DOCSLIB.ORG

Periosteo-Plastic Pneumonolysis by F

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Periosteo-Plastic Pneumonolysis by F Thorax: first published as 10.1136/thx.4.4.224 on 1 December 1949. Downloaded from Thorax (1949), 4, 224. PNEUMONOPLASTY: PERIOSTEO-PLASTIC PNEUMONOLYSIS BY F. RONALD EDWARDS Fromn the Thoracic Slugical Service of the Liverpool Regional Hospital Board and the Department of Surgery, University of Liverpool For many years thoracoplasty with extrafascial sad one, although the newer plastic materials apicolysis has been the major surgical procedure appear to be better tolerated by the tissues. of choice in applying collapse therapy to the treat- The following features are considered to be ment of pulmonary tuberculosis. The results of advisable in a collapse operation. this operation have been considered to be satis- (1) The collapse should be really permanent- factory, producing sputum-conversion figures of i.e., the collapsed lung should be covered by an 70-80% in various hands. The recent advances unexpandable medium of which the only natural in chemotherapy and surgical technique have one is bone. enabled excision therapy to take a gradually (2) The apical space should be ultimately filled increasing place in the surgical treatment, as it with fibrous tissue, and not air, fluid, or a foreign must inevitably do, for it is basically a sounder surgical principle. Nevertheless, collapse therapy body. is likely to remain for a long time one of the main (3) The thoracic cage should remain as intact copyright. forms of treatment of the disease. as possible so that deformity is minimal. Having undertaken various forms of thoraco- (4) The operation should be done in one stage. plasty on some 500 patients during the last 13 These desirable features can be combined years, consideration and reflection upon the opera- together in an operation, which I have termed tion and the types of disease on which it has been "pneumonoplasty " in preference to "periosteo- http://thorax.bmj.com/ performed leads me to the opinion that it should plastic pneumonolysis," which, although a truer be possible to produce a similar permanent col- description of the procedure, is cumbersome. lapse of the lung in cases of apical disease without In this operation an extensive extrapleural pneu- the destructive changes to the thoracic cage that monolysis is performed, the only ribs resected are the features of this operation. These destruc- being the fourth and fifth. The second to the tive changes tend not only to a deformity of one sixth or seventh intercostal bundles with the rib side of the chest which is aesthetically undesirable, periostea are mobilized, detached posteriorly, and but to difficulties of coughing and raising secretion re-attached to the side of the vertebral column in the post-operative stages which may lead to an at a lower level. on September 26, 2021 by guest. Protected extension of the disease to the lower lobe. The position of the bundles and periostea over Extrapleural pneumothorax is a kinder opera- the upper part of the lung is adjusted so that when tion to the patient, but it is not a permanent form recalcification occurs re-expansion of the lung is of collapse therapy, and the frequency of com- prevented (Figs. la, lb, and lc). Before this re- plications, among which the most serious are calcification the lung is held down by the liquid haemorrhage into the space, late tuberculous space which collects in the extrapleural space, and, if infection, and gradual re-expansion of the lung, absorption of this liquid is too rapid, temporary has led to its falling into disfavour, at least in most air refills are established. centres in Great Britain. Bailey in 1941 described an operation which he Maintenance of lung collapse by the introduction called extraperiosteal pneumonolysis which had of various solid or fluid media within the thoracic certain similar features to the pneumonoplasty, cage has been tried: fat, muscle, paraffin wax, but he did not free the lung anteriorly, nor was oil, and more recently lucite balls and polythene, any attempt made to re-attach the posterior ends but the fat absorbs, the muscle atrophies, and the of the bundles at a lower level. Furthermore, as history of the use of the foreign bodies has been a the intercostal bundles were not detached from the Thorax: first published as 10.1136/thx.4.4.224 on 1 December 1949. Downloaded from FIG. IC. copyright. .Subclavian artery. - - - - -Subclavian vein. http://thorax.bmj.com/ - . 3--2nd rib deperiostealized except for upper surface. _Z)___- 2nd bundle to 6th vertebra via mediastinum. -- 3rd rib deperiostealized. 3rd bundle to 6th vertebra. -4th rib removed. on September 26, 2021 by guest. Protected _ _ __. 4th bundle to 7th vertebrz. - - - t - 5ethrib removed. t<.5t8-h bundle to 7th vertebra. -- - ----6th rib partially deperiostealized. -- --- - - _6th bundle to 7th vertebra. - - - - - - - 7eh rib partially deperiostealized. FIG. la. Fully expanded lung. 44 Fici. I b.-PneuLnonolysis perfoi-med andi inter-costal bundles stitched down to vertebra. FiGc. 1c.-Operation conipleted by spreading oilt and FIcG. I b. suturing periostetLni. , Thorax: first published as 10.1136/thx.4.4.224 on 1 December 1949. Downloaded from 2226 F. RONALD EDWARDS lung, and re-applied over the apex, it is likely that ward, and the third and second intercostal bundles apical re-expansion would occur. divided posteriorly. These structures with the An account is given herewith of the results in attached periostea provide a further flap which the first 37 patients on whom pneumonoplasty has is turned forward anteriorly after the serratus been performed, and it is demonstrated that the anterior muscle slips have been divided. A linen operation does in fact produce the permanent thread stitch is inserted into the ligamentous struc- collapse effect upon the lung for which it was tures on the side of the sixth vertebra. The suture designed. must be very firmly inserted as it is the anchor for Cases were selected so that some conception the upper flaps. The intercostal vessels and the could be gained of the particular type of disease azygos vein should be clearly located at this stage for which this operation might be safely advised. so that these structures are not damaged by the insertion of the needle. The suture is left lying OPERATIVE TECHNIQUE free. All patients are anaesthetized with pentothal, The second intercostal bundle is now fixed over nitrous oxide and oxygen, and with d-tubocurarine the apex of the lung. The object is to bring this HCI as a relaxant. bundle and its periosteum directly backwards The patient is placed in the usual lateral thoraco- in a true antero-posterior direction close to the plasty position. mediastinum. Unfortunately, the second bundle A curved periscapular incision is made, not cannot be safely freed to its anterior limit because running so high but continued rather more laterally the muscle thins out anteriorly and tension may than the standard first-stage thoracoplasty incision. cause it and the periosteum to rupture. This would The musculature is divided and the scapula interfere with the blood supply of the flap and retracted. The fourth rib is delineated and some re-ossification might not occur. In order to get 20 cm., or more if the patient is of large stature, the second bundle as near to the mediastinum as is removed subperiosteally. The extrapleural space possible it is first taken internally and sutured tocopyright. is then entered by dividing the periosteum, and an the back of the second costal cartilage ; then it is extrapleural strip is made exactly as in performing brought backwards close to the mediastinum to an extrapleural pneumothorax operation. The the side of the sixth vertebra. The suture already strip is continued on the mediastinum down to the in situ is rethreaded on a needle and the second hilum, laterally and posteriorly to the level of bundle stitched with this to the vertebra. The the lower border of the sixth or seventh rib as sutures are put through the periosteum which is http://thorax.bmj.com/ required, and anteriorly to the fourth rib. attached to the muscle as this is the only part of Some 20 cm. of the fifth rib are then removed. the bundle which will stand tension. The third The periosteum of the inner surface of this rib bundle is treated similarly. The lower bundles is raised with great care, and every endeavour is are sutured under slight tension to the side of the made to keep this as intact as possible as it is seventh vertebra in a similar fashion. The lung the regenerated bone from the periosteum which is now held down but tends to bulge up on respira- will form the main framework of the shelf cover- tory movements between the bundles. If the ing and limiting the expansion of the apex of the periosteum has become torn, the loose pieces are on September 26, 2021 by guest. Protected lung. The preservation of this layer of periosteum spread out and sutured by fine interrupted nylon intact is not always easy as the support of the sutures to the adjacent bundles, and the periosteum underlying pleura and lung has been lost. The on the medial surface of the second bundle is outer periosteum of the sixth rib is incised along sutured to any available tissues in the mediastinum. its lower edge and elevated to the upper border At the end of the operation the apex of the lung for a length of 20 cm. The inner periosteum is should be controlled by a firm membrane consist- lifted, and. the fifth bundle with the periosteum of ing of periosteum and intercostal bundles. Obvi- the sixth rib is freed. The seventh rib is similarly ously these flaps would not stay in position for treated if required.
Load more

Recommended publications
  • National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: 1/1/2019
    National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: 1/1/2019 Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, prospective payment systems, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. TABLE OF CONTENTS FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES Introduction Introduction Intro-3 Purpose Intro-3 Policy Manual Background Intro-6 Edit Development and Review Process Intro-7 Sources of Information about NCCI and MUE Intro-9 Correspondence to CMS about NCCI and its Contents Intro-10 Chapter I - General Correct Coding Policies List of Acronyms I-3 A. Introduction I-5 B. Coding Based on Standards of Medical/Surgical I-9 Practice C. Medical/Surgical Package I-12 D. Evaluation and Management (E&M) Services I-17 E. Modifiers and Modifier Indicators I-19 F. Standard Preparation/Monitoring Services for I-27 Anesthesia G. Anesthesia Service Included in the Surgical Procedure I-27 H. HCPCS/CPT Procedure Code Definition I-28 I. CPT Manual and CMS Coding Manual Instructions I-29 J. CPT “Separate Procedure” Definition I-30 K. Family of Codes I-30 L.
    [Show full text]
  • FAQ Document
    The Society of Thoracic Surgeons Frequently Asked Questions: General Thoracic Database Version 2.07 December 2008 How to use the “interactive” FAQ Document: 1. To review all clinical questions in an individual section, click on the section title below. Section A: seq# 10 - 190 Section C: seq# 285 - 650 Section E: seq# 770 - 1210 Section B: seq# 200 - 260 Section D: seq# 660 - 750 Section F: seq# 1220 - 1340 2. To review an individual Seq# clinical question, click on the Seq# title below. Participation in both General Thoracic and Adult Cardiac Databases GENERAL STATEMENT #2 Seq# 200: Zubrod Score Seq# 775: Postop Events Seq# 300: WtLoss3Kg Seq# 860: Pneumonia Seq# 310: Category of disease Seq# 930: Other Pulmonary Event Seq# 390: PreOp Chemotherapy Seq# 940: Atrial Arrhythmia Seq# 400: PreOp Thoracic RT Seq# 1020: Anastomotic leak Seq# 430: Other Cormorbidity Seq# 1190: Empyema Seq# 540: Clinical Stage Not Applicable (2.06) Seq# 1200: Other event req. Rx Seq# 725: Reoperation Seq# 1250: 30 Day Status Seq# 740: Procedure Seq# 1280: Chest Tube Out Date Seq# 750: Primary Procedure Seq# 751: Thoracoscopy Approach NEW Date SeqNo FieldName Definition 3/06 Participation in both General We participate in both Adult Cardiac and Yes, enter into both. In the Adult Cardiac DB, the Thoracic and Adult Cardiac General Thoracic Database. Our question primary procedure would be Seq# 1310 pertains to whether the patient should end up OpOCard=Yes; Seq# 2510 ONCAoAn=Yes; Databases in both databases. Scenario--We had a Seq# 2530 ONCArch=Yes; Seq# 2540 patient who had an aortic aneurysm repair ONCDesc=Yes; Seq# 3220 Readm30=Yes; (arch/descending thoracic) and was entered Seq# ReadmRsn=either Pneumonia or other into the Adult Cardiac Database.
    [Show full text]
  • Toman's Tuberculosis Case Detection, Treatment, and Monitoring
    TOMAN’S TUBERCULOSIS TOMAN’S TUBERCULOSIS CASE DETECTION, TREATMENT, AND MONITORING The second edition of this practical, authoritative reference book provides a rational basis for the diagnosis and management of tuberculosis. Written by a number of experts in the field, it remains faithful to Kurt Toman’s original question-and-answer format, with subject matter grouped under the three headings Case detection, Treatment, and Monitoring. It is a testament to the enduring nature of the first edition that so much CASE DETECTION, TREA material has been retained unchanged. At the same time, the new edition has had not only to address the huge resurgence of tuber- culosis, the emergence of multidrug-resistant bacilli, and the special needs of HIV-infected individuals with tuberculosis, but also to encompass significant scientific advances. These changes in the profile of the disease and in approaches to management have inevitably prompted many new questions and answers and given a different complexion to others. Toman’s Tuberculosis remains essential reading for all who need to AND MONITORING TMENT, QUESTIONS learn more about every aspect of tuberculosis – case-finding, manage- ment, and effective control strategies. It provides invaluable support AND to anyone in the front line of the battle against this disease, from ANSWERS programme managers to policy-makers and from medical personnel to volunteer health workers. SECOND EDITION ISBN 92 4 154603 4 WORLD HEALTH ORGANIZATION WHO GENEVA Toman’s Tuberculosis Case detection, treatment, and monitoring – questions and answers SECOND EDITION Edited by T. Frieden WORLD HEALTH ORGANIZATION GENEVA 2004 WHO Library Cataloguing-in-Publication Data Toman’s tuberculosis case detection, treatment, and monitoring : questions and answers / edited by T.
    [Show full text]
  • 114.3 Cmr: Division of Health Care Finance and Policy Ambulatory Care
    114.3 CMR: DIVISION OF HEALTH CARE FINANCE AND POLICY AMBULATORY CARE 114.3 CMR 40.00: RATES FOR SERVICES UNDER M.G.L. c. 152, WORKERS’ COMPENSATION ACT Section 40.01: General Provisions 40.02: General Definitions 40.03: Service and Rate Coverage Provisions 40.04: Provisions Affecting Eligible Providers 40.05: Policies for Individual Service Types 40.06: Fees 40.07: Appendices 40.08: Severability 40.01: General Provisions (1) Scope, Purpose and Effective Date. 114.3 CMR 40.00 governs the payment rates effective April 1, 2009 for purchasers of health care services under M.G.L. c. 152, the Workers’ Compensation Act. Payment rates for services provided by hospitals are set forth in 114.1 CMR 41.00. Program policies relating to medical necessity and clinical appropriateness are determined pursuant to M.G.L. c. 152 and 452 CMR 6.00. (2) Coverage. The payment rates set forth in 114.3 CMR 40.06 are full payment for services provided under M.G.L. c. 152, § 13, including any related administrative or overhead costs. The insurer, employer and health care service provider may agree upon a different payment rate for any service set forth in the fee schedule in 114.3 CMR 40.00. No employee may be held liable for the payment for health care services determined compensable under M.G.L. c. 152, § 13. (3) Administrative Bulletins. The Division may issue administrative bulletins to clarify substantive provisions of 114.3 CMR 40.00, or to publish procedure code updates and corrections. For coding updates and correction, the bulletin will list: (a) new code numbers for existing codes, with the corresponding cross references between existing and new codes numbers; (b) deleted codes for which there are no corresponding new codes; and (c) codes for entirely new services that require pricing.
    [Show full text]
  • Emblemhealth's Pre-Authorization List
    EmblemHealth's Pre-authorization List This is a complete list of all services requiring a Prior Approval for HIP members or a Pre-Certification for GHI members* (jointly referred to as "pre-authorization") subject to their benefit plan's coverage for all places of service, including Office (POS 11). The list accounts for EmblemHealth's medical policies, medical technology database, provider manual, and special utilization management programs. Pre-authorization is not a guarantee of payment. Payment is subject to a member's eligibility for benefits on the date of service. Emergency services do not require a pre-authorization. *GHI PPO City of New York employees and non-Medicare eligible retirees with GHI PPO benefits will be managed by Empire BCBS for inpatient and outpatient services. To see what needs authorization, use their look-up tool: https://www.empireblue.com/wps/portal/ehpprovider. CPT/ HCPCS Description Code 0008M Oncology (breast), mRNA analysis of 58 genes using hybrid capture, on formalin-fixed paraffin- embedded (FFPE) tissue, prognostic algorithm reported as a risk score 00640 Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine 0085T Breath test for heart transplant rejection 0100T Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy 0195T Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes
    [Show full text]
  • Endoscopy Matrix
    Endoscopy Matrix CPT Description of Endoscopy Diagnostic Therapeutic Code (Surgical) 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) X 31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via X inferior meatus or canine fossa puncture) 31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via X puncture of sphenoidal face or cannulation of ostium) 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or X debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of hemorrhage X 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy X 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection X 31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery X 31253 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior X and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) X 31255 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior X and posterior 31256 Nasal/sinus endoscopy, surgical; with maxillary antrostomy X 31257 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior X and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior X and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical; with removal of
    [Show full text]
  • Supplement 1
    BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open Supplement 1 Embase ('chronic pain'/exp OR (((chronic* OR constant* OR continu* OR persist* OR longterm OR long-term OR longstanding OR long-standing OR longlasting OR long-lasting OR phantom) NEAR/6 (pain* OR discomfort* OR complaint*)):ti,ab,kw)) AND ('postoperative pain'/exp OR (((postoperative OR posttreatment OR postsurg*) NEAR/6 (pain* OR analgesi*)) OR ((post OR after OR follow*) NEAR/3 (surg* OR operat* OR treat* OR resect* OR transplant*) NEAR/6 (pain* OR analgesi*)) OR ((post* NEAR/1 pain*)) OR pain-relief-after OR ((post-extraction OR postextraction OR amputat* OR mediastinoscopy OR sternotomy OR thoracoplasty OR thoracoscopy OR thoracostomy OR thoracotomy OR thoracocentesis OR thymectomy OR tracheostomy OR tracheotomy OR Bronchoscopy OR pneumonolysis OR pneumonectomy OR esophagectomy OR oesophagectomy OR postmediastinoscop* OR poststernotom* OR postthoracoplast* OR postthoracoscop* OR postthoracostom* OR postthoracotom* OR postthoracocentesis OR postthymectom* OR posttracheostom* OR posttracheotom* OR postbronchoscop* OR postpneumonolysis OR postpneumonectom* OR postesophagectom* OR postoesophagectom* OR postlobectom*) NEAR/6 (pain* OR discomfort OR analgesi*))):ti,ab,kw) AND (('thorax surgery'/exp NOT 'heart surgery'/exp) OR 'lung tumor'/exp/dm_su OR (((thora* OR lung OR pulmonary OR esophag* OR oesophag* OR trachea*
    [Show full text]
  • Prognostic Factors for Chronic Post-Surgical Pain After Lung Or Pleural Surgery: a Protocol for a Systematic Review and Meta- Analysis
    Washington University School of Medicine Digital Commons@Becker Open Access Publications 6-15-2021 Prognostic factors for chronic post-surgical pain after lung or pleural surgery: A protocol for a systematic review and meta- analysis Pascal Richard David Clephas Sanne Elisabeth Hoeks Marialena Trivella Christian S Guay Preet Mohinder Singh See next page for additional authors Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs Authors Pascal Richard David Clephas, Sanne Elisabeth Hoeks, Marialena Trivella, Christian S Guay, Preet Mohinder Singh, Markus Klimek, and Michael Heesen Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2021-051554 on 15 June 2021. Downloaded from Prognostic factors for chronic post- surgical pain after lung or pleural surgery: a protocol for a systematic review and meta- analysis Pascal Richard David Clephas ,1 Sanne Elisabeth Hoeks ,1 Marialena Trivella ,2 Christian S Guay ,3 Preet Mohinder Singh ,3 Markus Klimek ,1 Michael Heesen4 To cite: Clephas PRD, ABSTRACT Strengths and limitations of this study Hoeks SE, Trivella M, et al. Introduction Chronic post- surgical pain (CPSP) after Prognostic factors for chronic lung or pleural surgery is a common complication and ► This systematic review and meta- analysis will be post- surgical pain after lung associated with a decrease in quality of life, long- term use or pleural surgery: a protocol the first to systematically identify all prognostic fac- of pain medication and substantial economic costs. An for a systematic review and tors for chronic post- surgical pain after lung or pleu- abundant number of primary prognostic factor studies are meta- analysis.
    [Show full text]
  • Copy of 2019 Price List for Website.Xlsx
    Service Code Service Description Charge 1100000 PRIVATE ROOM AND BOARD 3,339.00 1100001 ISOLATION ROOM 3,892.00 1200000 SEMI-PRIVATE ROOM AND BOARD 3,339.00 1200001 SWINGBED ROOM AND BOARD 2,593.00 1200002 ICU/MONITORED BED 4,048.00 1200005 SIU-ROOM AND BOARD 4,457.00 1700000 NURSERY ROOM AND BOARD 959.00 2000000 ICU ROOM AND BOARD 4,457.00 2500005 AHC MED CHARGE I 25.00 2500010 AHC MED CHARGE II 65.00 2500011 ACETAMINOPHEN 325MG TAB PO 9.00 2500020 PPD 33.00 2500100 ACTIDOSE/SORB 50GM/240ML SUSPO 107.00 2500110 ALBUTEROL 0.5% NEBSOL 20ML INH 97.00 2500135 BUDESONIDE 0.5/2ML NEB SOL INH 40.00 2500137 BUPIVACAINE 0.25% INJ 10 ML IV 66.00 2500138 BUPIVACAINE 0.5% INJ 10 ML IV 69.00 2500140 BUPIVACAINE MPF 0.75% INJ 10ML 52.00 2500141 BUPIVACAINE/EPI 0.25% INJ 10ML 75.00 2500142 BUPIVACAINE/EPI 0.5% INJ 10 ML - 2500143 BUPIVACAINE MPF 0.5% INJ 30ML 47.00 2500145 CALCIUM CARB 1000MG TABS PO 13.00 2500160 CEFUROXIME 250 MG TAB PO 34.00 2500165 CEPHALEXIN 500MG CAP PO 17.00 2500167 CHLORHEXIDINE 4% SOL 240ML TOP 47.00 2500169 CHLOROPROCAINE 3% 20 ML INJ 90.00 2500170 CHOLESTRYRAMINE 4GM LT POWD PO 18.00 2500173 CLOTRIMAZOLE 10MG TROCHE PO 17.00 2500180 CRASH CART ACCESS 330.00 2500185 D5/NACL 0.9% KCL20 MEQ 1000 ML 39.00 2500186 D5W 100 ML BAG IV 40.00 2500187 D5W 250 ML BAG IV 40.00 2500200 EPINEPHRINE 1MG/ML (1:1000)INJ 17.00 2500201 EPINEPHRINE 1MG/ML MDV 30M INJ 42.00 2500205 ETHYL CHLORIDE SPR 103.1ML TOP 79.00 2500215 FLUTIC/SALM 100/50 ADVAIR INH 340.00 2500216 FLUTIC/SALM 250/50 ADVAIR INH 430.00 2500221 FUROSEMIDE 10MG/ML INJ 10ML IV
    [Show full text]
  • Procedure Codes Section 5
    NEW YORK STATE MEDICAID PROGRAM PHYSICIAN – PROCEDURE CODES SECTION 5 - SURGERY Physician – Procedure Codes, Section 5 - Surgery _____________________________________________________________________________ Table of Contents ANESTHESIA SECTION------------------------------------------------------------------------2 GENERAL INFORMATION AND RULES------------------------------------------------2 CALCULATION OF TOTAL ANESTHESIA VALUES --------------------------------4 SURGERY SECTION ----------------------------------------------------------------------------5 GENERAL INFORMATION AND RULES------------------------------------------------5 SURGERY SERVICES ------------------------------------------------------------------------ 11 GENERAL -------------------------------------------------------------------------------------- 11 INTERGUMENTARY SYSTEM ----------------------------------------------------------- 11 MUSCULOSKELETAL SYSTEM--------------------------------------------------------- 38 RESPIRATORY SYSTEM ---------------------------------------------------------------- 108 CARDIOVASCULAR SYSTEM --------------------------------------------------------- 123 HEMIC AND LYMPHATIC SYSTEMS ------------------------------------------------ 167 MEDIASTINUM AND DIAPHRAGM --------------------------------------------------- 170 DIGESTIVE SYSTEM---------------------------------------------------------------------- 171 URINARY SYSTEM ------------------------------------------------------------------------ 214 MALE GENITAL SYSTEM ---------------------------------------------------------------
    [Show full text]
  • Physician Fee Schedule 2021 Note
    Physician Fee Schedule 2021 Note: 2021 Codes in Red; Refer to CPT book for descriptions R" in PA column indicates Prior Auth is required Codes listed as '$0.00" pay 45% of billed amount not to exceed provider’s usual and customary charge for the service The Anesthesia Base Rate is $15.20. Each 15 minute increment=1 time unit. Please use lab fee schedule for covered codes not listed below in the 80000-89249 range. Codes listed on the lab fee schedule that begin with a P or Q are currently non-covered for physicians Proc Inpat. Rate Outpat. Rate Tech. Prof. Base Unit Code Procedure Description PA Ind (Facility) (NonFacility) Comp. Comp. Value Notes See Billing See Billing Manual Manual 00100 ANES FOR PROCEDURES ON SALIVARY GLANDS, INCLUDING BIOPSY Instructions Instructions 5 See Billing See Billing Manual Manual 00102 ANES FOR PROCEDURES INVOLVING PLASTIC REPAIR OF CLEFT LIP Instructions Instructions 6 See Billing See Billing Manual Manual 00103 ANES FOR RECONSTRUCTIVE PROCED OF EYELID Instructions Instructions 5 See Billing See Billing Manual Manual 00104 ANES FOR ELECTROCONVULSIVE THERAPY Instructions Instructions 4 See Billing See Billing ANES FOR PROC ON EXTERNAL, MIDDLE, AND INNER EAR ,INC Manual Manual 00120 BIOPSY Instructions Instructions 5 See Billing See Billing ANES FOR PROC ON EXTERNAL, MIDDLE, AND INNER Manual Manual 00124 EAR,OTOSCOPY Instructions Instructions 4 See Billing See Billing ANES FOR PROC ON EXTERNAL, MIDDLE, AND INNER EAR, Manual Manual 00126 TYMPANOTOMY Instructions Instructions 4 See Billing See Billing Manual
    [Show full text]
  • General Rate Provisions 16.04: Maximum Allowable Fees - Anesthesia Services 16.05: Maximum Allowable Fees - Surgical Services 16.06 Severability
    Adopted Regulation August 31, 2012 114.3 CMR: DIVISION OF HEALTH CARE FINANCE AND POLICY AMBULATORY CARE 114.3 CMR 16.00: SURGERY AND ANESTHESIA SERVICES Section 16.01: General Provisions 16.02: General Definitions 16.03: General Rate Provisions 16.04: Maximum Allowable Fees - Anesthesia Services 16.05: Maximum Allowable Fees - Surgical Services 16.06 Severability 16.01: General Provisions (1) Scope, Purpose and Effective Date. (a) 114.3 CMR 16.00 governs the payment rates used by all governmental units for surgery and anesthesia services provided to publicly aided patients. 114.3 CMR 16.00 is effective July 1, 2012. Rates for services provided to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act) are set forth at 114.3 CMR 40.00. (b) The following laboratory services have a professional and technical component. These are codes: 83020, 83912, 84165, 84166, 84181, 84182, 85390, 85576, 86255, 86256, 86320, 86325, 86327, 86334, 86335, 87164, 87207, 88371, 88372 and 89060. The professional component is contained herein. The technical component for these codes is contained in 114.3 CMR 20.00 Clinical Laboratory Services. (2) Coverage. The payment rates in 114.3 CMR 16.00 are used to pay for: (a) Surgical and anesthesia services rendered to registered bed patients in a licensed health care facility by an eligible provider who is not under contractual arrangement with the licensed health care facility for medical services and who bills separately and apart from the health care facility for medical services rendered. (b) Surgical and anesthesia services rendered to ambulatory patients in a private medical office, freestanding ambulatory surgical center, licensed clinic facility, hospital outpatient department, independent diagnostic testing facility, or other appropriate setting by an eligible provider who bills for the medical services rendered and receives no other compensation for medical services rendered.
    [Show full text]