)
1. The prescribed minimum payments in this Schedule relate to prescribed health services which are provided by a private hospital or a hospital consultant to an insured person while that person is in receipt of services other than in-patient services or day-patient services. Prescribed minimum payments shall be determined under Table D.1 and D.2 as follows:—
TABLE D.1
In respect of
Prescribed Minimum Payment
Private Hospital
Hospital Consultant's
Charges
Fees
(Column 1)
(Column 2)
1 Procedures and services carried out when the insured person is in receipt of out-patient services only.
In respect of each procedure or
Either
group of procedures which gives rise to a payment under Column 2 of this table either
(a)
£15 for each procedure or group of associated procedures listed in Table C.4 of Schedule C;or
(a)
£6 for each procedure or group of associated procedures listed in Table C.4 of Schedule C;or
(b)
determined in accordance with Table C.3 of Schedule C for the procedures listed therein.
(b)
£15 for each procedure or group of associated procedures listed in Table C.3 plus £90 in respect of a Magnetic Resonance Imaging procedure and £60 in respect of a Computerised Tomography procedure
2. Services provided by a hospital consultant excluding those services described in sub-paragraph 1 of this Table or in Table D.2.
Not applicable.
£30 for each consultation.
TABLE D.2
In respect of
Prescribed Minimum Payment
Private Hospital
Hospital Consultant's
Charges
Fees
(Column 1)
(Column 2)
Procedures and services carried out when the insured person is in receipt of out-patient services only.
£15 for each procedure or group of associated procedures which results in a payment arising under Column 2 of this Table.
Determined in accordance with Table C.2 of Schedule C for the procedures listed therein.
GIVEN under the Official Seal of the Minister for Health this 28th
day of March, 1996.
Michael Noonan
Minister for Health
EXPLANATORY NOTE
(This note is not part of the Instrument and does not purport to be a legal interpretation).
These Regulations prescribe a minimum level of cover to be provided under health insurance contracts. They set out payments and periods applicable to the minimum level of benefits as regards hospital in-patient, day-patient and out-patient services and medical consultants' fees. They also set out minimum benefits applicable to maternity, convalescence and treatment for substance abuse. Provision is made for insurance undertakings to determine whether benefits are appropriate for payment as in-patient, day-patient or out-patient services. There are also excesses specified in relation to payment of benefit in respect of out-patient services. The Regulations set out the conditions relating to the payment of minimum benefit during waiting periods relating to first entry to health insurance and to pre-existing conditions. They provide for registered undertakings to specify health service providers who will make available health services for the purposes of payment of benefits under the Regulations. There are also a number of miscellaneous provisions.
3. The prescribed minimum payment in respect of the participation by a consultant anaesthetist in a surgical or radiological procedure, that procedure not being an integral part of another more serious procedure performed at the same time, shall be the anaesthetic procedure benefit as set out in Tables C.2 or C.3 respectively of this Schedule except that if that procedure is a linked procedure the prescribed minimum payment shall be that anaesthetic procedure benefit multiplied by a value derived from the following table
Value
For the linked procedure which has the greatest anaesthetic procedure benefit of all related linked procedures
1.00
For all other linked procedures
0.00
4. The prescribed minimum payment in respect of a period of in-patient attendance by a consultant anaesthetist on an insured person in a recognised intensive care unit shall be—
(a) determined in accordance with Table C.1 of this Schedule if that attendance arises in other than a post surgical context; and
(b) £45 if that attendance arises in a post surgical context provided that this payment shall only fall due for care on or after the third post operative day.
5. The prescribed minimum payment in respect of in-patient attendance by a hospital consultant, other than a consultant anaesthetist, shall be the in-patient attendance benefit determined in accordance with Table C.1 of this Schedule except that no payment shall fall due if that attendance arises:—
(a) in conjunction with a surgical procedure performed by that hospital consultant other than as provided under paragraph 7; or
(b) during a stay in a private psychiatric hospital.
6. The prescribed minimum payment in respect of an in-patient consultation is £33 and falls due when the admitting hospital consultant responsible for the care of an insured person refers that person to another hospital consultant for an opinion, other than where such a referral is a routine matter of policy, and shall be payable once only, irrespective of the number of examinations or visits required to form an opinion.
7. The prescribed minimum payment in respect of a surgical procedure performed by a hospital consultant, other than a consultant anaesthetist, that procedure not being an integral part of another procedure performed at the same time, shall be the surgical procedure benefit as set out in Table C.2 of this Schedule except that—
(a) where that procedure is a linked surgical procedure the prescribed minimum payment shall be that surgical procedure benefit multiplied by a value derived from the following table—
Value
For the linked surgical procedure which has the greatest surgical procedure benefit of all related linked surgical procedures
1.00
For the linked surgical procedure which has the second greatest surgical procedure benefit of all related linked surgical procedures
0.50
For the linked surgical procedure which has the third greatest surgical procedure benefit of all related linked surgical procedures
0.25
For all other linked surgical procedures
0.00
(b) notwithstanding subsection (a) herein where that procedure is designated as "I.P." and is a linked surgical procedure no prescribed minimum payment shall fall due;
(c) where that procedure is designated "Diagnostic" the prescribed minimum payment shall be—
(i) if the insured person is maintained in private hospital accommodation for a period of three in-patient days or less, the greater of the surgical procedure benefit and the in-patient attendance benefit for that period determined in accordance with Table C.1; and
(ii) if the insured person is maintained in private hospital accommodation for a period of more than three in-patient days, the sum of the surgical procedure benefit and the in-patient attendance benefit for that period.
(d) Notwithstanding subsection (a) herein where that procedure is designated as "*" and other surgical procedures so designated are carried out during the same in-patient stay or day-patient day the prescribed minimum payment shall be that surgical procedure benefit multiplied by a value derived from the following table
Value
For the surgical procedure which has the greatest surgical procedure benefit of all such designated surgical procedures.
1.00
For all other such designated surgical procedures
0.00
8. The prescribed minimum payment in respect of a radiological procedure performed by a consultant radiologist, that procedure not being an integral part of another more serious procedure performed at the same time, shall be the radiological procedure benefit as set out in Table C.3 of this Schedule or the surgical procedure benefit set out in Table C.2 of this Schedule as appropriate, except that no payment for Magnetic Resonance Imaging shall fall due other than in respect of the following clinical indications:-
Suspected Multiple Sclerosis after appropriate clinical screening
Suspect leukodystrophies
Vascular malformations
Epilepsy - Temporal lobe type
Suspect posterior fossa tumours
IAMS - suspect acoustic neuromas with audiology screening
Pituitary - after Computerised Tomography screen
Lower cranial nerve palsies, i.e. meningeal processes
Encephalitis
Spine
-
Post-operative failed back
-
Spinal cord compression (acute)
-
Cervical radiculopathy with
neurological signs
-
Spinal dysraphism and
associated abnormalities
-
Patients having had previous
Computerised Tomography or
myelogram which was in
conflict with the patient's
symptoms/signs
-
Intrinsic spinal cord disease
including cervical myelopathy
Bone Tumours
-
Staging of primary malignant
bone tumours
-
Soft tissue tumours for dialnosis
and staging
Shoulder Joint
-
Rotator cuff tears
Knee Joint
-
Assessment of menisceal tears,
cruciate ligament injuries and
losse bodies (but only when
clinically indicated in
preference to an arthroscopy)
Abdomen
-
Possible assessment of patients
with known liver tumours for
resection (previous dynamic
Computerised Tomography and ultrasound scans will have to have been performed)
Assessment of the inferior vena cave in patients with known solid renal tumours
9. The prescribed minimum payment in respect of a pathological procedure performed by a consultant pathologist shall be the procedure benefit as set out in Table C.4 of this Schedule, except that for each hospital admission a payment shall be due only once for any of the procedures comprising a designated group. A designated group is any of the following groups of pathological procedures
(a) Category 1 and 1(A) combined
(b) Category 5(A)
(c) Category 8(A)
(d) Category 9
10. In respect of each episode of radiotherapy the prescribed minimum payment to a consultant anaesthetist shall be £69 and the prescribed minimum payment to a hospital consultant, other than a consultant anaesthetist, shall be £50.
11. In respect of surgical procedures coded from 1636 to 1639 on Table C.2 of this Schedule only an in-patient attendance benefit determined in accordance with Table C.1 of this Schedule shall be payable if these are performed other than while an insured person is in receipt of day-patient services.
Table C.1
Period of Attendance
In Patient Attendance Benefit
1 day
£ 50
2 days
£ 50
3 days
£ 50
4 days
£ 50
5 days
£ 50
6 days
£ 50
7 days
£ 59
8 days
£ 67
9 days
£ 75
10 days
£ 84
11 days
£ 92
12 days
£ 100
13 days
£ 109
14 days
£ 117
15 days
£125
Periods in excess of 15 days
£8 for each day in excess of 15 days
plus £125
TABLE C.2
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
GENERAL SURGICAL OPERATIONS
ABDOMINAL WALL and PERITONEUM
5
Abdominal wall, secondary suture of
107
69
15
Laparotomy, division of adhesions
179
69
I.P.
20
Intra abdominal injury with rupture of viscus
322
107
I.P.
25
Intra abdominal injury, multiple complicated with rupture of viscus
394
154
I.P.
30
Laparotomy
144
69
I.P.
35
Laparoscopy with or without biopsy
107
54
I.P.
45
Omentopexy (otherwise)
144
69
50
Paracentesis abdominis
36
0
60
Pelvic abscess, drainage of
54
38
61
Percutaneous transabdominal biopsy
72
38
Diagnostic
80
Peritoneum, drainage of
144
69
I.P.
90
Laparotomy, intra-abdominal sepsis
287
69
I.P
5835
Peritoneal - venous shunt for ascites
287
92
ADRENAL GLANDS
95
Adrenalectomy (unilateral)
287
107
I.P.
100
Adrenalectomy (bilateral)
358
107
I.P.
101
Adrenalectomy for phaeochromocytoma
287
107
105
Adrenal glands - any other operations
287
107
106
Neuroblastoma, tru cut biopsy
66
38
Diagnostic
107
Neuroblastoma, resection
456
177
APPENDIX
110
Appendicectomy (with or without complications)
144
69
I.P.
GALL BLADDER and BILE DUCTS
115
Cholecystojejunostomy
287
107
116
Choledochojejunostomy (Roux - en - Y)
432
107
117
Choledochoduodenostomy
314
107
118
Surgical repair of post-operative bilary stricture
471
107
129
Hepaticojejunostomy
432
107
132
Cholecystectomy with exploration of common bile duct
394
107
135
Cholecystectomy (including laparoscopic method) and per operative cholangiogram
287
69
136
Percutaneous removal of gallstones from the bile ducts
179
69
140
Cholecystostomy with exploration, drainage or removal of calculus
179
69
145
Hepaticoduodenostomy
358
107
150
Transduodenal sphincteroplasty with or without transduodenal extraction of calculus
322
107
151
Transhepatic insertion of biliary endoprosthesis
215
92
152
Percutaneous insertion of gall bladder catheter for MTBE installation Including catheter removal
179
69
153
Insertion of naso biliary tube and administration of CDC/URSO
179
69
GASTRIC OPERATIONS
155
Antrectomy and drainage
358
69
165
Duodenal diverticula, excision of
322
92
175
Gastrectomy total or revision
430
131
180
Gastrectomy (sub total)
358
92
190
Gastroenterostomy
287
69
195
Gastroscopy or gastroduodenoscopy (fibroscope)
54
38
I.P.
Diagnostic
196
Upper G.I. endoscopy and biopsies
54
38
Diagnostic
197
Upper G.I. endoscopy and polypectomy
54
40
Diagnostic
200
Gastrostomy
215
69
201
Percutaneous gastrostomy
107
54
205
Gastrotomy/duodenotomy for haemorrhage
251
69
215
Oversewing perforated peptic ulcer
215
69
230
Rammstedt's operation
215
69
235
Stomach transection
358
69
240
Vagotomy and drainage or highly selective vagotomy
287
69
HERNIA
245
Epigastric/Ventral hernia, repair of
144
54
I.P.
246
Exomphalos, minor
228
69
247
Exomphalos, major
448
177
248
Exomphalos. delayed
448
177
250
Femoral hernia, repair of (bilateral)
268
69
255
Femoral hernia, repair of (unilateral)
179
54
I.P.
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
270
Hiatus hernia, abdominal repair of
322
92
271
Laparoscopic repair of hiatus hernia
322
92
275
Hiatus hernia, transthoracic, repair of
322
131
I.P.
280
Incisional hernia, repair of
287
54
I.P.
285
Inguinal hernia, repair of (bilateral)
215
69
I.P.
290
Inguinal hernia, repair of (unilateral)
144
54
I.P.
291
Strangulated inguinal hernia, unilateral
201
54
I.P.
295
Patent urachus, closure and repair of abdominal muscles
215
54
305
Recurrent hernia, repair of
215
69
I.P.
310
Umbilical hernia, repair of
144
54
I.P.
JEJUNUM and ILEUM
320
Congenital defects, correction of (including Meckel's diverticulum)
144
69
331
Gastroschisis
531
177
355
Ileostomy
287
69
I.P.
360
Intestinal obstruction (including bowel resection)
287
92
361
Intestinal atresia, single/multiple
359
107
364
Hydrostatic reduction of intussusception
144
69
370
Jejunostomy
144
69
385
Resection and anastomosis of jejunum or ileum
287
69
LARGE INTESTINE
389
Anal canal EUA
32
33
I.P.
390
Anal canal, plastic repair of (for incontinence)
215
69
395
Anal fissure, dilatation of anus for
36
38
I.P.
396
Anoplasty for low anorectal anomaly
215
69
397
Anorectal anomaly, (posterior sagittal anorectoplasty PSARP), for high/inter
424
177
400
Lateral internal sphincterotomy
72
42
I.P.
404
Parks' anal sphincter repair
424
177
405
Anal warts or papillae, removal of
54
38
I.P.
410
Anus, excision of epithelioma of, with colostomy
287
92
415
Anus, excision of epithelioma of, without colostomy
54
42
420
Caecostomy
287
92
I.P.
425
Caecostomy or colostomy, closure of
287
69
430
Colectomy, partial
287
92
435
Colectomy, total
358
154
436
Total colectomy and ileal pouch construction with temporary ileostomy
501
200
437
Closure of ileostomy
179
69
438
Total colectomy for toxic megacolon
573
177
450
Colonoscopy, one side
54
40
Diagnostic
455
Colonoscopy, both sides
144
40
Diagnostic
456
Colonoscopy plus polypectomy
72
40
Diagnostic
457
Colonoscopy plus polypectomy full colon
144
40
Diagnostic
458
Left colonoscopy and laser photocoagulation of rectum
107
40
459
Colonoscopy, full colon and laser photocoagulation of rectum
215
40
460
Colostomy
287
92
I.P.
465
Resection of bowel and colostomy or anastomosis for diverticulitis
322
92
470
Faecal fistula, closure or resection
358
92
485
Fistula in ano, excision
179
69
I.P.
490
Haemorrhoidectomy (external)
89
54
I.P.
495
Haemorrhoidectomy (external, multiple)
107
54
I.P.
500
Haemorrhoidectomy (internal)
144
54
I.P.
506
Haemorrhoids, injection and/or banding
36
0
I.P.
515
Imperforate anus, simple incision
36
38
520
Imperforate anus, with colostomy or pull through operation
287
107
525
Ischio rectal abscess, incision and drainage
107
38
I.P.
513
Meconium ileus, open reduction with or without stoma
359
107
514
Meconium ileus reduction
107
54
516
Necrotising enterocolitis, percutaneous drainage
76
38
517
Necrotising enterocolitis, laparotomy resection/stoma
359
107
530
Proctoscopy or sigmoidoscopy
36
38
I.P.
Diagnostic
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
535
Proctoscopy or sigmoidoscopy, with biopsy
36
38
I.P.
Diagnostic
536
Diagnostic flexible sigmoidoscopy and biopsies
36
40
I.P.
Diagnostic
540
Proctoscopy or sigmoidoscopy with biopsy of muscle coats of bowel, for megacolon
54
54
I.P.
Diagnostic
545
Prolapse of rectum, abdominal approach involving laparotomy, colostomy or intestinal anastomosis
358
107
549
Delorme procedure
286
107
550
Prolapse of rectum, perineal repair
107
69
I.P.
555
Rectal fistula, closure or repair
358
107
556
Balloon dilation of the rectum
72
54
560
Rectal or sigmoid polypi (removal by diathermy, etc)
107
54
565
Rectum, excision of (all forms including perineoabdominal, perineal anterior resection)
394
177
570
Rectum, partial excision of
394
177
574
Presacral teratoma, excision
537
177
575
Rectum (combined synchronous resection)
466
177
576
Revision/refashioning of ileostomy and duodenostomy, complicated reconstruction in - depth
179
69
I.P.
577
Low anterior resection with coloanal anastomosis for cancer
608
177
578
Soave procedure
608
177
580
Sigmoid myotomy (Reilly's operation)
161
69
581
Sigmoidoscopy including dilatation of intestinal strictures
89
38
585
Stricture of rectum (dilation of)
36
38
I.P.
590
Volvulus (stomach, small bowel or colon, including resection and anastomosis)
358
107
LIVER
595
Hepatotomy for drainage of abscess or cyst, one or two stages
144
69
600
Biopsy of liver (by laparotomy)
144
69
I.P.
Diagnostic
601
Transjugular liver biopsy
144
54
Diagnostic
605
Biopsy of liver (needle)
72
38
Diagnostic
610
Haemangioma of liver
144
131
611
Major liver resection
786
261
612
Kasai type liver resection
456
131
616
Wedge resection of liver
236
131
617
Intrahepatic cholangioenteric anastomosis
511
131
618
Resection of hilar bile duct tumour
608
261
619
Liver trauma
511
261
622
Insertion of hepatic artery catheter and reservoir pump
179
69
625
Left lateral lobectomy
430
261
630
Excision of hydatid cyst
315
131
MALE GENITAL TRACT
635
Circumcision (over 6 years)
72
38
640
Circumcision (under 6 years)
72
54
645
Epididymectomy
144
54
I.P.
650
Hydrocele (tapping)
36
38
655
Hydrocele, radical operation, bilateral
215
69
I.P.
660
Hydrocele, radical operation, unilateral
144
54
I.P.
665
Meatotomy
54
38
670
Orchidectomy, bilateral
144
69
I.P
675
Orchidectomy, unilateral
107
54
I.P
680
Orchidectomy with radical removal of lymph nodes
358
107
681
Injection of corpora cavernosa with pharmacologic agent(s) (e.g.papaverine, phentolamine)
36
38
685
Penis, amputation of partial
179
69
686
Chordee release of
144
69
690
Penis, amputation of - with block dissection of glands
358
69
691
Transcatheter embolosation for relief of priapism
215
69
695
Prepuce, dorsal incision of
54
38
700
Prostatectomy
287
69
701
Radical retropubic nerve sparing prostatectomy (includes bilateral
701
pelvic lymph adenectomy with bladder neck reconstruction and anastomosis to the urethra).
430
177
702
Transurethral microwave thermotherapy to the prostate (TUMT)
215
69
703
Insertion of an endo urethral stent for prostate obstruction
215
69
705
Spermatocele or spermatic cyst, (simple ) excision of
144
54
706
Spermatocele or spermatic cyst, (multiloculate) excision of
144
54
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
710
Testes, agenesis of - bilateral exploration of inguinal canals and pelvis
251
92
711
Electro ejaculation procedure
72
38
715
Testicle, imperfectly descended, orchidopexy
107
69
I.P.
720
Testicle, imperfectly descended bilateral orchidopexy
144
69
725
Testicle, imperfectly descended, associated with inguinal hernia
144
69
I.P.
730
Testes, imperfectly descended, associated with bilateral inguinal hernia
215
92
735
Testes, unilateral orchidopexy and exploration of opposite side
215
69
740
Testicular biopsy (needle)
54
38
Diagnostic
741
Testicular biopsy
107
38
Diagnostic
742
Insertion of testicular prosthesis, unilateral
144
38
745
Reduction of torsion of testicle
72
54
749
Transcatheter management of varicocele, including testicular venography
179
69
750
Varicocele, bilateral removal
251
92
755
Varicocele, unilateral removal
179
54
760
Vasotomy or ligation of vas
72
38
I.P.
765
Vas, reconstruction of (unilateral)
233
75
770
Vas. reconstruction of (bilateral)
322
92
PANCREAS
771
ERCP sphincterotomy and extraction of stones
198
54
772
ERCP sphincterotomy and insertion of endoprosthesis
215
69
774
ERCP (endoscopic retrograde cholangiogram of pancreas)
179
54
Diagnostic
775
Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (Whipple - type procedure); with pancreatojejunostomy
775
501
200
776
Pancreatic biopsy
215
92
Diagnostic
778
Pancreaticojejunostomy
466
154
780
Distal pancreatectomy
358
131
789
Total pancreatectomy, distal gastrectomy, splenectomy, duodenectomy,cholecystectomy and resection of distal bile duct
785
501
200
786
Simultaneous pancreas/kidney transplant
609
307
790
Drainage of pancreatic abscess or pseudocyst
358
200
795
Pancreatotomy for drainage of pancreatitis, abscess or cyst with exploration of biliary and pancreatic duct
430
200
SPLEEN
800
Splenectomy
287
92
I.P.
806
Transcatheter ablation of function of spleen
215
69
807
Aspiration of splenic cysts
107
54
URINARY TRACT
815
Aberrant vessels, division of
358
69
822
Permacath Hickman catheter for dialysis
179
69
823
Home based haemodialysis self dialysis training (max. 18 sessions)
22
0
824
Haemodlatysis, chronic, in patient's home or at hospital out patient department, after
824
completion of training sessions (minimum of three dialysis sessions per week inclusive of all consultant care) monthly benefit
134
0
825
Artificial kidney, use of (pre shunt) (haemodialysis, surgical fee)
89
0
826
Chronic haemodialysis (post shunt) 1st 12th treatment
36
0
827
Chronic haemodialysis (post shunt) 13th treatment onwards
36
0
828
Acute intermittent haemodialysis 1st 12th treatment
54
0
829
Acute intermittent haemodialysis 13th treatment onwards
54
0
830
Artificial kidney, use of (peritoneal dialysis)
89
0
831
Chronic peritoneal dialysis, hospital based establishment of therapy (1st 12th day)
36
0
832
Chronic peritoneal dialysis (hospital based after 12th day)
36
0
Peritoneal dialysis, chronic, in the patient's home or at hospital out
833
patient department, after completion of training sessions (minimum of three dialysis sessions per week inclusive of all consultant care) monthly benefit
151
0
834
Tenchkoff catheter for CAPD dialysis
144
69
835
Bladder, implantation of radioactive source
179
54
836
Bladder, instillation of anticarcinogenic agent (BCG)
54
38
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
837
Continuous veno venous haemofiltration dialysis (CVVHD), per day
54
0
840
Bladder - rupture of (simple)
215
69
845
Bladder - rupture of (complicated traumatic)
287
154
850
Bladder neck, transurethral resection of
144
54
855
Bladder tumour, diathermy to, primary resection
215
69
860
Bladder tumour, repeat diathermy
72
54
865
Cystectomy, partial
251
69
870
Cystectomy, with re-implantation of ureters
358
131
875
Cystectomy with ileal or sigmoid loop and bowel anastomosis
484
200
876
Cystectomy with ileal or sigmoid loop and bowel anastomosis including continent catheterizable diversion
538
200
877
Cystectomy with ileal or sigmoid loop and bowel anastomosis including neo bladder with urethral re anastomosis
609
223
880
Cystoscopy with or without biopsy
54
38
Diagnostic
881
Cystoscopy and removal of JJ stent
107
54
885
Cystoscopy with intravesical operation (diathermy, etc.)
89
54
886
Therapeutic overdistension of the bladder
54
38
I.P.
890
Cystoscopy with ureteric catheterisation including retrograde pyelography
72
54
I.P.
Diagnostic
895
Cystoscopy with removal of ureteric calculus
144
54
900
Cystoscopy with ureteric dilatation or meatotomy
107
54
905
Cystotomy
144
69
906
Augmentation cystoplasty (ileo caeco cystoplasty, colocystoplasty)
358
200
910
Diverticulum of bladder, excision or obliteration of
287
69
915
Embolisation of haemangioma of kidney
251
92
920
Hemi nephrectomy
251
92
923
Kidney transplant
501
200
924
Litholapaxy: Crushing or fragmentation of calculus by any means, in the bladder, including ultrasonic destruction
215
69
925
Nephrectomy
322
92
926
Nephrectomy and caval extension below liver
394
107
927
Nephrectomy and caval extension of tumour above liver
520
154
928
Nephrectomy with caval invasion
592
223
930
Nephrolithotomy
358
69
931
Percutaneous nephrolithotomy, unilateral
215
92
932
Percutaneous nephrolithotomy, bilateral
322
92
933
Percutaneous nephrolithotomy, staghorn
322
92
934
Percutaneous nephrostomy with or without antegrade pyelogram or stent placement
251
92
935
Peri renal tissues, exploration, open biopsy (no abnormality discovered)
215
92
I.P.
936
Percutaneous tract formation for renal stone removal
144
54
940
Pyelolithotomy
358
69
945
Pyeloplasty
394
92
950
Pyelotomy
215
69
955
Renal biopsy (needle)
72
38
Diagnostic
956
Renal cyst puncture and aspiration
107
54
960
Suprapubic cystostomy
107
69
I.P.
965
Suprapubic fistula, closure of
215
92
966
Transcatheter ablation of function of kidney
215
69
967
Transcatheter ablation of function of adrenal
215
69
970
Ureteric fistula, closure of (including uretero-vaginal and vesico - vaginal)
287
92
975
Ureterolithotomy
215
69
980
Ureterolithotomy (bilateral)
322
92
981
Ureterolysis (unilateral)
287
69
982
Ureterolysis (bilateral)
430
92
984
STING procedure
215
54
985
Ureters, transplantation of, (bilateral)
430
92
990
Ureter, transplantation of, (unilateral)
322
69
991
Stamey Raz urethropexy
215
69
995
Ureterostomy (unilateral)
215
69
1000
Ureterostomy (bilateral)
322
92
1005
Urethral rupture of (straddle injury), repair of
215
69
1010
Urethra rupture, repair of with fractured pelvis (orthopaedic surgeon)
358
154
1015
Urethral dilatation
36
38
I.P.
1020
Urethroscopy with treatment (diathermy)
72
38
I.P.
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
1025
Urethrostomy
144
54
I.P.
1030
Urethrotomy
72
42
l.P.
1031
Complex urodynamic evaluation involving cineradiology
72
54
Diagnostic
1032
Implantation of artificial urinary sphincter
358
69
1033
Whittaker test for evaluation of upper urinary tract obstruction
144
0
Diagnostic
1035
Vesicolic fistula, closure of
287
92
5845
Ileal conduit urinary diversion
430
131
5850
Cystoscopy and ureteroscopy
144
54
Diagnostic
5910
Lithotripsy, one or more sessions per hospital stay
215
69
5911
Lithotripsy including placement and removal of J stent and/or push ureteroscopy. one or more sessions per hospital stay
251
92
HEAD AND NECK
ARTERIES: (See also Neurological Section)
1041
Carotid body tumour greater than 4 cms
538
154
1042
Carotid body tumour less than 4 cms
394
92
CHEEK
1045
Cyst or benign tumour of cheek or mouth, excision of
54
38
1050
Malignant growth of cheek, full thickness/wide excision of
287
69
1051
Malignant growth of cheek, superficial, excision of
126
69
JAWS:See E.N.T. and Plastic Sections.LIPS: (see also Plastic Section)
1055
Cyst or benign tumour on lip, excision of
54
38
1058
Epithelioma of lip, lip shave
72
54
1059
Epithelioma of lip, wedge excision
144
54
1060
Epithelioma of lip, excision and flap reconstruction
287
69
NECK
1065
Branchial cyst, pouch or fistula, excision of
287
69
1075
Cysts or tuberculous glands of neck (deep to deep fascia) excision of
215
69
1080
Conservative neck dissection
287
107
1082
Radical neck dissection
342
107
1085
Thyroglossal cyst or fistula, excision of
287
69
1090
Torticollis, partial excision, open correction of
179
54
1095
Tuberculous caseous glands or sinuses, curettage of
72
38
PALATE: (See also Plastic Section)
1100
Laceration of palate, repair of
72
54
1105
Radical operation for malignant growth of palate
358
107
1104
Biopsy lesion of palate
34
38
MAXILLA
1106
Partial maxillectomy including plastic reconstruction
268
69
1107
Total maxillectomy includinq plastic reconstruction
358
107
PARATHYROID GLANDS
1110
Parathyroid adenoma, excision of
358
107
1111
Transcatheter ablation of function of parathyroid glands
215
69
1112
Parathyroid hyperplasia, excision of (4 glands - frozen section)
402
107
1113
Total parathyroidectomy with autotransplant or mediastinal exploration/intra-thoracic
475
107
1114
Parathyroid re-exploration
475
107
SALIVARY GLANDS
1115
Abscess of salivary gland, incision and drainage
54
54
1120
Fistula of salivary duct, repair of
251
54
1125
Parotid or submandibular duct, dilatation of
36
38
1126
Submandibular duct, relocation
358
107
1130
Excision of parotid tumour or parotid gland, lateral lobe, (enucleation of)
287
54
1133
Excision of parotid tumour or parotid gland, lateral lobe (superficial parotidectomy) with dissection and preservation of facial nerve
268
54
1134
Excision of parotid tumour or parotid gland, total, en bloc removal with sacrifice of facial nerve
340
75
1135
Excision of parotid tumour or parotid gland, total with dissection and preservation of facial nerve
412
92
1140
Salivary calculus, removal of
72
54
1150
Submandibular salivary gland, excision of
107
54
1151
Excision of sublingual gland
108
54
THYROID GLAND
1152
Thyroid cyst(s) aspiration/fine needle biopsy
29
0
I. P.
1154
Excision of thyroid cyst
252
92
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
1156
Percutaneous core needle biopsy of thyroid gland (for fine needle biopsy use procedure code 1152)
50
38
I.P.
Diagnostic
1155
Total/revision thyroidectomy
358
92
1157
Partial/subtotal thyroidectomy
344
92
TONGUE
1165
Excision of epithelioma of tongue with radical operation on glands
358
92
1170
Frenectomy (tongue tie)
36
38
1175
Hemiglossectomy
179
54
1176
Total glossectomy
358
92
1180
Growths of tongue, diathermy to
36
38
1185
Excision biopsy, oral cavity
54
38
I.P.
1186
Resection of tonsil, tongue base, palate, mandible and radical neck dissection
683
261
BREAST
1190
Abscess, incision and drainage of
54
38
1191
Breast cyst(s) aspiration/fine needle biopsy (diagnostic or therapeutic)
29
0
I.P.
1195
Percutaneous core needle biopsy of breast (for fine needle biopsy use procedure code 1191 )
54
54
I.P.
Diagnostic
1200
Cysts or benign tumours, excision of, or segmental resection
107
54
1205
Duct papilloma, excision
107
54
1210
Gynaecomastia (excision for), unilateral
134
54
1211
Gynaecomastia (excision for), bilateral
251
69
1214
Segmental mastectomy with axillary sampling
215
69
1215
Total mastectomy
215
69
1216
Mastectomy with axillary clearance
342
69
1217
Quadrant mastectomy with axillary clearance
342
69
1218
Mammographic wire guided breast biopsy
117
38
Diagnostic
LYMPHATICS
1310
Axillary/inguinal lymph node(s) superficial dissection of
73
42
I.P.
1315
Axillary lymph nodes complete dissection of
251
69
1320
Axillary or inguinal lymph nodes, incision of abscess
73
38
1326
Deep cervical node excision biopsy (not needle biopsy)
73
38
Diagnostic
1335
Inguinal or pelvic lymph node block dissection, unilateral
268
92
I.P.
1336
Inguinal or pelvic lymph node block dissection, bilateral
402
92
I.P.
1355
Lymphatic infusion
179
0
1365
Primary or secondary retroperitoneal, lymphadenectomy complete, transabdominal
430
92
I.P.
MUSCLES
1370
Haemangioma of muscle, excision and repair of
215
69
1375
Muscle, manipulation and stretching of
36
0
1380
Muscle, repair and suture of
144
54
1385
Muscle biopsy
54
38
Diagnostic
NERVES
(See also E.N.T.and Plastic Sections)
1390
Nerve biopsy
107
38
Diagnostic
1395
Nerve repairs (primary)
287
69
I.P.
1400
Nerve suture (secondary, including grafting and anastomosis)
322
69
1405
Neurectomy or local excision of neuroma
215
54
TENDONS
(See also Orthopaedic and Plastic Sections)
1410
Tendon repairs (primary) single
144
69
1415
Tendon repairs (primary) multiple
287
92
1420
Tendon sheath, incision of
72
38
1425
Tenotomy
72
38
1426
Tenolysis
144
69
VASCULAR
1427
Supra - renal aneurysm repair
573
223
1428
Repair of super renal aortic aneurysm rupture
573
223
1429
Tube graft repair of abdominal aorta
573
223
1431
Repair of ruptured abdominal aortic aneurysm
573
223
1432
Aorto bi-iliac bypass for atherosclerosis or aneurysm
573
223
1433
Aorto-femoral or bifemoral bypass for atherosclerosis or aneurysm
573
223
1434
Endarterectomy of abdominal aorta and iliac vessels
573
223
1436
Repair of ruptured iliac artery aneurysm
573
223
1437
Endarterectomy of iliac vessels alone
573
223
1438
Visceral artery repair, re-anastomosis or endarterectomy
573
223
1439
Renal artery anastomosis, endarterectomy or re-implantation or bypass
573
223
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
1156
Percutaneous core needle biopsy of thyroid gland (for fine needle biopsy use procedure code 1152)
50
38
I.P.
Diagnostic
1155
Total/revision thyroidectomy
358
92
1157
Partial/subtotal thyroidectomy
344
92
TONGUE
1165
Excision of epithelioma of tongue with radical operation on glands
358
92
1170
Frenectomy (tongue tie)
36
38
1175
Hemiglossectomy
179
54
1176
Total glossectomy
358
92
1180
Growths of tongue, diathermy to
36
38
1185
Excision biopsy, oral cavity
54
38
I.P.
1186
Resection of tonsil, tongue base, palate, mandible and radical neck dissection
683
261
BREAST
1190
Abscess, incision and drainage of
54
38
1191
Breast cyst(s) aspiration/fine needle biopsy (diagnostic or therapeutic)
29
0
I.P.
1195
Percutaneous core needle biopsy of breast (for fine needle biopsy use procedure code 1191 )
54
54
I.P.
Diagnostic
1200
Cysts or benign tumours, excision of, or segmental resection
107
54
1205
Duct papilloma, excision
107
54
1210
Gynaecomastia (excision for), unilateral
134
54
1211
Gynaecomastia (excision for), bilateral
251
69
1214
Segmental mastectomy with axillary sampling
215
69
1215
Total mastectomy
215
69
1216
Mastectomy with axillary clearance
342
69
1217
Quadrant mastectomy with axillary clearance
342
69
1218
Mammographic wire guided breast biopsy
117
38
Diagnostic
LYMPHATICS
1310
Axillary/inguinal lymph node(s) superficial dissection of
73
42
I.P.
1315
Axillary lymph nodes complete dissection of
251
69
1320
Axillary or inguinal lymph nodes, incision of abscess
73
38
1326
Deep cervical node excision biopsy (not needle biopsy)
73
38
Diagnostic
1335
Inguinal or pelvic lymph node block dissection, unilateral
268
92
I.P.
1336
Inguinal or pelvic lymph node block dissection, bilateral
402
92
I.P.
1355
Lymphatic infusion
179
0
1365
Primary or secondary retroperitoneal, lymphadenectomy complete. transabdominal
430
92
I.P.
MUSCLES
1370
Haemangioma of muscle, excision and repair of
215
69
1375
Muscle, manipulation and stretching of
36
0
1380
Muscle, repair and suture of
144
54
1385
Muscle biopsy
54
38
Diagnostic
NERVES
(See also E.N.T,and Plastic Sections)
1390
Nerve biopsy
107
38
Diagnostic
1395
Nerve repairs (primary)
287
69
I.P.
1400
Nerve suture (secondary, including grafting and anastomosis)
322
69
1405
Neurectomy or local excision of neuroma
215
54
TENDONS: (See also E.N.T. and Plastic Sections)
1410
Tendon repairs (primary) single
144
69
1415
Tendon repairs (primary) multiple
287
92
1420
Tendon sheath, incision of
72
38
1425
Tenotomy
72
38
1426
Tenolysis
144
69
VASCULAR
1427
Supra - renal aneurysm repair
573
223
1428
Repair of super renal aortic aneurysm rupture
573
223
1429
Tube graft repair of abdominal aorta
573
223
1431
Repair of ruptured abdominal aortic aneurysm
573
223
1432
Aorto bi-iliac bypass for atherosclerosis or aneurysm
573
223
1433
Aorto - femoral or bifemoral bypass for atherosclerosis or aneurysm
573
223
1434
Endarterectomy of abdominal aorta and iliac vessels
573
223
1436
Repair of ruptured iliac artery aneurysm
573
223
1437
Endarterectomy of iliac vessels alone
573
223
1438
Visceral artery repair, re-anastomosis or endarterectomy
573
223
1439
Renal artery anastomosis, endarterectomy or re-implantation or bypass
573
223
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
1441
Embolectomy of visceral branches, superior mesenteric or renal arteries
287
107
1442
Removal of infected aortic prosthesis
736
307
1443
Obturator bypass from aorta or iliac to profunda or distal femoral bypass
358
154
1444
Repair of abdominal aortic trauma
358
154
1446
Aortic exclusion by axillo-femoral bypass
358
154
1447
Endarterectomy of internal/external common carotid artery with or without shunt
573
223
1448
Patch repair of internal carotid artery
236
107
1449
Vertebral artery bypass or repair
528
154
1451
Open repair of subclavian artery
358
154
1454
Translocation of common carotid to subclavian artery
287
154
1456
Carotid subclavian bypass
287
200
1457
Subclavian/subclavian bypass
287
154
1458
Thoracotomy with repair of vessels of arch of aorta
573
223
1285
Intra arterial injection (excluding arteriography)
54
0
I.P.
1305
Renal stenosis, repair of
358
177
1306
Transcatheter embolisation
215
107
1307
Transcatheter removal of intravascular thrombus or foreign body
215
107
5866
Percutaneous angioplasty
215
131
VASCULAR - HEAD. NECK and UPPER LIMBS
1459
Subclavian to branchial bypass or endarterectomy
287
200
1461
Repair of subclavian aneurysm
287
200
1462
Brachial embolectomy
287
107
1463
Repair or bypass of brachial to radial or ulnar vessel
358
154
1464
Repair of trauma to brachial artery with endarterectomy patch or bypass
447
154
820
Arterial venous fistula in arm under L.A.
144
92
821
Gortex graft placement for AV access for dialysis
322
69
1290
Ligation of major vessels
179
54
1250
Arterial biopsy (temporal artery biopsy bilateral under L.A.)
72
54
Diagnostic
VASCULAR - LOWER LIMBS
1467
Femoral popliteal bypass, above knee vein
358
154
1468
Femoral to popliteal bypass, above knee synthetic
358
154
1469
Femoral to popliteal bypass, below knee vein
358
154
1471
Femoral to popliteal bypass, below knee synthetic
358
154
1472
Profundaplasty with or without patch or endarterectomy
358
154
1473
Common femoral artery endarterectomy
215
107
1474
Repair of femoral artery aneurysm
358
154
1280
Common femoral artery embolectomy
215
107
1476
Popliteal artery embolectomy
358
154
1477
Tibial artery embolectomy
358
154
1478
Femoral tibial artery bypass, including tibial-peroneal and peroneal artery bypass, or other distal vessels
573
223
1479
Popliteal aneurysm artery repair or bypass
358
154
1481
Femoral/femoral bypass
358
154
1482
Repair of femoral or popliteal vessels due to trauma
358
154
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
287
69
1484
As 1483 for one leg
198
54
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)
215
69
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) Ligation and division of the short saphenous vein at the sapheno
144
54
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) Ligation and division of the short saphenous vein at the sapheno
215
69
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)
144
54
1491
Cockett, Linton or Dodd procedure on perforators Ligation and division at the sapheno-femoral junction of the long
287
69
I.P.
1492
saphenous vein with ligation and avulsion of multiple varicose veins, one or both legs
144
54
1430
Iliac or femoral veins, removal of thrombus from
179
69
1435
Inferior vena cava, ligation or clipping of, with or without removal of thrombus
287
107
1440
Ligation and division of individual perforator
54
54
I.P.
1450
Portosystemic shunt
394
177
1455
Sclerosing operation on vein(s), one leg
36
0
I.P.
1460
Sclerosing operation on veins, both legs
54
0
I.P.
1465
Splenorenal anastomosis
358
177
1490
Varicose veins, exploration and removal of thrombus, unilateral
179
54
1495
Varicose veins, exploration and removal of thrombus, bilateral
215
69
1500
Venous pressure and blood volume studies
36
0
Diagnostic
SKIN and SUBCUTANEOUS TISSUES
1505
Abscess, cyst or tumour, aspiration of
36
38
1506
Angioma cauterisation or injection into, under general anaesthetic
36
38
1507
Angioma of skin and subcutaneous tissue or mucous surfaces, small, excision and repair of, under general anaesthetic
54
38
1508
Angioma of skin and subcutaneous tissue or mucous surfaces, large,.excision and repair of, under general anaesthetic
107
54
1509
Biopsy of skin, subcutaneous tissue and/or mucous membrane including simple closure
52
0
Diagnostic
1510
Excision and biopsy/curettage of a seborrhoeic keratosis / basal cell papilloma (single or multiple)
54
38
1513
Ellipse biopsy of the skin
70
0
Diagnostic
1514
Cryotherapy or curettage to solar or actinic keratosis or warts other than plantar (single or multiple)
54
38
1525
Foreign body, removal of
54
38
1540
Skin abscess, (superficial) incision and drainage of
54
38
1545
Keloid or other scar, excision of
54
38
1546
Enucleation of lipoma
72
54
1550
Malignant melanoma, wide excisional biopsy
107
69
1551
Malignant melanoma, wide excisional biopsy and graft
215
69
(See "LYMPHATICS" for block dissection of glands)
1555
Excision of pigmented naevi
54
38
1560
Incision and drainage of pilonidal abscess
52
38
1561
Pilonidal sinus or cyst, excision of
144
54
1565
Tubed pedicle flap, per stage
215
92
1570
Removal of foreign body from hand or foot under anaesthetic
54
54
1575
Basal cell carcinoma / squamous cell carcinoma, simple excision
107
69
1576
Basal cell carcinoma / squamous cell carcinoma, excision and graft or local flap
215
69
1577
Basal cell carcinoma / squamous cell carcinoma, curettage and/or electrosurgery
126
69
1580
Excision of a sebaceous cyst(s) (single or multiple)
72
38
1586
Laser treatment to naevi, initial patch test
54
38
1587
Laser treatment to naevi, each subsequent treatment session
107
38
1588
Excision of axillary skin for hyperhidrosis
144
54
1591
Hydradenitis suppurativa, excision and suture
89
38
1592
Hydradenitis suppurativa, excision and graft
215
69
1605
Surgical diathermy under general anaesthetic for any condition other than those listed separately
72
38
1610
Interstitial implant with radioactive source
72
54
1615
Wounds and sinuses, curettage of
54
38
1620
Wounds (multiple), suture or excision and suture
107
54
1625
Simple repair of superficial wounds
52
38
OTHER PROCEDURES
1630
Exchange transfusion
107
0
1635
Exchange transfusion (intra uterine)
144
0
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
1631
Hyperbaric oxygen therapy, initial, including full medical evaluation
107
0
1632
Hyperbaric oxygen therapy, subsequent, per session
36
0
1636
Intravenous immunoglobulin for patients with a haematological malignancy or immune deficiencies
35
0
1637
Blood transfusion for patients with a haematological malignancy or immune deficiencies
35
0
1638
Intravenous antibiotics for patients on cytotoxic chemotherapy regimens for malignant disease
35
0
1639
Electrolyte replacement for patients on cytotoxic chemotherapy regimens for malignant disease
35
0
1641
Therapeutic phlebotomy for patients with polycythemia rubra vera or haemochromatosis
36
0
1642
Isolated limb perfusion including exposure of major limb artery and vein, arteriotomy and venotomy
358
154
1645
Intracaviatory insertion with radioactive source (cranium, chest, abdomen )
215
69
1646
Plasmapheresis.
36
0
1657
Cytotoxic chemotherapy (combination therapy), infusion, for (a) initial day's treatment for a new patient, (b) first day's treatment of a new cycle of therapy, for an established patient, day care or in-patient.
52
0
1658
Succeeding days of cytotoxic chemotherapy (combination therapy) infusion treatment after the first day's treatment, day care or in-patient.
35
0
1663
Drainage of abscess or haematoma, (deep tissues) requiring general anaesthetic
72
38
4281
Bone marrow aspiration
36
38
Diagnostic
4282
Bone marrow biopsy
54
38
Diagnostic
4287
Bone marrow aspiration and biopsy
72
38
Diagnostic
4283
Allogeneic bone marrow transplantation, benefit includes all procedures and in-patient care
609
0
4284
Autologous bone marrow transplantation, benefit includes all procedures and in-patient care
501
0
4286
Bone marrow harvesting
107
69
I.P.
4288
Peripheral blood stem cell harvesting
107
0
I.P.
4291
Peripheral blood stem re infusion, benefit includes cytotoxic chemotherapy and in patient care
501
0
EAR, NOSE AND THROAT
EAR
(See also Plastic Section)
1665
Atresia of auricle, 2 or 3 stages, correction of (per stage)
251
69
I.P.
1666
Attico antrostomy, unilateral
358
107
1670
Ear polyp, excision of Ear toilet requiring use of operating microscope and micro
54
38
1671
inspection of tympanic membrane with or without general anaesthesia, unilateral or bilateral
54
38
I.P.
1675
Drainage external ear, abscess or haematoma
54
69
1680
External auditory canal excision of tumour
107
54
1685
External auditory canal removal of exostosis or osteoma
107
69
1686
Reconstruction of external auditory canal (meatoplasty) (e.g, for stenosis due to trauma, infection)
212
69
I.P.
1690
Facial nerve decompression (in temporal bone)
358
107
1695
Facial nerve graft (in temporal bone)
394
107
1700
Removal of foreign body from ear, under general anaesthetic
72
38
I.P.
1701
Labyrinthectomy; transcanal
266
92
1710
Mastoidectomy, radical with or without labyrinthectomy
358
107
1715
Mastoidectomy, simple
305
69
1730
Myringoplasty
251
92
I.P.
1735
Myringotomy
36
38
1740
Myringotomy (bilateral)
72
38
1741
Removal of drain tube(s) under general anaesthetic
36
38
1751
Pinna, total excision
144
54
1752
Pinna, partial excision with flap reconstruction
215
69
1753
Pinna, partial excision and graft
144
54
1755
Preauricular sinus, excision of
144
54
1760
Saccus endolymphaticus for Meniere's Disease
322
107
1765
Sebaceous cyst of ear, removal of
54
38
1770
Stapedectomy
430
92
1771
Stapedectomy with plastic reconstruction of ossicles
430
107
1790
Tympanoplasty
394
92
I.P.
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
5980
Combined approach tympanoplasty
466
107
1785
Myringotomy with insertion of grommet
107
42
1786
Myringotomy, bilateral, with insertion of grommets
161
54
1796
Electrocochleography
22
38
Diagnostic
NOSE
1800
Epistaxis anterior packing and/or cautery
72
38
I.P.
1805
Epistaxis posterior anterior packing and/or cautery
107
38
I.P.
1810
Epistaxis anterior ethmoid and/or internal maxillary ligation
144
54
I.P.
1815
Foreign body, removal under general anaesthetic
36
38
1820
Polypectomy, single
36
38
I.P.
1825
Polypectomy, multiple
107
38
I.P.
NOSE and ACCESSORY SINUSES
(See also Plastic Section)
1830
Accessory sinuses, open operations on, unilateral (including Caldwell Luc)
179
54
1840
Accessory sinuses, open operations on, bilateral (including Caldwell Luc)
268
69
1850
Antral biopsy
36
38
Diagnostic
1855
Antral puncture (antrotomy) and washout unilateral
72
38
I.P.
1860
Antral puncture (antrotomy) and washout bilateral
107
38
I.P.
1865
Antral lavage involving insertion of polythene tube (unilateral)
107
38
1870
Antral lavage involving insertion of polythene tubes (bilateral)
144
42
1875
Sinusotomy with or without biopsy, with mucosal stripping or removal of polyp(s)
107
54
1880
Nasal/Sinus endoscopy, surgical, with antrostomy (unilateral)
89
54
I.P.
1885
Nasal/Sinus endoscopy, surgical, with antrostomy (bilateral)
144
54
I.P.
1890
Repair of choanal atresia, intranasal
144
54
1895
Repair of choanal atresia, transpalatine
322
92
1896
Crawford tube insertion, unilateral
72
38
1897
Crawford tube insertion, bilateral
107
38
1900
Ethmoid area malignant tumour excision
179
92
1905
Nasal/Sinus endoscopy, with or without biopsy, polypectomy or debridement
72
54
I.P.
Diagnostic
1910
Ethmoidectomy extranasal (unilateral)
144
69
1915
Ethmoidectomy extranasal (bilateral)
215
92
1920
Ethmoidectomy intranasal (unilateral)
144
54
1925
Ethmoidectomy intranasal (bilateral)
198
69
1935
External frontal sinus exploration
358
69
1940
External frontal sinus operation for malignant disease
430
107
1945
External rhinotomy (with drainage of ethmoid frontal, or maxillary sinuses)
358
92
1968
Nasal septum insertion of prosthetic button
89
38
1969
Plastic repair of nasal septum
251
92
1970
Nasal septum, submucous resection of
144
54
1980
Naso pharyngeal tumour, excision of
430
223
1985
Oro antral fistula, closure of
358
54
1990
Cauterisation and/or ablation, mucous of turbinates, unilateral or bilateral, any method, superficial
72
38
I.P.
1992
Nasal/Sinus endoscopy, surgical with ethmoldectomy (partial or total)
205
92
1993
Nasal/Sinus endoscopy, surgical with frontal sinus exploration with or without removal of tissue from frontal sinus
228
92
1745
Nostril closure for atrophic rhinitis
144
54
4525
Rhinoplasty
322
92
I.P.
5975
Rhinoplasty, primary, including major septal repair
358
92
THROAT
1995
Abscess (retropharyngeal), incision and drainage (internal pharyngotomy)
72
54
1996
Bronchoscopy with bronchoalveolar lavage (includes irrigation of bronchial tree)
72
0
Diagnostic
1997
Bronchoscopy with transbronchial biopsy of lung
144
40
Diagnostic
2003
Bronchoscopy with combined bronchial and/or transbronchial biopsies and bronchoalveolar lavage
147
40
Diagnostic
1999
Bronchoscopy with laser ablation/ resection of tumour
215
69
2000
Bronchoscopy with brachytherapy or placement of radium source
215
69
2001
Bronchoscopy with selective bronchography
107
40
I.P
Diagnostic
2002
Bronchial provocation testing (histamine, methacholine etc.)
144
0
I.P.
Diagnostic
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
2011
Bronchoscopy with or without bronchial biopsy
72
40
I.P.
Diagnostic
2012
Bronchoscopy with or without bronchial biopsy (less than 2 years old)
92
54
I.P.
Diagnostic
2020
Bronchoscopy with removal of foreign body (includes foreign body removal by rigid endoscopy)
72
54
I.P.
Diagnostic
2030
Laryngoscopy
54
38
I.P.
Diagnostic
2040
Laryngectomy, all forms including vertical hemi laryngectomy and tracheostomy
501
200
2045
Larynx, microsurgery of
215
69
2050
Laryngofissure, external operation on
358
69
2055
Lateral pharyngotomy
287
69
2056
Direct operative laryngoscopy with operating microscope with or without biopsy, removal of foreign body, removal of lesion etc.
215
54
I.P.
2057
Vocal cord augmentation (injection of teflon)
161
54
2060
Oesophagoscopy
54
38
I.P.
Diagnostic
2065
Oesophagoscopy with biopsy and dilatation
89
54
I.P.
Diagnostic
2070
Oesophagoscopy with removal of foreign body
54
54
I.P.
2074
Upper G.I. endoscopy with oesophageal dilatation and lasertherapy
179
54
2075
Operative peroral endoscopy (including biopsy of larynx, trachea, bronchus, pharynx or oesophagus)
54
54
I.P.
2077
Oesophageal dilation and insertion of endoprosthesis
179
69
2079
Oesophagoscopy with multiple injection of oesophageal varices
107
69
5840
Oesophageal motility study
54
69
Diagnostic
2080
Papilloma or cyst of larynx, excision of
144
107
2081
Balloon dilatation of the oesophagus (includes endoscopy)
111
54
2085
Pharyngeal pouch or diverticulum, excision of
394
69
2090
Pharyngeal pouch or diverticulum endoscopic diathermy division
251
69
2096
Drainage and marsupialisation of cyst
161
54
2100
Pharyngolaryngectomy
538
261
2115
Incision and drainage, abscess; retropharyngeal or parapharyngeal
36
69
2125
Tonsils and/or adenoids (adults), removal of
161
54
2130
Tonsils and/or adenoids, removal of (children under 12 years)
126
54
2131
Tonsils or tonsils and adenoids, arrest of haemorrhage requiring general anaesthetic, following removal
89
54
2132
Tracheoesophageal puncture and insertion of prosthesis
126
54
2136
Transtracheal aspiration
72
0
Diagnostic
OTHER PROCEDURES
2126
Overnight oximetry
36
0
Diagnostic
2133
Kveim test including follow up punch biopsy of skin
52
0
Diagnostic
2134
Kveim test including follow-up ellipse biopsy of skin
70
0
Diagnostic
2137
Mantoux test, injection and follow up interpretation
52
0
Diagnostic
5895
Full pulmonary function studies carried out in a pulmonary function laboratory including report Prolonged post-exposure evaluation of bronchospasm after
70
0
Diagnostic
2141
exercise, with multiple spirometric determinations as in 5895 including measurement of thoracic gas volume and expired gas determinations
79
0
Diagnostic
2139
Full sleep study (polysomnography)
139
0
Diagnostic
GYNAECOLOGICAL OPERATIONS
CERVIX
2140
Cervix, amputation of
72
54
I.P.
2145
Cervix, biopsy of
36
38
I.P.
Diagnostic
2146
Cervix, cone biopsy of
72
54
I.P.
Diagnostic
2150
Cervical polypi, removal of
36
38
I.P.
2155
Cervix, dilatation of
36
38
I.P
2160
Cervix, local excision of lesion of
36
38
I.P.
2170
Cervix, suture of
54
38
I.P.
2171
Cervical cerclage
72
38
2175
Cervix, cautery of
36
38
I.P.
2180
Cervix, examination under anaesthesia
36
38
I.P.
Diagnostic
2181
Colposcopy
36
38
I.P.
Diagnostic
2182
Colposcopy and biopsy including Lletz procedure and/or laser therapy
54
38
Diagnostic
OBSTETRICAL
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
2185
Caesarean hysterectomy
430
131
2190
Caesarean section (grant In aid for obstetrician's fees) Ectopic pregnancy, surgical management (laparoscopic or open)
207
92
2200
salpingectomy and/or salpingo oophorectomy (unilateral or bilateral)
179
92
2205
Hydatidiform mole (hysterotomy)
144
92
2206
Vaginal delivery (grant in aid)
137
0
2207
Epidural anaesthesia for vaginal delivery
0
96
UTERUS and ADNEXA
2215
Aldridge sling operation
144
69
2220
Broad ligament, excision of cyst of
144
69
2225
Dilatation and curettage (diagnostic or therapeutic) Microsurgical repair of extensive tubal and peritubal disease
54
38
I.P.
2235
consequent on pelvic inflammatory disease and endometriosis including re-implantation of fallopian tube, unilateral Microsurgical repair of extensive tubal and peritubal disease
215
69
2240
consequent on pelvic inflammatory disease and endometriosis including re-implantation of fallopian tubes, bilateral Surgical repair of extensive tubal and peritubal disease consequent
322
92
2241
on pelvic inflammatory disease or endometriosis, unilateral or bilateral
228
69
2248
Hysteroscopy
54
38
2249
Transcervical endometrial resection
358
92
2250
Total abdominal hysterectomy Radical abdominal hysterectomy, with bilateral total pelvic
287
92
2255
lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)
484
131
2256
Total vaginal hysterectomy combined with anterior and posterior pelvic floor repair
466
92
2257
Total abdominal hysterectomy with unilateral or bilateral salpingo oophorectomy
466
92
2258
Resection of ovarian malignancy with total abdominal . hysterectomy, complete procedure
531
131
2259
Debulking of ovarian carcinoma with or without omenfectomy, complete procedure
380
131
2260
Sub total abdominal hysterectomy
287
92
2264
Total vaginal hysterectomy with urethropexy or urethroplasty
322
92
2265
Total vaginal hysterectomy
287
92
2267
Total vaginal hysterectomy and anterior or posterior pelvic floor repair
430
92
2270
Induction of radiation menopause
72
38
2273
Marlex sling procedure
144
69
2280
Myomectomy (multiple)
287
69
I.P.
2285
Myomectomy (simple, single)
251
69
I.P.
2289
Oophorectomy, unilateral or bilateral (complete or partial)
159
69
I.P.
2300
Ovarian cystectomy, unilateral or bilateral
179
69
I.P.
2319
Salpingectomy complete or partial, unilateral or bilateral
159
69
I.P.
2354
Salpingostomy or salpingolysis, unilateral or bilateral
228
69
I.P.
2364
Microsurgical tuboplasty (salpingostomy or salpingolysis), unilateral or bilateral
258
69
I.P.
2365
Salpingo oophorectomy, complete or partial, unilateral or bilateral
179
69
I.P.
2366
Salpingography and cannulisation for unblocking fallopian tubes, unilateral or bilateral
179
0
2370
Uterus, plastic reconstruction of
287
69
2375
Ventrosuspension/Gliliam's operation
144
69
I.P.
VULVOVAGINAL
2380
Atresia vaginae, relief of (including dilatation of vulva and vagina)
107
90
I.P.
2385
Bartholin's gland cyst, excision of
54
38
2390
Bartholin's or Skene's gland, abscess of, incision and drainage
54
38
I.P.
2391
Burch colposuspension
215
92
2395
Caruncle, vulvovaginal, removal of
54
38
I.P.
2400
Colporrhaphy with amputation of cervix, anterior and posterior (Manchester or Fothergill operation)
287
69
2410
Colpotomy
107
69
2415
Cystocele, repair of
144
69
I.P.
2420
Cystocele and rectocele, repair of (including colpoperineorraphy)
179
69
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
2425
Cysts or simple tumours of the vulva or vagina, excision of
72
38
2430
Hymenotomy
54
38
I.P.
2435
Hymenectomy
54
54
2440
Perineal tear complete repair of
215
54
2441
Partial vaginectomy
358
92
I.P.
2445
Rectocele, repair of
179
69
I.P.
2450
Stress incontinence, Marshall Marchetti, urethropexy for
215
92
2460
Vaginal fistulae (recto vaginal), repair of
179
92
2465
Vaginal fistulae (vesico vaginal), repair of
287
92
2470
Vaginal wall, suture of
107
54
2475
Vagina, plastic repair for dyspareunia
144
92
2480
Vulvectomy simple, without glands
287
92
2485
Vulvectomy radical, with glands
394
131
2486
Intracaviatory insertion of radioactive source, cervix, vagina or uterus
215
69
2484
Diagnostic laparoscopy with or without biopsy, with or without tubal irrigation/insufflation
108
69
I.P.
2488
Diagnostic laparoscopy with or without biopsy. This procedure also includes dilatation and curettage (diagnostic or therapeutic), with or without tubal irrigation/insufflation
146
69
I.P.
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.
126
69
I.P.
2489
As 2487 but including dilatation and curettage (diagnostic/therapeutic)
171
69
I.P.
OPHTHALMIC OPERATIONS
CONJUNCTIVA
2490
Conjunctival flap
72
38
2493
Conjunctivectomy
54
42
2495
Conjunctival graft
107
38
2498
Conjunctival tumour with or without graft
144
38
2496
Cryotherapy, unilateral
144
42
2497
Cryotherapy, bilateral
215
42
2500
Cyst/ Granuloma - excision of
54
38
2505
Foreign body - removal of, from conjunctiva
54
38
2520
Wounds, repair
72
54
2521
Symblepharon division
72
54
2526
Symblephora - division of (includes conjunctival graft)
144
69
2527
Conjunctival biopsy
54
42
ANTERIOR SEGMENT
2522
Removal of foreign body from anterior chamber, magnetic
287
69
2523
Removal of foreign body from anterior chamber, non-magnetic
287
69
2524
Removal of implanted material from anterior chamber
287
69
2525
Paracentesis of anterior chamber of eye with or without diagnostic aspiration of aqueous
107
54
I.P.
2580
Paracentesis of anterior chamber of eye for hyphaema with or without irrigation and/or air injection
179
38
2585
Paracentesis/Saemisch section etc.
179
38
2586
Reform anterior chamber secondary to trabeculectomy or post cataract surgery
179
38
CORNEA and SCLERA
2530
Corneal grafting - penetrating/lamellar
430
107
2531
Removal of sutures (late Stage) corneal/sclera
54
38
2532
Keratoprosthesis
440
69
2533
Epikeratophakia
440
69
2535
Corneal surface removed and EDTA application
72
38
2510
Pterygium removal
72
38
2511
Pterygium removal and conjunctival graft
144
42
2540
Comeal tattooing Ulcer/Recurrent erosion, surgical treatment/Cautery with or without
72
38
2548
pricking, with or without debridement, with or without cryotherapy - one or more treatments, per episode of illness
72
38
2546
Corneal scraping
72
38
2547
Corneal biopsy
72
38
2555
Corneal or scleral tumour, excision
179
69
2556
Perforating injury cornea and/or sclera not involving uveal tissue
179
54
2565
Perforating injury cornea and/or sclera with reposition or resection of uveal tissue
306
69
2566
Repair of scleral staphyloma with or without graft
430
69
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
2575
Foreign body, removal of, from cornea Keratotomy (Wedge resections, relaxing incisions etc; for the
54
38
2577
correction of abnormal refractive errors resulting from cataracts, corneal scars or post traumatic corneal astigmatism)
358
69
2579
Excimer laser therapy for corneal pathology, per course
215
54
EYELIDS
2589
Biopsy of eyelids
54
38
Diagnostic
2590
Chalazion - incision and curettage, one or more
72
38
2591
Botulinum injection for blepharospasm or to induce ptosis
89
38
2595
Ectropion
144
42
2600
Entropion
126
38
2596
Blepharophimosis - for pathology (not cosmetic)
188
69
2605
Epilation trichiasis
40
38
2606
Cryo to lash/electrolysis/ Removal lash follicle per course of therapy
79
38
2610
Injury to eyelid - repair (superficial)
54
38
2611
Opening of tarsorrhaphy
54
38
I.P.
2615
Injury to eyelid - repair (deep)
144
42
2620
Lid papilloma
144
42
2625
Superficial dermoid or cyst - excision of
107
38
2626
Canthotomy
31
0
I.P.
2630
Tarsorrhaphy
107
42
GLOBE
2635
Evisceration of eye
215
69
2640
Excision of eye plus implant
251
69
2645
Removal of intraocular foreign body
287
69
2660
Removal of eye
215
69
IRIS, CILIARY BODY and CHOROID OPERATIONS
2680
Division of anterior synechiae
179
54
I.P.
2685
Cyclodialysis
251
69
2696
Cyclocryotherapy/Diathermy
251
54
2700
Goniotomy
287
69
2710
Iridectomy
179
54
2711
Pupil reconstruction post trauma, post surgery
287
69
2725
Iris tumour, removal
287
69
2726
Iris biopsy
179
54
I.P.
2740
Trabeculectomy/Drainage procedure
287
54
2741
Laser trabeculoplasty, one or more treatments
251
54
2845
Local resection of ciliary body or choroidal tumour
215
42
2742
Trabeculectomy and tubes, etc.
424
54
LACRIMAL APPARATUS
2750
Canaliculus repair with or without tube
251
54
2755
Dacryocystorhinostomy with or without tubes
287
69
2756
Removal of D.C.R. tube
31
0
2760
Lacrimal abscess (dacryocystitis) incision
54
38
2761
Lacrimal sac, syringing and probing
72
38
2764
Intubation of nasolacrimal duct
287
54
I.P.
2766
Punctal closure with cautery or controller
54
38
2768
3 Snip operation of lacrimal punctum
72
38
2769
Correction of everted punctum: cautery only
54
38
2770
Lacrimal sac excision (dacryocystectomy)
287
54
2771
Lacrimal gland tumour excision
314
69
2772
Conjunctivo - dacryocystorhinostomy with Lester Jones tube
298
69
2775
Lacrimal sac. syringing
54
38
LENS
2779
Repositioning of intraocular lens
215
69
I.P
2780
Intraocular lens insertion not associated with concurrent cataract removal (secondary)
215
69
2785
Capsulotomy, needling (surgical)
107
69
2786
Revision of cataract wound
118
69
2795
Lens extraction
376
92
2802
Cataract extraction plus insertion of artificial lens (includes phacoemulsfication, etc.) For cataract extraction operations, all forms, where only monitored
466
92
2803
anaesthesia care is given, the anaesthetic benefit payable is shown opposite
0
38
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 YAG laser - for capsulotomy, pupil formation, iridectomy,
215
42
2647
membranectomy, ciliary body treatment, glaucoma, one or more treatments
215
0
2806
Argon laser therapy for pan -retinal photocoagulation of diabetic retinopathy (per course of therapy)
314
42
MUSCLES
2870
Routine squint operation, horizontal, vertical or oblique
287
69
2871
Transposition surgery - Jansens, Hummelsheim, Knapp procedure
393
69
2872
Adjustment post strabismus operation
95
38
2873
Botulinum toxin injection to extraocular muscles
89
38
2874
Muscle biopsy
79
38
I.P.
ORBIT
2890
Orbit, exenteration of
430
92
2895
Orbit, exploration of, including biopsy
215
54
2900
Orbit, removal of foreign body from
251
69
2905
Orbit, removal of tumour from (Kronlein's operation)
322
69
2910
Orbit, repair of fracture of
287
69
2911
Orbitotomy
440
92
2915
Orbit, repair of fracture of, with plastic implant
358
69
2912
Trans nasal wiring
354
69
2920
Radio Active Source application
144
42
POSTERIOR SEGMENT
2665
Prophylactic therapy for retinal detachment
298
54
2506
Removal of silicone oil
322
69
2675
Repair of retinal detachment - retinopexy with scleral buckling, scleral resection or scleral implant, etc. (For diathermy, cryotherapy or photocoagulation, use 2665)
538
107
2676
Vitrectomy
538
107
MISCELLANEOUS
2875
Retrobulbar, orbital floor, subconjunctival, subtenons and facial nerve injections
54
69
I.P.
2880
Examination of eye under general anaesthetic
54
38
I.P.
Diagnostic
2926
Fluorescein angiography
36
0
Diagnostic
DENTAL/ORAL SURGERY
2940
Dental cysts of maxilla or mandible
107
54
2950
Extraction of teeth (more than 6 permanent teeth) with or without alveolectomy
89
54
2980
Labial frenectomy with dissection of tissue
36
54
2985
Odontoma, excision of
89
54
3005
Root resection or apicectomy, single, with or without cyst removal and apical curettage
72
54
3010
Root resection or apicectomy, multiple, with or without cyst removal and apical curettage
107
69
3015
Reimplantation of tooth in socket with splinting
72
54
3020
Simple cysts or epulis, palate or floor of mouth, excision of
72
54
3025
Small tumours of dental origin, removal of, includes biopsy
54
54
3030
Tuberosities, reduction of
72
54
ORTHOPAEDIC OPERATIONS
HAND
(See also Plastic Section)
3035
Abscess or infected tendon sheath of palmar spaces, drainage of
54
38
3039
Synovectomy of metacarpophalangeal joints, (more than two joints) with release of ulnar intrinsic tendons
251
69
3040
Arthrodesis of joint
144
54
I.P.
3045
Arthroplasty using joint prosthesis single
144
54
3050
Arthroplasty using joint prosthesis two joints
215
69
3055
Arthroplasty using joint prosthesis more than two joints
322
75
3060
Bone tumours (benign), excision of
251
54
3070
Bursectomy
72
38
3075
Chondroma, excision of (multiple) with bone graft
251
69
3080
Chondroma, excision (single) with bone graft
179
54
3085
Exostosis, excision of
107
42
3095
Fracture of phalanges and/or metacarpals closed reduction
72
38
I.P.
3100
Fracture of phalanx single internal fixation
107
42
3105
Fracture of phalanges multiple internal fixation
179
69
3110
Ganglion of hand, surgical removal
107
38
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
3115
Manipulation for treatment of dislocation of metacarpophalangeal joint
36
38
I.P.
3120
Nail, removal of
36
38
3125
Nails, removal of all
72
38
3130
Application of plaster of Paris casts
36
38
I.P.
3135
Synovioma, excision of
107
54
3136
Tendon repair - flexor-double (hand)
246
69
3140
Traumatic amputation of finger - single - reconstructive operation
144
54
3145
Amputation of two or more fingers
287
69
3150
Trigger finger, correction of
72
54
3155
Whitlow incision and drainage
36
0
WRIST
3159
Arthroscopy of the wrist
144
54
Diagnostic
3160
Arthrodesis, using bone graft
322
75
3165
Arthroplasty
358
75
3170
Aspiration, wrist joint
36
38
3175
Bone grafting operation on scaphoid
215
69
3176
Herbert screw fixation, scaphoid
189
69
3180
Carpal bone (lunate scaphoid trapezium), excision of
144
54
3181
Trapezial joint replacement
430
75
3185
Carpal tunnel, decompression
107
54
3190
Carpus or peri carpal dislocations, manipulation
107
42
3195
Corrective osteotomy of lower end of radius
215
69
3200
Dislocation open reduction of
215
54
3205
Fracture (Colles') internal fixation of
144
69
3210
Fracture (Colles') manipulation and plaster of Paris
89
54
3211
Fracture of distal radius, external fixation of
108
38
3215
Injection, wrist joint
36
0
I.P.
3220
Ganglion, removal of aspiration
36
38
3225
Ganglion, removal of surgical
107
38
3229
Intercarpal fusion
189
69
3230
Nerve block for pain control
36
0
3235
Nerve median and ulnar nerve repair of
358
69
3240
Nerve median or ulnar nerve repair of
287
54
3245
Radial styloid, excision of
107
69
3250
Sympathetic block
72
0
3255
Synovectomy of wrist joint
215
69
3260
Tendon repair at wrist single
144
54
3265
Tendons repair at wrist multiple
215
69
3270
Tendon transfer about the wrist, single
179
69
3271
Tendon transfer about the wrist, multiple
268
92
3275
Ulna, lower end of (malunited Colles), excision of
107
69
3276
Smith's or Barton's fractures, internal fixation of
201
69
FOREARM and ELBOW
3280
Amputation through forearm
377
69
3285
Annular ligament, repair of
215
69
3290
Anterior capsulotomy and excision myositis ossificans
215
69
3295
Arthrodesis
358
69
3296
Arthroscopy, elbow, diagnostic, with or without synovial biopsy, removal of loose body or foreign body, synovectomy, debridement
144
54
3300
Arthroplasty
430
92
3305
Aspiration and injection forearm/elbow
36
38
I.P.
3315
Drainage of joint
72
42
3316
External fixation, upper limb
108
54
3320
Fracture forearm (complete) closed reduction and plaster of Paris
107
54
3325
Fracture forearm (greenstick) closed reduction and plaster of Paris
89
54
3330
Fracture about elbow, closed manipulation of
107
69
3335
Fracture dislocation, open reduction
287
69
3340
Fracture of forearm bones, open reduction of
358
69
3341
Open reduction, internal fixation and bone grafting (forearm & elbow)
417
92
3345
Fracture of lateral condyle, open reduction of
251
69
3350
Fracture of medial condyle, open reduction of
179
69
3355
Fracture (supracondylar), closed reduction of
107
54
3360
Fracture olecranon, screwing of
107
69
3365
Closed treatment of elbow dislocation
36
38
I.P.
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
3370
Nerve ulnar transplant
215
69
3375
Olecranon bursa, removal of
107
54
3380
Radius excision of head of
144
69
3381
Silastic interposition of radial head
265
69
3385
Synovectomy of elbow joint
287
69
3390
Tendon transplants about the elbow
179
54
3395
Tendon sheaths, removal of in forearm
179
54
3400
Tennis elbow advancement of extensor muscles
144
54
HUMERUS and SHOULDER
3401
Arthroscopy, shoulder, surgical, with removal of loose body or foreign body, synovectomy, debridement
215
69
3402
Arthroscopic suture capsulorrhaphy for anterior shoulder instability
430
107
3403
Arthroscopy, shoulder, diagnostic with or without synovial biopsy
144
54
Diagnostic
3404
Acromioplasty
215
69
5875
Shoulder replacement prosthesis
430
107
3405
Acromio clavicular joint, excision of
144
69
3410
Acromio clavicular joint, open reduction of
215
69
3411
Arthroscopic subacromial decompression
228
69
3412
Arthroscopic excision outer end clavicle
189
69
3413
Arthroscopic excision outer end of clavicle/subacromial decompression
265
69
3415
Amputation through arm
287
69
3420
Arthrodesis, humerus/shoulder
430
92
3425
Aspiration of joint, humerus/shoulder
36
38
3430
Biopsy, synovial, humerus/shoulder
54
38
Diagnostic
3435
Capsulotomy (acute capsulitis)
107
54
3440
Disarticulation, humerus/shoulder
430
92
3445
Dislocation, open reduction, humerus/shoulder
358
69
3450
Dislocation, acute, manipulation under general anaesthetic, humerus/shoulder
54
38
3455
Dislocation recurrent operation for, humerus/shoulder
358
69
3464
Forequarter amputation
456
92
3465
Fractured clavicle, closed reduction
89
38
3470
Fractured clavicle, open reduction
215
69
3475
Fractured humerus, open reduction with internal fixation
287
69
3480
Fractured humerus, open reduction and bone graft
358
69
3485
Fractured humerus, closed reduction
107
54
3490
Injection of joint, humerus/shoulder
36
38
I.P.
3495
Manipulation of humérus/ shoulder under general anaesthetic
36
38
I.P.
3500
Repair of capsule (in rotator cuff injuries) humerus/shoulder
322
69
3509
Saucerising humerus in chronic osteomyelitis
228
69
3510
Subacromial bursectomy
251
69
3515
Tendon transplant about shoulder
251
69
SPINAL REGION
3520
Anterior drainage of paravertebral abscess with bone graft
394
107
3521
Anterior release and fusion for scoliosis/kyphosis
759
261
3525
Antero lateral decompression
394
107
3526
Antero lateral decompression involving two or more levels
555
177
3530
Coccyx, excision of
215
54
3540
Epidural injection
89
0
I.P.
3541
Caudal injection
89
0
I.P.
3545
Epidural infusion with cannula
107
0
3550
Fracture or fracture dislocation of spine traction, reduction and plaster cast
394
92
3555
Fractured spine, open reduction of
394
177
3559
Chemonucleolysis for intervertebral disc
144
54
3560
Intervertebral disc, removal
251
92
3561
Needle aspiration of intervertebral disc
144
54
3563
Excision of thoracic intervertebral disc
538
200
3565
Laminectomy and exploration
358
92
3566
Neuralarch biopsy
92
38
3571
Posterior spinal fusion with instrumentation for scoliosis
759
261
3580
Spina bifida closure
358
69
3585
Spina bifida lumbar spinal osteotomy
358
107
3586
Spinal fusion, simultaneous combined anterior and posterior - one level, with instrumentation
759
261
3587
Spinal fusion, simultaneous combined anterior and posterior -multiple level with instrumentation
835
261
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
3588
Spinal fusion, simultaneous combined anterior and posterior fusion - one level without instrumentation
607
261
3589
Spinal fusion, simultaneous combined anterior and posterior fusion - multiple level, without instrumentation
759
261
3590
Spinal manipulation, under general anaesthetic
72
38
3592
External fixature of the spine
305
69
3593
Synthetic fusion (GRAF) one level
531
200
3594
Synthetic fusion (GRAF) two level
683
261
3598
Spinal fusion, multiple level, with internal fixation
759
261
3595
Spinal fusion
466
154
3596
Spinal fusion, in scoliosis spine, anterior and posterior
466
261
3597
Spinal fusion involving two or more levels
573
300
3600
Vertebral body biopsy
215
69
Diagnostic
3601
Spinal fusion, one level with instrumentation
501
261
3602
Removal of instrumentation
215
92
3603
Spinal stenosis decompression, one level
341
107
3604
Spinal stenosis decompression, two levels
380
107
SACRO - ILIAC JOINT REGION
3605
Arthrodesis, sacro iliac joint
394
92
3610
Aspiration, sacro iliac joint
36
38
3615
Biopsy of sacro iliac joint region
54
38
Diagnostic
3620
Injection, sacro iliac joint region
36
38
I.P.
3625
Pelvic osteotomy (bilateral) in ectopia vesica
358
107
HIP and FEMUR
3630
Acetabuloplasty shelf operation
251
92
3631
Internal fixation of acetabular fractures
609
300
3635
Acute dislocation manipulation for
107
42
3636
Congenital dislocation of hip, E.U.A. and P.O.P.
92
38
3640
Acute dislocation or fracture dislocation open reduction, hip/femur
358
107
3645
Above knee amputation
430
69
3650
Arthrodesis, hip/femur
501
92
3660
Arthroplasty of hip using prosthesis
430
107
3661
Revision of total hip arthroplasty, acetablar and femoral components with or without autograft or allograft
466
131
3665
Arthrotomy for loose body
287
69
3670
Colonna's arthroplasty
430
107
3675
Corrective osteotomy with or without internal fixation
358
107
3680
Curetting of greater trochanter and bursectomy
144
54
3685
Decompression operations or hanging hip operations
215
69
3690
Hind quarter amputation
501
154
3695
Drainage of hip joint for acute infection
144
54
3700
Exostosis of femoral neck in slipped femoral epiphysis, excision of
358
69
3705
Femoral condyle, osteotomy of
287
69
I.P.
3709
Fractured femur, hemiarthroplasty
430
107
3710
Fracture shaft of femur open reduction with internal fixation
358
69
3715
Fracture shaft of femur closed reduction with traction
144
69
3720
Fracture femur (supracondylar) open reduction of
358
69
3723
Fractured shaft of femur, closed intramedullary nailing
357
69
3724
Fractured shaft of femur closed intramedullary - interlocking nail
456
92
3725
Fracture of neck of femur intramedullary nail fixation of
322
69
3730
Fracture of femur (pertrochanteric or introchanteric) intramedullary nail fixation of
322
69
3731
Open treatment of anterior ring fracture and/or dislocation with internal fixation, (includes pubic symphysis and/or rami)
358
69
3732
Open treatment of posterior ring fracture and/or dislocation with internal fixation, (includes ilium, sacroiliac joint and/or sacrum)
471
154
3733
Pelvic fracture, external fixation
152
54
3735
Hip deformity, soft tissue operations for correction of
215
69
I.P.
3740
Injection or aspiration of the hip
36
38
I.P.
3745
Manipulation of hip closed, requiring general anaesthetic
36
38
3750
Open reduction and/or rotation osteotomy
358
69
3751
Open reduction, pelvic osteotomy and femoral shortening
501
92
3755
Pelvic osteotomy
430
92
3756
Modified innominate osteotomy including bone graft
501
92
3760
Pseudoarthroplasty of hip (Girdlestone operation)
322
107
3765
Slipped femoral epiphysis intramedullary nail, fixation of
322
69
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
3770
Slipped femoral epiphysis lower end stapling of
215
69
3775
Synovectomy of hip joint and debridement
322
69
3785
Transplantation of psoas muscle to greater trochanter (Mustard's or Sherrard's operation)
322
92
KNEE and LOWER LEG
3790
Below knee amputation
322
69
3795
Arthrodesis, knee
358
69
3810
Aspiration, knee/lower leg
36
38
3815
Baker's cyst excision of
215
69
3816
Bone transportation
305
69
3817
Removal of fixator device tibia
89
54
3819
Arthroscopy, knee, diagnostic, with or without synovial biopsy
126
54
Diagnostic
3820
Cartilage(s), removal of, knee
215
69
3821
Arthroscopy and removal of cartilage, knee
251
69
3822
Arthroscopy of the knee for removal of loose body or foreign body, synovectomy, debridement
198
69
5890
Ligament reconstruction at the knee joint
358
69
I.P.
5891
Ligament reconstruction of the knee joint using autogenous graft
358
69
I.P.
3825
Corrective osteotomy of tibia in region of knee
322
69
3830
Corrective osteotomy of tibia in region of ankle
251
69
3835
Cruciate ligaments repair
287
92
3836
Arthroscopic anterior cruciate ligament reconstruction
358
69
3837
Arthroscopic anterior cruciate ligament reconstruction and menisectomy
440
69
3838
Arthroscopic anterior cruciate ligament reconstruction and menisceal repair
471
69
3839
Arthroscopic menisceal repair
281
69
3840
Drainage of joint in acute infection
107
54
3845
Exploration of joint, knee/lower leg
179
54
3850
Fixed flexion of knee soft tissue operations for
287
69
3855
Fracture dislocation of knee joint, operations for
394
75
3860
Fracture of tibia (condylar) open reduction of
358
69
3865
Fracture of tibial shaft open reduction and internal fixation
358
69
3870
Fracture of tibial shaft closed reduction
107
69
3875
Injection of joint, knee/lower leg
36
38
I.P.
3880
Lateral ligaments, repair
251
69
3885
Manipulation under general anaesthetic, knee/lower leg
36
38
I.P.
3890
Osteochondritis dissecans Smillies operation for
144
54
3895
Patellectomy or open reduction of fractured patella
251
69
3900
Pre patellar bursa, removal of
144
54
3905
Plication of vastii, etc.
144
54
3910
Prosthetic replacement (total) of knee joint
430
107
3911
Revision of arthroplasty of knee joint with or without allograft one or more components
466
131
3912
Reconstruction of knee, (anterior cruciate)
358
69
3915
Quadriceps mechanism repair
251
69
3920
Slipped epiphysis, stapling of, or epiphysiodesis
287
69
3925
Slipped epiphysis (tibial and femoral combined) stapling of, or epiphysiodesis
358
69
3930
Slipped epiphyses (bilateral tibial), stapling of
287
69
3931
Slocum's or similar procedure
358
69
3935
Synovectomy
287
69
3940
Synovial biopsy, knee/lower leg
54
38
Diagnostic
3945
Tendon transplants about knee joint
287
69
3950
Transplant of tibial tubercle
287
69
ANKLE
3955
Arthrodesis of ankle joint
322
92
3956
Arthroscopy, ankle, with or without removal of loose body or foreign body, with or without synovectomy, debridement
161
54
3957
Arthroplasty (ankle)
212
69
3960
Aspiration and injection, ankle
36
38
I.P.
3965
Fracture of medial or lateral malleolus (1st degree Pott's fracture) internal fixation of
215
69
3970
Fracture of posterior malleolus (with or without fracture of other malleolus) internal fixation of
251
69
3971
Fracture of medial and lateral malleolus - open reduction and internal fixation of
265
69
3975
Fracture Pott's closed reduction
144
69
3980
Synovectomy and debridement
251
69
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
3985
Synovial biopsy, ankle
54
38
Diagnostic
3986
Talar fracture, open reduction and internal fixation of
251
69
3990
Tendo achillis, elongation of
215
69
3995
Tendo achillis, repair of
287
69
4000
Tendon transplants about the ankle joint and foot (multiple)
287
69
4005
Tendon transplants about the ankle joint and foot (single)
215
54
4010
Traumatic fracture and dislocation, open reduction of
287
69
4015
Unstable ankle Watson Jones operation for
287
69
CONGENITAL TALIPES EQUINOVARUS
4019
Astragalectomy
251
69
4020
Dwyer's Valgus osteotomy
215
69
4025
Manipulation and plaster fixation
54
38
4030
Manipulation and strapping
54
38
4035
Rotation osteotomy of tibia
287
69
4040
Soft tissue release
215
54
4045
Tarsal osteotomy
251
69
4050
Tendon transplant - single
215
54
4051
Tendon transplant - multiple
304
69
FOOT
4060
Arthrodesis of all inter phalangeal joints (Lambrinudi) unilateral
215
69
4065
Arthrodesis of all inter phalangeal joints (Lambrinudi) bilateral
322
92
4070
Arthrodesis of first metatarso phalangeal joint
144
54
I.P.
4075
Arthrodesis triple, in all its forms
358
69
4080
Arthrodesis, pantalar
430
92
4085
Claw foot (Steindlar) muscle stripping operations for
144
54
4090
Exostosis of first metatarsal (unilateral), removal of
107
54
4095
Exostosis of first metatarsal (bilateral), removal of
144
54
4100
Flat foot involving joint fusion, operation for
215
69
4101
Flexor tenotomy, single (foot)
76
38
4102
Flexor tenotomy, multiple (foot)
113
54
4103
Fracture of hindfoot, internal fixation, unilateral
228
69
4104
Fracture of hindfoot, internal fixation, bilateral
341
69
4105
Fracture of phalanges and/or metatarsals (closed reduction)
72
38
I.P.
4110
Fracture of phalanx and/or metatarsal (single) internal fixation of
107
54
4115
Fracture of phalanges and/or metatarsals (multiple) internal fixation of
215
69
4120
Ganglion of foot, excision of
72
38
4125
Hallux valgus and follow up, other than simple removal of exostosis (unilateral) operation for
215
54
4130
Hallux valgus and follow up, other than simple removal of exostosis (bilateral) operation for
287
69
4135
Hammertoe unilateral, correction of
107
54
4140
Hammertoe bilateral, correction of
161
69
4145
Grice's operation, subtalar bone block
107
54
4150
Ingrowing toe nail hemiphalangectomy
107
54
4155
Avulsion of nail plate, partial or complete, simple
35
0
4160
Ingrowing toe nail, removal of nail and nail bed
107
54
4165
Injection and manipulation, foot
36
38
I.P.
4170
Laprau's operation to correct position of toe
107
54
4175
Metatarsal heads, excision of all, and plastic correction of sole (unilateral)
161
54
4180
Metatarsal heads, excision of all, and plastic correction of sole (bilateral) (Hoffman's)
251
75
4181
Metatarsal joint replacement with prosthesis
358
69
4182
Metatarsal osteotomy, unilateral
152
54
4183
Metatarsal osteotomies, bilateral
228
75
4184
Chevron osteotomy - single
228
69
4185
Os calcis, osteotomy of (Dwyer)
215
69
4190
Os calcis and bursa, posterior exostosis of (unilateral) removal of
144
54
4195
Os calcis and bursa, posterior exostosis of (bilateral) removal of
215
69
4200
Plantar fascia, excision or division of (unilateral)
144
54
4205
Plantar fascia, excision or division of (bilateral)
215
69
4210
Plantar warts, surgical excision, one or more (not local application, cryotherapy etc.)
52
38
4211
Plantar warts, one or more, local application, per complete course of therapy
11
0
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
4215
Stamm's operation, unilateral
287
69
4220
Stamm's operation, bilateral
322
92
4225
Talectomy
287
69
4230
Tarsal osteotomy
179
54
4235
Tendon transplantation about the foot, multiple
287
69
4240
Tendon transplantation about the foot, single
215
54
4245
Tendon transplantation flexor and extensor all toes, unilateral
322
69
4250
Tendon transplantation flexor and extensor all toes, bilateral
394
92
4255
Trans metatarsal amputation of foot
215
54
4260
Trans metatarsal amputation of one toe
107
38
4261
Trans metatarsal amputation of two or more toes
215
54
MISCELLANEOUS
4264
Arthroscopy
72
54
Diagnostic
4265
Arthrotomy for removal of loose bodies
144
54
4270
Biopsy of tumour of long bones open
72
54
Diagnostic
4271
Costotransversectomy
205
54
4272
Excision of large malignant bone tumours for limb conservation
430
177
4273
Excision of large malignant bone tumours for limb conservation including prosthetic insertion
501
177
4275
Body plaster application
144
42
4280
Bone cysts excision
179
54
4285
Bursectomy large joints
144
75
4290
Chondroma removal
322
69
4295
Exostosis of long bones removal
144
54
4300
Fracture sternum and ribs operative reduction
179
92
4301
Limb lengthening (upper or lower limb) including osteotomy procedure and application of fixator devices
430
107
4305
Long bones, sequestrectomy, decortication or bone graft
322
69
4310
Osteomyelitis drilling of bones
161
54
4315
Osteomyelitis, marsupialisation and bone grafting
358
75
4320
Removal of plates, pins, screws, etc. (superficial)
89
54
4325
Removal of plates, pins, screws, etc. (deep)
215
69
4330
Trimming of stump following amputation of limb
107
54
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)
144
92
4340
Burns, over 10% body surface (equivalent of whole upper limb), excision and graft of
358
92
4350
Graft of extensive areas beyond 10%
430
92
4355
Graft of granulating areas less than 10%
179
54
4360
Major burns of face, excision and graft of
358
92
4365
Major burns of hands, excision and graft of
358
69
4370
Smaller areas, excision and graft of
215
54
BURNS - LATE DEFORMITIES
4385
Inlay grafts (ankle)
287
54
4390
Inlay grafts (elbow)
179
54
4395
Inlay grafts (fingers)
179
54
4400
Inlay grafts (knee)
287
54
4405
Scar excisions (per scar) flexion, elbows, fingers, groin, knees
144
54
4410
Z plasty (per scar) flexion, fingers, elbows, groin, knees
144
54
CLEFT LIP and PALATE
4415
Adjustment of lip margin
72
38
4420
Adjustment of scars, secondary
72
54
4425
Cleft palate reconstruction
287
92
4430
Complete cleft lip and anterior palate repair
358
92
4431
Primary repair, unilateral cleft lip
358
92
4432
Primary repair, bilateral cleft lip
376
92
4433
Secondary repair, unilateral cleft lip
358
92
4434
Secondary repair, bilateral cleft lip
376
92
4440
Fistula, secondary closure of
287
69
4460
Maxillary bone graft
358
107
4465
Nostril margin, secondary correction of
215
54
4466
Total cleft rhinoplasty
322
92
4470
Pharyngoplasty (not for snoring)
287
92
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
4475
Soft palate partial cleft, reconstruction of
251
69
BREAST RECONSTRUCTION
4479
Nipple reconstruction
198
69
4480
Breast reduction
501
92
4481
Breast augmentation (implants)
198
69
4482
Plastic repair of inverted nipple
215
42
4483
Transverse flap (TAIF or TRAM), reconstruction of breast, post mastectomy
430
177
4484
Mastopexy including full thickness graft from other areas
358
107
4485
Breast reconstruction, vertical rectus flap, post mastectomy
412
177
4486
Breast reconstruction, latissimus dorsi flap, with or without implant, post mastectomy
340
69
4487
Breast reconstruction, other flap, with or without implant, post mastectomy
340
69
4488
Breast reconstruction, implant only, post mastectomy
126
54
TISSUE EXPANDERS
4551
Insertion of expander including any subsequent injections of expander
322
69
4552
Removal of expander
107
54
4553
Removal of expander and inserting of expanded skin
233
69
EYELIDS
4490
Eyelid bags, repair of
251
54
FACIAL TRAUMA
4489
Facial trauma, suturing of facial nerve
287
75
4491
Facial trauma, suturing of facial nerve branch
251
69
4492
Facial trauma, grafting of facial nerve, sural nerve, greater auricular nerve
358
92
FACIAL TUMOURS
4493
Excision of facial nerve and graft, sural nerve, greater auricular nerve
412
92
DELAYED FACIAL REANIMATION - SKIN and DERMAL HITCHES
4494
Wedge excision of lower lip
251
75
4496
Nasolabial skin/dermal hitch
179
69
STATIC SLINGS
4497
Temporalis fascial sling, oral, nasolabial, ocular
466
154
4498
Orbicularis oris hitch
466
154
DYNAMIC SLINGS
4499
Masseter to oral angle, digastric to lower lip or temporalis to fascial slings
466
154
NERVE TRANSFERS
4500
Facial nerve graft (in face) (see E.N.T. operations for facial nerve graft in facial canal
430
107
4501
Cross facial nerve grafting, hypoglossal/facial nerve reanimation
609
223
COMPLEX FREE TISSUE TRANSFER
4502
Free muscle transfer, pectoralis minor, gracilis or extensor digitorum brevis as a second stage to 4501
609
223
4510
Facial reanimation in facial paralysis (unilateral)
466
107
OTHER PROCEDURES
4520
Moles or cysts, excision and suture (Plastic)
72
54
4530
Facial scars, dermabrasion, per scar
72
38
4535
Scars on face excision or Z plasty (3 or more)
251
69
4540
Scars on trunk excision or Z plasty
251
69
4545
Wounds of face suture (per wound)
72
38
EAR
4555
Accessory auricles, removal
72
38
4560
Epithelioma of ear, excision and reconstruction, lobule placement
144
54
4561
Cartilage graft(s), reconstruction of ear
322
75
4562
Ear reconstruction, further minor procedures
144
54
4575
Protruding ears correction with reconstruction of folds (bilateral)
268
69
4580
Protruding ears, correction of with reconstruction of folds (unilateral)
179
54
EYES
4585
Contracted socket
251
92
4590
Cyst of eyelids, excision of
72
38
4595
Enophthalmos bone graft
322
92
4605
Decompression, orbit
358
131
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
4610
Eyebrow graft
144
54
4615
Eyelids, repair of, for avulsion
144
54
4620
Eyelid, inlay grafts (one lid)
251
54
4625
Eyelid operations in facial paralysis
215
54
4630
Eyelid, total reconstruction of
358
69
4635
Muscle advancement for ptosis (unilateral)
268
69
4640
Naso lacrimal duct, reconstruction of
179
69
GENITO URINARY
4645
Ectopia vesica (reconstruction of bladder)
358
154
4650
Ectopia vesica (reconstruction of urethra) (per stage)
179
92
4655
Epispadias, correction of dorsal curvature
215
69
4660
Epispadias, reconstruction of urethra
215
69
4665
Hypospadias, correction of ventral curvature or chordee
215
69
4670
Hypospadias, fistula closure
215
69
4675
Hypospadias, reconstruction of urethra
251
69
4676
One stage hypospadias or epispadias repair with or without chordee, urethroplasty with skin graft repair
555
107
4680
Urethra, plastic reconstruction of
287
69
4681
Insertion of Jonas penile prosthesis
215
69
4682
Insertion of inflatable (multi component) penile prosthesis, including placement of pump, cylinders and/or reservoir
305
92
4685
Urethra, second stage, reconstruction of
358
69
4686
Cliteroplasty
304
92
4690
Vaginal reconstruction with skin graft
358
92
4691
Young Dee's Leadbetter operation
538
177
HANDS
4695
Congenital hand deformities reconstruction on each hand (per stage)
251
69
4700
Congenital hand deformities moderate repairs on each hand (per stage)
144
92
4705
Contractures extensive straightening of hand and inlay grafts
251
75
4710
Contractures, localised, division and graft
144
54
4711
Dermofasciectomy, removal of flexor, skin, full thickness skin graft including distal or full palm, one finger
287
92
4712
Dermofasciectomy, removal of flexor skin, full thickness skin graft including distal or full palm, one finger including simple fasciectomy to another finger
394
92
4715
Dupuytren's contracture fasciectomy (one or two fingers)
215
69
4720
Dupuytren's contracture fasciectomy (three or more fingers)
287
69
4721
Dupuytren's contracture, palm and fingers
304
69
4730
Injury to hand major multiple repair of tendons, nerves and skin
394
92
4735
Injury to hand, moderate, wound repair or graft
215
69
4740
Island grafting, for sensory loss, finger and/or thumb
394
92
4745
Neoplasm, major excision and repair with tendon grafts and flaps
430
92
4750
Neoplasm, localised excision and graft
215
69
4760
Nerve repair, primary, single or multiple
251
92
4765
Nerve repair in extensively scarred hand
358
92
4770
Opposition strut graft to thumb
287
69
4775
Palmar ganglion, compound, synovectomy of
287
69
4780
Policisation (finger replacement of lost thumb)
466
177
4785
Syndactyly, repair of (single)
287
69
4790
Syndactyly, repair of (multiple)
287
92
4795
Tendon grafting, single
251
54
4800
Tendon grafting, multiple
358
75
4805
Tendon repair, single
215
54
4810
Tendon repair, multiple
287
69
4815
Tendon transplants, for restoration of opposition
287
69
4820
Tendon transfers for paralysis, multiple
394
92
4825
Tube pedicle or flap reconstructions, first stage
322
92
4830
Tube pedicle or flap reconstructions, second stage
268
92
4835
Tube pedicle or flap reconstructions, final stage
358
69
4840
Wound suture of
72
38
MAXILLA and MANDIBLE
4845
Facial bone, simple fixation of undisplaced fracture (e.g. jaw sling)
107
54
4850
Facial bones, tumours of, major resection and/or reconstruction
430
107
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
4855
Fracture of maxilla or mandible, open reduction and fixation
287
69
4860
Fracture of maxilla or mandible, fixation of undisplaced
179
69
4865
Fracture of maxilla or mandible, malar bone or part of these, reduction without fixation
179
69
4870
Hypertelorism correction, sub cranial
501
223
4875
Mandible, excision of
358
107
4880
Maxilla or mandible, advancement or recession osteotomy of
287
223
4881
Maxillary and mandibular osteotomy
430
261
4885
Orbital floor, fracture of, reduction, direct wiring and build up from antrum
358
92
4890
Orbital floor, secondary bone grafting
287
69
4895
Osteomyelitis or abscess of facial bones, operation for
179
69
4900
Temporo mandibular joint, reduction of dislocation under general anaesthetic
72
38
4901
Arthroscopy, temporo mandibular joint for release of adhesions or arthroplasty, with or without biopsy
144
54
4905
Temporo mandibular joint, condylectomy for ankylosis
251
177
NOSE
4910
Bone graft
322
69
4915
Nasal tip deformities, correction of
251
54
4920
Fracture of nose, digital closed reduction
36
54
4925
Fracture of nose, instrumental closed reduction
54
54
4926
Fracture of nose, instrumental closed reduction with plaster of Paris fixation
72
54
4927
Fracture of nose, instrumental closed reduction with reduction of septum and plaster of Paris fixation
107
54
4930
Fracture of nose, open reduction
72
54
4935
Fracture of nose, open reduction with internal or external fixation
161
54
4940
Fracture of nose, open reduction with open reduction of fractured septum
251
54
4945
Reconstruction with imported flaps, partial
322
92
4950
Reconstruction with imported flaps, total
394
92
4955
Re fracture and open corrective rhinoplasty
358
92
SKIN REPLACEMENT AND RECONSTRUCTIONS
LOCAL GRAFTS and FLAPS
4956
Excision of lesion and split skin graft
144
69
4957
Excision of lesion and full thickness (Wolfe) skin graft
144
69
4958
Excision of lesion, local flap face
215
69
4959
Excision of lesion, local flap hand
215
69
4961
Excision of lesion, local flap limb
179
69
4962
Excision of lesion, local flap trunk
179
69
CUTANEOUS FLAPS
4963
Excision of lesion including scalp rotation flap
179
69
4964
Excision of lesion including cheek rotation flap
268
69
4966
Excision of lesion including cervicofacial rotation flap
268
69
4967
Excision of lesion including forehead flap
287
69
4968
Excision of lesion including deltopectoral flap
340
92
4969
Excision of lesion including groin flap
340
92
FASCIOCUTANEOUS FLAPS
4971
Fasciocutaneous flap upper limb
268
69
4972
Fasciocutaneous flap lower limb
268
69
4973
Fasciocutaneous flap trunk
268
69
(Flap repair is payable in addition to the primary operation for procedures 4974 to 4989
MYOCUTANEOUS FLAPS
4974
Myocutaneous flap, pectoralis
251
69
4976
Myocutaneous flap, latissimus dorsi
251
69
4977
Myocutaneous flap, latissimus dorsi with serratus and rib
268
69
4978
Myocutaneous flap, vertical rectus
268
69
4979
Myocutaneous flap, transverse rectus (TRAM)
251
69
4981
Myocutaneous flap, tensor fascia lata
268
69
4982
Myocutaneous flap, gluteal
268
69
FREE MICROVASCULAR FLAPS
4983
Free microvascular flap, radial forearm without bone
412
92
4984
Free microvascular flap, radial forearm with bone
448
107
4986
Free microvascular flap, latissimus dorsi
412
92
4987
Free microvascular flap, latissimus dorsi with serratus and rib
448
107
4988
Free microvascular flap, scapular
412
92
4989
Free microvascular flap, para scapular
412
92
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
(Flap repair is payable in addition to the primary operation for procedures 4953 and 4954)
4953
Free microvascular flap, fibula
412
92
4954
Free microvascular flap, deep circumflex iliac (DCIA)
412
92
REPLANTATION
4991
Replantation, per digit
412
92
4992
Replantation, hand (mid palm)
609
177
4993
Replantation, hand (wrist)
520
177
4994
Replantation, forearm
573
177
4996
Replantation, foot
573
177
4997
Replantation, scalp
412
92
4998
Replantation, ear
412
92
TRAUMA
4990
Major degloving injuries of limbs, excision and graft of
430
107
THORACIC OPERATIONS
LUNGS
5015
Lung abscess with thoracotomy, drainage of
394
200
5025
Pneumonolysis
251
154
5038
Refilling and maintenance of implantable pump or reservoir including access to pump port (see 5039)
54
0
5039
Implantation of catheter system and reservoir for administration of pain control therapy and/or chemotherapy
179
69
MEDIASTINUM
5041
Myocardial biopsy
179
75
Diagnostic
5055
Aortic endarterectomy
501
307
5065
Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter
80
0
I.P.
*
5801
Exploration of mediastinum
251
69
Diagnostic
5802
Endoscopic extirpation of lesion of mediastinum
251
69
Diagnostic
5803
Diagnostic endoscopic examination of mediastinum
251
69
Diagnostic
5804
Operation on lymphatic duct
366
107
5863
Thymectomy
394
107
5075
Blalock operation
430
307
5080
Cardiac catheterisation (left, right or both sides)
144
0
I.P.
Diagnostic
5090
Cardiac catheterisation and coronary angiography with or without ventriculography
207
0
I.P.
Diagnostic
*
5112
Cardiac catherisation and coronary angiography with or without ventriculography (including opacifaction of coronary bypass grafts)
234
0
I.P.
Diagnostic
*
5091
Cardioversion
89
54
5092
Venotomy and insertion of filter into the inferior vena cava
268
131
5093
Paediatric cardiac catheterisation (left, right or both sides)
215
107
Diagnostic
5094
Paediatric cardiac catheterisation and cardiac angiography combined
322
131
Diagnostic
5101
Coronary angioplasty, single or multiple vessel(s), with or without angiography with or without pacing
344
131
I.P.
*
5098
Recatheterisation post angioplasty/angiography (within 6 months)
73
54
I.P.
*
5855
Annuloplasty
430
300
Transcatheter placement of an intracoronary stent(s),
5103
percutaneous, with or without other therapeutic intervention, any method one or more vessel(s)
413
92
I.P.
*
5104
Intra coronary stent placement, post coronary angioplasty
394
92
Cardiac ultrasound, (echocardiography) m-mode, 2D including
5108
ventricular function, chamber dimensions, wall motion, doppler exam (pulse, continuous wave, colour flow) assessment of valve areas, pressure gradients, regurgitant fractions
91
0
I.P.
Diagnostic
*
5109
Cardiac ultrasound, transoesophageal
44
0
I.P.
Diagnostic
*
5110
Heller's operation
287
154
5113
Pericardial drainage
89
42
5114
Continuous pericardial drainage
151
54
5118
Atherectomy
609
200
5120
Mediastinum (cysts, etc.) and contents, any operation on (excluding biopsy)
501
154
5135
Mediastinoscopy and biopsy
251
69
Diagnostic
5136
Percutaneous transthoracic biopsy
72
38
Diagnostic
5137
Percutaneous transthoracic biopsy under CAT guidance
172
54
Diagnostic
5151
Percutaneous trans septal mitral valvuloplasty
358
131
5152
Valvuloplasty (other than mitral valvuloplasty)
430
131
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
5160
Oesophageal anastomosis
466
177
5870
Myocardial aneurysmyotomy
430
307
5161
Trachea oesophageal fistula repair of
466
261
5162
Repair, tracheo-oesophageal atresia
485
177
5163
Repair, tracheo-oesophageal fistula (TOF) alone (H-fistula)
424
177
5164
Repair, tracheo-oesophageal fistula (TOF) and atresia, replacement
608
307
5165
Oesophagectomy (all forms including three stage)
609
307
5170
Oesophagus, repair and short circuit
466
177
5171
Transection of oesophagus with repair, for oesophageal varices
358
177
5172
Oesophageal devascularisation
393
177
5180
Pott's operation
322
107
5190
Rashkind septostomy
287
250
5195
Resuscitation including electrical defibrillation and open cardiac massage
358
0
I.P.
5200
Transeptal left heart catheterisation
144
75
5205
Vagotomy (through chest)
287
154
5217
Needle biopsy, transthoracic
72
38
Diagnostic
5218
Needle biopsy, abdominal
72
38
Diagnostic
5219
Trans thoracic electro - cautery of subclavian chain for arm
340
107
HEART
5808
Transplantation of heart
1462
307
5809
Correction of tetralogy of fallot
573
307
5811
Atrial inversion for transposition of great vessels
609
307
5812
Other correction of transposition of great vessels
609
307
5813
Correction of total anomalous pulmonary venous connection
430
307
5814
Closure of defect of atrioventricular septum using dual prosthetic patches
573
261
5816
Closure of defect of interatrial septum
358
261
5817
Closure of defect of interventricular septum
573
261
5818
Planned repair of post infarction ventricular septal defect
573
261
5819
Emergency repair of post infarction ventricular septal defect
573
261
5821
Other open operations on the septum of the heart
358
261
5822
Creation of valved cardiac conduit
900
307
5823
Creation of other cardiac conduit
900
307
5824
Refashioning of atrium (Ebstein's)
358
261
5826
Operations on wall of atrium
358
261
5827
Excision of cardiac tumour
900
307
5828
Staged correction of hypoplastic left heart syndrome per stage
562
200
5829
Replacement of mitral valve (includes valvuloplasty)
501
307
5831
Plastic repair of mitral valve
501
261
5832
Replacement of aortic valve (includes valvuloplasty)
501
307
5833
Replacement of tricuspid valve (includes valvuloplasty)
501
307
5834
Replacement of pulmonary valve includes valvuloplasty valvotomy
787
307
5836
Open valvotomy
787
307
5837
Closed valvotomy
562
200
5838
Other open operation(s) on heart valves
787
307
5839
Double valves
573
307
5841
Removal of obstruction from structure adjacent to valve of heart
787
307
5842
Triple valves
573
307
5843
Valve and grafts
573
307
5844
Saphenous vein graft bypass for coronary artery(ies)
609
307
5846
Autograft bypass for coronary artery(ies)
609
307
5847
Allograft bypass for coronary artery(ies)
609
307
5843
Prosthetic bypass for coronary artery(ies)
609
307
5849
Connection of mammary artery(ies) to coronary artery(ies)
609
307
5851
Connection of other thoracic artery(ies) to coronary artery(ies)
609
307
5852
Correction of anomalous coronary arteries
609
307
5853
Other open operation(s) on coronary artery(ies)
609
307
5854
Map guided surgery for ventricular arrhythmias
900
307
5856
Exploration of heart
843
307
5857
Left ventricular aneurysmectomy
787
307
5858
Open operations on heart
787
307
5859
Insertion management and removal of ventricular assist device
562
200
5861
Insertion, maintenance and removal of aortic conterpulsation balloon pump
226
69
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
5862
Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial (single or dual chamber)
175
107
I.P.
*
5864
Insertion or replacement of pacemaker pulse generator
124
69
I.P.
*
5064
Insertion, replacement or repositioning of permanent transvenous electrode(s), single or dual chamber (15 days or more after initial insertion)
117
69
I.P.
*
5867
Removal of pacing system with bypass
562
200
I.P.
5868
Removal of permanent pacing system
135
69
I.P.
*
5069
Insertion of automatic implantable cardioverter/defibrillator
314
69
I.P.
*
5872
Excision of pericardium
358
261
5873
Decompression of cardiac tamponade (re operation for bleeding)
282
131
5874
Pericardiocentesis
107
42
5876
Transthoracic drainage of pericardium
226
69
5877
Incision of pericardium
226
69
5878
Rewiring of sternum
282
107
GREAT VESSELS
5879
Correction of truncus arteriosus
957
307
5871
Open correction of patent ductus arteriosus
394
261
5882
Closed correction of patent ductus arteriosus
394
281
5883
Creation of shunt to pulmonary artery from aorta using interposition tube prosthesis
422
154
5886
Connection to pulmonary artery from aorta
422
154
5887
Creation of shunt to pulmonary artery from subclavian artery using interposition tube prosthesis
422
154
5888
Connection to pulmonary artery from subclavian artery
422
154
5889
Repair of pulmonary artery/ PA De Banding
787
307
5884
Pulmonary artery banding
421
154
5892
Pulmonary embolectomy
843
307
5893
Open operations on pulmonary artery
358
300
5894
Extra anatomic bypass of aorta
676
307
5896
Replacement of ascending aorta
736
307
5897
Replacement of arch of aorta
736
307
5898
Replacement of aneurysmal segment of thoracic aorta
736
307
5899
Planned replacement of ascending aorta
957
307
5901
Planned replacement of arch of aorta
1013
307
5902
Replacement of aneurysm of aorta
843
307
5903
Other bypass of segment of aorta
736
307
5904
Revision operation of prosthetic aortic grafts
736
307
5962
Plastic repair of aorta (coarctation/ interrupted aortic arch)
394
261
CHEST WALL
5963
Repair of diaphragmatic hernia using thoracic approach
322
177
5907
Repair of congenital diaphragmatic hernia (anaesthetist benefit includes all pre-operative and post-operative intensive care for the child. The consultant anaesthetist should report all intensive care services using the Special Reporting Process, see pa
322
0
5908
Thoracoplasty one stage
322
131
5909
Excision of chest wall tumour
450
261
5912
Correction of pectus deformity of chest wall
466
107
5913
Reconstruction of chest wall
450
251
5914
Exploratory thoracotomy
198
92
5916
Resection of rib and open drainage of pleural cavity
251
92
5917
Repair of rupture of diaphragm
422
154
5918
Plication of paralysed diaphragm
338
154
TRACHEA
5919
Partial excision of trachea
731
307
5920
Reconstruction of trachea
787
307
5921
Tracheostomy permanent
179
69
5922
Insertion of mini tracheostomy
56
38
5923
Destruction of lesion of trachea by rigid endoscopy
84
54
5924
Dilatation of tracheal stricture by rigid endoscopy
84
54
5928
Therapeutic operations on bronchus or lung using rigid bronchoscopy
84
54
FIBREOPTIC ENDOSCOPIC PROCEDURES UNDER TOPICAL ANAESTHESIA
5931
Destruction of lesion of trachea
84
54
5932
Dilatation of tracheal stricture
84
54
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
5936
Dilatation of bronchial stricture by fibreoptic bronchoscopy
84
54
BRONCHI/LUNGS/PLEURA
5941
Total pneumonectomy
466
200
5942
Lobectomy of lung (including excision of segment)
466
200
5947
Removal of lung, with resection of segment of trachea followed by broncho-tracheal anastomosis (sleeve pneumonectomy)
607
307
5948
Removal of lung, with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy)
570
200
5943
Thoracoscopic lung resections
501
154
5944
Open excision of lesion of lung
466
200
5946
Decortication of pleura or lung
501
154
5949
Pleurectomy for pneumothorax, open
322
154
5951
Endoscopic examination of pleura
168
75
5952
Insertion of tube drain into pleural cavity
73
0
5953
Introduction of substance into pleural cavity with chest aspiration
73
0
5954
Introduction of substance into pleural cavity with chest drain
73
0
REVISION SURGERY
5956
Revision coronary artery surgery
609
307
5957
Revision repair of coarctation of aorta
394
261
5958
Revision closure of defect of intra ventricular septum
573
261
5959
Revision of valve surgery
573
307
PLEURA
5220
Apicolysis
251
107
5221
Closed pleural biopsy
72
0
Diagnostic
5230
Empyema, drainage
251
154
I.P.
5231
Percutaneous drainage of empyema
72
0
5234
Paracentesis thoracis
36
0
I.P.
Diagnostic
5235
Paracentesis thoracis with intercostal drain
107
0
I.P.
Diagnostic
5240
Paracentesis thoracis with infusion of cytotoxic drugs
107
0
5245
Phrenic avulsion
107
107
I.P.
5250
Pleurodesis
179
150
5251
Closed drainage of pneumothorax
107
0
5260
Thoracoscopy
179
69
I.P.
Diagnostic
5265
Thoracoscopy with intrapleural procedure
251
107
5270
Thoracotomy including lung or pleural biopsy
251
107
I.P.
Diagnostic
5274
Exploration for post operative haemorrhage or thrombosis, chest
287
107
ULTRASOUND/VASCULAR STUDIES
5926
Full mapping
609
223
Diagnostic
5930
Lower limb arterial ultrasound examination
54
0
Diagnostic
5935
Venous ultrasound examination
54
0
Diagnostic
5940
Duplex ultrasound scan
107
0
Diagnostic
5960
Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement
253
69
I.P.
*
5961
Intracardiac catheter ablation of arrhythmogenic focus for treatment of supraventricular of ventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combinatio
365
107
I.P.
*
5502
Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, HIS bundle recording, including insertion and repositioning of multiple electrode catheters
175
0
I.P.
Diagnostic
*
NEUROSURGICAL OPERATIONS
BRAIN and MENINGES
5290
Aneurysms (direct operations)
609
261
5292
Detachable balloon occlusion of carotico cavernous aneurysms and fistulae
358
107
5295
Anomalies (direct operations) including haemangioma
609
261
5305
Biopsy of brain
358
177
Diagnostic
5320
Brain tumour (all forms not otherwise listed)
430
261
5325
Brain wounds, open
466
177
5330
Calcified subdural haematoma, excision of
394
177
5345
Carotid ligation. neck
215
69
I.P.
5350
Carotid ligation, removal
144
69
5360
Cisternal puncture
179
54
I.P.
5365
Convexity meningioma, excision of
430
223
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
5370
C.S.F. Rhinorrhea repair
466
92
5376
Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery
573
223
5377
Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array)
725
223
5380
Glioma biopsy
394
177
Diagnostic
5385
Glioma (lobectomy)
394
223
5390
Glioma (part removal)
394
223
5400
Hemispherectomy
573
223
5410
Intra cerebral haemorrhage, open operation
394
177
5415
Intra cerebral and intracerebellar tumours not otherwise listed
394
261
5420
Intracranial abscess (open operation)
394
177
5425
Intracranial abscess (tapping)
358
92
5430
Intraventricular tumours, excision of
394
223
5435
Leucotomy
358
223
5440
Meningocele, repair of
358
131
5446
Direct lateral cervical puncture of c1 and c2 levels as for cervical myelogram
107
54
5450
Myelomeningocele, repair of
358
131
5455
Other extra cerebral intracranial tumours, excision of
394
261
5460
Parasagittal meningioma, repair of
430
223
5465
Pinealoma, excision of
394
177
5470
Pituitary gland, hypophysectomy all approaches
538
177
5480
Posterior fossa tumours, removal of
430
261
5484
Stereotactic computer assisted volumetric intracranial procedure (List separately in addition to code for primary procedure)
89
0
5490
Subdural haematoma (burr hole drainage)
358
92
5495
Subdural haematoma (open operation)
394
177
5500
Subdural tap (infant)
179
54
5505
Tentorial decompression
430
177
5510
Third ventriculostomy
430
177
5515
Torkilsden shunt
430
92
5520
Valve shunt (hydrocephalus)
287
92
5525
Valve shunt revision
287
92
5535
Ventricle puncture (fontanelle)
179
54
I.P.
5540
Ventriculography (adult)
179
54
I.P.
Diagnostic
5545
Ventriculography (child under 12)
179
54
I.P.
Diagnostic
CRANIAL NERVES
5555
Acoustic neuroma, removal of
609
261
5560
Auditory nerve, etc. (section)
430
131
5565
Differential section, facial nerve
322
131
5575
Injection trigeminal branch (peripheral)
72
0
5580
Injection trigeminal division
179
0
5585
Injection trigeminal ganglion
287
0
5590
Intracranial sensory root division (trigeminal)
430
223
5600
Peripheral nerve repairs
287
69
5605
Peripheral nerve tumour, excision of
251
69
5610
Sensory nerve neurectomy
215
54
5611
Rhizolysis, one or more facet joints
144
69
5615
Nerve block for pain control
72
0
5620
Sympathetic block including coeliac ganglion and stellate ganglion
107
0
5621
Intravenous block (Biers technique)
107
0
5622
E.C.T. (each session)
36
38
SCALP
5630
Cirsoid aneurysm scalp, repair of
358
69
5635
Laceration, suture of (per laceration)
54
38
SKULL
5645
Burr holes (diagnostic)
179
92
I.P
Diagnostic
5650
Burr holes (therapeutic)
358
92
I.P
5660
Craniotomy
538
261
5665
Depressed skull fracture (dural involvement)
287
131
5670
Depressed skull fracture, (simple) operation for
287
92
5675
Extradural haematoma, evacuation of
394
177
5690
Osteoma calvarium. excision of
358
92
5691
Consultant plastic surgeon cranio facialplasty, including the correction of craniosynostoses and facial synostoses
501
223
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
5692
Consultant neurosurgeon neurosurgical involvement with cranio facialplasty (for Anaesthetist Benefit see 5691 )
358
0
5693
Skull bone grafting to facial skeleton
340
92
5695
Platybasia, repair of
358
54
5700
Skull biopsy
179
54
I.P.
Diagnostic
5705
Skull defect repair
358
69
5710
Subtemporal decompression
322
92
5715
Suture splitting
322
92
SPINAL CORD
5719
Chemical lumbar sympathectomy
107
0
5725
Anomalies of cord vascular, operation for
609
177
5730
Cervical disc, partial excision of or fusion
394
154
5731
Cervical disc, excision of two or more levels
724
154
5732
Microneurosurgical subarticular fenestration and foraminal decompression including microdisectomy
491
177
5740
Chordoma (spinal), removal of
358
177
5745
Cord tumours, removal of
430
177
5746
Dumbbell tumours, transthoracic or abdominal removal
358
177
5755
Haematomyelia, aspiration of
394
107
5756
Intrathecal cytotoxic, chemotherapy infusion
126
42
5760
Lumbar puncture
54
70
I.P.
Diagnostic
5761
Cervical sympathectomy (unilateral)
322
92
5762
Cervical sympathectomy (bilateral)
376
92
5763
Exploration of the brachial plexus with removal of tumours
466
177
5765
Lumbar sympathectomy
322
69
5770
Lumbar sympathectomy (bilateral)
376
92
5771
Nerve root tumours, transthoracic or abdominal removal
358
177
5775
Spinal posterior rhizotomy
322
131
5785
Syringomyelia. aspiration of
394
177
NEUROLOGICAL ASSESSMENT
5880
EMG
72
0
Diagnostic
5881
Electromyography study rectal mucosal sensitivity testing
72
0
Diagnostic
5905
Video telemetric EEG recordings including full clinical evaluation and placement of sphenoidal electrodes
251
69
5906
Video telemetric EEG recordings including full clinical evaluation following placement of sub dural electrodes.
179
0
UROLOGY PROCEDURES
KIDNEY
925
Simple Nephrectomy
322
92
920
Hemi nephrectomy
251
92
921
Radical nephrectomy (includes adrenalectomy and para-aortic lymph nodes)
380
107
926
Radical nephrectomy and caval extension below liver
394
107
927
Radical nephrectomy and caval extension of tumour above liver
520
154
929
Nephroureterectomy including bladder cuff
475
107
930
Nephrolithotomy
358
69
931
Percutaneous nephrolithotomy
215
92
935
Peri renal tissues, exploration, open biopsy (no abnormality discovered)
215
92
I.P.
940
Pyelolithotomy
358
69
945
Pyeloplasty
394
92
955
Renal biopsy (needle)
72
38
Diagnostic
5910
ESWL, one or more sessions per hospital stay or as an outpatient up to 3 months
215
69
ADRENAL GLANDS
95
Adrenalectomy (unilateral)
287
107
I.P.
100
Adrenalectomy (bilateral)
358
107
I.P.
101
Adrenalectomy for phaeochromocytoma
287
107
106
Neuroblastoma, tru cut biopsy
66
38
Diagnostic
107
Neuroblastoma. resection
456
177
TRANSPLANTATION
923
Kidney transplant
501
200
URETER
5850
Ureteroscopy, diagnostic, with or without biopsy
110
54
Diagnostic
5911
Ureteroscopy & contact lithotripsy with placement/removal of J stent, one or more sessions per hospital stay
251
92
975
Open ureterolithotomy
215
69
981
Ureterolysis (unilateral)
287
69
982
Ureterolysis (bilateral)
430
92
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
983
Ureteric reimplantation, unilateral for reflux, stricture or fistula
342
92
I.P.
986
Ureteric reimplantation, bilateral for reflux, stricture or fistula
456
92
I.P.
984
STING procedure (initial)
215
54
987
STING procedure (repeat)
107
38
995
Ureterostomy (unilateral)
215
69
1000
Ureterostomy (bilateral)
322
92
996
Ureteric substitution (with bowel segment)
380
92
BLADDER
836
Bladder, instillation of anticarcinogenic agent (8CG)
42
38
898
Percutaneous suprapubic cystostomy
45
38
I.P.
1031
Complex urodynamic evaluation, involving cineradiography
72
54
Diagnostic
884
Cystoscopy with or without overdistension, with or without biopsy
54
38
I.P.
Diagnostic
890
Cystoscopy with ureteric catheterisation
72
54
885
Cystoscopy with diathermy to bladder tumour(s)
89
54
I.P.
887
Cystoscopy with insertion of JJ stent
91
54
881
Cystoscopy with removal of JJ stent
76
54
895
Cystoscopy with or without ureteroscopy and removal of ureteric calculus
144
54
I.P.
960
Open suprapubic cystostomy
107
69
I.P.
924
Litholapaxy
215
69
897
Open cystolithotomy
152
69
855
Primary transurethral resection of bladder tumour(s), one or more
215
69
910
Excision of bladder diverticulum
287
69
901
Closure of ruptured bladder (intraperitoneal)
286
69
865
Cystectomy, partial
251
69
875
Cystectomy with ileal or sigmoid conduit and bowel anastomosis
484
200
877
Cystectomy with continent diversion with or without construction of neobladder
609
223
906
Augmentation cystoplasty
358
200
899
Substitution cystoplasty
569
200
5845
Ileal conduit and bowel anastomosis
365
131
4645
Closure of bladder exstrophy
620
177
4691
Young - Dees operation
475
177
902
Bladder, implantation of radioactive sources, simple, one to four sources
87
38
903
Bladder, implantation of radioactive sources, intermediate, five to ten sources
131
54
904
Bladder, implantation of radioactive sources, complex, greater than ten sources
193
54
PROSTATE
713
Biopsy of prostate (perineal) or transrectal)
45
38
I.P.
Diagnostic
711
Electro ejaculation procedure
72
38
907
Bladder neck, transurethral incision of
152
54
850
Bladder neck, transurethral resection of
144
54
700
Transurethral prostatectomy
287
69
708
Open prostatectomy
365
107
701
Radical retropubic nerve sparing prostatectomy (includes bilateral pelvic lymph adenectomy with bladder neck reconstruction and anastomosis to the urethra)
430
177
URETHRA
1015
Urethral dilatation
36
38
I.P.
665
Meatotomy
54
38
I.P.
664
Meatoplasty
143
69
1030
Optical urethrotomy
72
42
I.P.
666
Urethroplasty for penile or bulbar urethral stricture
286
92
667
Acute repair of rupture of membranous urethra
286
92
668
Urethroplasty for repair of prostatic or membranous urethral stricture, complete procedure
456
154
703
Insertion of an endo urethral stent for urethral stricture
108
42
1032
Implantation of artificial urinary sphincter
358
69
676
Removal of artificial urinary sphincter
152
54
4670
Hypospadias, fistula closure
215
69
677
Hypospadias - MAGPI procedure
215
69
4675
Hypospadias, reconstruction of urethra
251
69
4660
Epispadias, reconstruction of urethra
215
69
Code
Surgical Procedure
Procedure Benefit IR£
Surgical
Anaesthetic
4676
One stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap
475
107
MALE GENITAL TRACT
681
Injection of corpora cavernosa with pharmacologic agent(s) (e.g. papaverine, phentolamine)
36
688
Biopsy of penis
45
38
I.P.
Diagnostic
695
Prepuce, dorsal incision of
54
38
696
Release of priapism (needle drainage)
54
38
663
Circumcision
72
54
686
Chordee release of
144
69
693
Nesbit procedure (plastic operation on penis to correct angulation)
212
69
4681
Insertion of malleable penile prosthesis
215
69
4682
Insertion of inflatable penile prosthesis
305
92
694
Removal of penile prosthesis
212
69
685
Penis, amputation of partial
179
69
687
Penis, amputation of - total
358
69
650
Hydrocele (tapping)
36
655
Hydrocelectomy, bilateral
185
69
I.P.
660
Hydrocelectomy, unilateral
129
54
I.P.
698
Excision of epididymal cyst(s) unilateral or bilateral
167
54
I.P.
645
Epididymectomy, unilateral
145
54
I.P.
699
Epididymectomy, bilateral
212
69
I.P.
755
Varicocelectomy
179
54
704
Epididymovasostomy, bilateral
266
92
715
Orchidopexy, unilateral
107
69
I.P.
720
Orchidopexy, bilateral
144
69
I.P.
735
Orchidopexy, unilateral for torsion and exploration of opposite side
178
69
740
Testicular biopsy (needle)
54
38
I.P.
Diagnostic
741
Testicular biopsy (open surgical)
107
38
I.P.
Diagnostic
742
Testicular prosthesis, insertion /replacement/removal of, unilateral
144
38
743
Testicular prosthesis, insertion /replacement/removal of, bilateral
178
69
675
Orchidectomy, unilateral
107
54
I.P.
670
Orchidectomy, bilateral
144
69
I.P.
672
Drainage of intra-scrotal abscess
45
I.P.
FEMALE GENITAL TRACT
2415
Cystocele, repair of
144
69
I.P.
991
Urethropexy for genuine stress incontinence (Stamey, Raz, Burch, Marshall-Marchetti)
215
69
992
Pubovaginal sling urethropexy
307
69
2465
Vaginal fistula (vesico vaginal), repair of
287
92
4690
Vaginal reconstruction with skin graft
358
92
993
Vesico colic fistula - excision of, and sigmoid colectomy
358
92
MISCELLANEOUS
820
Arterial venous fistula in arm under L.A.
144
92
821
Gortex graft placement for AV access for dialysis
322
69
822
Permacath Hickman catheter for dialysis
179
69
834
Insertion/replacement of Tenchkoff catheter for dialysis
144
69
838
Removal of Tenchkoff catheter
144
69
LYMPHATICS
1310
Axillary/inguinal lymph node(s) superficial dissection of
73
42
I.P.
1320
Axillary or inguinal lymph nodes, incision of abscess
73
38
1326
Deep cervical node excision biopsy (not needle biopsy)
73
38
Diagnostic
1315
Axillary lymph nodes complete dissection of
251
69
1335
Inguinal or pelvic lymph node block dissection, unilateral
268
92
I.P.
1336
Inguinal or pelvic lymph node block dissection, bilateral
402
92
I.P.
1355
Lymphatic infusion
179
1365
Primary or secondary retroperitoneal lymphadenectomy complete, transabdominal
430
92
I.P.
TABLE C.3
Code
Radiological Procedure
Procedure Benefit IR£
Radiological
Anaesthetic
ALIMENTARY TRACT
6000
Plain film, abdomen
11
6001
Plain film abdomen complete, including decubitus and/or erect views
22
SINGLE CONTRAST STUDIES(BARIUM OR WATER SOLUBLE)
6005
Ba. enema
33
6015
Ba. meal
22
6020
Ba. meal and follow through or small bowel study
33
6025
Ba. swallow
22
6060
Small bowel enema
46
6066
Defaecating proctogram
64
DOUBLE CONTRAST STUDIES
6010
Ba. enema, double contrast
46
6011
Ba. enema, therapeutic forreduction of intussusception
64
6021
Ba. meal (double contrast)
33
6030
Ba. swallow and meal
33
6035
Cholecystogram
22
6040
Screening crosbie capsule
22
6045
Screening diaphragm
22
6070
T - tube cholangiogram
22
6055
IV cholangiogram
33
CHEST
6075
Chest and ribs
11
6079
Chest, PA and lateral
11
6080
Chest, PA and lateral with flouroscopy
22
6085
Chest, PA lateral and apical-
11
6086
Chest, complete, minimum of four views
22
6090
Larynx
11
6095
Sternum and chest
11
6100
Thoracic inlet
11
C.T. SCANS
6102
Brain, without contrast
64
42
6103
Brain, with contrast material
100
42
6104
Orbit, sella or outer, middle, or inner ear, without contrast (except if done at same time as 6102 or 6103)
64
42
6106
Orbit, sella or outer, middle, or inner ear: with contrast material (except if done at same time as 6102 or 6103)
100
42
6107
Maxillofacial area, without contrast material (except if done at same time as 6102 or 6103)
64
42
6108
Maxillofacial area, with contrast material (except if done at same time as 6102 or 6103)
100
42
6109
Thorax, without contrast material
64
42
6112
Thorax, with contrast material
100
42
6111
CAT scanning for biopsy or drainage
100
42
6113
High resolution, lungs
100
42
6114
Abdomen, without contrast material
64
42
6116
Abdomen, with contrast material
100
42
6117
I.V. dynamic sequential scanning
100
42
6118
I.V. dynamic non-incremental scanning
100
42
SKELETAL
6224
C.T. of spine with contrast material
100
42
6226
Long bones
48
42
6227
Joints
64
42
6228
Spine
64
42
6229
Feet/Hands
64
42
JOINTS AND LONG BONES
6115
Ankle
11
6119
Ankle, complete, minimum of three views including inversion/eversion
22
6121
Acromioclavicular joints,bilateral, with or without weight distraction
22
6122
Knee, complete, including oblique(s), and tunnel, and/or patellar and/or standing views
22
Code
Radiological Procedure
Procedure Benefit IR£
Radiological
Anaesthetic
6120
Bone age
22
6125
Calcaneum
11
6130
Clavicle
11
6135
Elbow
11
6140
Femur
11
6145
Finger/toe
11
6150
Foot
11
6155
Hand
11
6160
Hip
11
6165
Humerus
11
6170
Knee
11
6175
Limb length/orthopaedicmeasurement
22
6180
Pelvis (inc. hips)
11
6185
Radius and ulna
11
6190
Sacro-lliac joints
11
6195
Scaphoid
11
6200
Scapula
11
6205
Scoliosis series
11
6210
Shoulder
11
6215
Sternoclavicular joint
11
6220
Tibia and fibula
11
6225
Wrist
11
MAGNETIC RESONANCE IMAGING (M.R.I.)
6230
Magnetic resonance imaging
73
42
6231
Magnetic resonance imaging with contrast enhancement
100
42
NUCLEAR MEDICINE IMAGING
MUSCULO SKELETAL SYSTEM
6270
Limited joint scan
22
6275
Multiple joint scan
33
6280
Sacro-iliac joint uptake
22
6290
Partial body bone scan
22
6295
Whole body bone scan
33
6300
3—Phase bone scan
33
6305
SPECT (tomo) bone scan
46
6340
Gallium scan
33
CENTRAL NERVOUS SYSTEM
6310
Static brain
22
6315
Dynamic brain scan
33
6320
SPECT brain (CBF, ceretec, ECD, blood pool)
46
6325
Static - planar cysternogram
45
6330
SPECT cysternogram
64
CARDIOVASCULAR SYSTEM
6260
Aortogram
22
6265
Arteriogram
22
6360
Angiocardiogram (1st pass)
33
6365
Blood pool scan (MUGA)
46
6370
Exercise blood pool scan (EX. MUGA)
73
6375
Dipyridamole thallium
73
6380
Exercise thallium
73
6385
P.Y.P. infarct scan
33
6390
Anti-myosin scan
33
6395
SPECT anti-myosin scan
46
6400
SPECT thallium
73
6570
Venogram, unilateral
33
6575
Venogram, bilateral
46
GENITOURINARY SYSTEM
6415
Renogram
33
6420
Combined renogram/GFR
46
6425
Captopril renogram
46
6430
Diuretic renogram
46
Code
Radiological Procedure
Procedure Benefit IR£
Radiological
Anaesthetic
6435
DMSA renal scan
33
6440
Micturating cystogram
46
6445
SPECT DMSA renal scan
46
6550
Testicular scan
33
GASTROINTESTINAL SYSTEM
6285
Abdominal scan (Meckel's)
22
6335
Duodenal/gastric reflux
22
6345
Gastric emptying
33
6350
G.I. bleed
33
6355
G.F.R. (Tc-99m DTPA, Cr-51 EDTA)
22
6525
Oesophageal motility study
33
6450
Colloid liver scan
33
6455
HIDA liver scan
33
6460
SPECT liver scan
46
6465
Hepatic (liver) blood flow
33
6540
Salivary scan
22
6545
Spleen scan
22
RESPIRATORY SYSTEM
6470
Aerosol lung scan
33
6475
Gallium lung scan
33
6480
Lung perfusion scan
33
6485
Lung ventilation scan
33
6490
SPECT lung scan
46
6495
Ventilation/perfusion lung scan
64
ENDOCRINE SYSTEM
6410
Whole body iodine scan
33
6520
MIBG scan
46
6530
Parathyroid scan
33
6555
Technetium scan of thyroid
22
6560
Iodine scan of thyroid
22
6565
Thallium scan of thyroid
22
OTHER SCANS
6255
Cholesterol scan
33
6285
Bile salt malabsorption scan
33
6500
Lymphoscintigram
33
6505
Marrow scan
46
6240
White blood cell scan (WBC)
33
6510
Monoclonal antibody scan-SPECT
46
6515
Monoclonal antibody scan - static
33
6535
Platelet scan
33
NUCLEAR MEDICINE IN-VIVO NON-IMAGING TESTS
GENERAL TESTS
6566
Bile salt absorption (ScHCAT)
22
6567
Bile salt breath test
11
6568
Exchangeable body sodium
22
6569
1—131 Uptake (thyroid uptake)
22
6571
1—131 Therapy (thyroid therapy)
33
6572
Oestrogen receptor assay
11
6573
Red cell survival
22
6574
Red cell mass
11
6576
Schilling test (urine)
22
6577
Schilling test (whole body monitor)
22
6578
Total body water
22
6579
Total body potassium
22
OBSTETRIC
6580
Abdomen
11
6585
Pelvimetry
22
SKULL
6590
Facial bones
11
6595
Foramina optic
11
Code
Radiological Procedure
Procedure Benefit IR£
Radiological
Anaesthetic
6600
Internal auditory canals
11
6605
Mandible
11
6610
Mastoid
11
6615
Maxilla
11
6620
Nasal bones
11
6625
Nasal sinuses
11
6630
Orbital views
11
6635
Parotid gland
11
6640
Pituitary fossa
11
6645
Skull
11
6650
Temporomandibular joint
22
SOFT TISSUES
6655
F.B. in eye and localisation
22
6660
Mammogram
33
6665
Soft tissue neck
11
SPECIAL PROCEDURES
6675
Angiogram (direct puncture, single vessel study, branchial, femoral) includes introduction of needles or catheter injection of contrast media and necessary pre and post injection care specifically related to the injection procedure
73
6680
Angiogram (selective catheter,single/multiple vessel study,coeliac, mesenteric, renal, subclavian etc) includes introduction of needles/catheter injection of contrast media and necessary pre and post injection care specifically related to injection procedure
100
6681
Single selective carotid angiography and/or vertebral study
107
6682
Bilateral carotid angiography study
185
6683
Bilateral carotid angiography and vertebral study
278
6685
Aortogram (arch/TLA, etc.)
73
6690
Cavernosogram
73
6705
Facet arthrogram (single level)
46
6706
Hepatic needle puncture/ catheterisation for biliary procedures
100
6710
Portogram
64
6720
Orbital venogram
64
6721
Spinal arteriogram
334
6725
Splenoportogram
64
6730
Venous sampling - adrenal, parathyroid, renal, etc.
100
6735
Venogram, peripheral, single limb
46
6740
Venography (selective, catheter, single vessel study and/or venous sampling, I.V.C., S.V.C., adrenal, renal, hepatic)
100
SPINE
6745
Cervical
11
6750
Coccyx
11
6755
Complete spine
22
6760
Dorsal (thoracic)
11
6765
Lumbar
11
6770
Sacrum
11
6775
Scoliosis views
22
6780
Skeletal survey
33
TEETH
6785
Occlusal (Intra-Oral)
11
6790
Pantomogram
22
6795
Tooth single
11
6800
Total Lower and Lower Jaw
22
ULTRASOUND
6805
Biliary
22
6810
Breast
22
6811
Chest
33
6825
Doppler (carotid, cerebral, peripheral, abdominal, renal, etc.)
46
6835
Eye
22
6840
Hip
33
6841
Knee
33
Code
Radiological Procedure
Procedure Benefit IR£
Radiological
Anaesthetic
6845
Obstetrical
22
6846
Obstetrical (with full foetal assessment)
46
6850
Paediatric cranial
46
6855
Pelvic
33
6856
Parotid gland
33
6857
Pleural space (for localisation)
33
6860
Prostate - transrectal
46
6865
Renal (kidneys)
33
6870
Shoulder
33
6875
Testicular
33
6880
Transvaginal
46
6885
Thyroid
22
6890
Upper abdominal (includes liver, pancreas, aorta and kidneys)
46
6895
Ultrasound guidance during investigations or therapeutic procedure
64
URINARY TRACT
6905
Cystogram
22
6910
I.V.P.
33
6915
Micturating cystogram
33
6920
Straight renal tract (KUB)
11
6925
Urethrogram
33
6930
Vesiculogram
33
OTHERS
6950
Antegrade pyelogram
46
6955
Arthrogram
46
6960
Bronchial brushing
73
6965
Bronchogram
46
6970
Dacrocystogram
33
6975
Discogram
64
6985
Hysterosalpingogram
33
6990
Laryngogram
33
6995
Lymphangiogram
100
7000
Myelogram
64
7005
Myelogram (direct lateral puncture, thoracic or cervical)
100
7010
Needle biopsy (trans-thoracic, bone, abdominal)
64
7011
Nephrostogram
46
7020
Percutaneous transhepaticcholangiogram
64
7025
Per-operative cholangiogram
33
7034
Imaging supervision, interpretation and report for injection procedures during cardiac catheterisation; ventricular and/or atrial angiography
27
7036
Radiological guidance during investigations or therapeutic procedure (use code 7034 for cardiology procedures)
64
7037
Radiological guidance for mammographic wire guided biopsy
27
7040
Retrograde pyelogram
33
7051
Sialgram, Parotid
33
7052
Sialogram, Submandibular
33
7055
Sinogram
22
7065
Tomograms (+ area films)
22
7070
Ventriculogram
64
THERAPEUTIC/INVASIVE PROCEDURES
Please note that therapeutic/invasive procedures are listed in Table C.2
TABLE C.4
Code
Pathological Investigation
Procedure Benefit IR£
8900
CATEGORY 1
13
HAEMATOLOGY
APTT, PT+INR, Blood Gp+uncomplicated crossmatch. Cold Aggluts,
FBC without film, HbH, (in)/direct Coomb's test. Monospot.
BIOCHEMISTRY
Single analytes
IMMUNOLOGY
a-1—AT, C3, C4, lgs, RA Screen, Thyroid Abs
MICROBIOLOGY
Pregnancy test. Stool O/B
CATEGORY 1(A)
13
HAEMATOLOGY
9230
Coag. Factor Assay
8930
Ferritin
8910
Fibrinogen
8935
Iron
9220
RBC autohaemolysis
9215
RBC osm frag.
9225
Platelet Aggregation
8920
Protein C
BIOCHEMISTRY
9185
All nuclear medicine in-vitro investigations(except for those investigations listed in category 5)
All Profiles
Biochemical Investigations of,
9000
-Renal (one or more)
9005
-Hepatic (one or more)
9010
-Cardiac (one or more)
9015
-Thyroid (one or more)
9020
-Bone(not PTH) (one or more)
9025
-Lipids (one or more)
9310
Biochemistry of hypertension
9165
GTT
9165
HbA1C
9166
Drug levels (including RIA)
9167
HPLC
IMMUNOLOGY
9285
Allurgens
9168
Caeruloplasmin
9169
CRP
9171
Cryoglobulins
9275
IgE
9172
PFB
8945
Streptolysin
8936
Transferrin
ENDICRINOLOGY
8937
Hormone Levels (except for those investigations listed in Category 5)
CATEGORY 3
5
HAEMATOLOGY
8905
FBC + manual film ± eosinophil count
9040
Kliehauer
8915
LAP
9035
Reticulocyte count
MICROBIOLOGY
8970
MSU + culture
9045
Stool O+P
BIOCHEMISTRY
9030
Sweat investigation
IMMUNOLOGY
9050
IF - single antibody e.g. ANF (except if this investigation gives rise to the investigations listed in Categories 4 or 5)
CATEGORY 4
10
BIOCHEMISTRY
9160
All electrophoresis|serum, lipoprotein, urine
9175
CSF including oligoclonal bands
9180
Myeloma Screen including electrophoresis
9181
Trace metals
9182
Vits A & E
HAEMATOLOGY
9205
Ab indentification (transfusion)
9200
Bleeding time
8925
HbA2
9210
Hb electrophoresis
9226
Thrombophilia screen -this consists of three or more of the following items
Antithrombin 3, protein C, protein S. factor 7, factor 12, platelet aggregation (spontaneous, second wave of aggregation with weak ADP, and response to dilutions of epinephrine)
8940
U. haemosiderin
9507
Flow cytometry
MICROBIOLOGY
9100
Interpretive review of culture result from wounds, joint fluids, sputum, intestine and other body sites including TB Culture
9385
Interpretative review of viral, bacterial or fungal sarology or viral culture
9202
Antibiotic assay }
9203
MBC } maximum payable, any combination, three
9204
MIC } per claim
9206
Cidal levels
9207
Toxin levels
IMMUNOLOGY
9221
ANCA-for single antibody
9222
AGBM-for single antibody
9280
Gel electrophoresis
9223
HIV, VD or Hepatitis screen
9224
Teicoic acid
9228
Cardiolipin
9227
CH50— functional assay
ALL DISCIPLINES
9694
Gene rearrangement studies
CATEGORY 5 (A)
20
BIOCHEMISTRY
9301
·Diabetic KA/hyperosmolar coma
9302
·Acute Renal failure
9303
· Acute hepatic failure
9306
·Porphyria investigation
9308
·Diabetes insipidus
ENDOCRINOLOGY
9304
·Dynamic endocrine function tests (IST. Synact, TRH, Dex supp)
9307
·Full endocrinological investigation of infertility
9309
·Full investigations for inborn errors of metabolism in paediatric patients.
Benefit is only payable once per patient at time of initial investigation(diagnosis).
CATEGORY 5 (B)
20
HISTOPATHOLOGY
9360
Small (1-2 blocks) include cytology and neuropathology
MICROBIOLOGY
9381
Interpretive review of culture of CSF, blood
IMMUNOLOGY
9391
Infertility screen
9270
Paraprotein typing
9392
IF - autoantibody screen and/or DNA Abs and/or subtyping
9605
Immune complex assays (except for those investigations listed in Category 1)
All DISCIPLINES
9393
Polymerase chain reaction
CATEGORY 6
31
HAEMATOLOGY
9501
Marrow aspirate (except immunocytochemistry)
9502
Marrow trephine
HISTOPATHOLOGY
9530
Medium (e.g. description + 3—5 blocks)
9540
Colonoscopic series
9550
Clinical (i.e. non screening cytology (not including smear + section)
9535
Lymph node
9545
Parathyroid
IMMUNOLOGY
9503
HLA typing
MICROBIOLOGY
9504
Immunofluorescence
9506
Electron microscopy
CATEGORY 7
56
HISTOPATHOLOGY
9601
Liver, renal biopsies including special stains
9602
Fine needle aspiration biopsy, cell block and smear done together
9650
Large (5 + blocks and all major dissections)
9651
Breast screening, localisation segments with review of radiographs
HAEMATOLOGY
9603
Marrow aspirate and trephine done together
IMMUNOLOGY
9670
IF - frozen section direct or indirect
9610
WBC function tests
CATEGORY 8 (A)
73
HISTOPATHOLOGY
9693
Frozen section or rapid intraoperative diagnosis
9691
Immunohistology (include fluorescence)
CATEGORY 8 (B)
73
HAEMATOLOGY
9505
Immunocytochemistry
CATEGORY 9
30
9700
All tests associated with Obstetrics, including normal delivery, caesarean section and miscarriage
SCHEDULE D
—Out-Patient Services
12. If a person to whom prescribed health services are provided is an insured person under more than one health insurance contract (other than any such contract which relates solely to ancillary health services and/or solely to the public hospital daily in-patient charges made under Regulations pursuant to
Section 53
of the
Health Act, 1970
) the prescribed minimum payment to be made under each such health insurance contract in respect of such prescribed health services shall be the prescribed minimum payment determined in accordance with articles 5 to 11 divided by the total number of such health insurance contracts.
13. The prescribed minimum payment may be made by the registered undertaking either to the health services provider or to the person who effected the health insurance contract under which the recipient of the prescribed health services is an insured person, depending upon the terms of the contract, and subject always to the requirements of
section 15
of the
Finance Act, 1987
.
14. Notwithstanding articles 5 and 6, in the case of a restricted membership undertaking lawfully carrying on health insurance business in the State on the 30th day of June 1994 and covering less than 1,500 insured persons at that date, the prescribed minimum payments (and where relevant the total periods over which such payments are required to be made) for the prescribed health services specified under the said articles shall be subject to a maximum of the lowest level of cover provided for those services under the rules of that undertaking at the date on which these regulations shall come into operation.
15. Notwithstanding sub-articles (3) and (4) of article 5, in the case of a restricted membership undertaking lawfully carrying on health insurance business in the State on the 30th day of June 1994 and covering 1,500 or more insured persons at that date, the prescribed minimum payments (and where relevant the total periods over which such payments are required to be made) for the prescribed health services specified under the said sub-articles shall be subject to a maximum of the lowest level of cover provided for those services under the rules of that undertaking at the date on which these regulations shall come into operation.
Schedule A
-Hospital Charges (In-patient and Day-patient Services)
S.I. No. 83 of 1996.
HEALTH INSURANCE ACT, 1994 (MINIMUM BENEFIT) REGULATIONS, 1996
The Minister for Health in exercise of the powers conferred on him by
sections 3
and
10
of the
Health Insurance Act, 1994
(No. 16 of 1994) hereby makes the following Regulations—
PART 1 GENERAL