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Approved Surgical Procedures UNION MEDICAL BENEFITS SOCIETY LTD APPROVED SURGICAL PROCEDURES The following list of surgical procedures should be read in conjunction with your policy document. If you are intending to have one of the listed procedures, please call our surgical team on 0800 600 666 so we can guide you through the prior approval process. If a surgical procedure is not listed below, it will not be covered unless UniMed decides, in its sole discretion, to offer cover. CARDIAC GENERAL • Pericardiotomy Breast • Pericardiocentesis • Breast Cyst Aspiration or Needle Biopsy • Drainage of Pericaridal Effusion • Breast Biopsy • Coronary Artery Bypass (using vein or artery) • Core Biopsy of Breast • Open Repair of Atrial Septal Defect (ASD) • Excision Accessary Breast Tissue • Valvuloplasty • Mastectomy • Aortic/ Mitral Valve Replacement via Sternotomy • Sentinel Node Biopsy with/without Axillary Dissection • Pulmonary Valve Replacement via Sternotomy • Breast Microdochotomy • Tricuspid Valve Replacement via Sternotomy • Balloon Valvuloplasty – Mitral/ Aortic Reconstruction Post Mastectomy • Pacemaker Surgery – Initial Implantation (Excluding the Cost • Breast/ Nipple Reconstruction of the Pacemaker) • Nipple Areolar Tattoo • Removal of Sternal Wire • Maze Arrhythmia Surgery Gastrointestinal • Removal & Rewiring of Sternal Wire • Anal Sphincterotomy • Maze Arrhythmia Surgery (Standalone procedure) • Simple Repair of Anal Fistula – Special approval only • Maze Procedure – Thoracoscopic • Anal Fistula Repair with Mucosal Advancement Flap • Bentall’s Procedure (includes Aortic Valve Replacement) • Insertion of Seton Tube • Open Ascending Aortic Aneurysm Repair (Suprarenal) • Anal Dilatation • Abdominal Paracentesis or Pleural Tap Interventional Cardiology • Haemorrhoidectomy • Percutaneous Repair of Atrial Septal Defect • Haemorrhoidal Artery Ligation (HAL) • Percutaneous Repair of Patent Foramen Ovale (PFO) • Injection/ Banding of Haemorrhoids • EP Studies – Cardiac Electrophysiology • Excision of Anal Skin Tag • Radio Frequency Ablation (RFA) (PVI)– Special approval only • Excision of Pilonidal Sinus • Angioplasty DES • Sigmoidoscopy with/ without Biopsy • Sigmoidoscopy And Anal Fistula Cardiac Imaging • Diagnostic Laparoscopy – Gastrointestinal • Cardiac Angiography with OCT • Biopsy of Internal Mass or Tumour (standalone) • Cardiac Angiography with Intravascular Ultrasound of Cardiac • Freeing of Abdominal Adhesions Vessels (IVUS) • Botulinum toxin injection for anal fissure • CT Coronary Angiography (CTCA) – Special approval only • Appendicectomy • Cardiac Angiography with Fractional Flow Reserve (FFR) • Reversal of Hartmann’s procedure • Coronary Angiogram • Sphincteroplasty • Coronary Angioplasty • Rectosigmoidectomy with Formation of Stoma (Hartmann’s Resection) • Hemicolectomy – With Formation of Stoma • Hemicolectomy – With Anastomosis UniMed Approved Surgical Procedures 2016.V2/2 PAGE 1 • Transverse Colectomy with Anastomosis • Supraomohyoid Gland Dissection • Sigmoidcolectomy With Anastomosis • Radical Neck Dissection • Sigmoidcolectomy With Formation of Stoma • Parotidectomy • Colectomy – Total with Ileo-Rectal Anastomosis • Parathyroidectomy • Laparoscopic Colectomy – Total with Ileo-Rectal Anastomosis • Excision of Submandibular Gland • Open Proctocolectomy with Anastomosis • Excision of Thyroglossal Cyst or Fistula • Proctocolectomy with Ileoanal Pouch and Loop Ileostomy • Thyroplasty • Colostomy – Formation/ closure • Total Thyroid Lobectomy • Ileostomy Formation/ closure • Thyroidectomy • Ileostomy Revision • Thyroidectomy Including Parathyroid Transplant • Creation of Gastrostomy or Jejunostomy • Tongue – Partial Removal, Hemi-Glossectomy • Gastrojejunstomy or Roux-en Y Anastomosis • Salivary Gland – Intraoral Removal of Duct Calculus • Colotomy – For Polyp or Wedge Resection of Colon For Polyp • Insertion of Oesaphageal Stent Lymph Nodes • Gastrectomy • Sentinel Node Biopsy • Total Gastrectomy and Oesaphogectomy By Abdominal • Excision of a Single Lymph Node (not elsewhere classified) Transthoracic Mobilisation • Simple Lymph Node Dissection of Neck • E.R.C.P. • Superficial Axillary Lymph Node Dissection • Sphincterotomy Or Stenting • Radical Node Dissection – Axilla • Toupet Fundoplication • Superficial Inguinal Node Dissection • Dilation of Oesophagus • Neck Dissection • Needle Biopsy of Liver (separate procedure) • Radical Inguinofemoral Node Dissection of Groin • Laparotomy • Radical Pelvic Node Dissection • Repair of Sphincter of Oddi • Laparoscopic Pelvic Node Dissection • Repair of Pancreatic Duct Sphincter • Pelvic Node Dissection including Para-Aortic Nodes for • Choledocho-jejunostomy or choledoco-duodenostomy Staging • Small Bowel Resection • Laparoscopic Small Bowel Resection Hernia • Biopsy of Liver • Repair of Umbilical Hernia • Hepatic Cryotherapy • Hernia – Femoral or Inguinal Repair • Liver Lobectomy • Herniotomy • Hepatectomy • Hernia-other • Radiofrequency Ablation of the Liver • Small Bowel Strictureplasty Skin and Superficial Structures • Oesophagectomy • Abscess – Small, or Cellulitis Requiring Incision and Drainage • Oesophagus – Hellers Operation with Local Anaesthetic • Pancreas – Total Excision Of, Or Pancreatico-Duodenectomy • Abscess – Large, or extensive Cellulitis Requiring Incision or • Whipples Procedure Drainage • Transanal Excision of Rectal Tumour • Debridement of infected wound/fistula/sinus • Transanal Endoscopic Microsurgery (TEM) • Fine Need Aspiration • Resection of Rectum • Removal of Foreign Body (simple) • Prolapse of Rectum – Rectopexy • Excision of Ganglion • Prolapse of Rectum – Excision of Rectal Mucosa (including • Aspiration/ drainage of Haematoma Sigmoidoscopy) • Skin Lesion Excision with Closure • Dynamic Graciloplasty • Mohs Micrographic Surgery and associated surgical closure • Splenectomy • Gastrointestinal Veins • Examination of Colon up to Splenic Flexure (Short • Varicose Veins Colonoscopy with Biopsy) • Endo Venous Ablation of Varicose Veins • Colonoscopy with Biopsy with/without Dilatation • Ultrasound Guided Sclerotherapy – Varicose Veins • Colonoscopy with Removal of Polyps • Varicose Veins Surgery • Gastroscopy (with biopsy) • Oesophageal Dilatation with Gastroscopy Lung / Chest • Endoscopy Mucosal Resection • Lung, Lobectomy • Endoscopy Argon Plasma Coagulation • Lung Biopsy / Exploration • Cholecystectomy • Thoracotomy, Chest Biopsy • Operative Cholangiogram • Mediastinoscopy • Laparoscopic Cholecystectomy • Thorascopic Pleurodesis Stapling Bullae • Nissen Repair or Wrap • Excision Thymoma With Sternotomy • Laparoscopic Cholecystectomy Converted to Open • Chest Biopsy, Needle • Choledochotomy • Mediastinal Mass Biopsy/ Excision • Hiatus Hernia Repair • Mediastinotomy or Thoracoscopy for Staging • Laparoscopic Hiatus Hernia Repair • Lung Lobectomy • Sacral Nerve Stimulation – Special approval only • Lung, Sleeve Lobectomy • Pneumonectomy Head and Neck • Transcervical Thymectomy • Branchial Fistula • Lung Biopsy – Wedge Resection • Sublingual gland excision • Thoracic Lymph Node Dissection in association • Simple Lymph Node Dissection of Neck with another procedure PAGE 2 UniMed Approved Surgical Procedures 2016.V2/2 Miscellaneous • Omentectomy • Insertion/ removal of Port-A-Cath • Oophorectomy • Central Vein Catheterisation • Salpingectomy • Examination Under Anaesthetic • Ovarian Cystectomy • P.C.O.S. Laparoscopic Drilling of Ovaries GYNAECOLOGY • Division of Adhesions to Ovaries Vulva • Biopsy of Ovary • Bartholins Cyst / Abscess Surgery • Salpingectomy • Separation of Labial Fusion • Laparotomy • Fenton’s Procedure • Salpingo Or Salpingolysis • Simple Excision Vulval Lesion – (including excision varicocele) • Salpingostomy • Vulva – Radical Excision Of, With Glands • Laparoscopic Diathermy • Simple Vulvectomy • Endometriosis Surgery • Multiple Vulval Biopsy Clinic Procedure Vagina • Cryotherapy/Cautery of Cervix • Revision of Episiotomy Scar (not cosmetic) • Colposcopy with Biopsy • Minor Revision Mesh Repair • Incision of Hymen • Colporrhaphy • Vulvoscopy with or without Biopsy • Repair of Enterocele • Insertion/ Removal of Intra-uterine Device • Repair of Vaginal Vault (including Sacrospinous Fixation) – Special approval only • Sacrocolpopexy, Levatorplasty INTERVENTIONAL RADIOLOGY • Repair of vaginal Fistula • Excision of Vaginal Lesion • Fine Needle Aspiration Under Ultrasound • Sacrocolporectopexy • Ultrasound Breast Cyst Aspiration • Pelvic Floor Repair • Core Biopsy With Ultrasound • Vaginal reconstruction disease related • CT Guided Biopsy/ Drainage • Vaginoplasty • Trans Perineal Prostate Biopsy • Laser division of vaginal band – Special approval only • Chemical Sympathectomy • Intradiscal/Verteb.Inject Cervix • Fluoroscopy (In Conjunction with Surgical Procedure) • Cervix – Amputation or Reconstruction Vaginal Approach • CT Guided Injection • Cervix – Biopsy • Stereotactic Mammotome Breast Biopsy • Cervix – Cauterisation • X-Ray or Ultrasound Guided Injection • Cervical Polypectomy • Brachytherapy Grid Guided Prostate Biopsy • Lletz Loop • Embolisation of Renal Artery • Cone Biopsy • Embolisation of Varicocele • MRI Breast Biopsy Uterus • Embolisation of Fibroid • Drainage of Pelvic Abscess Via Fornices • Biopsy/ Cone Biopsy of Cervix NEUROSURGERY • Removal of Polyp – Uterus/ Cervix • Craniotomy and Excision of Tumour – Supratentorial • Endometrial Biopsy (Pipelle) • Endoscopic Transsphenoidal Excision of Pituitary Adenoma • Laparoscopic Uterine Nerve Ablation • Repair of Encephalocele • Hysteroscopy D&C • Removal of Spinal Intradural Lesion – Cervical
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