GENERAL SURGERY PROCEDURE BUNDLES / (COLORECTAL, MINIMALLY INVASIVE SURGERY, BARIATRIC SURGERY, SURGICAL ONCOLOGY, TRANSPLANT, TRAUMA/ACUTE CARE/CRITICAL CARE SURGERY, THORACIC SURGERY, VASCULAR) LEVEL I CORE PRIVILEGES EVALUATION AND CLINICAL CARE Admit, Consult, H&P, Orders BREAST Incision & Drainage Breast Abscess 19020 Biopsy/Excision Breast Mass 19100 19126 Mastectomy 19300 19307 Fine Needle Aspir w/o Image 10021 I&D Abscess Cyst Simp Single 10060 Aspirate Abscess Hematoma Cyst 10160 Injection Procedure Only for Mammary Ductogram or Galactogram 19030 Excision Benign Lesions 11402-11404 Removal Tun CV Cath w/pump 36590 remove mediport Biopsy Lymph Node Superficial 38500 Biopsy Deep Axillary Node(s) 38525 Identification of Sentinel Node 38792 DIGESTIVE SYSTEM Esophagus Esophageal incision, FB removal, esophageal resection, endoscopy 43020 43235 Repair,Nissen(open)Manipulation 43300,43324,43450 Stomach Incision,Excision, 43500-43641 Laparoscopy Diagnostic 49230 Other Gastrojejunostomy 43830 Repair Perforated Gastric / Duodenal Ulcer 43840 Splenectomy, Open 38100 Splenorrhaphy 38115 Repair Paraesophageal / Diaphragmatic hernia 39502 Esophageal Myotomy, Abdominal Approach 43330 Small Intestine/Colon/Rectum/Anus Exploratory Laparotomy 49000 Enterolysis (Lysis of Adhesions) 44005 Reduction Intussusecption 44050 Excision Meckel s Diverticulum 44800 Small Bowel Resection, 44120, 44125 Colectomy, Anastomosis 44140 Partial Colectomy, Colostomy (Hartmann) 44143 Creation Enterostomy (Jejunostomy or Ileostomy) 44310 Creation Colostomy 44320 Feeding Jejunostomy 44015 Repair Enterotomy 44602 Appendectomy 44950 Appendectomy, Drainage Abscess 44960 Debride or Excise Perineal Infection 11004 Excision Pilonidal Cyst / Sinus 11771 Drainage Intra-Abdominal Abscess (Not Appendiceal) 49020 1 of 11
LEVEL I CORE PRIVILEGES Laparoscopy Exploratory Laparoscopy with/without Biopsies 49321 Appendectomy, Laparoscopic 44970 Cholecystectomy, Laparoscopic 47562 Liver/Biliary/Pancreas Biopsy of Liver 47100 Drainage Hepatic Abscess / Simple Cyst 47010 Drainage Hepatic Amoebic or Echinococcal Cyst / Abscess 47015 Repair Hepatic Laceration 47350 Cholecystectomy, Open 47600 Common Bile Duct Exploration 47420 Cholecystoenteric Anastomosis 47720 Choledochoenteric Anastomosis 47760 Excision of Choledochal Cyst 47715 Partial Pancreatectomy 48140 Pancreaticojejunostomy (Peustow) 48180 Drainage / Debride Infection 48005 Internal Drainage Pseudocyst 48520 External Drainage Pseudocyst 48510 HEAD AND NECK Thyroid Lobectomy 60210 Total Thyroidectomy 60240 Parathyroidectomy 60500 Tracheostomy 31600 GENITOURINARY Adrenalectomy, Open 60540 Cystotomy Cystostomy 51040 Cystectomy Partial 51550 Nephrectomy 50220 Closure Enterovesical Fistula 44661 Oophorectomy 58940 Salpingectomy 28700 Excision Ovarian Cyst 58940 Excision Urachal Cyst or Sinus 51500 HERNIA Inguinal Adult 49505 Umbilical Adult 49585 Femoral 49550 Ventral Incisional Initial 49560 Ventral Incisional Recurrent 49565 Remove Infected Abdominal Mesh 11008 SKIN / SUBCUTANEOUS Incision and Drainage, Debridement, Excision of skin and subcutaneous lesions, 10021-11646 Removal of Nails,Pilonidal Cysts 11719-11771 Wound closure, laceration repair 12001-13160 Skin Grafting 15002-15431 Burns Treatment 16000-16036 Destruction of skin lesions 17000-17286 2 of 11
LEVEL I CORE PRIVILEGES THORACIC Excision Esophageal Lesion, Primary Repair 43101 Cricopharyngeal Myotomy 43030 Heller Myotomy, Open (Thoracic Approach) 43331 Cervical Esophagostomy 43352 Esophageal Perforation Repair / Drainage 43415 Thoracentesis Tube Thoracostomy Pulmonary Descortication, Open 32320 VASCULAR Repair Trauma / Injury Major Vessel 35226 Ligation Major Vessel 37618 Placement Hickman / Broviac Catheter 36558 Placement Implantable Port 36571 Remove Catheter / Implantable Port Thromboembolectomy 34201 Lower Extremity Vein Stripping 37700 Amputation Digit Simple / Ray 28820 Amputation Transmetatarsal 28810 Amputation Below Knee 27880 Amputation Above Knee 27590 Amputation Guillotine 27882 Upper Extremity Fasciotomy 25024 Lower Extremity Fasciotomy 27602 ENDOSCOPY Upper GI Endoscopy 43235 43273 Sigmoidoscopy Colonoscopy Bronchoscopy (Flexible/Rigid) ADMINISTRATION OF SEDATION AND ANALGESIA 3 of 11
COLORECTAL Complex Anorectal Procedures Stapled Hemorrhoidpexy (PPH) 46947 Repair Complex Anorectal Fistulae 46707, 46710, 46712, 46288, 46270, 46280, 46275, 45562, 45563 45825 Closure Rectovaginal Fistula Perineal Approach 57300 Closure Rectovaginal Fistula Abdominal Approach 57305 Operation for Incontinence/Constipation 44150 Open Transabdominal Operation for Rectal Prolapse 45540, 45541, 45550 Laparoscopic Transabdominal Operation for Rectal Prolapse 45400, 45402 Perineal Operation for Rectal Prolapse 45540, 45541, 45550 Transanal Resection for Tumor/Polyp 45171, 45172 Pelvic Exenteration 45126 Operations for Anal Cancer 45110, 45112, 45119 Presacral Masses/Cysts/Tumors 49215 Hidradenitis Excision 11470, 11471 Abdominal and Perineal Prolapse Repairs 45540, 45541, 45550 Sphincteroplasty, Artificial Sphincter Implantation, Sacral Nerve Stimulation 46750, 46751, 46760, 46761, 46762 Post Episiotomy Perineal Body Reconstruction 46744-46750 Total Abdominal Colectomy for Constipation 44150, 44151, 44155-44158 EUA/Acetic Acid Inspection, Local Fulguration 45990 Local Resection, APR 45110, 45112, 45119 Complex Colon Procedures Colectomy with: Low Anterior Resection (lateral stalk ligation) 44145, 44146 Coloanal Anastomosis 44145, 44146, 44155 thru 44158 Colonic Pouch/Coloplasty 45119 Abdominoperineal Resection 45110, 45112, 45119 Pelvic Exenteratoin/Posterior Exenteration 45126 Endorectal Pullthrough IPAA 44120, 44121 Proctectomy 45110-45119 Laparoscopic Colon Procedures All Laparoscopic colon procedures (including lap assisted, hand assisted, regardless of diagnosis) Ileocolectomy, TAC/Ileostomy/IRA, Sigmoid/Sleeve Resection, IPAA, etc. 44202, 44204, 44205, 44206, 44207, 44208, 44210, 44211, 44212, 44213, 44227, 45395, 45397, 45400, 45402 4 of 11
ADVANCED LAPAROSCOPY/MINIMALLY INVASIVE SURGERY Gastrointestinal (laparoscopically or endoscopically) Gastrotomy 43500 Gastrojejunostomy 43820 Suture Repair Bleeding Ulcer 43501 Pyloromyotomy 43520 Gastric Wedge Resection 43610 Hemi-Gastrectomy without Vagotomy 43632 Hemi-Gastrectomy with Vagotomy 43632/43635 Total Gastrectomy 43621 Vagotomy and Pyloroplasty 43640 Highly Selective Vagotomy 43641 Nissen Fundoplication, Laparoscopic 43280 Heller Myotomy, Laparoscopic 43289 Repair Perforated Gastric / Duodenal Ulcer 43840 Repair Paraesophageal / Diaphragmatic hernia 39502 Esophageal Myotomy, Abdominal Approach 43330 Reduction Intussusecption 44050 Excision Meckel s Diverticulum 44800 Small Bowel Resection, Anastomosis 44120 Small Bowel Resection, Enterostomy 44125 Partial Colectomy, Anastomosis 44140 Partial Colectomy, Colostomy (Hartmann) 44143 Total Colectomy, Anastomosis 44150 Total Abdominal Colectomy, Ileostomy 44150 Colectomy, Laparoscopic 44204 Total Proctocolectomy with Ileostomy 44155 Creation Enterostomy (Jejunostomy or Ileostomy) 44310 Creation Colostomy 44320 Revision Enterostomy 44312 Revision Colostomy 44340 Takedown Colostomy 44626 Takedown Ileostomy 44620 Feeding Jejunostomy 44015 Repair Enterotomy 44602 Abdominoperineal Resection 44147 Ileocecectomy 44160 Low Anterior Resection 44145 Liver/Pancreas/Biliary/Spleen (laparoscopically or endoscopically) Splenectomy, 38100 Splenorrhaphy 38115 Biopsy of Liver 47100 Hepatic Resection 47120 Drainage Hepatic Abscess / Simple Cyst 47010 Drainage Hepatic Amoebic or Echinococcal Cyst / Abscess 47015 Repair Hepatic Laceration 47350 Common Bile Duct Exploration 47420 Cholecystoenteric Anastomosis 47720 Choledochoenteric Anastomosis 47760 Excision of Choledochal Cyst 47715 Partial Pancreatectomy 48140 Whipple Resection 48140 Total Pancreatectomy 48155 Pancreaticojejunostomy (Peustow) 48180 Internal Drainage Pseudocyst 48520 5 of 11
ADVANCED LAPAROSCOPY/MINIMALLY INVASIVE SURGERY (CONTINUED) Abdominal Wall (laparoscopically or endoscopically) Inguinal Hernia, Laparoscopic Adult 49650 Umbilical Adult 49585 Femoral 49550 Ventral Incisional Initial 49560 Endocrine Thyroid Lobectomy 60210 Total Thyroidectomy 60240 Parathyroidectomy 60500 Adrenalectomy Genitourinary (laparoscopically or endoscopically) Adrenalectomy 60540 Cystotomy Cystostomy 51040 Cystectomy Partial 51550 Nephrectomy 50220 Liver Donor Nephrectomy 50547 BARIATRIC SURGERY Open / Laparoscopic/Endoscopic Gastric Band Roux-en-Y Sleeve Gastrectomy ROSE Procedure 6 of 11
SURGICAL ONCOLOGY Breast Fine Needle Aspir w/image 10022 Adjacent Tissue Transfer /Rearrangement 14301, 14302 Excision of Chest Wall Tumor Including Ribs 19260 Excision of Chest Wall Tumor Involving Ribs 19271 Preoperative Placement of Needle Localization Wire, Breast 19290 Preoperative Placement Each Additional Lesion 19291 Image Placement Metallic Clip, Percutaneoius, during Breast Biopsy 19295 Placement of Radiotherapy.. 19296, 19297 Ultra Guide/Needle Biopsy Sup & Interp 76942 Echography Breast Unilateral/Bilateral 76645 Intraoperative Ultrasound 76998 Nipple/Areola Reconstruction 19350 Sentinal Lymph Node Biopsy Procedure Hepato/Pancreatico/Biliary Hepatic Lobectomy Total Pancreatectomy Hepatico Jejunostomy Choledocho Jejunostomy Radio Frequency Ablation of Hepatic Tumors Esophagus Excision Esophageal Lesion, Primary Repair 43101 Esophagectomy, Thoracotomy 43121 Esophagectomy, Transhiatal 43107 Esophagogastrectomy 43117 Thoracic????? Soft Tissue/Melanoma Excision of Extremity Soft Tissue Sarcoma Sentinal Lymph Node Biopsy 7 of 11
TRANSPLANT Liver Liver Transplant (cadaver or living) 47135/47136 Jump Graft Kidney 50327 Jump Graft Liver 47147 Live Donor Hepatectomies 47140//47141/47142 Major Liver Resections 47120/47122/47125/47130 Lap Liver Resections (unlisted) 47379 Lap & Open Radiofrequency Liver Ablations Portal Decompressive Procedure 36481 Split Liver Transplantation and Procurements. Pancreas Pancreas Transplant 48554 Pancreatic Lesion Excision 48120 Percutaneous Pancreas Biopsy 47370/47371 (laparoscopic 47380 (open) Kidney Renal Transplant (cadaver or living) 50360 Lap Nephrectomy 50545-50548 Open Nephrectomy 50220-50240 Percutaneous Kidney Biopsy Percutaneous Liver Biopsy Adrenalectomy 60540/60545 Dialysis Access Percutaneous A-V Fistula Surgery Peritoneal 8 of 11
TRAUMA/ACUTE CARE/CRITICAL CARE SURGERY Critical Care Airway Maintenance Intubation 31500 including fiberoptic bronchoscopy 31622 and laryngoscopy 31575 Temporary Cardiac Pacemaker Insertion and Application 33210 Cardioversion 92960 Echocardiography and Electrocardiography Interpretation 93314, 93010 Esophagoscopy and Gastroscopy with PEG Insertion 43246 Insertion of Central Venous, Arterial and Pulmonary Artery Balloon Flotation Catheters Insertion of Hemodialysis and Peritoneal Dialysis Catheters 49420 Intracranial Pressure Monitoring 61210 Lumbar puncture 62270, 62272 Management of Anaphylaxis and Acute Allergic Reactions E&M Management of life-threatening disorders in intensive care units including but not limited to shock, coma, heart failure, trauma, respiratory arrest, drug overdoses, massive bleeding, diabetic acidosis and kidney failure E&M Needle and Tube Thoracostomy 32551 Paracentesis 49080 Percutaneous Tracheostomy/Cricothyrotomy Tube Placement 31605 Pericardiocentesis 33010 Peritoneal lavage 49080 Thoracentesis 32421 Tracheostomy 31600 Image Guided Procedures 76998 Ventilator management, including experience with various modes and continuous positive airway pressure therapies (BiPAP and CPAP) 94002, 94003, 94660 Administration of Sedation and Analgesia 99144 Admit, evaluate, diagnose, and provide treatment or consultative services to critically ill adult patients with postsurgical or post-traumatic multiple organ dysfunction and in need of critical care for life threatening disorders. Assess, stabilize, and determine disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. E&M Trauma Evaluation and admission of all adult Level 1, 2, and 3 injured patients with criteria specified by the Trauma Program Director as reflected in hospital policy. Resuscitation and stabilization of adult injured patients using evaluation modalities including, but not limited to, FAST ultrasound E&M E&M Assessment and treatment of injured patients requiring operative intervention. Credentialed providers may provide emergency care of all neck, thoracic, abdominal and vascular injuries proximal to the knee or elbow with appropriate consultation. 99199 9 of 11
THORACIC SURGERY Thoracic/Esophagus/Diaphragm (laparoscopically or endoscopically) Mediastinoscopy 39400 Mediastinotomy 39000 Excision Mediastinal Tumor 39220 Thymectomy 60520 Transthoracic Drainage Empyema 32036 Pulmonary Lobectomy 32480 Pulmonary Wedge Resection, Open 32500 Pulmonary Segmental Resection, Open 32484 Repair Tracheo-Esophageal Fistula 43312 Creation Pericardial Window 33025 Vagotomy, All 64752 Cricopharyngeal Myotomy 43030 Esophageal Perforation Repair / Drainage 43415 Thoracoscopy Thoracoscopy 32601 Pleurodesis, Thoracoscopic 32650 Pulmonary Decortication, Thoracoscopic 32651 Pulmonary Wedge Resection, Thoracoscopic 32657 Pulmonary Segmental Resection, Thoracoscopic 32663 Exploratory Thoractomy 32100 Pneumonectomy 32440 10 of 11
VASCULAR Angiography, Carotid 75665 Angiography, Aorta 75600 Angiography, Extremity 75710 Angiography, Visceral 75726 Correction Thoracic Outlet Obstruction 32900 Excision Aneurysm, Upper Extremity 35011 Excision Aneurysm, Lower Extremity 35141 Repair Aneurysm Abdominal Aorta 35081 Excision False Aneurysm 35045 Carotid Endarterectomy 35301 Endarterectomy, Aortoiliofemoral 35363 Carotid Subclavian Bypass 35507 Axillo Femoral Bypass 35521 Aorto Iliac or Femoral Bypass 35546 Femoro Femoral Bypass 35558 Femoro Popliteal Bypass 35556 Femoro Tibial Bypass 35566 Renal Artery Revascularization 35450 Mesenteric Revascularization Procedures 35480 Insert IVC Filter 75940 Portosystemic Shunt 37140 Creation AV Fistula 36821 Placement AV Graft 36825 Removal Infected / Nonfunctional Graft Iliac Angioplasty with or without Stent 35454 Fem Pop Angioplasty with or without Stent 35456 Tibial Angioplasty with or without Stent 35459 Endovascular AAA Repair (1 Limb) 34802 Endovascular AAA Repair (2 Limb) 34803 Pulse Thrombolysis 75896 LEVEL II ADVANCED PRIVILEGES ROBOTIC(CONTACT PERIOPERATIVE SERVICES FOR ROBOTIC PRIVILEGING) LEVEL II ADVANCED PRIVILEGES LASER 11 of 11