Procedure codes

Index


Copyright

Introduction

1 - Consultations, simple investigations and procedures and general procedures

1.1 - Investigations

1.2 - Simple procedures

1.3 - General procedures

1.4 - Consultations and Physicians’ fees

1.5 - Practitioner and Therapist fees

2 - Brain, cranium and intracranial organs

2.1 - Brain

2.2 - Cranium

2.3 - Meninges

2.4 - Nerves

2.5 - Vessels

2.6 - Other

3 - Spine, spinal cord and peripheral nerves

3.1 - Spinal column (including intervertebral discs)

3.2 - Spinal cord

3.3 - Paraspinal injections

3.4 - Nerve roots

3.5 - Sympathetic nerves

3.6 - Peripheral nerves

3.7 - Other nerve blocks

3.8 - Other procedures

3.9 - Neurophysiological procedures

4 - Eye and orbital contents

4.1 - Globe and orbit

4.2 - Eyebrow and lid

4.3 - Lacrimal system

4.4 - Muscles

4.5 - Conjuctiva

4.6 - Cornea

4.7 - Sclera

4.8 - Iris and anterior chamber

4.9 - Lens

4.10 - Vitreous

4.11 - Retina

4.12 - General

5 - Ear, nose and throat

5.1 - External ear

5.2 - Middle ear and mastoid

5.3 - Inner ear

5.4 - Nose and nasal cavity

5.5 - Nasal sinuses

5.6 - Throat

5.7 - Larynx and trachea

5.8 - Fibreoptic endoscopic procedures (GA or LA)

6 - Face, mouth, salivary and thyroid

6.1 - Face and jaws

6.2 - Lips

6.3 - Tongue

6.4 - Palate

6.5 - Mouth cavity

6.6 - Salivary glands

6.7 - Teeth

6.8 - Neck

6.9 - Thyroid and parathyroid glands

7 - Breast

7.1 - Excision/biopsy codes

7.2 - Mastectomy (excluding implant/reconstruction)

7.3 - Reconstruction

7.4 - Other

8 - Thorax and intra-thoracic organs

8.1 - Oesophagus

8.2 - Chest wall

8.3 - Trachea

8.4 - Fibreoptic endoscopic procedures (GA or LA)

8.5 - Bronchi/lungs/pleura

8.6 - Mediastinum

8.7 - Video assisted thoracic surgery (VATS)

8.8 - Heart – cardiac surgery

8.9 - Heart – cardiology

8.10 - Great Vessels

8.11 - Other

9 - Vascular system

9.1 - Head and neck

9.2 - Thoracic vessels

9.3 - Renal vessels

9.4 - Abdominal vessels

9.5 - Ileo-femoral vessels

9.6 - Non-specific

9.7 - Varicose veins

9.8 - Lymphatic system

10 - Endoscopic gastrointestinal procedures

10.1 - Endoscopic gastrointestinal procedures

11 - Abdomen (excluding urinary and reproductive organs)

11.1 - Oesophagus

11.2 - Stomach

11.3 - Duodenum

11.4 - Small intestine

11.5 - Large intestine

11.6 - Rectum/anus

11.7 - Other organs (mainly digestive)

11.8 - Major vessels

11.9 - Abdominal wall

11.10 - Peritoneum

12 - Urinary system and male reproductive organs

12.1 - Kidney/renal pelvic

12.2 - Ureter

12.3 - Bladder

12.4 - Urethra

12.5 - Prostate

12.6 - Genitalia

13 - Pregnancy and confinement

13.1 - Pregnancy and confinement

14 - Female reproductive organs

14.1 - Uterus/adnexa

14.2 - Suspension

14.3 - Cervix uteri

14.4 - Vagina/perineum

14.5 - Vulva/labia

15 - Skin and subcutaneous tissue

15.1 - Lesions of skin

15.2 - Repair

15.3 - Burns, scars and contractures

15.4 - Flaps and free skin grafts

16 - Bones, joints and connective tissue/tendon muscle

16.4 - Nerves

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

16.6 - Hand

16.7 - Shoulder

16.8 - Elbow

16.9 - Hip, leg and pelvis

16.10 - Knee

16.11 - Foot

16.12 - External fixation/traction

17 - Interventional radiology

17.1 - Biopsy

17.2 - Drainage

17.3 - Angioplasty

17.4 - Embolisation

17.5 - Thrombolysis

17.6 - Dilatation

17.7 - Head and neck

17.8 - Spine

17.9 - Thorax

17.10 - Gastrointestinal

17.11 - Liver

17.12 - Urinary

17.13 - Other

18 - Chemotherapy

18.0. - Chemotherapy

19 - Haematology (Hospital Use Only)

19.1 - Bone Marrow

19.2 - Stem Cell

20 - Radiotherapy (Chapter Under Review)

Copyright


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

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

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

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

Introduction


This is the Schedule of procedures and fees for providers recognised by AXA PPP healthcare. It includes codes for procedures for which our policies provide benefit and is based on work undertaken by the Clinical Coding and Schedule Development group (CCSD). It also details billing principles which apply to invoices for private medical services provided to our members.

Reimbursement Status


In all instances specialists or clinical and complementary practitioners must work within their scope of practice and in line with their professional codes of conduct. Any new procedures that are not routinely undertaken within their routine practice must be considered and agreed by AXA PPP healthcare in advance and in conjunction with the clinical governance committees at the treating facility.

This document sets out what AXA PPP healthcare would expect specialist and practitioners to charge for the services they provide to patients. We will pay eligible fees in full when a specialist or practitioner charges up to the level shown within this document for treatment that they have provided; no payments will be made for supervision of services provided by others. All services claimed for must be listed in the Schedule of Procedures and Fees.

We have identified certain specialists and practitioners whose fees exceed this limit and these specialists’ and practitioners’ charges will always be limited to the level shown in the Schedule of Procedures and Fees for Fee Limited Specialists and any excess charge over this amount will not be reimbursed.

Billing Principles


The main principles which all providers must adhere to as a condition of recognition are as follows:

Procedure Code Query
If the operator is uncertain how to code for a specific procedure then they can ask us to advise what code they should use. To determine what the appropriate representative code is we will require the following information, a copy of the clinic letter and/or a justification letter detailing what is planned to take place during the treatment so that we can identify the most appropriate code for the planned treatment, this can be sent to us by using the following link https://survey.axappphealthcare.co.uk/fee-query/

Procedure Fees
The operator fee for a procedure includes all component parts of that procedure including preoperative assessment, the procedure itself and all routine aftercare including out-patient consultation for at least the first ten days. All our fees are inclusive of VAT.

Injections
We do not accept separate charges for giving sub-cutaneous, intramuscular or intravenous injections (or vaccinations where eligible) as on their own these are not deemed to be separate surgical procedures and any charge for giving injections is covered by the standard consultation charge.

Coding
Invoices must be coded using the industry standard CCSD codes as listed in this Schedule. The only item which should appear on an invoice is the (usually single) CCSD code for the procedure being performed. This code should only be used for the use set out in the standard description. If a code states ‘as sole procedure’ in its narrative it should not be performed in addition to another procedure. If any procedure is undertaken which is not coded, specialists should contact the specialist fees team with a detailed letter outlining what is being done and a breakdown of the proposed cost so that we can identify the most appropriate code to be used or the most appropriate level of reimbursement for the planned treatment, this can be sent to us by using the following link https://survey.axappphealthcare.co.uk/fee-query/ Diagnostic tests should be itemised and accurately coded as per the CCSD coding and narratives, these can be obtained from the CCSD website www.ccsd.org.uk

Unbundling
The component parts of single procedures or services must not be itemised out and billed as if they were separate or additional services. As a guide, there is no clinical intervention which should routinely need more than one code.
We will not reimburse additional charges for component parts of single procedures and will withdraw recognition from providers who persistently unbundle charges. Unbundling includes:

  • Charging for two procedures where one is part and parcel of the other or is so frequently performed that it is in effect part and parcel.
  • Charging for in-patient care or ITU care where this is simply routine post-operative care.
  • Charging for pre-operative assessment or post-operative analgesia including nerve blocks.
  • Using procedure combinations whose primary purpose is to increase reimbursement. An example of this would be charging for wound infiltration with local anaesthesia.
  • Charging for anaesthetic when anaesthetic services have also been provided by an anaesthetist.

Multiple Procedures
Different insurance companies have different rules about fees for multiple procedures. Where two procedures are performed at the same time we will pay full benefit for the highest rated procedure and 50% of the fee for the second highest rated procedure. Only in the most exceptional circumstances and on a case-by-case basis discussed prior to any treatment taking place will further procedures be considered for additional reimbursement. Please contact the specialist fees team via the following link & include copies of the Anaesthetist Charts & the Operation Notes for our review so that we can understand the additional complexities involved during the surgery that may indicate that a higher fee may be warranted: https://survey.axappphealthcare.co.uk/fee-query/

Multiple Specialists
Where two or more specialists operate on a member as a matter of preference, only a single fee is claimable.

Where two specialists perform different procedures and where the second procedure cannot be performed by a single specialist, then the two specialists will be treated separately for the purposes of this fee schedule. An example would be a mastectomy followed by a DIEP flap. These requests must be preauthorised and will be considered on a case by case basis, a justification letter will be required that clearly explains the medical need for additional specialists to be present, the procedure codes, the estimated time in theatre and requested fees (for each specialist) so that we can determine the appropriate level of reimbursement required . Please contact the specialist fees team via the following link https://survey.axappphealthcare.co.uk/fee-query/

In any other circumstances where two specialists are required, this should be agreed in advance with the specialist fees team.

Fees Outside Of Our Billing Principles
Requests for additional fees for services that sit outside of our billing principles must be preauthorised & will be considered on a case by case basis. To review a request we will require a copy of the clinic letter sent back to the GP which relates to the specific treatment you are recommending and/or a justification letter detailing why this additional cost is warranted so that we can understand the clinical rationale for the recommended treatment and determine the appropriate level of reimbursement required. Please contact the specialist fees team via the following link https://survey.axappphealthcare.co.uk/fee-query/

Consultation Charges
A consultation means a face-to-face consultation only. Only a single consultation may be claimed on any one day, consultation fees are set regardless of time or complexity. We do not provide benefit for consultations using electronic communication for example by email, telephone or across the internet. Consultation fees are inclusive of any room charges or any other additional charges.

In-patient care charges are claimable only by the physician in charge of the case and are for face to face visits and are not claimable for being on-call. Other specialists may claim benefit for specific consultations for specific problems only, but this should be pre-authorised. We consider out-patient follow-up within ten days of a surgical procedure to be an integral part of post-operative care and thus to be covered by the charge for the procedure and this would not be reimbursed as an extra service.

During the course of a members treatment we may need to request medical information or a Medical Information Form may need to be completed to obtain relevant information about a claim. We try to ensure that only the minimum amount of information is requested in order to service the request. Any medical information or Medical Information Form submitted must be completed and/or signed by the controlling specialist. Please note that we do not expect any charge to be made for the provision of this information or the completion of the report.

Anaesthetic Fees
The benefit for anaesthesia includes an amount for pre-operative assessment (whether on the ward or at a clinic), the anaesthetic itself including any lines or monitoring and post-operative care including analgesia, care in ITU or HDU, nerve blockage, neuroaxial blockade or epidural. None of these should be listed as extra. Operations should be coded using the single CCSD code which describes the operation performed plus all its component parts. Additional codes should only be used for genuine separate and additional procedures. There is no code for CVP lines as part of anaesthesia or ITU care and specifically the code L9110 should not be used.

Anaesthesia By The Operator
All procedure prices within the schedule are all inclusive of any charges for local/topical anaesthesia and IV sedation by the main operator. We will not pay extra if a separate charge is received for local/topical anaesthesia or IV sedation by main operator or from a separate anaesthetist. If you require any further advice please contact the Specialist Fees team via the following link https://survey.axappphealthcare.co.uk/fee-query/

Intensive Care
For patients in intensive care which is medically necessary and not for routine care post-surgery, a fee is payable as indicated in this Schedule. This covers consultation, monitoring and procedures such as CVP lines, arterial lines and dialysis, pulmonary artery catheters etc. Additional fees may be claimed for procedures with a CCSD code and can be claimed by the specialist in primary charge of the case. Other specialists may claim for necessary consultations for specific problems but not a daily fee.

Chemotherapy and Radiotherapy
Charges for the administration and supervision of chemotherapy and radiotherapy should be made in accordance with the principles set out section 18 of this Schedule.

All Inclusive Fee Arrangements
Our contracts with hospitals listed in our Network of Hospitals www.axappphealthcare.co.uk/specialists include some services where specialists’ fees are included within the prices we have agreed with the hospitals, notably diagnostic radiology, pathology and in-patient therapies. In these circumstances specialists should negotiate appropriate remuneration for their services with the hospital. This arrangement provides clarity and reassurance for patients that all charges associated with such services are covered under our contract with the hospital.

Radiology
All diagnostic radiology must be billed through the hospital in accordance with contracted rates. Therapeutic interventional radiology can be billed in accordance with fees contained in this Schedule.

Pathology
All pathology charges must be billed through the hospital or clinic where the procedure took place. Where the specimen is taken in a consulting room owned and managed by a consultant specialist, we will accept invoices from any recognised pathology facility with which we have a fee agreement.

Facility, Consumable and Equipment Charges
Charges may be made for facilities provided there is a formal agreement in place between the facility and AXA PPP healthcare. Consumable items (including drug costs) and equipment charges should be invoiced to AXA under the agreement of the facility unless there has been a prior arrangement made directly with AXA PPP healthcare. No charges should be made for any item which is not subject to a formal agreement.

Submission of Claims


In line with our members’ policies, all eligible claims must be submitted within six months of treatment. Invoices for eligible treatment must be submitted electronically and full treatment details must be provided to avoid processing delays. Electronic billing must be submitted via Healthcode & the following link www.healthcode.co.uk/medical-billing/home

When you open this link you should select the option to “register for HC VEDA”.

Payment


Payment will be made by monthly interval payment. This will be accompanied by a remittance advice which provides a breakdown of the total amount paid, the members it relates to and any shortfalls in payment made such as shortfalls due to a policy excess. A similar remittance advice is also sent to the member advising them of any liability including an invoice to show the amount of any shortfall and to whom this should be paid. To support this payment, the member will also be provided with the details of the specialist's invoice address that was either submitted on the application form or more recently on a change of address form. Specialists are advised to consider this if they have provided a home rather than a business address for this purpose.

Effective and Appropriate Medical Treatment


We do not provide benefit for experimental or unproven procedures, including those using new technology or drugs, where safety and effectiveness have not been established or generally accepted. Please contact the Medical Department at AXA PPP healthcare before undertaking treatment which might fall into this category. Under no circumstances should codes intended for existing procedures be used for new and as yet uncoded procedures. The narratives and codes are protected by copyright and may not be altered or used in any other way except as published in the Schedule of procedures and fees.

Fraud and Misrepresentation


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

Our business is conducted on the basis of good faith. We monitor claims using data mining software and routinely audit claims by reference to medical records. We will not tolerate fraud and misrepresentation and will cease doing business with any provider who provides false, misleading or selective information. We will also refer cases of fraud to the General Medical Council and to the police as appropriate. We consider the following examples constitute fraudulent billing:

  • Exaggeration of the complexity of the procedure performed for example coding a diagnostic procedure as if it were therapeutic.
  • Misrepresentation of the medical history or the procedure performed.
  • Omission of material facts.
  • The use of jargon or technical information which whilst strictly correct is presented in a way likely to mislead a non-medically qualified claims assessor (an example would be a claim for laser insitu keratomileusis (LASIK) coded as keratoplasty).
  • Unbundling.

Audit


On occasion, we conduct audits of medical notes as part of our quality control procedures. Specialists and practitioners who are recognised by us for benefit purposes are required to provide this information on receipt of a consent form signed by the member authorising this disclosure.

Network Policies


The majority of our members (over 90%) have chosen to purchase a network policy which requires them to receive treatment at one of the facilities listed in our Directory of Hospitals. Under the terms of our network arrangement, we settle hospital charges in full for eligible treatment at any of these listed hospitals, but only a small daily benefit is paid if treatment is undertaken at a facility which is not in our Directory. This arrangement does not, however, compromise access to care that is medically necessary.
Should a patient need facilities or treatments, which are not available at a convenient hospital in our Directory of Hospitals, then we will cover the costs of eligible treatment in full at whichever hospital is best able to provide the necessary care. However, this must be agreed with us before treatment takes place or, in an emergency, as soon as is possible after admission.

To request an exemption, please complete a network exemption referral form which can be found at www.axappphealthcare.co.uk specialists/contact us/Network Exemption/PDF Hospital Exemption form and fax it to the number below. The Network team will review the clinical justification for an out-of-directory admission and confirm whether it will be eligible for full reimbursement.

Network Exemption Team:

Helpline: 01892 772218

Fax: 0117 972 6006

Failure to pre-authorise out-of-directory admissions may result in the member incurring a significant shortfall in benefit.

1 Consultations, simple investigations and procedures and general procedures

  1.1 Investigations
  20110 ECG (Including reporting)
  20150 Patch testing (Inclusive of application, reading & reporting)
  20210 Pure tone audiogram (air conduction) - including masking
  20141 Continuous ambulatory ECG for up to 72 hours (including reporting)
  20220 Pure tone audiogram (air and bone conduction) - including masking
  20230 Impedance audiogram
  20240 Impedance audiogram as part of other procedure
  64301 Echocardiography +/- bubble contrast (including reporting) as sole procedure
  1.2 Simple procedures
  20144 Continuous ambulatory ECG for over 72 hours and up to 7 days (including reporting)
  25000 Incision and drainage (not elsewhere covered)
  25022 Stellate ganglion block (local anaesthetic)
  C6180 Bleb needling +/- antimetabolites (including topical or local anaesthetic)
  C6181 Laser suture lysis (including topical or local anaesthetic)
  E2880 Epley manoeuvre (code for specialist use only)
  F2621 Frenotomy /frenectomy of tongue under local anaesthetic
  H2510 Rigid sigmoidoscopy including proctoscopy and biopsy
  H5230 Injection of sclerosing substance into haemorrhoids
  H5240 Banding of haemorrhoids
  H5260 Low voltage treatment of internal haemorrhoids
  L8600 Unilateral varicose vein injection sclerotherapy
  S1110 Curettage/cryotherapy of lesion of skin including cauterisation - up to three
  S1500 Biopsy of skin or subcutaneous tissue
  S1510 Needle/tru-cut biopsy of muscle
  S4780 Aspiration of subcutaneous haematoma
  S5322 Injection of therapeutic substance into keloid scar Minor
  X3520 IV sedation administered by anaesthetist (as sole procedure)
  X3530 Sedation or general anaesthesia for MRI or CT scan
  W9040 Injection(s) +/- aspiration, into joint, cyst, bursa or soft tissue Minor
  S5211 Injection of Botulinum Toxin for Hyperhidrosis minor
  W9282 Joint fluid examination (eg polarising microscopy) performed by consultant including aspiration of fluid
  X4810 Change of cast without general anaesthetic (as sole procedure)
  1.3 General procedures
  20130 Exercise ECG (including base line 12 lead ECG and reporting)
  20132 Exercise or dobutamine stress echocardiography (including ECG and reporting)
  20140 24 hour ECG Holter (including reporting)
  20142 Insertion of implantable ECG loop recorder (including reporting)
  20143 Removal of implantable ECG loop recorder (including reporting)
  22000 Routine electroencephalography (EEG) in adult or child aged over 5 (including reporting)
  25010 Paravertebral block up to two levels (without X-ray control)
  64300 Echocardiography (including reporting) as sole procedure
  G2180 Ambulatory 24h pH and impedance monitoring
  D0702 Aural toilet (including microsuction and/or suction of exteriorised mastoid cavity) including bilateral
  P2730 Colposcopy (+/- biopsy, polypectomy or vulvoscopy)
  Q1280 Introduction of a Mirena coil
  Q2020 Endometrial biopsy or aspiration
  S4760 Fine needle aspiration cytology
  1.4 Consultations and Physicians’ fees
    In-patient care fees are only claimable by the person in primary charge of the case.... Other specialists may claim for specific consultations for specific purposes. ITU fees are expected to include insertion of central lines, arterial lines, dialysis lines, pulmonary artery catheters and similar.

Surgeon Physician Psychiatrist
20300 Initial out-patient consultation £130 £175 £180
20310 Follow-up out-patient consultation £100 £120 £150
In & day-patient care £50 £60 £50
ITU (see policy) £200
  1.5 Practitioner and Therapist fees
    We will pay fees up to the contracted or agreed rate which we have in-place with the individual recognised practitioner who provides the treatment. The member will not be responsible for any shortfall (subject to any policy or benefit limitations).

The following fees are reimbursable per session of treatment. No more than one session can be claimed on the same day.

Orthoptist£45Physiotherapist£35
Osteopath£35Chiropractor£35
Nurse practitioner£60Dietician£60
Psychologist£100Speech therapist£75
Neuropsychologist£100Psychotherapist£85
Acupuncturist£60Homeopath£60

Neuropsychological and Neuropsychiatric Assessment

We will pay a fee of up to £600 for an eligible assessment. To qualify, the assessment must be pre authorised by our customer service department. If not pre authorised, the reimbursement limit of £100 for psychologists and £180 for psychiatrists will apply, and we will shortfall the claim. The payment we make is to include all preparation, report writing, travel and any other administrative costs.
2 Brain, cranium and intracranial organs
Excision of lesion of pituitary gland includes packing of the nose and removal of packs where required.
These should not be charged separately.
Additional charges should not be made for cranioplasty with intracranial procedures. The code for stereotactic ablation of a lesion includes removal/biopsy of the lesion.
  2.1 Brain
  A0110 Hemispherotomy Complex
  A0180 Excision of abscess of brain Complex
  A0200 Excision of lesion of tissue of brain Complex
  A0280 Awake craniotomy with ablation of lesion of brain with or without cortical mapping/stereotaxy Complex
  A0300 Stereotactic ablation of tissue of brain Complex
  A0310 Stereotactic biopsy of lesion or tissue of brain Complex
  A0380 Stereotactic radiotherapy (SRT) using GammaKnife or similar SRT technology Complex
  A0400 Biopsy of lesion of tissue of brain (including via a burr hole or stealth guided) Complex
  A0900 Implantation of neurostimulator to brain Major
  A0980 Deep brain stimulation Complex
  A1220 Creation of ventriculovascular anastomosis Major
  A1240 Creation of ventriculoperitoneal shunt Major
  A1250 Creation of subcutaneous cerebrospinal fluid reservoir Major
  A1300 Maintenance of cerebroventricular shunt Major
  A1430 Removal of cerebroventricular shunt Intermediate
  A1440 Irrigation of cerebroventricular shunt Minor
  A1700 Therapeutic endoscopic operations on ventricle of brain (including examination and biopsy of lesion) Xmajor
  A2080 Ventricular puncture (as sole procedure) Minor
  A2220 Puncture of cistern of brain Minor
  2.2 Cranium
  A4280 Intracranial infection: burr hole Intermediate
  V0110 Reconstructive cranioplasty Xmajor
  V0130 Surgery for craniostenosis (single suture) Major
  V0180 Surgery for craniostenosis (more than one suture) Xmajor
  V0310 Exploratory open craniotomy Xmajor
  V0330 Exploratory burr hole of cranium Major
  V0382 Total petrosectomy (for tumour) Complex
  V0383 Lateral petrosectomy (for tumour) Complex
  V0390 Foramen magnum decompression Complex
  V0510 Excision of lesion of cranium Major
  V0530 Elevation of depressed fracture of cranium Major
  V0580 Repair of compound fracture of cranium Xmajor
  2.3 Meninges
  A2210 Drainage of subarachnoid space of brain Major
  A3810 Excision of lesion of meninges of brain Complex
  A3830 Operation for arachnoidal cyst Xmajor
  A3900 Repair of dura Complex
  A4010 Evacuation of extradural haematoma Complex
  A4110 Evacuation of subdural haematoma or abscess Complex
  A4180 Subdural haemorrhage – tap Minor
  2.4 Nerves
  A2500 Intracranial transection of cranial nerve Complex
  A2600 Other intracranial destruction of cranial nerve Complex
  A2900 Excision of lesion of cranial nerve (intracranial) Complex
  A2952 Excison of acoustic neuroma (vestibular schwannoma) - tumours less than 2.5cm (performed by single surgeon) Complex
  A2953 Excision of acoustic neuroma (vestibular schwannoma) - tumours more than 2.5cm or compressing brain stem (performed by single surgeon) Complex
  A2954 Excision of acoustic neuroma (vestibular schwannoma) - tumours managed by combined oto-neurosurgical team irrespective of tumour size Complex
  A3000 Repair of cranial nerve (intracranial) Complex
  A3200 Decompression of cranial nerve (craniotomy) Complex
  A3300 Implantation of neurostimulator to cranial nerve Major
  A3330 Removal of neurostimulator from cranial nerve Major
  A3680 Excision of cerebello-pontine angle tumour Complex
  2.5 Vessels
  A0260 Excision of arteriovenous malformation from vessels of brain Complex
  A4080 Craniotomy – post-operative haemorrhage Xmajor
  L3320 Clipping of cerebral artery aneurysm Complex
  L3380 Reinforcement of aneurysm of cerebral artery Complex
  L3400 Open operations on cerebral artery Complex
  2.6 Other
  A8300 Electro-convulsive therapy Minor
  B0100 Open hypophysectomy (including total) Complex
  B0210 Cryotherapy to pituitary gland Xmajor
  B0410 Transsphenoidal hypophysectomy (including total) Complex
  B0610 Excision of pineal gland Complex
3 Spine, spinal cord and peripheral nerves
There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances.

Spinal fusion includes bone grafting and this should not be charged separately.

Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately.

Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region.

Chemonucleolysis includes discography and this should not be charged separately.

Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis.

The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.
  3.1 Spinal column (including intervertebral discs)
    Cervical region

  A5291 Transforaminal Epidural (Cervical) Intermediate
  A5292 Transforaminal Epidural (Thoracic) Intermediate
  A5293 Transforaminal Epidural (Lumbar) Intermediate
  A5294 Transforaminal Epidural (Caudal) Intermediate
  V2200 Posterior decompression +/- foraminotomy - cervical region (1 or 2 levels) Complex
  V2282 Prosthetic intervertebral disc replacement - cervical region (1 or 2 levels) Complex
  V2300 Revisional posterior decompression +/– foraminotomy (cervical region) Complex
  V2990 Open door laminoplasty of the cervical region (Hirobyashi) Complex
  V3720 Posterior fusion +/- instrumentation - cervical region (1 or 2 levels) Xmajor
  V2900 Anterior discectomy - cervical region (1 or 2 levels) Xmajor
  V2902 Revisional anterior discectomy (cervical region) Complex
  V2950 Anterior discectomy, decompression and fusion (including bone grafting) - cervical region (1 or 2 levels) Complex
  V2980 Combined anterior and posterior fusion of cervical spine Complex
  V3730 Trans oral surgery including posterior fixation Complex
  V3721 Posterior fusion +/- instrumentation - cervical region (3 or more levels) Xmajor
  V2901 Anterior discectomy - cervical region (3 or more levels) Xmajor
  V2201 Posterior decompression +/- foraminotomy - cervical region (3 or more levels) Complex
  V2283 Prosthetic intervertebral disc replacement - cervical region (3 or more levels) Complex
  V2951 Anterior discectomy, decompression and fusion (including bone grafting) - cervical region (3 or more levels) Complex
    Thoracic region

  V2402 Posterior decompression (thoracic region) Xmajor
  V2400 Posterior decompression with fusion (thoracic region) Complex
  V2430 Revisional posterior decompression with fusion (thoracic region) Complex
  V3120 Transthoracic/antero-lateral excision of intervertebral disc +/– fusion Complex
  V3122 Revisional transthoracic/antero-lateral excision of intervertebral disc +/– fusion Complex
  V3140 VATS percutaneous discectomy +/– fusion (thoracic region) Xmajor
  V3100 Combined anterior discectomy and posterior fusion (thoracic region) Complex
  V3102 Revisional combined anterior discectomy and posterior fusion (thoracic region) Complex
  V3181 Prosthetic intervertebral disc replacement in the thoracic spine Complex
    Lumbar region

  V2540 Posterior excision of disc prolapse (including microdiscectomy +/- decompression) - lumbar region (1 or 2 levels) Xmajor
  V2544 Revision of posterior excision of disc prolapse (lumbar region) Complex
  V2542 Posterior excision of disc prolapse with undercutting facetectomy +/- decompression - lumbar region (1 or 2 levels) Xmajor
  V2543 Revision of posterior excision of disc prolapse with undercutting facetectomy (lumbar region) Complex
  V2560 Decompression for central spinal stenosis (one or two levels) Xmajor
  V2562 Decompression for central spinal stenosis (three or more levels) Complex
  A5410 Epidural blood patch Minor
  V3345 Mobilisation of the lumbar/thoracic vessels to provide spinal surgical access (by vascular surgeon) as sole procedure Major
  V3381 Prosthetic intervertebral disc replacement - lumbar region (3 or more levels) Complex
  V3341 Primary anterior discectomy, decompression and anterior fusion +/- instrumentation - lumbar region (3 or more levels) Xmajor
  V2501 Primary posterior fusion +/- decompression +/- discectomy - lumbar region (3 or more levels) Complex
  V2546 Posterior excision of disc prolapse with undercutting facetectomy +/- decompression - lumbar region (3 or more levels) Xmajor
  V2541 Posterior excision of disc prolapse (including microdiscectomy +/- decompression) - lumbar region (3 or more levels) Xmajor
  V2570 Percutaneous vertebroplasty Xmajor
  V2660 Revision of decompression for central spinal stenosis Complex
  V2500 Primary posterior fusion +/- decompression +/- discectomy - lumbar region (1 or 2 levels) Complex
  V3362 Primary posterior fusion with instrumentation +/- decompression +/- discectomy (including Graf stabilisation and all fusion approaches) (lumbar region) Complex
  V2652 Revision posterior fusion +/– instrumentation (lumbar region) Complex
  V3340 Primary anterior discectomy, decompression and anterior fusion +/- instrumentation - lumbar region (1 or 2 levels) Xmajor
  V3350 Combined anterior approach discectomy, decompression and fusion and posterior fusion (lumbar region) Complex
  V3380 Prosthetic intervertebral disc replacement - lumbar region (1 or 2 levels) Complex
  V4140 Removal of posterior spinal implant Major
  V4740 Image guided percutaneous spinal biopsy Major
  V4900 Open biopsy of lesion of spine where no other operative procedure on the spine is performed. Major
  V5210 Chemonucleosis (multiple levels) Intermediate
  W0660 Coccygectomy (multiple levels) Intermediate
  V5230 Discogram/diagnostic vertebral disc injection under X-ray control Minor
  V5002 Manipulation of spine under GA/IV sedation (sole procedure) Minor
  V2680 Revision anterior decompression with fusion and instrumentation (lumbar region) Complex
    Scoliosis (including kyphosis, fractures, tumours and infections)

  V4100 Posterior correction of idiopathic juvenile scoliosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex
  V4120 Anterior correction of idiopathic juvenile scoliosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex
  V4000 Combined anterior and posterior correction and instrumentation, +/- fusion of idiopathic juvenile scoliosis (including spinal monitoring) Complex
  V4280 Correction of adult degenerative or adult scoliosis including decompression +/- fusion (including spinal cord monitoring) Complex
  V4010 Posterior correction of idiopathic juvenile kyphosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex
  V4122 Anterior correction of idiopathic juvenile kyphosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex
  V4160 Posterior correction of degenerative adult kyphosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex
  V4150 Anterior correction of degenerative adult kyphosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex
  V4300 Anterior vertebrectomy with decompression and implant Complex
  V4302 Combined anterior vertebrectomy with posterior fusion and instrumentation Complex
  V4142 Removal of posterior scoliosis instrumentation (as sole procedure) Major
  W2912 Application of halo (as sole procedure) Intermediate
  V4451 Balloon kyphoplasty – single level Major
  V4452 Balloon kyphoplasty - two level Xmajor
  V4453 Balloon kyphoplasty - greater than two levels Xmajor
  V4081 Anterolateral access with instrumentation +/- decompression +/- duscectomy (including graf stabilisation and all fusion approaches) -lumbar region (3 or more levels) Complex
  V4081 Anterolateral access with instrumentation +/- decompression +/- duscectomy (including graf stabilisation and all fusion approaches) -lumbar region (3 or more levels) Complex
  V4080 Anterolateral access with instrumentation +/- decompression +/- discectomy (including graf stabilisation & all fusion approaches) lumbar region (1 or 2 levels) Complex
  V3300 Percutaneous intradiscal laser ablation (lumbar region) Major
  3.2 Spinal cord
  A4400 Partial excision of spinal cord Complex
  A4500 Open operations on spinal cord Complex
  A4730 Percutaneous cordotomy of spinal cord Xmajor
  A4850 Implantation/removal of intrathecal drug delivery system Major
  A4860 Implantation/removal of epidural delivery system Major
  A4900 Repair of spinal myelomeningocele Complex
  A5110 Excision of intradural lesion Complex
  A5300 Drainage of spinal canal (including insertion of shunt) Xmajor
  A5530 Lumbar puncture (including spinal manometry) Minor
  A5580 CSF infusion studies Intermediate
  V4980 Excision of intramedullary tumour Complex
  A4831 Trial of neurostimulator to spinal cord (as sole procedure) not at time of permanent implant Major
  A4832 Implantation of spinal cord stimulator Major
  3.3 Paraspinal injections
  25010 Paravertebral block up to two levels (without X-ray control)
  25011 Paravertebral block up to two levels (under X-ray control) Minor
  25012 Sacral root block (under X-ray control) Minor
  25020 Intravenous regional sympathetic block (guanethidine block) - 1 injection Minor
  25030 Stellate ganglion block (neurolytic) Minor
  25100 Coeliac plexus block, splanchnic nerve block, hypogastric block - diagnostic Intermediate
  25110 Coeliac plexus block, splanchnic nerve block, hypogastric block - therapeutic Intermediate
  25130 Dorsal root ganglion block (radiofrequency) Major
  25140 Intrathecal neurolysis Intermediate
  25150 Trigeminal ganglion injection (local anaesthetic under X-ray control) Intermediate
  25160 Trigeminal ganglion radiofrequency lesion (under X-ray control) Intermediate
  A5200 Epidural injection (cervical) Intermediate
  A5210 Epidural injection (lumbar) Minor
  A5220 Epidural injection (thoracic) Intermediate
  A5230 Epidurogram Minor
  A5420 Injection of therapeutic substance into CSF Minor
  A5720 Facet or sacroiliac joint (RF) radiofrequency thermocoagulation, cryotherapy or phenol (including rhizolysis under image guidance) - up to 3 joints Intermediate
  A5730 Facet or sacroiliac joint (RF) radiofrequency thermocoagulation, cryotherapy or phenol (including rhizolysis under image guidance) - 4 to 6 joints Major
  A5752 Medial Branch Block (under x-ray control) - 1 to 2 levels Intermediate
  A5762 Medial Branch Block (under x-ray control) - 3 to 4 levels Intermediate
  A5772 Medial Branch Block (under x-ray control) - 5 to 6 levels Intermediate
  A5790 Sacroiliac joint injection under image guidance (and bilateral) Minor
  A5211 Epidural injection (caudal) Minor
  A5751 Facet joint injection (under x-ray control) - 1 to 2 joints Intermediate
  A5761 Facet joint injection (under x-ray control) - 3 to 4 joints Intermediate
  A5771 Facet joint injection (under x-ray control) - 5 or more joints Intermediate
  AA460 Destruction of branch of trigeminal nerve (neurolytic/RF/cryoprobe) Intermediate
  3.4 Nerve roots
  3.5 Sympathetic nerves
  25020 Intravenous regional sympathetic block (guanethidine block) - 1 injection Minor
  25022 Stellate ganglion block (local anaesthetic) Minor
  25030 Stellate ganglion block (neurolytic) Minor
  25100 Coeliac plexus block, splanchnic nerve block, hypogastric block - diagnostic Intermediate
  25110 Coeliac plexus block, splanchnic nerve block, hypogastric block - therapeutic Intermediate
  A7500 Lumbar sympathectomy diagnostic (local anaesthetic under X-ray control) Intermediate
  A7510 Thorascopic cervical sympathectomy Xmajor
  A7520 Thoracic sympathectomy diagnostic (local anaesthetic under X-ray control) Intermediate
  A7530 Laparoscopic lumbar sympathectomy Major
  A7600 Lumbar sympathectomy therapeutic (neurolytic under X-ray control) Intermediate
  A7620 Thoracic sympathectomy therapeutic (neurolytic under X-ray control) Major
  A7682 Presacral sympathectomy - diagnostic Major
  A7683 Presacral sympathectomy - therapeutic Major
  A7085 Sacral nerve stimulation for faecal/urinary incontinence or constipation Major
  3.6 Peripheral nerves
  A6030 Transection of peripheral nerve for neuroma Intermediate
  A6080 Neurectomy (major nerve) Intermediate
  A6110 Excision of lesion of peripheral nerve (eg neurilemoma) Intermediate
  A6180 Excision of lesion of major nerve Intermediate
  A6300 Graft to peripheral nerve Xmajor
  A6302 Graft to major nerve Xmajor
  A6400 Repair of peripheral nerve Intermediate
  A6402 Repair of major nerve Major
  A6510 Carpal tunnel release (open) Intermediate
  A6580 Carpal tunnel release (open) - bilateral Intermediate
  A6600 Release of entrapment of deeply placed peripheral nerve Intermediate
  A6700 Release of entrapment of peripheral nerve Intermediate
  A6710 Cubital tunnel release (open) (without transposition) Intermediate
  A6711 Cubital tunnel release (open) bilateral (without transposition) Intermediate
  A6810 Neurolysis and transposition of peripheral nerve (excludes carpal tunnel release) Intermediate
  A6900 Revision of release of peripheral nerve Major
  A7010 Implantation of neurostimulator into peripheral nerve Major
  A7011 Trial of neurostimulator to peripheral nerve (as sole procedure) not at time of permanent implant Intermediate
  A7013 Placement of tined lead neurostimulator not at time of permanent implant Intermediate
  A6530 Carpal tunnel release (endoscopic) Intermediate
  A6570 Carpal tunnel release (endoscopic) - Bilateral Intermediate
  A6740 Cubital tunnel release (endoscopic) (without transposition) Intermediate
  A6750 Cubital tunnel release (endoscopic) Bilateral (without transposition) Intermediate
  A7310 Biopsy of peripheral nerve Intermediate
  A7340 Exploration and grafting of brachial plexus Complex
  3.7 Other nerve blocks
  25150 Trigeminal ganglion injection (local anaesthetic under X-ray control) Intermediate
  A7300 Radiofrequency (including pulsed denervation), cryoprobe or phenol for permanent lesion of major nerve trunk Intermediate
  A7302 Continuous nerve block as sole procedure Minor
  A7352 Image-guided local anaesthetic blockade of named major nerve or plexus Minor
  AA460 Destruction of branch of trigeminal nerve (neurolytic/RF/cryoprobe) Intermediate
  3.8 Other procedures
  V6080 Percutaneous disc decmpression using coblation Major
  25160 Trigeminal ganglion radiofrequency lesion (under X-ray control) Intermediate
  T6520 Tendon sheath injection of therapeutic substance including viscosupplement +/- image guidance Minor
  T7290 Trigger point injection/Enthesis - one injection Minor
  T7292 Trigger point injection/Enthesis - more than one injection Minor
  V5484 Interspinous dynamic stabilisation procedure Xmajor
  X3750 Botulinum toxin injections to muscle Minor
  X3770 Intramuscular injection with X-ray control (eg piriformis block) Minor
  Y3800 Insertion of indwelling axillary catheter Intermediate
  Y3810 Insertion of indwelling pleural catheter Intermediate
  Y3820 Insertion of indwelling psoas catheter Intermediate
  V5487 Pedicle based dynamic semi-rigid stabilisation procedure (e.g accuflex)
  V5486 Pedicle based dynamic soft stabilisation procedure (e.g graf ligament) Extra Major
  3.9 Neurophysiological procedures
  22000 Routine electroencephalography (EEG) in adult or child aged over 5 (Including reporting)
  22002 Routine electroencephalography (EEG) in child under 5 (including reporting) Minor
  22003 Sleep Electroencephalography (EEG) Minor
  22004 24 hour ambulatory Electroencephalography (EEG) (Including reporting) Minor
  22005 24 hour video telemetry Electroencephalography (EEG) (Including reporting) Minor
  22011 Recording and reporting on evoked potential study Minor
  22022 Recording and reporting on electromyography and nerve conduction studies (EMG); CTS (Bilateral upper limb only) or peripheral neuropathy Minor
  22023 Recording and reporting on electromyography and nerve conduction studies (EMG); Mononeuropathy (eg ulnar), Cx/Lumbar radiculopathy, Myopathy Minor
  22024 Recording and reporting on electromyography and nerve conduction studies (EMG); Mononeuritis Multiplex, MND-AHC, Multiple Muscle Monitoring (eg Torticollis), Myaesthenia Gravis (- SFEMG) Minor
  22025 Recording and reporting on electromyography and nerve conduction studies (EMG); Myaesthenia Gravis (+ SFEMG) Minor
  22028 Inpatient Sleep study (polysomnography) including reporting Minor
  22029 Home sleep study including reporting Minor
4 Eye and orbital contents
The benefit for cataract removal by the various approaches includes subconjunctival injection and injection into the anterior chamber where required. These should not be charged separately.

When it is necessary to convert a phakoemulsification into an extra capsular extraction this should be charged as a single procedure.

Retrobulbar injection. This code is for therapeutic retrobulbar injection. It is not for anaesthesia during cataract surgery.

Removal of sutures. This code is for use after keratoplasty only.

We do not cover blepharoplasty and this should not ever be coded as correction of ptosis/eyelid reconstruction.
  4.1 Globe and orbit
  C0110 Exenteration of orbit Major
  C0120 Enucleation/evisceration of eyeball Major
  C0122 Enucleation/evisceration of eyeball (with implant) Major
  C0212 Excision of lesion of orbit - anterior approach Major
  C0213 Excision of lesion of orbit - lateral orbitomy Major
  C0512 Simple reconstruction of socket (not including implant or graft) Major
  C0513 Reconstruction of socket with either implant or graft Complex
  C0514 Reconstruction of socket with implant and graft Complex
  C0610 Biopsy of lesion of orbit Intermediate
  C0620 Drainage of orbit Intermediate
  C0630 Decompression of orbit Major
  C0640 Removal of foreign body from orbit Major
  C0650 Exploration of orbit (as sole procedure) Major
  C0840 Orbital injection Minor
  4.2 Eyebrow and lid
  C1010 Excision of lesion of eyebrow Minor
  C1040 Suture of eyebrow Minor
  C1110 Excision of lesion of canthus Intermediate
  C1130 Correction of epicanthus Intermediate
  C1140 Correction of telecanthus Intermediate
  C1150 Graft of skin to canthus Intermediate
  C1160 Canthotomy Minor
  C1210 Excision of lesion of eyelid Minor
  C1230 Curettage/cryotherapy of lesion of eyelid Minor
  C1420 Graft of skin to eyelid Intermediate
  C1512 Correction of lower lid ectropion without graft/flap Intermediate
  C1513 Correction of lower lid ectropion with graft/flap Intermediate
  C1522 Correction of entropion - lower lid Intermediate
  C1818 Reverse ptosis repair of eyelid Major
  C1523 Correction of entropion - upper lid, including graft/flap Intermediate
  C1532 Correction of trichiasis by electrolysis/diathermy/cryotherapy/laser Minor
  C1540 Surgical correction of trichiasis/upper lid entropion, including graft/flap Minor
  C1640 Tarsorrhaphy Intermediate
  C1700 Total reconstruction of eyelid - unilateral Major
  C1710 Suture of eyelid (laceration) (as sole procedure) Minor
  C1810 Correction of ptosis of eyelid - simple, including tarsomullerectomy Major
  C1812 Correction of ptosis of eyelid - complex Major
  C1813 Correction of ptosis of eyelid with autologous fascia lata Major
  C2220 Biopsy of lesion of eyelid Minor
  4.3 Lacrimal system
  C2540 Dacryocystorhinostomy (including insertion and later removal of tube) Major
  C2542 Dacryocysto-rhinostomy (endoscopic/laser assisted), including insertion and later removal of tube Xmajor
  C2550 Lacrimal intubation (as sole procedure) Intermediate
  C2610 Excision/biopsy of lacrimal sac Intermediate
  C2640 Incision of lacrimal sac Minor
  C2650 Probing of nasolacrimal system with/without syringing and/or irrigation Minor
  C2910 Puncto-canaliculoplasty Minor
  C2920 Insertion of canalicular or punctal plugs Minor
  4.4 Muscles
  C3112 Surgical correction of squint - unilateral Major
  C3113 Surgical correction of squint - bilateral Major
  C3180 Revision of squint surgery Xmajor
  C3530 Surgical correction of squint with adjustable sutures Xmajor
  C3780 Injection of botulinum toxin into extraocular or periocular muscles Intermediate
  4.5 Conjuctiva
  C3910 Excision/biopsy of conjunctival lesion Minor
  C3920 Cauterisation including cryotherapy to conjunctival lesion Minor
  C6180 Bleb needling +/- antimetabolites (including topical or local anaesthetic)
  C3950 Radiotherapy to conjunctival lesion Minor
  C4010 Mucosal graft to conjunctiva Intermediate
  C4050 Suture of conjunctiva Minor
  C4100 Drainage of conjunctival cyst Minor
  C4340 Subconjunctival injection Minor
  C4350 Exploration of conjunctiva (including removal of foreign body) Minor
  4.6 Cornea
  C3960 Excision of pterygium Minor
  C4520 Excision of lesion of cornea Minor
  C4620 Lamellar graft (keratoplasty) to cornea Xmajor
  C4630 Perforating graft (keratoplasty) to cornea Xmajor
  C4640 Descemets stripping endothelial keratoplasty (DSEK) Xmajor
  C4650 Revision of corneal graft/wound Major
  C4690 Implantation of synthetic corneal rings for keratoconus (including INTACS) Intermediate
  C4710 Repair of corneal wound Minor
  C4730 Removal of corneal suture Minor
  C4810 Removal of superficial corneal foreign body Minor
  C4980 Tension sutures Intermediate
  C5180 Corneal scraping for culture Minor
  C5130 Ultraviolet irradiation of riboflavin for cross linking of corneal collagen Major
  4.7 Sclera
  C5300 Excision of lesion of sclera Intermediate
  C5720 Repair of scleral laceration Intermediate
  C5730 Scleral graft Major
  C6181 Laser suture lysis (including topical or local anaesthetic)
  4.8 Iris and anterior chamber
  C5910 Iridocyclectomy Xmajor
  C5920 Surgical iridectomy Intermediate
  C6010 Surgical trabeculectomy or other penetrating glaucoma procedures (including topical or local anaesthetic) Major
  C6051 Aqueous shunt tube surgery for glaucoma (including topical or local anaesthetic) including donor patch - unilateral Intermediate
  C6052 Aqueous shunt tube surgery for glaucome (including topical or local anaesthetic) including donor patch - bilateral Intermediate
  C6110 Laser trabeculoplasty (including topical or local anaesthetic) – bilateral Intermediate
  C6111 Laser trabeculoplasty (including topical or local anaesthetic) - unilateral Intermediate
  C6720 Laser treatment for glaucoma e.g. Cyclodiode Intermediate
  C6120 Trabecular stent bypass microsurgery for open-angle glaucoma (including topical or local anaesthetic) Major
  C6130 Goniotomy (surgical treatment of glaucoma) (including topical or local anaesthetic) Major
  C6150 Revision of previous glaucoma surgery (including topical local anaesthetic) Major
  C6160 Complex glaucoma surgery (including anti-metabolites/insertion of seton devices) (including topical or local anaesthetic) Major
  C6170 Goniosynechialysis or goniopuncture (with laser or operatively) (including topical or local anaesthetic) Intermediate
  C6230 Laser iridotomy Intermediate
  C6410 Repair of prolapsed iris Major
  C6420 Excision of lesion of iris Major
  C6450 Removal of foreign body from iris Major
  C6610 Ciliary body ablation Intermediate
  C6710 Cyclodialysis (separation of ciliary body) Major
  C6910 Reformation of anterior chamber Major
  C6920 Paracentesis Intermediate
  C6930 Injection into anterior chamber (including topical or local anaesthetic) Minor
  C6940 Irrigation/aspiration of anterior chamber Minor
  C6980 Removal of foreign body from anterior chamber Intermediate
  C6990 Insertion of valve into anterior chamber of eye Major
  4.9 Lens
  C7100 Extracapsular cataract extraction without implant - bilateral Xmajor
  C7110 Extracapsular cataract extraction without implant - unilateral Major
  C7122 Ultrasound phacoemulsification of cataract, with lens implant - unilateral (including topical or local anaesthetic) Intermediate
  C7123 Phacoemulsification of cataract, without lens implant - unilateral (including topical or local anaesthetic) Intermediate
  C7124 Phacoemulsification of cataracts, without lens implant - bilateral (including topical or local anaesthetic) Major
  C7125 Ultrasound phacoemulsification of cataracts, with lens implant - bilateral (including topical or local anaesthetic) Major
  C7341 Yag laser photodisruption of posterior capsule of lens (including laser capsulotomy) - bilateral Intermediate
  C7525 Repositioning of lens implant Minor
  C7180 Extracapsular cataract extraction with implant - unilateral Intermediate
  C7190 Extracapsular cataract extraction with implant - bilateral Xmajor
  C7340 Yag laser photodisruption of posterior capsule of lens (including laser capsulotomy) - unilateral Minor
  C7510 Secondary insertion of lens implant Major
  C7520 Lens implant/exchange Major
  C7530 Removal of lens implant Intermediate
  4.10 Vitreous
  C7910 Anterior vitrectomy Major
  C7920 Pars plana vitrectomy with internal tamponade, scleral buckling and retinopexy without dissection or excision of epiretinal membrane/macular surgery Xmajor
  C7922 Pars plana vitrectomy/vitreous biopsy Major
  C7923 Intravitreal injection of pharmaceutical for neovascular age related macular degeneration Minor
  C7924 Intravitreal injection of pharmaceutical for central retinal vein occlusion Minor
  C7982 Pars plana vitrectomy with internal tamponade, scleral buckling and retinopexy with dissection or excision of epiretinal membrane/macular surgery Complex
  C7940 Intravitreal injection of pharmaceutical agent (not elsewhere classified) Minor
  4.11 Retina
  C5432 Conventional retinal surgery (may include scleral buckling, injection of gas, drainage and retinopexy) Xmajor
  C5480 Removal of silicone oil Intermediate
  C8200 Laser photocoagulation/cryotherapy of lesion of retina Intermediate
  C8240 Photodynamic therapy to the retina (PDT) Intermediate
  C8440 Retinal examination under anaesthetic including retinopexy if necessary Minor
  4.12 General
  C8650 Fluorescein angiography of eye (including ocular photography) Minor
  C8654 Insertion of radioactive plaque into eye (including later removal) Major
5 Ear, nose and throat
Septorhinoplasty is only eligible under certain limited circumstances for restoration of normal appearance immediately after trauma/tumour. The presence of nasal obstruction does not make a septorhinoplasty eligible for benefit. We request that all such procedures are preauthorised to avoid disappointment to policyholders.

Uvulopalatoplasty is not included in our schedule and is not eligible under any circumstances for treatment of sleep apnoea.

FESS includes removal of nasal polyps, antrostomy and turbinate reduction and these should not be charged as extra.

Codes designed for use in theatre should not be used in the out-patient setting, for example nasal cautery or removal of foreign body from nose.

Packing of the nose should not be charged as extra with nasal surgery.

The code for Epley manoeuvre is soley for use by specialists and practitioners. Where a member has an appointment specifically to undertake the Epley manoeuvre we do not expect to receive a consultation charge. We do not expect to receive any charges from hospitals or facilities for this service unless they are billing on behalf of the service provider.
  5.1 External ear
  D0110 Total excision of pinna Major
  D0132 Excision accessory auricle/preauricular appendage Minor
  D0140 Excision of preauricular sinus Intermediate
  D0210 Excision of lesion of pinna Intermediate
  D0280 Removal of multiple boney exostoses EAC Intermediate
  D0310 Reconstruction of external ear for anotia/microtia using cartilage Complex
  D0330 Pinnaplasty (including bilateral) (child 14 and below only) Intermediate
  D0340 Soft tissue meatoplasty of EAC Intermediate
  D0342 Boney meatoplasty Major
  D0410 Drainage of haematoma/abscess of pinna Minor
  D0610 Biopsy of lesion of pinna (as sole procedure) Minor
  D0630 Repair of pinna Minor
  D0702 Aural toilet (including microsuction and/or suction of exteriorised mastoid cavity) including bilateral
  D0730 Removal of foreign body from external auditory canal (and bilateral) Minor
  D0810 Excision of lesion of external auditory canal Minor
  D0812 Removal of solitary osteoma of EAC Intermediate
  D0820 Reconstruction of external auditory canal Xmajor
  5.2 Middle ear and mastoid
  D1010 Radical mastoidectomy (including meatoplasty) Major
  D1020 Modified radical mastoidectomy (including meatoplasty) Xmajor
  D1040 Simple mastoidectomy Major
  D1060 Revision of mastoidectomy (including meatoplasty) Major
  D1240 Exploration of facial nerve, mastoid segment, facial nerve Xmajor
  D1420 Myringoplasty Major
  D1421 Fat Plug Myringoplasty Minor
  D1440 Combined approach tympanoplasty - intact canal wall tympanoplasty Major
  D1510 Myringotomy and insertion of tube through tympanic membrane (and bilateral) Intermediate
  D1520 Suction clearance of middle ear (as sole procedure) Minor
  D1530 Myringotomy (and bilateral) Minor
  D1540 Exploration of entire middle ear course of VII Complex
  D1610 Ossiculoplasty Xmajor
  D1710 Stapedectomy (as sole procedure) Major
  D1720 Revision stapedectomy (as sole procedure) Xmajor
  D2070 Transtympanic steroid injection (including topical or local anaesthetic) Minor
  D1900 Middle ear tumour excision Major
  D1910 Middle ear polypectomy Minor
  D2030 Removal of Grommets Minor
  D2040 Diagnostic tympanotomy (as sole procedure) Major
  D2050 Tympanic neurectomy Xmajor
  T8950 Repair of peri-lymph fistula Major
  V0382 Total petrosectomy (for tumour) Complex
  V0383 Lateral petrosectomy (for tumour) Complex
  W1870 Drainage of petrous apex for sepsis Complex
  D2822 Examination of ear under general anaesthetic (as sole procedure) Minor
  5.3 Inner ear
  A2952 Excison of acoustic neuroma (vestibular schwannoma) - tumours less than 2.5cm (performed by single surgeon) Complex
  A2953 Excision of acoustic neuroma (vestibular schwannoma) - tumours more than 2.5cm or compressing brain stem (performed by single surgeon) Complex
  A2954 Excision of acoustic neuroma (vestibular schwannoma) - tumours managed by combined oto-neurosurgical team irrespective of tumour size Complex
  E2880 Epley manoeuvre (code for specialist use only)
  A8480 Transtympanic electrocochleography Intermediate
  AA489 Transtympanic chemical labrynthectomy Minor
  D2420 Insertion of cochlear implant Complex
  D2610 Operation(s) on endolymphatic sac Major
  D2620 Membranous labyrinthectomy Xmajor
  D2630 Osseous labyrinthectomy Xmajor
  5.4 Nose and nasal cavity
  E0110 Total excision of nose Major
  E0230 Septorhinoplasty including graft/implant following trauma or excision of tumour (including attention to turbinates) Major
  E0260 Rhinoplasty following trauma or excision of tumour (including attention to turbinates) Major
  E0310 Submucous resection of nasal septum Intermediate
  E0330 Biopsy of of septum of nose Minor
  E0340 Closure of perforation of septum of nose Intermediate
  E0360 Septoplasty of nose (including attention to turbinates) Intermediate
  E0220 Septorhinoplasty (including attention to turbinates) Major
  E0390 Extracorporeal septoplasty Major
  E0380 Nasal septum cauterisation (and bilateral) Minor
  E0412 Reduction turbinates of nose (laser, diathermy, out fracture etc) Minor
  E0420 Reduction turbinates of nose (trim, radical excision) Intermediate
  E0440 Division of adhesions of turbinate of nose (and bilateral) Minor
  E0520 Ligation of artery of internal nose (including endoscopic, as sole procedure) Intermediate
  E0610 Packing of cavity of nose (as sole procedure) Minor
  E0810 Polypectomy of internal nose (and bilateral, including endoscopic) Minor
  E0820 Excision of lesion of internal nose Minor
  E0830 Correction of congenital atresia of choana (including endoscopic) Major
  E0850 Removal of foreign body from cavity of nose Minor
  E0910 Excision of lesion of external nose Minor
  5.5 Nasal sinuses
  E1220 Caldwell-Luc procedure Intermediate
  E1240 Vidian neurectomy (including endoscopic) Major
  E1260 Image guided endoscopic frontal, sphenoid and/or ethmoid sinus surgery (FESS) and bilateral Major
  E1310 Antral puncture and wash-out (and bilateral) Minor
  E1330 Intranasal antrostomy including endoscopic and antral washout (including bilateral) Intermediate
  E1350 Closure of oro-antral fistula with local flap Intermediate
  E1360 Endoscopic balloon dilation frontal sinuplasty and bilateral Major
  E1370 Endoscopic balloon dilation maxillary sinuplasty and bilateral Major
  E1380 Endoscopic balloon dilation sphenoid sinuplasty and bilateral Major
  E1410 External frontoethmoidectomy and bilateral Major
  E1432 FESS Uncinectomy, ethmoidectomy, antrostomy or antral puncture inc polypectomy and attention to turbinates etc Major
  E1450 Bone flap to frontal sinus (and bilateral) Major
  E1460 Trephining of frontal sinus and bilateral Minor
  E1470 Median drainage of frontal sinus (modified Lothrop procedure) and bilateral Complex
  E1480 Endoscopic exploration frontal sinus beyond frontoethmoid recess and bilateral Xmajor
  E1500 Operation(s) on sphenoid sinus (including endoscopic) and bilateral Intermediate
  E1742 Lateral rhinotomy into sinuses Intermediate
  E1750 Transnasal repair of leaking CSF (Including endoscopic) Xmajor
  E1780 Diagnostic endoscopy of sinus and bilateral (as sole procedure) Minor
  V0700 Cranio-facial resection Complex
  W2620 Manipulation under anaesthesia of fractured nose (as sole procedure) Minor
  5.6 Throat
  E1910 Total pharyngectomy Complex
  E1920 Partial pharyngectomy Xmajor
  E2010 Adenoidectomy Minor
  E2100 Repair of pharynx Major
  E2320 Open operation(s) on pharyngeal pouch Major
  E2330 Removal of lesion of para-pharyngeal space Major
  E2400 Therapeutic endoscopic operation on pharynx Minor
  E2480 Endoscopic operation(s) on pharyngeal pouch (e.g. Dohlman's procedure) Major
  E2500 Diagnostic nasolaryngopharyngoscopy +/- biopsy as sole procedure Minor
  F3400 Tonsillectomy - child (and bilateral) up to and including age 12 Intermediate
  F3440 Tonsillectomy - adult, age 13 + (and bilateral) Intermediate
  F3480 Adenotonsillectomy (and bilateral) Intermediate
  F3620 Drainage of peritonsillar abscess ('quinsy') Minor
  F3650 Arrest of haemorrhage following tonsillectomy/adenoidectomy Intermediate
  E2501 FIBRE OPTIC EXAMINATION OF THE PHARYNX +/- BIOPSY/REMOVAL OF FOREIGN BODY MINOR
  F4300 Transoral laser microsurgery, including pharyngotomy, partial laryngectomy, partial glossectomy and/ or tracheostomy Complex
  5.7 Larynx and trachea
  E2140 Reconstruction using stomach pull up following pharyngolaryngectomy Complex
  E3681 Stroboscopy of larynx Minor
  E2150 Reconstruction free jejunal graft following pharyngolaryngectomy Complex
  E2300 Pharyngeal myotomy Intermediate
  E2910 Total laryngectomy Complex
  E2920 Horizontal supra-glottic laryngectomy Major
  E2930 Vertical hemi-laryngectomy Major
  E2940 Partial laryngectomy Major
  E2950 Laryngofissure and cordectomy of vocal cord Major
  E2952 Laryngofissure Major
  E2970 Sub-total laryngectomy Xmajor
  E3010 Glottoplasty (e.g.vocal pitch change surgery) Major
  E3100 Reconstruction of larynx with graft Complex
  E3400 Cordectomy (endoscopic) Intermediate
  E3410 Laser surgery to vocal cord (including microlaryngoscopy) Intermediate
  E3520 Microlaryngoscopy/laryngoscopy +/- biopsy, excision of lesion, polyp or cyst Intermediate
  E3810 Injection into larynx Intermediate
  E3900 Partial excision of trachea with reconstruction Complex
  E4030 Tracheoplasty Major
  E4032 Tracheoplasty for congenital conditions Complex
  E4100 Insertion of voice prosthesis (TOF) Major
  E4210 Tracheostomy Intermediate
  E4230 Mini-tracheostomy (percutaneous) Minor
  5.8 Fibreoptic endoscopic procedures (GA or LA)
  E4510 Fibreoptic examination of trachea including biopsy/removal of foreign body Minor
  E4800 Therapeutic bronchoscopy (including laser, cryotherapy, lavage, snare, dilatation of stricture, insertion of stent) Minor
  E4840 Dilatation of tracheal stricture including insertion of stent Intermediate
  E4850 Therapeutic bronchoscopy for removal of foreign body Minor
  E4990 Panendoscopy +/- incisional biopsy Intermediate
  E4991 Therapeutic Panendoscopy +/- excision biopsy, excision or destruction of lesions Intermediate
  E5180 Diagnostic bronchoscopy +/- biopsy Minor
6 Face, mouth, salivary and thyroid
Charges for removal of roots should not be made in conjunction with removal of impacted teeth.

When bone grafting is used as part of treatment of a bone cyst, this should not be charged as a separate service. Specifically the code for alveolar bone grafting is not appropriate in these circumstances.

Closure of an oro-antral fistula should not be charged in conjunction with removal of impacted teeth/complex buried roots.
  6.1 Face and jaws
  V0820 Open reduction and fixation of fractured jaw Intermediate
  V0830 Closed reduction and fixation of fractured jaw Intermediate
  V0910 Open reduction and fixation of nasal ethmoidal fracture Complex
  V0930 Closed reduction of fracture of zygomatic complex of bones Intermediate
  V0980 Open reduction of fracture of zygomatic complex of bones Major
  V1082 Partial maxillectomy for malignancy Xmajor
  V1083 Hemi-maxillectomy for malignancy Xmajor
  V1150 Removal of internal fixation and/or inter-maxillary fixation from jaw Minor
  V1330 Biopsy of lesion of facial bone Minor
  V1400 Excision of mandible Major
  V1422 Extensive segmental excision of mandible Xmajor
  V1423 Extensive excision of mandible with disarticulation Xmajor
  V1440 Excision of lesion of jaw Intermediate
  V1730 Extra-oral fixation of mandible Intermediate
  V1910 Reconstruction of jaw (non-vascularised reconstruction) Xmajor
  V1930 Alveolar bone graft - unilateral Intermediate
  V1931 Alveolar bone graft - bilateral Intermediate
  V2020 Prosthetic replacement of temporomandibular joint Xmajor
  V2030 Arthroplasty of temporomandibular bone joint Major
  V2110 Temporomandibular meniscectomy Major
  V2120 Reduction of dislocation of temporomandibular joint Intermediate
  V2151 Arthrocentesis of temporomandibular joint - unilateral Minor
  V2152 Arthrocentesis of temporomandibular joint - bilateral Minor
  V0721 Eminectomy of temporomandibular joint - unilateral Intermediate
  V0722 EMINECTOMY OF TEMPOROMANDIBULAR JOINT - BILATERAL INTERMEDIATE
  V2162 Therapeutic arthroscopic operation of temporomandibular joint +/- lysis and/or lavage - bilateral intermediate
  V2161 Therapeutic arthroscopic operation of temporomandibular joint +/- lysis and/or lavage -unilateral intermediate
  V2161 Therapeutic arthroscopic operation of temporomandibular joint +/- lysis and/or lavage -unilateral intermediate
  6.2 Lips
  F0110 Excision of vermilion border of lip and advance of mucosa of lip Intermediate
  F0200 Excision of lesion of lip Intermediate
  F0312 Primary closure of cleft lip - unilateral Major
  F0313 Primary closure of cleft lip - bilateral Major
  F0314 Primary closure of cleft lip - unilateral including anterior palate Major
  F0315 Primary closure of cleft lip - bilateral including anterior palate Major
  F0320 Revision of primary closure of cleft lip Major
  F0420 Reconstruction of lip using skin flap Major
  F0530 Suture of lip Minor
  6.3 Tongue
  F2210 Total glossectomy Xmajor
  F2220 Partial glossectomy for malignancy Major
  F2310 Excision/destruction of lesion of tongue Intermediate
  F2620 Frenotomy /frenectomy of tongue under general anaesthetic Minor
  F2640 Freeing of adhesions of tongue Minor
  F2650 Suture of tongue Intermediate
  F2660 Tongue flap - first stage and second stage Major
  F2621 Frenotomy /frenectomy of tongue under local anaesthetic
  6.4 Palate
  F2810 Excision/destruction of lesion of palate Intermediate
  F2910 Primary repair of cleft palate Xmajor
  F3070 Suture of palate Minor
  F3240 Operations on uvula Intermediate
  6.5 Mouth cavity
  F1140 Vestibuloplasty Intermediate
  F3810 Excision/destruction of lesion of mouth Minor
  F4040 Suture of mouth as sole procedure Minor
  F4050 Graft of skin or mucosa to mouth Intermediate
  F4210 Biopsy of lesion of mouth Minor
  F4230 Removal of excess mucosa from mouth Intermediate
  6.6 Salivary glands
  F4400 Excision of parotid gland (other than F4410/F4430) Major
  F4410 Total excision of parotid gland and preservation of facial nerve Xmajor
  F4430 Partial excision of parotid gland and preservation of facial nerve Xmajor
  F4440 Excision of submandibular gland Intermediate
  F4450 Excision of sublingual gland Intermediate
  F4600 Incisional drainage of abscess or haematoma of salivary glands (ie including submandibular, parotid and sublingual glands) Minor
  F4640 Fine needle aspiration of parotid gland Minor
  F4810 Open biopsy of lesion of salivary gland Minor
  F4830 Therapeutic sialendoscopy Intermediate
  F5010 Transposition of parotid duct (including bilateral) Intermediate
  F5020 Transposition of submandibular duct (including bilateral) Intermediate
  F5110 Open extraction of calculus from parotid duct Intermediate
  F5120 Open extraction of calculus from submandibular duct Intermediate
  F5510 Dilatation of parotid duct Minor
  F5610 Manipulative removal of calculus from parotid duct Intermediate
  6.7 Teeth
  F0830 Replantation of natural tooth/teeth following trauma Intermediate
  F0910 Surgical removal of impacted/buried tooth/teeth Intermediate
  F0950 Surgical removal of complicated buried roots Intermediate
  F1810 Enucleation of cyst of jaw Intermediate
  F0911 Coronectomy Intermediate
  6.8 Neck
  T8510 Radical dissection of cervical lymph nodes Complex
  T8610 Biopsy/sampling of cervical lymph nodes Minor
  T8722 Selective dissection of cervical lymph nodes, levels 1 to 4 Xmajor
  T8723 Selective dissection of cervical lymph nodes, levels 1 to 5 (+/- 6) Complex
  T9400 Operations on branchial cyst Intermediate
  T9420 Operations on branchial fistula Major
  6.9 Thyroid and parathyroid glands
  B0812 Total thyroidectomy/near total thyroidectomy Major
  B0813 Total thyroidectomy including block dissection of lymph nodes Major
  B0820 Bilateral subtotal thyroidectomy Major
  B0830 Total thyroid lobectomy and isthmectomy Major
  B1280 Ultrasound guided radiofrequency ablation of benign thyroid nodule Intermediate
  B0850 Isthmectomy of thyroid gland Major
  B0860 Partial thyroidectomy (not elsewhere classified) Major
  BT210 Oral introduction of liquid radioactive agent (brachytherapy) for thyroid tumour ablation Minor
  B0900 Operations on aberrant thyroid tissue (including excision/removal of retrosternal goitre) Xmajor
  B1012 Excision of thyroglossal cyst/tract Intermediate
  B1220 Fine needle aspiration of thyroid gland Minor
  B1230 Core biopsy of thyroid gland Minor
  B1250 Thyroid: re-operation Complex
  B1450 Parathyroidectomy Xmajor
  B1680 Parathyroid: re-operation Xmajor
  B1690 Mediastinal parathyroidectomy with sternotomy Complex
  E3180 Thyroplasty (Isshiki type 1) Major
7 Breast
  7.1 Excision/biopsy codes
  B2800 Excision of breast lump/fibroadenoma Intermediate
  B2820 Wide local excision of breast +/- local mobilisation of glandular breast tissue to fill surgical cavity Intermediate
  B2830 Re-excision of lesion of breast if resection margins are not clear (as sole procedure) Intermediate
  B2880 Excision biopsy of breast lesion after localisation Intermediate
  B3212 Percutaneous suction core biopsy Minor
  B3220 Core biopsy of lesion of breast Minor
  T9000 Sentinel node mapping and sampling with blue dye or radioactive probe for breast cancer Intermediate
  T9020 Sentinel node mapping and sampling with blue dye and radioactive probe for breast cancer Intermediate
  B2831 Re-excision of lesion of breast if resection margins are not clear with local mobilisation Intermediate
  T9030 Intraoperative sentinel node mapping, using One Step Nucleic Acid Amplification (OSNA), for breast cancer Intermediate
  7.2 Mastectomy (excluding implant/reconstruction)
  B2710 Radical mastectomy including block dissection Major
  B2742 Modified radical mastectomy including lymph node sampling Major
  B2743 Modified radical mastectomy excluding lymph node sampling Major
  B2760 Skin/Nipple sparing mastectomy (including axillary node biopsy) Major
  B2744 Modified radical mastectomy including lymph node clearance Major
  B2752 Subcutaneous mastectomy Major
  B2780 Simple mastectomy (including axillary node biopsy) – unilateral Major
  7.3 Reconstruction
  B2700 Subcutaneous mastectomy with immediate implant Major
  B2912 Mastectomy and immediate reconstruction of breast using latissimus dorsi Xmajor
  B2913 Reconstruction of breast using latissimus dorsi including implantation of prosthesis (including delayed reconstruction) Xmajor
  B2914 Mastectomy followed by immediate Deep Inferior Epigastric Flap (DIEP) reconstruction - bilateral Complex
  B2915 Reconstruction of breast using extended latissimus dorsi flap (including delayed reconstruction) Complex
  B2916 Mastectomy and immediate reconstruction of breast using extended latissimus dorsi flap Xmajor
  B2917 Reconstruction of breast using fixed prosthesis and acellular dermal matrix (ADM) (including delayed reconstruction) Major
  B2918 Mastectomy and immediate reconstruction of breast using fixed prosthesis and acellular dermal matrix (ADM) - unilateral Xmajor
  B2984 Reconstruction of breast using pedicled TRAM (including delayed reconstruction) Complex
  B2985 Reconstruction of breast using free TRAM (including delayed reconstruction Complex
  B2986 Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - unilateral (Single Flap) Complex
  B2996 Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - bilateral (single flap per breast) Complex
  B2989 Mastectomy followed by immediate Deep Inferior Epigastric Flap (DIEP) reconstruction - unilateral Complex
  B2987 Reconstruction of breast using Transverse Upper Gracilis (TUG) flap (including delayed reconstruction and nipple reconstruction) Complex
  B2988 Reconstruction of breast using ALT (anteriolateral thigh) flap including delayed reconstruction Complex
  B2921 Lumpectomy and immediate partial reconstruction of breast using pedicled perforator flap (eg. Lateral Intercostal Artery Perforator (LICAP) or Thoraco-Dorsal Artery Perforator (TDAP)) Xmajor
  B2922 Partial reconstruction of breast using pedicled perforator flap (eg. Lateral Intercostal Artery Perforator (LICAP) or Thoraco-Dorsal Artery Perforator (TDAP) including delayed reconstruction) Xmajor
  B2999 Reconstruction of breast using stacked deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - unilateral (2 flaps) Complex
  B2991 Laparoscopic mobilisation of the greater omentum for reconstruction of breast (including delayed reconstruction) Major
  B3012 Mastectomy and immediate reconstruction of breast using expandable prosthesis Xmajor
  B3013 Mastectomy and immediate reconstruction of breast using fixed prosthesis Xmajor
  B3014 Reconstruction of breast using expandable prosthesis (including delayed reconstruction) Major
  B3015 Reconstruction of breast using fixed prosthesis (including delayed reconstruction) Major
  B3016 Mastectomy and immediate reconstruction of breast using fat transfer Xmajor
  B3180 Implantation of prosthesis into breast as sole procedure Intermediate
  B3580 Nipple areola complex reconstruction +/- liposuction and fat transfer Major
  B3810 Reconstruction of breast using SGAP (superior gluteal artery perforator) flap including delayed reconstruction. Complex
  7.4 Other
  B3310 Drainage of breast abscess including haematoma and seroma Minor
  B3440 Microdochotomy Intermediate
  B3592 Micropigmentation (tattooing) of nipple areola complex Minor
  B3593 Microdochectomy or mammodochectomy (Hadfield’s procedure) Intermediate
  B3594 Plastic procedures on nipple Intermediate
  B3595 Excision of mammary fistula Intermediate
8 Thorax and intra-thoracic organs
It is common practice with a number of intra-thoracic procedures to perform a rigid bronchoscopy. This should not be separately itemised for billing purposes when this is a routine part of the procedure.

Insertion of a chest drain should not be charged for separately with intra-thoracic surgery.
  8.1 Oesophagus
  G0100 Oesophagectomy/oesophagogastrectomy with anastomosis in chest Complex
  G1470 Fibreoptic endoscopic photodynamic therapy (PDT) of lesion of oesophagus Intermediate
  G0220 Total oesophagectomy and interposition of intestine Complex
  G0260 Endoscopically assisted oesophagectomy Complex
  G0300 Sub-total oesophagectomy with anastomosis in neck Complex
  G0400 Open excision of lesion of oesophagus Major
  G0500 Bypass of oesophagus Xmajor
  G0640 Closure of bypass of oesophagus Major
  G0730 Repair of congenital oesophageal atresia (with or without fistula) Complex
  G0740 Repair of ruptured oesophagus Complex
  G0920 Oesophagocardiomyotomy (Heller's operation) Major
  G1400 VATS excision lesion of oesophagus Xmajor
  G2312 Transthoracic repair of paraoesophageal hiatus hernia Xmajor
  G2320 Transthoracic repair of diaphragmatic hernia (acquired) Xmajor
  G2330 Transabdominal repair of hiatus hernia Major
  G2340 Transabdominal repair of diagphragmatic hernia Complex
  G2400 Transthoracic fundoplication and gastroplasty Xmajor
  G2402 Transthoracic fundoplication Xmajor
  G2430 Transabdominal anti-reflux operations Complex
  G2590 Revision of anti-reflux procedures Complex
  A2781 Laparoscopic vagotomy/seromyotomy Major
  8.2 Chest wall
  E4722 Thoracotomy and closure of broncho-pleural fistula Xmajor
  T0110 Thoracoplasty Xmajor
  T0132 Excision of chest wall tumour - with chest wall reconstruction Xmajor
  T0133 Excision of chest wall tumour - without chest wall reconstruction Xmajor
  T0210 Correction of pectus deformity of chest wall (or other congenital defect thereof) complex
  T0212 Secondary correction of scolios-related chest wall deformity (posterior costoplasty) (as sole procedure) Complex
  T0320 Exploratory thoracotomy Major
  T0810 Resection of rib and open drainage of pleural cavity Major
  T1500 Repair of rupture of diaphragm complex
  T1620 Plication of paralysed diaphragm Xmajor
  T1640 Repair of congenital diaphragmatic hernia Xmajor
  T2781 Repair of epigastric hernia Intermediate
  8.3 Trachea
  E3900 Partial excision of trachea with reconstruction Complex
  E4030 Tracheoplasty Major
  E4032 Tracheoplasty for congenital conditions Complex
  E4100 Insertion of voice prosthesis (TOF) Major
  E4210 Tracheostomy Intermediate
  E4230 Mini-tracheostomy (percutaneous) Minor
  8.4 Fibreoptic endoscopic procedures (GA or LA)
  E4510 Fibreoptic examination of trachea including biopsy/removal of foreign body Minor
  E4800 Therapeutic bronchoscopy (including laser, cryotherapy, lavage, snare, dilatation of stricture, insertion of stent) Minor
  E4840 Dilatation of tracheal stricture including insertion of stent Intermediate
  E4850 Therapeutic bronchoscopy for removal of foreign body Minor
  E5180 Diagnostic bronchoscopy +/- biopsy Minor
  8.5 Bronchi/lungs/pleura
  E4400 Carinal resection +/- pneumonectomy Complex
  E4600 Sleeve resection of bronchus or pulmonary artery with pulmonary resection Complex
  E5410 Pneumonectomy Complex
  E5430 Pulmonary lobectomy including segmental resection Complex
  E5480 Lung resection with resection of chest wall Complex
  E5520 Open excision of lesion of lung Complex
  E5532 Thoracotomy and lung biopsy as sole procedure Intermediate
  E5533 Percutaneous radiofrequency ablation of malignant neoplasm of lung Complex
  E5700 Thoractomy lung volume reduction - bilateral Complex
  E5702 Thoracotomy lung volume reduction - unilateral Complex
  E5703 Thoracotomy bullectomy - bilateral Complex
  E5704 Thoracotomy bullectomy - unilateral +/- pleurodesis in presence of emphysema Xmajor
  E5705 Thoracotomy pleurectomy/pleurodesis +/- ligation of bullae for pneumothorax Xmajor
  E5910 Needle biopsy of lung Minor
  T0710 Decortication of pleura of lung Complex
  T0910 Open pleural biopsy as sole procedure Xmajor
  E5540 Laser resection of lung metastases Complex
  T1220 Drainage of pleural cavity Minor
  T1240 Insertion of tube drain into pleural cavity Minor
  T1300 Introduction of substance into pleural cavity with chest drain Minor
  T1410 Needle biopsy of pleura Minor
  E5100 Endobronchial ultrasound (as sole procedure) Minor
  T1480 Insertion of pleuro-peritoneal shunt Intermediate
  8.6 Mediastinum
  B1690 Mediastinal parathyroidectomy with sternotomy Complex
  B1800 Thymectomy for myasthenia gravis Major
  E6100 Open resection of invasive mediastinal tumour Complex
  E6110 Open excision of mediastinal tumour including congenital cysts/posterior chest wall lesions Xmajor
  E6300 Diagnostic mediastinoscopy Intermediate
  E6310 Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal masses Major
  8.7 Video assisted thoracic surgery (VATS)
  A7560 VATS sympathectomy - unilateral Major
  A7561 VATS sympathectomy - bilateral Xmajor
  E5432 VATS lobectomy Major
  E5442 VATS wedge resection of lung Major
  E5590 VATS bullectomy - unilateral Major
  E5591 VATS bullectomy - bilateral Complex
  E5592 VATS lung volume reduction - unilateral Complex
  E5593 VATS lung volume reduction - bilateral Complex
  E5594 VATS debridement of empyema Major
  E5932 VATS lung biopsy Intermediate
  E6200 VATS excision lesion of mediastinum including thymectomy Xmajor
  G0922 VATS oesophageal / oesophagogastric myotomy Major
  G1400 VATS excision lesion of oesophagus Xmajor
  G2331 Laparoscopic repair of hiatus hernia with anti-reflux procedure (eg fundoplication) Major
  T1030 VATS pleurodesis/pleurectomy Major
  T1032 Thoracoscopy and drainage and chemical pleurodesis Intermediate
  T1100 Diagnostic thoracoscopy (+/- biopsy) Minor
  8.8 Heart – cardiac surgery
    We will provide benefit for surgeon and anaesthetist standby during coronary angioplasty provided the surgeon and anaesthetist are physically present and have no other obligations at that time. There is a code AA588 for this purpose. Please note, however, should surgery become necessary we will not also reimburse a charge for standby.

The benefit for therapeutic interventional procedures such as angioplasty with stenting or ablation includes an amount for any diagnostic procedure performed on the same day. Transoesophageal echocardiography should not be charged as an addition with valve procedures.

We will not pay additional amounts for supervision of post-operative care by cardiologists. In exceptional circumstances we will consider charges but these must be justified and agreed with us before they are invoiced.

We acknowledge that the procedure K3580 - Trans catheter aortic valve implantation (TAVI) requires a multidisciplinary approach from a cardiologist and a cardio-thoracic surgeon. The fee we publish for K3580 is payable to the team so invoices may either be submitted by one specialist for the full amount or by both specialists for 50% of the published fee. The fee of £2300 is not claimable by both specialists.

  K0400 Correction of tetralogy of Fallot Complex
  K0500 Atrial inversion for transposition of great vessels Complex
  K0530 Double switch procedure (atrial and arterial) Complex
  K4610 Minimally invasive direct coronary artery bypass (MIDCAB) including harvesting of graft Complex
  K0700 Correction of total anomalous pulmonary venous connection Complex
  K0900 Repair of complete atrioventricular septal defect Complex
  K0930 Closure of partial atrioventricular septal defect Complex
  K1000 Closure of defect of interatrial septum (secundum Atrial Septal Defect or Patent Foramen Ovale) Complex
  K1100 Closure of defect of interventricular septum Complex
  K1180 Endovascular closure of perimembranous ventricular septal defect Complex
  K1200 Norwood stage 1 procedure Complex
  K1600 Therapeutic transluminal operations on atrial septum of heart Complex
  K1680 Transluminal closure of atrial septal defect / patent foramen ovale Complex
  K1800 Placement of valve to cardiac conduit Complex
  K1850 Revision placement of valve to cardiac conduit Complex
  K2310 Excision of cardiac tumour Complex
  K2540 Replacement of mitral valve with sub-valve preservation (including biopsies) Complex
  K2542 Revision replacement of mitral valve Complex
  K2580 Repair of mitral valve Complex
  K2600 Replacement or repair of aortic valve Complex
  K2602 Minimally invasive replacement of aortic valve Complex
  K2610 Ross procedure Complex
  K2612 Replacement of aortic valve with homograft or stentless porcine Complex
  K2613 Revision of aortic valve replacement Complex
  K2700 Replacement of tricuspid valve (including valvuloplasty) Complex
  K2780 Repair of tricuspid valve, eg for Ebstein's disease Complex
  K2800 Replacement of pulmonary valve (including valvuloplasty/valvotomy) Complex
  K2810 Percutaneous replacement/implantation of pulmonary valve Complex
  K3100 Open valvotomy Complex
  K3210 Closed mitral valvotomy Complex
  K3500 Therapeutic transluminal operation(s) on valve of heart Xmajor
  K3580 Trans catheter aortic valve implantation (TAVI) Complex
  K4100 Bypass for coronary artery(ies) including harvesting of grafts and endarterectomy Complex
  L2720 Endovascular aneurysm repair (EVAR) of suprarenal aorta, with insertion of fenestrated graft (up to two orifices) Complex
  L2780 Endovascular aneurysm repair (EVAR) of suprarenal aorta, with insertion of fenestrated graft (three to four orifices) Complex
  L2710 Endovascular aneurysm repair (EVAR) of infrarenal aorta Complex
  K4410 Revision bypass for coronary artery(ies) (including harvesting of grafts) Complex
  K4600 Off-pump coronary artery bypass (OPCAB) Complex
  K4880 Correction of anomalous coronary arteries Complex
  K5120 Intravascular ultrasound of coronary arteries (as sole procedure) Major
  K5283 Complex Cox lesion set maze operation Complex
  K5330 Repair of post infarction ventricular septal defect Complex
  K5380 Repair of ventricular aneurysm Complex
  K6700 Pericardiectomy Complex
  K6810 Decompression of cardiac tamponade or re-exploration for bleeding Xmajor
  L0110 Correction of truncus arteriosus Complex
  L0610 Formation of atriopulmonary connection (or any modification of Fontan type procedure) Complex
  L2360 Repair of interrupted aortic arch Complex
  L2382 Aortic root replacement with valve conduit or homograft and/or remodelling Complex
  L2560 Percutaneous or open placement of intra-aortic balloon (including subsequent removal) Intermediate
  8.9 Heart – cardiology
  K1690 Non-surgical reduction of myocardial septum (e.g. alcohol septal ablation) Complex
  K6581 Coronary angioplasty following angiography with fractional flow study on the same day, +/- insertion of stent Complex
  K5720 Ablation of AV nodal re-entry tachycardia (including mapping) Complex
  K5770 Ablation of arrhythmia in complex congenital heart disease (including mapping) Complex
  K5790 Ablation of left atrial tachycardia (including mapping) Complex
  K2280 Percutaneous occlusion of left atrial appendage Xmajor
  K6105 Insertion of dual chamber implantable cardioverter defibrillator (ICD) Complex
  K6060 Lead replacement for Pacemaker or implantable cardioverter defibrillator (ICD) Major
  K6050 Replacement implantable cardioverter defibrillator (ICD), without lead change Intermediate
  K6582 Adult cardiac catheterisation - radial access (including coronary arteriography/catheterisation of right/left side of heart/contrast radiology) - with pressure wire (including fractional flow reserve measurement) Intermediate
  K6584 Adult cardiac catheterisation - femoral access (including coronary arteriography/catheterisation of right/left side of heart/contrast radiology) - with pressure wire (including fractional flow reserve measurement) Intermediate
  K6513 Adult cardiac catheterisation - radial access (including coronary arteriography/ catheterisation of right/left side of heart/contrast radiology) Intermediate
  K4900 Percutaneous transluminal angioplasty of coronary artery(ies) (including laser) Complex
  K4902 Percutaneous transluminal angioplasty of coronary artery(ies) with intravascular ultrasound (including laser) Complex
  K4910 Percutaneous transluminal angioplasty of coronary artery(ies) with stent insertion Complex
  K4912 Percutaneous transluminal angioplasty of coronary artery(ies) with stent insertion and intravascular ultrasound Complex
  K5280 Map guided surgery for ventricular arrhythmias (including mapping) Xmajor
  K5710 Ablation of atrio-ventricular junction (including mapping) Xmajor
  K5730 Ablation of atrial arrhythmia (including mapping) Complex
  K5740 Ablation of ventricular arrhythmia (including mapping) Complex
  K5750 Internal cardioversion Intermediate
  K5760 Ablation of atrial fibrillation by isolation of the pulmonary veins (including mapping) Complex
  K5780 Ablation of accessory pathway or selected modification of AV node (including mapping) Complex
  K5810 Diagnostic intracardiac electrophysiological study including characterisation of intracardiac conduction and any testing of anti-arrhythmic drug efficacy by programmed stimulation Major
  K6511 Adult cardiac catheterisation - femoral access (including coronary arteriography/ catheterisation of right/left side of heart/contrast radiology) Intermediate
  K6115 Insertion of an implantable cardioverter defibrillator with subcutaneous leads (subcutaneous ICD) Complex
  K5040 Rotoblation of coronary vessel(s) percutaneous transluminal rotational atherectomy (PCRS) +/- insertion of stent Complex
  K6586 Adult cardiac catheterisation - brachial access (including coronary arteriography/catheterisation of right/left side of heart / contrast radiology) - with pressure wire (including fractional flow reserve measurement) Intermediate
  K6111 Insertion of combined biventricular pacemaker and cardioverter defibrillator (CRT-D) Complex
  K6514 Adult cardiac catheterisation - brachial access (including coronary arteriography/ catheterisation of right/left side of heart/contrast radiology) Intermediate
  K4920 Percutaneous transluminal angioplasty of coronary artery(ies) for chronic total occlusions (CTO), +/- insertion of stent Complex
  K5110 Angioscopy Intermediate
  K6000 Cardiac pacemaker system introduced through vein (single chamber) Major
  K6010 Cardiac pacemaker system introduced through vein (dual chamber) Major
  K6015 Implantation of biventricular pacemaker Complex
  K6070 Implant of temporary pacing electrode (as sole procedure) Intermediate
  K6020 Resiting of Pacemaker or implantable cardioverter defibrillator (ICD) Intermediate
  K6030 Replacement of generator for intravenous cardiac pacemaker system (without lead change) Major
  K6040 Removal of pacing system with bypass Complex
  K6080 Removal of pacing system without bypass (including leads) Minor
  K6082 Removal of pacing system (generator only) Intermediate
  K6100 Insertion of single chamber implantable cardioverter defibrillator (ICD) Complex
  K5020 Coronary angiography proceeding to angioplasty on the same day, +/- insertion of stent Complex
  K6590 Coronary angiography including intravascular ultrasound Major
  K6520 Paediatric cardiac catheterisation Major
  K5830 Endomyocardial biopsy Intermediate
  K5050 Coronary angioplasty following angiography with intravascular ultrasound on the same day, +/- insertion of stent Complex
  K6820 Pericardiocentesis Intermediate
  8.10 Great Vessels
  L0200 Closed ligation of patent ductus arteriosus Complex
  L0230 VATS closure of patent ductus arteriosus Complex
  L0310 Percutaneous transluminal prosthetic occlusion of patent ductus arteriosus Complex
  L0620 Creation of communication between pulmonary artery and aorta Complex
  L0710 Creation of shunt from subclavian artery to pulmonary artery Complex
  L0900 Formation of cavo-pulmonary shunt (Glenn) Complex
  L1080 Open operations/repair of pulmonary artery Complex
  L1240 Pulmonary embolectomy Complex
  L1300 Transluminal operations on pulmonary artery Xmajor
  L1810 Repair of leaking aneurysm of ascending aorta Complex
  L1880 Repair of leaking aneurysm of arch of aorta Complex
  L1890 Repair of leaking aneurysm of thoracic aorta Complex
  L1892 Immediate repair of aortic dissection (ie within two weeks of happening) Complex
  L1910 Elective repair of aneurysm of ascending aorta Complex
  L1980 Elective repair of aneurysm of arch of aorta Complex
  L1990 Elective repair of aneurysm of thoracic aorta Complex
  L1992 Delayed repair of aortic dissection (ie more than two weeks after happening) Complex
  L2190 Replacement of graft of thoraco-abdominal aneurysm Complex
  L2200 Revision of prosthesis of abdominal aorta Complex
  L2290 Excision of infected aortic graft with bypass Complex
  L2302 Coarctation repair Complex
  L2303 Coarctation repair involving prosthetic graft Complex
  L2350 Revision operation on ascending aorta and proximal descending aorta Complex
  L2600 Percutaneous transluminal balloon operations on aorta Major
  L7042 Atrial switch procedure for transposition of great vessels Complex
  W7042 Cannulation or decannulation for ECMO (Extracorporeal membrane oxygenation) Major
  8.11 Other
  64302 Transoesophageal echocardiography (including reporting) (as sole procedure) Intermediate
  A2720 Proximal gastric vagotomy Major
  A2730 Highly selective vagotomy Major
  A2780 Vagotomy and pyloroplasty Major
  X5020 External cardioversion Minor
9 Vascular system
  9.1 Head and neck
  L2930 Bypass carotid artery from the arch Complex
  L2950 Carotid endarterectomy Complex
  L3710 Bypass of subclavian artery from the arch Complex
  L3711 Bypass of subclavian artery - extra-thoracic Complex
  L3730 Endarterectomy and patch repair of subclavian artery Complex
  XR287 Catheter cerebral venography and manometry Intermediate
  9.2 Thoracic vessels
  L1810 Repair of leaking aneurysm of ascending aorta Complex
  L1880 Repair of leaking aneurysm of arch of aorta Complex
  L1890 Repair of leaking aneurysm of thoracic aorta Complex
  L1892 Immediate repair of aortic dissection (ie within two weeks of happening) Complex
  L1910 Elective repair of aneurysm of ascending aorta Complex
  L1980 Elective repair of aneurysm of arch of aorta Complex
  L1990 Elective repair of aneurysm of thoracic aorta Complex
  L1992 Delayed repair of aortic dissection (ie more than two weeks after happening) Complex
  L2190 Replacement of graft of thoraco-abdominal aneurysm Complex
  L2290 Excision of infected aortic graft with bypass Complex
  L2600 Percutaneous transluminal balloon operations on aorta Major
  9.3 Renal vessels
  L4140 Endarterectomy of renal artery Complex
  L4190 Reconstruction of renal artery(ies) Complex
  L4292 Reconstruction of transplant renal artery Xmajor
  L4300 Transluminal operations on renal artery Major
  9.4 Abdominal vessels
  L1620 Axillo-unifemoral bypass Complex
  L1680 Axillo-bifemoral bypass Complex
  L1940 Open infrarenal abdominal aortic aneurysm tube graft Complex
  L1960 Open infrarenal abdominal aortic aneurysm bifurcation graft Complex
  L2200 Revision of prosthesis of abdominal aorta Complex
  L2600 Percutaneous transluminal balloon operations on aorta Major
  L4530 Endarterectomy and patch repair of visceral branch of abdominal aorta Complex
  L4600 Other open operations on other visceral branch of abdominal aorta Complex
  9.5 Ileo-femoral vessels
  L5100 Aorto-iliac, aorto-femoral, ilio-femoral bypass Complex
  L5180 Aorto-bifemoral bypass Complex
  L5210 Endarterectomy and patch repair of iliac artery Complex
  L5300 Open operations on iliac artery Complex
  L5400 transluminal operations on iliac artery Intermediate
  L5910 Femoro-femoral bypass Complex
  L5922 Femoro-popliteal bypass using prosthesis Complex
  L5923 Femoro-popliteal bypass using vein Complex
  L5924 Femoro-popliteal bypass using vein cuff/patch Complex
  L5950 Femoro-distal calf bypass using prosthesis +/- vein cuff/patch Complex
  L5960 Femoro-distal calf bypass using vein Complex
  L6000 Endarterectomy of femoral artery Complex
  L6230 Reconstruction/bypass for popliteal aneurysm Complex
  L6300 Transluminal procedures on femoral artery Major
  L6530 Revision femoral bypass graft Xmajor
  9.6 Non-specific
  L6710 Biopsy of artery (including temporal) (as sole procedure) Minor
  L6800 Repair of limb artery Xmajor
  L6840 Repair of limb artery using vein graft Xmajor
  L7010 Open embolectomy of artery Xmajor
  L7110 Percutaneous transluminal angioplasty of artery, +/- insertion of stent Intermediate
  L7410 Creation of arteriovenous shunt (synthetic graft) Major
  L7420 Creation of arteriovenous fistula (including subsequent closure) Intermediate
  L7422 Creation of arteriovenous fistula for dialysis Intermediate
  L7423 Ligation of arteriovenous fistula for dialysis Intermediate
  L7520 Repair of acquired arteriovenous fistula Complex
  L7580 Repair arteriovenous fistula Complex
  L8110 Creation of peritoneovenous shunt (Levine/Denver) Intermediate
  L9000 Open removal of thrombus from vein Major
  L9110 Insertion of tunnelled central venous catheter (Hickman Line) Intermediate
  L9112 Surgical insertion of central venous dialysis line Intermediate
  L9113 Percutaneous insertion of central venous dialysis line Intermediate
  L9114 Removal of central venous dialysis line Minor
  L9115 Implantation of port device (PowerPort) Intermediate
  L9180 Insertion of implantable central venous port (portacath) e.g Port-a-Cath under image guidance Intermediate
  L7511 Excision of arteriovenous malformation from peripheral vessel Intermediate
  L9181 Removal of Portacath/vasoport unit Minor
  L9350 Basilic vein transposition Major
  L9730 Isolated limb perfusion Xmajor
  X4110 Open insertion of Tenckhoff catheter Intermediate
  X4112 Percutaneous insertion of Tenckhoff catheter Minor
  X4120 Removal of Tenckhoff catheter Minor
  XR916 Surgical removal of cuffed central venous catheter - tunnelled (X-ray guided) Minor
  9.7 Varicose veins
  L8510 Ligation/stripping of long or short saphenous vein (including local excision/multiple phlebectomy) Intermediate
  L8512 Endovenous laser treatment (EVLT) of single venous trunk +/- phlebectomies - unilateral Intermediate
  L8513 Endovenous laser treatment (EVLT) of single venous trunk +/- phlebectomies - bilateral Major
  L8514 Endovenous laser treatment (EVLT) of more than one venous trunk +/- phlebectomies - unilateral Major
  L8515 Endovenous laser treatment (EVLT) of more than one venous trunk +/-phlebectomies - bilateral Major
  L8880 Endovenous mechanochemical ablation for varicose veins - unilateral Intermediate
  L8881 Endovenous mechanochemical ablation for varicose veins - bilateral Intermediate
  L8520 Ligation/stripping of long or short saphenous vein (including local excision/multiple phlebectomy) - bilateral Major
  L8530 Operations for recurrent varicose veins with re-exploration of groin and/or popliteal fossa - unilateral Major
  L8532 Operations for recurrent varicose veins without re-exploration of groin or popliteal fossa - unilateral Major
  L8540 Radiofrequency ablation of more than one venous trunk +/- phlebectomies - unilateral Intermediate
  L8541 Radiofrequency ablation of more than one venous trunk +/- phlebectomies - bilateral Major
  L8580 Operations for recurrent varicose veins with re-exploration of groin and/or popliteal fossa - bilateral Xmajor
  L8582 Operations for recurrent varicose veins without re-exploration of groin or popliteal fossa - bilateral Xmajor
  L8620 Ultrasound-guided foam Sclerotherapy for varicose vein(s) unilateral Intermediate
  L8621 Ultrasound-guided foam Sclerotherapy for varicose vein(s) – bilateral Intermediate
  L8542 Radiofrequency ablation of single venous trunk +/- phlebectomies - unilateral Intermediate
  L8543 Radiofrequency ablation of single venous trunk +/- phlebectomies - bilateral Major
  L8680 Bilateral varicose vein injection sclerotherapy Intermediate
  L8700 Ligation/stripping of long and short saphenous veins (including local excision/multiple phlebectomy) Major
  L8750 Local excision (multiple phlebectomy) of varicose vein(s) of leg - unilateral Intermediate
  L8751 Local excision (multiple phlebectomy) of varicose vein(s) of leg - bilateral Intermediate
  L8780 Ligation/stripping of long and short saphenous veins (including local excision/multiple phlebectomy) bilateral Complex
  L9510 Venography (and bilateral) Minor
  9.8 Lymphatic system
  T8510 Radical dissection of cervical lymph nodes Complex
  T8520 Block dissection of axillary lymph nodes (axillary clearance levels 1-3) Major
  T8540 Block dissection of para-aortic lymph nodes Xmajor
  T8550 Block dissection of inguinal lymph nodes Major
  T8580 Block dissection of pelvic lymph nodes (as sole procedure) Major
  T8592 Laparoscopic retroperitoneal lymph node dissection Major
  T8594 Laparoscopic para-aortic lymph node dissection Complex
  T8610 Biopsy/sampling of cervical lymph nodes Minor
  T8620 Sampling of axillary lymph nodes Minor
  T9030 Intraoperative sentinel node mapping, using One Step Nucleic Acid Amplification (OSNA), for breast cancer Intermediate
  T8640 Sampling of internal mammary lymph nodes Intermediate
  T8700 Excision biopsy of lymph node for diagnosis (cervical, inguinal, axillary) Intermediate
  T8722 Selective dissection of cervical lymph nodes, levels 1 to 4 Xmajor
  T8723 Selective dissection of cervical lymph nodes, levels 1 to 5 (+/- 6) Complex
  T9000 Sentinel node mapping and sampling with blue dye or radioactive probe for breast cancer Intermediate
  T9020 Sentinel node mapping and sampling with blue dye and radioactive probe for breast cancer Intermediate
  T8780 Sentinel node biopsy (except where otherwise listed) Intermediate
  T9610 Excision of cystic hygroma Major
  T8562 LAPAROSCOPIC PELVIC LYMPHADENECTOMY (AS SOLE PROCEDURE) Major
10 Endoscopic gastrointestinal procedures
The benefit for endoscopic therapeutic procedures includes an amount for diagnostic endoscopy. This should therefore not be charged for separately.

The benefit for gastroscopy and sigmoidoscopy includes an amount for sedation.

Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
  10.1 Endoscopic gastrointestinal procedures
  G1900 Rigid oesophagoscopy including any biopsy, laser or diathermy destruction of lesions Intermediate
  G2110 Oesophageal physiology studies (including pH measurement) Minor
  G4410 Therapeutic oesophago-gastro-duodenoscopy (OGD) with insertion of prosthesis Intermediate
  G4430 Therapeutic oesophago-gastro-duodenoscopy (OGD) with dilatation Minor
  H6260 Proctoscopy (+/- Biopsy) Minor
  G2180 Ambulatory 24h pH and impedance monitoring
  H2350 Endoscopic mucosal resection (EMR) of colorectal tumour Intermediate
  G2120 High resolution oesophageal manometry Minor
  G4370 Therapeutic oesophago-gastro-duodenoscopy (OGD) with elective banding of oesophageal varices Minor
  G4371 Therapeutic oesophago-gastro-duodenoscopy (OGD) with therapy for acutely bleeding ulcer or varices Minor
  G4440 Therapeutic oesophago-gastro-duodenoscopy (OGD) with insertion of percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy Intermediate
  G4480 Therapeutic enteroscopy Intermediate
  G4520 Diagnostic enteroscopy Intermediate
  G4530 Catheterless oesophageal pH monitoring (eg Bravo) Intermediate
  G6500 Diagnostic eosophago-gastro-duodenoscopy (OGD) includes forceps biopsy, biopsy urease test and dye spray Minor
  G7900 Ileoscopy via stoma with therapy Minor
  G8080 Capsule endoscopy including interpretation and evaluation Intermediate
  G8082 Diagnostic oesophago-gastro-duodenoscopy (OGD) and immediate colonoscopy includes forceps biopsies, biopsy test and dye spray (as sole procedure) Intermediate
  G8083 Therapeutic oesophago-gastro-duodenoscopy (OGD) and immediate colonoscopy includes forceps biopsies, biopsy test and dye spray (as sole procedure) Intermediate
  H2001 Double balloon enteroscopy Major
  H2002 Diagnostic colonoscopy, includes forceps biopsy of colon and ileum Intermediate
  H2003 Therapeutic colonoscopy with snare loop biopsy or excision of lesion Intermediate
  H2180 Fibreoptic colonoscopy and recanalisation of tumour Major
  H2220 Endoscopic ultrasound for tumour staging, including diagnostic endoscopy Intermediate
  H2502 Diagnostic flexible sigmoidoscopy, including forceps biopsy and proctoscopy Minor
  H2503 Therapeutic sigmoidoscopy with snare loop biopsy or excision of lesion Minor
  H4190 Therapeutic High Resolution Anoscopy (HRA) in symptomatic patients (+/- biopsy or ablation of lesion of anus) Minor
  J3900 Therapeutic ERCP with insertion of biliary or pancreatic stent(s), sphincterotomy or stone extraction Major
  J4300 Diagnostic ERCP (includes forceps biopsy) Intermediate
  J6730 Endoscopic upper gastrointestinal ultrasound, eg for pancreaticobiliary diagnosis/transmucosal biopsy Intermediate
  H6840 Flexible pouchoscopy +/- biopsy and/or removal of polyp(s) Minor
11 Abdomen (excluding urinary and reproductive organs)
Many pathological processes eg cholecystitis result in the formation of adhesions. Adhesiolysis is therefore part of these procedures. We no longer have a specific code for division of adhesions. When major problems due to adhesions are encountered, we request that a note of explanation is provided and we will give consideration as to whether we will pay additional benefit.
  11.1 Oesophagus
  A2781 Laparoscopic vagotomy/seromyotomy Major
  G0100 Oesophagectomy/oesophagogastrectomy with anastomosis in chest Complex
  G0220 Total oesophagectomy and interposition of intestine Complex
  G0300 Sub-total oesophagectomy with anastomosis in neck Complex
  G0400 Open excision of lesion of oesophagus Major
  G0500 Bypass of oesophagus Xmajor
  G0640 Closure of bypass of oesophagus Major
  G0730 Repair of congenital oesophageal atresia (with or without fistula) Complex
  G0920 Oesophagocardiomyotomy (Heller's operation) Major
  G0980 Thorascopic oesophagogastric myotomy Major
  G2312 Transthoracic repair of paraoesophageal hiatus hernia Xmajor
  G2320 Transthoracic repair of diaphragmatic hernia (acquired) Xmajor
  G2330 Transabdominal repair of hiatus hernia Major
  G2331 Laparoscopic repair of hiatus hernia with anti-reflux procedure (eg fundoplication) Major
  G2340 Transabdominal repair of diaphragmatic hernia Complex
  G2400 Transthoracic fundoplication and gastroplasty Xmajor
  G2402 Transthoracic fundoplication Xmajor
  G2430 Transabdominal anti-reflux operations Complex
  G2590 Revision of anti-reflux procedures Complex
  G4610 Transoral Incisionless Fundoplication (TIF) Major
  G1460 Endoscopic mucosal resection of high-grade dysplasia in Barrett's oesophagus Major
  G1421 Endoscopic ablation of high-grade dysplasia in barrett's oesophagus Intermediate
  11.2 Stomach
  A2720 Proximal gastric vagotomy Major
  A2730 Highly selective vagotomy Major
  A2780 Vagotomy and pyloroplasty Major
  G2710 Total gastrectomy and excision of surrounding tissue Complex
  G2800 Partial gastrectomy Xmajor
  G2810 Partial gastrectomy and excision of surrounding tissue Complex
  G3100 Laparoscopic biliary gastric bypass Complex
  G3210 Gastro–jejunostomy Major
  G3220 Revision of gastro–jejunostomy Xmajor
  G3400 Gastrostomy Major
  G3440 Closure of Gastrostomy Major
  G3520 Closure of perforated ulcer of stomach Major
  G3580 Laparoscopic closure of peptic ulcer Major
  G3610 Gastropexy for reflux Major
  G3800 Open operations on stomach not elsewhere classified Major
  G4010 Pyloromyotomy Major
  G4030 Pyloroplasty Major
  G4680 Endoscopic mucosal resection (upper gastrointestinal tract) (EMR) Intermediate
  G4690 Endoscopic submucosal dissection of gastric lesions Major
  G3490 Endoscopic removal of percutaneous endoscopic gastrostomy (PEG) tube Intermediate
  11.3 Duodenum
  G5000 Open excision of lesion of duodenum Xmajor
  G5010 Open excision of congenital lesion of duodenum including malrotation Complex
  G5050 Endoscopic submucosal dissection of duodenal lesions Major
  G5100 Bypass of duodenum Major
  G5320 Closure of perforated ulcer of duodenum Major
  11.4 Small intestine
  G4020 Surgery for correction of congenital intestinal atresias Xmajor
  G5810 Excision of jejunum Major
  G6000 Open formation of jejunostomy Major
  G6080 Laparoscopically assisted resection of small intestine Major
  G6082 Open resectionof small intestine tumour Major
  G6100 Bypass of jejunum Major
  G6710 Intubation of jejunum for decompression of intestine (without laparotomy) Major
  G7100 Bypass of ileum Major
  G7250 Ileoanal anastomosis and creation of pouch Complex
  G7402 Open formation of ileostomy Major
  G7403 Laparoscopic ileostomy Major
  G7512 Revision of ileostomy - local Major
  G7513 Revision of ileostomy - laparotomy Major
  G7530 Closure of ileostomy (as sole procedure) Intermediate
  11.5 Large intestine
  H0210 Appendicectomy Major
  H0280 Laparoscopic appendicectomy Major
  H0310 Drainage of abscess of appendix or drainage of intra-abdominal abscess Major
  H0510 Total excision of colon and ileorectal anastomosis Complex
  H0610 Extended excision of right hemicolon Xmajor
  H0700 Right hemicolectomy Xmajor
  H0750 Laparoscopically assisted right hemicolectomy Xmajor
  H0800 Excision of transverse colon Xmajor
  H0900 Excision of left hemicolon Xmajor
  H1000 Excision of sigmoid colon Xmajor
  H1200 Excision of lesion of colon (transabdominal) Major
  H1300 Bypass of colon Major
  H1542 Closure of colostomy Major
  H1581 Laparoscopic colostomy and stoma formation (including revision) Major
  H1590 Open formation of colostomy Major
  H1700 Intra abdominal manipulation of colon for intussusception (as sole procedure) Major
  H1880 Laparoscopically assisted left colon resection Xmajor
  11.6 Rectum/anus
  G7250 Ileoanal anastomosis and creation of pouch Complex
  H0410 Panproctocolectomy and ileostomy Complex
  H0480 Abdominal revision of restorative proctocolectomy Complex
  H1550 Abdominal operation for Hirschprung's disease (eg Duhamel, Söave and Surcuson operations) Complex
  H3310 Abdominoperineal pull through resection with colo-anal anastomosis +/- colonic pouch and associated stoma Complex
  H3320 Abdominoperineal resection of rectum and anus Complex
  H3322 Laparoscopic abdominoperineal resection Complex
  H3332 Anterior resection - high (i.e. colorectal anastomosis above the peritoneal reflection) Complex
  H3334 Anterior resection - low (ie colorectal anastomosis at or below the peritoneal reflection Complex
  H3362 Hartmann's procedure Xmajor
  H3363 Colectomy and colostomy and preservation of rectum Xmajor
  H3364 Laparoscopic anterior resection - high (i.e. colorectal anastomosis above the peritoneal reflection) Complex
  H3365 Laparascopic anterior resection - low (ie colorectal anastomosis at or below the peritoneal reflection) Complex
  H3380 Partial excision of rectum and sigmoid colon for prolapse Xmajor
  H3382 Proctectomy Major
  H3390 Reversal of Hartmann's procedure Complex
  H3400 Open excision of lesion of rectum and colon Major
  H3500 Fixation of rectum for prolapse Major
  H3580 Laparoscopic rectopexy Major
  H3590 Stapled transanal rectal resection (STARR) for obstructed defaecation syndrome Major
  H4000 Transanal resection of rectal cancer Major
  H4080 Injection of bulking agents for faecal incontinence Intermediate
  H4122 Transanal endoscopic mircosurgery Xmajor
  H4130 Perianal excision of lesion of rectum (including sigmoidoscopy) Intermediate
  H4180 Full or partial thickness rectal biopsy Minor
  H4200 Perineal repair of prolapse of rectum Major
  H4430 Examination of rectum under anaesthetic (as sole procedure) Minor
  H4480 Dilation of stricture of rectum Minor
  H4680 Repair of faecal fistula Intermediate
  H4800 Excision of lesion of anus Minor
  H4900 Destruction of lesion of anus Minor
  H5020 Repair of anal sphincter (including sigmoidoscopy) Major
  H5042 Primary repair of high/intermediate congenital ano-rectal anomaly Complex
  H5043 Primary repair of low congenital anorectal anomaly Xmajor
  H5080 Repair of anal trauma Intermediate
  H5100 Haemorrhoidectomy (including sigmoidoscopy) Intermediate
  H5101 Laser haemorrhoidectomy (including sigmoidoscopy) Intermediate
  H5250 Circular stapling haemorrhoidectomy Intermediate
  H5400 Anorectal stretch Minor
  H5510 Laying open of low anal fistula (fistulotomy) (including sigmoidoscopy) Intermediate
  H5520 Laying open of high anal fistula (fistulotomy) (including sigmoidoscopy) Major
  H5540 Seton placement for treatment of anal fistula Minor
  H5541 Adjustment or removal of Seton under general anaesthetic Minor
  H5620 Lateral sphincterotomy of anus Minor
  BT251 Planning for insertion and removal of radioactive agent (brachytherapy) into rectal tumour Intermediate
  BT252 Insertion and removal of radioactive agent (brachytherapy) into rectal tumour Major
  BT253 Low energy contact X ray brachytherapy (the Papillon technique) for early stage rectal cancer Intermediate
  H5640 Excision of anal fissure Minor
  H5800 Drainage through perineal region (including ischiorectal abscess) (including sigmoidoscopy) Minor
  H5940 Excision of pilonidal sinus and suture/skin graft Intermediate
  H6020 Laying open of pilonidal sinus Minor
  H3381 Total mesorectal excision (TME) Complex
  L7032 Haemorrhoidal artery ligation operation (including image-guided) +/- recto anal prolapse repair Minor
  H3335 Endoscopic vaccum therapy for colorectal anastomotic leakage Intermediate
  11.7 Other organs (mainly digestive)
  B2222 Adrenalectomy - bilateral (open) Xmajor
  B2223 Adrenalectomy - bilateral (laparoscopic) Xmajor
  B2232 Adrenalectomy - unilateral (open) Major
  B2233 Adrenalectomy - unilateral (laparoscopic) Major
  J0200 Partial hepatectomy (left hepatectomy or resection of up to three segments) +/- choleycystectomy Complex
  J1041 Hepatic venous wedge pressure (HVWP) Intermediate
  J0210 Hemihepatectomy (resection of four or more segments) +/- cholecystectomy Complex
  J0310 Resection of liver tumour(s) Complex
  J0312 Microwave ablation for primary or metastatic cancer of the liver Major
  J0400 Repair of liver (including therapeutic laparoscopic operations on liver) Major
  J0510 Open drainage of liver Intermediate
  J0780 Radiofrequency thermocoagulation of liver with scalpel liver resection Complex
  J0740 Open hepatectomy and ablation Complex
  J0900 Diagnostic laparoscopy (including any biopsy) Intermediate
  J1300 Percutaneous biopsy of lesion of liver Minor
  J1400 Open puncture of liver Major
  J1800 Cholecystectomy (including mini-cholecystectomy) Major
  J1820 Cholecystectomy with exploration of common bile duct Major
  J1830 Laparoscopic cholecystectomy Xmajor
  J1880 Laparoscopic cholecystectomy with perioperative cholangiogram Xmajor
  J1900 Anastomosis of gall bladder (to another viscus) Xmajor
  J2720 Partial excision of bile duct and anastomosis of bile duct to duodenum/jejunum Xmajor
  J2800 Excision of lesion of bile duct Major
  J2900 Anastomosis of hepatic duct Complex
  J3000 Anastomosis of common bile duct Major
  J3100 Open introduction of prosthesis into bile duct Major
  J3200 Repair of bile duct Xmajor
  J3300 Incision of bile duct (including exploration for calculus removal) Major
  J3500 Sphincterotomy of bile duct and pancreatic duct using duodenal approach Major
  J5000 Percutaneous examination of bile duct Intermediate
  J5750 Laparoscopic distal pancreatectomy Xmajor
  J5500 Total pancreatectomy and excision of surrounding tissue Complex
  J5520 Total pancreatectomy Complex
  J5610 Pancreatoduodenectomy and excision of surrounding tissue (Whipple's procedure) Complex
  J5700 Distal pancreatectomy Xmajor
  J5800 Excision of lesion of pancreas Major
  J5900 Anastomosis of pancreatic duct (to another viscus) Xmajor
  J6100 Open drainage of lesion of pancreas Major
  J6180 Drainage of pancreatic abscess Major
  J6200 Incision of pancreas Major
  J6300 Open examination of pancreas Major
  J6600 Therapeutic percutaneous operations on pancreas Major
  J6900 Open splenectomy Major
  J6980 Laparoscopic splenectomy Major
  L8110 Creation of peritoneovenous shunt (Levine/Denver) Intermediate
  J5611 LAPAROSCOPIC PANCREATODUODENECTOMY AND EXCISION OF SURROUNDING complex
  J5612 Robotic-Assisted Pancreatoduodenectomy and Excision of Surrounding Tissue (Whipples Procedure) complex
  11.8 Major vessels
  L7040 Open cannulation of intra abdominal artery for infusion chemotherapy Major
  L7710 Creation of portocaval shunt Complex
  L7920 Plication of vena cava Xmajor
  L7980 Repair of wound of major artery or vein of abdomen (including aorta and vena cava) Major
  11.9 Abdominal wall
  T1640 Repair of congenital diaphragmatic hernia Xmajor
  T1900 Simple excision of inguinal hernial sac (herniotomy) - unilateral Intermediate
  T1910 Simple excision of inguinal hernial sac (herniotomy) – bilateral Major
  T2000 Primary repair of inguinal hernia Intermediate
  T2510 Laparoscopic repair of paratomal hernia requiring mesh Intermediate
  T2002 Laparoscopic repair of inguinal hernia - unilateral Intermediate
  T2010 Primary repair of inguinal hernia – bilateral Major
  T2012 Laparoscopic repair of inguinal hernia - bilateral Intermediate
  T2080 Primary repair of strangulated inguinal hernia Major
  T2100 Repair of recurrent inguinal hernia Major
  T2102 Laparoscopic repair of recurrent inguinal hernia - unilateral Intermediate
  T2110 Repair of recurrent inguinal hernia - bilateral Xmajor
  T2112 Laparoscopic repair of recurrent inguinal hernia - bilateral Intermediate
  T2200 Primary repair of femoral hernia Intermediate
  T2280 Primary repair of strangulated femoral hernia Major
  T2300 Repair of recurrent femoral hernia Major
  T2400 Repair of umbilical hernia (irrespective of age) Intermediate
  T2500 Open repair of incisional or ventral hernia not requiring mesh Intermediate
  T2501 Open repair of incisional or ventral hernia requiring mesh Intermediate
  T2503 Laparoscopic repair of incisional or ventral hernia not requiring mesh Intermediate
  T2600 Repair of recurrent incisional or ventral hernia not requiring mesh Major
  T2720 Laparoscopic repair of incisional or ventral hernia requiring mesh Intermediate
  T2730 Repair of dorsal hernia including lumbar hernia Major
  T2740 Repair of perineal hernia including scrotal that are not inguinal Intermediate
  T2750 Repair of sciatic hernias Intermediate
  T2830 Resuture of previous incision in abdominal wall (“burst abdomen”) Intermediate
  T2620 Repair of recurrent incisional or ventral hernia requiring mesh Major
  T2640 Repair of recurrent incisional or ventral hernia requiring removal of previously inserted mesh Major
  T2780 Component Separation Technique (CST) repair of recurrent incisional abdominal hernia +/- mesh Xmajor
  T7972 Exploration and repair of groin disruption including repair of muscle fascia and tendons (Gilmore's Groin Repair) Intermediate
  11.10 Peritoneum
  T3010 Laparotomy for postoperative haemorrhage Major
  J9900 Cytoreductive surgery (Sugarbaker technique) with intraperitoneal chemotherapy [fees on application] Complex
  T3080 Laparotomy and repair of multiple visceral trauma Complex
  T3410 Open drainage of subphrenic abscess Major
  T3600 Wedge excision or removal of omentum (as sole procedure) Major
  T3910 Excision of retroperitoneal tumour, +/-ureterolysis Xmajor
  T3610 Omental biopsy +/- an ascitic drain under image guidance Intermediate
  T3930 Retroperitoneal abscess Intermediate
  T3980 Excision of presacral tumour Intermediate
  T4130 Freeing of adhesions of peritoneum Major
  T4300 Laparoscopic adhesiolysis (including biopsy) Intermediate
  T4302 Open adhesiolysis (including biopsy) Intermediate
  T4610 Paracentesis abdominis for ascites Minor
  T4680 Suprapubic drainage of pelvic abscess Intermediate
12 Urinary system and male reproductive organs
We assume that the following (when required) are an intrinsic part of all endoscopic therapeutic procedures of the urethra, prostate, bladder, ureters and kidney. This includes not only procedures such as resection of bladder tumours and TURP but also insertion and removal of JJ stents, retrograde pyelography etc.

M4510 Diagnostic endoscopic examination of bladder (including any biopsy)
M7700 Diagnostic endoscopic examination of urethra (as sole procedure)
M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent)

The following procedures are only eligible for benefit where the primary pathology being treated is a urethral stricture or otherwise in exceptional circumstances. Where the procedure represents gaining access for a cystoscope or other instrument, additional charges should not be made.

M7920 Dilatation of urethra (including cystoscopy)
M7940 Internal urethrotomy (including cystoscopy)
M5820 Dilatation of outlet of female bladder (with cystoscopy)

Generally we consider that the various procedures for extraction of calculi include cystoscopy, diagnostic ureteroscopy, retrograde pyelography and insertion of stent where required. We will consider making additional benefit available for difficult procedures on a case by case basis. This does not apply to insertion or removal of stent when performed at a different time from the main procedure. Charges should not be made for anaesthesia with flexible cystoscopy.
  12.1 Kidney/renal pelvic
  J5481 Pancreatic with kidney transplant (simultaneous pancreas SPK) Complex
  M0102 Transplantation of kidney - 1st and 2nd transplant Xmajor
  M0103 Transplantation of kidney - 3rd transplant Xmajor
  M0282 Laparoscopic nephroureterectomy Xmajor
  M1350 Antegrade pyelogram (including bilateral) Intermediate
  N1101 Correction of hydrocele(s) - bilateral Intermediate
  M0104 Transplantation of kidney into patient with abnormal, augmented or absent bladder Xmajor
  M0210 Nephrectomy and excision of perirenal tissue Xmajor
  M0220 Nephroureterectomy - unilateral Xmajor
  M0221 Nephroureterectomy - bilateral Xmajor
  M0222 Nephroureterectomy for live donor transplantation Xmajor
  M0250 Nephrectomy - unilateral Major
  M0251 Nephrectomy - bilateral Major
  M0260 Transplant nephrectomy Major
  M0280 Laparoscopic nephrectomy Major
  M0303 Robotic assisted laparoscopic partial nephrectomy Major
  M0300 Open partial nephrectomy Major
  M1120 Diagnostic ureterorenoscopy (+/- cystoscopy) Minor
  M1130 Therapeutic ureterorenoscopy (+/- cystoscopy and insertion/removal of stent) Minor
  M0302 Laparoscopic partial nephrectomy Major
  M0380 Laparoscopic upper or lower pole heminephrectomy Complex
  M0412 De-roofing and aspiration of renal para pelvic cyst Major
  M0510 Open pyeloplasty Major
  M0550 Repair of kidney wound Xmajor
  M0610 Open removal of calculi from kidney Major
  M0680 Drainage of pyonephrosis Intermediate
  M0800 Other open operations on kidney Major
  M0812 Open biopsy of renal transplant Intermediate
  M0813 Percutaneous biopsy of renal transplant Minor
  M0814 Open biopsy of native kidney Major
  M0840 Exploration of renal transplant for bleeding Intermediate
  M0880 Open drainage of perinephric abscess Major
  M0910 Endoscopic fragmentation of calculi of kidney (including cystoscopy and insertion/removal of stent) Major
  M0940 Percutaneous nephrolithotomy (including cystoscopy and retrograde catheterisation) Complex
  M0941 Percutaneous nephrolithotomy (including cystoscopy and retrograde catheterisation) (involving two specialties) (we will pay this fee per specialty) Complex
  M1000 Therapeutic endoscopic operations on kidney (including cystoscopy and retrograde catheterisation) Major
  M1080 Laparoscopic pyeloplasty Complex
  M1090 Robotic assisted laparoscopic pyeloplasty Complex
  M1110 Diagnostic endoscopic examination of kidney (including biopsy) Major
  M1310 Percutaneous fine needle biopsy of lesion of kidney Minor
  M1360 Percutaneous insertion of nephrostomy tube Intermediate
  M1380 Percutaneous tru-cut needle biopsy of lesion of kidney Intermediate
  M2890 Push manipulation of stone prior to lithotripsy (as sole procedure) Intermediate
  12.2 Ureter
  M1820 Excision of segment of ureter Major
  M1910 Construction of ileal conduit including ureteric implantation Xmajor
  M2012 Replantation of ureter into bowel (including bilateral) Xmajor
  M2030 Bilateral replantation of ureter into bladder Xmajor
  M2080 Unilateral replantation of ureter into bladder (including cystoscopy) Major
  M2100 Other connection of ureter Major
  M2130 Ileal or colonic replacement of ureter Complex
  M2160 Reconstruction of transplant ureter Xmajor
  M2200 Ureterostomy - closure Major
  M2202 Ureterostomy - formation Major
  M2210 Open correction vesicoureteric reflux-unilateral Major
  M2280 Open correction vesicoureteric reflux-bilateral Xmajor
  M2310 Open ureterolithotomy (including cystoscopy) Major
  M2510 Excision of ureterocele (with or without ureteric reimplantation) - unilateral Major
  M2511 Excision of ureterocele (with or without ureteric reimplantation) - bilateral Xmajor
  M2530 Ureterolysis – unilateral Major
  M2580 Ureterolysis – bilateral Xmajor
  M2600 Therapeutic nephroscopic operations on ureter (including cystoscopy) Major
  M2680 Endoscopic removal and insertion of prosthesis into ureter (including cystoscopy) Major
  M2730 Ureteroscopic extraction of calculus of ureter (including cystoscopy and insertion/removal of stent) Intermediate
  M2920 Endoscopic insertion/removal of prosthesis into ureter (including bilateral and cystoscopy, +/- pyelography) Major
  M3111 Holmium Laser Lithotripsy for calculi of ureter (including cystoscopy and insertion/removal of stent) Major
  M2930 Removal of prosthesis from ureter (including cystoscopy) Minor
  M2932 Cystoscopy and removal of transplant stent Minor
  M3000 Endoscopic examination of ureter (+/- cystoscopy and insertion/removal of stent) Intermediate
  M3010 Endoscopic retrograde pyelography (including bilateral and cystoscopy) Intermediate
  M3202 Operations on ureteric orifice (including endoscopic) Intermediate
  12.3 Bladder
  A7081 Percutaneous posterior tibial nerve stimulation (PTNS) for overactive bladder (OAB) syndrome or faecal incontinence Minor
  M2981 Endoscopic vesico-ureteric anti-reflux procedure (and bilateral) (including cystoscopy) Intermediate
  M4713 Bladder instillation as sole procedure Minor
  M4714 Therapeutic injection into bladder wall (including cystoscopy) Minor
  M3400 Open total cystectomy (with construction of intestinal conduit or bladder) Complex
  M3420 Laparoscopic cystectomy (with construction of intestinal conduit or bladder) (including cystoscopy) Complex
  M3500 Partial cystectomy (including cystoscopy) Major
  M3510 Diverticulectomy of bladder Major
  M3600 Enlargement of bladder (including cystoscopy) Complex
  M3602 Enterocystoplasty (including cystoscopy) Complex
  M3640 Repair of bladder exstrophy Complex
  M3700 Repair of bladder (including cystoscopy) Major
  M3720 Repair of vesicocolic fistula Xmajor
  M3780 Repair of cutaneous vesical fistula Intermediate
  M3820 Cystostomy and insertion of suprapubic tube into bladder (including cystoscopy) Intermediate
  M3880 Stab cystostomy Minor
  M3900 Open removal of calculus from bladder (including cystoscopy) Intermediate
  M4110 Open excision of lesion from bladder (including cystoscopy) Major
  M4210 Endoscopic resection of lesion of bladder (including cystoscopy) Major
  M4230 Endoscopic destruction of lesion of bladder (including cystoscopy) Intermediate
  M4310 Endoscopic transection of bladder (including cystoscopy) Major
  M4320 Endoscopic hydrostatic distention of bladder (including cystoscopy) Minor
  M4400 Urethral sphincterotomy (including cystoscopy) Intermediate
  M4514 Endoscopic examination of bladder (rigid cystoscopy) including any biopsy Minor
  M3412 Laparoscopic cystoprostatectomy (with construction of intestinal conduit or bladder) Complex
  M4410 Litholapaxy (including cystoscopy) Major
  M4420 Endoscopic extraction of calculus of bladder (including cystoscopy) Intermediate
  M4430 Endoscopic removal of foreign body from bladder (including cystoscopy) Intermediate
  M4480 Resection of bladder neck (including cystoscopy) Intermediate
  M4510 Diagnostic endoscopic examination of bladder (flexible cystoscopy) including any biopsy Minor
  M4712 Bladder instillation of pharmacologic agent (including cystoscopy) Minor
  M4512 Examination of bladder using hexaminolevulinate blue-light fluorescence cystoscopy +/- resection of lesions Minor
  M4910 Closure of cystostomy Intermediate
  M5100 Combined abdominal and vaginal operations to support outlet of female bladder (including sling procedures) (including cystoscopy) Major
  M5180 Revision combined abdominal and vaginal operations to support outlet of female bladder (including sling procedures and cystoscopy) Xmajor
  M5220 Retropubic suspension of neck of bladder (including colposuspension)(including cystoscopy) Major
  M5222 Laparoscopic colposuspension Major
  M5250 Needle suspension of bladder neck (including cystoscopy) Intermediate
  M5280 Revision retropubic suspension of neck of bladder (including colposuspension and cystoscopy) Major
  M5300 Vaginal operations to support outlet of female bladder (including cystoscopy) Major
  M5520 Implantation of artificial urinary sphincter at bladder neck and/or removal (including cystoscopy) Major
  M5630 Therapeutic injection into bladder neck for treatment of stress incontinence (periurethral bulking agents), including cystoscopy Intermediate
  M5820 Dilatation of outlet of female bladder (with cystoscopy) Minor
  M6480 Operation to support outlet of male bladder (including sling procedures) (including cystoscopy) Major
  M6620 Endoscopic incision of outlet of male bladder (with cystoscopy) Intermediate
  M7590 Insertion of suburethral tape sling (e.g. TOT or TVT) +/- administration of local anaesthetic by operating surgeon (including cystoscopy) Major
  P2510 Repair of vesicovaginal fistula (including cystoscopy) Major
  12.4 Urethra
  M5580 Excision of urethral caruncle Minor
  M5600 Therapeutic endoscopic operations on outlet of female bladder (including cystoscopy) Intermediate
  M7200 Urethrectomy Major
  M7280 Urethral valve resection Major
  M7312 Repair of penile/perineal hypospadias Major
  M7313 Repair of penile shaft hypospadias Major
  M7314 Repair of distal hypospadia Major
  M7315 Secondary adjustment of penile skin following hypospadias repair Major
  M7316 Complex secondary repair of hypospadias Xmajor
  M7320 Repair of epispadias Xmajor
  M7330 Closure of fistula of urethra (including cystoscopy) Intermediate
  M7332 Closure of fistula of urethra after hypospadias Major
  M7340 Repair of urethrorectal fistula Major
  M7360 Simple urethroplasty, eg primary repair, segment, anterior urethra (including cystoscopy) Major
  M7380 Repair of rupture of urethra (including cystoscopy) Major
  M7500 Excision of diverticulum of urethra (including cystoscopy) Intermediate
  M7620 Removal of foreign body from urethra Minor
  M7700 Diagnostic endoscopic examination of urethra (as sole procedure) (including cystoscopy) Minor
  M7920 Dilatation of urethra (including cystoscopy) Minor
  M7940 Internal urethrotomy (including cystoscopy +/- dilataion) Intermediate
  M7361 Complex Urethroplasty, Eg Revision Surgery of the Anterior Urethra, Segment, Posterior Urethra, +/- Grafting (Including Cystoscopy) Major
  12.5 Prostate
  BT211 Planning for insertion and removal of a radioactive agent (brachytherapy) into prostate tumour Major
  BT212 Insertion of low dose radioactive agent (brachytherapy) into prostate tumour Complex
  BT222 Insertion and removal of high dose radioactive agent (brachytherapy) into prostate tumour Complex
  M7030 Limited/single core transrectal needle biopsy of prostate +/- ultrasound guidance Minor
  M6100 Open excision of prostatatic adenoma Major
  M6180 Radical prostatectomy, reconstruction of bladder neck including bilateral pelvic lymphadenectomy (including cystoscopy) Complex
  M6182 Laparoscopic radical prostatectomy, reconstruction of bladder neck including bilateral pelvic lymphadenectomy (including cystoscopy) Complex
  M6192 Robotic assisted laparoscopic radical prostatectomy, reconstruction of bladder neck including bilateral pelvic lymphadenectomy (including cystoscopy) Complex
  M6530 Endoscopic resection of prostate (TUR) (including cystoscopy) Major
  M6532 Holmium laser resection of prostate (HoLRP) (including cystoscopy) Xmajor
  M6533 Holmium Laser Enucleation of Prostatic Adenoma (HoLEP) Major
  M6580 Endoscopic biopsy of prostate (including cystoscopy) Intermediate
  M6582 Transperineal template-guided biopsies of the prostate under image guidance Intermediate
  M6712 Prostatic cryotherapy Complex
  M6730 Drainage of prostatic abscess Intermediate
  M6760 Photoselective vaporisation of prostate (GreenLight/Niagara laser PVP) (including cystoscopy) Xmajor
  M6762 Photoselective vaporisation of prostate (KTP Laser PVP) (including cystoscopy) Xmajor
  M6770 High intensity focused ultrasound of prostate (including cystoscopy) Complex
  M6780 Prostatic hyperthermia (up to six courses) Major
  M7020 Transrectal sextant needle biopsy of prostate with ultrasound guidance Minor
  M7080 Insertion of urethral stent for relief of prostatic obstruction (including cystoscopy) Major
  12.6 Genitalia
  M8120 Meatoplasty Intermediate
  M8130 External meatotomy of urethral orifice Minor
  N0500 Bilateral excision of testes Major
  N0630 Laparoscopic orchidectomy Intermediate
  N0680 Orchidectomy and excision of spermatic cord (+/- insertion of prosthesis) Intermediate
  N0700 Excision of lesion of testis Intermediate
  N0820 Orchidopexy bilateral Major
  N0920 Orchidopexy Intermediate
  N1000 Prosthesis of testis (insertion or removal) Intermediate
  N1100 Correction of hydrocele(s) – unilateral Intermediate
  N1320 Fixation of testis Intermediate
  N1340 Biopsy of testis Minor
  N1350 Exploration of testis (including biopsy) Intermediate
  N1352 Laparoscopy for impalpable testis Intermediate
  N1380 Bilateral fixation of testis Intermediate
  N1510 Bilateral epididymectomy Intermediate
  N1520 Unilateral epididymectomy Minor
  N1580 Excision of epididymal cyst Intermediate
  N1900 Operation(s) on varicocele Intermediate
  N1910 Laparoscopic varicocelectomy Major
  N2200 Operation(s) on seminal vesicle Major
  N2610 Total amputation of penis Major
  N2620 Partial amputation of penis Major
  N2710 Excision of lesion of penis Intermediate
  N2780 Operation for Peyronie's disease (eg Nesbitt's) Intermediate
  N2781 Lue's procedure for Peyronie's disease Intermediate
  N3032 Revision of circumcision Intermediate
  N2820 Reconstruction of penis Major
  N2840 Repair of avulsion of penis Major
  N2842 Frenuloplasty of penis Minor
  N2880 Repair of injury to penis Intermediate
  N3010 Preputioplasty Intermediate
  N3020 Division of preputial adhesions Minor
  N3030 Circumcision Intermediate
  N3210 Biopsy of lesion of penis Minor
13 Pregnancy and confinement
  13.1 Pregnancy and confinement
  R1210 Cerclage of cervix of gravid uterus Minor
  R1220 Removal of cerclage of cervix of gravid uterus Minor
  R1820 Caesarean delivery Major
  R2120 Forceps cephalic delivery Intermediate
  R2510 Caesarean hysterectomy Xmajor
  R2810 Curettage of delivered uterus Minor
14 Female reproductive organs
The benefit for hysteroscopy includes an amount for D&C and insertion of mirena coil. We will not reimburse additional charges for this as a separate service. Similarly where a therapeutic hysteroscopy is performed, we will not reimburse an additional charge for a diagnostic hysteroscopy.

The benefit for hysterectomy for ovarian malignancy includes an amount for removal of omentum and this should not be listed as extra.

Cystoscopy should not be charged as an additional procedure with suspension/uro-gynaecological procedures.

We consider insertion of suprapubic catheter to be an intrinsic part of procedures such as a suprapubic sling or retropubic suspension of bladder neck and will not reimburse these as an additional procedure.

The benefit for colposcopy includes an amount for punch biopsy.

The benefit for therapeutic laparoscopy includes an amount for diagnostic laparoscopy.

The code for insertion of prosthesis into the ureter is designed for use by urologists inserting a stent and not for the circumstances where the ureter is being identified during hysterectomy. We recognise that this does involve some additional work and consider that a small uplift would be reasonable.

The code for division of adhesions is no longer in our Schedule. Adhesions are a part of a large number of gynaecological pathologies and the benefit for treatment includes an amount for division of adhesions. We do however accept that there are some cases where numerous dense adhesions add considerably to the complexity of a procedure and in such cases suggest an enhanced fee is submitted together with a note of explanation.

Postoperative analgesia is part of all surgery. We will not reimburse additional charges by surgeons or anaesthetists for wound infiltration with local anaesthetic.
  14.1 Uterus/adnexa
  Q2231 Laparoscopic oophorectomy and salpingectomy, +/- biopsy eg. omentum, peritoneum, lymph node (as sole procedure) – unilateral Major
  Q0710 Radical hysterectomy and lymphadenectomy (Wertheim's) +/- ureterolysis Complex
  Q0712 Radical trachelectomy including laparoscopic and removal of lymph nodes +/- ureterolysis Complex
  Q0740 Total abdominal hysterectomy (+/- oophorectomy) +/- ureterolysis Major
  Q0890 Vaginal hysterectomy including salpingo-oophorectomy (including laparoscopically assisted) +/- ureterolysis Xmajor
  Q0830 Vaginal hysterectomy with laparoscopic assistance +/- ureterolysis Major
  Q0750 Subtotal abdominal hysterectomy (+/- oophorectomy) +/- ureterolysis Major
  Q0751 Laparoscopic subtotal hysterectomy (+/- oophorectomy) +/- ureterolysis Major
  Q2081 Myolysis of uterine fibroids Major
  Q0800 Vaginal hysterectomy without laparoscopic assisted Major
  Q0790 Laparoscopic total hysterectomy (+/- oophorectomy) +/- ureterolysis Major
  Q0880 Hysterectomy with excision / biopsy and/or removal of omentum and uterine adnexa for ovarian malignancy +/- ureterolysis Xmajor
  Q0920 Myomectomy (including laparoscopically) +/- ureterolysis Major
  Q1281 Removal and/or replacement of an embedded / migrated Mirena coil (as sole procedure) Minor
  Q0950 Plastic reconstruction of uterus Major
  Q1700 Therapeutic hysteroscopic operations on uterus (including endometrial ablation excluding microwave or radiofrequency ablation) +/- Mirena coil insertion Major
  Q1701 Laparoscopic excision of endometriosis, +/-ureterolysis Major
  Q1702 Microwave endometrial ablation including hysteroscopy Major
  Q1703 Impedance controlled bipolar radiofrequency ablation for menorrhagia including hysteroscopy Major
  Q1800 Hysteroscopy (including biopsy, dilatation, curettage and resection of polyp(s) +/- Mirena coil insertion) Intermediate
  Q1802 Hysteroscopy with resection of fibroids (excluding morcellation) +/- insertion on Mirena coil Major
  Q2230 Laparoscopic oophorectomy and salpingectomy, +/- biopsy eg. omentum, peritoneum, lymph node (as sole procedure) - bilateral Major
  Q2330 Salpingectomy (including bilateral) (as sole procedure) Major
  Q2232 Open oophorectomy and salpingectomy, +/- biopsy eg. omentum, peritoneum, lymph node (as sole procedure) - unilateral Major
  Q3110 Removal of products of conception from fallopian tube (ectopic pregnancy) including laparoscopically Major
  Q3800 Laparoscopy and therapeutic procedures (including laser, diathermy and destruction e.g. endometriosis, adhesiolysis, tubal and ovarian surgery, +/-ureterolysis) Major
  Q3900 Laparoscopy (including e.g. puncture of ovarian cysts, +/- biopsy, minor endometriosis, +/- ureterolysis) Intermediate
  Q4400 Ovarian cystectomy +/- omental biopsy (as sole procedure and including bilateral) Major
  T8580 Block dissection of pelvic lymph nodes (as sole procedure) Major
  X1410 Total exenteration of pelvis Complex
  X1420 Anterior exenteration of pelvis Complex
  X1430 Posterior exenteration of pelvis Complex
  Q2233 Open oophorectomy and salipingectomy, +/- biopsy e.g. omentum, peritoneum, lymph node (as sole procedure) - bilateral Major
  Q0711 Robotic Assisted Radical Hysterectomy And Lymphadenectomy (Wertheim's) +/- Ureterolysis Complex
  14.2 Suspension
  M5100 Combined abdominal and vaginal operations to support outlet of female bladder (including sling procedures)(including cystoscopy) Major
  M5180 Revision combined abdominal and vaginal operations to support outlet of female bladder (including sling procedures and cystoscopy) Xmajor
  M5220 Retropubic suspension of neck of bladder (including colposuspension)(including cystoscopy) Major
  M5250 Needle suspension of bladder neck (including cystoscopy) Intermediate
  M5280 Revision retropubic suspension of neck of bladder (including colposuspension and cystoscopy) Major
  M5300 Vaginal operations to support outlet of female bladder (including cystoscopy) Major
  M5630 Therapeutic injection into bladder neck for treatment of stress incontinence (periurethral bulking agents), including cystoscopy Intermediate
  M7590 Insertion of suburethral tape sling (e.g. TOT or TVT) +/- administration of local anaesthetic by operating surgeon (including cystoscopy) Major
  Q5450 Laparoscopic hysteropexy (including sacrohysteropexy) using mesh +/- ureterolysis Major
  Q2080 Ventrosuspension of uterus (including laparoscopic) Intermediate
  14.3 Cervix uteri
  BT341 Planning for insertion and removal of a radioactive agent (brachytherapy) into cervix or other female intra-pelvic tissue Intermediate
  BT342 Insertion and removal of a radioactive agent (brachytherapy) into cervix or other female intra-pelvic tissue Major
  Q0100 Amputation of cervix uteri Intermediate
  Q0220 Laser destruction of lesion of cervix uteri (+/- colposcopy or polypectomy) Minor
  Q0230 Cauterisation of lesion of cervix uteri (+/- loop diathermy, colposcopy or polypectomy) Minor
  Q0330 Cone biopsy of cervix uteri and/or (+/- laser, colposcopy or polypectomy) Intermediate
  Q0340 Punch biopsy of cervix uteri Minor
  Q1010 Dilation of cervix uteri and curettage of retained products of conception following miscarriage Intermediate
  Q1030 Dilatation of cervix uteri and curettage of uterus including polypectomy and diathermy of cervix Minor
  14.4 Vagina/perineum
  M3710 Cystourethroplasty (including cystoscopy) Major
  M5582 Diathermy of urethral caruncle Minor
  P1300 Operations on female perineum Minor
  P1400 Incision of introitus of vagina Minor
  P1920 Excision of septum of vagina Intermediate
  P2000 Excision of lesion of vagina (e.g. warts and cysts) Intermediate
  P2100 Reconstruction of vagina Xmajor
  P2210 Anterior +/- posterior colporrhaphy and amputation of cervix uteri (including primary repair of enterocele) Major
  P2230 Posterior colporrhaphy Intermediate
  P2310 Anterior +/- posterior colporrhaphy (including primary repair of enterocele) (including cystoscopy) Major
  P2340 Repair of enterocele (+/- posterior repair colporrhaphy) (as sole procedure) Major
  P2930 Biopsy of lesion of vagina Minor
  P2380 Anterior (+/- posterior) colporrhaphy with vaginal hysterectomy (including primary repair of enterocele and cystoscopy) Xmajor
  P2420 Sacrocolpopexy (including laparoscopic) +/- ureterolysis Major
  P2450 Sacrospinous fixation Major
  P2510 Repair of vesicovaginal fistula (including cystoscopy) Major
  P2520 Repair of urethrovaginal fistula (including cystoscopy) Major
  P2530 Repair of rectovaginal fistula Xmajor
  BT281 Planning for insertion and removal of radioactive agent (brachytherapy) into vaginal tumour Intermediate
  BT282 Insertion and removal of radioactive agent (brachytherapy) into vaginal tumour Major
  P2120 Total removal of vaginal mesh/tape with reconstruction of vagina and/or uretha, including cysoscopy and/or proctoscopy [fees on application] Complex
  P2110 Partial removal of vaginal mesh/tape with reconstruction of vagina and or/uretha, including cystoscopy and/or proctoscopy [fees on application] Complex
  P2932 Examination of vagina under anaesthetic as sole procedure Minor
  14.5 Vulva/labia
  P0310 Excision of Bartholin gland Intermediate
  P0320 Marsupialisation of Bartholin cyst Intermediate
  P0510 Simple vulvectomy Major
  P0580 Radical vulvectomy (including block dissection of inguinal gland) Complex
  P0600 Excision of lesion of vulva Minor
  P0910 Biopsy of lesion of vulva Minor
  P0610 Laser destruction of lesion of vulva Minor
15 Skin and subcutaneous tissue
When skin lesions are removed either by excision biopsy or wide excision, the resulting defect can usually be closed by primary suture. It is our view, therefore, that the primary closure is an intrinsic part of these procedures. When Mohs’ micrographic surgery is performed, the resulting defect is normally of a size and shape that cannot be closed by primary suture. In these cases, a small skin graft or local flap is routinely performed. The benefit for the procedure includes an amount for flap closure. Where the lesion being removed is in a site which causes particular problems, we will allow flexibility, but we ask that sufficient clinical detail is provided with the claim to allow this to be taken into account.

Many excisions or excision biopsies are performed under local anaesthesia. This is considered by us to be intrinsic to the procedure and is not eligible for separate benefit. The fee payable for anaesthesia is for care of an unconscious or semiconscious patient during surgery and not for simple administration of an injection.

The codes for removal of malignant lesions should only be used where a malignant lesion is removed with a margin of normal tissue and a histology report confirms a malignancy.

  15.1 Lesions of skin
  H5680 Excision of pressure sore excluding repair Intermediate
  S0410 Wide excision of sweat glands - bilateral axillae Intermediate
  S0520 Microscopically controlled excision of lesion of skin or subcutaneous tissue (Mohs micrographic surgery) with immediate reconstruction Xmajor
  S0602 Primary excision of malignant lesion - head and neck Intermediate
  S0603 Primary excision of malignant lesion - trunk and limbs Intermediate
  S0604 Secondary excision of malignant lesion - head and neck Intermediate
  S0605 Secondary excision of malignant lesion - trunk and limbs Intermediate
  S0521 Microscopically controlled excision of lesion of skin or subcutaneous tissue (Mohs micrographic surgery) without reconstruction Major
  S0606 Photodynamic therapy to malignant lesion of skin - up to three Intermediate
  S0607 Photodynamic therapy to malignant lesion of skin - four or more Major
  S0608 Sentinel lymph node biopsy for melanoma Intermediate
  S0632 Excision of lesion of skin or subcutaneous tissue - up to three, Head & Neck (excluding lipoma) Minor
  S0633 Excision of lesion of skin or subcutaneous tissue - up to three, Trunk & Limbs (excluding lipoma) Minor
  S0642 Excision of lesion of skin or subcutaneous tissue - four or more, Head & Neck (excluding lipoma) Intermediate
  S0643 Excision of lesion of skin or subcutaneous tissue - four or more, Trunk & Limbs (excluding lipoma) Intermediate
  S0651 Removal of benign lesion on trunk or limbs less than 10 cm in diameter or on scalp less than 5cm in diameter (excluding lipoma) Minor
  S0652 Removal of benign lesion on trunk or limbs greater than 10 cm in diameter or on scalp greater than 5 cm in diameter (excluding lipoma) Intermediate
  S0653 Removal of benign lesion in muscle or deeper tissue (excluding lipoma) Intermediate
  S0654 Removal of benign lesion on head and neck (excluding scalp) which is closed by primary closure or advancement flap (excluding lipoma) Intermediate
  S0655 Removal of benign lesion on head and neck requiring flap closure (excluding advancement flap) (excluding lipoma) Intermediate
  S0656 Removal of lipoma Intermediate
  S0820 Curettage/cryotherapy of lesions of skin including cauterisation - four or more Intermediate
  S0922 Laser destruction of lesion(s) of skin - up to 25cm² in area Minor
  S0923 Laser destruction of lesion(s) of skin - over 25cm² in area Minor
  S0940 Photodynamic therapy to non malignant lesions of skin Intermediate
  S1420 Shave biopsy of lesion of skin Minor
  S4480 Removal of foreign body in deeper tissue Intermediate
  S4720 Drainage of lesion of skin, including abscess Minor
  S4740 Drainage of large subcutaneous abscess/haematoma Minor
  S6400 Excision of nail bed (Zadik's) (including anaesthetic) Intermediate
  S7010 Wedge excision or avulsion of nail (including chemical ablation of nail bed) Minor
  15.2 Repair
  S4182 Debridement and primary suture of wound with involvement of deeper tissue - Head and Neck Intermediate
  S4183 Debridement and primary suture of wound with involvement of deeper tissue - Trunk and Limbs Intermediate
  S4212 Debridement and primary suture of wound without involvement of deeper tissue (skin and subcutaneous fat only) - Head and Neck Intermediate
  S4213 Debridement and primary suture of wound without involvement of deeper tissue (skin and subcutaneous fat only) - Trunk and Limbs Intermediate
  S4230 Secondary suture of skin Minor
  S4812 Insertion of skin expander into tissue Intermediate
  S4950 Fat transfer, including extraction and volume adjustment, of scar defect following trauma (excluding breast) Intermediate
  S4930 Removal of skin expander or valve Intermediate
  S5710 Debridement of wound (and surgical toilet) - up to 25cm² in area Minor
  S5712 Debridement of wound (and surgical toilet) - over 25cm² in area Minor
  W0950 Radical clearance of sarcoma of trunk or limbs, +/- amputation or insertion of prosthesis Complex
  W0960 Excision of benign tumour of bone with bone grafting Xmajor
  W0951 Radical clearance of sarcoma of head and neck necessitating flap reconstruction Complex
  15.3 Burns, scars and contractures
  S5520 Burn excision (wound/scar) head, neck, hands, feet & genitalia, up to 9cm² Intermediate
  S5522 Burn excision (wound/scar) head, neck, hands, feet & genitalia, 9cm² - 25cm² Intermediate
  S5523 Burn excision (wound/scar) head, neck, hands, feet & genitalia, greater than 25cm² Major
  S5524 Burn excision (wound/scar) trunk & limbs (not more than 2% of body area) Intermediate
  S5525 Burn excision (wound/scar) trunk & limbs (between 2% and 10% of body area) Intermediate
  S5526 Burn excision (wound/scar) trunk & limbs (between 10% and 25% of body area) Major
  S5532 Dressing of burn of skin or subcutaneous tissue - less than 2% Minor
  S5533 Dressing of burn of skin or subcutaneous tissue - 2% - 10% Minor
  S5534 Dressing of burn of skin or subcutaneous tissue - 10% - 25% Minor
  S5535 Dressing of burn of skin or subcutaneous tissue - greater than 25% Minor
  S5560 Release of burn scar contracture, head, neck, hands, feet and genitalia Xmajor
  S5562 Release of burn scar contracture, trunk and limbs Major
  15.4 Flaps and free skin grafts
    Flaps

Unless explicitly stated these codes relate to the formation, division and transfer of the flap and include repair of the donor site. They do not include excision of skin or wound at the recipient site.

  S2500 Local flap – less than 9cm2 Major
  S2502 Local flap – 9cm2 or more (excluding graft/flap to secondary defect) Major
  S2503 Local flap – 9cm2 or more (including graft/flap to secondary defect) Xmajor
  S1700 Distant flap – delay/division/inset Major
  S2002 Small island flap (less than 9cm2) Intermediate
  S2000 Large island skin flap (9cm2 or more) (eg radical forearm) including closure of secondary defect Xmajor
  S1740 Large myocutaneous (muscular/cutaneous) flap (9cm2 or more) including closure of secondary defect Xmajor
  B2984 Delayed reconstruction of breast using pedicled TRAM Complex
  S1750 Large muscle flap (9cm2 or more) including skin graft and closure of secondary defect Xmajor
  S2220 Neurovascular island flap Xmajor
  T7602 Microvascular free tissue transfer (when added to other codes) including closure of secondary defect Complex
  T7620 Free functioning muscle transfer (as sole procedure) including closure of secondary defect Complex
  S1900 Distant pedicle flap – elevation including transfer (including closure/grafting to secondary defect) Complex
  T7603 Microvascular free tissue transfer (as sole procedure including closure of secondary defect) Complex
  T7604 Vein/artery graft of part of microvascular free tissue transfer Major
  W3180 Free composite (ie including bone) vascularised grafts Complex
  S3100 Re-exploration of free flap Xmajor
   

Free Skin Grafts

Unless explicitly stated these codes relate to the formation, division and transfer of the graft and include repair of the donor site. They do not include excision of skin or wound at the recipient site. All definitions relate to recipient sites unless otherwise stated.

  S3500 Split autograft of skin, trunk and limbs – up to 25cm2 in area Intermediate
  S3530 Split autograft of skin, trunk and limbs – over 25cm2 and up to 5% of body surface area Major
  S3532 Split autograft of skin, trunk and limbs – each additional 5% of body surface area Major
  S3622 Full thickness graft, trunk and limbs – up to 9cm2 in area Intermediate
  S3623 Full thickness graft, trunk and limbs – each additional 25cm2 in area Minor
  S3624 Full thickness graft, head, neck, hands and genitalia – up to 9cm2 in area Major
  S3625 Full thickness graft, head, neck, hands and genitalia each additional 16cm2 in area Minor
16 Bones, joints and connective tissue/tendon muscle
When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances).

We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant.

Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures.

EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice.

Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure.

Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service.

There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression.

Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3).

Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas.

The following definitions are used throughout this section:

Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna

Small bones – all bones of hand, wrist, foot, ankle and also the patella

Large joints – ankle, elbow, hip, knee, shoulder and wrist

Small joints – all other joints of the hand and foot

Child Aged 0-15

Adult Aged 16 and over
  16.4 Nerves
  A6030 Transection of peripheral nerve for neuroma Intermediate
  A6080 Neurectomy (major nerve) Intermediate
  A6110 Excision of lesion of peripheral nerve (eg neurilemoma) Intermediate
  A6180 Excision of lesion of major nerve Intermediate
  A6300 Graft to peripheral nerve Xmajor
  A6302 Graft to major nerve Xmajor
  A6400 Repair of peripheral nerve Intermediate
  A6402 Repair of major nerve Major
  A6510 Carpal tunnel release (open) Intermediate
  A6580 Carpal tunnel release (open) - bilateral Intermediate
  A6600 Release of entrapment of deeply placed peripheral nerve Intermediate
  A6700 Release of entrapment of peripheral nerve Intermediate
  A6710 Cubital tunnel release (open) (without transposition) Intermediate
  A6711 Cubital tunnel release (open) bilateral (without transposition) Intermediate
  A6810 Neurolysis and transposition of peripheral nerve (excludes carpal tunnel release) Intermediate
  A6900 Revision of release of peripheral nerve Major
  A7010 Implantation of neurostimulator to peripheral nerve Major
  A7011 Trial of neurostimulator to peripheral nerve (as sole procedure) not at time of permanent implant Intermediate
  A6530 Carpal tunnel release (endoscopic) Intermediate
  A6570 Carpal tunnel release (endoscopic) - Bilateral Intermediate
  A6740 Cubital tunnel release (endoscopic) (without transposition) Intermediate
  A6750 Cubital tunnel release (endoscopic) Bilateral (without transposition) Intermediate
  A7310 Biopsy of peripheral nerve Intermediate
  A7340 Exploration and grafting of brachial plexus Complex
  16.5 Joints, including replacement/reconstruction (not listed elsewhere)
  W5540 Debridement of infected total joint replacement Major
  W5722 Excision reconstruction of small joint Major
  W5723 Excision reconstruction of large joint Major
  W6912 Total synovectomy of small joint Major
  W9050 Shoulder hydrodistension +/- image guidance Minor
  W6913 Total synovectomy of large joint Major
  W7400 Reconstruction of one or two ligaments not elsewhere specified Major
  W7500 Prosthetic open repair of ligament Major
  W7881 Release of contracture of interphalangeal joint of finger (excluding trigger finger or Dupuytren's disease) Intermediate
  W8150 Arthrotomy of large joint, including removal of loose body from joint Intermediate
  W8180 Arthrotomy of small joint, including removal of loose body from joint Minor
  W8300 Therapeutic arthroscopy operation on articular cartilage (other than W8200 and W8230) (as sole procedure) Intermediate
  W8380 Therapeutic arthroscopy operation on articular cartilage (other than W8200) - bilateral (as sole procedure) Major
  W8600 Therapeutic arthroscopy operation on cavity of joint (not otherwise specified) (as sole procedure) Major
  W8680 Therapeutic arthroscopy operation on cavity of joint - bilateral (not otherwise specified) (as sole procedure) Complex
  W8700 Diagnostic arthroscopic examination of joint, with or without biopsy (not otherwise specified) (as sole procedure) Intermediate
  W8780 Diagnostic arthroscopic examination of joint, with or without biopsy - bilateral (not otherwise specified) (as sole procedure) Intermediate
  W8782 Flexible arthroscopy, +/- biopsy (as sole procedure) Intermediate
  W9017 Yttrium joint injection (with radioactive precautions) Minor
  W9020 Dynamic arthrogram of joint Intermediate
  W9030 Injection(s) +/- aspiration, into joint, cyst, bursa or soft tissue with image guidance Minor
  W9240 Examination/ manipulation of joint under general anaesthetic +/- injection +/- arthrogram (as sole procedure) Minor
  W9032 Injection of viscosupplement into joint with image guidance Minor
  W9033 Injection of viscosupplement into joint with image guidance - bilateral Minor
  W9035 Injection(s) +/- aspiration, into two or more joints, cysts, bursae or soft tissue, with image guidance Minor
  W9042 Injection of viscosupplement into joint Minor
  W9043 Injections of viscosupplement into joints - bilateral Minor
  W9045 Injection(s) +/- aspiration, into two or more joints, cysts, bursae or soft tissue Minor
  W9170 Manipulation of foot/ankle joint under local anaesthetic +/- injection (as a sole procedure) Minor
  16.6 Hand
    Incision/excision

  T7440 Injection into cord for Dupuytren’s Contracture (including post injection finger extension) Minor
  T5202 Dupuytren’s fasciectomy palm only Intermediate
  T5203 Dupuytren’s fasciectomy single digit with proximal interphalangeal joint Intermediate
  T5210 Dupuytren’s fasciectomy multiple digits with proximal interphalangeal joints Major
  T5222 Dupuytren’s dermofasciectomy and graft, or for recurrent disease – single digit Major
  T5223 Dupuytren’s dermofasciectomy and graft, or for recurrent disease – multiple digits Major
  T5410 Dupuytren’s subcutaneous fasciotomy Minor Minor
  W0282 Total excision of trapezium Xmajor
  W0283 Total excision of trapezium with spacer Xmajor
  W0284 Total excision of trapezium and ligament reconstruction Xmajor
  W0285 Trapezio-metacarpal joint surface replacement Major
   

Repair/reconstruction

  W1641 Osteotomy of short bone of hand (including fixation and bone grafting) Intermediate
  T6710 Primary repair of extensor of hand Intermediate
  T6820 Secondary repair or reconstruction of extensor of hand/forearm Major
  T6914 Tenolysis of extensor tendon of hand Intermediate
  T6750 Primary repair of flexor of hand (excluding Zone II) Intermediate
  T6752 Primary repair of flexor of hand in Zone II Major
  T6830 Secondary or second repair of 1st stage reconstruction of flexor of hand Major
  T6832 Second stage reconstruction of flexor of hand Major
  T6982 Tenolysis of flexor tendon of hand Intermediate
  T6402 Tendon transfer of hand – single Major
  T6410 Tendon transfer of hand – multiple (eg for radial nerve injury) Major
  W0120 Pollicisation of finger for thumb reconstruction Complex
  W0512 Interpositional silastic arthroplasty of MCP/PIP joints – single Major
  W0513 Interpositional silastic arthroplasty of MCP/PIP joints - multiple Major
  W0514 Prosthetic surface arthroplasty of interphalanageal/metacarpo-phalangeal joint – single joint (both cemented and uncemented) Major
  W5310 Total prosthetic replacement of wrist joint Xmajor
  W8830 Diagnostic arthroscopic examination of wrist joint, with or without biopsy (as sole procedure) Intermediate
  W8602 Therapeutic arthroscopy of wrist joint (sole procedure) Major
  W7482 Scaphoid lunate ligament reconstruction Major
  W7483 Triquetrolunate ligament reconstruction Major
  W7484 Multiple ligament reconstruction Xmajor
  W7485 Small joint (eg interphalangeal/metacarpo-phalangeal joint) ligament reconstruction Major
  W7486 Carpo-metacarpal joint ligament reconstruction Major
  W6230 Vascular implantation to carpal bone Xmajor
  W0110 Toe to hand transfer (as sole procedure) including closure of secondary defect Complex
   

Fixation/arthrodesis

  W3200 Open reduction and internal fixation of cancellous bone graft scaphoid non-union Major
  W3202 Open reduction and internal fixation wedge reconstruction bone graft scaphoid non-union Major
  W3203 Early open reduction and internal fixation of scaphoid fracture ie within 6 weeks of fracture Major
  W6202 Partial fusion of wrist Intermediate
  W6200 Total fusion of all joints of wrist with or without graft and with or without internal fixation Major
  W5930 Fusion of digit joint(s) of hand with or without graft and with or without internal fixation Intermediate
   

Other (eg amputation)

  X0710 Forequarter amputation Complex
  X0720 Disarticulation of shoulder Xmajor
  X0750 Amputation of arm Major
  X0820 Partial amputation of digit Intermediate
  X0822 Amputation of whole ray Major
  X0880 Amputation through mid-carpal/transmetacarpal Intermediate
  X0910 Hindquarter amputation Complex
  16.7 Shoulder
    Incision/excision

  W0610 Total excision of cervical rib Major
  W0890 Excision distal clavicle, as sole procedure Major
   

Repair/reconstruction

  A7340 Exploration and grafting of brachial plexus Complex
  W4900 Shoulder hemiarthroplasty, as sole procedure Xmajor
  W4930 Revisional shoulder hemiarthroplasty Xmajor
  W5050 Reverse polarity arthroplasty of shoulder Xmajor
  W4902 Shoulder hemiarthroplasty with reconstruction for fracture Xmajor
  W5000 Primary total shoulder replacement Xmajor
  W5030 Revision total shoulder replacement Complex
  W4920 Conversion of hemiarthroplasty to total shoulder replacement Complex
  W5600 Primary repair of rupture of acromioclavicular or sternoclavicular joint +/- internal fixation Xmajor
  W5630 Secondary repair of acromioclavicular or sternoclavicular joint +/– internal fixation Xmajor
  W7713 Primary stabilisation of multi-directional instability of shoulder joint +/- tendon repair Major
  W7714 Primary open or arthroscopic shoulder stabilisation pocedure (including labral/SLAP/tendon repair) Major
  W7715 Corocoid bone block transfer for recurrent instability of shoulder (Bristow-Latarjet Procedure) Major
  W7780 Revision stabilisation of shoulder joint Xmajor
  W7810 Open arthrolysis of shoulder contracture +/- manipulation/injection Major
  W7872 Arthroscopic arthrolysis of shoulder contracture +/- manipulation/injection Major
  T7910 Open sub acromial decompression and rotator cuff repair +/- excision of distal clavicle Major
  T7915 Arthroscopic rotator cuff repair greater than 2cm Xmajor
  T7981 Extensive, greater than 2cm tear repair of large muscle including arthroscopic (excluding rotator cuff) Major
  T7982 Arthroscopic sub acromial decompression and rotator cuff repair (including arthroscopic procedures in glenohumeral joint) Major
  T7990 Revision of open or arthroscopic rotator cuff repair +/- decompression Major
  W8193 Arthroscopic subacromial decompression Major
  W8194 Arthroscopic sub-acromial decompression and excision of distal clavicle (including arthroscopic procedures in glenohumeral joint) Major
  W8603 Therapeutic arthroscopy of shoulder (as sole procedure) Major
  W8820 Diagnostic arthroscopic examination of shoulder joint, with or without biopsy (as sole procedure) Intermediate
  T6450 Tenodesis of biceps tendon (as sole procedure) Major
   

Fixation/arthrodesis

  W6012 Primary arthrodesis of joint with or without graft and with or without internal fixation – shoulder Major
  W6030 Revision or conversion to arthrodesis of shoulder Xmajor
  W2810 Repair of non-union of clavicle Major
  W4940 Scapulo-thoracic fusion Xmajor
  W9111 Manipulation of joint (including intra-articular injection) for “Frozen Shoulder” (as sole procedure) – bilateral Intermediate
  W9112 Manipulation of joint (including intra-articular injection) for “Frozen Shoulder” (as sole procedure) Minor
  16.8 Elbow
    Incision/excision

  W5550 Excision of radial head (as sole procedure) Major
   

Repair/reconstruction

  W5510 Total prosthetic replacement of elbow Xmajor
  W5520 Revisional prosthetic replacement of elbow Complex
  T8050 Surgical release of humeral epicondylitis (lateral or medial) (eg “Tennis Elbow”) Intermediate
  W5560 OK (Outerbridge and Kashiwagi) procedure Major
  W5512 Prosthetic replacement of radial head Xmajor
  T6782 Repair of distal biceps tendon Major
  W7850 Open arthrolysis of elbow Major
  W7860 Arthroscopic arthrolysis of elbow (as sole procedure) Major
  W5502 Interposition arthroplasty of elbow Xmajor
  W5040 Replacement of elbow and shoulder (single operation) Complex
  W8880 Arthroscopy of elbow (as sole procedure) Major
  16.9 Hip, leg and pelvis
    Incision/excision

  W0702 Excision of ectopic bone around a total hip replacement Intermediate
  W7761 Repair of hip labral tear Major
   

Repair, reconstruction and replacement

  W1911 Core decompression of hip Major
  W3712 Primary total hip replacement with or without cement Xmajor
  W3713 Complex primary total hip replacement including bone grafting or femoral osteotomy Xmajor
  W3714 Total hip replacement, with or without cement, after excision arthroplasty or arthrodesis, including conversion of hemiarthroplasty or revision of other previous hip surgery which involved internal fixation Xmajor
  W3715 Hip resurfacing arthroplasty Xmajor
  W3716 Minimally invasive hip replacement (2 incisions) Xmajor
  W3717 Minimally invasive hip replacement (one incision) Xmajor
  W3719 Hip Resurfacing Arthroplasty - Bilateral Complex
  W3732 Revision of uncemented or cemented total hip replacement without adjunctive procedures Complex
  W3733 Revision of total hip replacement including insertion of reconstruction rings, plates, screws, etc., and/or impaction bone grafting to acetabulum and/or femur Complex
  W3740 Second, third or further revision total hip replacement (excluding acetabular liner and head changes) Complex
  W3741 Proximal Femoral Replacement Complex
  W3942 Removal of total hip replacement and creating a pseudarthrosis Xmajor
  W3943 Removal of total hip replacement and complete clearance of cement Complex
  W3944 Acetabular liner and head changes Complex
  W3780 Total prosthetic replacement of the hip, with or without cement, bilateral Complex
  W4600 Prosthetic replacement of head of femur Major
  W1700 Shelf augmentation of acetabulum, eg Wainwright or Trillat Xmajor
  T7930 Repair of abductor mechanism of hip Major
  W1648 Osteotomy/transfer of greater trochanter in isolation Xmajor
  W6600 Closed reduction of dislocated hip prosthesis Intermediate
  W6540 Open reduction of dislocated hip prosthesis Major
  W8800 Diagnostic arthroscopic examination of hip joint including wash-out, with or without biopsy (as sole procedure) Intermediate
  W8620 Therapeutic arthroscopy examination of hip joint, +/- biopsy Xmajor
   

Fixation/arthrodesis

  W6013 Primary arthrodesis of hip joint with or without graft and with or without internal fixation – hip Major
  W1640 Simple pelvic osteotomy and fixation eg Salter or Chiari osteotomies Major
  W1649 Complex pelvic osteotomies and fixation, eg triple osteotomy, peri-acetabular osteotomy Complex
  W1912 Pinning of head of femur – open or percutaneous (eg slipped femoral epiphysis, undisplaced neck fracture) Major
  W1913 Pinning for bilateral slipped upper femoral epiphysis Xmajor
  W3945 Open reduction and internal fixation for periprosthetic fracture around hip Xmajor
  W4542 Open reduction, internal fixation and revision of femoral component for peri-prosthetic fracture Complex
  W4543 Open reduction, internal fixation and complete revision for peri-prosthetic fracture Complex
   

Other

  X0930 Amputation of leg/foot (including Symes Lisfranc and Chopart) Major
  X2280 Manipulation of hip and casting (as sole procedure) Minor
  T6213 Soft tissue operations in the region of the greater trochanter (trochanteric bursitis, snapping hip) Major
  W9018 Percutaneous biopsy/ arthrography/ aspiration in assessment of total hip replacement Minor
  X2200 Closed reduction and Frog POP for congenital dislocation of hip (including dynamic arthrogram, traction and soft tissue release) Major
  X2260 Open reduction and Frog POP for congenital dislocation of hip (including traction and innominate/femoral osteotomy) Complex
  X2262 Complex open reduction for congenital dislocation of hip (i.e. pelvic and femoral or Pemberton osteotomy or revision of open reduction) Complex
  16.10 Knee
    Incision/excision

  W5210 Revision of unicompartmental knee replacement Complex
  W5800 Conversion of a unicompartmental knee replacement to a total replacement of knee joint Complex
  W1660 Tibial osteotomy Major
   

Repair/reconstruction

  W3090 Core decompression of knee Major
  W3122 Harvesting for autologous chondrocyte transplantation into knee including arthroscopy Major
  W0633 Prosthetic replacement of Patellofemoral joint - bilateral (as sole procedure) Xmajor
  W7430 Reconstruction of lateral collateral ligament complex Major
  W7440 Allograft anterior cruciate ligament reconstruction Xmajor
  W7530 Repair of lateral collateral ligament complex Major
  W4210 Total prosthetic replacement of knee joint, with or without cement, +/– patella Xmajor
  W4244 Tibial liner exchange in total knee replacement Complex
  W4212 Minimally invasive knee replacement Complex
  W5200 Unicompartmental knee replacement Xmajor
  W5201 Unicompartmental knee replacement - bilateral Complex
  W4280 Total prosthetic replacement of knee joint – bilateral Complex
  W4230 Revision of total replacement of knee joint Complex
  W4200 Complex primary total knee replacement (ie including bone graft, augmentation or osteotomy) Complex
  W4240 2 stage revision of total knee replacement for infection – first stage Xmajor
  W4242 2 stage revision of total knee replacement for infection – second stage Xmajor
  W7580 Open surgical stabilisation of patella, including soft tissue/tendon transfer or release, +/- application of cast (adult) Xmajor
  W7582 Open surgical stabilisation of patella, including soft tissue/tendon transfer or release, +/- application of cast (child) Xmajor
  W7451 2 stage revision anterior cruciate ligament reconstruction - first stage Major
  W7452 2 stage revision anterior cruciate ligament reconstruction - second stage Major
  W0632 Prosthetic patello-femoral replacement (as sole procedure) Major
  W7583 Repair of patellar/quadricep tendon Major
  W8520 Arthroscopy of knee (including examination under anaesthetic, washout and biopsy) (as sole procedure) Intermediate
  W8200 Arthroscopic meniscectomy (including debridement) Major
  W8280 Arthroscopic meniscectomy (including debridement) – bilateral Complex
  W8500 Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or microfracture) Major
  W8580 Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or microfracture) – bilateral Complex
  W8230 Arthroscopic meniscal repair Major
  W7492 Open/arthroscopic lateral release Intermediate
  W0630 Patellectomy Major
  W8400 Repair of knee ligaments (open or arthroscopic) Major
  W7420 Autograft anterior cruciate ligament reconstruction (including arthroscopic and meniscectomy) Xmajor
  W8240 Meniscal allograft transplantation Xmajor
  W7490 Reconstruction of posterior lateral corner of knee Major
  W7410 Multiple ligament reconstruction of knee including posterior cruciate ligament Complex
  W7470 Revision of anterior cruciate ligament reconstruction including autograft/allograft Xmajor
  W7480 Posterior cruciate ligament reconstruction including arthroscopic Xmajor
   

Fixation/arthrodesis

  W6014 Primary arthrodesis of knee joint with or without graft and with or without internal fixation Major
  W5810 Patella resurfacing (as sole procedure) Major
  W7430 Reconstruction of lateral collateral ligament complex Major
  16.11 Foot
   

Ankle

  W5790 Repair to plantar plate Major
  T6720 Tendo Achilles lengthening percutaneous Intermediate
  T6722 Tendo Achilles lengthening primary open Major
  T6723 Tendo Achilles lengthening repeat procedure Major
  T6780 Primary repair of Achilles tendon Intermediate
  T6810 Secondary repair of Achilles tendon Major
  T6822 Delayed or secondary repair of Achilles tendon with tendon or fascial graft Xmajor
  W8840 Diagnostic arthroscopic examination of ankle including anterior synovectomy to gain vision (as sole procedure) Intermediate
  W8630 Therapeutic arthroscopy of ankle with either soft tissue procedures or bony procedures +/– joint surface procedure (as sole procedure) Major
  W8640 Complex therapeutic arthroscopy of ankle, with multiple bony, joint surface and soft tissue procedures +/- ligament reconstruction (As Sole Procedure) Major
  W7880 Open or arthroscopic release of ankle joint contracture (excluding Achilles tendon lengthening) Major
  W4410 Total prosthetic replacement of ankle joint Xmajor
  W4420 Complex total replacement of ankle (ie including custom prosthesis, wedges, internal fixation of fractures) Complex
  W4430 Revision of total prosthetic replacement of ankle joint Complex
  T6770 Peroneal sling/groove reconstruction and replacement of dislocated peroneal tendons Major
  W7530 Repair of lateral collateral ligament complex Major
  W7430 Reconstruction of lateral collateral ligament complex Major
  W6015 Ankle arthrodesis – open Intermediate
  W6016 Ankle arthrodesis with autogenous graft Intermediate
  W6017 Ankle arthrodesis with internal fixation (arthroscopic) Intermediate
  W6018 Ankle arthrodesis – revision, including converstion from total ankle replacement Intermediate
  W6019 Ankle syndesmosis reconstruction Complex
   

Hind foot and mid foot

  W8850 Diagnostic subtalar arthroscopy including synovectomy to gain vision (as sole procedure) Intermediate
  W8650 Therapeutic sub-talar arthroscopy additional to synovectomy to gain vision Major
  W0432 Isolated sub talar fusion or mid foot fusion with autogenous graft (adult) Major
  W0434 Isolated sub talar fusion or mid foot fusion without autogenous graft (adult) Major
  W0420 Triple fusion of joints of hindfoot without autogenous graft Major
  W0422 Triple fusion of joints of hindfoot with autogenous graft Major
  W0460 Complex procedure to mid foot or hind foot without autogenous bone graft (osteotomy/fusion +/– tendon transfers) Xmajor
  W0462 Complex procedure to mid foot or hind foot with autogenous bone graft (osteotomy/fusion +/– tendon transfers/fixation) Xmajor
  W0463 Complex procedure to mid foot and hind foot without autogenous graft (osteotomy/fusion +/– tendon transfers/fixation) Complex
  W0464 Complex procedure to mid foot and hind foot with autogenous graft (including osteotomy, fusion +/– tendon transfers, fixation) Complex
   

Forefoot

  W0300 Multiple procedures on forefoot, distal to and including the tarsometatarsal joints, which involves at least two distinct procedures not intrinsic to each other Xmajor
  W0310 Multiple procedures on forefoot, distal to and including the tarsometatarsal joints, which involves at least two distinct procedures not intrinsic to each other - bilateral Complex
  W1590 Correction of retracted/dislocated metatarso-phalangeal joint including tendon transfer, division/realignment of bone and internal fixation Major
  W1040 Osteotomy of short bone of foot (excluding hallux valgus and including internal fixation) Intermediate
   

Hallux

  W0860 Metatarso-phalangeal cheilectomy - unilateral, as sole procedure Major
  W0861 Metatarso-phalangeal cheilectomy - bilateral, as sole procedure Xmajor
  W7910 Metatarsal osteotomy (eg Scarf) for Hallux valgus, with or without internal fixation and soft tissue correction Major
  W7980 Metatarsal osteotomy (eg Scarf) for Hallux valgus, with or without internal fixation and soft tissue correction - bilateral Xmajor
  W5700 Excision arthroplasty of first metatarso-phalangeal joint with prosthetic implantation or interposition arthroplasty Major
  W5701 Excision arthroplasty of first metatarso-phalangeal joint with prosthetic implantation or interposition arthroplasty – bilateral Xmajor
  W5710 Excision arthroplasty of first metatarso-phalangeal joint, (e.g. Keller, Bonney-Kessel procedures) including cheilectomy Intermediate
  W5780 Excision arthroplasty of first metatarso-phalangeal joint, (e.g. Keller, Bonney-Kessel procedures) including cheilectomy - bilateral Major
  W0321 Osteotomy/ies (eg Scarf and Akin) for Hallux Valgus correction with or without internal fixation and soft tissue correction Major
  W0322 Osteotomy/ies (eg Scarf and Akin) for Hallux Valgus correction with or without internal fixation and soft tissue correction - bilateral Xmajor
  W0330 Fusion of first metatarso-phalangeal joint Intermediate
  W0380 Fusion of first metatarso-phalangeal joint – bilateral Major
  W5920 Fusion of first metatarso-phalangeal joint with bone grafting +/- internal fixation (as sole procedure) Intermediate
   

Toes

  T6460 Tendon transfer of toe – unilateral Intermediate
  T6461 Tendon transfer of toe – bilateral Major
  W5940 Fusion of interphalangeal joint(s) of toe (including internal fixation) Intermediate
  W5980 Fusion of interphalangeal joint(s) of toe (including internal fixation) – bilateral Major
  W0881 Excision of joint of toe with release of contracture and soft tissue correction Major
  T6462 Excision or partial excision of IP joint of lesser toe with tendon transfer Intermediate
   

General foot

  T6762 Repair of tendon of foot – flexor Minor Minor
  W7900 Excision of medial eminence 1st or 5th MT head with soft tissue repair (bunionectomy) Intermediate
  T6763 Repair of tendon of foot – extensor Minor Minor
  X1110 Amputation of toe Intermediate
  X0822 Amputation of whole ray Major
  X0930 Amputation of leg/foot (including Symes Lisfranc and Chopart) Major
  16.12 External fixation/traction
  W2910 Application of skeletal traction to bone Minor
  W2930 Removal of skeletal traction from bone Minor
  W3010 Application of external fixation to bone Major
  W3030 Removal of external fixation from bone Minor
17 Interventional radiology
Many therapeutic procedures necessitate a diagnostic procedure. For example, angioplasty cannot be performed without angiography. We will not reimburse additional charges for these diagnostic procedures unless a separate and distinct procedure took place.

We will not normally reimburse standby fees for these procedures. If it is felt to be clinically necessary to have a surgeon on standby, we request you contact the specialist fees team using the telephone numbers at the front of this Schedule.

The code and narrative for all these procedures includes imaging guidance by one of the following methods: X-ray, CT/MRI, fluoroscopy or ultrasound.

If a vascular procedure is jointly performed by a surgeon and interventional radiologist then the benefit should be split between the two specialists. Separate charges should not be made.
  17.1 Biopsy
  B2890 Ultrasound guided interstitial laser ablation of breast lesion Intermediate
  XR100 Fluoroscopically guided biopsy(ies) Intermediate
  XR110 Ultrasound guided biopsy(ies) Intermediate
  XR120 CT/MRI guided biopsy(ies) Intermediate
  XR121 Unilateral image guided vacuum assisted excision of breast lesion (with biopsy) Intermediate
  XR130 Transjugular/transfemoral plugged liver biopsy(ies) Intermediate
  XR160 Percutaneous image guided fine needle aspiration(s) (FNA) - Unilateral Minor
  XR140 Unilateral stereotactic core biopsy breast Intermediate
  XR142 Bilateral stereotactic core biopsy of breasts Intermediate
  XR161 Percutaneous image guided fine needle aspiration(s) (FNA) – bilateral Minor
  17.2 Drainage
  XR170 Fluoroscopically guided drainage of fluid collection Intermediate
  XR180 Ultrasound guided drainage of fluid collection Intermediate
  XR190 CT/MRI guided drainage of fluid collection Major
  17.3 Angioplasty
  XR252 Venoplasty Major
  XR254 Angioplasty of other arteries (e.g. sub-clavian, tibial, femoro-popliteal) including peripheral angiogram +/- insertion of stent Major
  XR260 Angioplasty with insertion of metallic stent Major
  XR270 Angioplasty with insertion of metallic stent-graft Major
  XR280 Insertion of aortic metallic stent-graft Complex
  XR290 Cerebral angioplasty with or without insertion of metallic stent Complex
  XR430 Renal angioplasty, +/- insertion of stent Major
  XR516 Angioplasty of iliac artery, +/- insertion of stent Major
  17.4 Embolisation
  XR302 Endovascular management of brain arteriovenous malformation (including 2 separate interventions) Complex
  XR303 Additional management of brain arteriovenous malformation (per additional intervention) Minor
  XR306 Endovascular treatment of cerebral aneurysm Xmajor
  XR352 Embolisation of artery/vein Major
  XR360 Embolisation of vascular mass (including uterine embolisation) Complex
  XR370 Embolisation of bronchial artery Complex
  XR380 Embolisation of aneurysm Complex
  XR391 Embolisation of arteriovenous malformation (AVM) e.g. of foot, minor organ Major
  XR362 Embolisation of pelvic vein varices Major
  XR442 Embolisation of varicocele of gonadal vein Major
  XR361 Prostate Artery Embolisation major
  17.5 Thrombolysis
  XR410 Thrombolysis or aspiration of thrombus under imaging control Intermediate
  17.6 Dilatation
  XR450 Dilatation of stricture under imaging control Intermediate
  XR565 Percutaneous dilatation of biliary stricture under imaging control Xmajor