Allianz Worldwide Care. UK Fee Schedule. Effective from 2015

Transcription

1 Allianz Worldwide Care UK Schedule Effective from 2015

2 Table of Contents Introduction... 4 Scope... 4 Coding... 4 Reimbursement Single s... 5 Multiple s... 5 Bilateral s... 5 Complex s... 5 Consultations... 6 Radiology and Pathology... 6 Unbundling... 6 Anaesthesia... 7 More Than One Specialist... 7 Assistants... 7 Shortfalls... 7 All Inclusive Pricing... 8 Treatment Guarantee (Pre-Authorisation) Appropriate Treatment Guidelines for Appropriate Treatment Fraud Invoicing Payment Copyright Schedule Section 1 - Investigations, Simple s and Consultation Codes Section 2 Brain, Cranium and Other Intracranial Organs Section 3 Spine, Spinal Cord and Peripheral Nerves Section 4 Eye and Orbital Contents Section 5 Ear, Nose and Throat Section 6 Face, Mouth, Salivary and Thyroid Section 7 - Breast Section 8 - Thorax and Intra-thoracic Organs

3 Section 9 - Vascular System Section 10 - Endoscopic GIT s Section 11 - Abdomen (excl. Urinary and Reproductive Organs) Section 12 - Urinary System and Male Reproductive Organs Section 13 - Pregnancy and Confinement Section 14 - Female Reproductive Organs Section 15 - Skin and Subcutaneous Tissue Section 16 - Bones, Joints and Connective Tissue/Tendon Muscle Section 17 - Interventional Radiology Section 18 - Chemotherapy

4 Introduction This Allianz Worldwide Care Schedule has been designed to be used by consultants and specialists undertaking treatment on our members in the UK. The Schedule provides a detailed list of procedure codes and narratives based upon the industry standard CCSD codes. Allianz Worldwide Care has published recommended fees for each of the procedures listed. These fees are considered to be reasonable and customary and have been calculated based upon detailed claims analysis, market research, the complexity of the procedure and its duration. For surgical procedures, both a procedure (surgeon s) fee and an anaesthetist fee, where appropriate, have been listed. In addition to the published fees, Allianz Worldwide Care has also outlined invoicing principles for consultants and specialists to follow when issuing invoices to Allianz Worldwide Care. This Schedule may be amended or altered by Allianz Worldwide Care at any time due to the evolving nature of medical treatments and practices. Scope This Schedule is applicable only in the UK and relates specifically to : Allianz Worldwide Care international medical insurance scheme members; Allianz Worldwide Care Health Trust members; and Members who are insured with, or are part of, a healthcare plan administered by Allianz Worldwide Care or any subsidiary company of Allianz Worldwide Care. This Schedule covers any future Allianz Worldwide Care products, companies or schemes within the UK. Coding Invoices should detail the CCSD code for the procedure performed, as listed in this document. Given that the published fee includes all component parts of the procedure, typically no additional lines or items should appear on an invoice; except where multiple procedures are performed. The CCSD code shown on an invoice should accurately reflect the treatment description as provided in the procedure narrative. If you are planning on performing a procedure or treatment that is not listed in this Schedule please contact the Medical Services Department to discuss this matter and to confirm procedural and anaesthetist fees. Medical Services Department contact details: Tel: Fax: medical.services@allianzworldwidecare.com 4

5 Reimbursement The fees published within this document show the monetary amount that Allianz Worldwide Care expects to reimburse consultants and specialists, for the eligible treatment of an Allianz Worldwide Care member in the UK. Please note that eligible treatments and the amount of benefit available to a member will depend on the specific health insurance policy that they have purchased with Allianz Worldwide Care. It is recommended that this matter is discussed with the member, prior to treatment taking place. Single s Where only one procedure is performed, the consultant or specialist is entitled to 100% reimbursement of the fee published within this Schedule. The published fees include all pre- and post-procedural attendance and care, including daily ward care. The aforementioned treatment costs should not be invoiced separately. Multiple s Different medical insurance companies have varying policies on how multiple medical procedures are reimbursed. If more than one procedure is performed on an Allianz Worldwide Care member under the same anaesthetic, then an additional benefit is payable. Below are the guidelines for multiple procedures: Where two procedures are performed, Allianz Worldwide Care will pay 100% of the fee for the primary procedure and 50% of the fee for the secondary procedure. Please note that the secondary procedure fee is calculated as 50% of the fee payable for the procedure itself and not based on the fee payable for the primary procedure. Allianz Worldwide Care will consider additional reimbursement for a third procedure, but this must be agreed prior to treatment taking place and will be assessed on a caseby-case basis. If reimbursement for a third procedure is agreed by Allianz Worldwide Care then 25% of the fee will be paid. Only in exceptional circumstances will any additional funding be considered for any more than three procedures. Bilateral s In most instances, bilateral procedures have their own unique CCSD procedure code. If there is a code for the bilateral procedure then the published fee for that code applies. Where there is no bilateral code published, Allianz Worldwide Care s multiple procedure rules (above) are applicable. Complex s In the instance where a planned procedure is anticipated to be considerably more complex than normal, or once the procedure is underway it becomes apparent that it is going to take an unusually long time in theatre; Allianz Worldwide Care is prepared to review the published reimbursement fee. Reasons why additional funding should be considered by Allianz Worldwide Care must be provided to the Medical Services Department prior to an invoice being received for the 5

6 procedure(s) in question. Where possible, this information should be provided prior to the treatment commencing. Medical Services Department contact details: Tel: Fax: medical.services@allianzworldwidecare.com Consultations Out-patient consultations: Allianz Worldwide Care will only reimburse consultations that happened face-to-face; Telephone consultations should not be claimed; and Only one consultation per member, per day may be claimed In-patient consultations: In-patient consultations are only eligible for reimbursement if carried out by the leading consultant or specialist. Radiology and Pathology Allianz Worldwide Care has pricing agreements in place with hospitals that form part of our UK Hospital Network. Many of the prices agreed with hospitals include specialist fees, notably diagnostic radiology and pathology services. For these services, specialists should negotiate appropriate remuneration with the hospital. All diagnostic radiology should be invoiced through the hospital or facility in accordance with contracted fees. If you wish to bill independently for the hospital or facility then this should be approved with Allianz Worldwide Care prior to the invoice being sent for payment. Therapeutic interventional radiology can be invoiced in accordance with fees contained in this schedule. All pathology charges should be invoiced through the hospital, recognised pathology facility or facility where the procedure took place. If you wish to bill independently for the hospital or facility then this should be approved with Allianz Worldwide Care prior to the invoice being sent for payment. Unbundling Unbundling is the practice whereby a procedure is broken down into individual components, where such components form an integral part of the main procedure and are charged for in an itemised manner. Individual components of a procedure should not be separated out and invoiced to Allianz Worldwide Care separately. The published fee for single procedures takes into account all the component elements required to perform the procedure, and therefore, any component parts of a single procedure will not be reimbursed by us. Any consultants or specialists consistently unbundling procedures may have their recognition status withdrawn by us. Special attention should be given to local anaesthetic and/or sedation as in many instances this is considered part and parcel of the procedure itself by generally accepted standards. 6

7 Anaesthesia The anaesthetic fee is only applicable for attending anaesthetists and covers all routine preand post-operative care and attendance. This includes pre-operative assessments and routine and planned critical care monitoring. No additional fees are expected to be paid by Allianz Worldwide Care for anaesthesia and/or sedation where a published value of zero ( 0) is shown. There are a number of procedures where local anaesthetic and/or sedation are generally considered to be part and parcel of the procedure itself. In these instances, no additional fee should be claimed. If a procedure that is (by generally accepted standards) normally performed by the main operator under local anaesthetic, is performed under general anaesthetic then an additional fee of up to 100 may claimed. However, this is only applicable for cases where a separate anaesthetic invoice has not been received by an anaesthetist. More Than One Specialist Where a procedure requires more than one specialist in attendance then Allianz Worldwide Care will consider additional reimbursement, where best practice is being followed. In these instances, you should contact the Medical Services Department prior to the treatment taking place to discuss a higher fee. Medical Services Department contact details: Tel: Fax: medical.services@allianzworldwidecare.com Assistants s for assistants should not be claimed as these are considered to be included in the published fee. Shortfalls Allianz Worldwide Care considers the fees published within this schedule to be fair, reasonable and customary for the service provided. In instances where the consultant or specialist fee exceeds the published fee, then a shortfall may occur. In this case, the shortfall amount is considered to be the member s liability. If it is anticipated that a shortfall is likely to occur, the member should be made explicitly aware of this prior to treatment taking place. Allianz Worldwide Care reserves the right to suspend or withdraw a consultant or specialist s recognition, if the fees charged are persistently in excess of those published and are unjustifiable. 7

8 All Inclusive Pricing It is sometimes the case that Allianz Worldwide Care has agreements in place with hospitals and facilities, where consultant and specialist fees are built into the contracted fee. In this situation consultants and specialists should not invoice Allianz Worldwide Care, as this would constitute double billing. The consultant or specialist should make separate arrangements with the hospital or facility for reimbursement. 8

9 Treatment Guarantee (Pre-Authorisation) Certain treatments and costs require pre-authorisation. When required, the relevant sections of the Allianz Worldwide Care Treatment Guarantee Form need to be completed by the member and their consultant/specialist. This form is then submitted to our Medical Services Department for approval prior to treatment. We will respond within 24 hours of receipt of a fully completed Treatment Guarantee Form. Should the correct conditions be met, Allianz Worldwide Care will respond with a Guarantee of Payment. This guarantee is a statement issued to the consultant or specialist, confirming that Allianz Worldwide Care will pay for the described procedure up to a specified contribution. Treatment Guarantee is required for the following benefits, which may or may not be included in the member's plan: In-patient benefits as listed in the member s Table of Benefits Day-care treatment Out-patient surgery MRI (Magnetic Resonance Imaging), PET (Positron Emission Tomography) and CT-PET scans Nursing at home Routine maternity including complications of pregnancy and childbirth (in-patient treatment only) Oncology (in-patient and day-care treatment only) Occupational therapy (out-patient treatment) Rehabilitation treatment Medical evacuation (or repatriation where covered) Expenses for one person accompanying an evacuated/repatriated person Repatriation of mortal remains Palliative care and long term care Travel costs to another Channel Island, the UK or France (for members covered under the Corporate Healthcare Plan for the Channel Islands) The member's Table of Benefits will confirm which benefits are available to them, and which of these require Treatment Guarantee. Treatment Guarantee is necessary in order to ensure that all costs are fully covered within the insured member s plan. As with all health insurance policies, Allianz Worldwide Care will only cover treatment that is medically necessary and charges that are usual and customary (with reference to this fee schedule). Therefore, it is vital that we are contacted prior to treatment so that we can confirm the medical necessity of the treatment, as well as the appropriateness of costs. In the event that Treatment Guarantee is not obtained and the treatment is subsequently proven to be medically necessary, Allianz Worldwide Care reserves the right to pay only 80% or 50% of the published fee/invoiced amount. The level of reimbursement will vary depending on the treatment undertaken, as per the conditions of the member s policy. In instances where this occurs, the shortfall amount is considered the member s liability. The Treatment Guarantee process is outlined here: Treatment Guarantee forms can be downloaded here: 9

10 Medical Services Department contact details: Tel: Fax: medical.services@allianzworldwidecare.com 10

11 Appropriate Treatment Consultants and specialists must operate in accordance with good clinical practice and in line with professional codes of conduct. Only procedures that are deemed medically necessary and appropriate will be reimbursed by Allianz Worldwide Care. Guidelines for Appropriate Treatment s performed on Allianz Worldwide Care members must be: a. Essential to identify or treat a member s condition, illness or injury b. Consistent with the member s symptoms, diagnosis or treatment of the underlying condition c. In accordance with current good clinical practice and professional standards of medical care in the medical community d. Required for reasons other than the comfort or convenience of the member e. Proven and demonstrated to have medical value and are not deemed by us to be experimental f. Considered to be the most appropriate type of procedure g. Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the member s medical condition h. Provided only for an appropriate duration of time Any procedure, which is considered experimental or unproven, in the reasonable opinion of Allianz Worldwide Care and based on generally accepted medical practice, will not be reimbursed. 11

12 Fraud Fraud can be an action that falls within any one of the following three areas: Fraud by false representation; Fraud by failing to disclose information; and Fraud by abuse of position. Allianz Worldwide Care takes fraud very seriously and we have rigorous processes and procedures in place to identify any fraudulent activity. We monitor claims and conduct regular audits, with reference to medical reports if necessary. We will not tolerate fraud and reserve the right to withdraw consultant recognition if fraud is suspected. In addition to this, cases of fraud will be reported to the police and to the General Medical Council (GMC) or in the case of dentistry, the General Dental Council (GDC). Below is a list of examples that we consider to be fraudulent invoicing. Consultants and specialists should not knowingly: a. Invoice for procedures that they have not performed b. Invoice for services rendered to a person other than the member named on the Allianz Worldwide Care membership card c. Use separate codes for a single procedure (double billing) d. Invoice for multiple codes where one of those codes includes the other (unbundling) e. Use codes that do not accurately reflect the procedure performed f. Exaggerate the complexity of procedures performed g. Misrepresent the charges h. Split the fees incurred in a single day into more than one day i. Alter dates of treatment or diagnosis 12

13 Invoicing Consultants and specialists should endeavour to invoice Allianz Worldwide Care within thirty (30) days of the member being discharged following treatment. Please note that Allianz Worldwide Care reserves the right to refuse invoices that are received six (6) months or more after the date of discharge. For further information on invoicing, including a full description of the information and detail that is to be included, please refer to the Terms and Conditions of your recognition with Allianz Worldwide Care. Payment Allianz Worldwide Care will reasonably endeavour to settle invoices in Sterling (GBP) within thirty (30) days of receipt of invoice. This payment arrangement is subject to the receipt of all necessary information, the Terms and Conditions of your recognition and the Terms and Conditions of the member s policy. Allianz Worldwide Care reserves the right to request further documentation or information if necessary. A settlement statement will be sent to you advising you of the total amount paid by electronic transfer. This settlement statement, where applicable, will detail any claim that has been declined and the reason for such a decline. Allianz Worldwide Care reserves the right to decline settlement, in part or in full, in accordance with the member s policy with us. A settlement may be declined: If Allianz Worldwide Care cannot verify that the person to whom the invoice relates is currently insured by the company; If the treatment is deemed not to be medically necessary; or If a treatment guarantee (pre-authorisation) has not been provided, where required. Allianz Worldwide Care will not be liable for any amount that is not covered under the member s policy or for any co-payments, deductibles or amounts exceeding the member s plan and benefit limits. Copyright This Schedule is based on the CCSD Schedule of s - The Clinical Coding and Schedule Development Group. All information, material and concepts comprised in this publication are exclusively owned by and subject to the copyright and other intellectual property rights of Allianz Worldwide Care. They may not be separately represented or reproduced. You are not authorised to alter or attempt to alter or vary any information, material or concepts on or comprised in this publication. 13

14 UK Schedule Section 1 - Investigations, Simple s and Consultation Codes 1.1 Investigations ECG Exercise ECG Exercise stress echocardiography hour ECG Holter monitoring Long term ambulatory ECG monitoring (event recording) Insertion of implantable ECG loop recorder Removal of implantable ECG loop recorder Patch testing Air conduction audiogram Audiogram with other cochlear test Impedance audiogram Impedance audiogram as part of other procedure Echocardiography G2180 Ambulatory 24h ph and impedance monitoring Simple s Incision and drainage (not elsewhere covered) AC100 Local anaesthetic by main operator S4780 Aspiration of subcutaneous haematoma S5210 S5240 S5300 Injection into subcutaneous tissue/painful trigger point under local anaesthetic Two or more injections into subcutaneous tissue/painful trigger point under local anaesthetic Introduction of substance into skin (including hormone pellet) V4800 Injection around apophyseal facet(s) of vertebrae X3510 IV sedation administered by operator X3590 Intravenous infusion (as sole procedure) X3770 X3800 Intramuscular injection with XRC (e.g. piriformis block) Ophthalmic local anaesthetic injection administered by operator

15 1.3 Consultation Codes Surgeon Physician Psychiatrist Initial consultation Follow-up consultation Section 2 Brain, Cranium and Other Intracranial Organs 2.1 Brain A0110 Hemispherectomy 2, A0180 Excision of abscess of brain 1, A0200 Excision of lesion of tissue of brain 2, A0280 Awake craniotomy with ablation of lesion of brain with or without cortical mapping/stereotaxy 2, A0300 Stereotactic ablation of tissue of brain 1, A0310 Stereotactic biopsy of lesion or tissue of brain 1, A0380 Stereotactic radiosurgery of neuronal tissue using gamma knife 1, A0400 Open biopsy of lesion of tissue of brain 1, A0900 Implantation/removal of neurostimulator from brain (any route) A0980 Deep brain stimulation for Parkinson s disease 2, A1060 Fiducial placement A1070 Robotic stereotactic radiosurgery, first/sole session using Cyberknife 1,570 0 A1080 Robotic stereotactic radiosurgery, second to fifth sessions per course of treatment, including adjustments using Cyberknife A1220 Creation of ventriculovascular anastomosis A1240 Creation of ventriculoperitoneal shunt A1250 A1300 Creation of subcutaneous cerebrospinal fluid reservoir Maintenance of cerebroventricular shunt (including revision) A1430 Removal of cerebroventricular shunt A1440 Irrigation of cerebroventricular shunt A1700 Therapeutic endoscopic operations on ventricle of brain (including examination and biopsy of lesion) A2080 Ventricular puncture (as sole procedure) A2220 Puncture of cistern of brain A2223 Cerebral angiogram

16 2.2 Cranium A4280 Intracranial infection: burrhole V0110 Reconstructive cranioplasty 1, V0130 Craniostenosis (for single suture) V0180 Craniostenosis (for more than one suture) 1, V0310 Exploratory open craniotomy V0330 Exploratory burrhole of cranium V0382 Total petrosectomy (for tumour) 1, V0383 Lateral petrosectomy (for tumour) 1, V0390 Foramen magnum decompression 1, V0510 Excision of lesion of cranium V0530 Elevation of depressed fracture of cranium V0580 Repair of compound fracture of cranium 1, Meninges A2210 Drainage of subarachnoid space of brain A3810 Excision of lesion of meninges of brain 2, A3830 Operation for arachnoidal cyst A3900 Repair of dura 1, A4010 Evacuation of extradural haematoma 1, A4110 Evacuation of subdural haematoma or abscess 1, A4180 Subdural haemorrhage - tap Nerves A2500 Intracranial transection of cranial nerve 1, A2600 Other intracranial destruction of cranial nerve 1, A2900 Excision of lesion of cranial nerve (intracranial) 2, A2952 A2953 A2954 Excison of acoustic and cerebello-pontine angle neuroma - tumours less than 2.5 cms performed by single surgeon Excision of acoustic and cerebello-pontine angle neuroma - tumours more than 2.5 cms or compressing brain stem performed by single surgeon Excision of acoustic and cerebello-pontine angle neuroma - tumours managed by combined otoneurosurgical team irrespective of tumour size 2, , , A3000 Repair of cranial nerve (intracranial) 1, A3200 Decompression of cranial nerve (craniotomy) 1, A3300 Neurostimulation of cranial nerve (intracranial) A3330 Removal of neurostimulator from cranial nerve A3680 Excision of cerebellopontine angle tumour 2,

17 2.5 Vessels A0260 Excision of arteriovenous malformation from vessels of brain 2, A4080 Craniotomy - post-operative haemorrhage L3320 Ligation/clipping of aneurysm of cerebral artery 1, L3380 Reinforcement of aneurysm of cerebral artery 1, L3400 Open operations on cerebral artery 1, Other A8300 Electro-convulsive therapy B0100 Hypophysectomy 1, B0210 Cryotherapy to pituitary gland B0410 Excision of lesion of pituitary gland 2, B0610 Excision of pineal gland 2, Section 3 Spine, Spinal Cord and Peripheral Nerves 3.1 Spinal Column (including Intervertebral Disc) A5290 Transforaminal epidural V2200 V2282 V2300 V2400 Posterior decompression +/- foraminotomy (cervical region) Prosthetic intervertebral disc replacement in the cervical spine Revisional posterior decompression +/- foraminotomy (cervical region) Posterior decompression with fusion (thoracic region) , , , V2402 Posterior decompression (thoracic region) V2430 V2500 V2540 V2542 V2543 V2544 V2560 Revisional posterior decompression with fusion (thoracic region) Primary posterior fusion +/- decompression +/- discectomy (lumbar region) Posterior excision of disc prolapse including microdiscectomy (lumbar region) Posterior excision of disc prolapse with undercutting facetectomy (lumbar region) Revision of posterior excision of disc prolapse with undercutting facetectomy (lumbar region) Revision of posterior excision of disc prolapse (lumbar region) Decompression for central spinal stenosis (1 or 2 levels) 1, , , , V2562 Decompression for central spinal stenosis (3 or 1,

18 more levels) V2570 Percutaneous vertebroplasty V2652 V2660 Revision posterior fusion +/- instrumentation (lumbar region) Revision of decompression for central spinal stenosis 1, , V2680 Revision anterior discectomy, decompression and anterior fusion +/- instrumentation (lumbar 1, region) V2900 Anterior discectomy (cervical region) 1, V2902 Revisional anterior discectomy (cervical region) 1, V2950 V2980 V2990 V3100 V3102 V3120 V3122 V3140 V3181 V3300 V3340 V3350 V3362 Anterior discectomy, decompression and fusion (including bone grafting / multiple levels) (cervical region) Combined anterior and posterior fusion of cervical spine Open door laminoplasty of the cervical region (Hirobyashi) Combined anterior discectomy and posterior fusion (thoracic region) Revisional combined anterior discectomy and posterior fusion (thoracic region) Transthoracic/ anterolateral excision of intervertebral disc +/- fusion Revisional transthoracic/ anterolateral excision of intervertebral disc +/- fusion VATS percutaneous discectomy +/- fusion (thoracic region) Prosthetic intervertebral disc replacement in the thoracic spine Minimally invasive intradiscal surgery (including laser/instrumentation) (lumbar region) Primary anterior discectomy, decompression and anterior fusion +/- instrumentation (lumbar region) Combined anterior discectomy and fusion and posterior fusion (lumbar region) Primary posterior fusion with instrumentation +/- decompression +/- discectomy (including graf stabilisation and interbody fusion (PLIF)) (lumbar region) 1, , , , , , , , , , , , V3380 Prosthetic replacement of lumbar disc 1, V3472 Revision of minimally invasive intradiscal surgery (lumbar region) 1, V3720 Posterior fusion (cervical region) 1, V3730 Trans-oral surgery - including posterior fixation 1, V4000 V4100 Combined anterior and posterior correction and instrumentation of scoliosis Posterior correction of scoliosis with instrumentation and fusion 2,850 1,110 2,

19 V4120 Anterior correction of scoliosis with instrumentation and fusion 2, V4140 Removal of posterior spinal implant V4142 V4150 V4160 V4300 V4302 Removal of posterior scoliosis instrumentation (as sole procedure) Anterior correction of degenerative adult kyphosis with instrumentation, +/-fusion (including spinal cord monitoring) Posterior correction of degenerative adult kyphosis with instrumentation, +/-fusion (including spinal cord monitoring) Anterior vertebrectomy with decompression and implant Combined anterior vertebrectomy with posterior fusion and instrumentation , , , ,520 1,010 V4451 Balloon kyphoplasty - single level V4452 Balloon kyphoplasty - two levels V4453 Balloon kyphoplasty - greater than two levels V4740 Percutaneous spinal biopsy (CT controlled) V4742 V4900 V5002 V5003 Spinal endoscopy or percutaneous spinal biopsy (Fluroscopy controlled) Open biopsy of lesion of spine where no other operative procedure on the spine is performed Manipulation of spine under GA/IV sedation (as sole procedure) Manipulation of spine without GA/IV sedation (as sole procedure) V5210 Chemonucleolysis (multiple levels) V5230 Discogram/Diagnostic intervertebral disc injection under X-ray control V5482 Dynamic spine stabilisation procedure W0660 Coccygectomy (multiple levels) W2912 Application of halo (as sole procedure) Spinal Cord A4400 Partial excision of spinal cord 1, A4500 Open operations on spinal cord 1, A4730 Percutaneous cordotomy of spinal cord 1, A4850 Implantation/removal of intrathecal drug delivery system A4860 Implantation/removal of epidural delivery system A4900 Repair of spinal myelomeningocele 1, A5110 Excision of intradural lesion 1, A5300 Drainage of spinal canal (including insertion of shunt) A5530 Lumbar puncture (including spinal manometry) A5580 CSF infusion studies

20 V4980 Excision of intramedullary tumour 1, Paraspinal Injections Paravertebral block up to two levels (without X- ray control) Paravertebral block up to two levels (under X-ray control) Sacral root block (under X-ray control) Dorsal root ganglion block (local anaesthetic or neurolytic) Dorsal root ganglion block (radiofrequency) Intrathecal neurolysis A5200 Epidural injection (cervical) A5210 Epidural injection (lumbar/caudal) A5220 Epidural injection (thoracic) A5230 Epidurogram A5240 Epiduroplasty (Racz catheter or equivalent) A5420 Injection of therapeutic substance into CSF A5720 A5730 A5750 A5760 A5770 A5790 Facet or sacroiliac joint (RF) radiofrequency thermocoagulation including rhizolysis (under X- ray control) - up to 3 joints Facet or sacroiliac joint (RF) radiofrequency thermocoagulation including rhizolysis (under X- ray control) - 4 to 6 joints Facet joint injection (under X-ray control) - up to 2 joints Facet joint injection (under X-ray control) - 3 to 4 joints Facet joint injection (under X-ray control) - 5 to 6 joints Sacroiliac joint injection under image guidance (and bilateral) 3.4 Nerve Roots A5780 Rhizolysis (open) Sympathetic Nerves Intravenous regional sympathetic block (guanethidine block) - 1 injection Stellate ganglion block (local anaesthetic) Stellate ganglion block (neurolytic) Coeliac plexus block, splanchnic nerve block, hypogastric block - diagnostic Coeliac plexus block, splanchnic nerve block, hypogastric block - therapeutic

21 A7500 Lumbar sympathectomy : diagnostic (local anaesthetic under X-ray control) A7510 Thorascopic cervical sympathectomy A7520 Thoracic sympathectomy : diagnostic (local anaesthetic under X-ray control) A7530 Laparoscopic lumbar sympathectomy A7600 A7620 Lumbar sympathectomy : therapeutic (neurolytic under X-ray control) Thoracic sympathectomy : therapeutic (neurolytic under X-ray control) A7682 Presacral sympathectomy - diagnostic A7683 Presacral sympathectomy - therapeutic Peripheral Nerves A6030 Transection of peripheral nerve for neuroma A6080 Neurectomy (major nerve) A6110 Excision of lesion of peripheral nerve (e.g. neurilemma) A6180 Excision of lesion of major nerve A6300 Graft to peripheral nerve A6302 Graft to major nerve A6400 Repair of peripheral nerve A6402 Repair of major nerve A6510 Carpal tunnel release, including endoscopic A6530 Carpal tunnel release (endoscopic) A6570 Carpal tunnel release (endoscopic) - bilateral A6580 Carpal tunnel release, including endoscopicbilateral A6600 Release of entrapment of deeply placed peripheral nerve A6700 Release of entrapment of peripheral nerve A6710 A6711 A6740 A6750 A6810 Cubital tunnel release including endoscopic (without transposition) Cubital tunnel release including endoscopicbilateral (without transposition) Cubital tunnel release (endoscopic) (without transposition) Cubital tunnel release (endoscopic) bilateral (without transposition) Neurolysis and transposition of peripheral nerve (includes ulnar at elbow) A6900 Revision of release of peripheral nerve A7010 Implantation of neurostimulator to peripheral nerve A7011 Trial of neurostimulator (as sole procedure) not at time of permanent implant A7085 Sacral nerve stimulation for faecal/urinary

22 incontinence or constipation A7310 Biopsy of peripheral nerve A7340 Exploration and grafting of brachial plexus 1, Other Nerve Blocks A7300 Trigeminal ganglion injection (local anaesthetic under X-ray control) Permanent lesion of major nerve trunk (radiofrequency, cryoprobe or phenol) A7302 Continuous nerve block as sole procedure A7350 Local anaesthetic blockade of major nerve trunk (including occipital block, spheno-palatine block, diagnostic block of trigeminal branch, intercostal nerve block and supra-scapular nerve block) A7352 Ultrasound guided nerve block as sole procedure AA460 Destruction of branch of trigeminal nerve (neurolytic/rf/cryoprobe) 3.8 Other s Trigeminal ganglion radio frequency lesion (under X-ray control) A5540 Spinal angiogram T6520 Tendon sheath injection T7290 Trigger point injection/enthesis - 1 injection T7292 Trigger point injection/enthesis - more than 1 injection V5282 Intradiscal Electrothermal Therapy (IDET) V5484 V5486 V5487 Spinal dynamic stabilisation devices (Interspinous distraction devices e.g. X-stop) Pedicle based dynamic soft stabilisation procedure (eg Graf ligament) Pedicle based dynamic semi-rigid stabilisation procedure (eg AccuFlex) X3750 Botulinus toxin injections to muscle X3760 Simple intramuscular injection, without X-ray control (as sole procedure) 90 0 X3770 Intramuscular injection with XRC (e.g. piriformis block) Y0910 Sclerosant injections (e.g. ligaments of back) Y3800 Insertion of indwelling axillary catheter Y3810 Insertion of indwelling pleural catheter Y3820 Insertion of indwelling psoas catheter

23 3.9 Neurophysiological s Routine Electroencephalography (EEG) in adult or child aged over 5 Routine Electroencephalography (EEG), child aged 0-4 years Sleep Electroencephalography (EEG) hour ambulatory Electroencephalography (EEG) 24 hour video telemetry Electroencephalography (EEG) Recording and reporting on evoked potential study Recording and reporting on electromyography and nerve conduction studies (EMG); CTS (Bilateral U.L. only) or peripheral neuropathy Recording and reporting on electromyography and nerve conduction studies (EMG); Mononeuropathy (e.g. ulnar), Cx/Lumbar radiculopathy, Myopathy Recording and reporting on electromyography and nerve conduction studies (EMG); Mononeuritis Multiplex, MND - AHC, Multiple Muscle Monitoring (e.g. Torticollis), Myaesthenia Gravis (-SFEMG) Recording and reporting on electromyography and nerve conduction studies (EMG); Myaesthenia Gravis (+SFEMG) Spinal monitoring - up to 4 hours Spinal monitoring - more than 4 hours Inpatient sleep study (polysomnography) A8480 Transtympanic electro-cochleography Section 4 Eye and Orbital Contents 4.1 Globe and Orbit C0110 Exenteration of orbit C0120 Enucleation/evisceration of eyeball C0122 Enucleation/evisceration of eyeball (with implant) C0212 Excision of lesion of orbit - anterior approach C0213 Excision of lesion of orbit - lateral orbitomy C0512 C0513 Simple reconstruction of socket (not including implant or graft) Reconstruction of socket with either implant or graft C0514 Reconstruction of socket with implant and graft

24 C0610 Biopsy of lesion of orbit C0620 Drainage of orbit C0630 Decompression of orbit C0640 Removal of foreign body from orbit C0650 Exploration of orbit (as sole procedure) C0840 Orbital injection Eyebrow and Lid C1010 Excision of lesion of eyebrow C1040 Suture of eyebrow C1110 Excision of lesion of canthus C1130 Correction of epicanthus C1140 Correction of telecanthus C1150 Graft of skin to canthus C1160 Canthotomy C1210 Excision of lesion of eyelid C1230 Curettage/cryotherapy of lesion of eyelid C1320 Blepharoplasty - one eyelid C1340 Blepharoplasty - two eyelids C1341 Blepharoplasty - three or four eyelids C1420 Graft of skin to eyelid C1512 Correction of lower lid ectropion without graft/flap C1513 Correction of lower lid ectropion with graft/flap C1522 Correction of entropion - lower lid C1523 Correction of entropion - upper lid, including graft/flap C1532 Correction of trichiasis by electrolysis/diathermy/cryotherapy/laser C1540 Surgical correction of trichiasis /upper lid entropion, including graft/flap C1640 Tarsorrhaphy C1700 Total reconstruction of eyelid - unilateral C1710 Suture of eyelid (laceration) (as sole procedure) C1810 Correction of ptosis of eyelid - simple, including tarsomullerectomy C1812 Correction of ptosis of eyelid - complex C1813 Correction of ptosis of eyelid with autologous fascia lata C2220 Biopsy of lesion of eyelid

25 4.3 Lacrimal System C2510 C2520 C2540 C2542 Canaliculo-dacryocysto-rhinostomy (including intubation) Conjunctivo-dacryocysto-rhinostomy (including intubation) Dacryocysto-rhinostomy, including insertion of tube Dacryocysto-rhinostomy (endoscopic/laser assisted), including insertion of tube C2550 Lacrimal intubation (as sole procedure) C2610 Excision/Biopsy of lacrimal sac C2640 Incision of lacrimal sac C2650 Probing of nasolacrimal system with/without syringing and/or irrigation C2910 Puncto-canaliculoplasty Muscles C3112 Surgical correction of squint - horizontal 1 muscle C3113 C3114 C3115 Surgical correction of squint - horizontal 2 muscles (in one eye, or one muscle in each of two eyes) Surgical correction of squint - inferior oblique surgery Surgical correction of squint - other vertical muscles C3180 Revision of squint surgery C3530 C Conjunctiva Surgical correction of squint with adjustable sutures Injection of botulinum toxin into extraocular or periocular muscles C3910 Excision/biopsy of conjunctival lesion C3920 Cauterisation including cryotherapy to conjunctival lesion C3950 Radiotherapy to conjunctival lesion C4010 Mucosal graft to conjunctiva C4050 Suture of conjunctiva C4100 Drainage of conjunctival cyst C4340 Subconjunctival injection C4350 Exploration of conjunctiva (including removal of foreign body)

26 4.6 Cornea C3960 Excision of pterygium C4520 Excision of lesion of cornea C4620 Lamellar graft (keratoplasty) to cornea C4630 Perforating graft (keratoplasty) to cornea C4640 Descemets stripping endothelial keratoplasty (DSEK) C4650 Revision of corneal graft/wound C4690 Implantation of Synthetic corneal rings for keratoconus (including INTACS) C4710 Repair of corneal wound C4730 Removal of corneal suture C4810 Removal of superficial corneal foreign body C4980 Tension sutures C5122 C5130 Chelation of cornea/photo therapeutic keratectomy Ultraviolet irradiation of riboflavin for cross linking of corneal collagen C5180 Corneal scraping for culture Sclera C5300 Excision of lesion of sclera C5340 Insertion of tantalum marker ring C5720 Repair of scleral laceration C5730 Scleral graft Iris and Anterior Chamber C5910 Iridocyclectomy C5920 Surgical iridectomy C6010 C6012 Surgical trabeculectomy or other penetrating glaucoma procedures Canaloplasty (of Schlemm's Canal with microcatheter) combined with Phakoemulsification of lens with implant Phako- Canaloplasty " C6110 Laser trabeculoplasty C6130 Goniotomy (surgical treatment of glaucoma) C6150 Revision of previous glaucoma surgery C6160 C6170 Complex glaucoma surgery (including antimetabolites/insertion of seton devices) Goniosynechialysis or goniopuncture (with laser or operatively) C6230 Laser iridotomy C6410 Repair of prolapsed iris

27 C6420 Excision of lesion of iris C6450 Removal of foreign body from iris C6610 Ciliary body ablation C6710 Cyclodialysis (separation of ciliary body) C6910 Reformation of anterior chamber C6920 Paracentesis C6930 Injection into anterior chamber C6940 Irrigation/aspiration of anterior chamber C6980 Removal of foreign body from anterior chamber C6990 Insertion of valve into anterior chamber of eye Lens C7100 C7110 C7122 C7123 C7124 Extracapsular extraction without implant - bilateral Extracapsular extraction without implant - unilateral Phakoemulsification of lens with implant - unilateral Phakoemulsification of lens without implant - unilateral Phakoemulsification of lens without implant - bilateral 1, C7125 Phakoemulsification of lens with implant - bilateral 1, C7180 Extracapsular extraction with implant - unilateral C7181 Cataract anaesthetist standby C7190 Extracapsular extraction with implant - bilateral 1, C7340 Yag laser photodisruption of posterior capsule of lens (including laser capsulotomy) C7510 Secondary insertion of lens implant C7520 Lens implant/exchange C7530 Removal of lens implant Vitreous C7910 Anterior vitrectomy C7920 Pars plana vitrectomy with internal tamponade, scleral buckling and retinopexy 1, C7922 Pars plana vitrectomy/vitreous biopsy C7923 C7924 C7982 Intravitreal injection of pharmaceutical for neovascular age related macular degeneration Intravitreal injection of pharmaceutical for central retinal vein occlusion Pars plana vitrectomy with internal tamponade, scleral buckling and retinopexy, including dissection or excision of epiretinal membrane/macular surgery ,

28 4.11 Retina C5432 Conventional retinal surgery (may include scleral buckling, injection of gas, drainage and retinopexy) C5480 Removal of silicone oil C8200 Laser photocoagulation/cryotherapy of lesion of retina C8240 Photodynamic therapy to the retina (PDT) C General C8650 Retinal examination under anaesthetic including retinopexy if necessary Fluorescein angiography of eye (including occular photography) C8652 Ocular photography (as sole procedure) 80 0 C8654 Insertion of radioactive plaque into eye (including later removal) Section 5 Ear, Nose and Throat 5.1 External Ear D0110 Total excision of pinna D0132 Excision accessory auricle/preauricular appendage D0140 Excision of preauricular sinus D0210 Excision of lesion of pinna D0280 D0310 Removal of multiple bony exostoses external auditory canal Reconstruction of external ear for anotia/microtia using cartilage graft D0330 Pinnaplasty (including bilateral) D0340 Soft tissue meatoplasty of external auditory canal D0342 Bony meatoplasty D0410 Drainage of haematoma/abscess of pinna D0610 Biopsy of lesion of pinna (as sole procedure) D0630 Repair of pinna D0702 Aural toilet - including microsuction 80 0 D0730 Removal of foreign body from external auditory canal (and bilateral) D0810 Excision of lesion of external auditory canal D0812 Removal of solitary osteoma of external auditory canal D0820 Reconstruction of external auditory canal

29 5.2 Middle Ear and Mastoid D1010 Radical mastoidectomy (including meatoplasty) D1020 Modified radical mastoidectomy (including meatoplasty) D1040 Simple mastoidectomy D1060 Revision of mastoidectomy (including meatoplasty) D1240 Exploration of facial nerve, mastoid segment D1420 Myringoplasty D1440 D1510 D1520 Combined approach tympanoplasty - intact canal wall tympanoplasty Myringotomy and insertion of tube through tympanic membrane (and bilateral) Suction clearance of middle ear (as sole procedure) D1530 Myringotomy (and bilateral) D1540 Exploration of entire middle ear course of VII 1, D1610 Ossiculoplasty D1710 Stapedectomy D1720 Revision stapedectomy D1900 Middle ear tumour excision D1910 Middle ear polypectomy D2030 Removal of grommets D2040 Diagnostic tympanotomy (as sole procedure) D2050 Tympanic neurectomy D2822 Examination of ear under general anaesthetic (as sole procedure) T8950 Repair of peri-lymph fistula V0382 Total petrosectomy (for tumour) 1, V0383 Lateral petrosectomy (for tumour) 1, W1870 Drainage of petrous apex for sepsis Inner Ear A2952 A2953 A2954 Excison of acoustic and cerebello-pontine angle neuroma - tumours less than 2.5 cms performed by single surgeon Excision of acoustic and cerebello-pontine angle neuroma - tumours more than 2.5 cms or compressing brain stem performed by single surgeon Excision of acoustic and cerebello-pontine angle neuroma - tumours managed by combined otoneurosurgical team irrespective of tumour size 2, , , A8480 Transtympanic electro-cochleography AA489 Transtympanic chemical labyrinthectomy

30 D2420 Insertion of cochlea implant D2610 Operation(s) on endolymphatic sac D2620 Membranous labyrinthectomy D2630 Osseous labyrinthectomy Nose and Nasal Cavity E0110 Total excision of nose E0230 E0260 Septorhinoplasty +/- graft/implant following trauma or excision of tumour Rhinoplasty following trauma or excision of tumour E0310 Submucous resection of nasal septum E0330 Biopsy of septum of nose E0340 Closure of perforation of septum of nose E0360 Septoplasty of nose E0380 Nasal septum cauterisation (and bilateral) E0412 E0420 E0440 Reduction turbinates of nose (laser, diathermy, out fracture etc.) Reduction turbinates of nose (trim, radical excision) Division of adhesions of turbinate of nose (and bilateral) E0520 Ligation of artery of internal nose (including endoscopic) E0610 Packing of cavity of nose (as sole procedure) E0810 Polypectomy of internal nose (and bilateral, including endoscopic) E0820 Excision of lesion of internal nose E0830 Correction of congenital atresia of choana (including endoscopic) E0850 Removal of foreign body from cavity of nose E0910 Excision of lesion of external nose Nasal Sinuses C2542 Dacryocysto-rhinostomy (endoscopic/laser assisted), including insertion of tube E1220 Caldwell-Luc E1240 Vidian neurectomy (including endoscopic) E1260 Image guided endoscopic frontal, sphenoid and/or ethmoid sinus surgery (FESS) E1310 Antral puncture and wash-out (and bilateral) E1330 Intranasal antrostomy including endoscopic (and bilateral) E1350 Closure of oro-antral fistula E1360 Endoscopic balloon dilation frontal sinuplasty (as sole procedure)

31 E1370 E1380 Endoscopic balloon dilation maxillary sinuplasty (as sole procedure) Endoscopic balloon dilation sphenoid sinuplasty (as sole procedure) E1410 External frontoethmoidectomy E1420 Intranasal ethmoidectomy (and bilateral) E1432 FESS Uncinectomy, ethmoidectomy, antrostomy or antral puncture inc polypectomy and attention to turbinates etc. E1440 Transantral ethmoidectomy (and bilateral) E1450 Bone flap to frontal sinus (and bilateral) E1460 Trephining of frontal sinus E1470 E1480 E1500 Median drainage of frontal sinus (modified Lothrop procedure) Endoscopic exploration frontal sinus beyond frontoethmoid recess Operation(s) on sphenoid sinus (including endoscopic) 1, E1742 Lateral rhinotomy into sinuses E1750 E1780 Transnasal repair of leaking CSF (including endoscopic) Diagnostic endoscopy of sinus (as sole procedure) 1, V0700 Cranio-facial resection 1, W2620 Manipulation under anaesthesia of fractured nose (as sole procedure) Throat E1910 Total pharyngectomy 1, E1920 Partial pharyngectomy E2010 Adenoidectomy E2100 Repair of pharynx E2320 Operation(s) on pharyngeal pouch (exterior approach) E2330 Removal of lesion of para-pharyngeal space 1, E2400 Therapeutic endoscopic operation on pharynx E2480 Pharyngeal pouch - endoscopic procedures E2500 E3680 Diagnostic endoscopic examination of pharynx/larynx (including biopsy) (as sole procedure) Endoscopic laryngo-pharyngoscopy as sole outpatient procedure F3400 Tonsillectomy - child (and bilateral) F3440 Tonsillectomy - adult (and bilateral) F3480 Adenotonsillectomy (and bilateral) F3620 Drainage of peritonsillar abscess (quinsy")" F3650 Arrest of haemorrhage following