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 (With Effect from 01.07.2019)

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.

Billing Principles: Introduction


These Billing Principles will give you clarity in your work with us and support for your patients’ care.

In these Principles we tell you what services and treatment we will and will not pay for. The information will guide you on when you need to contact us, helps in paying your invoices quickly, and ensures our work together runs smoothly.

Following these Principles also means giving us the information we need, at the right time. This helps ensure we can best support your patient’s care and that commercial discussions don’t get in the way of treatment.

We do expect you to adhere to these Principles, which support your recognition and form part of your contract. Failure to adhere to these principles may affect your recognition with us.

Important Points


  • We will pay eligible fees in full when you charge up to the level shown within the Schedule of Procedures and Fees https://provider.axappphealthcare.co.uk/schedule-of-procedures-and-fees/ for treatment you have provided. We will not pay for you to supervise services provided by others.
  • Please do not bill for any service or treatment that is not listed in the Schedule of Procedures and Fees, outlined in these Billing Principles or outlined in your contract, without first seeking approval from AXA PPP healthcare.
  • In line with the good practice guidelines of your regulatory authority, any medical records or information you send us should be complete, accurate, clear and signed by the treating provider. They should include details of procedures, treatments or consultations as appropriate and include the patient’s name, relevant dates and treatment start and end times. If in any doubt, please send us typed copies of medical records, with copies of the originals.
  • As the treating provider, we hold you responsible for ensuring the information you provide, such as coding or medical notes, is accurate. This is important as we use this information to assess eligibility and to settle claims.
  • We need time to consider pre-operative requests which may affect your fees or the way you carry out a procedure. Please send us the relevant information at least five working days before the scheduled treatment.
  • We expect you to follow the ethical guidance provided by your regulatory body. An example of such guidance from the General Medical Council (GMC) can be found here: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/duties-of-a-doctor
  • Please do not consider the provisions of any sections of these Billing Principles in isolation. Each section should be considered in relation to the others.

    1: Pre-treatment and pre-authorisation provisions


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

    Consultations should be face-to-face, unless you have an agreement with us for remote or telephone consultations.

    We set the consultation fee, which includes room and other charges, regardless of time taken or complexity. We expect you to see each patient for the appropriate time to treat their individual condition. We do not expect to be invoiced for additional time or double sessions when treatment has overrun the scheduled time.

    We expect to be billed for only one consultation for each patient on any given day.

    You may perform certain minor operations during consultations. Please bill for these using the codes listed in our Schedule of Procedures and Fees https://provider.axappphealthcare.co.uk/schedule-of-procedures-and-fees/

    We will pay for in-patient consultations if you:
  • are the physician in charge of the patient’s care,
  • have visited them in hospital and
  • are not providing routine post-operative care.

    We would not expect you to bill for a consultation if you:
  • are on call, or
  • have operated on or provided anaesthesia to the patient in question within the past 10 days, or
  • are performing planned surgery for that patient on the day of the consultation.

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

    1.2 Tests, pathology and diagnostic radiology
    You should only request diagnostic tests or pathology tests when you have reasonable suspicion of a medical condition, in line with national guidelines and evidence-based practice and where the tests are required to direct and manage a patient’s treatment plan.

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

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

    We will not generally pay you separately for diagnostic tests, pathology or diagnostic radiology at facilities in our network, or for reporting on the results of these diagnostics. We pay the hospital, clinic or facility directly for these services. If required, you should negotiate appropriate payment for your services with the facility.

    You may bill for therapeutic interventional radiology following our Schedule of Procedures and Fees https://provider.axappphealthcare.co.uk/schedule-of-procedures-and-fees/ For diagnostic tests you perform in your private consulting rooms you should submit invoices using CCSD coding and narratives published on the CCSD website https://www.ccsd.org.uk/

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

    1.3 Information you should provide before a consultation
    We expect you to comply with the Private Healthcare Market Investigation Order 2014, published by the Competition and Markets Authority (CMA).

    Before confirming an outpatient consultation appointment, you should give your patient the following information:
  • the estimated cost of the consultation
  • details of any financial interests you may have in the facility or its equipment
  • a list of all insurers who recognise you
  • a statement that insured patients should check with their insurers the cover they have
  • a reason for further tests or treatment
  • an estimate of the cumulative cost of the treatment pathway which has been recommended. This should include: - all fees you charge separately from hospital fees - contact details for any other consultants whose fees are not included in the quote - a statement of services which have not been included in the estimate, such as those resulting from unforeseeable complications. Where alternative treatments are available but the appropriate treatment can only be decided during surgery, the estimate should set out the relevant options and associated fees.

    Please also provide this information to the Private Healthcare Information Network (PHIN) www.phin.co.uk which provides patients with information to help them make their private healthcare choices.

    Treatment at a facility outside our network
    The majority of our members have chosen a policy requiring them to receive treatment at one of our network facilities.

    We pay all charges for eligible treatment at any hospital listed as a network facility in line with our agreements. In normal circumstances, we pay only a small daily benefit for treatment at a facility that is outside of our network and is not listed in our directory.

    In exceptional circumstances, if a patient needs facilities or treatments which are not available at one of our network facilities, we may pay the charges.

    You must agree this specific exemption with us before treatment or, in an emergency, as soon as possible after admission. Where we have agreed, we will pay all charges for eligible treatment at the relevant facility which is best placed to provide the necessary care.

    To request an exemption, please complete the Hospital Exemption Request form on our Provider website https://www.axappphealthcare.co.uk/network-exemption The Network Development team will review your clinical reasons and let you know if we will accept treatment outside our network.

    2: Treatment Provisions


    2.1 Coding
    We work with the Clinical Coding and Schedule Development (CCSD) group to help create industry standard procedure codes. We publish any codes we introduce in the ‘Important information’ section of our Schedule of Procedures and Fees. Please use these codes when billing us for treatment. They should be reasonable and within their intended purpose, as defined by the CCSD: https://www.ccsd.org.uk/

    Procedure narratives and codes are protected by copyright and may not be altered or used in any way other than as published in the Schedule of Procedures and Fees.

    If you believe there is no appropriate code for the treatment you wish to carry out or that the narrative does not reflect what you are doing, please contact the CCSD directly and request a new code. We review requests and possible changes with them regularly.

    2.2 Our fees
    We list the majority of procedures we pay for in our Schedule of Procedures and Fees https://provider.axappphealthcare.co.uk/schedule-of-procedures-and-fees/

    We will pay eligible fees in full when you charge up to the level shown within the Schedule of Procedures and Fees https://provider.axappphealthcare.co.uk/schedule-of-procedures-and-fees/ for treatment you have provided. We will not pay for you to supervise services provided by others.

    Our fees include all component parts, for example:
  • pre-operative assessment
  • the procedure itself, including local anaesthetic and/or intravenous (IV) sedation by the main operator
  • all routine aftercare, including any consultations within 10 days of the procedure.

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

    We pay the hospital, facility or clinic directly for the in-patient services listed below. We do not pay you separately for these services:
  • consumables, including drug costs
  • equipment charges
  • in-patient therapies.

    If required, you should negotiate appropriate payment for your services with the facility.

    2.3 Our fees: exceptions
    Please do not bill for any service or treatment not listed in the Schedule of Procedures and Fees, outlined in these Billing Principles or outlined in your contract, without first seeking approval from AXA PPP healthcare. If you believe an additional fee is appropriate, for example where you have to see a patient within 10 days of their surgical procedure because the wound has reopened, please:
  • tell us what fees you would like us to reconsider and why
  • submit a copy of your clinic letter using our specialist fees enquiry form https://provider.axappphealthcare.co.uk/individual/individual-provider-support/ We will then consider your request.

    2.4 Unsure what code to use for surgery?
    We may still cover procedures which are not listed by code in our Schedule of Procedures and Fees. We’ll need additional information from you to help us consider your proposed treatment.

    If you can’t find the code you need, please:
  • give us a detailed analysis of what you’re planning
  • include the nearest appropriate code from our Schedule of Procedures and Fees and/or the CCSD website and
  • submit a copy of your clinic letter using our specialist fees enquiry form https://provider.axappphealthcare.co.uk/individual/individual-provider-support/
  • make sure we have this information at least five working days before the procedure is due to take place.

    We’ll use this information to help find the correct code and we’ll tell you the corresponding fee.

    When there is no appropriate procedure code, we will allocate the nearest code and may also review the fee independently, considering any additional complexities.

    Once you have the right code, please share this with your patient so they can authorise their treatment. This will also help avoid any doubt when you invoice us.

    2.5 Unbundling
    We take a common-sense approach to unbundling and will list the most frequently occurring procedures together. The list is not exhaustive, but we do not expect procedures to be broken down into their component steps.

    Here are some examples of unbundling which show what we would consider unreasonable combinations or billing:
  • charging for two procedures where one is part and parcel of the other or is so frequently performed that it is in effect part and parcel, for example suturing to close an operation wound
  • charging for in-patient care or intensive treatment unit (ITU) care routinely considered part of the procedure, for example with a complex procedure such as a Whipples procedure
  • charging for pre-operative or post-operative assessment or analgesia, including local anaesthetic or IV sedation by the specialist performing the procedure
  • using procedure combinations whose primary purpose is to increase reimbursement. An example of this would be charging for wound infiltration with local anaesthesia or a Whipples procedure with a gallbladder removal code, as these elements are integral to the operation
  • charging for an anaesthetic when an anaesthetist has provided anaesthetic services
  • charging for a multidisciplinary team meeting
  • consultations during a course of chemotherapy.

    In most cases, we will outline which procedures we don’t expect to see billed together on our Schedule of Procedures and Fees and publish these on our ‘Important changes’ document on our website.

    Sole Procedures
    A code has ‘sole procedure’ in the narrative when it is usually performed by itself. Otherwise it is part and parcel of another procedure in the same area of the body. You should normally bill sole procedures in isolation, but there may be times that it is appropriate to bill a sole procedure code alongside another code. Please tell us about these exceptions by following the guidance below.

    Exceptions
    Our unbundling or sole procedure rules may not apply if you perform procedures on a separate area of the body in a single session. If this applies in a specific case please:
  • complete the specialist fees enquiry form on our Provider website https://provider.axappphealthcare.co.uk/individual/individual-provider-support/ , selecting ‘query about our billing principles’, at least five working days before the procedure
  • supply the relevant codes and areas of the body to support your request.

    We’ll tell you whether you can bill separately for these codes. If you submit an invoice without contacting us we will not pay all the separate charges or we may recoup money paid by mistake.

    3: Bespoke Requests


    3.1 Fee Uplifts and Multiple Specialist Requests
    On occasion you may need to submit more than one code for surgery. When this happens we will pay the full amount for the procedure with the highest complexity and 50% of the fee for the second procedure.

    We appreciate that we can’t address every medical situation or surgical complication in setting fees. If you are planning a complex series of procedures which are not covered in the principle outlined in the paragraph above, we may consider a bespoke request.

    This may include pre-operative or post-operative uplift requests and multiple specialist requests.

    We define these here:

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

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

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

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

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

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

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

    Please submit your bespoke request using the specialist fees enquiry form on our Provider website https://provider.axappphealthcare.co.uk/individual/individual-provider-support/ We review all requests individually using the evidence you provide.

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

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

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

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

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

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

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

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

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

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

    4: Specific provisions


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

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

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

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

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

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

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

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

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

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

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

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

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

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

    5: Administration and governance


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

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

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

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

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

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

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

    As the treating provider, we hold you responsible for ensuring the information you provide, such as coding or medical notes, is accurate. This is important as we use this information to agree treatment for patients and settle their claims quickly.

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

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

    We expect your documents to be complete, accurate, clear and signed by you. They should include details of procedures, treatments or consultations as appropriate and include the patient’s name, relevant dates and treatment start and end times.

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

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

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

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

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

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

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


  • 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
      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
      S5211 Injection of Botulinum Toxin for Hyperhidrosis
      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 £250
    20310 Follow-up out-patient consultation £100 £120 £170
    20320 In & day-patient care £50 £60 £50
    ITU (see policy) £200
    Family therapy £290
    Psychological therapy £100
      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
    Audiologist£150

    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 £250 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
      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
      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
      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
      M4514 Endoscopic Examination of Bladder (Rigid Cystoscopy) Including any Biopsy Minor
      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 Transvaginal cerclage of cervix of gravid uterus Minor
      R1220 Transvaginal 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
      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 -including 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