Ministry of Health TABLE OF SURGICAL PROCEDURES (Updated as of 1 Feb 2021) 1 TABLE OF CONTENTS Guiding Principles………………………………………………………...2 Guidance on Specific Procedures………………………………………3 SA - Integumentary ........................................................................... 4 SB - Musculoskeletal ....................................................................... 12 SC - Respiratory .............................................................................. 33 SD - Cardiovascular ........................................................................ 36 SE - Hemic & Lymphatic ................................................................. 44 SF - Digestive .................................................................................. 46 SG - Urinary .................................................................................... 59 SH - Male Genital ............................................................................ 63 SI - Female Genital ......................................................................... 66 SJ - Endocrine ................................................................................. 74 SK - Nervous ................................................................................... 75 SL - Eye ........................................................................................... 83 SM - ENT ......................................................................................... 90 Annex…………………………………………………………………….95 GUIDING PRINCIPLES The Table of Surgical Procedures (TOSP) is an exhaustive list of procedures with table ranking 1A to 7C, for which MediSave / MediShield Life can be claimed. TOSP codes focus on the intent and outcome of the surgical procedure, regardless of the surgical access route and/or technology used. Any procedures not listed or without a table ranking 1A to 7C are not claimable. Specifically, Minor Surgical Procedures (procedures with table ranking “MSP”) are procedures which the TOSP review committee decided to be non-claimable. The list of MSPs is non-exhaustive, i.e. procedures not in the TOSP and not a MSP are still not claimable. For a single episode of surgery/procedure, if a single TOSP code adequately describes the surgery/procedure performed, only one TOSP code should be utilised1. This is regardless of the number of primary surgeons involved in the surgery/procedure. For example, a revision total knee replacement should only be coded for by SB717K. Additional codes for the removal of screws or prostheses should not be included. The example stated is by no means exhaustive and serves as an illustration of the general principle which will be applied to all procedures. If the complexity of a procedure is not stipulated in the TOSP code description, the code should be interpreted as encompassing a range of complexities and not just the basic standard procedure. For guidelines on MediSave claims for surgical procedures, please refer to Annex. Appeals will be assessed based on the prevailing guidelines at time of appeal. 1 A single surgical/procedural episode refers to the entire suite of services provided during the time the patient arrives to the operating theatre complex until the patient leaves. If the patient requires anesthesia, the continuous period under General Anesthesia/Sedation is also defined under the same surgical episode. 2 GUIDANCE ON SPECIFIC PROCEDURES Pain procedures A therapeutic pain procedure performed in the same setting as a surgical procedure should not be charged separately from the surgical code. This would apply for all forms of anaesthesia: general, regional or local. Diagnostic anaesthetic blocks, unlike therapeutic anaesthetic blocks, can be coded as a standalone procedure. A maximum of 1 pain procedure code, excluding those which are already done in the operating theatre complex (e.g. pre-emptive anaesthesia administered outside of the operating theatre complex), should be claimed throughout the entire admission for the same indication. For multiple pain procedures performed at the same spinal level on the same side, only one code (of the highest table) should be claimed. Spine – revision surgery Revision surgery codes apply to revision performed at the same level as primary operation. If procedure is performed for adjacent segment disease, the applicable code for non-revision surgery should be used (not to be combined with other codes). If procedure is performed to address a complication of the initial surgery, the revision surgery code can be used. Cosmetic procedures MediSave use is not allowed for cosmetic surgeries, except those defined as cosmetic surgery to reconstruct a body part, particularly face and neck, where that part (physical appearance or function) has been affected by trauma, cancer, congential anomalies, nerve palsies and other disfiguring diseases (to be ascertained by pre-surgical photographs). Medical practitioners are expected to exercise good clinical judgement in determining if a procedure is cosmetic in nature. If audited, medical practitioners must be prepared to justify their decision. For consistency, the use of MediSave for complications arising from cosmetic surgery will follow the above principles i.e. MediSave claims will be disallowed for treatment of complications where the treatment itself is cosmetic in nature. Frequency-Limited TOSP codes For TOSP codes with restrictions on the frequency at which these procedures can be claimed (i.e. only one claim allowed within a specified timeframe), medical practitioners and institutions should ensure that the frequency of claims adhere to the period specified in the respective code descriptions.