MALAYSIAN MEDICAL ASSOCIATION MALAYSIAN MEDICAL ASSOCIATION

MEDICAL PROCEDURES AND SERVICES NOMENCLATURE (MPSN®) AND RELATIVE VALUES

GUIDELINES

FOR

MEDICAL PRACTITIONERS

IN MALAYSIA

COPY RIGHT 2020

FIRST EDITION --- 1987 SECOND EDITION --- 1992 THIRD EDITION --- 1997 FOURTH EDITION --- 2002 FIFTH EDITION Version 1.0 _ 2008 Version 1.1. _ 2019 Version 2.0. _ 2020 COPY RIGHT NOTICE WARNING: The doing of an unauthorized act in relation to copyright work may result in both a civil claim for damages and criminal prosecution

The Malaysian Medical Association (hereinafter referred to as MMA) published the Schedule of Fees in 1987,1992,1997 and 2002.

This 2008 Edition has been renamed as Medical Procedures and Services Nomenclature and Schedule of Relative Values (hereinafter referred to as MPSN®) and is protected by copyright and is the property of the MMA as were the previous editions of the Fee Schedule. The 2008 MPSN® is produced by kind permission of materials from the BUPA Schedule of Procedures (1995) of the British United Provident Association Ltd. London, United Kingdom. The BUPA Schedule of Procedures (1995) is based on the UK Office of Population Censuses and Surveys. Classification of Operations and Surgical Procedures 4th Edition © Crown Copyright 1987 and has been used by kind permission of the Controller of Her Majesty’s Stationery Office.

In addition to the above, the MPSN® (2008) is the result of work developed by the Health Insurance Committee (HIC) of the MMA. Advice and suggestions by a large number of medical organisations and societies were taken into account. These were via discussions, consultations, written feedback and review of similar fees guidelines published by sister bodies from within and outside the country.

The 5th Edition has been further revised in 2019 and as published as Version 1.1 and in 2020 as Version 2.0. These two are substantially the same as version 1.0 except that new procedures approved by the Ministry of Health have been added.

ALL RIGHTS RESERVED

No part of the MMA MPSN® may be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise or stored in any retrieval system of any nature without the written permission of MMA, and a licence to use, the application for which shall be made to the MMA, in writing and addressed to:-

The Honorary General Secretary Malaysian Medical Association 4th Floor, MMA House 124 Jalan Pahang 53000 Kuala Lumpur Malaysia Tel: +603 4041 1375 (Hunting Line) Fax: +603 4041 8187 Email: [email protected], [email protected]

Website: www.mma.org.my I OPCS 4 CODES – DEVELOPMENT LICENCE

The Grant of this license to the Malaysian Medical Association is solely for the utilization of the Data known as the Classification of Surgical Operations and Procedures (OPCS4 Codes) and that:

1. It is to be used for the production of a standard guide by the medical profession, hospitals, insurance companies, managed care organisations, third party administrators and the general public in Malaysia and

2. The publication and distribution of the data shall be limited to Malaysia

The Host undertakes that the Service will carry an acknowledgement of British Crown Copyright in the form specified for this purpose below and a statement that no responsibility for the accuracy and comprehensiveness of the Data is accepted by the Data Provider or British United Provident Assurance Ltd. The notices shall be incorporated in the Services by the Host in a manner that ensures that they are displayed to every user of the Service. The Host also undertakes that any literature distributed by or on behalf of the Host which promotes the Service shall include an acknowledgement of the British Copyright in the form specified below.

British Crown Copyright 1993 Published by permission of the Controller of Her Britannic Majesty’s Stationery Office

INFRINGEMENT OF COPYRIGHT

The Host shall report any infringement of copyright, of which it becomes aware, forthwith to the Data Provider so that it may then instruct the Controller, Her Britannic Majesty’s Stationery Office, as legal owner of the British Crown Copyright, to take any necessary infringement action to remedy this matter.

II CONTENTS

Page

INTRODUCTION AND NOTES i-iv

PART A

GENERAL PRACTITIONERS

Consultation Fees 1 Medical Examination Fees 1 House Calls and Medical Assistance Fees 1 Legal Reports and Court Appearances Fees 1

Common Procedures 2- 3

SPECIALISTS CONSULTATION AND FOLLOW-UP FEES

Consultation Fees 4 ICU Consultation 5 Court Attendance 5

GENERAL PROCEDURES

Anaesthesiology 6-8 Cardiology 9-10 Dermatology and Venereology 11-12 Gastroenterology and Hepatology 13 Haematology 14 Nephrology 15 Neurology 16 Obstetrics and Gynaecology 17 Occupational Medicine 18 Oncology 19-21 Ophthalmology 22 Paediatrics 23-26 Pathology 27-29 Psychiatry – Psychotherapy 30 Respiratory Medicine 31 Radiology 32-40

RELATIVE VALUE TABLE AND CONVERSION FACTOR 41-42

III CONTENTS Page PART B

Simple Investigations and Procedures Investigations 1 Procedures 1

General Procedures 2

Brain, Cranium and other Intracranial Organs Brain 3 Cranium 4 Meninges 4 Nerves 4 Vessels 5 Others 5

Spine, Spinal Cord and Peripheral Nerves Cervical Region 6 Thoracic Region 6 Lumbar Region 7 Spinal Cord 8 Nerve Roots 8 Sympathetic Nerves 8 Peripheral Nerves 8-9 Pain Relief 9-10 Neurophysiological Procedures 10

Eye and Orbital Contents Globe and Orbit 11 Eyebrow and Lid 11-12 Lacrimal System 12 Muscles 12 Conjunctiva 13 Cornea 13 Sclera 14 Iris and Anterior Chamber 14 Lens 14-15 Vitreous 15 Retina 15 General 15

IV CONTENTS Page PART B

Ear, Nose and Throat External Ear 16 Middle Ear and Mastoid 16 Inner Ear 17 Nose and Nasal Cavity 17-18 Nasal Sinuses 18 Throat 19 Larynx and Trachea 19-20 Fibreoptic Endoscopic Procedures under Topical Anaesthesia 20

Face, Mouth, Head and Neck Face and Jaws 21-22 Lips 22 Tongue 22 Palate 23 Mouth Cavity 23 Salivary Glands 23-24 Teeth 24 Neck 24 Thyroid and Parathyroid Glands 25

Breasts Breasts 26

Cardiololgy Pacing and Electrophysiological Procedures 27 Invasive Diagnostic Procedures 27-28 Interventional Cardiac Procedures 28 Interventional Peripheral Procedures 29 Coronary Care Procedures 29 Spiral Angiography Computed Tomography Procedures 30

Cardiothoracic Surgery Oesophagus 31 Chestwall 31 Trachea/Bronchus 32 Lung 32 Mediastinum 33 Heart Cardiac Surgery 33-34 Great Vessels 34-35

V CONTENTS PART B Page Vascular System Aorta 36 Arteriovenous 36 Artery 36 Carotid 36 Sympathectomy 36 Varicose veins 37 Vascular access and grafts 37 Vein 37 Lymphatic 37

Endoscopic Gastro Intestinal Procedures Oesophagus 38 Stomach 38 Duodenum 39 Small Intestine 39 Colon 39 Sigmoid Colon 40 Rectum and Anus 40 ERCP 40 Endoscopic Ultrasound Procedures 40 Ultrasound Guided Therapeutic Intervention 41 Laparoscopic Procedures 41

Abdomen (other than urinary and reproductive organs) Oesophagus 42 Stomach 42 Duodenum 43 Small Intestine 43 Large Intestine 43 Rectum/Anus 44 Other organs, mainly digestive 45 Major Vessels 46 Abdominal Wall 46 Peritoneum 46

Urinary System and Male Reproductive Organs Kidney/Renal Pelvic 47 Ureter 48 Bladder 49-50 Urethra 50-51 Prostate 51 Genitalia 51-53 Others 53

VI CONTENTS PART B Page

Female Reproductive Organs Uterus/Adnexa 54 Suspension 54 Cervix Uteri 55 Vagina/Perineum 55 Vulva/Labia 55 Haemostasis 55 Pregnancy and Confinement Intrapartum 56 Postpartum 56 Contraception 56

Skin and Subcutaneous Tissue Lesions of Skin 57 Repair 57 Burns 58 Grafts 58 Flaps/Transplant 58

Bones, Joints Etc (not listed elsewhere) Connective Tissue/Tendon Muscle 59 Bone (Non-specific) 59-60 Fractures 60-61 Nerves 61 Joints (not listed elsewhere) 61 Joint Replacement/Reconstruction (not listed elsewhere) 62 Fixation/Arthrodesis 62 Hand 62 Shoulder 63 Elbow 63 Hip, Leg and Pelvis 63-64 Knee 64 Foot 64-65 Illizarov 65 External Fixation/Traction 65

Paediatric Surgery Ano-rectal 66 Bile Duct 66 Chest Wall 66 Cloaca 66 Colon 66 Liver 66 Oesophagus 66 Pancreas 66

VII CONTENTS PART B Page

Paediatric Surgery Trachea 67 Tumour 67 Vagina 67 Clitoris 67 Bladder 67 Diaphragm 67 Testis 67 Abdominal Wall 67 Bronchus 68 Duodenum 68 Hernia 68 Laparotomy 68 Lung 68 Urethra 68 Spleen 68 Stomach 69 Small Bowel 69 Lymphangioma 69 Rectum 69 Testis 69 Penis 69 Others 69

Interventional Radiology Biopsies/Localisation 70 Drainages/Lysis 70 Dilatations/Stenting 70 Spinal and Pain Interventions 71-72 Hepatobiliary/Gastrointestinal Interventions and Tumour Ablations 72-73 Genitourinary Interventions 73 Revascularisations 74 Neurovascular Interventions 74 Embolisation 74-75 Vascular Access/Interventions 75 Venous Sampling 75 Others 76 Diagnostic 76-77

ADDENDUM 78-80

VIII

INTRODUCTION AND NOTES

INTRODUCTION AND NOTES

TO THE MEDICAL PROCEDURES AND SERVICES NOMENCLATURE (MPSN ®) AND SCHEDULE OF RELATIVE VALUES

FIFTH EDITION Version 2.0 (2020)

GENERAL The Malaysian Medical Association (MMA) first released a Schedule of Fees in 1987. The 1. Fifth Edition, now renamed as Medical Procedures and Services Nomenclature (MPSN ®) (2008) and Schedule of Relative Values (RV). The Fifth Edition was revised in 2019 and published as Version 1.1 and further revised in 2020 and publidhed as Version 2.0

2. The previous Schedule, Fourth Edition, was published in 2002 and the changes from the Third Edition reflected a 10% increase in consultation and procedural fees as compared with the Third Schedule in 1997.

3. A major part of the Fourth Schedule was incorporated into the Thirteenth Schedule (Regulation 433) of the Private Healthcare Facilities and Services Regulations 2006. This law governs the professional fees of all medical practitioners in Malaysia.

4. This Fifth Schedule is the result of work developed by the Health Insurance Committee (HIC) of the MMA. Advice and suggestions by a large number of medical organisations and societies were taken into account. These were via discussions, consultations, written feedback and review of similar fees guidelines published by sister bodies from within and outside the country. 5.

OBJECTIVES 1. The MPSN® aims to provide a comprehensive classification of medical procedures and services and provide a guideline of relative value (RV) for calculation of fees. The RVs have been adopted by the MMA after careful study and investigation of practice costs and other relevant and material circumstances as being, in its opinion, fair and reasonable and appropriate for the services provided by the medical professional, is fair to the consumer (patient), health care insurers and third party payors (TPP).

2. This Schedule is intended to be a guide for all stakeholders in healthcare in Malaysia. The Schedule of Relative value is provided as guidance for calculating the fees only. As such, statements to the effect that fees charged are MMA recommended fees should not be used in any billing or in any other form.

i PRINCIPLES

1. The MPSN® and Schedule of Relative Value is for the medical practitioners (Medical doctors) only. 2.The Relative Value of each service in this Schedule is based on the following factors:

2.1 Professional work that encompasses the medical complexity of the procedure/service; the level of expertise required; the time expanded in provision of the service; 2.2 limited cost of practice 2.3 professional liability insurance

These three are based on the following factors: 2.4 the medical complexity of the procedure/service; 2.5 the level of expertise required; 2.6 the time expanded in provision of the service; 2.7 the resources required for the provision of the service; 2.8 medical liability and risks involved in the particular procedure

3. The Relative Values indicated in this Schedule are based on the fees in the previous Schedules. Increases were allowed to reflect inflation over the last six years.

4. The Health Insurance Committee used information and feedback from the various (mostly Malaysian) sources described above in developing the Ringgit values in this Schedule.

5. This Schedule is therefore not a direct adoption of the BUPA Schedule of Procedures as in previous Schedules. Instead, the varying increases for different services and procedures tend to reflect prevailing market profiles in Malaysia.

6. Similarly, the coding system for the different procedures has been expanded to accommodate new procedures. The new coding system is therefore also not a direct adoption of the OPCS Classification of Operations and Surgical Procedures as employed previously.

7. A new feature in this Edition is the Conversion Factor Table which replaces the Look Up Table in the previous Editions of the Fee Schedule. Procedures are classified into 25 categories, ranging from MINOR 1 to CMO 5 for surgical and anaesthesiology procedures with a Conversion Factor for each category.The Conversion Factor is the indicative value of the cost of providing the service. This has been calculated from the previous fee schedules and taking into consideration the inflation in the intervening period from the publication of the 4th Edition.

8. Various technical aspects in the development of this Schedule involve:

8.1 Deletion of outdated or obscure operations and procedures; 8.2 Introduction of new procedures; 8.3 Updating the names of certain procedures; 8.4 Increases in conversion factor for each procedure have been kept reasonable usin limitations set and imposed by the Health Insurance Committee.

9. A new feature in this Edition is the Conversion Factor Table (previously known as Look Up Table). The Conversion Factor is the indicative value of the cost of providing the service. This has been calculated from the previous fee schedules and taking into consideration the inflation in the intervening period from the publication of the 4th Edition.

10. This Version 2.0 (2020) contains new procedures that have been approved by the Ministry of Health from 2013 till January 2020 and these procedures can be found in the Addendum at the end of Part B (Pages 78-79) ii SUMMARY OF SCHEDULE CONTENTS

1. This Schedule is divided into two parts – Part A and Part B.

2. Part A consists of Relative Values for consultation and general procedures. These are mostly non- interventional.

3. Part B consists of (mostly) interventional or operative procedures. These procedures have been classified into 25 categories. Each category has a conversion factor (in Malaysian Ringgit) value for surgeon and anaesthetist attached to it.

4. The two respective Relative Values and Conversion Factor Tables are printed on Page 41 and Page 42.

GUIDELINES FOR BILLING / INVOICING FOR SERVICES 1. PROFESSIONAL CHARGES: The RV for a procedure shall be the same for all medical practitioners, irrespective of specialty unless stated otherwise.

2. The relative value (RV) in this schedule refers to professional or work component, limited cost of practice, medical liability insurance only. Charges for non-professional items are not included in this Schedule. The total fees charged for a procedure may include additional charges for equipment used, utilisation of facilities e.g. operating theatre, and consumables like needles, sutures, catheters, GST and other taxes if applicable.

3. As required by the Code of Professional Conduct of the Malaysian Medical Council, the medical practitioners, where practicable, must provide patients (or a third party/guardian responsible for the financial affairs) with sufficient information regarding the fees chargeable so that the patient is able to make an informed financial decision.

4. Medical practitioners should at all times regard themselves as being free, and indeed duty bound, to make their own judgment as to what fees they will charge for any service within the limitations of any statutory regulations that may be in force at the time.

5. On occasions, the complexity of the consultation or procedure may warrant charges in excess of the relative values recommended in this Schedule, the medical practitioners are advised to inform, discuss and obtain written agreement of the patient or the Third Party Payors and any regulatory agency that may be involved in the payment or determination of fees under the Regulations.

6. Medical practitioners may continue their practice of reducing fees for patients at their own discretion for deserving patients in exceptional circumstances.

7. Where a procedure comprises of a combination of procedures that are customarily performed together and for which a specified combined procedure is provided in the Schedule, the procedure shall not be fragmented or unbundled in the computation of fees.

MULTIPLE PROCEDURES 8. When two or more procedures are done through the same incision on a patient at a particular time, the Surgeon fees shall be calculated as 100 percent of the surgical procedure with the highest relative value and 50 percent of the fees chargeable for each of the procedures with lesser relative values.

9. When two or more procedures are done through the same incision on a patient at a particular time, the Anaesthesiologist fees shall be calculated as 100 percent of the highest relative value for the anaesthetic procedure and 50 percent of the fees chargeable for each of the procedures with lesser relative values.

iii 10. When two or more procedures are done through separate incisions on a patient at a particular time:

10.1 Surgeon fees are calculated as follows:

10.2.1 procedure with the highest relative will be charged as 100% 10.2.2 procedure(s) with the lesser relative value will be charged as 75%

10.2 Anaesthesiologist fees are calculated as follows: 10.2.1 procedure with the highest relative will be charged as 100% 10.2.2 procedure(s) with the lesser relative value will be charged as 75%

11. When a procedure requires the services of a second practitioner (Assistant), the fees charged by the second practitioner (Assistant), shall not exceed 50 percent of the fees charged by the primary (first) practitioner for the procedure(s). This situation is usually met in complex operations requiring two surgeons in the interest of patient safety, operative efficiency and quality of care. Examples include liver resection or complex scoliosis surgery.

12. In such a situation, the anaesthetist fees shall be calculated based on the anaesthetist relative values of all the procedures performed by the primary (first) practitioner.

13. When a procedure requires a second anaesthetist, in the interest of the patient safety and quality of care (e.g. during long and complex procedures) the fees charged by the second anaesthetist shall not exceed 50 percent of the fees charged by the primary (first) anaesthetist for the procedure.

14. For procedures performed under local anaesthesia (LA), and when this LA is administered by the operating practitioner, a charge not exceeding 20 percent of the procedure fee or RM 125, whichever is lower may be levied.

15. Procedure fees apply whether the operation is performed as an elective or emergency procedure.

DISCLAIMER

1. Despite extensive efforts, discrepancies and omissions may exist in a Schedule of this magnitude and diversity.

2. We welcome any comments, especially on anomalies detected in the Schedule, and will endeavour to include these in future editions of the Schedule.

3. If anomalies do occur, we believe that medical practitioners will use their own discretion and goodwill in the application of the Schedule so that the interests of all parties are protected.

4. The Schedule of Relative Values is provided as guidance for calculating the fees only. As such, statements to the effect that fees charged are MMA recommended fees should not be used in any billing or in any other form.

WHAT IS NEW. The Fifth Edition Version 2.0 (2020) contains all the newer procedures that had been approved by the Ministry of Health since 2013.

iv

PART A

GENERAL PRACTITIONERS

AND

SPECIALISTS CONSULTATION AND FOLLOW-UP FEES GENERAL PRACTITIONERS CONSULTATION FEES RM

Initial Consultation (Normal working hours 9.00am – 5.00pm)

10010 Minor Case 35 10011 Intermediate Case 70 10012 Complex Case 125

Subsequent Consultation 10013 Minor Case 25 10014 Intermediate Case 45 10015 Complex Case 80

Consultation after stipulated clinic hours is 50% above the normal rate.

Consultation fee for those with Post graduate qualification in Family Medicine Fee is 50% additional.

MEDICAL EXAMINATION FEES

10020 Medical Health Fitness Examinations for Life Insurance 80 10021 Attending Doctors Reports 80 10022 Routine, Pre-employment, Annual Medical Examination 100 10023 Fitness, Comprehensive Health Examination (Excluding investigations) 80 10024 Aviation Medical Examination 200 10025 Foreign Workers Medical Examination 60 10026 Health Fitness Certificate for Food Handlers 60 10030 Examination of Medico-Legal Cases 750 10040 Disability Evaluation 1000 10050 Participation on Medical Board (per day) 750 10080 Heavy Goods and Public Vehicle Driving License 80

HOUSE CALLS AND MEDICAL ASSISTANCE FEES 11000 House Calls : Office Hours 300 : After Office Hours 450 11010 Medical duty for events and functions (per hour up to 8 hours) 80 11020 Medical attendance or transfer/repatriation of patient (Per day excluding actual expenses incurred in the cost of travel, subsistence and accommodation) 750

LEGAL REPORTS AND COURT APPEARANCES FEES 12001 Qualifying Expenses (Preparation) 500 12002 Conduct Money (Travel and Accommodation) (Actual) 12004 Non-Expert Witness (Statement of Facts only) 750 12005 Expert Witness (Giving Opinion) 1500 12006 Search Fee for Medical Report 50 12007 Attending Physicians Statement for Lawyers and others 100 12008 Attending Physicians Statement for Insurance Companies (Claim Form) 80

PART A Page 1 GENERAL PRACTITIONERS PROCEDURES

According to the Procedure Fee Schedule in PARTS A and B. For Procedures under Local Anaesthesia (LA) and when the LA is administered by the operating practitioner, an additional charge of 20% of the procedure fee or RM 125 whichever is lower is levied.

COMMON PROCEDURES RM

Cardiac GCA2950 Cardiopulmonary resuscitation, basic life support 325 GCA2951 Cardiopulmonary resuscitation, advanced life support 425

GCA3000 ECG 25 GCA3784 Ambulatory BP Recording and Interpretation 100

Eye GEY5204 Staining of the eye for foreign body 20 GEY5205 Removal of foreign body, external eye, superficial, 40 GEY5206 Irrigation of the eye, external 20

GEY2101 Glaucoma, testing 20 GEY2220 Fundoscopy 15

Ear, Nose and Throat Foreign body removal, external auditory meatus, without general GET9200 35 anaesthesia GET9201 Irrigation of the Ear 25 GET0901 Nasal packing, control of nasal haemorrhage, simple, anterior only 20 GSK2011 Ear Lobe Repair, simple, each ear 180

Gastrointestinal GGI3752 Nasogastric tube insertion 30 GGI9082 Abdominal paracentesis, (abdominal tap), diagnostic 50 GGI5300 Proctoscopy, diagnostic 20 GGI6221 Haemorrhoids, rubber banding, ligation, including proctoscopy, 175

Genitourinary GUR1701 Insertion of bladder catheter, non-indwelling, for emptying 30 GUR1702 Insertion of bladder catheter, indwelling, temporary, eg Foley 45 GUR1100 Bladder Tap, aspiration with needle, suprapubic, adult 30

Orthopaedic Casting of extremities, simple. plaster of paris, or similar, GBJ9058 75 (excluding cost of material)

GMS0600 Joint Aspiration, arthrocentesis and/or injections of small joints 75

PART A Page 2 Obstetrics & Gynaecology RM

GOG7450 Vaginal examination, speculum, 20 GOG7451 Pap’s Smear, including vaginal examination 35

Respiratory

GRS4010 Peak Flow Meter 25 GRS4644 Nebuliser 70

Skin & Wound Care

GSK0060 Incision and drainage of single small abscess, cyst, furuncle 150 Removal of foreign body, subcutaneous tissue, simple, under local GSK0120 200 anaesthesia Biopsy of skin, subcutaneous tissue, simple closure, single lesion, under GSK1100 200 local anaesthesia GSK1730 Avulsion of nail, single, complete or partial, under local anaesthesia 200 GSK1740 Subungual haematoma, evacuation 150 GSK1900 Intralesional injection, each lesion 25

GSK2001 Wound Toilet & Suturing for injuries, less than 3 cm 50 GSK2202 Wound Toilet & Suturing for injuries, 3 – 6 cm 75 GSK2004 Wound Toilet & Suturing for injuries, more than 6 cm – 3 areas 150

GSK2101 Simple wound dressing with sterile gauze less than 3 cm 10 GSK2102 Wound dressing with sterile gauze 3 – 6 cm 20 GSK2103 Wound dressing with sterile gauze more than 6 cm 30

GSK2151 Suture removal, wound less than 3cm 20 GSK2152 Suture removal, wound 3 – 6cm 30 GSK2153 Suture removal, wound more than 6cm 40

Vascular

GVS1000 Venesection, collection of blood 20 GVS1005 Insertion of intravenous canula 30 GVS1006 Intravenous infusion, initiation 30 GVS1010 Arterial Puncture, collection of blood 75

GVS1001 Intramuscular Injection 8 GVS1003 Intravenous Injection, through needle or preexisting canula 15

Laboratory

GPL2948 Blood glucose testing, reagent strip 10 GPL1002 Urine analysis, reagent strip testing (FEME) 15 GPL1025 Urine pregnancy test, colour comparison 20 GPL2044 Urine for microalbuminuria 15

PART A Page 3 SPECIALISTS CONSULTATION AND FOLLOW-UP FEES

CONSULTATION FEES

Initial Consultation at Workplace: RM

During Office Hours 20010 Simple 70

20011 Intermediate 140

20012 Complex 200

After Office Hours 20020 Simple 140

20021 Intermediate 200

20022 Complex 300

Subsequent Follow-Up Consultations at Workplace:

During Office Hours 20030 Simple 40

20031 Intermediate 70

20032 Complex 140

After Office Hours 20040 Simple 80

20041 Intermediate 140

20042 Complex 200

20050 Home visits or subsequent consultations at home 500

PART A Page 4 SPECIALISTS CONSULTATION AND FOLLOW-UP FEES (continued)

ICU CONSULTATION RM During Office Hours 20013 ICU Initial Consultation (non-anesthesiologist, intensivist) 300

20014 ICU Subsequent Follow-up (non-anesthesiologist, intensivist) 200

After Office Hours 20015 ICU Initial consultation (non-anesthesiologist, intensivist) 450

20016 ICU subsequent follow-up (non-anesthesiologist, intensivist) 300

Refer Anaesthsiology section for fees for intensive care services by anaesthesiologists and intensivists

COURT ATTENDANCE

20023 Qualifying Expenses (Preparation) 500

20024 Conduct Money (Travel and Accommodation) Actual

20025 Non-Expert Witness (Statement of Facts only) 1000-2000

20026 Expert Witness (Giving Opinion) 3000-5000

20027 Comprehensive Medical Report for Insurance Companies, Lawyers and 200-1000 Others

20028 Claims Form, preparation 80

Note: 1. It is recommended that the fees for ward visits per day should not exceed the total fee of two visits for that day, except when additional visits are at the patients request or when the patients condition deems it necessary.

2 Expert opinions given over the telephone or other electronic media to the patient or for the management of the patient also constitutes a consultation and can be duly charged.

PART A Page 5 ANAESTHESIOLOGY

1. INTRODUCTION Anaesthetists fee calculation for the anaesthetic services shall follow the Anaesthetist’s category listed in Part B of the MPSN®, and the corresponding Conversion Factor in Part A in page 41 and page 42.

2. CONSULTATION AND PREOPERATIVE ASSESSMENT FEES These fees shall follow the Schedule for the Specialists Consultation and Follow Up fees in Part A. (Refer pages 4-5)

3. ANAESTHETISTS CATEGORY IN PART B The fee is for the administration of anaesthesia and is inclusive of induction, maintenance and reversal of anaesthesia and all necessary support and monitoring activities intraoperatively that may be required normally for that particular procedure. It also includes fees for post anaesthesia care in the post anaesthesia care unit (PACU) and recovery room/ward. The fee shall also apply for monitored anaesthesia care. Any procedures done for specialized monitoring may be charged separately (e.g. Swan Ganz catheter, somatosensory evoked potential monitoring, Transoesophageal Echocardiography

4. REGIONAL ANAESTHESIA When regional anaesthesia (infiltration, nerve blocks, plexus blocks, central neural blocks) is established as the principle means of anaesthesia for a surgical procedure, the fee charged shall follow the same category in Part B.

5. ANAESTHESIA FOR MULTIPLE SURGICAL PROCEDURES When multiple surgical procedures are performed during the same anaesthetic, the fees charged shall be as given in the section Guidelines for Billing /Invoicing for Services in the Introduction and Notes (Refer When a procedure requires a second anaesthetist in the interest of patient safety and quality of care (e.g. during long and complex procedures) the fees charged by the second anaesthetist shall not exceed 50 percent of the fees charged by the primary (first) anaesthetist for the procedure.

6. POST ANAESTHESIA CARE Continued post anaesthesia care in the ward or intensive care unit shall follow the schedule for the Specialists Consultation and Follow Up fees in Part A. (Refer pages 4-5).

7. DIAGNOSTIC/ INTERVENTIONAL RADIOLOGY PROCEDURES Refer to fees in the appropriate section in Part B.

8. INTENSIVE CARE

CODE DESCRIPTION ANAESTHETIST’S CATEGORY/FEE First Consultation, assessment, and initiation of treatment (intubation and AN10101 ventilation including non-invasive procedures like application of BIPAP, 675 CPAP ventilation) during office hours.

First Consultation, assessment, and initiation of treatment (intubation and AN10102 ventilation including non-invasive procedures like application of BIPAP, 825 CPAP ventilation) after office hours.

AN10103 Subsequent follow-up during office hours 200

AN10104 Subsequent follow-up after office hours 300

PART A Page 6 ANAESTHESIOLOGY (continued)

9. OBSTETRIC ANALGESIA SERVICES RM

Epidural/Spinal (includes assessment and initiation of procedure) during AN10201 550 office hours

Epidural/Spinal (includes assessment and initiation of procedure) after AN10202 775 office hours

AN10203 Attendance during delivery (on request) 385

AN10204 Post-delivery visit, removal of catheter 70

10. PAIN MANAGEMENT

Patient Controlled Analgesia with intravenous drugs for acute pain/post- AN10301 345 operative Pain Management (Assessment and initiation)

Placement of Epidural catheter for post-operative pain management AN10302 (assessment and initiation), as a sole procedure. (Not to be used if the 550 epidural catheter is placed for anaesthesia for a surgical procedure)

Placement of catheter for neural blockade of peripheral nerves, plexuses, AN10303 as a sole procedure (Not to be used if the catheter is placed for anaesthesia 475 for a surgical procedure)

Refer to Part B Pages 9-10 for other Pain Management procedures. If the procedure is done by the Anaesthetist then the Surgeon’s category of Relative Value shall apply.

If the procedure requires an anaesthetic to be given for the procedure to be done by another practitioner, then the Operator category of relative value shall apply for the anaesthetist providing the anaesthetic.

PART A Page 7 ANAESTHESIOLOGY (continued)

11. GENERAL PROCEDURES

INC6360 Intravenous Infusion, including insertion of canula 120

VS6430 Administration of Blood, blood components 180

VS6416 Venesection, collection of venous blood, adult, child 65

VS6600 Arterial puncture, collection of blood, diagnosis 75

VS6620 Peripheral arterial cannulation only, as a sole procedure 150

Peripheral arterial cannulation, setting up monitoring system, as a sole VS6621 225 procedure

Central venous line cannulation, non-tunneled, including femoral vein, VS6556 550 including setting up monitoring system, with ultrasound guidance

Central venous line cannulation, tunneled, with ultrasound guidance, for VS6558 1100 prolonged infusion, without subcutaneous port (OPCS code L9110)

Right heart flow directed balloon catheter (e.g Swan-Ganz), insertion for CAC3503 550 measurement of pulmonary pressures, cardiac output, oxygen saturation

CAC2950 Cardiopulmonary Resuscitation, including ACLS 450

Intra-operative 2-Dimensional Real Time Transoesophageal Echocardiography incorporating Doppler techniques with colour flow CAC3318 mapping and recording into video tape or digital medium, performed 400 during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure.

PART A Page 8 CARDIOLOGY RM CAC3000 Electrocardiogram (ECG), 12 leads, , tracing, interpretation and report 40

CAC3010 Electrocardiogram (ECG), 12 leads, interpretation and report only 35

Electrocardiographic continuous, monitoring (e.g. Holter, or other types) CAC3224 110 with interpretation and report

CAC3784 Ambulatory blood pressure monitoring, any method, interpretation and 110 report

ECHO CARDIOGRAPHY

Echocardiography, M-mode recording, 2 dimensional, Doppler CAC3306 330 echocardiography, colour mapping with interpretation and report

Echocardiography, transoesophageal, including probe placement, with CAC3315 385 interpretation and report

Echocardiography, exercise or pharmacologically induced stress test, CAC3350 physician supervision, interpretation and report 330

OTHER GENERAL PROCEDURES:

CAC2950 Cardiopulmonary resuscitation, including ACLS 425 CAC2960 Cardioversion, elective, external 250

Other vascular access codes are found in the Anaesthesiology section above

NON-INVASIVE PROCEDURES

Continuous ECG Recording of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), not in CAC3224 association with Ambulatory Blood Pressure Monitoring, involving 180 microprocessor based analysis equipment, interpretation and report of recordings by a specialist physician or consultant physician.

Multi-Channel ECG Monitoring and Recording during exercise (motorised treadmill or cycle ergometer capable of quantifying external workload in watts) or pharmacological stress, involving the continuous attendance of a medical practitioner for not less than 20 minutes, with CAC3018 200 resting ECG, and with or without continuous blood pressure monitoring and with or without continuous blood pressure monitoring and the recording of other parameters, on premises equipped with mechanical respirator and defibrillator.

Signal Averaged ECG Recording involving not more than 300 beats, using at least 3 leads with data acquisition at not less than 1000Hz of at CAC3278 100 least 100 QRS complexes, including analysis, interpretation and report of recording.

CAC3268 Ambulatory ECG Monitoring, patient activated event recording 70

PART A Page 9 CARDIOLOGY (continued) RM CAC3279 Implanted Pacemaker Testing for Single Chamber Pacemaker 50

CAC3300 Implanted pacemaker testing for atrioventricular synchronous pacemaker 100

CAC3724 Implanted ECG Loop Recording reporting 70

NSC5924 Up-Right Tilt Table Testing of autonomic nervous system function 220

M-Mode and 2-Dimensional Real Time Echo-Cardiographic Examination of the Heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and CAC3306 330 continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium.

Exercise Stress Echocardiography performed in conjunction with item CAC3306, with two-dimensional recordings before exercise (baseline) CAC3349 400 from at least three acoustic windows and matching recordings from the same windows at, or immediately after, peak exercise.

Pharmacological Stress Echocardiography performed in conjunction with item CA3, with two-dimensional recordings before drug infusion CAC3350 (baseline) from at least three acoustic windows and matching recordings 400 from the same windows at least twice during drug infusion, including recordings on video tape or digital medium.

Intra-operative 2-Dimensional Real Time Transoesophageal Echocardiography incorporating Doppler techniques with colour flow CAC3318 mapping and recording into video tape or digital medium, performed 400 during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure.

PART A Page 10 DERMATOLOGY AND VENEREOLOGY

DERMATOLOGY PROCEDURES

ALLERGY TEST RM Skin sensitivity tests (intradermal) using up to 20 reagents (excluding cost ALC5024 200 of reagents)

Skin sensitivity tests (patch test) using up to 26 reagents i.e. standard ALC5052 250 series (excluding cost of reagents)

Skin sensitivity tests (patch test) using more than 26 reagents i.e. standard ALC5053 300 battery plus extras (excluding cost of reagents)

Skin sensitivity tests (patch test) using supplementary series i.e. cost per ALC5054 200 series (excluding cost of reagents)

GENERAL DERMATOSURGERY

SK50040 Excision – cysts, scars, benign tumours (simple) 500 SK50041 Excision – cysts, scars, benign tumours (complex) 700 SK50050 Excision – malignant skin tumours requiring wide excision 950 SK50060 Multiple intralesional steroid injections 200 SK50080 Cryotherapy – less than 5 lesions 150 SK50081 Cryotherapy – more than 5 lesions 250 Cryotherapy – malignant tumours requiring wide areas of SK50090 treatment 500

PHOTOTHERAPY

SK50100 Phototherapy (UVB)/session – Regional 60 SK50101 Phototherapy (UVB)/session – Whole body 95 SK50050 P.U.V.A./session – Regional 95 SK50060 P.U.V.A./session – Whole body 120 SK50080 Photopatch testing 250 SK50081 MED phototesting 250 SK50090 MPD phototesting 250

OTHER DERMATOLOGY PROCEDURES

SK50110 Wedge excision of toenail 400 SK50111 Matrisectomy of nail 150 SK50112 DGI examination of specimen 150 SK50180 Skin biopsy 300 SK50190 Microscopic examination (Dark ground) 60 SK50200 Microscopic examination for skin scrapings, smears etc. 60 SK50201 Electrosurgery – keratosis, warts, angiomas, etc. (<5 lesions) 250 SK50202 Electrosurgery – keratosis, warts, angiomas, etc. (5-20 lesions) 500 SK50203 Electrosurgery – keratosis, warts, angiomas, etc. (>20 lesions) 700 SK50207 Chemical cautery - keratosis, warts, angiomas etc. 150 SK50208 Chemical cautery - keratosis, warts, angiomas etc.(5 lesions) 300 SK50305 Electrolysis of hair/per session 300 SK50306 Iontophoresis per session (e.g. For hyperhidrosis) 200 SK50307 Transdermal Iontophoresis (e.g. Drug delivery) 250

PART A Page 11 DERMATOLOGY AND VENEREOLOGY (continued)

CUTANEOUS LASER PROCEDURES RM SK50400 Cutaneous laser ablation of skin tumours (<5 lesions) 500 SK50401 Cutaneous laser ablation of skin tumours (5-20 lesions) 750 SK50402 Cutaneous laser ablation of skin tumours (>20 lesions) 1000 Pigment laser treatment of skin pigmentation and tattoos – small area SK50410 500 (<9cm2) Pigment laser treatment of skin pigmentation and tattoos – medium sized SK50411 750 area – (9 – 50cm2) Pigment laser treatment of skin pigmentation and tattoos - large area SK50412 1000 (>50cm2) SK50413 Pigment laser treatment of tattoo of eyebrows 500 SK50414 Pigment laser treatment of tattoo of eyelids 750 SK50420 Vascular laser treatment of vascular lesion small area (<9cm2) 500 Vascular laser treatment of vascular lesion medium sized area - (9 – SK50421 750 50cm2) SK50422 Vascular laser treatment of vascular lesion – large area (more than 50cm2) 1000 SK50430 Laser resurfacing (ablative) of one cosmetic unit 1000 SK50431 Laser resurfacing (non-ablative) of one cosmetic unit 750 SK50440 Laser/IPL assisted hair removal – small area (<9cm2) 500 SK50441 Laser/IPL assisted hair removal – medium area (9 – 50cm2) 750 SK50442 Laser/IPL assisted hair removal – large area (>50cm2) 1000 SK50443 Intense Pulse Light (IPL) treatment whole face 800

CHEMICAL PEELING

SK50500 Chemical peeling of lesion of skin – superficial peel 300 SK50501 Chemical peeling of lesion of skin – medium depth 500 SK50502 Chemical peeling of lesion of skin – deep peel 1000

MISCELLANEOUS PROCEDURES

SK50600 Comedone extract/per session 250 SK50601 Paring of hyperkeratosis, corns, etc. 250 SK50603 Milia extraction 250 SK50700 Day care skin nursing/session 200 SK50701 Whole body wrap dressing e.g. atopic eczema 500 SK50800 Microdermabrasion - face 300 SK50801 Microdermabrasion - body 500 SK50900 Botulinum toxin injection of one cosmetic unit 600 SK50910 Fillers injection of one cosmetic unit 500

PART A Page 12 GASTROENTEROLOGY AND HEPATOLOGY Procedures for Gastroenterology and Hepatology Refer to the appropriate sections in Part B

PART A Page 13 HAEMATOLOGY

PROCEDURES RM

Haematology THERAPEUTIC APHERESIS – Removal of plasma and cellular components of blood, using continuous or intermittent flow techniques; including morphological tests for cell counts and viability studies if done, continuous monitoring of vital signs, fluid balance, blood volume and other parameters, under the supervision of a consultant physician.

VS6511 Plasma 1200 VS6512 White blood cells 1200 VS6513 Red blood cells 1200 VS6514 Platelets 1200

VS6520 Donor haemapheresis, for the collection of blood products for transfusion, 480 morphological testing, continuous or intermittent flow techniques, continuous monitoring of patient, under supervision by a consultant physician

In vitro harvesting, cryopreservation, processing of peripheral blood or HS8204 1000 bone marrow for autologous transplantation HS8230 Harvesting of bone marrow, allogenic, for transplantation 1380 HS8231 Harvesting of bone marrow, autologous, for transplantation 1380

VS6430 Administration of Blood, blood components 180

HS8240 Stem Cell Transplant, Allogeneic, complete procedure 6000 HS8241. Stem Cell Transplant, Mini-Allogeneic, complete procedure 7000 HS8242 Stem Cell Transplant, Autologous, complete procedure 7500

Chemotherapy, Other Highly Complex Biologic Agent Administration Refer to Oncology Section

General Procedures

Lumbar Puncture, -diagnostic and as a sole and not part of other SP2275 325 procedure, adult patients (OPCS Code A5530)

HS8220 Bone Marrow Aspiration 250 HS8221 Bone Marrow, trephine Biopsy 480

INC6360 Intravenous Infusion, including insertion of canula 120

VS6416 Venesection, collection of venous blood, adult, child 65

VS6590 Removal of venous access device, Hickmann’s Catheter 200

PART A Page 14 NEPHROLOGY

RM Central venous line cannulation, non-tunneled, including femoral vein, VS6559 550 with ultrasound guidance, for temporary vascular access for dialysis

Manipulation of catheter, removal of intraluminal obstructive material, 340 VS6596 brushing

Insertion of intraperitoneal catheter, percutaneous, for peritoneal dialysis, 750 GI9418 chemotherapy instillation, ascites management; complete procedure including contrast image guidance when performed

GI9421 Insertion of intraperitoneal catheter, tunneled, for dialysis, open method 800

M1310 Percutaneous fine needle biopsy of lesion of kidney (Refer Part B) 500

M1380 Percutaneous tru-cut needle biopsy of lesion of kidney (Refer Part B) 900

M1410 Insertion of permanent catheter, e.g. Tenckhoff catheter (Refer Part B) 1100

NDC0935 Nephrologist cover and Expertise per chronic HD session 30

PART A Page 15 NEUROLOGY

OPERATOR PROCEDURES CATEGORY

VSC3886 Transcranial Doppler, intracranial arteries, complete study MINOR 3 NSC5970 Nerve Conduction Study MINOR 1 NSC5971 Concentric Needle EMG MINOR 5 NSC5872 Single Fibre EMG, (OPCS Code 22020) INTER 5 NSC5812 Report of EEG (OPCS Code 22000) MINOR 1 NSC5950 Report of Ambulatory EEG, lateralization of cerebral seizure focus MINOR 5 Report Video-Telemetry EEG, lateralization of cerebral seizure, multi- NSC5951 channel, combined video and EEG recording INTER 5 Report of Somatosensory Evoked Potentials, specify region in report NSC5925 MINOR 5 (OPCS Code 22011) Intraoperative continuous Evoked Potential Monitoring, by a physician, NSC5940 MAJOR 2 other than the operative surgeon, present throughout the procedure NSC5930 Record and report of visual evoked potentials, testing central nervous MINOR 1 system, any method ETC2586 Report of Auditory Evoked Potentials MINOR 1 ETC2584 Trans tympanic electro-cochleography, (OPCS Code A8480) INTER 1 Lumbar Puncture, -diagnostic and as a sole and not part of other SP2275 MINOR 1 procedure, adult patients (OPCS Code A5530) SP2272 Lumbar Puncture with continuous drainage, catheter, therapeutic MINOR 3 SSC5808 Polysomnography, interpretation and report, any age MINOR 3 MS0206 Muscle biopsy, needle, tru-cut, percutaneous, (OPCS Code S1520) MINOR 1 MS0526 Nerve entrapment injection, e.g. carpal tunnel MINOR 2 Initial hyperacute and critical care for stroke, for the hyperaute assessment (attended within the time window for consideration of reperfusion therapy VS7213 MAJOR 1 i.e. intravenous thrombolysis and/or endovascular thrombectomy) and management of patients with acute stroke for a period up to 3 hours Initial hyperacute and critical care for stroke, for the hyperaute assessment (attended within the time window for consideration of reperfusion therapy VS7214 i.e. intravenous thrombolysis and/or endovascular thrombectomy) and MAJOR 2 management of patients with acute stroke for a period up to 6 hours

VS7215 Administration and management of intravenous thrombolytic therapy for INTER 2 stroke, as a sole procedure

BOTULINUM INJECTIONS:

SK5900 Botulinum toxin injection, face or head MINOR 5 SK5901 Botulinum toxin injection, neck INTER SK5902 Botulinum toxin injection, limbs INTER SK5903 Botulinum toxin injection, limbs INTER 4

PART A Page 16 OBSTETRICS AND GYNAECOLOGY OPERATOR PROCEDURES CATEGORY

Invasive procedures

OG9000 Amniocentesis, diagnostic INTER 1

OG9001 Amniocentesis, therapeutic fluid reduction, with ultrasonic guidance INTER 3

OG9015 Chorionic villus sampling (CVS) INTER 3

Foetal blood sampling INTER 3 OG9030 OG9076 Foetal procedures, placement of shunts INTER 4

OG9077 Foetal procedures, biopsy INTER 4

VS6460 Foetal procedures, intrauterine transfusion INTER 4 Irrigation of vagina /insertion of vaginal medication for treatment of 100 OG7150 infection Fitting and insertion of vaginal ring pessary; other intravaginal support 150 OG7160 device Pap smear 80 OG7452

ULTRASOUND RM

RD6813 Ultrasound, pregnant uterus, 1st Trimester/Nuchal Scan 200 RD6815 Foetal Anomaly Scan (2nd/3rd Trimester) 350 Foetal Anomaly Scan (2nd/3rd Trimester) with 3D/4D, reevaluation of RD6816 400 organ systems suspected to be abnormal RD6827 Foetal Doppler studies 150 RD6830 Transvaginal scan/Follicular tracking, non-obstetric 150 RD6835 Sonohysterography with infusion of saline or contrast material 200

PREGNANCY AND CONFINEMENT/INTRAPARTUM

Normal Delivery } Assisted Delivery – Forceps/Ventouse/Twins } Refer to Caesarean Delivery with complications } Part B

ADDENDUM The following procedures were approved by the Ministry of Health as per the letter with Reference No: KKM 87/A6/1/JLD 3(29) dated 10th September 2015

CODES IN PART A Surgeon's Fee Irrigation of vagina /insertion of vaginal medication for treatment of OG7150 100 infection Fitting and insertion of vaginal ring OG7160 150 pessary or other intravaginal support device OG7452 Pap smear 80 RD6835 Sonohysterography with infusion of saline or contrast material 200

PART A Page 17 OCCUPATIONAL MEDICINE

Medical Surveillance Use and Standard of Exposure of Chemicals Hazardous to Health, Regulations RM Review of chemical health risk assessment report, review of hygiene OMC1001 report, review of past surveillance reports documentation, interpretation and report 80

OMC1010 History, Physical Examination and Documentation, existing workers 80

Summary Reports (Inclusive of 5 USECHH forms), for submission to OMC1020 40 DOSH

Spirometry

OMC1100 Medical surveillance, of workers 45

OMC1110 Fitness for respirator use (inclusive of forms and report) 55

OMC1200 Audiometry, pure tone, interpretation and report 35

Laboratory Investigations as per Lab cost

Radiological Investigations Refer to MMA MPSN Schedule, Radiology

Walk through survey

OMC1500 Whole Plant 200 per hour

OMC1502 Work Unit 200 per hour

OMC1530 Environmental and Health Safety Committee Meeting Attendance 200 per hour

OMC1550 Medical Examination, Pre-employment, Pre-placement, Fitness to work 100

USECHH: Use of Standards of Exposure to Chemicals Hazardous to Health CHRA: Chemical Health Risk Assessment

PART A Page 18 ONCOLOGY

RADIOTHERAPY

PALLIATIVE RADIOTHERAPY RM Short course radiotherapy with aim to relieve symptoms includes the following: Fields : 1 – 2 Fields, Planning : 2 – Dimensional Duration : One day – 2 weeks

RK0700 1 Fraction 900 RK0701 5 Fraction 1000 RK0702 10 Fractions 1200

ADJUVANT RADIOTHERAPY Radiotherapy given following surgery to improve local control rates and possibly survival

RK07010 Minor, includes the following Fractions: 15 – 20# Fields: 1 – 2 Fields 500 Planning: 2 – Dimensional Duration: 3 – 4 weeks

Major, includes the following Fractions: 15 – 20# RK07011 Fractions: 21 – 30# 1800 Fields: >2 Fields Planning: 3 – Dimensional Duration: 4 – 6 weeks

RADICAL AND RE-TREATMENT RADIOTHERAPY Radical radiotherapy is radiation given in high doses with the aim to cure patients of cancer

Complex 2 – Dimensional, includes the following RK07020 Fractions: 25 – 45 Fractions

Fields: >2 Fields 2250 Planning: 3 – Dimensional

Duration: 5 – 9 weeks

Complex 3 – Dimensional, includes the following Fractions: 25 – 45 Fractions RK07021 Fields: >2 Fields 2500 Planning: 3 – Dimensional Duration: 5 – 9 weeks

SPECIALISED RADIOTHERAPY

INTENSITY MODULATED RADIOTHERAPY (IMRT) RM

IMRT, IGRT, inclusive of the following parameters: Fractions: 20 – 45 Fractions Fields : 5 – 9 Fields RK7418 Planning : 3 – Dimensional Inverse Planning Duration : 4 – 9 weeks Treatment time per fraction: 20 – 25 minutes each 5000

PART A Page 19 ONCOLOGY (continued)

STEREOTACTIC RADIATION (SRS) RM

RK7432 Stereotactic radiosurgery, Single Fraction 4000

RK7433 Stereotactic radiosurgery, multiple fractions 5000

RK7436 Stereotactic Radiotherapy, fractionated 5000

BRACHYTHERAPHY

RK7326 Low dose rate brachytherapy 1000

RK7327 High dose rate brachytherapy, intra-cavitary, single fraction 1500 RK7328 High dose rate brachytherapy intraluminal, single fraction 1000 RK7329 High dose rate brachytherapy intraluminal, multiple fractions 1500 RK7330 High dose rate brachytherapy, implants 2500

RADIONEUCLIDE THERAPY

RK7785 Low Dose < 30mCi or (out-patient procedure) 550

RK7786 High Dose < 30mCi or (requires in patient radiation shielded room) 1000

CHEMOTHERAPY

Infusion chemotherapy, and administration of other highly complex drug or highly complex biologic agent

Intravenous Infusion Chemotherapy administration, including complex biologic agent, CTC6409 intravenous push technique or by intravenous infusion, not more than 1 300 hour, first day

Chemotherapy administration, including complex biologic agent, CTC6413 intravenous infusion, more than 1 hour but not more than 6 hours, first 600 day

Chemotherapy administration, including complex biologic agent, CTC6416 intravenous infusion, prolonged infusion, more than 6 hours, first day 800

CTC6419 Intravenous infusion, progressive chemotherapy, subsequent days, per day 200

Intra-arterial Infusion

Chemotherapy administration, including complex biologic agent, intra- CTC6420 arterial push technique or by intra-arterial infusion, not more than 1 hour, 300 first day

Chemotherapy administration, including complex biologic agent, intra- CTC6422 600 arterial infusion, more than 1 hour but not more than 6 hours, first day

PART A Page 20 ONCOLOGY (continued) RM Chemotherapy administration, including complex biologic agent, intra- CTC6425 800 arterial infusion, prolonged infusion, more than 6 hours, first day

Intra-arterial infusion, progressive chemotherapy, subsequent days, per CTC6426 day 200

NON-INFUSIONAL CHEMOTHERAPY

CTC6402 Hormonal therapy implant, subcutaneous, intramuscular 400 CTC6403 Non-hormonal therapy implant, subcutaneous, intramuscular 400 CTC6440 Intrapleural, chemotherapy administration, including thoracocentesis 600

Intraperitoneal, chemotherapy administration through pre-existing CTC6446 intraperitoneal catheter 600 (For insertion of intraperitoneal catheter Refer to Part B, Code L7040) CTC6450 Intrathecal, chemotherapy administration, including spinal puncture 600

Chemoport Delivery/Access Ambulatory drug delivery device, portable pump, refilling and CTC6521 140 maintenance of

CTC6522 Implanted device or reservoir, refilling and maintenance of 220

CTC6523 Irrigation of implanted devices, prior to chemotherapy 100

PART A Page 21 OPHTHALMOLOGY

PROCEDURES RM EYC2015 Refraction 65

EYC2020 Gonioscopy, as a sole procedure 65

EYC2021 Keratometry 65

EYC2025 Corneal Topography, including interpretation and report 275

EYC2060 Hess Chart, with interpretation and report 135

EYC2083 Automated perimetry 275

EYC2250 Anterior/fundus photography, including report 75

EYC2225 Indirect Ophthalmoscopy, with retinal drawing for retinal detachment, 65 melanoma, interpretation and report

EYC2228 Fundus fluorescein angiogram, including report, (OPCS code C8650) 325

EYC2229 Schirmer’s test, for diagnosis of hypo-lacrimation 30

EYC2270 Electrophysiology, electro-oculography, with report 400

EYC2271 Electrophysiology, electro-oculography, without report 275

EYC2275 Electrophysiology, electro-retinography, with report 400

EYC2276 Electrophysiology, electro-retinography, without report 275

EYC5206 Irrigation of the eye, external 40

EYC8810 Probing and syringing, irrigation of nasolacrimal duct 135

RD 6511 Ophthalmic ultrasonography, A-scan 135

RD 6512 Ophthalmic ultrasonography, B-scan 275

RD 6514 Pachymetry, ultrasound determination of corneal thickness 135

Dressings – Refer to codes below:

GSK2101 Simple wound dressing with sterile gauze less than 3 cm 10

GSK2102 Wound dressing with sterile gauze 3 – 6 cm 20

GSK2103 Wound dressing with sterile gauze more than 6 cm 30

PART A Page 22 PAEDIATRICS

NEONATOLOGY RM VS6450 Exchange Transfusion, neonate, blood 700 VS6415 Neonatal venepuncture, collection of blood 75 VS6406 Percutaneous insertion peripheral venous catheter 250 VS6601 Arterial puncture, collection of blood, diagnosis 100 VS6625 Peripheral arterial cannulation 250 VS6660 Umbilical artery, vein, catheterization 300 P1900 Central venous line insertion for neonate (as in Part B) 475

Attendance at delivery, stabilisation of newborn, resuscitation, office PNC9464 300 hours Attendance at delivery, stabilisation of newborn, resuscitation, after office PNC9465 450 hours PNC9465 Newborn resuscitation, office hours 200 PNC9466 Newborn resuscitation, after office hours 300 RD6506 Ultrasound brain, ventricular size determination, cerebral content 200 SP2270 Lumbar puncture, neonate 200 CR1020 Ventricular tap 300

PUR1101 Urinary bladder tap, aspiration with needle, suprapubic, neonate 50

RESPIRATORY Diagnostic RMC4011 Spirometry, measurement of forced expiratory flows, in a child 90 Spirometry, measurement of forced expiratory flows, in a child, before RMC4012 150 and after inhalation of bronchodilator RMC4013 Lung function test, measurement of lung volumes, in child 200 RMC4620 6-minute walk pulmonary stress testing, exercise test for bronchospasm 200 RMC4644 Administration of aerosol medication, bronchodilator, via nebulizer 50 RMC4726 Plethysmography test, determination of lung volume 400 RMC4729 Diffusing capacity of carbon monoxide test, DLCO 200 RMC4762 Pulse oximetry, overnight continuous monitoring 100 RMC4774 Carbon dioxide monitoring, end tidal, overnight 100

Ventilator Management RMC4660 Continuous positive airway pressure (CPAP), initiation, management 150 Application of ventilator, invasive or non-invasive, initiation, setting up of RMC4661 300 ventilator parameters, e.g. CPAP, BIPAP Pulmonary rehabilitation or management counseling, including RMC4664 demonstration, evaluation of use of nebuliser, aerosol generator and metered dose inhalers (max. 1 hour) 200

Allergy Testing

Challenge test; inhalational bronchial challenge with Methacholine, ALC5070 200 Histamine, Saline, or similar substances.

For allergy testing through application of allergenic substances through skin refer to Allergy Testing in the Dermatology and Venereology Section in Part A, page 11

PART A Page 23 Miscellaneous SSC5808 Report Polysomnography, any age 425 P1911 Excision of skin tag in newborn 100

PAEDIATRICS (continued)

CARDIOLOGY RM RD6827 Foetal echocardiography with colour and wave Doppler 300

Paediatric cardiac catheterization, combined left and right heart, for CAC3531 1400 congenital cardiac anomalies, imaging supervision and interpretation

CAC2985 Paediatric percutaneous transluminal valvuloplasty 2800

Percutaneous transluminal prosthetic occlusion of vascular malformation, VS7204 2800 e.g. patent ductus arteriosus, coronary fistula/AV malformation

Percutaneous trans coronary myocardial alcohol septal ablation for VS7202 2800 hypertrophic cardiomyopathy

Percutaneous transluminal modification of atrioventricular node (by CAC3620 1800 electrophysiology)

ENDOCRINOLOGY

Low dose or high dose dexamethasone suppression test, professional PL0420 services including counselling and supervision; venesection and 200 collection of blood, other fluids if needed by consultant physician

Luteinizing Hormone Releasing Hormone (LHRH) test; professional PL3727 services including counselling and supervision; venesection and collection 200 of blood, other fluids if needed by consultant physician

Oral glucose tolerance test (OGTT), professional services including PL2951 counselling, and supervision; venesection and collection of blood by 200 consultant physician

Growth hormone (GH) stimulation provocative test (e.g. Insulin, PL3003 glucagon, arginine,) professional services including counselling, 200 venesection and collection of blood by consultant physician

Human chorionic gonadotrophin (HCG) stimulation test; professional PL0426 services including counselling and supervision; venesection and collection 200 of blood, other fluids if needed by consultant physician

Renin/aldosterone postural test; professional services including PL0408 counselling and supervision; venesection and collection of blood, other 200 fluids if needed by consultant physician

Adrenocorticotropin (ACTH) stimulation test; professional services PL0400 including counselling and supervision; venesection and collection of blood, other fluids if needed by consultant physician 200

PART A Page 24 PAEDIATRICS (continued)

GENETIC-METABOLIC RM

Allopurinol challenge test; professional services including counselling and PL1098 200 supervision; collection of fluids if needed, by consultant physician

GCC6040 Genetic Counselling, with patient/family 200

Planning for metabolic diet; including consultation and examination, PMS9382 counselling, ordering of appropriate laboratory tests 200

RHEUMATOLOGY

MS0600 Joint Aspiration, arthrocentesis and/or injections of small joints 75

Joint Aspiration, arthrocentesis and/or injections of intermediate joints, MS0605 150 e.g. ankle, bursa, elbow, wrist

Joint Aspiration, arthrocentesis and/or injections of major joints, e.g. hip, MS0610 200 knee, shoulder

NEPHROLOGY

Continuous Ambulatory Peritoneal Dialysis (CAPD) first month, in a child, including monitoring of adequacy of nutrition, assessment of NDC1000 3000 growth and development, with a minimum of four face-to face consultations, counselling

CAPD subsequent months/per month, in a child, including monitoring of adequacy of nutrition, assessment of growth and development with a NDC1001 2000 minimum of four face-to face consultations, counselling of patient and family

Continuous renal replacement therapy, assessment of patient, initiation of NDC1002 350 treatment, monitoring, first day

Acute hemodialysis, including assessment, monitoring, counselling of NDC2000 450 family

Acute hemodialysis in hemodialysis unit (weight < 15 kg), including NDC2001 400 assessment, monitoring, counselling of family

Acute hemodialysis in hemodialysis unit (weight > 15 kg), including NDC2002 315 assessment, monitoring, counselling of family

Chronic hemodialysis in hemodialysis unit (body weight < 15 kg), per NDC2010 300 session

Chronic hemodialysis in hemodialysis unit (body weight > 15 kg), per NDC2011 215 session

NDC2020 Intermittent peritoneal dialysis per day 200

PART A Page 25 PAEDIATRICS (continued)

GENERAL RM

CAC2951 Cardiopulmonary resuscitation, PALS 350 HS8220 Bone Marrow Aspiration 250 HS8221 Trephine biopsy of bone marrow (OPCS code W3650) 480 SP2271 Lumbar puncture, paediatric patient 200

VS6416 Venesection, collection of venous blood, adult, child 65 VS6600 Arterial puncture, collection of blood, diagnosis 75 VS6800 Intraosseous infusion 175 INC6360 Intravenous Infusion, including insertion of canula 120

IMO0460 Immunisation, any method, counselling by medical practitioner 25

GUR1100 Urinary bladder tap, aspiration with needle, suprapubic 30 GUR1701 Insertion of bladder catheter, non-indwelling, for emptying 30 GUR1702 Insertion of bladder catheter, indwelling, temporary, eg Foley 45

Plasmapheresis per treatment, ) See code in Haematology Section, Part A

Insertion of cuffed hemodialysis catheter ) Insertion of temporary peritoneal dialysis catheter ) See Codes in Nephrology Section, Part A Insertion of temporary hemodialysis catheter ) Renal biopsy (ultrasound guided) )

Cystotomy See Code M3820 in Part B, Section on Bladder

Subdural tap See Code A4180 in Part B, Section on Meninges

Ventricular puncture See Code V0590 in Part B, Section on Cranium

COMMUNITY AND ADVANCED

Developmental screening, using standardized form, interpretation and CNC6110 report 100

PSY0837 Individual counseling of child or teenager per hour 300

PSY0846 Family counseling (therapy) session per day, with or without patient 300

Disability and education assessment, including report or certification, if DEC9450 required 400

Planning services for a disabled child, including examination, formulation DEC9455 of diagnosis, preparation of future medical treatment plan, preparation of 300 necessary certification, if required, per hour

Report on child or adolescent (for parent or non-Agency) for disability, DEC9457 abuse 300

PART A Page 26 PATHOLOGY

ANATOMICAL PATHOLOGY RM Level II Uncomplicated excision specimens, gross and microscopic examination PL8301 60-70 e.g. Appendix, fallopian tubes, vas, tonsils, adenoids, sebaceous cyst, nasal polyp, heart valve, vas deferens, hernial sac

Level IIA. More complicated excision specimens PL8302 110-130 Diagnostic Biopsy (wedge/punch/trucut) (1 paraffin block)

Level III Medium sized specimens, gross and microscopic examination e.g. Eye, salivary gland, thyroid, breast lump, gall bladder, prostatic chips, PL8304 splenectomy, simple hysterectomy, ovarian cyst, excised diabetic ulcer, 160-200 products of conception, cartilage, bone fragments, synovium, ganglion, cyst, sinus polyps, tonsil, adenoids, excised tumour < 10cm, diagnostic biopsy sent as 2-3 separate specimens

Level IV Large specimens, gross and microscopic examination e.g. Laryngectomy, pneumonectomy, simple mastectomy, breast hook wire PL8305 with margins, gastrectomy, gut resection, colon, nephrectomy, THBSO, 320-380 cone biopsy, amputated limb (except for diabetes), excised tumour > 10cm, diagnostic biopsy sent as 4-10 separate specimens

Level V Radical specimens, gross and microscopic examination e.g. Radical neck dissection, mastectomy with axillary clearance, PL8307 400-450 Whipple's Wertheim's, vulvectomy with lymphadenectomy, any other radical dissections requiring margins and lymph node status

SPECIALISED HISTOPATHOLOGY

Lymphoproliferative disorders, including immunohistology-phenotyping PL1402 260-315 of lymphomas Liver for non-neoplastic conditions, muscle, including special stains, PL8310 190-220 report PL8331 Frozen section (with follow-up paraffin section report) 380-510 PL8346 Renal biopsy, including special stains and immunofluorescence 380-450

AUTOPSY

PL8045 Visit to scene of crime 380-650 PL8040 Procedure, forensic examination and report 650-2000 PL8041 Histopathology reporting 50-500

CYTOPATHOLOGY RM PL8104 Gynaecological smear report, screening and interpretation 45-50 PL8160 Non-gynaecological smear report 80-90 S4760 Aspiration Cytology Procedure (Code in Part B) MINOR 1 PL8173 Aspiration cytology, fine needle aspirate, report 150-200

PART A Page 27 PATHOLOGY (continued)

HAEMATOLOGY AND TRANSFUSION RM

PL5060 Report based on blood film, 40-65 HS8220 Bone marrow aspiration Procedure 250 HS8221 Bone marrow trephine Procedure 480 PL5097 Bone marrow aspiration, biopsy, report 125-250 PL5390 Report on coagulation tests, fibrinolysins, coagulopathy screen 65-130 Report on special haematological investigations e.g. folate-B12 status, PL5391 65-130 Coomb's test, Hb analysis, cytochemistry etc

Transfusion Services, difficult cross match, irregular antibody, PL6077 interpretation and report e.g. Discrepancies of grouping and 40-65 incompatibility of blood/blood products

Transfusion services, investigation of transfusion reaction, other problems PL6078 125-250 interpretation and report

Pheresis ) Harvesting of bone marrow ) See codes in Haematology Section, Part A Grafting of bone marrow )

GENETICS

PL8264 Chromosomes study immunofluorescence 125-380

PL8270 Immunophenotyping 125-380

PL8358 DNA content (ploidy) 125-380 PL1261 Gene rearrangement studies 125-380 PL6354 Lymphocyte subsets, B cells, NK cells, T cells CD4, CD8 125-380 PL8291 Report on molecular cytogenetic studies 125-380 PL6812 Human Leucocyte Antigen (HLA) typing 125-380

PL6910 Paternity testing 125-380

IMMUNOLOGY RM Report on general immunology test PL6319 40-70 e.g. Autoimmune disease screen, auto-antibodies screen Report on special immunological investigations e.g. Serum protein electrophoresis, CSF electrophoresis, immunotyping of PL6321 65-250 monoclonal proteins, immunophenotyping of immune disorders, investigations of proteinuria, cellular function studies

PART A Page 28 PATHOLOGY (continued)

MEDICAL MICROBIOLOGY

PL7020 Report on routine culture and sensitivity 12 - 18 PL7021 Report on special cultures 65-130 PL7022 Report on antimicrobial susceptibility testing by MIC (per test) 95-190 PL7023 Report on direct smears examination (Gram/Giemsa/Acid fast) 40-55 PL7024 Positive blood culture smear examination and preliminary report 130-190 Report on antigen detection (immunofluorescence, ELISA, PL7025 65-95 Latex/Coagulation) PL7026 Report on serological tests 40-55 PL7027 Report on special serological tests 65-130

Consultation on patient management, with consultation on patient management See Specialist Consultation Fees

Consultation on infection control ---See Specialist consultation fees

CHEMICAL PATHOLOGY

Report on General Chemistry Profiles PL7030 40-60 e.g. Liver, Bone, Cardiac PL7031 Report on General Chemistry Screen including Executive Screen 60-180 Report on Special Chemistry investigations e.g. Metabolic studies (lipid, PL7032 bone) endocrine disorders, toxicology studies, therapeutic drug 60-360 monitoring, maternal and foetal health assessment Report on Dynamic Studies PL7033 120-400 e.g. Function studies (GI, Endocrine, Renal)

Consultations:

Clinical chemical pathology consultation; investigation strategy; non- PL0500 80-140 analytical variations; drug interferences; with written report

Clinical chemical pathology consultation; comprehensive review and PL0502 100-150 correlation between clinical data and clinical information provided

MISCELLANEOUS PL8348 Electron microscopy, for diagnostic purpose 320-380

Second opinion: PL8321 Data interpretation and bone marrow slides 130-260 PL8323 Histopathology and Cytopathology 260-700 Comprehensive review of specimens and reports, including autopsy PL8325 findings 300-1500

PART A Page 29 PSYCHIATRY – PSYCHOTHERAPY

RM Individual psychotherapy – not less than 45 minutes per session, includes PSY0836 300 behaviour therapy and hypnotherapy

Marital Therapy per couple per session – for a couple together for not less PSY0837 300 than 45 minutes

Group psychotherapy – one hour per group of not less than three patients PSY0853 75 and not more than eight patients – per person

Family Therapy per family per session – not less than three members for PSY0847 300 not less than 45 minutes

Child Psychotherapy per session – including relevant family interviews for PSY0848 300 not less than 30 minutes

PSY0870 Each Electroconvulsive Therapy (E.C.T.), with monitoring 375

PSY0876 Cognitive Behaviour Therapy – individual session – up to 1 hour 300

Pain Management Program: Cognitive Behaviour Therapy – Group PSY0879 Therapy, Not less than 5 persons, not more than 10 persons – per person, 250 per day (8 hours)

PART A Page 30 RESPIRATORY MEDICINE

Lung Function Tests RM

RMC4100 Spirometry, measurement of forced expiratory flows, adult 50 Spirometry, measurement of forced expiratory flows, adult before and RMC4101 100 after inhalation of bronchodilator

Full lung function test, with diffusing capacity of carbon monoxide and RMC4750 250 plethysmography, volume, pressure measurement

Respiratory Support

RMC4660 Continuous positive airway pressure (CPAP), initiation, management 150

Application of ventilator, invasive or non-invasive, initiation, setting up of RMC4661 300 ventilator parameters, e.g. CPAP, BIPAP

Pulmonary rehabilitation or management counseling, including RMC4664 demonstration, evaluation of use of nebuliser, aerosol generator and 200 metered dose inhalers, use of oxygen generator (max. 1 hour)

Allergy Testing

Challenge test; inhalational bronchial challenge with Methacholine, ALC5070 200 Histamine, Saline, or similar substances.

Miscellaneous

SSC5808 Polysomnography, interpretation and report, any age 425

Note: 1. For other allergy testing through application of allergenic substances through skin refer to Allergy Testing in the Dermatology and Venereology Section in Part A, page 11

2. Invasive respiratory system procedures refer to the Cardiothoracic Surgery Section in Part B

PART A Page 31 RADIOLOGY (Doctors’ Professional Fees)

PLAIN RADIOGRAPHS RM CHEST 100000 Chest (Single view) 15 100001 Chest (Two views) 25 100002 Chest (Three views) 30 100003 Chest (Four views) 35

ABDOMEN 100010 Abdomen (Single view) 15 100011 Abdomen (Two views) 25 100012 Abdomen (Three views) 30 100013 Kidney, Ureter and Bladder (KUB) (Single view) 15 100014 Lateral pelvimetry 15 100015 AP & Lateral pelvimetry 30

SPINE 100020 Cervical spine (Single view) 15 100021 Cervical spine (Two views) 25 100022 Cervical spine (Three views) 30 100023 Cervical spine (Four views) 35 100024 Cervical spine (Five views) 40

100030 Thoracic spine (Single view) 15 100031 Thoracic spine (Two views) 25 100032 Thoracic spine (Three views) 30

100040 Lumbo-sacral spine (Single view) 15 100041 Lumbo-sacral spine (Two views) 25 100042 Lumbo-sacral spine (Three views) 30 100043 Lumbo-sacral spine (Four views) 35 100044 Skeletal survey 70

SKULL 100070 Skull (Single view) 15 100071 Skull (Two views) 25 100072 Skull (Three views) 30 100073 Skull (Four views) 35

FACIAL BONES 100080 Facial Bones (Single view) 15 100081 Facial Bones (Two views) 25 100082 Facial Bones (Three views) 30

100090 Nasal bones (Single view) 15

MANDIBLE 100100 Mandible (Single view) 15 100101 Mandible (Two views) 25 100102 Mandible (Three views) 30

PART A Page 32 RADIOLOGY (continued) (Doctors’ Professional Fees)

TEMPORO-MANDIBULAR JOINTS RM 100103 Temporo-mandibular Joints (Single view) 15 100104 Temporo-mandibular Joints (Two views) 25 100105 Temporo-mandibular Joints (Three views) 30 100106 Temporo-mandibular Joints (Four views) 35

MASTOIDS 100110 Mastoids (Single view) 15 100111 Mastoids (Two views) 25 100112 Mastoids (Three views) 30 100113 Mastoids (Four views) 40

PARANASAL SINUSES 100120 Paranasal Sinuses (Single view) 15 100121 Paranasal Sinuses (Two views) 25 100122 Paranasal Sinuses (Three views) 30

ORBITS 100140 Orbits (Two views) 15 100141 Orbits (Three views) 25 100142 Orbits (Four views) 30

EXTREMITIES UPPER EXTREMITY

SHOULDER 100160 Shoulder (Single view) 15 100161 Shoulder (Two views) 25 100162 Shoulder (Three views) 30 100163 Shoulder (Four views) 35 100164 Acriomo-clavicular joints - Both weight bearing 15

ARM (Humerus) 100170 Arm (Single view) 15 100171 Arm (Two views) 25

Elbow Joint 100180 Elbow Joint (Single view) 15 100181 Elbow Joint (Two views) 25 100182 Elbow Joint (Three views) 30 100183 Elbow Joint (Four views) 35

FOREARM (Radius/Ulna) 100190 Forearm (Single view) 15 100191 Forearm (Two views) 25

PART A Page 33 RADIOLOGY (continued) (Doctors’ Professional Fees)

WRIST JOINT RM 100200 Wrist Joint (Single view) 15 100201 Wrist Joint (Two views) 25 100202 Wrist Joint (Three views) 30 100203 Wrist Joint (Four views) 35

HAND 100210 Hand (Single - One view) 15 100211 Hand (Single - Two views) 25 100212 Hand (Single - Three views) 30 100213 Hand (Both - One view) 15 100214 Hand (Both - Two views) 25 100215 Hand (Both - Three views) 30 100216 Left Hand for bone age 15

THUMB OR SINGLE DIGIT 100220 Thumb or Single digit (Single view) 10 100221 Thumb or Single digit (Two views) 15

CLAVICLE 100230 Clavicle (Single view) 15 100231 Clavicle (Two views) 25

STERNO-CLAVICULAR JOINT 100232 Sterno-Clavicular Joint (Single view) 15 100233 Sterno-Clavicular Joint (Two views) 25 100234 Sterno-Clavicular Joint (Three views) 30 100235 Sternum - (Single view) 15

SCAPULA 100240 Scapula (Single view) 15 100241 Scapula (Two views) 25 100250 Scaphoid views (4 views) 30

LOWER EXTREMITY PELVIS 100050 Pelvis (Single view) 15 100051 Pelvis (Two views) 25 100052 Pelvis (Three views) 30

HIP JOINT 100270 Hip Joint (Single view) 15 100271 Hip Joint (Two views) 25 100272 Hip Joint (Three views) 30 100273 Hip Joint (Four views) 35 100274 Hip Joint (Five views) 40

PART A Page 34 RADIOLOGY (continued) (Doctors’ Professional Fees)

FEMUR (THIGH) RM 100280 Femur (Single view) 15 100281 Femur (Two views) 25

KNEE 100290 Knee (Single view) 15 100291 Knee (Two views) 25 100292 Knee (Three views) 30 100293 Knee (Four views) 35 100294 Knee (Five views) 40

LOWER LEG TIB/FIB 100300 Lower leg (Single view) 15 100301 Lower leg (Two views) 25

ANKLE 100310 Ankle (Single view) 15 100311 Ankle (Two views) 25 100312 Ankle (Three views) 30 100313 Ankle (Four views) 35 100314 Ankle (Five views) 40

FOOT 100330 Foot (Single view) 15 100331 Foot (Two views) 25 100332 Foot (Three views) 30

BOTH FEET 100334 Both Feet (Two views) 25 100335 Both Feet (Three views) 30

SUBTALAR JOINTS 100320 Subtalar Joints (Single view) 15 100321 Subtalar Joints (Two views) 25 100322 Subtalar Joints (Three views) 30 100323 Subtalar Joints (Four views) 35

CALCANEUM 100340 Calcaneum (Single view) 15 100341 Calcaneum (Two views) 25

BONE DENSITOMETRY 100350 Dexa 50 100351 Ultrasound 40

PART A Page 35 RADIOLOGY (continued) (Doctors’ Professional Fees)

RADIOGRAPHIC CONTRAST EXAMINATION RM 100360 Barium swallow 50 100361 Barium meal (double contrast) 75 100362 Barium meal and follow through 90 100363 Small bowel enema 90 100364 Gastrograffin or non-ionic contrast upper gastro-intestinal study 90 100365 Barium enema (single or double contrast) 90 100366 Gastrograffin or non-ionic contrast enema 90 100367 Loopogram 90 100368 Duodenal intubation 80 100380 Cystogram 100 100381 Ascending urethrogram 90 100382 Micturating cystourethrogram 90 100383 Retrograde pyelogram: one side 90 100384 Retrograde pyelogram: both side 120 100385 Ileal conduit study 90 100386 Nephrostomy: one side 60 100387 Nephrostomy: both side 90

100390 IVU standard dose contrast 90

100400 T-Tube cholangiogram 50 100401 Operative cholangiogram 50

100411 Hysterosalpingogram – reporting only 50 100413 Hysterosalpingogram with cannulation 200

100420 Sinogram 90

100430 Sialogram: Parotid one side 125 100431 Sialogram: Parotid bilateral 250

MAMMOGRAM 100470 Mammography (Unilateral) 60 100471 Mammography (Bilateral) 80

CT SCANS 100500 Brain (without contrast) 140 100501 Brain (with contrast) 180

100510 Abdomen (without contrast) 140 100511 Abdomen – single phase (with iv contrast) 200 100512 Abdomen – multiple phases (with iv contrast) 250

100520 Pelvis (without contrast) 140 100521 Pelvis (with iv contrast) 180

PART A Page 36 RADIOLOGY (continued) (Doctors’ Professional Fees)

CT SCANS (continued) RM 100530 Spines: Cervical or Lumbar (without iv contrast) 140 100531 Spines: Cervical or Lumbar (with iv contrast) 180 100540 Spines: Thoracic (without contrast) 140 100541 Spines: Thoracic (with iv contrast) 180

100550 Chest (without contrast) 140 100551 Chest (with iv contrast) 180

100553 Low dose screening CT of the chest 140 100554 HRCT - inspiratory 140 100555 HRCT - inspiratory + expiratory 200 100556 Chest and Upper abdomen (with iv contrast) 250

100557 CT Coronary angiogram 600 100558 CT Cardiac for calcium scoring 150

100560 Neck/Thyroid (without contrast) 140 100561 Neck/Thyroid (with non-ionic contrast) 180

100570 Postnasal space and neck (without contrast) 140 100571 Postnasal space and neck (with iv contrast) 180

100580 Orbits (without contrast) 75 100581 Orbits (with iv contrast) 125

100590 Pituitary fossa (without contrast) 75 100591 Pituitary fossa (with iv contrast) 125

100600 I.A.M. (without contrast) 75 100601 I.A.M. (without iv contrast) 125

100650 Total Body Scan (Brain, Neck, Chest, Abdomen & Pelvis) 300

100640 Chest, Abdomen and Pelvis (without contrast) 200 100641 Chest, Abdomen and Pelvis (with iv contrast) 300

100643 CTU (plain) 140 100644 CT Bronchogram 180 100645 CTU single phase (with iv contrast) 250 100646 CTU multiphase (with iv contrast) 300

Single plane high resolution CT of the parasanal sinuses for sinusitis 100610 100 (without contrast) 100612 Single plane CT of the parasanal sinuses (with iv contrast) 180 100620 Abdomen, Pelvis (without contrast) 200 100621 Abdomen, Pelvis (with iv contrast) 300

PART A Page 37 RADIOLOGY (continued) (Doctors’ Professional Fees)

CT SCANS (continued) RM 100623 CT Colonoscopy 500

100630 Chest, Upper Abdomen (without contrast) 250 100631 Chest, Upper Abdomen (with iv contrast) 300

100670 CT Extremities (without contrast - one region) 140 100671 CT Extremities (with iv contrast - one region) 180

100673 3D CT (additional professional fees only) 200 100674 CTA (additional processional fees only) 200

ULTRASOUND 100700 Upper Abdomen 60 100701 Pelvis 60 100702 Ultrasound Abdomen and Pelvis 75 100703 Kidneys and Bladder 60 100704 Kidneys and Bladder + residual urine volume estimation 70

100710 Brain (neonatal) 60

100720 Detailed ultrasound scan of foetus 250

100730 Thyroid 60

100740 Breast 60

100750 Doppler ultrasound of extra-cranial carotids 150 100760 Doppler ultrasound of arteries per region 90

100761 Doppler ultrasound of veins single limb 90 100762 Doppler ultrasound of veins two limbs 150 100763 Doppler ultrasound of arteries for single limb 180 100764 Doppler ultrasound of arteries for two limbs 280 100765 Doppler ultrasound for varicose veins 180 100766 Doppler ultrasound transcranial 180 100770 Musculoskeletal ultrasound per region (joint) 100

100780 Ultrasound scrotum 60 100781 Ultrasound scrotum with doppler 90

100790 Doppler ultrasound for other organs (per organ) not listed above 90

100810 Endo-cavitary ultrasound 100 100811 Ultrasound chest 50

Surcharge for each portable ultrasound payable to radiologist during 100840 100 normal working hours Surcharge for each portable ultrasound payable to radiologist after normal 100841 200 working hours

PART A Page 38 RADIOLOGY (continued) (Doctors’ Professional Fees)

SCREENING RM Endoscopic Retrograde Cholangio Pancreatography (screening and 100850 reporting only) 100852 Fluoroscopy for other procedures (professional fee only) 100

MRI 100900 Brain (without contrast) 240 100901 Brain (with iv contrast) 315 100902 Brain with MRA/MRV(intracranial) 420 100903 Brain + MRA + iv Contrast 480 100904 Brain + MRA + Bilateral Carotids + Contrast 630 100905 MRA intracranial or extracranial carotids 240

100915 Brain MRV sequence only 100

100920 Pituitary (without contrast) 240 100921 Pituitary (with iv contrast) 315 100922 Pituitary (with iv contrast dynamic) 420

100930 I.A.M (without contrast) 240 100931 I.A.M (with iv contrast) 315 100932 I.A.M + Brain (without contrast) 420 100933 I.A.M + Brain (with iv contrast) 480

ORBITS 100940 Orbits (without contrast) 240

100941 Orbits (with iv contrast) 315 100942 Orbits and Brain (without contrast) 420 100943 Orbits and Brain (with iv contrast) 480

NECK 100950 Neck (without contrast) 240 100951 Neck (with iv contrast) 315 100952 Neck and Brain (without contrast) 450 100953 Neck and Brain (with iv contrast) 510 100954 Brachial plexus (without contrast) 285 100955 Brachial plexus (with iv contrast) 360

THORAX 100960 Mediastinum (without contrast) 240 100961 Mediastinum (with iv contrast) 315

BREAST 100962 Breast (without contrast) 240 100963 Breast (with iv contrast) 315

PART A Page 39 RADIOLOGY (continued) (Doctors’ Professional Fees)

CARDIAC RM 100970 Cardiac MRI Morphology 315 100971 Cardiac MRI Coronary 315 100972 Cardiac MRI Functional 315 100973 Cardiac MRI Comprehensive 600

100975 Thoracic MRA 315 100976 Pulmonary MRA 315

UPPER ABDOMEN 100980 Upper abdomen – plain 315 100981 Upper abdomen – (with iv contrast) 360

100983 Magnetic resonance cholangiopancreatography (MRCP) 240 100984 Magnetic resonance Urography (MRU) 240

100985 Abdomen MRA 315

PELVIS 100990 Pelvis - plain 315 100991 Pelvis (with iv contrast) 360

100993 MRI Pelvimetry 150

100994 Abdomen and pelvis – plain 450 100995 Abdomen and pelvis (with iv contrast) 550

SPINE 101000 MRI whole spine (without contrast) 485 101001 MRI whole spine (with iv contrast) 555 101002 MRI cervical spine (without contrast) 315 101003 MRI cervical spine (with iv contrast) 420 101004 MRI thoracic spine (without contrast) 315 101005 MRI thoracic spine (with iv contrast) 420 101006 MRI lumbar spine (without contrast) 315 101007 MRI lumbar spine (with iv contrast) 420

EXTREMITIES (Joints = Shoulder, sternoclavicular, elbow, wrist, hip, sacro-iliac, knee, ankle, sub-tarsal) 101010 MRI Single joint (without contrast) 315 101011 MRI Single joint (with iv contrast) 420

(Region=arm, forearm, hand, thigh, lower leg-calf, foot) 101012 MRI Single region (without contrast) 360 101013 MRI Single region (with iv contrast) 450

101015 MR Spectroscopy (Additional Radiologist fee) 300 101020 MRI additional sequence 100

PART A Page 40 RELATIVE VALUE TABLE AND CONVERSION FACTOR MPSN 5TH EDITION, 2008

OPERATOR/SURGEON 1 2 3 4 5

MINOR RM325 RM400 RM425 RM500 RM600

INTER RM800 RM900 RM1,100 RM1,250 RM1,400

MAJOR RM1,700 RM1,900 RM2,050 RM2,250 RM2,400

MAJOR PLUS RM2,500 RM2,750 RM2,900 RM3,000 RM3,200

COMPLEX MAJOR RM3,500 RM4,000 RM5,250 RM6,500 RM7,750

ANAESTHETIST 1 2 3 4 5

MINOR RM275 RM275 RM275 RM275 RM275

INTER RM345 RM385 RM450 RM475 RM550

MAJOR RM625 RM675 RM750 RM825 RM900

MAJOR PLUS RM1,025 RM1,100 RM1,250 RM1,450 RM1,700

COMPLEX MAJOR RM2,000 RM2,300 RM2,750 RM3,250 RM3,600

PART A Page 41 RELATIVE VALUE TABLE AND CONVERSION FACTOR PHFSA REGULATIONS, SCHEDULE 13, REVISED 2013 (Fee adjustment gazetted in 2013. The new fee was increased by 14.4% from the fees gazetted in 2006)

OPERATOR/SURGEON 1 2 3 4 5

MINOR RM315 RM370 RM405 RM480 RM580

INTER RM725 RM865 RM1,000 RM1,160 RM1,340

MAJOR RM1,565 RM1,760 RM1,890 RM2,040 RM2,145

MAJOR PLUS RM2,305 RM2,390 RM2,480 RM2,570 RM2,705

COMPLEX MAJOR RM2,895 RM3,600 RM4,750 RM5,970 RM7,030

ANAESTHETIST 1 2 3 4 5

MINOR RM265 RM265 RM265 RM265 RM265

INTER RM315 RM355 RM405 RM435 RM505

MAJOR RM570 RM625 RM685 RM760 RM820

MAJOR PLUS RM940 RM985 RM1,125 RM1,320 RM1,550

COMPLEX MAJOR RM1,815 RM2,110 RM2,500 RM2,930 RM3,305

PART A Page 42

PART B

SCHEDULE OF PROCEDURES SIMPLE INVESTIGATIONS AND PROCEDURES

CODE NARRATIVE

INVESTIGATIONS 20110 ECG See Cardiology 20150 Patch testing See Dermatology 20210 Air conduction audiogram See ENT procedures 20220 Audiogram with other cochlear test See ENT procedures 20230 Impedance audiogram See ENT procedures 20240 Impedance audiogram as part of other procedure See ENT procedures

Surgeons' Anaesthetists' CODE NARRATIVE Category Category

PROCEDURES 25000 Incision and drainage MINOR 1 MINOR H2510 Rigid sigmoidoscopy including biopsy MINOR 1 MINOR H5230 Injection of sclerosing substance into haemorrhoids MINOR 1 MINOR H5240 Banding of haemorrhoids MINOR 1 MINOR L8600 Injection into varicose vein(s) of leg MINOR 1 MINOR S1110 Curettage/cryotherapy of lesion of skin including cauterisation MINOR 1 MINOR S1500 Biopsy of skin or subcutaneous tissue MINOR 1 MINOR S1510 Percutaneous biopsy (not elswhere specified) MINOR 1 MINOR S4780 Aspiration of subcutaneous haemotoma MINOR 1 MINOR S5210 Injection into subcutaneous tissue/painful trigger point MINOR 1 MINOR (including local anaesthetic and steroid) S5300 Introduction of substance into skin (including hormone pellet) MINOR 1 MINOR V4800 Injection around apophyseal facet(s) of vertebra(ae) without x-ray MINOR 1 MINOR control W3630 Diagnostic aspiration of cysts, joints, cavities MINOR 1 MINOR W9040 Injection into joint(s) without x-ray control MINOR 1 MINOR X4810 Application of plaster cast (where this is the sole procedure) MINOR 1 MINOR

PART B Page 1 GENERAL PROCEDURES

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

GENERAL PROCEDURES 20130 Exercise ECG Refer Cardiology Part A 20140 Continuous ECG Holter monitoring Refer Cardiology Part A 64300 Echocardiography Refer Cardiology Part A 25010 Paravertebral block (without x-ray control) MINOR 4 MINOR 25022 Stellate ganglion block (local anaesthetic) MINOR 4 MINOR P2730 Colposcopy (+/- biopsy) MINOR 3 MINOR 5 Q2020 Endometrial biopsy or aspiration MINOR 3 MINOR 5 S4760 Fine needle aspiration cytology MINOR 1 MINOR S7010 Wedge excision or avulsion of nail including chemical ablation of MINOR 4 INTER 1 nail bed X4880 Application of plaster jacket, hip spica, long leg cast, or cast brace MINOR 3 MINOR 5

PART B Page 2 BRAIN, CRANIUM AND OTHER INTRACRANIAL ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

BRAIN A1250 Creation of subcutaneous cerebrospinal fluid reservoir MAJOR 4 MAJOR 5 A1240 Creation of ventriculoperitoneal shunt MAJOR 4 MAJOR 5 A1220 Creation of ventriculovascular anastomosis MAJOR 4 MAJOR 5 A1810 Diagnostic endoscopic examination and biopsy of lesion of MAJOR + 4 MAJOR + 2 ventricle of brain A0181 Excision intracranial-extracerebral tumour CMO 4 CMO 4 A0182 Excision of difficult skull base tumour CMO 5 CMO 5 A0180 Excision of abscess of brain CMO 3 CMO 2 A0200 Excision of lesion of tissue of brain CMO 4 CMO 3 B0610 Excision of pineal region, brain stem, deep seated midline lesion CMO 5 CMO 5 B0410 Excision of Pituitary Gland lesion, Craniotomy/transphenoidal CMO 5 CMO 5 A0183 Excision/repair of encephalocoele CMO 2 CMO 2 A0110 Hemispherectomy CMO 5 CMO 5 A0900 Implantation/removal of neurostimulator from brain (any route) MAJOR 5 MAJOR 5 A1441 Insertion of Neurostimulator in brain and spine CMO 3 CMO 3 A1442 Insertion of Ventricular catheter for ICP monitoring MAJOR 2 MAJOR 2 A1440 Irrigation of cerebroventricular shunt/tapping, reprogramming MINOR 5 INTER 4 A1443 Leucotomy, Lobotomy for psychiatric causes CMO 3 CMO 3 A1300 Maintenance of cerebroventricular shunt (including revision) MAJOR 1 MAJOR 3 A0400 Open biopsy of lesion of tissue of brain CMO 2 MAJOR + 5 A1430 Removal of cerebroventricular shunt INTER 5 INTER 5 A0300 Stereotactic ablation of tissue of brain, pallidectomy, biopsy CMO 3 CMO 1 A0500 Stereotactic radiosurgery of brain CMO 3 CMO 3 A0600 Surgery for movement disorder, including deep brain stimulation CMO 4 CMO 4 A0700 Surgery for epilepsy, corpus callosum section, corticectomy, etc. CMO 4 CMO 4 A1700 Therapeutic endoscopic operations on ventricle of brain MAJOR + 4 MAJOR + 2 A2080 Ventricular puncture INTER 3 INTER 5 A1210 Ventriculocisternostomy CMO 2 MAJOR + 5

PART B Page 3 BRAIN, CRANIUM AND OTHER INTRACRANIAL ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

CRANIUM V0180 Craniostenosis (for more than one suture) CMO 2 CMO 2 V0130 Craniostenosis (for single suture) MAJOR + 3 MAJOR + 1 W1880 Drainage of skull INTER 5 INTER 5 V0530 Elevation of depressed fracture of cranium MAJOR 3 MAJOR + 1 V0510 Excision of lesion of cranium MAJOR 5 MAJOR 5 V0520 Excision of tumour, cyst of scalp INTER 4 INTER 4 V0330 Exploratory burrhole of cranium (Unilateral) MAJOR + 1 MAJOR 5 V0340 Exploratory burrhole of cranium (Bilateral) MAJOR + 5 MAJOR + 4 V0310 Exploratory open craniotomy MAJOR + 5 MAJOR + 4 V0390 Foramen Magnum decompression CMO 3 CMO 1 A4280 Intracranial infection: burr hole MAJOR 3 MAJOR 4 V0380 Petrosectomy CMO 2 CMO 2 V0100 Plastic repair of cranium MAJOR + 5 MAJOR + 4 V0110 Reconstructive cranioplasty MAJOR + 5 MAJOR + 4 V0120 Repair of compound fracture of cranium with dural penetration MAJOR + 5 MAJOR + 5 V0580 Repair of compound fracture of cranium with no dural penetration MAJOR + 4 MAJOR + 4 V0560 Repair of skull fracture with CSF fistula MAJOR + 5 MAJOR + 5 V0570 Toilette and suture of scalp laceration MINOR 5 MINOR 5 V0590 Ventricular puncture INTER 3 INTER 3

MENINGES A2200 Cisternal puncture INTER 2 INTER 2 A2210 Drainage of subrarachnoid space of brain MAJOR 1 MAJOR 2 A4010 Evacuation of extradural haematoma (Intracranial Hematoma) CMO 2 MAJOR + 4 A4110 Evacuation of subdural haematoma or abscess CMO 2 MAJOR + 4 A3810 Excision of lesion of meninges brain CMO 5 CMO 3 A3830 Operation of arachnoidal cyst MAJOR + 5 MAJOR + 3 A3900 Repair of dura CMO 2 MAJOR + 4 A4180 Subdural haemorrahage - tap MINOR 1 INTER 4

NERVES A3200 Decompression of cranial nerve (caraniotomy) CMO 4 CMO 3 A3100 Decompression of facial nerve entrapment (mastoid portion) CMO 2 CMO 2 A2950 Excision of acoustic neuroma CMO 5 CMO 4 A3680 Excision of cerebellopontine angle tumour CMO 5 CMO 4 A2900 Excision of lesion of cranial nerve (intracranial) CMO 5 CMO 4 A2500 Intracranial transection of cranial nerve CMO 4 CMO 4 A3300 Neurostimulation of cranial nerve (intracranial) MAJOR 5 MAJOR 4 A2600 Other intracranial destruction of cranial nerve CMO 4 CMO 4 A3330 Removal of neurostimulator from cranial nerve MAJOR 3 MAJOR 2 A3000 Repair of cranial nerve (intracranial) CMO 1 CMO 1

PART B Page 4 BRAIN, CRANIUM AND OTHER INTRACRANIAL ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

VESSELS A4020 Clipping/excision/endovascular procedure for spinal cord CMO 4 CMO 4 aneurysm, AVM A4030 Clipping of giant, complexaneurysm/AVM CMO 5 CMO 5 A4080 Craniotomy-postoperative haemorrhage MAJOR + 5 MAJOR + 4 L7545 Excision of arteriovenous malformation CMO 5 CMO 2 A4040 Excision of carotid body tumour CMO 4 CMO 4 A4050 Internal carotid-external carotid bypass CMO 4 CMO 4 L3320 Ligation/clipping of aneurysm of cerebral artery CMO 4 CMO 3 L3400 Open operations on cerebral artery CMO 4 CMO 3 L3380 Reinforcement of aneurysm of cerebral artery CMO 4 CMO 3

OTHERS A8300 Electro-convulsive therapy MINOR 1 MINOR B0100 Hypophysectomy CMO 4 CMO 3 B0210 Cryotherapy to pituitary gland MAJOR + 4 MAJOR + 4

PART B Page 5 SPINE, SPINAL CORD AND PERIPHERAL NERVES

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

CERVICAL REGION V2200 Primary posterior decompression including fusion CMO 2 MAJOR + 4 V2280 Primary posterior decompression with fusion and instrumentation CMO 3 MAJOR + 5 V2990 Open door laminoplasty of the cervical region (Hirobyashi) CMO 3 CMO 1 V2300 Revision posterior decompression including fusion CMO 4 CMO 2 V2380 Revision posterior decompression with fusion and instrumentation CMO 5 CMO 2 V2310 Revision anterior decompression incuding fusion CMO 4 CMO 2 V2390 Revision anterior decompression with fusion and instrumentation CMO 5 CMO 2 V2980 Combined anterior and posterior fusion of cervical spine, including CMO 5 CMO 3 instrumentation V3730 Trans oral surgery including posterior fixation CMO 4 CMO 2 V2910 Primary posterior excision of cervical disc CMO 1 MAJOR + 4 V3000 Revision posterior excision of intervertebral disc(s) including fusion CMO 3 CMO 1 V3010 Revision posterior excision of intervertebral disc(s) with bone grafting, CMO 4 CMO 2 fusion and instrumentation V2940 Primary anterior excision of disc(s), including fusion, bone grafting CMO 2 MAJOR + 4 V2950 Primary anterior excision of disc(s), with fusion and instrumentation CMO 3 MAJOR + 4 V3040 Revision anterior excision of disc(s), including fusion, bone grafting CMO 4 CMO 1 V3050 Revision anterior excision of disc(s), with fusion, bone grafting and CMO 5 CMO 3 instrumentation V3060 Screw fixation of odontoid/lesion of C1/C2 CMO 5 CMO 5 V3070 Vertebrectomy, bone grafting, fusion, instrumentation CMO 5 CMO 3 V3080 Artificial cervical disc replacement (including excision of disc) CMO 2 MAJOR + 5

THORACIC REGION V3110 Primary transthoracic/posterior/antero-lateral excision of intervertebral CMO 1 MAJOR + 4 disc(s), including fusion V3180 Primary transthoracic/posterior/antero-lateral excision of intervertebral disc(s) with bone grafting, fusion and instrumentation CMO 1 MAJOR + 4

V2400 Primary posterior decompression, including bone grafting and fusion CMO 2 MAJOR + 4 V2410 Primary posterior decompression, with bone grafting, fusion and CMO 2 MAJOR + 4 instrumentation V2431 Revision posterior decompression - with bone grafting, fusion and CMO 3 CMO 1 instrumentation V2420 Primary anterior/transthoracic decompression, including fusion and CMO 3 CMO 1 bone grafting V2421 Primary anterior/transthoracic decompression with bone grafting, fusion CMO 4 CMO 2 and instrumentation V2480 Revision anterior/transthoracic decompression, including fusion CMO 5 CMO 2 V2490 Vertebroplasty/Kyphoplasty MAJOR 5 MAJOR 4 V2422 Endoscopic thoracic discectomy CMO 1 MAJOR + 4

PART B Page 6 SPINE, SPINAL CORD AND PERIPHERAL NERVES

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

LUMBAR REGION V3310 Primary posterior excision of intervertebral disc(s), including fusion MAJOR + 2 MAJOR + 1 V3360 Primary posterior excision of intervertebral disc(s) with fusion and CMO 2 MAJOR + 5 instrumentation (including Graf Stabilisation) V3410 Revision posterior excision of intervertebral disc(s), including fusion CMO 3 MAJOR + 3 V3450 Revision posterior excision of intervertebral disc(s), with fusion and CMO 4 CMO 1 instrumentation V3330 Primary transabdominal/retro-peritoneal excision of intervertebral CMO 3 MAJOR + 4 disc(s), including fusion and instrumentation V3430 Revision anterior excision of intervertebral disc(s), including fusion CMO 4 CMO 2 V3460 Revision anterior excision of intervertebral disc(s) - with fusion and CMO 5 CMO 3 instrumentation V2530 Primary posterior decompression on spine, including fusion CMO 1 MAJOR + 2 V2550 Primary posterior decompression with fusion and instrumentation CMO 2 MAJOR + 4 V2650 Revision posterior decompression with fusion and instrumentation CMO 3 CMO 1 V2520 Primary anterior decompression including fusion CMO 2 MAJOR + 5 V2580 Primary anterior decompression with fusion and instrumentation CMO 3 MAJOR + 5 V2680 Revision anterior decompression with fusion and instrumentation CMO 4 CMO 2 V2590 Combined anterior and posterior decompression including fusion and CMO 5 CMO 3 instrumentation V4100 Posterior spinal fusion with instrumentation for scoliosis, kyphosis, CMO 5 CMO 3 fractures, tumours or infection V4120 Anterior spinal fusion with instrumentation - for scoliosis, CMO 5 CMO 3 kyphosis, fractures, tumours or infection V3300 Percutaneous (or laser) disc(s)ectomy MAJOR + 2 MAJOR + 1 V3370 Microdisc(s)ectomy MAJOR + 2 MAJOR + 1 V3470 Revision Microdisc(s)ectomy CMO 1 MAJOR + 3 V4130 Removal of correctional instrumentation from spine MAJOR 1 MAJOR 2 V4900 Exploration of spine including biopsy MAJOR 3 MAJOR 3 V5000 Manipulation of spine MINOR 5 INTER 3 V5210 Chemonucleoysis INTER 4 INTER 4 V5220 Vertebroplasty/Kyphoplasty MAJOR 5 MAJOR 4 V5230 Endoscopic lumbar discectomy MAJOR + 2 MAJOR 5 V5240 Artificial lumbar disc replacement CMO 3 CMO 1 V5250 Primary lumbar transforaminal lumbar interbody fusion (TLIF)/ CMO 4 CMO 2 posterior lumbar interbody fusion (PLIF) V5260 Revision lumbar transforaminal lumbar interbody fusion (TLIF)/ CMO 5 CMO 3 posterior lumbar interbody fusion (PLIF) V5270 Epidural Lysis, including use of radio frequency thermocoagulation MAJOR 3 MAJOR 3

PART B Page 7 SPINE, SPINAL CORD AND PERIPHERAL NERVES

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

SPINAL CORD A5300 Drainage of spinal canal hydromyelia/syringomyelia, MAJOR + 5 MAJOR + 3 decompression (including insertion of shunt) A5110 Excision of intradural lesion CMO 3 MAJOR + 5 V4980 Excision of intramedullary tumour CMO 3 MAJOR + 5 A5530 Lumbar puncture (including spinal manometry) MINOR 2 MINOR A4500 Open operations on spinal cord, laminectomy, cordostomy, CMO 3 MAJOR + 5 myelostomy A4400 Partial excision of spinal cord CMO 3 MAJOR + 5 A4900 Repair of spinal myelomeningocele, extensive CMO 2 MAJOR + 4 A4950 Repair of spinal myelomeningocele, simple MAJOR + 3 MAJOR + 3

NERVE ROOTS A5780 Rhizolysis (open) MAJOR + 5 MAJOR + 1

SYMPATHETIC NERVES A7530 Laparoscopic/open lumbar sympathectomy (Bilateral) CMO 2 MAJOR + 5 A7540 Laparoscopic/open lumbar sympathectomy (Unilateral) MAJOR + 3 MAJOR + 3 A7580 Presacral sympathectomy MAJOR 1 MAJOR 3 A7560 Thoracoscopic/open cervical sympathectomy (Bilateral) CMO 2 CMO 2 A7510 Thoracoscopic/open cervical sympathectomy (Unilateral) MAJOR + 3 MAJOR + 1

PERIPHERAL NERVES A7310 Exploration/neurolysis/biopsy of peripheral nerve INTER 2 INTER 2 A6510 Carpal or cubital tunnel release including endoscopic INTER 2 INTER 4 A6580 Carpal or cubital tunnel release including endoscopic (Bilateral) MAJOR 1 MAJOR 4 A6180 Excision of lesion (major nerve) INTER 5 INTER 5 A6110 Excision of lesion of peripheral nerve INTER 3 INTER 4 A5900 Excision of peripheral nerve INTER 2 INTER 4 A7340 Exploration and grafting of brachial plexus CMO 2 CMO 2 A7010 Implantation of neurostimulator into peripheral nerve MAJOR 4 MAJOR 4 A6080 Neurectomy (major nerve) INTER 5 INTER 5 A6810 Neurolysis and transposition of peripheral nerve INTER 3 INTER 5 A6310 Primary graft to peripheral nerve MAJOR + 2 MAJOR 4 A6440 Primary repair of nerve trunk INTER 3 INTER 5 A6420 Primary repair of peripheral nerve INTER 2 INTER 5 A6210 Primary repair of peripheral nerve including microsurgery MAJOR 4 MAJOR 5 A6600 Release of entrapment of deeply placed peripheral nerve INTER 2 INTER 4 A6700 Release of entrapment of peripheral nerve INTER 2 INTER 4 A6900 Revision of release of peripheral nerve MAJOR 1 MAJOR 1 A6320 Secondary graft to peripheral nerve MAJOR + 2 MAJOR 4 A6480 Secondary repair of nerve trunk MAJOR 1 INTER 5

PART B Page 8 SPINE, SPINAL CORD AND PERIPHERAL NERVES

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

PERIPHERAL NERVES (continued) A6430 Secondary repair of peripheral nerve INTER 4 INTER 4 A6220 Secondary repair of peripheral nerve including microsurgery MAJOR 5 MAJOR 4 A6030 Transection of peripheral nerve INTER 2 INTER 4

PAIN RELIEF 25010 Paravertebral block (without x-ray control) MINOR 4 MINOR 25011 Paravertebral block up to two levels (under x-ray control) MINOR 5 MINOR 25012 Sacral root block (under x-ray control) MINOR 5 MINOR 25022 Stellate ganglion block (local anaesthetic) MINOR 4 MINOR 25030 Stellate ganglion block (neurolytic/radiofrequency) MINOR 5 MINOR 25100 Coeliac plexus block (local anaesthetic) INTER 4 INTER 4 25110 Splanchnic nerve block - bilateral (local anaesthethic) INTER 4 INTER 4 25120 Dorsal root ganglion block (local anaesthetic or neurolytic) INTER 3 INTER 3 25130 Dorsal root ganglion block (radio frequency) MAJOR 1 MAJOR 1 25140 Intrathecal neurolysis INTER 4 INTER 4 25150 Trigeminal ganglion injection (local anaesthetic under x-ray control) INTER 4 INTER 4 25160 Trigeminal ganglion radio frequency lesion (under x-ray control) MAJOR 5 MAJOR 5 A4730 Percutaneous cordotomy of spinal cord MAJOR + 5 MAJOR + 3 A5200 Epidural injection (cervical) INTER 1 INTER 1 A5210 Epidural injection (lumbar) MINOR 4 INTER 1 A5220 Epidural injection (thoracic) INTER 1 INTER 1 A5420 Injection of therapeutic substance into CSF MINOR 2 MINOR A5720 Facet or sacroiliac joint (RF) radio frequency thermocoagulation including rhizolysis (under x-ray control with sedation/GA) - 3 INTER 4 INTER 4 joints A5730 Facet or sacroiliac joint (RF) radio frequency thermocoagulation including rhizolysis (under x-ray control with sedation/GA) - 6 MAJOR 4 MAJOR 4 joints A5750 Facet joint injection (under x-ray control with sedation/GA) - 2 joints INTER 1 INTER 1 A5760 Facet joint injection (under x-ray control with sedation/GA) - 4 joints INTER 2 INTER 2 A5770 Facet joint injection (under x-ray control with sedation/GA) - 6 joints INTER 3 INTER 3 A7010 Implantation of neurostimulator into peripheral nerve MAJOR 4 MAJOR 4 A7300 Peripheral nerve lesion (radio frequency, cryoprobe or phenol) INTER 1 INTER 1 A7350 Local anaesthetic blockade of major nerve trunk, nerve entrapment MINOR 2 MINOR injection A7500 Lumbar sympathectomy: diagnostic (local anaesthetic under x-ray INTER 3 INTER 2 control) A7520 Thoracic sympathectomy: diagnostic (local anaesthetic under x-ray INTER 4 INTER 3 control) A7600 Lumbar sympathectomy: therapeutic (neurolytic under x-ray INTER 5 INTER 5 control)

PART B Page 9 SPINE, SPINAL CORD AND PERIPHERAL NERVES

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

PAIN RELIEF (continued) A7620 Thoracic sympathectomy: diagnostic (radio frequency under x-ray MAJOR 1 INTER 5 control) B0210 Cryotherapy to pituitary gland MAJOR + 4 MAJOR + 1 W9030 Injection(s) into large joint(s) under x-ray control MINOR 4 MINOR A7650 Medial branch block - lumbar or thoracic, 2-4 levels, under x-ray INTER 1 MINOR control A7655 Medial branch block - cervical 2-4 levels, under x-ray control INTER 3 INTER 1 A7660 Radiofrequency lesions of medial branches - cervical, thoracic and MAJOR 1 INTER 4 lumber, 2-4 levels under x-ray control A7665 Epidural steroid injection - lumbar and thoracic MINOR 5 MINOR 5 A7670 Implanted epidural or intrathecal catheter - thoracic or lumbar, MAJOR 4 MAJOR 5 under x-ray control A7675 Intercostal nerve block - local anaesthetic MINOR 4 INTER 1 A7680 Intercostal nerve block - neurolytic MINOR 5 INTER 1 A7685 Interpleural block with catheter - local anaesthetic MINOR 4 INTER 1 A7690 Plexus block with catheter - local anaesthetic MINOR 4 INTER 1 A7695 Spinal cord stimulator implantation MAJOR + 1 MAJOR + 1 A7699 Coeliac plexus block (neurolytic) MAJOR 1 MAJOR 1

NEUROPHYSIOLOGICAL PROCEDURES A8300 Electro-convulsive therapy MINOR 1 INTER 1 22000 Electroencephalography (EEG) MINOR 1 MINOR 22011 Recording and reporting on evoked potential study MINOR 5 MINOR 22020 Recording and reporting on electromyography and nerve MINOR 5 MINOR conduction studeis (EMG) A8480 Trans tympanic electro-cochleography INTER 1 INTER 1

PART B Page 10 EYE AND ORBITAL CONTENTS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

GLOBE AND ORBIT C0110 Exenteration of orbit CMO 4 CMO 2 C0120 Enucleation of eyeball MAJOR 4 MAJOR 3 C0210 Excision of extraconal lesion CMO 4 CMO 2 C0310 Excision of intraconal lesion CMO 4 CMO 2 C0510 Reconstruction of cavity of orbit CMO 5 CMO 3 C0610 Biopsy of lesion of orbit INTER 4 INTER 5 C0620 Drainage of orbit INTER 5 INTER 3 C0630 Decompression of orbit CMO 2 MAJOR + 4 C0640 Removal of foreign body from orbit MAJOR + 2 MAJOR + 2 C0650 Exploration of orbit CMO 1 MAJOR + 3 C0820 Open reduction of fracture of orbit and floor construction CMO 2 MAJOR + 4 C0840 Retrobullar/Periocular injection INTER 1 MINOR C0845 Orbital floor exploration CMO 2 MAJOR + 4 C0850 Orbital floor exploration and grafting of fracture CMO 4 CMO 2 C0855 Optic nerve sheath decompression/fenestration CMO 2 MAJOR + 4 C0860 Primary insertion of orbital implant MAJOR + 2 MAJOR 5 C0865 Secondary insertion of orbital implant CMO 1 MAJOR + 2 C0870 Evisceration of eyeball MAJOR 4 MAJOR 4

EYEBROW AND LID C1010 Excision of lesion of eyebrow MINOR 5 INTER 3 C1040 Suture of eyebrow MINOR 4 INTER 3 C1110 Excision of lesion of canthus INTER 3 INTER 5 C1130 Correction of epicanthus MAJOR 1 MAJOR 2 C1140 Correction of telecanthus MAJOR + 1 MAJOR + 2 C1160 Canthotomy/curettage MINOR 5 INTER 5 C1240 Excision/curettage/cryotherapy of lesion of eyelid(s) MINOR 4 MINOR C1420 Graft of skin to eyelid INTER 3 INTER 5 C1510 Correction of ectropion (Unilateral) INTER 4 INTER 3 C1520 Correction of entropion (Unilateral) INTER 4 INTER 3 C1530 Correction of trichiasis MINOR 3 INTER 3 C1640 Tarsorrhaphy INTER 2 INTER 3 C1700 Total reconstruction of eyelid (Unilateral) CMO 3 MAJOR + 5 C1710 Suture of eyelid (laceration) INTER 1 INTER 5 C1780 Total reconstruction of eyelid (Bilateral) CMO 4 CMO 2 C1810 Correction of Ptosis MAJOR + 1 MAJOR + 1 C1850 Tarsomullerectomy MAJOR 2 MAJOR 1 C1910 Drainage of lesion of eyelid MINOR 2 INTER 2 C2220 Biopsy of lesion of eyelid INTER 1 INTER 3 C2225 Botulinium injection INTER 1 MINOR

PART B Page 11 EYE AND ORBITAL CONTENTS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

EYEBROW AND LID (continued) C2310 Correction of Epiblepharon INTER 4 INTER 3 C2320 Corrective Canthopexy (Unilateral) MINOR 4 MINOR C2330 Eyelid reconstruction with grafts CMO 1 MAJOR + 3 C2340 Ptosis repair by tarsal plate reduction (Bilateral) MAJOR + 2 MAJOR + 2 C2350 Ptosis repair by tarsal plate reduction (Unilateral) INTER 5 INTER 5 C2360 Ptosis repair with tendon grafts (Bilateral) CMO 1 MAJOR + 5 C2370 Removal of lid sutures MINOR 1 MINOR C2380 Removal of eyelashes by electrolysis/laser/cryotherapy MINOR 2 MINOR

LACRIMAL SYSTEM C2510 Canaliculo-dacryocysto-rhinostomy CMO 1 MAJOR + 4 C2520 Conjunctivo-dacryocysto-rhinostomy CMO 1 MAJOR + 4 C2530 Dacryocysto-rhinostomy with/without insertion of tube CMO 1 MAJOR + 5 C2610 Excision of lacrimal sac INTER 4 INTER 5 C2630 Biopsy of lacrimal sac MINOR 5 INTER 5 C2640 Incision of lacrimal sac MINOR 4 INTER 3 C2730 Syringing of nasolacrimal system under G.A. MINOR 4 INTER 1 C2750 Probing of nasolacrimal sac under G.A. INTER 1 INTER 2 C2910 Repair of torn canaliculus MAJOR + 1 MAJOR 5 C2920 Dilation of lacrimal punctum under G.A. MINOR 2 MINOR C2930 Punctal occlusion MINOR 2 MINOR C2940 Endoscopic DCR CMO 2 MAJOR + 4

MUSCLES C3110 Surgical correction of squint (one or both eyes) MAJOR 4 MAJOR 4 C3180 Revision of squint (one or both eyes) MAJOR + 3 MAJOR + 1 C3410 Tenotomy of muscle (one or both eyes) MAJOR 2 MAJOR 5 C3510 Transposition of muscle (one or both eyes) MAJOR + 3 MAJOR + 1 C3530 Surgical correction of squint with adjustable sutures (one or both MAJOR + 4 MAJOR + 1 eyes) C3580 Revision of squint surgery with adjustable sutures (one or both CMO 2 MAJOR + 4 eyes) C3780 Correction of squint with botulinum toxin INTER 5 INTER 4

PART B Page 12 EYE AND ORBITAL CONTENTS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

CONJUNCTIVA C3910 Excision of conjunctival lesion INTER 3 INTER 5 C3920 Cauterisation/Cryotherapy to conjunctival lesion MINOR 4 INTER 5 C3950 Radiotherapy to conjunctival lesion MINOR 5 INTER 5 C4010 Mucous membrane graft MAJOR + 1 MAJOR 3 C4050 Suture of conjunctiva INTER 1 INTER 5 C4080 Removal of suture of conjunctiva MINOR 2 INTER 5 C4100 Drainage of conjunctival cyst MINOR 2 INTER 5 C4310 Division of adhesions of conjunctiva MINOR 4 INTER 5 C4320 Biopsy of lesion MINOR 4 INTER 5 C4340 Subconjunctival injection MINOR 2 INTER 4 C4350 Exploration of conjunctiva (including removal of foreign body) MINOR 4 INTER 4 C4360 Conjunctival/Limbal graft INTER 4 INTER 3 C4370 Primary Pterygiun excision INTER 5 INTER 5 C4380 Pterygium excision-secondary/recurrent MAJOR + 1 MAJOR 5

CORNEA C4520 Excision of lesion of cornea MAJOR 1 MAJOR 3 C4540 Cryotherapy of lesion MINOR 5 INTER 4 C4620 Lamellar keratoplasty CMO 2 MAJOR + 5 C4630 Penetrating keratoplasty CMO 1 MAJOR + 4 C4710 Repair of corneal wound MAJOR 1 MAJOR 5 C4730 Removal of corneal suture MINOR 4 INTER 4 C4810 Removal of superficial foreign body MINOR 3 INTER 4 C4980 Tension sutures INTER 5 MAJOR 2 C5120 Chelation of cornea INTER 1 INTER 3 C5140 Tattooing of cornea INTER 1 INTER 3 C5180 Scraping for culture MINOR 3 INTER 3 C5185 Amniotic membrane graft MAJOR + 2 MAJOR 5 C5190 Anterior stromal puncture MINOR 4 MINOR C5195 Astigmatic keratotomy MAJOR 1 MAJOR 1 C5200 Conductive keratoplasty INTER 5 INTER 4 C5205 Gluing INTER 1 MINOR C5210 Intracorneal ring/Lens/Implant MAJOR + 2 MAJOR + 2 C5215 Lasik/Lasek/Epilasik MAJOR + 2 MAJOR + 2 C5220 Limbal stem cell transplantation MAJOR + 2 MAJOR + 2 C5225 Permanent keratoprosthesis CMO 5 CMO 3 C5230 Photorefractive/phototherapeutic keratectomy (PRK/PTK) MAJOR 2 MAJOR 2 C5235 Refractive keratoplasty MAJOR + 2 MAJOR 5 C5240 Removal of Lasik flap striae INTER 2 INTER 1 C5245 Suture of Lasik flap MAJOR 2 MAJOR 2 C5250 Temporary keratoprosthesis CMO 3 CMO 1 C5255 Washout of Lasik flap INTER 2 INTER 1

PART B Page 13 EYE AND ORBITAL CONTENTS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

SCLERA C5300 Excision of lesion MAJOR 5 MAJOR 5 C5720 Repair of scleral laceration MAJOR 5 MAJOR 5 C5730 Scleral graft MAJOR 1 MAJOR 1 C5735 Laser suturelysis INTER 2 INTER 3 C5740 Sclerostomy drainage INTER 5 INTER 4

IRIS AND ANTERIOR CHAMBER C5910 Iridocycletomy CMO 3 CMO 1 C5920 Surgical iridectomy INTER 4 MAJOR 3 C6010 Surgical trabeculectomy MAJOR + 2 MAJOR + 2 C6110 Laser trabeculoplasty INTER 4 MAJOR 2 C6120 Trabeculotomy (including laser) MAJOR 5 MAJOR + 1 C6130 Goniotomy (surgical treatment of glaucoma) MAJOR 3 MAJOR 1 C6230 Laser iridotomy INTER 4 INTER 5 C6410 Repair of prolapsed iris MAJOR 3 MAJOR 3 C6420 Excision of lesion of iris MAJOR 3 MAJOR 3 C6450 Removal of foreign body from iris MAJOR 3 MAJOR 3 C6620 Cyclotherapy (cauterisation of ciliary body) INTER 4 INTER 5 C6710 Cyclodialysis (separation of ciliary body) MAJOR 1 MAJOR 3 C6910 Reformation/Irrigation of anterior chamber MAJOR 1 MAJOR 1 C6920 Paracentesis/Injection into anterior chamber INTER 3 INTER 4 C6980 Removal of foreign body from anterior chamber INTER 4 INTER 4 C7000 Cyclodestructive procedures/Cyclophotocoagulation MAJOR 1 MAJOR 1 C7005 Insertion of aniridia ring (artificial iris) CMO 2 MAJOR + 4 C7010 Implantation of glaucoma drainage device CMO 3 CMO 1 C7015 Repair of cyclodialysis/Iridodialysis CMO 2 MAJOR + 4 C7020 Revision of glaucoma drainage device including tube extension CMO 3 CMO 1 C7025 Surgical Pupilloplasty MAJOR + 2 MAJOR 5 C7030 Viscocanulostomy/Deep sclerectomy CMO 2 MAJOR + 4 C7035 Laser Iridoplasty INTER 5 INTER 5

LENS C7100 Extracapsular cataract extraction with/without implant MAJOR + 4 MAJOR + 4 C7120 Phacoemulsification with/without implant MAJOR + 5 MAJOR + 2 C7340 Yag laser photodistruption of posterior capsule of lens (including MINOR 5 INTER 5 laser capsulotomy) C7510 Secondary insertion of lens implant MAJOR 2 MAJOR 3 C7520 Revision of lens implant MAJOR 5 MAJOR + 1 C7530 Removal of lens implant MAJOR 5 MAJOR 5

PART B Page 14 EYE AND ORBITAL CONTENTS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

LENS (continued) C7540 Complicated cataract with/without implant CMO 3 CMO 1 C7550 Lensectomy with/without implant CMO 2 MAJOR + 4 C7555 Phakic IOL CMO 2 MAJOR + 4 C7560 Piggy-Back IOL MAJOR 2 MAJOR 2 C7565 Sclera/Iris Fixation of IOL CMO 2 MAJOR + 4 C7570 Scleral Fixation of Capsular Tension Ring MAJOR 2 MAJOR 2

VITREOUS C7910 Vitrectomy by anterior approach MAJOR 2 MAJOR 4 C7920 Vitrectomy pars plana approach with insertion of internal CMO 3 CMO 3 tamponade C7980 Vitrectomy combined with membranectomy with/without tamponade CMO 5 CMO 5 C7925 Intravitreal Injection or Tap INTER 5 INTER 5 C7930 Automated vitreous biopsy with intravitreal injection MAJOR 2 MAJOR 2 C7940 Intravitreal implant of drug delivery system CMO 2 MAJOR + 4 C7945 Pars Plana Vitrectomy with removal of IOFB CMO 5 CMO 3 C7950 Pars Plana Vitrectomy with removal of IOL/Dislocated Lens CMO 4 CMO 2 C7955 Pars Plana Vitrectomy with buckling of sclera CMO 5 CMO 3

RETINA C5430 Buckling of sclera (including implant/encircling explant) CMO 3 CMO 1 C5480 Removal of silicone oil MAJOR 2 MAJOR 2 C8200 Laser photocoagulation/cryotherapy/of retina per session per eye MAJOR 2 MAJOR 2 C8420 Excision of lesion of retina CMO 2 MAJOR + 5 C8430 Biopsy of lesion of retina CMO 2 MAJOR + 2 C8440 Macular Translocation/Subretinal membranectomy CMO 5 CMO 3 C8450 Retina Photodynamic Therapy MAJOR 2 MAJOR 2 C8460 Retina Pneumoreretinoplexy CMO 2 MAJOR + 4

GENERAL C8650 Flourescein angiography of eye MINOR 1 MINOR C8660 Examination under anaesthesia INTER 1 MINOR

PART B Page 15 EAR, NOSE AND THROAT

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

EXTERNAL EAR D0110 Total excision of external ear MAJOR 1 MAJOR 5 D0130 Excision of preauricular abnormality INTER 3 INTER 3 D0210 Excision of lesion of external ear INTER 1 INTER 3 D0280 Removal of exostoses from external auditory canal MAJOR 2 MAJOR 1 D0310 Reconstruction of external ear using graft CMO 1 MAJOR + 2 D0320 Reconstruction of external ear MAJOR 5 MAJOR 3 D0340 Meatoplasty of external ear MAJOR 1 INTER 5 D0630 Repair of external ear MINOR 3 INTER 3 D0730 Removal of foreign body from external auditory canal under G.A. MINOR 2 MINOR (and Bilateral) D0820 Reconstruction of external auditory canal MAJOR + 5 MAJOR + 3 D0850 Ear examination and suction clearance with microscopic (and Bilateral) INTER 5 INTER 5

MIDDLE EAR AND MASTOID D1030 Myringotomy and insertion of tube through TM (and Bilateral) INTER 2 INTER 2 D1010 Radical mastoidectomy MAJOR + 3 MAJOR + 1 D1050 Modified radical mastoidectomy with reconstruction MAJOR + 5 MAJOR + 5 D1020 Modified radical mastoidectomy MAJOR + 3 MAJOR + 1 D1040 Simple mastoidectomy MAJOR + 1 MAJOR 5 D1060 Revision of mastoidectomy MAJOR 4 MAJOR + 1 D1240 Exploration of mastoid, facial nerve MAJOR + 1 MAJOR + 1 D1410 Tympanoplasty MAJOR 5 MAJOR + 1 D1420 Myringoplasty MAJOR 4 MAJOR 4 D1510 Myringotomy and insertion of tube through tympanic membrane INTER 2 INTER 2 (and Bilateral) D1520 Suction clearance of middle ear MINOR 2 MINOR D1530 Myringotomy (and Bilateral) MINOR 2 MINOR D1610 Ossiculoplasty with/without tympanoplasty MAJOR + 5 MAJOR + 1 D1710 Stapedectomy MAJOR 4 MAJOR 4 D1900 Middle ear tumour excision MAJOR 4 MAJOR 4 D1910 Middle ear polypectomy (and Bilateral) MINOR 5 MINOR D2010 Tympanotomy and biopsy of lesion of middle ear MAJOR 2 MAJOR 1 V0380 Petrosectomy CMO 2 CMO 2 D2020 Atticotomy MAJOR + 1 MAJOR + 3 D2030 Implant of one anchored hearing aid MAJOR + 1 MAJOR + 1 D2040 Ear Glomux Tumour Excision Trans-Tympance/Transmatoid MAJOR + 5 MAJOR + 5

PART B Page 16 EAR, NOSE AND THROAT

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

INNER EAR A8484 Transtympanic electro-cochleography INTER 2 INTER 2 D2400 Operation(s) on cochlea MAJOR 5 MAJOR + 4 D2610 Operation(s) on endolymphatic sac MAJOR 5 MAJOR + 1 D2620 Membranous labyrinthectomy MAJOR + 2 MAJOR + 1 D2630 Osseous labyrinthectomy MAJOR + 3 MAJOR + 1 D2640 Cochlea Implant CMO 1 CMO 1

NOSE AND NASAL CAVITY E0390 Orbital decompression MAJOR + 1 MAJOR + 1 E0395 Endoscopic Dacryocystorhinostomy with/without insertion of tube MAJOR + 4 MAJOR + 4 E0110 Total excision of nose MAJOR 1 MAJOR 4 E0230 Septorhinoplasty +/- graft/implant following trauma or excision of MAJOR 5 MAJOR 4 tumour E0260 Rhinoplasty following trauma or excision of tumour MAJOR 4 MAJOR 4 E0310 Submucous excision of septum of nose INTER 4 INTER 3 E0320 Excision of lesion of septum of nose MINOR 5 INTER 2 E0330 Biopsy of lesion of septum of nose MINOR 2 INTER 2 E0340 Closure of perforation of septum of nose INTER 5 INTER 3 E0350 Incision of septum of nose MINOR 3 INTER 1 E0360 Septoplasty of nose INTER 5 INTER 4 E0380 Nasal septum cauterisation (and Bilateral) MINOR 1 MINOR E0410 Submucous diathermy to turbinate of nose (and Bilateral) MINOR 3 MINOR E0420 Excision of turbinate of nose (and Bilateral) INTER 1 INTER 3 E0430 Excision of lesion of turbinate of nose (and Bilateral) MINOR 3 INTER 3 E0440 Division of adhesions of turbinate of nose (and Bilateral) MINOR 2 INTER 3 E0450 Biopsy of lesion of turbinate of nose (and Bilateral) MINOR 2 INTER 3 E0460 Cauterisation of turbinate of nose (and Bilateral) MINOR 2 MINOR E0520 Ligation of artery of internal nose INTER 5 INTER 5 E0530 Embolisation of artery of internal nose INTER 5 INTER 5 E0610 Packing of cavity of nose (as sole procedure) MINOR 1 INTER 5 E0810 Polypectomy of internal nose (and Bilateral) MINOR 4 INTER 2 E0820 Excision of lesion of internal nose MINOR 3 INTER 2 E0830 Correction of congenital atresia of choana MAJOR 1 MAJOR 3 E0850 Removal of foreign body from cavity of nose MINOR 1 INTER 2 E0910 Excision of lesion of external nose MINOR 1 INTER 4 E0400 Dacryocysto-Rhinostomy DCR Endoscopic MAJOR + 4 MAJOR + 1 E0405 Nasal Polypectomy Endoscopic INTER 5 INTER 5 E0415 Nasal valve repair of nose INTER 5 INTER 5 E1810 Nasal fracture reduction MINOR 5 MINOR 5

PART B Page 17 EAR, NOSE AND THROAT

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

NOSE AND NASAL CAVITY (continued) E0425 Endoscopic repair of CSF Leak Nasoendoscopic MAJOR + 2 MAJOR 5 E0435 Repair of nasal tip and Alar INTER 5 INTER 5 E0445 Reconstruction of nasal tip and Alar MAJOR 5 MAJOR 4 E0455 Reduction fracture nasal bone INTER 5 INTER 5

NASAL SINUSES E1220 Drainage of maxillary antrum (including Caldwell-Luc) (and INTER 3 INTER 4 Bilateral) E1240 Transantral neurectomy of vidian nerve using sublabial approach MAJOR 2 MAJOR 3 (and Bilateral) E1310 Antral puncture and wash-out (and Bilateral) MINOR 4 MINOR E1330 Intranasal antrostomy including endoscopic (and Bilateral) INTER 2 INTER 5 E1350 Closure of oro-antral fistula INTER 5 INTER 4 E1410 External frontoethmoidectomy (and Bilateral) MAJOR 5 MAJOR 4 E1420 Intranasal ethmoidectomy (and Bilateral) INTER 4 INTER 5 E1430 External ethmoidectomy including endoscopic (and Bilateral) MAJOR 1 MAJOR 3 E1431 Anterior and posterior opening into FESS MAJOR 2 MAJOR 3 E1440 Transantral ethmoidectomy (and Bilateral) MAJOR 1 MAJOR 3 E1450 Bone flap to frontal sinus (and Bilateral) MAJOR + 3 MAJOR + 1 E1460 Trephining of frontal sinus MINOR 5 MINOR E1480 Radical frontoethmoidectomy MAJOR + 2 MAJOR + 1 E1492 Sub-total FESS (Functional Endoscopic Sinus Surgery) MAJOR 1 MAJOR 3 E1500 Operation(s) on sphenoid sinus INTER 2 INTER 5 E1700 Operation(s) on nasal sinus (unspecified) INTER 2 INTER 5 E1740 Lateral Rhinotomy into sinus for malignancy MAJOR 2 MAJOR 2 E1780 Diagnostic endoscopy of sinus (as sole procedure) MINOR 1 INTER 3 E1785 Examination of nasal cavity and/or post-nasal space under GA MINOR 1 MINOR E1790 Nasoendoscopy MINOR 1 MINOR E1795 Maxillectomy MAJOR 4 MAJOR 3 E1800 Frontoethmoidectomy with osteoplatic flap MAJOR + 2 MAJOR + 2 E1805 Endoscopic repair of CSF leak CMO 2 CMO 2

PART B Page 18 EAR, NOSE AND THROAT

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

THROAT E1910 Total pharyngectomy CMO 4 CMO 2 E1920 Partial pharyngectomy MAJOR + 1 CMO 1 E2010 Adenoidectomy MINOR 3 MINOR E2100 Repair of pharynx MAJOR 5 MAJOR 5 E2310 Open excision of lesion of pharynx INTER 1 INTER 5 E2320 Operation(s) on pharyngeal pouch MAJOR 3 MAJOR 3 E2400 Therapeutic endoscopic operation on pharynx MINOR 5 INTER 3 E2480 Pharyngeal pouch - endoscopic resection MAJOR 3 MAJOR 2 E2500 Diagnostic endoscopic examination of pharynx (including biopsy) MINOR 5 INTER 3 F3400 Tonsillectomy - child (and Bilateral) INTER 3 INTER 4 F3440 Tonsillectomy - adult (and Bilateral) INTER 4 INTER 4 F3460 Excision of lingual tonsil INTER 2 INTER 4 F3480 Adenotonsillectomy (and Bilateral) INTER 4 INTER 4 F3620 Drainage of peritonsillar abscess ("quinsy") MINOR 1 INTER 1 F3625 Incision and drainage intra-oral for oral cavity abscess MINOR 1 MINOR F3630 Cricopharyngeal myotomy MAJOR 5 MAJOR 5 F3635 Uvulo-palato-pharyngoplasty MINOR 5 MINOR F3640 Excision and repair of pharyngo-cutaneous fistula CMO 1 CMO 1 F3645 Endoscopic Adenoidectomy INTER 1 INTER 1 F3650 Pharyngeal Exploration for bleeding MINOR 5 MINOR F3655 Pillar Implant MINOR 5 MINOR

LARYNX AND TRACHEA E2910 Total laryngectomy (including neck dissection) CMO 2 CMO 1 E2940 Partial laryngectomy MAJOR 5 MAJOR + 2 E2950 Laryngofissure and chordectomy of vocal chord MAJOR 2 MAJOR 2 E2960 Laryngectomy (excluding neck dissection) MAJOR + 4 MAJOR + 4 E3010 Glottoplasty MAJOR 2 MAJOR 2 E3100 Reconstruction of larynx with graft CMO 2 CMO 1 E3520 Endoscopic excision of lesion of larynx (including INTER 4 MAJOR 1 microlaryngoscopy) E3610 Laryngoscopy/endoscopy with/without biopsy MINOR 5 INTER 5 E3810 Injection into larynx INTER 4 INTER 5 E3900 Partial excision of trachea with reconstruction CMO 4 CMO 4 E4030 Tracheoplasty MAJOR + 2 MAJOR + 2 E4100 Open placement of prosthesis in trachea MAJOR 2 MAJOR 2 E4210 Tracheotomy INTER 3 MAJOR 1 E4230 Insertion of mini-tracheostomy MINOR 5 INTER 3 E4250 Diagnostic examination of bronchus using rigid bronchoscope INTER 3 INTER 5 including biopsy/removal of foreign body

PART B Page 19 EAR, NOSE AND THROAT

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

LARYNX AND TRACHEA (continued) E4255 Rigid oesophagoscopy +/- biopsy/removal/laser or diathermy of INTER 2 INTER 5 lesions E4260 Bronchus: Neonatal rigid bronchoscopy INTER 5 MAJOR 5 E4265 Endolaryngeal resection of tumour MAJOR 5 MAJOR + 5 E4270 Supraglottopexy for laryngomalacia MAJOR 5 MAJOR + 5

FIBREOPTIC ENDOSCOPIC PROCEDURES UNDER TOPICAL ANAESTHESIA E4910 Fibreoptic examination of trachea and bronchus including INTER 1 INTER 5 biopsy/removal of foreign body E4860 Bronchial lavage (diagnostic or therapeutic) INTER 2 INTER 5 E4840 Dilatation of tracheal stricture including insertion of stent INTER 2 INTER 5 E4880 Dilatation of bronchial stricture by fibreoptic bronchoscope INTER 3 INTER 5 E4980 Transbronchial biopsy INTER 3 INTER 5

PART B Page 20 FACE, MOUTH, HEAD AND NECK Surgeon's Anaesthetist's CODE NARRATIVE Category Category

FACE AND JAWS V0830 Closed reduction of fracture of maxilla INTER 1 MAJOR 1 V0835 Distraction osteogenesis of maxilla CMO 4 CMO 2 V1000 Excision of maxilla MAJOR 4 MAJOR + 1 V1005 Exploration of orbital floor CMO 2 MAJOR + 4 V1130 Extra-oral fixation of maxilla INTER 1 MAJOR 3 V1080 Formal hemi-maxillectomy for malignancy MAJOR + 5 MAJOR + 2 V1120 Internal fixation of maxilla INTER 1 MAJOR 3 V1010 Le Fort 1 osteotomy of mazilla CMO 4 CMO 2 V0820 Open reduction of fracture of maxilla INTER 5 MAJOR 3 V0980 Open reduction of fracture of zygomatic complex of bones MAJOR 1 MAJOR 1 V0930 Reduction of fracture of zygomatic complex of bones INTER 3 INTER 5 V0900 Reduction of other fractures of bones of face MINOR 5 INTER 4 V1150 Removal of fixator from maxilla MINOR 5 MAJOR 1 V1015 Removal of osteosynthesis plates and screws of maxilla MINOR 4 MINOR V1020 Repair of oro-antral fistula of mazillary sinus INTER 1 INTER 1 V1025 Retrieval of foreign body from maxillary sinus INTER 4 INTER 4 V1030 Segemental osteotomy of maxilla CMO 2 MAJOR + 5 V1035 Surgically assisted arch expansion of maxilla CMO 1 MAJOR + 3 V1040 Unilateral lift of maxillary sinus MAJOR 1 MAJOR 1 V1045 Bilateral distraction osteogenesis of mandible CMO 4 CMO 2 V1330 Biopsy of lesion of facial bone including mandible/maxilla MINOR 3 INTER 2 V1530 Closed reduction of fracture of mandible MINOR 5 INTER 5 V1050 Enucleation of small cyst of mandible/maxilla INTER 2 INTER 3 V1440 Excision of lesion of jaw INTER 4 INTER 4 V1400 Excision of mandible MAJOR 4 MAJOR + 1 V1420 Extensive excision of mandible MAJOR + 5 MAJOR + 3 V1730 Extra-oral fixation of mandible INTER 3 MAJOR 3 V1055 Harvesting bone graft from ramus of mandible MAJOR 1 MAJOR 1 V1710 Intermaxillary fixation of mandible/maxilla INTER 1 MAJOR 3 V1950 Manipulation of mandible MINOR 3 INTER 2 V1520 Open reduction of fracture of mandible INTER 3 MAJOR 3 V1060 Open reduction of fracture of mandibular condyle CMO 4 CMO 2 V1065 Other subsigmoid osteotomy of mandible CMO 4 CMO 2 V1910 Reconstruction of jaw CMO 1 MAJOR + 2 V1740 Removal of fixator from mandible MINOR 5 INTER 5 V1070 Sagittal split osteotomy mandible CMO 4 CMO 2 V1075 Segmental Osteotomy of mandible CMO 1 MAJOR + 3 V1088 Unilateral distraction osteogenesis CMO 1 MAJOR + 2 V1085 Vertical subsigmoid osteotomy of mandible CMO 4 CMO 2 V1930 Alveolar bone augmentation INTER 5 INTER 5

PART B Page 21 FACE, MOUTH, HEAD AND NECK

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

FACE AND JAWS (continued) V1090 Alveolar bone graft for alveolar cleft MAJOR + 1 MAJOR 5 V1095 Alveolar distraction osteogenesis INTER 5 INTER 5 V1100 Alveolar guided bone regeneration INTER 1 INTER 1 V1105 Excision of alveolar malignant lesion MAJOR 2 MAJOR 2 V1110 Arthrocentesis of temporomandibular joint MAJOR 1 MAJOR 1 V2030 Arthroplasty of temporomandibular bone joint MAJOR 3 MAJOR 2 V2010 Arthroscopy of temporomandibular joint MAJOR 3 MAJOR 2 V2040 Facial lacerations simple INTER 3 INTER 3 V2050 Genioplasty of chin CMO 1 MAJOR + 2 V2060 Lateralisation/repositioning of inferior alveolar nerve CMO 1 MAJOR + 2 V2110 Menisectomy of temporomandibular bone joint INTER 4 INTER 5 V2020 Prosthetic replacement of temporomandibular joint CMO 1 MAJOR + 2 V2120 Reduction of dislocation of temporamandibular joint INTER 1 INTER 2 V2070 Removal of osteosynthesis plates and screws MINOR 4 MINOR V2080 Toilet and suture of complex major facial lacerations CMO 1 MAJOR + 2 V2090 Unilateral release of ankylosis of temporomandibular joint CMO 4 CMO 2

LIPS F0620 Biopsy of lesion of lip MINOR 4 INTER 2 F0200 Excision biopsy of lesion of lip INTER 2 INTER 3 F0110 Excision of vermilion border of lip and advance of mucosa of lip INTER 3 INTER 4 F0120 Labial frenectomy MINOR 4 MINOR F0310 Primary closure of cleft lip (and Bilateral) MAJOR 2 MAJOR 5 F0420 Reconstruction of lip using skin flap MAJOR 4 MAJOR 4 F0410 Reconstruction of lip using tongue flap MAJOR 5 MAJOR 3 F0430 Repair of cleft lip/nose/palate MAJOR + 2 MAJOR + 1 F0320 Revision of primary closure of cleft lip MAJOR 5 MAJOR 5 F0530 Suture of lip MINOR 4 INTER 4

TONGUE F2410 Biopsy of lesion of tongue MINOR 1 INTER 3 F2310 Excision/destruction of lesion of tongue INTER 2 INTER 5 F2640 Freeing of adhesions of tongue MINOR 1 INTER 3 F2620 Frenotomy/frenectomy of tongue MINOR 4 INTER 4 F2220 Partial glossectomy (including block dissection) MAJOR + 5 MAJOR + 5 S2810 Tongue flap - first stage MAJOR 2 MAJOR 5 S2880 Tongue flap - second stage INTER 3 MAJOR 2 F2210 Total glossectomy (including block dissection) CMO 2 CMO 1

PART B Page 22 FACE, MOUTH, HEAD AND NECK

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

PALATE F3210 Biopsy of lesion of palate MINOR 4 INTER 3 F2810 Excision/destruction of lesion of palate INTER 2 INTER 5 F3230 Incision of palate MINOR 2 INTER 3 F3240 Operations on uvula INTER 1 INTER 4 F3010 Plastic repair of palate using flap of palate INTER 5 MAJOR 3 F3020 Plastic repair of palate using flap of skin MAJOR 3 MAJOR 3 F2910 Primary repair of cleft palate MAJOR + 1 MAJOR 5 F2920 Revision of repair of cleft palate MAJOR 1 MAJOR 3 F3070 Suture of palate MINOR 5 INTER 4

MOUTH CAVITY F4210 Biopsy of lesion of mouth MINOR 2 INTER 2 F3810 Excision/destruction of lesion of mouth MINOR 5 INTER 3 F3820 Free gingival grafting INTER 3 INTER 3 F4030 Graft/harvesting of mucosa to mouth INTER 2 MAJOR 1 F4020 Graft of skin to mouth INTER 3 MAJOR 2 F3830 Incision and drainage of intra-oral abscess MINOR 4 INTER 3 F3840 Laser ablation of lesion of oral mucosa INTER 3 INTER 3 F3910 Reconstruction of mouth using flap MAJOR 5 MAJOR 4 F3920 Reconstruction of mouth using graft INTER 3 MAJOR 4 F4230 Removal of excess mucosa from mouth INTER 2 INTER 4 F4040 Suture of mouth MINOR 5 INTER 5 F1140 Vestibuloplasty following trauma INTER 4 INTER 4

SALIVARY GLANDS F4410 Total conservative parotidectomy CMO 3 MAJOR + 5 F4430 Superficial parotidectomy CMO 2 MAJOR + 4 F4440 Excision of submandibular gland MAJOR 1 INTER 5 F4450 Excision of sublingual gland INTER 3 INTER 5 F4510 Excision of lesion of parotid gland INTER 4 INTER 5 F4520 Excision of lesion of submandibular gland INTER 4 INTER 5 F4530 Excision of lesion of sublingual gland MINOR 3 INTER 5 F4610 Drainage of parotid gland abscess MINOR 3 INTER 3 F4620 Drainage of submandibular gland abscess MINOR 3 INTER 3 F4630 Drainage of sublingual gland abscess MINOR 3 INTER 3 F4810 Biopsy of lesion of salivary gland MINOR 5 INTER 4 F4820 Closure of fistula of salivary gland INTER 2 INTER 4 F5010 Transposition of parotid duct INTER 4 INTER 4 F5020 Transposition of submandibular duct INTER 4 INTER 4

PART B Page 23 FACE, MOUTH, HEAD AND NECK

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

SALIVARY GLANDS F5110 Open extraction of calculus from parotid duct INTER 2 INTER 2 F5120 Open extraction of calculus from submandibular duct INTER 1 INTER 4 F5210 Ligation of parotid duct MINOR 4 INTER 4 F5220 Ligation of submandibular duct MINOR 4 INTER 4 F5320 Operation(s) on submandibular duct MINOR 4 INTER 4 F5510 Dilation of parotid duct MINOR 3 MINOR F5610 Manipulative removal of calculus from parotid duct INTER 1 INTER 1

TEETH F1820 Apisectomy of tooth INTER 2 INTER 2 F1830 Dental implant: first stage MAJOR 1 MAJOR 1 F1810 Enucleation of cyst of jaw INTER 2 INTER 4 F1840 Extra oral implant: first stage MAJOR 1 MAJOR 1 F1850 Extraction of tooth (simple) MINOR 1 MINOR F1860 Osseointegrated implant: second stage MINOR 4 MINOR F1870 Periodontal surgery INTER 1 MINOR F1880 Periodontium: surgery with graft INTER 4 INTER 4 F0830 Replantation of tooth/teeth following trauma INTER 2 INTER 2 F1890 Surgical exposure of impacted canine tooth INTER 1 MINOR F0910 Surgical removal/exposure of impacted/buried tooth/teeth INTER 3 INTER 4 F1895 Surgical removal of buried roots (simple) INTER 1 INTER 1 F0950 Surgical removal of complicated buried roots INTER 3 INTER 4 F1900 Transplantation of tooth MAJOR 1 MAJOR 1

NECK T8510 Block dissection of cervical lymph nodes (not included in other CMO 1 MAJOR + 3 procedures) T8610 Biopsy/sampling of cervical lymph nodes MINOR 3 INTER 4 T9400 Operations on branchial cleft cyst INTER 5 MAJOR 5 T9420 Operations on branchial cleft fistula MAJOR 4 MAJOR 5

PART B Page 24 FACE, MOUTH, HEAD AND NECK

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

THYROID AND PARATHYROID GLANDS B0810 Total thyroidectomy MAJOR + 4 MAJOR + 2 B0820 Bilateral subtotal thyroidectomy MAJOR + 4 MAJOR + 2 B0830 Hemi-thyroidectomy MAJOR 4 MAJOR 3 B0860 Partial thyroidectomy MAJOR 4 MAJOR 3 B0900 Operations on aberrant thyroid issue (including retrosternal) CMO 1 MAJOR + 3 B1010 Excision of thyroglossal cyst INTER 3 MAJOR 2 B1020 Excision of thyroglossal tract INTER 5 MAJOR 2 B1210 Excision of lesion of thyroid gland INTER 5 MAJOR 2 B1220 Fine needle aspiration of thyroid gland MINOR 1 INTER 1 B1230 Needle biopsy of thyroid gland MINOR 5 INTER 1 B1450 Parathyroidectomy CMO 1 MAJOR + 3 B1680 Parathyroid : second operation CMO 2 MAJOR + 4

PART B Page 25 BREASTS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

BREASTS B2700 Subcutaneous mastectomy MAJOR 1 MAJOR 1 B2710 Radical mastectomy MAJOR + 1 MAJOR 4 B2740 Modified radical mastectomy (including block dissection) MAJOR 4 MAJOR 3 B2780 Simple mastectomy (including axillary node biopsy) MAJOR 1 MAJOR 3 B2800 Excision of lesion of breast INTER 3 INTER 3 B2810 Segmental resection or quadrantectomy INTER 5 INTER 5 B2820 Wide local excision of lesion of breast INTER 5 INTER 5 B2830 Repeat local excision to clear margins INTER 3 INTER 5 B2910 Reconstruction of breast using latissimus dorsi CMO 2 MAJOR + 4 B2920 Reconstruction of breast using local flap MAJOR + 1 MAJOR 4 B2980 Reconstruction of breast using TRAMS CMO 3 CMO 1 B2925 Reduction mammoplasty CMO 2 MAJOR + 4 B2930 Augmentation mammoplasty MAJOR 1 MAJOR 1 B2935 Mastopexy unilateral MAJOR 1 MAJOR 1 B3030 Removal of prosthesis from breast INTER 2 INTER 3 B3180 Implantation of prosthesis following mastectomy INTER 5 MAJOR 3 B3210 Percutaneous biopsy of lesion of breast MINOR 2 MINOR S4760 Fine needle aspiration cytology MINOR 1 MINOR B3280 Stereotactic/guidewire excision of lesion of breast INTER 5 INTER 5 B3310 Drainage of breast abscess MINOR 5 INTER 3 B3440 Microdochotomy INTER 3 INTER 3 B3500 Operation(s) on nipple (where not included in other procedures) INTER 2 INTER 3 T8520 Block dissection of axillary lymph nodes (where not included in MAJOR 2 MAJOR 2 other procedures) T8620 Biopsy/sampling of axillary lymph nodes MINOR 3 INTER 1 T8640 Biopsy of internal mammary lymph nodes INTER 1 INTER 5

PART B Page 26 CARDIOLOGY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

PACING AND ELECTROPHYSIOLOGICAL PROCEDURES D3010 Implantable ECG Loop Recorder, insertion of MINOR 4 MINOR 4 D3020 Implantable ECG Loop Recorder, removal of MINOR 4 MINOR 4 D3030 Single Chamber Permanent Transvenous Electrode, insertion, MAJOR 1 MAJOR 1 removal or replacement of D3040 Permanent Cardiac Pacemaker, insertion, removal or replacement of INTER 1 INTER 1 D3050 Dual Chamber Permanent Transvenous Electrodes, insertion MAJOR 4 MAJOR 4 removal or replacement of and not associated with CA 18 D3060 Permanent Transvenous Electrode through the Coronary Sinus, MAJOR 4 MAJOR 4 insertion, removal or replacement of D3070 Biventricular Permanent Cardiac Pacemaker, insertion removal or MINOR 5 MINOR 5 replacement of D3080 Automatic Defibrillator, insertion of patches for, or insertion of MAJOR + 4 MAJOR + 4 transvenous endocardial defibrillation electrodes for D3090 Automatic Defibrillator Generator, insertion or replacement of INTER 1 INTER 1 D3100 Biventricular Permanent Cardiac Pacemaker and Automatic INTER 2 INTER 2 Defibrilator Generator, insertion removal or replacement of D3110 Extraction of chronically implanted transvenous pacing or defibrillator lead or leads, by percutaneous method where the CMO 5 CMO 5 leads have been in situ for greater than six months D3120 Cardiac Electrophysiological study up to and including 3 catheter MAJOR 4 MAJOR 4 investigation D3130 Cardiac Electrophysiological Study 4 or more catheter CMO 2 CMO 2 D3140 Cardiac Electrophysiological Study, for follow-up testing of INTER 3 INTER 3 implanted defibrillator D3150 Amblation of Arrhythmia Circuit or Focus or isolation procedure CMO 4 CMO 4 involving 1 atrial chamber D3160 Ablation of Arrhythmia Circuits or Foci, or isolation procedure involving both atrial chambers and including curative procedures CMO 5 CMO 5 for atrial fibrillation D3170 Ventricular Arrhyhmia with mapping and ablation, including all associated electrophysiological studies, performed on the same CMO 5 CMO 5 day

INVASIVE DIAGNOSTIC PROCEDURES D3180 Right Heart Catheterisation INTER 4 INTER 4 D3190 Left Heart Catheterisation INTER 5 INTER 5 D3200 Right Heart Catheterisation with Left Heart Catherisation MAJOR 1 MAJOR 2 D3210 Selective Coronary Angiography, placement of catheters and INTER 4 INTER 5 injection of opaque material into the native coronary arteries D3220 Selective Coronary Angiography, placement of catheters and injection of opaque material with right or left heart catheterisation MAJOR 2 MAJOR 3 or both, or aortography

PART B Page 27 CARDIOLOGY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

INVASIVE DIAGNOSTIC PROCEDURES (continued) D3230 Selective Coronary Graft Angiography, placement of catheter(s) and injection of opaque material into free coronary graft (s) MINOR 5 MINOR 5 attached to the aorta D3240 Selective Coronary Graft Angiography, placement of catheter(s) and injection of opaque material into direct internal mammal INTER 4 INTER 4 artery graft (s) D3250 Myocardial Biopsy, by cardiac catheterization INTER 1 INTER 1

INTERVENTIONAL CARDIAC PROCEDURES D3260 Atrial Septal Defect closure, with septal occluder or other similar MAJOR + 1 MAJOR + 1 device, by transcatheter approach D3270 Ventricular Septal Defect closure, with septal occluder or other CMO 2 CMO 2 similar device, by transcatheter approach D3280 Balloon Valvuloplasty or Isolated Atrial Septostomy MAJOR + 1 MAJOR + 1 D3290 Transluminal Balloon Angioplasty of 1 coronary artery INTER 5 INTER 5 D3300 Transluminal Balloon Angioplasty in the setting of an acute MAJOR 3 MAJOR 3 myocardial infaction D3310 Transluminal Balloon Angioplasty of 2 coronary artery MAJOR 3 MAJOR 3 D3320 Transluminal Balloon Angioplasty of more than 2 coronary artery MAJOR 5 MAJOR 5 D3330 Transluminal Stent Insertion including associated balloon dilation MAJOR 3 MAJOR 3 for a single coronary artery D3340 Transluminal Stent Insertion including associated balloon MAJOR + 5 MAJOR + 5 dilatation in the setting of an acute myocardial infarction D3350 Transluminal Stents Insertion including associated balloon MAJOR + 5 MAJOR + 5 dilatation for two coronary artery D3360 Transluminal Multiple Stents insertion including associated CMO 2 CMO 2 balloon dilatation for coronary artery D3370 Thrombus Management either use of distal protection devices or MINOR 4 MINOR 4 devices for removal of thrombus D3380 Percutaneous Transluminal Rotational Athrectomy of 1 coronary MAJOR 1 MAJOR 1 artery D3390 Percutaneous Transluminal Rotational Athrectomy of more than 1 MAJOR + 4 MAJOR + 4 coronary artery

PART B Page 28 CARDIOLOGY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

INTERVENTIONAL PERIPHERAL PROCEDURES D3400 Transluminal Balloon Angioplasty of 1 peripheral artery or vein of INTER 5 INTER 5 1 limb D3410 Transluminal Balloon Angioplasty of aortic arch branches, aortic visceral branches, or more than 1 peripheral artery or vein of 1 MAJOR 1 MAJOR 1 D3420 Transluminallimb Stent Insertion including associated balloon MAJOR 1 MAJOR 1 dilatation for 1 peripheral artery or vein of 1 limb D3430 Transluminal Stent Insertion, 1 or more stents, with or without MAJOR + 5 MAJOR + 5 associated balloon dilatation, for 1 carotid artery D3440 Transluminal Stent Insertion including associated balloon dilatation for visceral arteries or veins, or more than 1 peripheral MAJOR 3 MAJOR 3 artery or vein of 1 limb D3450 Peripheral Arterial Athrectomy including associated balloon MAJOR 4 MAJOR 4 dilatation of 1 limb D3460 Peripheral Arterial or Venous Catheterisation with administration INTER 2 INTER 2 of thrombolytic or chemothrapeutic agents, by continuous infusion D3470 Peripheral Arterial or Venous Catheterisation to administer agents MAJOR 4 MAJOR 4 to occlude arteries, veins or arterio-venous fistulae D3480 Insertion of Inferior Vena Caval Filter INTER 5 INTER 5 D3490 Retrieval of Inferior Vena Caval Filter MAJOR 1 MAJOR 1 D3500 Retrieval of foreign body in Pulmonary Artery MAJOR 4 MAJOR 4 D3510 Retrieval of foreign body in Right Atrium MAJOR 2 MAJOR 2 D3520 Retrieval of foreign body in Inferior Vena Cava or Aorta MAJOR 1 MAJOR 1 D3530 Retrieval of foreign body in Peripheral Vein or Peripheral Artery INTER 4 INTER 4

CORONARY CARE PROCEDURES D3540 Central Vein Catheterisation (via jugular, subclavian or femoral MINOR 1 INTER 1 vein) by percutaneous or open exposure D3550 Right Heart Balloon Catheter, insertion of, including pulmonary MINOR 1 INTER 1 wedge pressure and cardiac output measurement D3560 Intraaterial Cannulation for the purpose of taking multiple arterial MINOR 1 NIL blood samples for blood gas analysis D3570 Intra-Aortic Balloon pump, percutaneous insertion of INTER 1 MAJOR 1 D3580 Counterpulsation by intraaortic balloon management on the first day including initial and subsequent consultations and monitoring MINOR 2 NIL of parameters D3590 Counterpulsation by Intraaortic Balloon management on each subsequent to the first, including associated consultations and MINOR 1 NIL monitoring of parameters D3600 Temporary Transvenous Pacemaking Electrode, insertion of INTER 1 INTER 3 D3610 Pericardium, paracentesis of (excluding aftercare) MINOR 1 MAJOR 1

PART B Page 29 CARDIOLOGY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

SPIRAL ANGIOGRAPHY COMPUTED TOMOGRAPHY PROCEDURES D3620 Including any scans performed before intravenous contrast injection 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional INTER 1 INTER 5 surface shaded display, with hardcopy recording of multiple projections, where the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism

PART B Page 30 CARDIOTHORACIC SURGERY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

OESOPHAGUS G0100 Oesophagocardiomyotomy, open/thoracoscopic MAJOR + 3 MAJOR + 3 G0400 Anti-reflux operations, transabdominal/transthoracic/laparoscopic CMO 2 CMO 2 G0500 Oesophageal duplication, open or thoracoscopic excision CMO 3 CMO 3 G0600 Repair of oesophagus, transthoracic/thoracoscopic CMO 2 CMO 2 G0700 Rigid oesophacoscopy +/- biopsy/removal/laser INTER 5 INTER 5 G2600 Revision of anti-reflux operations CMO 3 CMO 3 G0200 Hernia: Hiatus hernia repair, transthoracic/transabdominal/ CMO 2 CMO 2 laparoscopic G0300 Hernia: Diaphragmatic hernia repair, transthoracic/transabdominal CMO 2 CMO 2

CHESTWALL T0110 Thoracoplasty CMO 2 CMO 2 T0130 Excision of chest wall tumour MAJOR + 3 MAJOR + 3 T0210 Thorax: Correction of pectus deformity of chest wall CMO 3 CMO 3 T0280 Thorax: Multiple ribs and sternal fracture fixation CMO 2 CMO 2 T0310 Exploratory median sternotomy MAJOR + 4 MAJOR + 4 T0320 Thorax: Exploratory thoracotomy MAJOR + 4 MAJOR + 4 T0810 Thorax: Resection of rib and open drainage of pleural cavity MAJOR + 3 MAJOR + 3 T1550 Repair of rupture of diaphragm CMO 2 CMO 2 T1620 Plication of paralysed diaphragm CMO 1 CMO 1 T1640 Repair of congenital diaphragmatic hernia CMO 2 CMO 2 T1670 Diaphragm: Diaphragmatic eventration, repair of CMO 3 CMO 3 T1650 Chest Wall deformity correction, open or laparoscopic CMO 2 CMO 2 T1660 Closure of ectopia cords CMO 5 CMO 5 T0390 Thoracotomy or sternotomy for removal of thymus or mediastinal CMO 3 CMO 3 tumour T0400 Sternotomy wound, debridement of, not involving reopening of INTER 4 INTER 4 mediastinum T0410 Sternotomy wound, debridement of, involving curettage of infected bone, with/without removal of sternal wires but not INTER 5 INTER 5 involving reopening of mediastinum T0420 Sternum, reoperation on, for dehiscence or infection involving CMO 2 CMO 2 reopening of mediastinum, with/without rewiring T0430 Sternum and mediastinum, reoperation for infection of, involving CMO 3 CMO 3 muscle advancement flaps or greater omentum

PART B Page 31 CARDIOTHORACIC SURGERY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

TRACHEA/BRONCHUS E3900 Partial excision of trachea including reconstruction CMO 4 CMO 4 E4030 Tracheoplasty MAJOR + 2 MAJOR + 2 E4100 Open placement of prosthesis in trachea MAJOR 2 MAJOR 2 E4210 Tracheostomy INTER 3 MAJOR 1 E4230 Mini-tracheostomy MINOR 5 INTER 3 E4890 Bronchoscopy, rigid/fiberoptic +/- biopsy INTER 5 INTER 5 E4860 Bronchial lavage (Diagnostic or therapeutic) INTER 3 INTER 5 E4870 Stenosis: Repair of, Endotracheal INTER 3 MAJOR 2 E4880 Dilatation of bronchial stricture by fiberoptic bronchoscope MAJOR + 3 MAJOR + 3 E4980 Transbronchial biopsy INTER 3 INTER 5 E5110 Diagnostic examination of bronchus using rigid bronchoscope INTER 5 INTER 5 (including biopsy/removal of foreign body/dilatation of stricture) T1420 Bronchial cyst, excision of CMO 2 CMO 2 T1430 Neonatal rigid bronchoscopy INTER 5 MAJOR 1

LUNG E5410 Total Pneumonectomy CMO 5 CMO 5 E5430 Open lobectomy of lung (including excision of segment) CMO 5 CMO 5 E5480 Lung resection with resection of chest wall CMO 5 CMO 5 E5490 Thoracoscopic lung resection (including video assisted) CMO 2 CMO 2 E5520 Open excision of lesion of lung CMO 1 CMO 1 E5910 Needle biopsy of lung INTER 2 INTER 5 T0710 Decortication of pleura or lung CMO 2 CMO 2 T0790 Pleurectomy for pneumothorax MAJOR + 5 MAJOR + 5 T0910 Open excision/biopsy of lesion of pleura MAJOR + 5 MAJOR + 5 T1010 Endoscopic excision of lesion(s) of lung/pleura CMO 2 CMO 2 T1100 Thorax: Thoracoscopy (+/- biopsy) pleura/lung MAJOR 2 MAJOR 2 T1220 Drainage of pleural cavity MINOR 5 MINOR 5 T1240 Insertion of tube drain into pleural cavity INTER 2 INTER 2 T1300 Thorax: Introduction of substance into pleural cavity INTER 2 INTER 2 T1410 Biopsy of pleura INTER 2 INTER 2 T1440 Bullectomy and Pleurodesis MAJOR 2 MAJOR 2 T1450 Congenital cystic adenomatoid malformation of lung (CCAM) of CMO 2 CMO 2 lung excision T1460 Drainage of abscess of lung or pleura; open or thoracoscopic MAJOR + 3 MAJOR + 3 T1470 Lung volume reduction surgery CMO 3 CMO 3 T1480 Open lung resection CMO 2 CMO 2 T1490 Pleurodesis of pneumothorax CMO 2 CMO 2 T1500 Plumonary sequestration, excision of CMO 2 CMO 2 T1510 Redo lung surgery MAJOR + 3 MAJOR + 3 T1520 Thorax: Lung transplant CMO 5 CMO 5

PART B Page 32 CARDIOTHORACIC SURGERY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

MEDIASTINUM E6150 Exploration of mediastinum CMO 2 CMO 2 E6210 Endoscopic excision of lesion of mediastinum MAJOR + 3 MAJOR + 3 E6300 Diagnostic endoscopic examination of mediastinum MAJOR + 3 MAJOR + 3 E6400 Redo Heart/Mediastinal Surgery/(Re-sternotomy/Re-thoracotomy CMO 5 CMO 5 T0380 Mediastinium, cervical exploration with/without biopsy INTER 5 INTER 5

HEART CARDIAC SURGERY K0400 Correction of tetralogy of Fallot CMO 5 CMO 5 K0500 Atrial inversion for transportation of great vessels CMO 5 CMO 5 K0600 Other correction of transportation of great vessels CMO 5 CMO 5 K0700 Correction of total anomalous pulmonary venous cennection CMO 5 CMO 5 K0900 Closure of defect of atrioventricular septum using dual prosthetic CMO 5 CMO 5 patches K0800 Atrio-ventricular canal defect repair +/- mitral valve repair CMO 5 CMO 5 K1000 Closure of defect of interatrial septum CMO 5 CMO 5 K1100 Closure of defect of interventricular septum CMO 5 CMO 5 K1800 Creation of valved cardiac conduit CMO 5 CMO 5 K1900 Conduit repair including Rastelli/REV Procedure CMO 5 CMO 5 K2000 Fontan operation CMO 5 CMO 5 K2100 Interatrial septectomy CMO 5 CMO 5 K2200 Ross procedure (Pulmonary autograft procedure) CMO 5 CMO 5 L0110 Correction of truncus arteriosus CMO 5 CMO 5 K2310 Excision of cardiac tumour CMO 5 CMO 5 K2300 Heart, Valve: Mitral valve replacement CMO 5 CMO 5 K2400 Heart, Valve: Mitral valve repair CMO 5 CMO 5 K2450 Heart, Valve: Aortic valve replacement CMO 5 CMO 5 K2500 Heart, Valve: Aortic valve repair CMO 5 CMO 5 K2600 Heart, Valve: Tricuspid valve repair or replacement CMO 5 CMO 5 K2700 Heart, Valve: Pulmonary valve replacement CMO 5 CMO 5 K2800 Heart, Valve: Valvotomy, open CMO 5 CMO 5 K3200 Closed valvotomy (mitral/pulmonary) CMO 5 CMO 5 K3700 Removal of obstruction from structure adjacent to valve of heart CMO 5 CMO 5 K4880 Correction of anomalous coronary arteries CMO 5 CMO 5 K4890 Coronary artery bypass graft, excluding harvest of conduit (s). CMO 5 CMO 5 K4895 Coronary artery bypass graft, additional graft MAJOR 3 MAJOR 3 K4900 Midcab coronary artery bypass graft without c-pulm bypass pump CMO 5 CMO 5

PART B Page 33 CARDIOTHORACIC SURGERY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

HEART CARDIAC SURGERY (continued) K4910 Minimal invasive open heart surgery with cardiopulmonary bypass CMO 5 CMO 5 pump K5200 Open operation(s) on conducting system of heart CMO 5 CMO 5 K5380 Repair of ventricular aneurysm CMO 5 CMO 5 K5390 Planned replacement of aneurysmal ventricle, RV patch or other CMO 5 CMO 5 vessels K5400 Heart transplant CMO 5 CMO 5 K6700 Excision of pericardium CMO 2 CMO 2 K6810 Decompression of cardiac tamponade MAJOR + 3 MAJOR + 3 K6900 Incision of pericardium INTER 3 MAJOR 1 K6910 Pericardium: Pericardial window MAJOR + 5 MAJOR + 5 K6920 Pericardium: Pericardiectomy for constrictive pericarditis CMO 5 CMO 5 K6040 Removal of pacing system with bypass CMO 5 CMO 5 K6080 Removal of pacing system without bypass INTER 2 INTER 2 T0540 Removal of wire from chest wall MAJOR 1 MAJOR 1 T0340 Removing of chest of bleeding MAJOR + 2 MAJOR + 2 T0350 Ischaemic ventricular septal rupture, repair of CMO 5 CMO 5 T0360 Myomectomy of myotomy for hypertrophic obstructive CMO 5 CMO 5 cardiomyopathy T0370 Pericardiectomy with cardiopulmonary bypass CMO 5 CMO 5 T0530 Systemic Pulmonary or Cavo-pulmonary shunt, creation of, with CMO 5 CMO 5 cardiopulmonary bypass, for congenital heart disease T0545 Ventricular septectomy for congenital heart disease CMO 5 CMO 5 T0550 Femoral cannulation for cardiopulmonary bypass CMO 2 CMO 2 T0560 Intraventricular baffle or conduit, insertion of, for congenital heart CMO 5 CMO 5 disease T0570 Emergency cardiothoracic surgery CMO 5 CMO 5 T0580 Harvest of internal mammary artery graft INTER 1 INTER 1 T0590 Artery harvesting (other than internal mammary) for coronary MAJOR 5 MAJOR 5 artery bypass

GREAT VESSELS L0200 Closed ligation of patent ductus arteriosus CMO 2 CMO 2 L0210 Device: Cardiac pacemaker system - epicardial or through vein MAJOR 2 MAJOR 2 L0220 Device: Endoscopic vein harvest for CABG MAJOR 2 MAJOR 2 L0230 Vein: Vein graft, harvesting of MAJOR 2 MAJOR 2 L0240 Vein: Vein harvest for CABG MAJOR 2 MAJOR 2 L0250 Device: Extracorporeal life support system, setting up of CMO 2 CMO 2 L0260 Device: Intra Aortic Balloon pump insertion INTER 5 INTER 5 L0270 Device: Implantable ventricular assist device CMO 5 CMO 5

PART B Page 34 CARDIOTHORACIC SURGERY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

GREAT VESSELS (continued) L0500 Creation of shunt to pulmonary artery from aorta using tube prosthesis CMO 4 CMO 4 L0600 Connection from pulmonary artery or aorta CMO 4 CMO 4 L0700 Creation of shunt to pulmonary artery from subclavian artery using CMO 3 CMO 3 interposition tube prosthesis L0800 Connection to pulmonary artery from subclavian artery CMO 4 CMO 4 L1000 Repair of pulmonary artery CMO 5 CMO 5 L1200 Open operations on pulmonary artery CMO 3 CMO 3 L1240 Pulmonary embolectomy CMO 5 CMO 5 L1800 Emergency replacement of anerysmal segment of ascending aorta CMO 5 CMO 5 L1880 Emergency replacement of anerysmal segment of arch of aorta CMO 5 CMO 5 L1890 Emergency replacement of anerysmal segment of descending thoracic CMO 5 CMO 5 aorta L1910 Planned replacement of anerysmal segment of ascending aorta CMO 5 CMO 5 L1980 Planned replacement of anerysmal segment of arch of aorta CMO 5 CMO 5 L1990 Planned replacement of anerysmal segment of descending thoracic aorta CMO 5 CMO 5 L2100 Replacement of thoraco-abdominal aneurysms CMO 5 CMO 5 L2000 Revision of prosthesis of abdominal aorta CMO 3 CMO 3 L2290 Excision of infected aortic graft with bypass CMO 5 CMO 5 L2300 Repair of aorta CMO 3 CMO 3 T0450 Patent ductus arteriousus, division or ligation of, with cardiopulmonary CMO 5 CMO 5 bypass T0460 Aorta, anastomosis or repair of, without cardiopulmonary bypass, for CMO 4 CMO 4 congenital heart disease T0470 Aorta, anastomosis or repair of, with cardiopulmonary bypass, for CMO 5 CMO 5 congenital heart disease T0480 Aortic interruption, repair of, for congenital heart disease CMO 5 CMO 5 T0490 Main pulmonary artery, banding, debanding or repair of, without CMO 4 CMO 4 cardiopulmonary bypass, for congenital heart disease T0500 Main pulmonary artery, banding or repair of, with cardiopulmonary CMO 5 CMO 5 bypass, for congenital heart disease T0510 Vena cava, anastomosis or repair of, without cardiopulmonary bypass, CMO 3 CMO 3 for congenital heart disease T0520 Vena cava, anastomosis or repair of, with cardiopulmonary bypass, Systemic Pulmonary or Cavo-pulmonary shunt, creation of, without CMO 3 CMO 3 cardiopulmonary bypass, for congenital heart disease

PART B Page 35 VASCULAR SYSTEM

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

AORTA L1940 Aorta (abdominal): Aneurysm, excision and inlay graft of CMO 3 CMO 3 L1960 Aorta (abdominal): Aorto-(bi) femoral or aorto-(bi) illiac bypass CMO 4 CMO 4 L4530 Aorta (abdominal): Open operation of renal/visceral branch of aorta CMO 4 CMO 4 L1810 Aorta (thoracic): Aneurysm, excision and inlay graft of CMO 5 CMO 5 L3710 Aorta (thoracic): Bypass of subclavian artery from arch CMO 3 CMO 3 L2190 Aorta (thoraco-abdominal): Aneurysm, excision and inlay graft of CMO 5 CMO 5 L2195 Infected aortic graft, excision and replacement or bypass CMO 5 CMO 5 L2300 Repair of aorta CMO 3 CMO 3

ARTERIOVENOUS L7505 Arteriovenous fistula, ligation CMO 3 CMO 3 L7515 Arteriovenous malformation (complex), excision of CMO 5 CMO 2 L7510 Arteriovenous malformation (superficial), excision of MAJOR + 1 MAJOR + 1 L7420 Creation of arteriovenous fistula INTER 5 INTER 5 L7520 Creation of arteriovenous fistula (complicated) MAJOR 2 MAJOR 2 L7525 Creation of arteriovenous fistula (graft implantation) MAJOR 2 MAJOR 2 L7530 Creation of arteriovenous fistula (vein transposition) MAJOR 2 MAJOR 2

ARTERY L7010 Embolectomy or thrombectomy of artery or graft MAJOR + 2 MAJOR + 2 L6800 Repair of artery MAJOR + 1 MAJOR + 1 L6880 Repair of artery or vein, microsurgical MAJOR + 5 MAJOR + 5 L6840 Repair of artery using vein graft MAJOR + 5 MAJOR + 5 L6830 Repair of artery using vein graft, microsurgical CMO 3 CMO 3

CAROTID L2940 Carotid ligation, aneurysm/AV fistula MAJOR 1 MAJOR 1 L2930 Bypass of carotid from arch CMO 3 CMO 3 L2960 Carotid body tumour excision CMO 3 CMO 3 L2950 Endarterectomy/endovascular procedure CMO 3 CMO 3 L2900 Reconstruction of carotid artery (vein patch and bypass) CMO 2 CMO 2 L2970 Cava: Bidirectional cavo pulmonary connection (Glenn's shunt) CMO 4 CMO 4

SYMPATHECTOMY L2980 Cervical, open or endoscopic CMO 2 CMO 2 L2990 Lumbar CMO 2 CMO 2

PART B Page 36 VASCULAR SURGERY

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

VARICOSE L8750 Varicose veins: Local excision (multiple phlebectomy) INTER 1 INTER 1 L8510 Varicose veins: Sapheneous vein (long/short, ligation/stripping) INTER 5 INTER 5 L8755 Varicose veins: Subfascial ligation of perforators, open/endoscopic MAJOR 3 MAJOR 3 L8530 Varicose veins: Surgery for recurrency MAJOR 5 MAJOR 5 L8765 Varicose veins: Injection of sclerosing agent MINOR 1 MINOR L8775 Varicose veins: Excision of venous ulcer INTER 3 INTER 3

VASCULAR L9110 Vascular access: Hickman line/tunnelled central line insertion INTER 3 INTER 3 L9180 Vascular access: Chemoport insertion INTER 3 INTER 3 L9120 Vascular grafts: Arterial aneurysm - endoluminal grafting CMO 3 CMO 3 L6000 Vascular grafts: Femoral artery, endarterectomy of CMO 1 CMO 1 L5910 Vascular grafts: Femoro-femoral bypass CMO 1 CMO 1 L5920 Vascular grafts: Femoro-popliteal or distal bypass graft CMO 3 CMO 3 L2200 Vascular revision: Aortic prosthesis, revision/excision of CMO 3 CMO 3 L6530 Vascular revision: Bypass graft, revision MAJOR + 5 MAJOR + 5 L3730 Subclavian or iliac artery, open operations on CMO 3 CMO 3

VEIN L9200 Endolaser vein surgery MAJOR + 4 MAJOR + 4 L9250 Insertion of venous filter INTER 4 INTER 4 L9000 Thrombus from vein, open removal of MAJOR 5 MAJOR 5 L9150 Harvest for CABG MAJOR 1 MAJOR 1

LYMPHATIC T8510 Block dissection of cervical lymph nodes (not included in other CMO 1 MAJOR + 3 procedures) T8520 Block dissection of axillary lymph nodes MAJOR 2 MAJOR 2 T8540 Block dissection of para-aortic lymph nodes MAJOR + 4 MAJOR 5 T8550 Block dissection of inguinal lymph nodes MAJOR 2 MAJOR 3 T8580 Block dissection of pelvic lymph nodes (not included in other MAJOR 4 MAJOR 4 procedures) T8610 Biopsy/sampling of cervical lymph nodes MINOR 3 INTER 3 T8620 Biopsy/sampling of axillary lymph nodes MINOR 3 INTER 1 T8670 Biopsy/sampling of inguinal lymph nodes MINOR 3 INTER 3 T8700 Excision biopsy of lymph node INTER 1 INTER 4 T8710 Excision biopsy of scalene lymph node INTER 1 INTER 4 T8800 Drainage of lesion of lymph node MINOR 4 MINOR T8900 Operations on lymphatic duct MAJOR + 1 MAJOR 5 T9610 Excision of cystic hygroma MAJOR 1 MAJOR 4

PART B Page 37 ENDOSCOPIC AND LAPAROSCOPIC GASTRO-INTESTINAL TRACT PROCEDURES

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

ENDOSCOPIC GASTRO INTESTINAL PROCEDURES NOTE: All Gastrointestinal Endoscopic Therapeutic Procedures Include Diagnostic Procedure Oesophagus G1400 Oesophagoscopy, rigid or flexible, diagnostic with or without biopsy, brushing, washing, and collection of specimen as a single procedure MINOR 3 INTER 4

G1405 Oesophagoscopy, rigid or flexible, removal of foreign body, MINOR 5 INTER 4 polypectomy any method G1407 Oesophagoscopy, rigid or flexible, injection sclerotherapy, any INTER 3 MAJOR 1 substance, for oesophageal varices, and/or variceal banding G1408 Oesophagoscopy, rigid or flexible, dilatation of oesophageal stricture, INTER 3 INTER 4 tumour, achalasia, use of guide wire G1409 Oesophagoscopy, rigid or flexible, oesophageal mucosal resection INTER 3 INTER 5 G1410 Oesophagoscopy, rigid or flexible, destruction of lesion, ablation of INTER 3 INTER 4 tumour, any method, recanalisation of tumour

Stomach NOTE: Therapeutic-oesophago-gastro-duodenoscopy, includes oesophagus, stomach, duodenum and/or jejunum as appropriate G6500 Therapeutic-oesophago-gastro-duodenoscopy, diagnostic, with or without biopsy, brushing, washing, and collection of specimen as a MINOR 1 INTER 4 single procedure G6502 Therapeutic-oesophago-gastro-duodenoscopy, removal of foreign body MINOR 5 INTER 4 G6504 Therapeutic oesophago-gastro-duodenoscopy, injection sclerotherapy INTER 3 INTER 5 for gastric varices G6506 Therapeutic oesophago-gastro-duodenoscopy, polypectomy MINOR 5 INTER 4 G6508 Therapeutic oesophago-gastro-duodenoscopy, haemostasis of gastric INTER 3 INTER 5 bleeders; injection,clip, thermal, or any other methods G6510 Therapeutic oesophago-gastro-duodenoscopy, gastric mucosal resection

G6520 Therapeutic oesophago-gastro-duodenoscopy including destruction of INTER 3 INTER 4 lesion, tumour ablation, any method G6530 Therapeutic oesophago-gastro-duodenoscopy including INTER 3 INTER 5 pyloric dilatation with or without stenting G6532 Therapeutic oesophago-gastro-duodenoscopy, transmural drainage of INTER 3 INTER 4 pseodocyst G6534 Therapeutic oesophago-gastro-duodenoscopy, with placement of INTER 3 INTER 4 intraluminal tube or catheter G6535 Therapeutic oesophago-gastro-duodenoscopy, placement of gastric INTER 3 INTER 5 balloon G6590 Percutaneous endoscopic gastrostomy MAJOR 2 MAJOR 5

PART B Page 38 Surgeon's Anaesthetist's CODE NARRATIVE Category Category

Duodenum diagnostic, with or without biopsy, brushing, washing, and collection of specimen as a single procedure G6610 Therapeutic oesophago-gastro-duodenoscopy including destruction of lesion, dilatation, insertion of prosthesis, INTER 3 INTER 4 recanalisation of tumour G6620 Therapeutic oesophago-gastro-duodenoscopy, haemostasis of duodenal INTER 3 INTER 5 bleeders; injection,clip, thermal, or any other methods G6630 Therapeutic oesophago-gastro-duodenoscopy, polypectomy MINOR 5 INTER 4 G6640 Therapeutic oesophago-gastro-duodenoscopy including INTER 3 INTER 5 destruction of lesion, tumour ablation, any method

Small Intestine G7900 Enteroscopic examination of small intestine, ileum, through stoma, including dilatation, with or without biopsy, brushing, washing, and INTER 4 INTER 5 collection of specimen as a single procedure G7910 Enteroscopic examination, small intestine, haemostasis of bleeders, INTER 3 INTER 5 injection,clip, thermal or any other methods G7920 Enteroscopic examination, dilatation, as a single procedure INTER 3 INTER 5 G7930 Enteroscopic examination, small intestine, polypectomy MINOR 5 INTER 4 G7940 Enteroscopic examination, small intestine, destruction of lesion, tumour INTER 3 INTER 5 ablation, any method G7990 Percutaneous endoscopic jejunostomy MAJOR 2 MAJOR 5

Colon H2000 Fibreoptic colonoscopy, diagnostic as a single procedure INTER 1 INTER 3 H2110 Fibreoptic colonoscopy, excision biopsy/destruction of lesion, INTER 3 INTER 5 polypectomy, any method H2112 Fibreoptic colonoscopy, dilatation only, as a single procedure INTER 5 INTER 5 H2115 Fibreoptic colonoscopy, tumour ablation, any method INTER 5 INTER 5 H2120 Fibreoptic colonoscopy, with or without dilatation, recanalisation of MAJOR 1 MAJOR 4 tumour, stenting H2130 Fibreoptic colonoscopy, haemostasis of bleeders; injection,clip, thermal, INTER 5 INTER 5 or any other methods H2150 Fibreoptic colonoscopy, mucosal resection MAJOR 4 MAJOR + 2

PART B Page 39 Surgeon's Anaesthetist's CODE NARRATIVE Category Category

Sigmoid Colon H2500 Rigid sigmoidoscopy, diagnostic, with or without biopsy, brushing, washing, and collection of specimen as a single procedure INTER 1 INTER 3

H2501 Flexible sigmoidoscopy, diagnostic, with or without biopsy, brushing, washing, and collection of specimen as a single procedure INTER 1 INTER 3

H2504 Flexible sigmoidoscopy, biopsy/removal/destruction of lesion, polyps, INTER 3 INTER 5 tumour ablation, any method H2506 Flexible sigmoidoscopy, haemostasis of bleeders, injection,clip, thermal, INTER 1 INTER 3 or any other methods H2510 Flexible sigmoidoscopy, stenting, with or without dilatation, MAJOR 1 MAJOR 4 recanalisation of tumour

Rectum and Anus H2600 Proctoscopy, with or without biopsy, brushing, washing, and collection MINOR 1 MINOR 1 of specimen as a single procedure H2565 Proctoscopy, rubber banding of haemorrhoids MINOR 1 MINOR 1

Endoscopic Retrograde Cholangiopancreatography (ERCP) J4300 ERCP, diagnostic procedure, with or without biopsy, brushing, washing, INTER 4 INTER 5 and collection of specimen as a single procedure J4301 ERCP, therapeutic procedure, balloon dilatation of ampulla, biliary tract MAJOR 2 MAJOR 5 and/or pancreatic ducts J4302 ERCP, therapeutic procedure, sphincterotomy, papilltomy MAJOR 2 MAJOR 5 J4303 ERCP, therapeutic procedure, removal of calculi, with or without MAJOR 3 MAJOR + 1 sphincterotomy, from the biliary and/or pancreatic ducts J4310 ERCP, therapeutic procedure, destruction of calculi, using lithotripsy, with or without sphincterotomy, from the biliary and/or pancreatic ducts MAJOR 3 MAJOR + 1

J4315 ERCP, therapeutic procedure, destruction of calculi, using lithotripsy, with or without sphincterotomy, from the biliary and/or pancreatic ducts MAJOR 3 MAJOR + 1

J4320 ERCP, therapeutic procedure, destruction of lesion, tumour ablation, MAJOR 4 MAJOR + 2 any method

ENDOSCOPIC ULTRASOUND PROCEDURES U2000 Diagnostic Evaluation of Submucosal Lesions INTER 3 INTER 5 U2010 Evaluation of Portal Hypertension INTER 3 INTER 5 U2020 Staging of Gastrointestinal Cancers INTER 3 INTER 5 U2030 Staging of Non-Gastrointestinal Cancers INTER 3 INTER 5 U2040 Evaluation of Cystic Lesions INTER 3 INTER 5 U2050 Evaluation of Raised Tumour Markers INTER 3 INTER 5 U2060 Evaluation of Pancreas INTER 3 INTER 5 U2070 Therapeutic Fine Needle Aspiration of Lesions MAJOR 1 MAJOR 4

PART B Page 40 Surgeon's Anaesthetist's CODE NARRATIVE Category Category

ULTRASOUND GUIDED THERAPEUTIC INTERVENTION U2110 Cyst Gastrostomy MAJOR 3 MAJOR + 1 U2120 Hepatico Gastrostomy MAJOR 3 MAJOR + 1 U2130 Coeliac Plexus Block MAJOR 3 MAJOR + 1 U2140 Pancreatic Pseudocyst Drainage MAJOR 3 MAJOR + 1 U2150 Intra-Abdominal Abscess Drainage MAJOR 3 MAJOR + 1

NOTE: All Laparoscopic Therapeutic Procedures Include Diagnostic Procedure G2331 Laparoscopic repair of hiatus hernia CMO 1 MAJOR + 5 A2781 Laparoscopic vagotomy/seromyotomy MAJOR 4 MAJOR + 2 G3280 Laparoscopic gastro-jejunostomy MAJOR 5 MAJOR + 3 G3480 Laparoscopic gastrostomy/jejunostomy MAJOR 2 MAJOR 5 G3580 Laparoscopic closure of perforated ulcer of stomach MAJOR 3 MAJOR + 1 G5280 Laparoscopic closure of perforated ulcer of duodenum MAJOR 3 MAJOR + 1 G6080 Laparoscopic resection of small intestine MAJOR + 1 MAJOR + 3 H0280 Laparoscopic appendicectomy MAJOR 1 MAJOR 4 H1581 Laparoscopic colostomy MAJOR 4 MAJOR + 2 H1880 Laparoscopic colonic resection MAJOR + 2 MAJOR + 3 H3361 Laparoscopic anterior resection of rectum and exteriorisation of CMO 3 CMO 3 bowel H3580 Laparoscopic rectopexy MAJOR 3 MAJOR + 1 J1830 Laparoscopic cholecystectomy MAJOR + 3 MAJOR + 4 J1880 Laparoscopic cholecystectomy with peroperative cholangiogram MAJOR + 5 MAJOR + 5 J6980 Laparoscopic splenectomy MAJOR 1 MAJOR 4 T2090 Laparoscopic repair of groin hernia MAJOR + 3 MAJOR + 4 G2500 Laparoscopic banding for morbid obesity MAJOR + 5 MAJOR + 5

FOR LAPAROSCOPIC PROCEDURES OF OTHER ABDOMINAL ORGANS REFER TO THE APPROPRIATE SECTIONS

PART B Page 41 ABDOMEN (other than urinary and reproductive organs)

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

OESOPHAGUS E3691 Thorascopic oesophageal mobilisation via mediastinum CMO 3 CMO 1 G0150 Oesophagogastrectomy CMO 4 CMO 1 G0220 Total oesophagogastrectomy and interposition of viscus CMO 5 CMO 3 G0450 Open excision of lesion of oesophagus MAJOR 3 MAJOR + 3 G0550 Bypass of oesophagus MAJOR + 3 MAJOR + 5 G0620 Revision of oesophageal anastomosis MAJOR + 5 MAJOR + 4 G0640 Closure of bypass of oesophagus MAJOR 5 MAJOR + 3 G0750 Transthoracic repair of oesophagus CMO 2 MAJOR + 5 G0781 Thorascopic repair of oesophagus CMO 1 MAJOR + 4 G0920 Oesophagocardiomyotomy (Heller's operation) MAJOR 4 MAJOR + 2 G0980 Thorascopic oesophagogastric myotomy MAJOR 5 MAJOR + 2 G2310 Transthoracic repair of hiatus hernia CMO 1 MAJOR + 5 G2320 Transthoracic repair of diaphragmatic hernia CMO 1 MAJOR + 5 G2330 Transabdominal repair of hiatus hernia CMO 1 MAJOR + 4 G2340 Transabdominal repair of diaphragmatic hernia CMO 1 MAJOR + 1 G2331 Laparoscopic repair of hiatus hernia CMO 1 MAJOR + 4 G2430 Transabdominal anti-reflux operations CMO 1 MAJOR + 4 G2590 Revision of anti-reflux procedures CMO 2 MAJOR + 5

STOMACH A2720 Proximal gastric vagotomy MAJOR 4 MAJOR 3 A2730 Highly selective vagotomy MAJOR 4 MAJOR 3 A2780 Vagotomy and pyloroplasty MAJOR 5 MAJOR 5 A2710 Total gastrectomy CMO 2 MAJOR + 4 G2800 Partial gastrectomy MAJOR + 1 MAJOR 4 G3000 Plastic operation(s) on stomach MAJOR 3 MAJOR 3 G3210 Gastro-jejunostomy MAJOR 5 MAJOR 3 G3220 Revision of gastro-jejunostomy MAJOR + 1 MAJOR 4 G3400 Gastrostomy MAJOR 2 MAJOR 1 G3440 Closure of gastrostomy MAJOR 1 MAJOR 1 G3520 Closure of perforated ulcer of stomach MAJOR 3 MAJOR 3 G3580 Laparoscopic closure of perforated ulcer of stomach MAJOR 3 MAJOR 3 G3800 Other open operation(s) on stomach MAJOR 3 MAJOR 3 G4010 Pyloromyotomy MAJOR 3 MAJOR 3 G4030 Pyloroplasty MAJOR 3 MAJOR 3 A2781 Laparoscopic vagotomy/seromyotomy MAJOR 4 MAJOR 3 G3280 Laparoscopic gastro-jejunostomy MAJOR 5 MAJOR 5 G3480 Laparoscopic gastrostomy/jejunostomy MAJOR 2 MAJOR 1 G3490 Suture ligation of bleeding ulcer MAJOR 3 MAJOR 3

PART B Page 42 ABDOMEN (other than urinary and reproductive organs)

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

DUODENUM G5000 Open excision of lesion of duodenum MAJOR + 1 MAJOR 4 G5100 Bypass of duodenum MAJOR 3 MAJOR 4 G5280 Laparoscopic closure of perforated ulcer of duodenum MAJOR 3 MAJOR 3 G5320 Closure of perforated ulcer of duodenum MAJOR 3 MAJOR 3 G5330 Suture ligation of bleeding ulcer MAJOR 3 MAJOR 3

SMALL INTESTINE G5910 Resection of small intestine segment MAJOR + 1 MAJOR 3 G6000 Jejunostomy MAJOR 2 MAJOR 3 G6080 Laparoscopic resection of small intestine MAJOR + 1 MAJOR 3 G6100 Bypass of jejunum MAJOR 3 MAJOR 3 G6710 Intubation of jejunum of decompression of intestine MAJOR 3 MAJOR 3 G7100 Bypass of ileum MAJOR 3 MAJOR 3 G7250 Ileoanal anastomosis and creation of pouch CMO 3 MAJOR + 5 G7400 Ileostomy MAJOR 3 MAJOR 3 G7500 Refashioning of ileostomy MAJOR 1 MAJOR 1 G7530 Closure of ileostomy (in isolation) MAJOR 1 MAJOR 1 G7810 Open operation on ileum (including reduction of intussusception) MAJOR 3 MAJOR 3

LARGE INTESTINE H0210 Appendicectomy MAJOR 1 MAJOR 1 H0280 Laparoscopic appendicectomy MAJOR 1 MAJOR 1 H0310 Drainage of abscess of appendix MAJOR 1 MAJOR 2 H0510 Total excision of colon and ileorectal anastomosis CMO 2 MAJOR + 4 H0610 Extended excision of right hemicolon MAJOR + 2 MAJOR 5 H0700 Other excision of right hemicolon MAJOR + 2 MAJOR 4 H0800 Excision of transverse colon MAJOR + 2 MAJOR 4 H0900 Excision of left hemicolon MAJOR + 2 MAJOR 5 H1000 Excision of sigmoid colon MAJOR + 2 MAJOR 5 H1200 Excision of lesion of colon (transabdominal) MAJOR 2 MAJOR 4 H1300 Bypass of colon MAJOR 4 MAJOR 4 H1400 Exteriorisation of caecum MAJOR 2 MAJOR 4 H1540 Closure of colostomy - extra peritoneal INTER 5 MAJOR 2 H1580 Closure of colostomy - intra peritoneal MAJOR 3 MAJOR 4 H1581 Laparoscopic colostomy MAJOR 4 MAJOR 4 H1590 Colostomy (including revision) MAJOR 4 MAJOR 4 H1700 Intra abdominal manipulation of colon (including reduction of MAJOR 4 MAJOR 3 intussusception) H1880 Laparoscopic colonic resection MAJOR + 2 MAJOR 5 H3010 Radiological reduction of intussusception of colon using barium MINOR 5 MAJOR 1 enema

PART B Page 43 ABDOMEN (other than urinary and reproductive organs)

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

RECTUM/ANUS G7250 Ileoanal anastomosis and creation of pouch CMO 3 MAJOR + 5 H0410 Panproctocolectomy and ileostomy CMO 3 CMO 1 H2510 Rigid sigmoidoscopy including biopsy MINOR 1 MINOR H3310 Abdominoperineal pull through resection with colo-anal CMO 3 CMO 1 anastomosis and associated colostomy H3320 Abdominoperineal resection of rectum and anus CMO 3 CMO 1 H3330 Anterior resection CMO 3 CMO 1 H3360 Anterior resection of rectum and end colostomy (with closure of CMO 2 MAJOR + 5 rectum) H3361 Laparoscopic anterior resection of rectum and exteriorisation of CMO 3 CMO 1 bowel H3380 Partial excision of rectum and sigmoid colon for prolapse MAJOR + 5 MAJOR + 1 H3390 Reversal of Hartmann's procedure CMO 2 MAJOR + 5 H3400 Open excision of lesion of rectum MAJOR 5 MAJOR + 1 H3500 Fixation of rectum for prolapse MAJOR 3 MAJOR + 1 H3580 Laparoscopic rectopexy MAJOR 3 MAJOR + 1 H4000 Transanal resection for rectal cancer MAJOR 4 MAJOR 2 H4130 Peranal excision of lesion of rectum INTER 5 MAJOR 2 H4180 Full or partial thickness rectal biopsy MINOR 3 MINOR 5 H4200 Perineal repair of prolapse of rectum MAJOR 2 MAJOR 3 H4480 Dilation of stricture of rectum MINOR 2 MINOR H4680 Repair of faecal fistula INTER 2 MAJOR 2 H4800 Excision of lesion of anus MINOR 2 MINOR 5 H4900 Destruction of lesion of anus MINOR 2 MINOR 5 H5020 Repair of anal sphincter MAJOR 1 MAJOR 2 H5080 Repair of anal trauma INTER 5 MAJOR 2 H5100 Haemorrhoidectomy INTER 3 INTER 5 H5230 Injection of sclerosing substance into haemorrhoids MINOR 1 MINOR H5240 Banding of haemorrhoids MINOR 1 MINOR H5400 Anorectal stretch (including EUA and sigmoidoscopy) MINOR 2 MINOR H5510 Laying open of low anal fistula INTER 2 INTER 5 H5520 Laying open of high anal fistula MAJOR 1 MAJOR 2 H5620 Lateral sphincterotomy of anus MINOR 3 INTER 3 H5640 Excision of anal fissure MINOR 3 INTER 3 H5800 Drainage through perineal region (including ischio-rectal abscess) MINOR 5 INTER 3 H5810 Staple haemorrhoidectomy INTER 4 INTER 5

PART B Page 44 ABDOMEN (other than urinary and reproductive organs)

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

OTHER ORGANS, MAINLY DIGESTIVE B2200 Adrenalectomy MAJOR 5 MAJOR + 1 B2300 Operations on aberrant adrenal tissue MAJOR 5 MAJOR + 1 J0200 Partial excision of liver CMO 2 MAJOR + 5 J0210 Hemihepatectomy CMO 4 CMO 2 J0310 Non-anatomical resection of liver tumour CMO 2 MAJOR + 5 J0400 Repair of liver MAJOR + 3 MAJOR + 2 J0800 Therapeutic laparoscopic operations on liver INTER 5 MAJOR 1 J0900 Diagnostic laparoscopic examination of liver (including any biopsy) INTER 5 INTER 5 J1300 Percutaneous biopsy of lesion of liver MINOR 4 INTER 1 J1400 Open puncture of liver MAJOR 1 MAJOR 1 J1800 Cholecystectomy (including mini-cholecystectomy) MAJOR 3 MAJOR 3 J1820 Cholecystectomy with exploration of common bile duct MAJOR 4 MAJOR 4 J1830 Laparoscopic cholecystectomy MAJOR + 3 MAJOR + 3 J1880 Laparoscopic cholecystectomy with peroperative cholangiogram MAJOR + 5 MAJOR + 5 J1900 Anastomosis of gall bladder (to another viscus) MAJOR + 1 MAJOR 4 J2720 Partial excision of bile duct and billiary reconstruction CMO 5 CMO 3 J2800 Excision of lesion of bile duct MAJOR 5 MAJOR + 1 J2900 Anastomosis of hepatic duct CMO 1 MAJOR + 4 J3000 Anastomosis of common bile MAJOR 5 MAJOR + 1 J3100 Open introduction of prosthesis into bile duct MAJOR 5 MAJOR 4 J3200 Repair of bile duct MAJOR + 2 MAJOR + 2 J3300 Exploration of bile duct including calculus removal MAJOR 5 MAJOR + 1 J3500 Sphincterotomy of bile duct and pancreatic duct using duodenal MAJOR 5 MAJOR 5 approach J5000 Percutaneous examination of bile duct INTER 3 INTER 5 J5520 Total pancreatectomy CMO 5 CMO 3 J5610 Whipple’s Procedure, including pancreatoduodenectomy; cholecystectomy and bile duct excision; lymphadenectomy; CMO 5 CMO 5 gastrojejunostomy and duodenojejunostmy; hepaticojejunostomy; pancreaticojejunotomy or pancreaticogastrostomy J5700 Distal pancreatectomy MAJOR + 5 MAJOR + 2 J5800 Excision of lesion of pancreas MAJOR 4 MAJOR + 2 J5900 Anastomosis of pancreatic duct (to viscus) MAJOR + 5 MAJOR + 1 J6100 Open drainage of lesion of pancreas including pseudocyst MAJOR 4 MAJOR 4 J6180 Drainage of pancreatic abscess MAJOR 4 MAJOR 4 J6200 Incision of pancreas MAJOR 4 MAJOR 4 J6300 Open examination of pancreas MAJOR 4 MAJOR 4 J6600 Therapeutic percutaneous operations on pancreas MAJOR 1 MAJOR 3 J6900 Open splenectomy MAJOR 1 MAJOR 4 J6980 Laparoscopic splenectomy MAJOR 1 MAJOR 4 L8110 Creation of peritoneo-venous shunt (Levine/Denver) INTER 5 INTER 4 L8120 Pancreatic cyst jejunostomy MAJOR + 5 MAJOR + 1 L8130 Repair of spleen MAJOR 2 MAJOR 4 L8140 Partial splenectomy MAJOR 3 MAJOR 4

PART B Page 45 ABDOMEN (other than urinary and reproductive organs)

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

MAJOR VESSELS L7040 Open cannulation of intra abdominal artery for infusion MAJOR 5 MAJOR 3 chemotherapy L7710 Creation of portocaval shunt CMO 3 MAJOR + 5 L7920 Plication of vena cava MAJOR + 1 MAJOR + 1 L7980 Repair of wound of major artery or vein of abdomen (including MAJOR 5 MAJOR + 4 aorta and vena cava)

ABDOMINAL WALL T1640 Repair of congenital diaphragmatic hernia CMO 2 CMO 2 T1900 Herniotomy INTER 3 INTER 5 T2000 Primary repair of inguinal hernia INTER 4 INTER 5 T2080 Primary repair of strangulated inguinal hernia MAJOR 3 MAJOR 2 T2090 Laparoscopic repair of groin hernia MAJOR + 3 MAJOR + 5 T2100 Repair of recurrent inguinal hernia MAJOR 3 MAJOR 3 T2200 Primary repair of femoral hernia INTER 3 INTER 5 T2280 Primary repair of strangulated femoral hernia MAJOR 3 MAJOR 2 T2300 Repair of recurrent femoral hernia MAJOR 1 MAJOR 1 T2400 Repair of umbilical hernia (irrespective of age) INTER 3 MAJOR 1 T2500 Primary repair of incisional hernia INTER 5 INTER 5 T2600 Repair of recurrent incisional hernia MAJOR 3 MAJOR 3 T2700 Repair of other hernia of abdominal wall INTER 5 INTER 5 T2830 Resuture of previous incision in abdominal wall (burst abdomen) INTER 5 MAJOR 1 T2840 Mesh repair inguinal hernia INTER 5 INTER 5

PERITONEUM T3010 Laparotomy for post operative haemorrhage MAJOR 2 MAJOR 5 T3080 Laparotomy and repair of multiple visceral trauma CMO 2 MAJOR + 5 T3410 Open drainage of subphrenic abscess MAJOR 2 MAJOR 3 T3600 Operations on omentum MAJOR 3 MAJOR 3 T3910 Retroperitoneal tumour MAJOR + 5 MAJOR + 1 T3930 Retroperitoneal abscess INTER 4 MAJOR 3 T3980 Presacral tumour INTER 5 MAJOR + 1 T4130 Freeing of adhesions of peritoneum MAJOR 1 MAJOR 3 T4300 Laparoscopy including biopsy and adhesiolysis INTER 4 INTER 4 T4610 Paracentesis abdominis for ascites MINOR 1 MINOR T4680 Suprapubic drainage of pelvic abscess INTER 2 INTER 5 T4690 Laparotomy (exploratory, unspecified) MAJOR 1 MAJOR 1

PART B Page 46 URINARY SYSTEM AND MALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

KIDNEY/RENAL PELVIC M1110 Diagnostic endoscopic examination of kidney (including biopsy MAJOR 4 MAJOR 3 and other therapeutic procedures) M1120 Donor Nephrectomy MAJOR + 5 MAJOR + 2 M0620 Drainage of kidney MAJOR 2 MAJOR 4 M0880 Drainage of perinephric abscess MAJOR 2 MAJOR 3 M0680 Drainage of pyonephrosis MAJOR 2 MAJOR 4 M0910 Endoscopic fragmentation of calculus of kidney MAJOR 3 MAJOR 3 M0260 Excision of rejected transplanted kidney MAJOR 4 MAJOR 4 M1480 Extracorporeal fragment of calculus of kidney-stone (entire course) MAJOR 1 MAJOR 2 M1400 Extracorporeal fragmentation of calculus of kidney (lithotripsy) - INTER 4 INTER 5 single treatment M1410 Insertion of Tenckhoff catheter INTER 3 INTER 2 M0280 Laparoscopic nephrectomy CMO 2 MAJOR + 1 M0240 Laparoscopic renal cystectomy MAJOR + 2 MAJOR + 1 M0250 Nephrectomy (Simple) MAJOR 4 MAJOR 5 M0255 Nephrectomy for scarred kidney MAJOR + 2 MAJOR + 2 M0220 Nephro-ureterectomy MAJOR + 2 MAJOR 5 M0510 Open pyeloplasty with exploration of kidney, NT placement with MAJOR 4 MAJOR 3 or without stenting M0610 Open removal of calculus from kidney MAJOR + 2 MAJOR 4 M0800 Other open operations on kidney MAJOR 3 MAJOR 3 M0300 Partial excision of kidney MAJOR 5 MAJOR 5 M0270 Percutaneous antegrade endopyelotomy M1310 Percutaneous fine needle biopsy of lesion of kidney MINOR 4 INTER 2 M1360 Percutaneous insertion of nephrostomy tube INTER 5 INTER 3 M0940 Percutaneous nephrolithotomy (including cystoscopy and CMO 1 MAJOR + 2 retrograde catheterisation) M0950 Percutaneous nephrolithotomy (multiple tracts) staghorn CMO 2 MAJOR + 4 (including cystoscopy and retrograde catheterisation) M1380 Percutaneous tru-cut needle biopsy of lesion of kidney INTER 2 INTER 1 M1320 Pyeloplasty- robotic CMO 2 MAJOR + 4 M1330 Pyelostomy, unilateral INTER 4 INTER 3 M0210 Radical Nephrectomy MAJOR + 2 MAJOR + 3 M0230 Radical Nephrectomy (+ tumour from supradiaphragmatic IVC) CMO 3 CMO 1 M0290 Radical Nephrectomy (tumor > 8cm or renal vein or IVC involvement) CMO 2 MAJOR + 4 M0295 Removal of Tenckhoff catheter MINOR 5 MINOR M0550 Repair of kidney wound MAJOR + 1 MAJOR 4 M0560 Retograde transureteric endopyelotomy MAJOR + 5 MAJOR + 2 M0100 Transplantation of kidney CMO 3 CMO 3

PART B Page 47 URINARY SYSTEM AND MALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

URETER M2030 Bilateral replantation of ureter into bladder MAJOR + 3 MAJOR + 1 M2010 Bilateral replantation of ureter into bowel MAJOR + 5 MAJOR + 1 M1910 Construction of ileal conduit including ureteric implantation MAJOR + 2 MAJOR + 2 M1920 Endoscopic anti-reflux procdure on ureter (Bilateral) MAJOR 2 MAJOR 2 M1930 Endoscopic dilatation of ureter MINOR 4 MINOR M1940 Endoscopic dilatation of ureteric stricture MAJOR 2 MAJOR 2 M3000 Endoscopic examination of ureter with biopsy INTER 2 INTER 4 M2920 Endoscopic insertion of prosthesis into ureter, J stent, cystoscopy INTER 3 INTER 4 M3220 Endoscopic meatotomy of ureteric orifice INTER 1 INTER 5 M2930 Endoscopic removal of prosthesis from ureter MINOR 4 INTER 4 M3010 Endoscopic retrograde pyelography INTER 2 INTER 4 M1820 Excision of segment of ureter MAJOR 2 MAJOR 2 M3110 Extracorporeal shockwave lithotripsy of calculus of ureter INTER 4 MAJOR 3 M2130 Ileal or colonic replacement of ureter CMO 1 MAJOR + 4 M2280 Open correction vesico-ureteric reflux - (Bilateral) CMO 2 MAJOR + 4 M2210 Open correction vesico-ureteric reflux - (Unilateral) MAJOR 5 MAJOR 3 M2310 Open ureterolithotomy MAJOR 3 MAJOR 3 M3200 Operations on ureteric orifice INTER 1 INTER 5 M2100 Other connection of ureter MAJOR 5 MAJOR 5 M2110 Repair of ureterocoele MAJOR 5 MAJOR 4 M2120 Repair of ureterovaginal fistula MAJOR + 5 MAJOR + 2 M2150 Retrograde manipulation of ureteric stone and J stenting INTER 4 INTER 3 M2140 Retrograde ureteroscopic laser ablation of ureteric stone MAJOR 5 MAJOR 4 M2600 Therapeutic nephroscopic operations on ureter MAJOR 2 MAJOR 5 M2080 Unilateral replantation of ureter into bladder MAJOR 5 MAJOR + 2 M2020 Unilateral replantation of ureter into bowel MAJOR 5 MAJOR 5 M2040 Ureteric dilatation and insertion of Memokath stent for stricture MAJOR 5 MAJOR 4 M2980 Ureteric meatotomy MINOR 4 MINOR M2580 Ureterolysis - (Bilateral) MAJOR + 4 MAJOR + 4 M2530 Ureterolysis - (Unilateral) MAJOR 5 MAJOR 3 M2730 Ureteroscopic extraction of calculus of ureter INTER 5 INTER 4 M2740 Ureteroscopy for diagnosis INTER 4 INTER 3 M2750 Ureteroscopy for multiple calculi (complex) MAJOR 5 MAJOR 4 M2200 Ureterostomy - closure MAJOR 5 MAJOR 3 M2220 Ureterostomy - (Unilateral) INTER 5 INTER 5

PART B Page 48 URINARY SYSTEM AND MALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

BLADDER M4600 Bladder augmentation, open or laparoscopic MAJOR + 5 MAJOR + 5 M4610 Bladder neck reconstruction MAJOR + 5 MAJOR + 5 M4620 Burch colposuspension with or without cystoscopy MAJOR + 1 MAJOR + 1 M4630 Check cystoscopy MINOR 4 MINOR M4640 Clam ileocystoplasty MAJOR + 5 MAJOR + 5 M4650 Closure of bladder/vesicostomy INTER 4 INTER 4 M4910 Closure of cystostomy INTER 2 INTER 4 M4920 Closure of exstrophy - bladder CMO 2 MAJOR + 5 M5100 Combined abdominal and vaginal operations to support outlet of MAJOR 3 MAJOR 3 female bladder M5120 Construction of ileal conduit CMO 2 CMO 2 M5130 Continent diversion CMO 4 CMO 4 M5140 Cystoscopy MINOR 4 MINOR M5150 Cystoscopy for clot evacuation and diathermy of bleeders INTER 1 INTER 1 M3820 Cystostomy and insertion of suprapubic tube into bladder INTER 1 MAJOR 2 M4510 Diagnostic endoscopic examination of bladder (including any biopsy) MINOR 5 INTER 1 M5820 Dilatation of outlet of female bladder (with cystoscopy) MINOR 5 INTER 2 M3550 Diverticulectomy of bladder MAJOR 4 MAJOR 5 M2981 Endoscopic anti-reflux procedure INTER 5 INTER 5 M4230 Endoscopic destruction of lesion of bladder INTER 2 INTER 4 M4420 Endoscopic extraction of calculus of bladder + cystoscopy INTER 3 INTER 4 M4320 Endoscopic hydrostatic distention of bladder +/- biopsy MINOR 3 MINOR M6620 Endoscopic incision of outlet of male bladder INTER 5 INTER 4 M4430 Endoscopic removal of foreign body from bladder INTER 3 INTER 4 M4210 Endoscopic resection of lesion of bladder +/- biopsy MAJOR 3 MAJOR 3 M4310 Endoscopic transection of bladder MAJOR 3 MAJOR 3 M3600 Enlargement of bladder CMO 1 MAJOR + 2 M3610 EUA and TUR of multiple bladder tumours, cystoscopy MAJOR 4 MAJOR 4 M3620 Examination of bladder under anaesthesia MINOR 1 MINOR M3630 Excision of urachal cyst INTER 4 INTER 3 M5520 Implantation of artificial urinary sphincter into bladder and/or removal MAJOR 5 MAJOR 3 (with cystoscopy) M5530 Insertion of tension free vaginal tape - bladder INTER 5 INTER 5 M5540 Instillation of intravesical agent MINOR 1 MINOR M5550 Neobladder reconstruction CMO 2 CMO 1 M4110 Open excision of lesion from bladder MAJOR 3 MAJOR 3 M3900 Open removal of calculus from bladder/Vesicolithotomy INTER 5 INTER 5 M3500 Partial cystectomy with/without cystoscopy MAJOR 4 MAJOR 3 M3510 Radical cystectomy CMO 1 MAJOR + 5 M3400 Radical cystectomy (with construction of intestinal conduit or bladder) CMO 4 CMO 2 M3700 Repair of bladder injury, exploration MAJOR 5 MAJOR 4

PART B Page 49 URINARY SYSTEM AND MALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

BLADDER (continued) M3780 Repair of cutaneous vesical fistula INTER 4 MAJOR 4 M3760 Repair of epispadias of bladder MAJOR + 5 MAJOR + 4 M3750 Repair of recurrent vesico-vaginal fistula MAJOR + 5 MAJOR + 4 M3720 Repair of vesicocolic fistula MAJOR + 1 MAJOR 5 P2510 Repair of vesico-vaginal fistula MAJOR 5 MAJOR 5 M4480 Resection of bladder neck INTER 5 INTER 4 M5220 Retropubic suspension of neck of bladder MAJOR 3 MAJOR 3 M4400 Sphincterotomy INTER 4 INTER 4 M3880 Stab cystotomy MINOR 1 MINOR M5210 Suprapubic sling operation MAJOR 3 MAJOR 4 M5230 TURP or TUIBN with vesicolithotripsy/vesicolitholapaxy, cystoscopy MAJOR + 5 MAJOR + 4 M4780 Urodynamic studies/urodynamic assessment MINOR 5 MINOR M5300 Vaginal operations to support outlet of female bladder MAJOR 3 MAJOR 3 M5310 Vesicolitholapaxy/vesicolithotripsy + cystoscopy (stones >3cm or MAJOR 5 MAJOR 5 multiple) M4410 Vesicolitholapaxy/vesicolithotripsy + cystoscopy (single stone <3cm) MAJOR 2 MAJOR 3 M4440 Vesicostomy MAJOR 1 MAJOR 1

URETHRA M7330 Closure of fistula of urethra INTER 2 INTER 5 M7700 Diagnostic endoscopic examination of urethra (in isolation) MINOR 3 MINOR M7920 Dilatation of urethra MINOR 1 INTER 2 M7500 Excision of diverticulum of urethra INTER 4 INTER 5 P5041 Excision of ectopic ureterocoele MAJOR + 4 MAJOR + 4 M7580 Excision of prolapse of urethra MINOR 4 INTER 3 P5040 Excision of ureterocoele MAJOR + 3 MAJOR + 3 M5580 Excision/diathermy of urethral caruncle MINOR 2 MINOR M8130 External meatotomy of urethral orifice MINOR 5 MINOR P5050 First stage repair of penile hypospadias MAJOR 1 MAJOR 1 P5058 Hypospadias repair with free bladder or buccal mucusa graft/ redo CMO 3 CMO 3 for failed previous repair P5059 Implantation of artificial urinary sphincter of urethra CMO 2 MAJOR + 4 P5060 Insertion of periurethral continence balloon MAJOR + 1 MAJOR 5 M7940 Internal urethrotomy (including cystoscopy) INTER 2 INTER 4 M8120 Meatoplasty INTER 1 INTER 2 M7620 Removal of foreign body from urethra MINOR 3 INTER 3 M7320 Repair of epispadias MAJOR + 3 MAJOR + 1 M7310 Repair of hypospadias, proximal penile MAJOR 4 MAJOR 3 M7380 Repair of rupture of urethra, primary MAJOR 4 MAJOR 3 M7340 Repair of urethrorectal fistula MAJOR + 4 MAJOR + 1

PART B Page 50 URINARY SYSTEM AND MALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

URETHRA (continued) P5050 Repair of urethrovaginal fistula MAJOR 1 MAJOR 1 P5051 Single stage island flap repair of proximal or penoscrotal hypospadias CMO 1 CMO 2 P5052 Single stage repair for severe hypospadias with penoscrotal CMO 3 CMO 3 transposition/perineal +/- graft M5600 Therapeutic endoscopic operations on outlet of female bladder INTER 1 INTER 3 M7600 Therapeutic endoscopic operations on urethra INTER 2 INTER 4 M7630 Urethral realignment and SPC insertion for ruptured urethra MAJOR 5 MAJOR 4 M7640 Urethral sphincterotomy with cystoscopy INTER 4 INTER 3 M7280 Urethral valve resection MAJOR 1 INTER 5 M7200 Urethrectomy MAJOR 2 MAJOR 3 M5500 Urethrocele INTER 4 INTER 5 M7361 Urethroplasty (complex), trans pubic, with/without graft MAJOR 4 MAJOR 3 M7360 Urethroplasty (simple) MAJOR 2 MAJOR 2

PROSTATE M6730 Drainage of prostatic abscess with/without cystoscopy INTER 5 INTER 5 M6580 Endoscopic biopsy of prostate INTER 2 INTER 4 M6530 Endoscopic resection of prostate (TUR) MAJOR 4 MAJOR 4 M7080 Insertion of urethral stent for relief of prostatic obstruction MAJOR 3 MAJOR 3 M7090 Laparoscopic radical prostatectomy CMO 3 CMO 1 M7100 Laser TURP MAJOR 5 MAJOR 5 M6220 Open biopsy of lesion of prostate INTER 2 MAJOR 3 M6100 Open excision of prostate, transvesical, Millins MAJOR 4 MAJOR 3 M7020 Prostate, needle biopsy/transrectal ultrasound guided MINOR 3 MINOR M6780 Prostatic hyperthermia (up to six courses) MAJOR 1 MAJOR 1 M6180 Radical prostatectomy, reconstruction of bladder neck CMO 3 MAJOR + 5 M6190 Robotic radical prostatectomy CMO 4 CMO 2 M6720 Transurethral microwave therapy MAJOR 1 MAJOR 1 M6740 Transurethral needle ablation of prostate MAJOR 1 MAJOR 1

GENITALIA N0930 Abdominal undescended testis MAJOR 1 MAJOR 2 N1510 Bilateral epididymectomy INTER 5 MAJOR 1 N3210 Biopsy of lesion of penis MINOR 3 MINOR N1340 Biopsy of testis MINOR 5 INTER 1 N1360 Cavernosaphenous shunt - penis MAJOR + 1 MAJOR 5 N3035 Circumcision INTER 1 INTER 3 N3040 Circumcision neonatal INTER 1 INTER 3 N1100 Correction of hydrocele INTER 3 MAJOR 1

PART B Page 51 URINARY SYSTEM AND MALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

GENITALIA (continued) N3010 Diagnostic laparoscopy for testicular maldescent INTER 3 INTER 4 N3030 Diathermy of penile or meatal warts MINOR 1 MINOR N3020 Division of preputial adhesions MINOR 3 MINOR N3050 Epididymo-vasostomy (macroscopic) MAJOR 1 MAJOR 1 N3060 Epididymo-vasostomy, microscopic (Bilateral) MAJOR + 1 MAJOR 5 N1580 Excision of epididymal cyst INTER 2 INTER 5 N0700 Excision of lesion of testis INTER 1 INTER 5 N0750 Exploration of acute scrotum INTER 3 INTER 3 N0800 Exploration of testis (including biopsy) INTER 1 INTER 2 M8130 External meatotomy of urethral orifice MINOR 5 MINOR N1320 Fixation of testis INTER 2 INTER 4 N1310 Insertion of penile prosthesis (three piece) CMO 2 MAJOR + 4 N1330 Insertion of penile prosthesis semi malleable) MAJOR 1 MAJOR 1 N0630 Laparoscopic orchidectomy INTER 5 INTER 4 M8120 Meatoplasty INTER 1 INTER 2 M8140 Microsurgical sperm aspiration (MESA) INTER 2 INTER 2 M8150 Microsurgical varicocele ligation MAJOR 1 MAJOR 1 M8160 Microsurgical vasovasostomy (Bilateral) MAJOR + 1 MAJOR 5 N0910 Microvascular transfer of intrabdominal testis to scrotum MAJOR + 1 MAJOR 5 N2780 Operation for Peyronie's disease INTER 4 INTER 4 N2200 Operation(s) on seminal vesicle MAJOR 1 INTER 5 N1900 Operation(s) on varicocele INTER 2 INTER 5 N0680 Orchidectomy and excision of spermatic cord, radical INTER 5 INTER 4 N0920 Orchidopexy INTER 3 INTER 5 N0820 Orchidopexy (Bilateral) MAJOR 2 MAJOR 5 N2620 Partial amputation of penis MAJOR 1 MAJOR 3 N2630 Penile frenuloplasty alone MINOR 3 MINOR N2640 Percutaneous testicular sperm aspiration MINOR 1 MINOR N1000 Prosthesis of testis (insertion or removal) INTER 1 INTER 3 N2820 Reconstruction of penis MAJOR 2 MAJOR 3 N2840 Repair of avulsion on penis MAJOR 5 MAJOR 3 N2880 Repair of injury on penis INTER 5 INTER 5 N1300 Scrotal exploration MINOR 4 MINOR N1380 Scrotal exploration and Bilateral fixation of testis INTER 2 INTER 5 N1350 Scrotal exploration of testis (including biopsy) INTER 2 INTER 4 N1370 Scrotal exploration with orchidectomy for torsion and fixation of MAJOR 2 MAJOR 2 contralateral testis N1385 Shunt procedures for priapism MAJOR 4 MAJOR 4 N1390 Simple orchidectomy - (Bilateral) MAJOR 2 MAJOR 2 N0500 Simple orchidectomy - (Unilateral) MAJOR 1 MAJOR 2 N2610 Total amputation of penis MAJOR 5 MAJOR 3

PART B Page 52 URINARY SYSTEM AND MALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

GENITALIA (continued) N1520 Unilateral epididymectomy INTER 2 INTER 5 N1530 Vasectomy MINOR 5 MINOR N1540 Vasectomy reversal (macroscopic) MAJOR 1 MAJOR 1 N2050 Vasography, scrotal exploration MINOR 2 INTER 1 N2060 Winter procedure for priapism (Trucut) INTER 1 MINOR

OTHER T8540 Block dissection of para-aortic lymph nodes MAJOR + 4 MAJOR 4

PART B Page 53 FEMALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

UTERUS/ADNEXA Q0710 Radical hysterectomy and lymphadenectomy (Wertheim's) CMO 4 CMO 2 Q0740 Total abdominal hysterectomy MAJOR 4 MAJOR 5 Q0750 Subtotal abdominal hysterectomy MAJOR 4 MAJOR 5 Q0780 Hysterectomy and removal of uterine adnexa MAJOR 4 MAJOR 5 Q0800 Vaginal hysterectomy (including laparoscopically assisted) MAJOR 4 MAJOR 5 Q0880 Hysterectomy and removal of uterine adnexa for ovarian CMO 2 MAJOR + 3 malignancy Q0920 Myomectomy (including laparoscopically) MAJOR 4 MAJOR 5 Q0950 Plastic reconstruction of uterus MAJOR 1 MAJOR 3 Q1700 Therapeutic endoscopic operations on uterus (including MAJOR 1 MAJOR 3 endometrial ablation) Q1800 Hysteroscopy with/without D&C, biopsy (including polypectomy) INTER 2 INTER 5 Q2020 Endometrial biopsy or aspiration MINOR 3 MINOR 5 Q2230 Bilateral oophorectomy and salpingectomy (in isolation) MAJOR 3 MAJOR 3 Q2300 Unilateral oophorectomy and salpingectomy (in isolation) INTER 5 MAJOR 3 Q3110 Removal of products of conception from fallopian tube (ectopic MAJOR 2 MAJOR 4 pregnancy) including laparoscopically Q3900 Laparoscopy (including e.g. puncture of ovarian cysts, +/- biopsy, INTER 4 MAJOR 1 minor endometriosis) Q3902 Tubal patency test; open or laparoscopic methods, (Add on Code) RM270 MINOR Q3800 Laparascopy and therapeutic procedures including laser, diathermy and destruction e.g. endometriosis, adhesiolysis, tubal surgery and solid MAJOR 3 MAJOR 4 tumours

Q4400 Ovarian cystectomy (not included in other procedures) (and Bilateral) MAJOR 3 MAJOR 3 T8580 Block dissection of pelvic lymph nodes (not included in other MAJOR 4 MAJOR 4 procedures) X1000 Pelvic EUA for staging of malignancy or congenital anomaly MINOR 2 MINOR X1410 Total exenteration of pelvis CMO 4 CMO 4 X1420 Anterior exenteration of pelvis CMO 4 CMO 3 X1430 Posterior exenteration of pelvis CMO 4 CMO 3

SUSPENSION M5100 Combined abdominal and vaginal operations to support outlet of MAJOR 4 MAJOR 4 female bladder; vault suspension M5210 Suprapubic sling operation MAJOR 3 MAJOR 4 M5220 Retropubic suspension of neck of bladder MAJOR 3 MAJOR 3 M5300 Vaginal operations to support outlet of female bladder MAJOR 3 MAJOR 3 Q2080 Ventro-suspension of uterus including laparoscopic INTER 5 MAJOR 2

PART B Page 54 FEMALE REPRODUCTIVE ORGANS

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

CERVIX UTERI P2730 Colposcopy, cervix (+/- biopsy) MINOR 3 MINOR Q0100 Amputation of cervix uteri INTER 4 INTER 5 Q0220 Laser destruction of lesion of cervix uteri MINOR 2 MINOR Q0230 Cauterisation of lesion of cervix uteri (including loop diathermy) MINOR 2 MINOR Q0330 Cone biopsy of cervix uteri (including laser) INTER 2 INTER 5 Q0340 Punch biopsy of cervix uteri MINOR 1 MINOR Q1030 Dilatation of cervix uteri and curettage of uterus including, polypectomy and diathermy of cervix (for women over 40 years of age) MINOR 4 INTER 1

Q1031 Dilatation of cervix when done as a sole procedure MINOR 2 MINOR Q1040 Cervical cerclage insertion INTER 1 INTER 1 Q1041 Cervical cerclage removal MINOR 2 MINOR

VAGINA/PERINEUM M3710 Cystourethroplasty MAJOR 2 MAJOR 3 M5580 Excision/diathermy of urethral caruncle MINOR 2 MINOR P1303 Removal of impacted foreign body, vagina MINOR 2 MINOR P1304 Colposcopy of the vagina, with or without biopsy MINOR 2 MINOR P1305 Operations on female perineum MINOR 4 MINOR P1405 Incision of introitus of vagina MINOR 4 INTER 5 P1800 Other obliteration of vagina MAJOR 3 MAJOR 4 P1925 Excision of septum of vagina INTER 1 INTER 5 P2000 Excision of lesion of vagina (e.g. warts and cysts) INTER 2 INTER 5 P2100 Reconstruction of vagina CMO 1 MAJOR + 3 P2110 Vaginectomy, partial MAJOR 2 MAJOR 1 P2210 Anterior +/- posterior colporrhaphy and amputation of cervix uteri MAJOR 4 MAJOR 4 (including primary repair of enterocele) P2230 Posterior colporrhaphy INTER 5 MAJOR 2 P2310 Anterior +/- posterior colporrhaphy MAJOR 3 MAJOR 3 (including primary repair of enterocele) P2340 Repair of enterocele (in isolation) +/- posterior colporrhaphy MAJOR 2 MAJOR 3 P2380 Anterior (+/- posterior) colporrhaphy with vaginal hysterectomy MAJOR + 3 MAJOR + 1 (including primary repair of enterocele) P2505 Vault suspension surgery, abdominally or vaginally MAJOR 4 MAJOR 4 P2506 Repair of vault laceration/hematoma under anesthesia other than local MINOR 4 MINOR anesthesia P2507 Repair of vaginal laceration/hematoma under anesthesia other than local MINOR 4 MINOR anesthesia P2510 Repair of vesicovaginal fistula MAJOR 5 MAJOR 5 P2520 Repair of urethrovaginal fistula MAJOR 3 MAJOR 5 P2530 Repair of rectovaginal fistula MAJOR + 3 MAJOR + 1 P2540 Repair of ureterovaginal fistula MAJOR + 3 MAJOR + 1

VULVA/LABIA P0310 Excision of Bartholin gland INTER 2 INTER 2 P0320 Marsupialisation of Bartholin gland INTER 2 INTER 2 P0505 Colposcopy of the vulva with or without biopsy MINOR 2 MINOR P0510 Simple vulvectomy MAJOR 5 MAJOR 4 P0550 Excision of excess labial tissue INTER 1 INTER 4 P0580 Radical vulvectomy (including block dissection of inguinal gland) CMO 1 MAJOR + 3 P0600 Excision of lesion of vulva MINOR 5 INTER 2

HAEMOSTASIS P0700 Introduction of any hemostatic agent or pack or suture for nonobstetrical MINOR 2 MINOR vulva, vagina or cervical haemorrhage

PART B Page 55 PREGNANCY AND CONFINEMENT INTRAPARTUM R2340 Management of termination of pregnancy (TOP) - in a second trimester pregnancy R2350 Induction of labour or augmentation of labour, inclusive of but not exhaustive of artificial rupture of membrane, MINOR 2 oxytoxin infusion, prostaglandin insertion; one single charge per labour

R2400 Normal delivery, as a sole procedure INTER 4 INTER 4 R2410 Management of labour including vaginal delivery, vaginal breech delivery, vaginal multiple pregnancy delivery, including episiotomy, MAJOR 3 MAJOR 1 repair of first and second degree laceration with/without instrumentation eg. forceps and vacuum. (Amended Narrative) R1820 Caesarean delivery MAJOR 5 MAJOR + 2 R1821 Caesarean delivery with complications, including previous scar, failed instrumentation, placenta previa and multiple pregnancies (Amended 3120 CMO 1 Narrative)

POSTPARTUM R2510 Caesarean hysterectomy CMO 2 CMO 2 R2810 Currettage of delivered uterus MINOR 5 INTER 4 R3010 Repositioning of inverted uterus INTER 2 MAJOR 4 X3220 Manual removal of Placenta MINOR 5 INTER 1 X3225 Surgical management of PPH including but not limited to balloon insertion, B lynch suture, internal iliac ligation, uterine artery ligation INTER 4 INTER 5

VS6450 Neonatal exchange blood transfusion ( See Part A, under Paediatrics,

Neonatology)

CONTRACEPTION X3230 IUD insertion/Removal MINOR 1 MINOR X3240 IUD removal under GA MINOR 2 MINOR X3250 Placement/insertion of other contraceptive device MINOR 3 MINOR X3260 Bilateral tubal ligation INTER 5 INTER 5

PART B Page 56 SKIN AND SUBCUTANEOUS TISSUE

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

LESIONS OF SKIN H5680 Coccygeal /pressure ulcer excision INTER 2 MAJOR 3 S0520 Microscopically controlled excision of lesion of skin or MAJOR + 3 MAJOR + 1 subcutaneous tissue (Moh's chemosurgery) S0600 Malignant melanoma excision including grafting/wide excision MAJOR 5 MAJOR 4 S0630 Excision of lesion of skin or subcutaneous tissue - up to three MINOR 3 INTER 3 S0640 Excision of lesion of skin or subcutaneous tissue - four or more INTER 3 INTER 5 S0680 Lesion requiring wide excision (including rodent ulcer excision) INTER 3 INTER 3 S0820 Curettage/cryotherapy of lesions of skin including cauterisation - INTER 3 INTER 2 four or more S0920 Laser destruction of lesion of skin MINOR 5 MINOR S1420 Shave biopsy of lesion of skin MINOR 1 MINOR S4480 Removal of foreign body in deeper tissue INTER 1 INTER 2 S4720 Drainage of lesion of skin including abscess MINOR 2 MINOR S4740 Drainage of large subcutaneous abscess/haematoma MINOR 5 INTER 3 S6020 Limited area dermabrasion of skin MINOR 5 INTER 1 S6080 Extensive dermabrasion of skin INTER 3 INTER 4 S6400 Excision of nail bed (Zadeks) INTER 1 INTER 4 S1110 Curettage/cryotherapy of lesion(s) of skin including cauterisation MINOR 1 MINOR

S1500 Biopsy of skin or subcutaneous tissue MINOR 1 MINOR S1510 Percutaneous biopsy (not elsewhere specified) MINOR 1 MINOR S7010 Wedge excision or avulsion of nail including chemical ablation of MINOR 4 INTER 1 nail bed H5940 Excision of pilonidal sinus and suture/skin graft INTER 4 MAJOR 2 H6020 Laying open of pilonidal sinus MINOR 5 MINOR

REPAIR S4180 Primary suture of wound with involvement of deeper tissue INTER 5 MAJOR 2 S4230 Secondary suture of skin MINOR 2 INTER 1 S4810 Insertion/removal of skin expander into tissue INTER 5 INTER 5 S5710 Debridement of wound (and surgical toilet) unspecified MINOR 4 INTER 1 S5740 Debridement of wound (surgical toilet), straight lacerations 10-20cm MAJOR 1 MAJOR 1 S5750 Debridement of wound (surgical toilet), straight lacerations 5-10cm INTER 4 INTER 3 S5760 Debridement of wound (surgical toilet), straight lacerations 1-5cm MINOR 4 MINOR S5770 Debridement of wound (surgical toilet), straight lacerations < 1cm MINOR 1 MINOR S5780 Debridement of wound (surgical toilet), jagged lacerations 1-5cm INTER 1 INTER 1 S5790 Facial lacerations simple INTER 4 INTER 3 S5800 Toilet and suture of complex major lacerations (excluding face) MAJOR + 5 MAJOR + 3 S5810 Toilet and suture of complex major facial lacerations CMO 2 MAJOR + 5

PART B Page 57 SKIN AND SUBCUTANEOUS TISSUE

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

BURNS S5520 Escharectomy of burnt skin or subcutaneous tissue (not more than INTER 5 INTER 4 10%) S5530 Escharectomy of burnt skin or subcutaneous tissue (greater than MAJOR 2 MAJOR 4 10%) S5720 Extensive dressing of burnt skin or subcutaneous tissue, initial INTER 1 MAJOR 2 S5721 Extensive dressing of burnt skin or subcutaneous tissue, repeat MINOR 4 INTER 4

GRAFTS S3500 Split autograft of skin - small site INTER 3 INTER 5 S3530 Split autograft of skin - large site MAJOR 4 MAJOR 4 S3620 Full thickness graft (> 1 sq cm) INTER 4 MAJOR 3 S3630 Full thickness graft (< 1 sq cm) INTER 3 MAJOR 3

FLAPS/TRANSPLANT S1710 Reconstruction of Delto Pectoralis Flap MAJOR + 5 MAJOR + 2 S1720 Reconstruction of Pectoralis Major Myocutaneous Flap MAJOR + 5 MAJOR + 2 S1700 Distant flap of skin and muscle MAJOR + 1 MAJOR 5 S1730 Extensive excision with multiple flap closures MAJOR + 5 MAJOR + 2 S2400 Large local flap including myocutaneous and fancia INTER 5 INTER 5 S2500 Small local flap INTER 5 INTER 5 S1740 Microvascular free tissue flap MAJOR + 5 MAJOR + 2 S2220 Neurovascular island flap MAJOR + 2 MAJOR + 2 T7600 Microvascular free tissue transfer CMO 2 MAJOR + 5

PART B Page 58 BONE, JOINT ETC (not listed elsewhere)

Surgeon's Anaesthetist's CODE NARRATIVE Category Category

CONNECTIVE TISSUE/TENDON MUSCLE T5230 Plantar fasciectomy INTER 1 INTER 5 T5300 Excision of lesion of fascia MINOR 4 INTER 5 T5400 Other operations of fascia MINOR 5 INTER 1 T5900 Excision of ganglion, including repeat excision INTER 3 INTER 2 T6220 Excision of bursa INTER 1 INTER 3 T6400 Transfer of tendon INTER 3 INTER 4 T6410 Transfer of multiple tendons MAJOR 1 MAJOR 3 T6500 Excision of lesion of tendon INTER 1 INTER 4 T6580 Tendon graft, as sole procedure INTER 5 INTER 4 T6800 Secondary repair of tendon (including graft, transfer and/or MAJOR 3 MAJOR 2 prosthesis) T6910 Tenolysis, other than flexor INTER 4 INTER 4 T7010 Percutaneous tenotomy MINOR 3 MINOR T7050 Lengthening of tendon(s), including tenotomy INTER 4 INTER 4 T7110 Tenosynovectomy, including arthroscopic INTER 2 INTER 4 T7230 Release of constriction of sheath of tendon INTER 3 INTER 4 T7980 Limited repair of muscle, (i.e. less than 2cm tear), (e.g. rotator INTER 1 MAJOR 2 cuff), including arthroscopic T7910 Extensive (i.e. greater than 2cm tear) repair of muscle MAJOR 5 MAJOR 4 (e.g. rotator cuff), including arthroscopic T8000 Release of contracture of muscle INTER 4 MAJOR 1 T8100 Open biopsy of muscle MINOR 5 INTER 1 S1520 Needle/tru-cut biopsy of muscle MINOR 1 MINOR T7900 Excision of lesion of muscle without skin graft MAJOR 1 MAJOR 2 T8380 Excision of lesion of muscle with skin graft MAJOR 3 MAJOR 3

BONE (NON-SPECIFIC) W3650 Trephine biopsy of bone marrow MINOR 5 INTER 3 W3620 Open bone biopsy INTER 1 INTER 3 W3510 Introduction of therapeutic substance into bone, e.g. application of MINOR 5 MINOR anti-biotic for infected hip replacement as a sole procedure W3530 Removal of wire from bone, including k-wires MINOR 3 INTER 1 W0700 Excision of ectopic bone MINOR 5 INTER 3 W0640 Total excision of sesamoid bone INTER 1 INTER 4 W0850 Partial excision of bone (including exostoses) INTER 3 INTER 3 W0600 Total excision of bone with or without prosthetic MAJOR + 3 MAJOR + 1 replacement/reconstruction, e.g. trapezium W0900 Radical resection of bone tumour MAJOR + 5 MAJOR + 2 W1080 Osteotomy of large bone, with/without fixation, including graft MAJOR 4 MAJOR 4

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Surgeons's Anaesthetist's CODE NARRATIVE Category Category

BONE (NON-SPECIFIC) (continued) W1800 Drainage/debridement of bone(s), including sequestectomy for INTER 5 INTER 5 osteomylitis W2700 Fixation of epiphysis INTER 4 MAJOR 3

FRACTURES W1910 Primary open reduction of fracture of femur and open fixation MAJOR + 1 MAJOR 5 using pin and plate W6630 Primary closed reduction of fracture or dislocation of joint, INTER 1 INTER 3 with/without fixation including plaster of Paris, e.g. Colle's W2500 Closed reduction of fracture of long bone and external fixation, MAJOR 2 MAJOR 3 including POP and percutaneous k-wires, e.g. forearm W2580 Closed reduction of fracture of small bone and external fixation, INTER 2 INTER 5 including POP and percutaneous k-wires, W1920 Primary open reduction of long bone with fixation MAJOR 4 MAJOR 4 W6500 Primary open reduction of fracture with/without dislocation of joint MAJOR 3 MAJOR 3 W1940 Primary open reduction of small bone with fixation including intra- INTER 5 MAJOR 1 articular W2100 Primary open reduction of intra-articular fracture of long bone e.g. MAJOR 3 MAJOR 4 proximal humerus W2080 Open reduction of fracture of pelvis and internal fixation CMO 3 CMO 1 W2070 Open reduction and internal fixation of complex acetabular pelvic CMO 3 CMO 1 fracture W6700 Secondary open reduction of dislocation of joint INTER 2 INTER 3 W2300 Secondary open reduction of fracture of small bone, including INTER 5 INTER 5 intra-articular W2310 Secondary open reduction of fracture of long bone and MAJOR 3 MAJOR 3 intermedullary fixation or internal fixation for non union/mal- W2380 Locked intramedullary nailing MAJOR + 5 MAJOR + 2 W2330 Secondary open reduction of intra-articular fracture of bone MAJOR 3 MAJOR 3 W3040 Application of IIizarov frame for secondary non union/mal-union CMO 3 CMO 1 W3020 Adjustments to IIizarov frame rings for secondary non union/mal- MAJOR 2 MAJOR 2 union W3050 Adjustments to pin sites secondary for non-union/mal-union MINOR 5 MINOR W3100 Bone graft (except where part of another procedure) MAJOR 1 MAJOR 1 X2280 Manipulation and plaster of Paris for hip MINOR 5 INTER 3 W2830 Removal of internal fixation/prosthesis from bone/joint, excluding INTER 5 INTER 4 k-wires W3530 Removal of wire from bone, including k-wires MINOR 3 INTER 1

PART B Page 60 BONE, JOINTS ETC (not listed elsewhere)

Surgeons's Anaesthetist's CODE NARRATIVE Category Category

FRACTURES (continued) S5730 Surgical toilet to wound under general anaesthetic MINOR 4 INTER 1 S6010 Fixation of Epidural Fracture INTER 5 INTER 5 S6030 ORIF/Bone Grafting non-union clavicle INTER 5 INTER 5 S6040 Removal of cast (sole procedure) MINOR 1 MINOR

NERVES A6510 Carpal or cubital tunnel release, including endoscopic INTER 2 INTER 4 A6580 Carpal or cubital tunnel release, including endoscopic (Bilateral) MAJOR 1 MAJOR 4 A6600 Release of entrapment of deeply placed peripheral nerve including Anterior Interosseous Nerve and Posterior Interosseous Nerve INTER 2 INTER 4

A6820 Anterior transposition of ulna nerve INTER 3 INTER 5 A6830 Submuscular transposition of ulna nerve MAJOR 3 MAJOR 3 A6900 Revision of release of peripheral nerve MAJOR 1 MAJOR 1 A7310 Exploration/neurolysis/biopsy of peripheral nerve INTER 2 INTER 2

JOINTS (not listed elsewhere) W6900 Excision of synovial membrane of joint MAJOR 1 MAJOR 2 W7200 Primary prosthetic replacement/reconstruction/repair of ligament, MAJOR 1 MAJOR 1 including prosthesis W7700 Stabilising operations on joint MAJOR 1 MAJOR 2 W7800 Release of contracture of joint INTER 4 INTER 3 W8150 Arthrotomy of large joint, including removal of loose body from INTER 4 INTER 3 joint W8180 Arthrotomy of small joint, including removal of loose body from MINOR 1 MINOR joint W8300 Therapeutic arthroscopic operations on intra-articular cartilage INTER 4 INTER 5 (other than W8200) W8380 Therapeutic arthroscopic operations on intra-articular cartilage MAJOR 3 MAJOR 5 (other than W8200) Bilateral W8600 Therapeutic arthroscopic operations on cavity of joint MAJOR 3 MAJOR 3 W8680 Therapeutic arthroscopic operations on cavity of jont-Bilateral CMO 1 MAJOR + 3 W8700 Diagnostic arthroscopic examination of joint, with/without biopsy INTER 2 INTER 4 W9030 Injection(s) into large joint(s) under x-ray control MINOR 4 MINOR X2380 Manipulation of joint MINOR 3 INTER 3

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Surgeons's Anaesthetist's CODE NARRATIVE Category Category

JOINT REPLACEMENT/RECONSTRUCTION (not listed elsewhere) W5410 Prosthetic replacement of articulation of bone MAJOR 5 MAJOR 4 W5500 Prosthetic interposition arthroplasty of joint, e.g. hip, knee, shoulder MAJOR + 1 MAJOR 5 W5720 Excision reconstruction of joint MAJOR 2 MAJOR 2

FIXATION/ARTHRODESIS W1320 Osteotomy of hip with fixation MAJOR + 1 MAJOR + 1 W1640 Pelvic osteotomy with fixation CMO 2 MAJOR + 4 W6010 Primary arthrodesis of large joint and bone graft MAJOR 2 MAJOR 5 W6210 Primary arthrodesis and internal fixation, (hand/foot), including INTER 4 MAJOR 3 bone graft

HAND T5410 Dupuytren's subcutaneous fasciotomy MINOR 5 INTER 1 T5200 Dupuytren's fasciectomy - single digit INTER 4 INTER 4 T5210 Dupuytren's fasciectomy for Palm and multiple digits MAJOR 2 MAJOR 2 T5220 Dupuytren's dermofasciectomy and graft, or for recurrent disease MAJOR 5 MAJOR 5 T6710 Repair of extensor of hand INTER 2 INTER 4 T6750 Repair of flexor of hand, including prosthetic implant MAJOR 2 MAJOR 2 T6830 Secondary or second stage repair of flexor of hand (including MAJOR 3 MAJOR 2 prosthetic implant) T6850 Secondary repair of tendon of hand/forearm (excluding flexor), INTER 3 INTER 4 without transfer or graft T6820 Secondary repair of tendon of hand/forearm (excluding flexor) MAJOR 2 MAJOR 2 with graft/transfer T6580 Tendon graft as sole procedure INTER 5 INTER 4 T6910 Tenolysis, other than flexor INTER 4 INTER 4 T6980 Tenolysis of flexor MAJOR 1 INTER 5 W0120 Pollicisation of finger for thumb reconstruction CMO 2 MAJOR + 4 W0180 Repair of finger tip injury following avulsion with flap MAJOR 1 INTER 5 W0230 Multiple joint procedures on hand including synovectomy MAJOR + 2 MAJOR 5 W5930 Fusion of metacarpo-phalangeal/intercarpal joint INTER 3 MAJOR 1 W0510 Prosthetic arthroplasty of digital joint(s) MAJOR 2 MAJOR 2 W3200 Bone graft to scaphoid with internal fixation, including Herbal screw MAJOR 3 MAJOR 2 X0810 Amputation of hand MAJOR 1 MAJOR 2 X0820 Amputation of digit INTER 3 INTER 5 X0880 Amputation through mid-carpal/transmetacarpal INTER 3 INTER 4 W6200 Fusion of wrist MAJOR 4 MAJOR 5 W6300 Digital nerve repair by microsurgery INTER 4 INTER 3 W6310 Policisation of finger MAJOR + 5 MAJOR + 2 W6320 Replantation of digit, microsurgery MAJOR + 5 MAJOR + 2 W6330 Replantation of wrist, microsurgery MAJOR + 5 MAJOR + 2

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Surgeons's Anaesthetist's CODE NARRATIVE Category Category

SHOULDER T7980 Limited repair of muscle, (i.e. less than 2cm tear), (e.g. rotator INTER 1 MAJOR 2 cuff), including arthroscopic T7910 Extensive (i.e. greater than 2cm tear) repair of muscle MAJOR 5 MAJOR 4 (e.g. rotator cuff), including arthroscopic T7990 Revision rotator cuff repair MAJOR 5 MAJOR 4 W0810 Acromioplasty MAJOR 1 MAJOR 2 W0890 Excision distal clavicle, in isolation MAJOR 1 MAJOR 2 W5500 Prosthetic interposition arthroplasty of joint, e.g. hip, knee, shoulder MAJOR + 1 MAJOR 5 W5600 Primary repair of rupture of acromioclavicular joint including MAJOR + 5 MAJOR + 2 internal fixation W5630 Secondary repair of rupture of acromioclavicular joint including MAJOR + 5 MAJOR + 2 internal fixation W5890 Reconstruction of acromioclavicular joint MAJOR + 5 MAJOR + 2 W4900 Shoulder hemiarthroplasty MAJOR + 1 MAJOR 5 W4930 Revision shoulder hemiarthroplasty MAJOR + 4 MAJOR + 1 W5000 Primary total shoulder replacement MAJOR + 5 MAJOR + 2 W5030 Revision total shoulder replacement CMO 2 MAJOR + 5 W7710 Stabilisation of shoulder joint, including anterior, posterior or MAJOR 3 MAJOR 3 multi-directional, including arthroscopic W7780 Revision stabilisation of shoulder joint MAJOR + 2 MAJOR 5 W7810 Release of shoulder contracture MAJOR 5 MAJOR 4 W2810 Plating and/or bone grafting for non-union of clavicle MAJOR 4 MAJOR 4 A7340 Exploration and grafting of brachial plexus CMO 2 CMO 2 W8190 Sub-acromial decompression, including arthroscopic MAJOR 3 MAJOR 3 W0610 Total excision of cervical or first rib MAJOR 5 MAJOR 5

ELBOW W5510 Total prosthetic replacement of elbow MAJOR + 5 MAJOR + 2 W5520 Revisional prosthetic replacement of elbow CMO 2 MAJOR + 5 T7230 Release of constriction of sheath of tendon INTER 3 INTER 4

HIP, LEG AND PELVIS W0940 Excision of lesion of bone pelvis/hip MAJOR 1 MAJOR 3 W1320 Osteotomy of hip with fixation MAJOR + 1 MAJOR + 1 W1640 Pelvic osteotomy with fixation CMO 2 MAJOR + 4 W3710 Total prosthetic replacement of hip joint MAJOR + 5 MAJOR + 2 W3730 Revision of total prosthetic replacement of hip joint including removal CMO 3 CMO 1 W3780 Total prosthetic replacement of hip joint (Bilateral) CMO 4 CMO 2 W4600 Prosthetic replacement of head of femur MAJOR 5 MAJOR 5 W3720 Removal of hip implant as a sole procedure MAJOR 5 MAJOR 5

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Surgeons's Anaesthetist's CODE NARRATIVE Category Category

HIP, LEG AND PELVIS (continued) T5540 Release fasciotomy of anterior/posterior compartment of leg MAJOR 2 MAJOR 2 X0930 Amputation of leg/foot MAJOR 4 MAJOR 3 X2280 Manipulation and Plaster of Paris for hip MINOR 5 INTER 3 X2100 Pelvis Anterior exenteration of pelvis MAJOR + 5 MAJOR + 2 X2110 Pelvis Posterior exenteration of pelvis MAJOR + 5 MAJOR + 2 X2120 Pelvis Total exenteration of pelvis MAJOR + 5 MAJOR + 2

KNEE W8700 Diagnostic arthroscopic examination of joint, with/without biopsy INTER 2 INTER 4 W4210 Total prosthetic replacement of knee joint MAJOR + 5 MAJOR + 2 W5200 Unicompartmental knee replacement MAJOR + 5 MAJOR + 2 W4230 Revision of total replacement of knee joint, including removal of CMO 3 CMO 1 W4280 Total prosthetic replacement of knee joint (Bilateral) CMO 4 CMO 2 W7230 Primary prosthetic replacement of cruciate ligament MAJOR + 3 MAJOR + 1 W7420 Autograft reconstruction of cruciate ligament, including arthroscopic MAJOR + 4 MAJOR + 1 W7580 Stablisation of patella MAJOR + 3 MAJOR + 1 W8200 Therapeutic arthroscopic operations of semi lunar cartilage MAJOR 3 MAJOR 3 W8280 Therapeutic arthroscopic operations of semi lunar cartilage (Bilateral) CMO 1 MAJOR + 3 W8400 Simple repair of knee ligaments MAJOR 3 MAJOR 3 W8500 Therapeutic arthroscopic operations on cavity of knee MAJOR 3 MAJOR 3 W8580 Therapeutic arthroscopic operations on cavity of knee (Bilateral) CMO 1 MAJOR + 3 W4220 Removal of knee implant as a sole procedure MAJOR 5 MAJOR 5

FOOT T6760 Primary repair of tendon of foot MINOR 4 INTER 4 T6780 Primary repair of Achilles tendon INTER 4 INTER 4 T6810 Secondary repair of Achilles tendon MAJOR 3 MAJOR 3 T6860 Secondary repair of tendon of foot INTER 1 INTER 4 W0300 Multiple joint procedures on forefoot MAJOR + 2 MAJOR 5 W0310 Multiple joint procedures on forefoot (Bilateral) CMO 2 MAJOR + 4 W1510 Osteotomy of metatarsal (e.g. Akin, McNab etc.) INTER 2 INTER 4 W0330 Fusion of first metatarso-phalangeal joint INTER 3 INTER 5 W0380 Fusion of first metatarso-phalangeal joint (Bilateral) MAJOR 2 MAJOR 5 W0860 Metartarso-phalangeal cheilectomy MAJOR 1 MAJOR 1 W0420 Triple fusion of joints of hind foot MAJOR 3 MAJOR 3 W1580 Osteotomy for pes clavus MAJOR 3 MAJOR 3 X2700 Correction of minor congenital deformity of foot MAJOR 1 MAJOR 1 X2780 Correction of minor congenital deformity of foot (Bilateral) MAJOR + 3 MAJOR + 1 W4410 Total prosthetic replacement of ankle joint MAJOR + 5 MAJOR + 2

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Surgeons's Anaesthetist's CODE NARRATIVE Category Category

FOOT (continued) W4430 Revision of total prosthetic replacement of ankle joint CMO 2 MAJOR + 5 W0450 Closing wedge osteotomy/translation of calcaneal spur, including MAJOR 2 MAJOR 2 internal fixation W5700 Excision arthroplasty of first metatarso-phalangeal joint with MAJOR 2 MAJOR 2 prosthetic implantation W5710 Excision arthroplasty of first metatarso-phalangeal joint, including INTER 4 INTER 5 Keller's W5780 Excision arthroplasty of first metatarso-phalangeal joint, including MAJOR 3 MAJOR 5 Keller's (Bilateral) W5940 Fusion of interphalangeal joint(s) of toe INTER 3 INTER 4 W1590 Correction of retracted/dislocated metatarso-phangeal joint(s) including tendon transfer, division/realignment of bone and MAJOR 3 MAJOR 5 internal fixation W5980 Fusion of interphalangeal joint(s) of toe (Bilateral) MAJOR 2 MAJOR 4 W6210 Primary arthrodesis and internal fixation, (hand/foot), including INTER 4 MAJOR 3 bone graft W7900 Simple bunionectomy INTER 1 INTER 2 W7920 Simple bunionectomy (Bilateral) INTER 4 MAJOR 2 W7910 Metatarsal osteotomy for Hallux valgus INTER 5 MAJOR 3 W7980 Metatarsal osteotomy for Hallux valgus (Bilateral) MAJOR 5 MAJOR + 2 W7930 Metatarsal osteotomy for Hallux valgus, with internal fixation and MAJOR 3 MAJOR 4 soft tissue correction W7950 Metatarsal osteotomy for Hallux valgus, with internal fixation and CMO 1 MAJOR + 3 soft tissue correction (Bilateral) X1110 Amputation of toe(s) INTER 3 INTER 4 X0500 Radical excision of bone tumour with implantation of prosthesis CMO 3 CMO 1 for limb

ILLIZAROV W2820 Adjustment of Illizarov frame under GA MAJOR 1 MAJOR 1 W2840 Application of Illizarov frame for complex deformity MAJOR + 5 MAJOR + 2 W2850 Deformity correction by external fixator (non-Illizarov) MAJOR + 5 MAJOR + 2

EXTERNAL FIXATION/TRACTION W2910 Application of skeletal traction to bone MINOR 5 INTER 3 W2930 Removal of skeletal traction from bone MINOR 3 INTER 1 W3010 Application of external fixation to bone MAJOR 2 MAJOR 2 W3030 Removal of external fixation from bone MINOR 5 INTER 1

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Surgeons's Anaesthetist's CODE NARRATIVE Category Category

ANO-RECTAL P1000 High anorectal malformation, laparotomy and repair of CMO 3 CMO 3 P1010 Anorectal malformation, anterior sagittal anorectoplasty CMO 1 CMO 1 P1020 Anorectal malformation, laparoscopic assisted abdominal perineal CMO 1 CMO 1 pull through operation P1030 Anorectal malformation, posterior sagittal anorectoplasty CMO 2 CMO 2

BILE DUCT P1040 Choledochal Cyst, excision of and reconstruction CMO 5 CMO 5 P1050 Kasai porto-enterostomy for biliary atresia CMO 5 CMO 5

CHEST WALL P1060 Closure of ectopia cordis CMO 4 CMO 4 P1070 Chest wall deformity correction, open or laparoscopic CMO 1 CMO 1

CLOACA P1080 Cloacal malformation, posterior sagittal anorecto-vagino- urethroplasty for

COLON P1090 Reconstruction for long segment Hirschsprung's disease CMO 3 CMO 3 P1100 Hirschsprung's disease, Rectosigmoidectomy and Reconstruction CMO 3 CMO 3 P1120 Colonic atresia, excision and re-anastomosis for neonate MAJOR + 1 MAJOR + 1 P1130 Neonatal colostomy, transverse or sigmoid MAJOR 1 MAJOR 1

LIVER P1140 Liver transplantation CMO 5 CMO 5

OESOPHAGUS P1150 Oesophageal atresia, oesophageal replacement for CMO 3 CMO 3 P1160 Oesophageal duplication, open or thorascopic excision CMO 2 CMO 2 P1170 Repair of neonatal oesophagus CMO 2 CMO 2 P1180 Neonatal cervical esophagostomy MAJOR 1 MAJOR 1 P1190 Neonatal esophagoscopy INTER 4 INTER 4

PANCREAS P1200 Near total pancreatectomy for nesidioblastosis CMO 4 CMO 4 P1210 Subtotal pancreatectomy for nesidioblastosis CMO 4 CMO 4

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TRACHEA P1220 Recurrent tracheo-oesophageal fistula, repair of CMO 4 CMO 4 P1230 Tracheo-oesophageal cleft, separation of CMO 4 CMO 4 P1240 Aortopexy for tracheomalacia CMO 2 CMO 2 P1250 Tracheo-oesophageal fistula (H type), repair of CMO 4 CMO 4 P1260 Trachoe-oesophageal fistula; open or thorascopic division of CMO 4 CMO 4

TUMOUR P1270 Thoracic neural crest tumour, open or thorascopic excision CMO 2 CMO 2 P1280 Abdominal neuroblastoma, excision of CMO 2 CMO 2 P1290 Sacrococcygeal teratoma, excision of CMO 2 CMO 2 P1300 Retroperitoneal tumour or teratoma, excision of CMO 1 CMO 1

VAGINA P1310 Vaginoplasty (complicated) with bowel replacement for CMO 5 CMO 5 masculinised female P1320 Vaginoplasty with simple skin flap for masculinised female MAJOR 1 MAJOR 1 P1330 Vaginostomy for hydrocolpos MAJOR 1 MAJOR 1

CLITORIS P1340 Reduction clitoroplasty for masculinised female MAJOR + 5 MAJOR + 5

BLADDER P1350 Closure of exstrophy CMO 4 CMO 4 P1360 Bladder augmentation, open or laparoscopic CMO 1 CMO 1 P1370 Bladder neck reconstruction MAJOR + 5 MAJOR + 5 P1380 Vesicostomy MAJOR 1 MAJOR 1 P1390 Closure of bladder/vesicostomy INTER 4 INTER 4 P1400 Excision of urachal cyst INTER 4 INTER 4

DIAPHRAGM P1410 Diaphramatic eventration, repair of CMO 2 CMO 2

TESTIS P1420 Microvascular testicular transfer for intra-abdominal testis CMO 1 CMO 1

ABDOMINAL WALL P1430 Neonatal closure of exomphalos major CMO 1 CMO 1 P1440 Neonatal closure of gastroschisis CMO 1 CMO 1 P1450 Abdominoplasty for prune belly syndrome MAJOR + 1 MAJOR + 1 P1460 Neonatal closure of exomphalos minor MAJOR 1 MAJOR 1

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BRONCHUS P1470 Bronchial cyst, excision of CMO 2 CMO 2 P1480 Neonatal rigid brochoscopy INTER 4 INTER 4

DUODENUM P1490 Duodenal stenosis or atresia, Duodeno-duodenostomy for MAJOR + 5 MAJOR + 5 P1500 Ladd's procedure formal-rotation MAJOR + 1 MAJOR + 1 P1505 Plication of dilated duodenum or jejunum in atresia MAJOR + 1 MAJOR + 1

HERNIA P1510 Neonatal strangulated hernia, repair MAJOR 3 MAJOR 3 P1520 Neonatal herniotomy MAJOR 1 MAJOR 1

LAPAROTOMY P1530 Meconium pseudocyst, laparotomy for CMO 1 CMO 1 P1540 For Necrotising enterocolitis MAJOR + 1 MAJOR + 1 P1550 Intestinal duplication, laparotomy and excision of MAJOR + 1 MAJOR + 1 P1560 Short bowel syndrome, Intestinal surgery for MAJOR + 1 MAJOR + 1

LUNG P1570 Drainage of abscess of lung or pleura; open or thorascopic MAJOR + 1 MAJOR + 1 P1580 Congenital cystic adenomatoid malformation (CCAM) of lung CMO 1 CMO 1 P1590 Pulmonary sequestration, excision of CMO 1 CMO 1

URETHRA P1600 Epispadias, repair of CMO 1 CMO 1 P1610 Hypospadia (perineal), single stage repair +/- graft CMO 1 CMO 1 P1620 Hypospadias repair (redo) for failed previous repair CMO 1 CMO 1 P1630 Hypospadia (distal penile), repair of MAJOR + 1 MAJOR + 1 P1640 Hypospadia (penile), First stage repair of MAJOR + 1 MAJOR + 1 P1650 Hypospadia (penoscrotal with chordee), single stage repair MAJOR + 1 MAJOR + 1 P1660 Hypospadia (proximal penile), repair of MAJOR + 1 MAJOR + 1 P1670 Urethroplasty MAJOR + 1 MAJOR + 1 P1680 Ureterostomy, (Unilateral) MAJOR + 1 MAJOR + 1 P1690 Glandular or coronal hypospadias, repair of MAJOR + 1 MAJOR + 1

SPLEEN P1700 Repair of spleen MAJOR + 1 MAJOR + 1 P1710 Subtotal splenectomy MAJOR + 1 MAJOR + 1

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STOMACH P1720 Pyloric atresia, Gastro-duodenostomy for MAJOR + 1 MAJOR + 1 P1730 Neonatal gastrostomy MAJOR 1 MAJOR 1 P1740 Neonatal pyloromyotomy MAJOR 1 MAJOR 1

SMALL BOWEL P1750 Jejunal or ileal atresia, resection and anastomosis MAJOR + 1 MAJOR + 1 P1760 Neonatal feeding jejunostomy MAJOR 1 MAJOR 1 P1770 Neonatal ileostomy MAJOR 1 MAJOR 1

LYMPHANGIOMA P1780 Lymphangioma, excision of large CMO 1 CMO 1 P1790 Lympangioma, excision of small MAJOR + 1 MAJOR + 1

RECTUM P1805 Neonatal rectal biopsy INTER 1 INTER 1 P1810 Rectal prolapse, perianal suture for MINOR 3 MINOR 3 P1820 Rectal prolapse, presacral injection of substance for MINOR 4 MINOR 4

TESTIS P1830 Exploration or acute scrotum INTER 4 INTER 4 P1840 Orchidopexy INTER 4 INTER 4

PENIS P1850 Penile chordee with no hypospadias, correction of MAJOR 1 MAJOR 1 P1860 Neonatal circumcision INTER 1 INTER 1

OTHERS P1870 Staged Fowler Stephens ligation of testicular vessel, open or MAJOR 1 MAJOR 1 laparoscopic P1880 Continent urinary diversion MAJOR + 1 MAJOR + 1 P1890 Anus: Neonatal anoplasty MAJOR 1 MAJOR 1 P1900 Vascular access: Insertion of central venous line for neonate INTER 4 INTER 4 P1910 Ear: Pre-auricular skin tag, excision of INTER 1 INTER 1 P1920 Skin: Abscess/lesion of skin, drainage of small (Neonatal) MINOR 4 MINOR 4 P1930 Kidney: Pyelostomy, (Unilateral) INTER 4 INTER 4

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Surgeon's Anaesthetist's CODE NARRATIVE Category Category

BIOPSIES/LOCALISATION XR100 INRAD - Fluroscopically guided biopsy MINOR 5 INTER 5 XR110 INRAD - Ultrasound guided biopsy INTER 1 INTER 5 XR120 INRAD - CT/MRI guided biopsy INTER 2 INTER 5 XR130 INRAD - Transjugular/transfemoral plugged liver biopsy (ies) INTER 3 INTER 5 XR140 Percutaneous spinal/transpedicular biopsy INTER 5 INTER 5 XR150 Image guided localisation, with hookwire or equivalent devices, MINOR 1 INTER 5 per lesion, excluding diagnostic fee XR160 Vacuum assisted lumpectomy (mammotome or equivalent) INTER 3 INTER 5 1 lesion, not including diagnostic evaluation XR200 Vacuum assisted lumpectomy (mammotome or equivalent) INTER 5 INTER 5 2 lesions, not including diagnostic evaluation XR210 Vacuum assisted lumpectomy (mammotome or equivalent) MAJOR 2 MAJOR 2 3 lesions, not including diagnostic evaluation XR220 Vacuum assisted lumpectomy (mammotome or equivalent) MAJOR 3 MAJOR 3 4 lesions or more, not including diagnostic evaluation

DRAINAGES/LYSIS XR170 INRAD - Fluroscopically guided drainage of fluid collection, MINOR 5 INTER 3 unilocular, non-critical location XR230 INRAD - Fluroscopically guided drainage of fluid collection: complex, retroperitoneal, high risk, multiple catheters in the same INTER 5 INTER 5 area/organ, with/without combined US or CT assistance XR180 INRAD - Ultrasound guided drainage of fluid collection INTER 3 INTER 5 XR190 INRAD - CT/MRI guided drainage of fluid collection INTER 5 INTER 5 XR240 Intracavitory fibrinolysis, excluding drainages INTER 3 INTER 5 XR280 Intracavitory fibrinolysis, including drainages INTER 5 INTER 5 XR300 Percutaneous pleudodesis MINOR 4 INTER 3 XR305 Change of drainage catheter, per site MINOR 3 INTER 1

DILATATIONS/STENTING XR455 INRAD - Dilatation of stricture under imaging control INTER 3 INTER 3 XR565 INRAD - Percutaneous dilatation of biliary stricture under MAJOR 3 MAJOR 3 imaging control XR315 INRAD - Endoluminal stone extraction from salivary duct MINOR 5 INTER 1 imaging control, per side XR310 INRAD - Insertion of nasolacrimal stent under imaging control, MAJOR 1 INTER 3 per side

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Surgeon's Anaesthetist's CODE NARRATIVE Category Category

SPINAL AND PAIN INTERVENTIONS XR500 INRAD - Chemonucleolysis, per level INTER 3 INTER 3 XR510 INRAD - Fluroscopically guided discectomy (including laser) per level MAJOR 2 MAJOR 1 XR520 INRAD - CT guided discectomy (including laser) MAJOR + 1 MAJOR + 1 XR330 INRAD - Fluroscopically guided percutaneous vertebroplasty, MAJOR 2 MAJOR 2 single level XR340 INRAD - Fluoroscopically guided percutaneous vertebroplasty, MAJOR + 1 MAJOR + 1 two levels XR530 INRAD - Fluroscopically guided percutaneous vertebroplasty, MAJOR + 3 MAJOR + 3 three levels XR540 INRAD - CT guided percutaneous vertebroplasty, per level MAJOR + 1 MAJOR + 1 XR380 Fluroscopic guided kyphoplasty, single level MAJOR + 1 MAJOR + 1 XR390 Fluroscopic guided kyphoplasty, two levels MAJOR + 3 MAJOR + 3 XR400 Fluroscopic guided kyphoplasty, three levels MAJOR + 5 MAJOR + 5 XR410 Image guided percutaneous transdiscal RF ablation, per level MAJOR 2 MAJOR 2 XR420 Image guided percutaneous ozone annuloplasty, per level MAJOR 3 MAJOR 3 XR430 Image guided percutaneous radiofrequency annuloplasty, per level MAJOR 3 MAJOR 3

XR440 Image guided percutaneous thoracic sympathectomy, neurolytic INTER 5 INTER 5 XR450 Image guided percutaneous lumbar sympathectomy, neurolytic INTER 3 INTER 5 XR460 Image guided percutaneous sympathectomy: Radiofrequency, MAJOR 3 MAJOR 3 thoracic XR470 Image guided percutaneous sympathectomy: Radiofrequency, MAJOR 2 MAJOR 2 Lumbar, splanchnic nerve XR480 Image guided facet joint injection, lumbar/thoracic INTER 3 INTER 5 XR490 Image guided facet joint injection, cervical INTER 5 INTER 5 XR550 Image guided peripheral joint injection of substance MINOR 2 INTER 5 XR560 Image guided dorsal root ganglion block, single level, LA or INTER 3 INTER 3 neurolytic XR620 Image guided dorsal root ganglion block, each additional level MINOR 1 MINOR XR660 Image guided radiofrequency ablation: facet or sacroiliac Joints MAJOR 1 MAJOR 1 XR670 Image guided radiofrequency ablation: Dorsal root ganglion, MAJOR 1 MAJOR 1 cervical XR680 Image guided radiofrequency ablation: Dorsal root ganglion, INTER 5 INTER 5 lumbar/thoracic XR690 Image guided Injection, LA or neurolytic: Sphenopalatine or INTER 3 INTER 5 trigeminal ganglion, 1 side XR700 Image guided radiofrequency ablation: Sphenopalatine or MAJOR 2 MAJOR 2 trigeminal ganglion, 1 side XR710 Image guided Injection, LA or neurolytic: Superior cervical INTER 3 INTER 5 ganglion, 1 side XR720 Image guided radiofrequency ablation: Superior cervical ganglion INTER 5 INTER 5

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Surgeon's Anaesthetist's CODE NARRATIVE Category Category

SPINAL AND PAIN INTERVENTIONS (continued) XR730 Image guided stellate ganglion ablation, neurolytic INTER 3 INTER 5 XR740 Image guided stellate ganglion ablation, radiofrequency INTER 5 INTER 5 XR750 Image guided RF cordotomy MAJOR 5 MAJOR 5 XR760 Image guided Epidural injection: Cervical/Thoracic MINOR 5 INTER 1 XR780 Image guided Epidural injection: Lumbar MINOR 4 INTER 1 XR790 Epidural adhesiolysis, standard MAJOR 3 MAJOR 3 XR800 Epidural adhesiolysis, complex or cervical MAJOR + 1 MAJOR + 1 XR810 Epidural adhesiolysis, follow up infusion MINOR 2 INTER 1 XR820 Image guided percutaneous epidural electrode insertion MAJOR 1 MAJOR 1 XR830 Image guided spinal stimulator implantation MAJOR 2 MAJOR 2 XR840 Image guided subcutaneous reservoir and spinal catheter insertion INTER 3 INTER 5 XR850 Image guided intrathecal drug injection MINOR 5 INTER 5 XR860 Image guided peripheral nerve ablation, radiofrequency or MINOR 5 INTER 1 chemical, per lesion XR870 Discography, 1 level: Lumbar - Fluroscopic guided INTER 3 INTER 5 XR880 Discography, 1 level: Cervical or thoracic - Fluroscopic guided INTER 5 INTER 5

HEPATOBILIARY/GASTROINTESTINAL INTERVENTIONS AND TUMOUR ABLATIONS XR595 INRAD - Insertion of tracheal/bronchial metallic stent INTER 5 MAJOR 4 XR600 INRAD - Insertion of oesophageal metallic stent under imaging INTER 5 INTER 5 control XR585 INRAD - Percutaneous gastrostomy INTER 5 INTER 5 XR590 INRAD - Percutaneous gastrojejunostomy MAJOR 2 MAJOR 2 XR890 Hydrostatic or air reduction of intussusceptin under image MINOR 4 INTER 4 guidance XR580 INRAD - Percutaneous cholecystotomy MAJOR 1 MAJOR 1 XR900 Percutaneous transhepatic biliary drainage (PTBD), standard: INTER 3 INTER 5 Moderate or well dilated system, 1 side XR930 Percutaneous transhepatic biliary drainage (PTBD), standard: INTER 5 MAJOR 1 Moderate or well dilated system, 2 sides XR970 Percutaneous transhepatic billiary drainage (PTBD), complex: Non-dilated or mildly dilated system, or requiring balloon MAJOR 3 MAJOR 3 dilatation XR570 INRAD - Percutaneous insertion of plastic biliary endoprosthesis, MAJOR 1 MAJOR 1 standard with moderate or grossly dilated system XR980 INRAD - Percutaneous insertion of plastic biliary endoprosthesis, MAJOR 3 MAJOR 3 complex or non-dilated system XR575 INRAD - Percutaneous insertion of metallic biliary endoprosthesis, standard: 1 side with moderate or grossly dilated MAJOR 3 MAJOR 3 system XR990 INRAD - Percutaneous insertion of metallic biliary endoprosthesis, complex, bilateral, non - dilated or minimally MAJOR + 3 MAJOR + 2 dilated system

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Surgeon's Anaesthetist's CODE NARRATIVE Category Category

HEPATOBILIARY/GASTROINTESTINAL INTERVENTIONS AND TUMOUR ABLATIONS (continued) XR1000 Image guided percutaneous tumour ablation therapy: INTER 1 INTER 1 chemical 1 lesion XR1010 Image guided percutaneous tumour ablation therapy: INTER 3 INTER 3 chemical 2 -3 lesions XR1020 Image guided percutaneous tumour ablation therapy: INTER 3 INTER 3 Cryo or radiofrequency, 1 lesion, standard anatomy XR1030 Image guided percutaneous tumour ablation therapy: MAJOR 5 MAJOR 5 Cryo or radiofrequency, 2 lesions, standard anatomy XR1040 Image guided percutaneous tumour ablation therapy: Cryo of radiofrequency, 3 lesions or complex/large lesion/dangerous MAJOR + 3 MAJOR + 3 anatomy XR960 INRAD - Percutaneous laser coagulation of mass MAJOR + 5 MAJOR + 5 XR610 INRAD - Transjugular intrahepatic portosystemic shunt MAJOR + 1 MAJOR + 1

GENITOURINARY INTERVENTIONS XR630 INRAD - Percutaneous nephrostomy, 1 side INTER 3 INTER 3 XR1050 INRAD - Percutaneous nephrostomy, 2 sides INTER 5 INTER 5 XR1060 INRAD - Percutaneous nephrostomy with ureteric cannulation and INTER 5 INTER 5 bladder internalisation, 1 side XR1070 INRAD - Percutaneous nephrostomy with ureteric cannulation and MAJOR 2 MAJOR 2 bladder internalisation, 2 sides XR1080 Percutaneous ureteric balloon dilatation, 1 side INTER 5 INTER 5 XR1090 Percutaneous ureteric balloon dilatation, 2 sides MAJOR 2 MAJOR 2 XR1100 Antegrade ureteric stenting, 1 side MAJOR 2 MAJOR 2 XR1110 Antegrade ureteric stenting, 2 sides MAJOR + 1 MAJOR + 1 XR640 INRAD - Percutaneous removal of calculus MAJOR 5 MAJOR 5 XR650 INRAD - Percutaneous pyelolysis MAJOR 5 MAJOR 5 XR1120 Ureteric embolisation, 1 side MAJOR 2 MAJOR 2 XR1130 Ureteric embolisation, 2 sides MAJOR + 1 MAJOR + 1 XR1140 Image guided fallopian tube recanalisation, 1 side INTER 3 INTER 3 XR1150 Image guided fallopian tube recanalisation, 2 sides INTER 5 INTER 5

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Surgeon's Anaesthetist's CODE NARRATIVE Category Category

REVASCULARISATIONS XR250 INRAD - Angioplasty, 1 lesion MAJOR 3 MAJOR 3 XR1160 INRAD - Angioplasty, multiple lesions, single territory MAJOR + 1 MAJOR + 1 XR1170 INRAD - Angioplasty, multiple lessions, multiple territories, MAJOR + 5 MAJOR + 5 single limb XR260 INRAD - Angioplasty with insertion of metallic stent, 1 lesion MAJOR 5 MAJOR 5 XR1180 INRAD - Angioplasty with insertion of metallic stent, 2 lesions MAJOR + 2 MAJOR + 2 XR1190 INRAD - Angioplasty with insertion of metallic stent, 3 lesions MAJOR + 5 MAJOR + 5 XR270 INRAD - Angioplasty with insertion of metallic stent-graft, per lesion MAJOR 5 MAJOR 5 XR1200 INRAD - Insertion of aortic metallic stent-graft CMO 2 CMO 2 XR1210 Subintimal Angioplasty, 1 artery MAJOR 5 MAJOR 5 XR1220 Subintimal Angioplasty, 2 arteries MAJOR + 3 MAJOR + 3 XR1230 Subintimal Angioplasty, 3 arteries MAJOR + 5 MAJOR + 5

NEUROVASCULAR INTERVENTIONS XR290 INRAD - Cerebral angioplasty, per lesion CMO 3 CMO 3 XR1240 INRAD - Cerebral angioplasty with insertion of metallic stent per CMO 4 CMO 4 lesion XR295 INRAD - Cerebral angioplasty with insertion of metallic stent-graft CMO 4 CMO 4 XR1245 Extracranial angioplasty/stenting, per lesion CMO 2 CMO 2 XR1260 Carotid/Vertebral transsarterial thrombolysis, not including CMO 3 CMO 3 adjunctive procedure XR1270 Intracranial clot retrieval, not including adjunctive procedure CMO 3 CMO 3 XR1280 Intracranial/skull base tumour embolization CMO 3 CMO 3

EMBOLISATION XR350 INRAD - Embolisation of artery or vein: standard MAJOR 2 MAJOR 2 XR1290 INRAD - Embolisation of artery or vein: superselective or use of MAJOR 5 MAJOR 5 microcatheter XR1300 INRAD - Embolisation of artery or vein: superselective, complex/ MAJOR + 5 MAJOR + 5 high risk anatomy or multiple pedicles XR360 INRAD - Embolisation vascular mass MAJOR + 1 MAJOR + 1 XR370 INRAD - Embolisation of bronchial artery MAJOR + 5 MAJOR + 5 XR1310 Transcatheter regional radio-isotope embolisation MAJOR + 5 MAJOR + 5 XR1320 Transarterial regional stem cell transplantation MAJOR + 5 MAJOR + 5 XR1330 Percutaneous atherectomy MAJOR + 1 MAJOR + 1 XR1340 Percutaneous laser recanalisation MAJOR + 1 MAJOR + 1 XR1350 Endovascular brachytherapy, not including diagnostic angiogram INTER 5 INTER 5 and adjunctive procedure XR1360 Intravascular ultrasound (IVUS), not including adjunctive INTER 5 INTER 5 procedures

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Surgeon's Anaesthetist's CODE NARRATIVE Category Category

EMBOLISATION (continued) XR1370 INRAD - Embolisation of aneurysm, not including adjunctive CMO 4 CMO 1 procedures XR1380 INRAD - Embolisation of arteriovenous malformation, per region CMO 4 CMO 1 XR1390 Embolisation of Dural AVF, single pedicle, per side CMO 3 CMO 1 XR1400 Embolisation of Dural AVF, complex, multiple pedicles, per side CMO 4 CMO 1 XR1410 Embolisation of Carotico - Cavernous Fistulae, single balloon CMO 2 MAJOR + 4 occlusion, per side XR1420 Embolisation of Dural AVF, complex, transarterial/transvenous, CMO 4 CMO 1 per side XR1430 INRAD - Thrombolysis or aspiration of thrombus under imaging control, excluding diagnostic angiogram, adjunctive procedure and MAJOR + 5 MAJOR + 5 follow up interventions XR1440 Thrombolysis: Carotid/Vertebral territory, excluding adjunctive CMO 4 CMO 1 procedures XR935 INRAD - Insertion of vena cava filter INTER 3 INTER 5

VASCULAR ACCESS/INTERVENTIONS XR910 INRAD - Insertion of central venous catheter - non tunneled MINOR 5 INTER 3 (x-ray guided) complex, high risk XR915 INRAD - Insertion of central venous catheter - tunneled INTER 3 INTER 5 (x-ray guided) XR1450 Port placement: Venous, (x-ray guided) INTER 5 INTER 5 XR1460 Port placement: Arterial, without embolisation/arterial remodelling MAJOR 1 MAJOR 1 XR1470 Port placement: Arterial, complex or with embolisation/arterial MAJOR + 5 MAJOR + 5 remodelling XR1480 Peritoneal Catheter/Portacath insertion INTER 2 INTER 5 XR1490 Port removal MINOR 2 INTER 3 XR1500 Catheter removal MINOR 1 INTER 3 XR1510 Hickman line removal MINOR 2 INTER 4 XR1520 Fibrin Stripping of central venous line INTER 3 INTER 4

VENOUS SAMPLING XR1530 Inferior petrosal venous sampling MAJOR 1 MAJOR 1 XR1540 Venous Sampling: Standard, adrenal, ovarian INTER 3 INTER 3 XR1550 Venous Sampling: Complex, arterial stimulated, pancreatic, MAJOR 2 MAJOR 2 parathyroid

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Surgeon's Anaesthetist's CODE NARRATIVE Category Category

OTHERS XR920 INRAD - Cyst ablation under imaging control, 1 lesion INTER 3 INTER 3 XR1560 INRAD - Cyst ablation under imaging control, 2 lesions INTER 4 INTER 4 XR1570 INRAD - Cyst ablation under imaging control, 3 lesions INTER 5 INTER 5 XR1580 Image guided cyst aspiration, per cyst MINOR 1 INTER 2 XR1590 INRAD - Retrieval of foreign body under x-ray guidance, non- MAJOR 2 MAJOR 2 critical systems XR940 INRAD - Retrieval of foreign body under image guidance, MAJOR + 5 MAJOR + 5 complex, pulmonary or other critical organs XR1600 INRAD - Retrieval of foreign body under image guidance, CMO 3 CMO 3 neurovascular XR950 INRAD - Occulusion of fistula under imaging control MAJOR 2 MAJOR 2 XR1610 Intra - operative ultrasound localisation MINOR 4 MINOR

DIAGNOSTIC XR1620 Aortogram INTER 3 INTER 5 XR1630 Peripheral angiogram, non-selective, flush aortic injection INTER 5 INTER 5 XR1640 Peripheral angiogram, selective, per side INTER 5 INTER 3 XR1650 Cerebral angiogram MAJOR 2 MAJOR 2 XR1660 Carotid angiogram INTER 5 INTER 5 XR1670 Carotid and cerebral angiogram MAJOR 3 MAJOR 3 XR1680 Visceral/Pelvic angiogram: Hepatic, renal, internal iliac INTER 5 INTER 5 XR1690 Mesenteric angiogram, non-selective cannulation INTER 5 INTER 5 XR1700 Mesenteric angiogram: Superselective, with tertiary branch MAJOR 5 MAJOR 5 cannulation XR1710 Bronchial arteriogram MAJOR 5 MAJOR 5 XR1720 Spinal angiogram MAJOR + 1 MAJOR + 1 XR1730 Pulmonary angiogram MAJOR 5 MAJOR 5 XR1740 Stereotactic radiosurgery angiogram, excluding CT/MR planning MAJOR 3 MAJOR 3 XR1750 Upper or lower limb Venogram: 1 limb MINOR 1 INTER 3 XR1760 Upper or lower limb Venogram: 2 limbs MINOR 4 INTER 5 XR1770 Superior or inferior venocavogram INTER 1 INTER 3 XR1780 Selective visceral or wedged hepatic portogram INTER 5 INTER 3 XR1790 Fistulogram/Shuntogram MINOR 1 INTER 3 XR1800 Cathetogram MINOR 1 INTER 3 XR1810 Lymphangiogram: 1 limb INTER 2 INTER 3 XR1820 Lymphangiogram: 2 limbs INTER 5 INTER 3 XR1830 Cavernosogram INTER 1 INTER 3 XR1840 Follow up angiographic study, same procedure: single run MINOR 1 INTER 3 XR1850 Follow up angiographic study, same procedure: 2 - 4 runs MINOR 4 INTER 4 XR1860 Follow up angiographic study, same procedure: > 5 runs INTER 2 INTER 5

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Surgeon's Anaesthetist's CODE NARRATIVE Category Category

DIAGNOSTIC (continued) XR1870 Percutaneous transhepatic cholangiogram, PTC, 1 side MINOR 4 INTER 3 XR1880 Percutaneous transhepatic cholangiogram, PTC, 2 sides INTER 1 INTER 5 XR1890 Percutaneous cholecystogram MINOR 4 INTER 3 XR1900 Percutaneous nephrostogram, within needle puncture, 1 side MINOR 4 INTER 3 XR1910 Percutaneous nephrostogram, within needle puncture, 2 sides INTER 2 INTER 4 XR1920 Percutaneous nephrostogram, within needle puncture, transplant INTER 1 INTER 5 kidney XR1930 Herniography INTER 1 INTER 3 XR1940 Bronchography, digital cine INTER 1 MAJOR 5 XR1950 Myelogram with lumbar puncture MINOR 5 INTER 3 XR1960 Dacrocystrogram MINOR 3 INTER 3 XR1970 Arthrography, per joint MINOR 1 INTER 3 XR1980 Ductogram, per side MINOR 3 INTER 3 XR1990 Functional digital cine fluroscopic study: Standard MINOR 1 INTER 3 XR2000 Functional digital cine fluroscopic study: Intermediate MINOR 1 INTER 4 XR2010 Functional digital cine fluroscopic study: Complex MINOR 3 INTER 5 XR2030 Injection of substances, local or regional, anaesthetic or steroid MINOR 1 INTER 2

PART B Page 77 ADDENDUM The following procedures were approved by the Ministry of Health as per the letter with Reference No: KKM 87/A6/1/JLD 3(29) dated 10th September 2015

CODES IN PART B P0505 Colposcopy of the vulva with or without biopsy MINOR 2 MINOR Introduction of any hemostatic agent or P0700 pack or suture for nonobstetrical vulva, vagina or cervical haemorrhage MINOR 2 MINOR

P1303 Removal of impacted foreign body MINOR 2 MINOR P1304 Colposcopy of the vagina, with or without biopsy MINOR 2 MINOR Vault suspension surgery, abdominally or P2505 MAJOR 4 MAJOR 4 vaginally Repair of vault laceration/hematoma P2506 MINOR 4 MINOR under anesthesia other than local anesthesia Repair of vaginal laceration/hematoma P2507 MINOR 4 MINOR under anesthesia other than local anesthesia P2110 Vaginectomy, partial MAJOR 2 MAJOR 1

Q1031 Dilatation of cervix when done as a sole procedure MINOR 2 MINOR Q1040 Cervical cerclage insertion INTER 1 INTER 1 Q1041 Cervical cerclage removal MINOR 2 MINOR Tubal patency test;open or laparoscopic methods, (Add on Code) Q3902 270 265 X1000 Pelvic EUA for staging of malignancy or congenital anomaly MINOR 2 MINOR

Management of termination of pregnancy (TOP) - in a second trimester R2300 INTER 2 MINOR 2 pregnancy Induction of labour or augmentation of labour, inclusive of but not exhaustive of artificial rupture of membrane, R2300 MINOR 2 oxytoxin infusion, prostaglandin insertion; one single charge per labour

Management of labour including vaginal delivery, vaginal breech delivery, vaginal multiple pregnancy delivery, including episiotomy, R2410 MAJOR 3 repair of first and second degree laceration with/without instrumentation eg. forceps and vacuum. Complicated caesarean section, R2420 including previous scar, failed instrumentation, placenta previa and RM3,120 CMO 1 multiple pregnancies Surgical management of PPH including X3225 but not exhaustive of balloon insertion, B lynch suture, internal iliac INTER 4 INTER 5 ligation, uterine artery ligation

CODES IN PART A Surgeon's Fee Irrigation of vagina /insertion of vaginal medication for treatment of OG7150 100 infection Fitting and insertion of vaginal ring OG7160 150 pessary or other intravaginal support device OG7452 Pap smear 80 Sonohysterography with infusion of RD6835 200 saline or contrast material

PART B Page 78 ADDENDUM CODE NARRATIVE Surgeon's Anaesthetist's OBSTETRICS AND GYNAECOLOGY (KKM 87/A6/1/27JLD 3 Category Category (29) P0505 Colposcopy of the vulva with or without biopsy MINOR 2 MINOR Introduction of any hemostatic agent or P0700 pack or suture for nonobstetrical vulva, vagina or cervical haemorrhage MINOR 2 MINOR P1303 Removal of impacted foreign body MINOR 2 MINOR P1304 Colposcopy of the vagina, with or without biopsy MINOR 2 MINOR P2110 Vaginectomy, partial MAJOR 2 MAJOR 1 Vault suspension surgery, abdominally or P2505 vaginally MAJOR 4 MAJOR 4 Repair of vault laceration/hematoma P2506 under anesthesia other than local anesthesia MINOR 4 MINOR Repair of vaginal laceration/hematoma P2507 under anesthesia other than local anesthesia MINOR 4 MINOR Q1031 Dilatation of cervix when done as a sole procedure MINOR Q1033 Cervical polypectomy; as a sole procedure 260 MINOR Q1040 Cervical cerclage insertion INTER 1 INTER 1 Q1041 Cervical cerclage removal MINOR 2 MINOR Tubal patency test;open or laparoscopic methods, (Add on Code) Q3902 270 265 X1000 Pelvic EUA for staging of malignancy or congenital anomaly MINOR 2 MINOR

Management of termination of pregnancy (TOP) - in a second trimester R2300 pregnancy INTER 2 INTER 2 Induction of labour or augmentation of labour, inclusive of but not exhaustive of artificial rupture of membrane, R2300 oxytoxin infusion, prostaglandin insertion; one single charge per labour MINOR 2 Management of labour including vaginal delivery, vaginal breech delivery, vaginal multiple pregnancy delivery, including episiotomy, R2410 repair of first and second degree laceration with/without instrumentation eg. forceps and vacuum. MAJOR 3 Complicated caesarean section, R2420 including previous scar, failed instrumentation, placenta previa and multiple pregnancies RM3,120 CMO 1

Surgical management of PPH including X3225 but not exhaustive of balloon insertion, B lynch suture, internal iliac ligation, uterine artery ligation INTER 4 INTER 5

CODES IN PART A (KKM 87/A6/1/27JLD 3 (29) Fee Irrigation of vagina /insertion of vaginal medication for treatment of OG7150 infection 100 Fitting and insertion of vaginal ring OG7160 pessary or other intravaginal support device 150

OG7452 Pap smear 80 Sonohysterography with infusion of RD6835 saline or contrast material 200

PART B Page 79 HAEMORRHOIDS. ( KKM 87/A9/7l42 (7) 5/02/ 2013 H5110 Haemorrhoidal artery ligation INTER 4 INTER 4 H5112 Submucosal laser ablation INTER 3 INTER 3

PANCREAS (KKM.600-8/37I8 (34)) 11/02/2019 Whipple’s Procedure, including pancreatoduodenectomy; cholecystectomy and bile duct excision; lymphadenectomy; J5610 gastrojejunostomy and duodenojejunostmy; hepaticojejunostomy; pancreaticojejunotomy or pancreaticogastrostomy CMO 5 CMO 5

BREAST ( KKM 87/A9/7186 (3)) 7/11/2013 Sentinel Lymph Node(s) for breast cancer using preoperative T8625 lymphotropic dye injection and lymphoscintigraphing, including the injection procedure MAJOR 1 MAJOR 1

KIDNEY. (KKM 87/A9/7186 (3)) 7/11/2013 M0280 Laproscopic Partial Nephrectomy RM4,750 RM2,500

PROSTATE (KKM 87/A9/7186 (3)) 7/11/2013 M7100 Laser vaporization of prostate including cystourethroscopy MAJOR + 5 MAJOR + 5

VASCULAR. (KKM 600-8/3/4 (9)) 16/04/2019 L9200 Endo Venous Laser Ablation (EVLA) of varicose vein MAJOR 3 MAJOR + 1

CARDIO VASCULAR ( KKM 87/A9/7l34 JLD3 (26) 20/01/2020 Invasive imaging with intravascular (IVUS) or intracardiac echo (ICE) or optical coherence tomography (OCT) performed in one or more D3243 vessels/cardiac chambers during diagnostic evaluation and/or therapeutic intervention; includes technical insertion of device, imaging acquisition and interpretation INTER 5 INTER 5 Use of coronary pressure wire during selective coronary angiography to measure fractional flow reserve (FFR), coronary flow reserve (CFR) and D3245 iFR in one or more intermediate coronary artery or graft lesions (stenosis of 30-70%), to determine whether revascularisation should be performed where previous stress testing has either not been performed or the results are inconclusive. RM1,635 MAJOR 1

Neurology Procedures (KKM 87/A9/7/34 JLD3 (30) 15 May 2020

Initial hyperacute and critical care for stroke, for the hyperaute assessment (attended within the time window for consideration of VS7213 reperfusion therapy i.e. intravenous thrombolysis and/or endovascular MAJOR 1 thrombectomy) and management of patients with acute stroke for a period up to 3 hours Initial hyperacute and critical care for stroke, for the hyperaute assessment (attended within the time window for consideration of VS7214 reperfusion therapy i.e. intravenous thrombolysis and/or endovascular MAJOR 2 thrombectomy) and management of patients with acute stroke for a period up to 6 hours VS7215 Administration and management of intravenous thrombolytic therapy for INTER 2 stroke, as a sole procedure

PART B Page 80