SCHEDULE 1 - GENERAL TERMS AND CONDITIONS

APPENDIX THREE - MBSE CODES 2013/14

Orthopaedic

Specialty Type Body Site Code

Ankle/Foot

AFT30

AFT31

AFT32

AFT33

AFT34

AFT35

AFT36

Core

Item ID

AFT22

AFT23

AFT24

AFT25

AFT26

Description

Ankle Arthrodesis

Subtalar Arthrodesis

Triple Arthrodesis

Talonavicular Arthrodesis

Calcaneocuboid Arthrodesis

AFT27

AFT28

AFT29

TMT Arthrodesis Single

TMT Arthrodesis Multiple

MTP Arthrodesis

PIP/DIP Arthrodesis

Distal Tibial Osteotomy with or without internal fixation

Distal Fibular Osteotomy with internal fixation

Calcaneal Osteotomy

Midtarsal Osteotomy

1st Metatarsal Osteotomy Unilateral

Lesser Metatarsal Osteotomy

AFT37

AFT38

AFT39

AFT41

AFT42

AFT43

AFT44

Phalangeal Osteotomy

Tenotomy of foot

Amputation toe - MTP/IP joint

Joint release for claw toe

Tendo Achilles Repair Primary

Tendo Achilles Debridement

Tendo Achilles Lengthening or

Gastrocnemius Slide

Procedure

Type

Block

[1543]

[1543]

[1543]

[1571]

[1571]

[1571]

[1571]

[1543]

[1543]

[1499]

[1499]

[1556]

[1528]

[1528]

[1547]

[1532]

[1530]

[1533]

[1548]

[1542]

[1542]

[1542]

MBS-E Short Description

4971200 Arthrodesis of ankle

5011800 Athrodesis of subtalar joint

4981500 Triple arthrodesis of foot

5010900 Arthrodesis of joint, not elsewhere classified




4984500 Arthrodesis of 1st metatarsophalangeal joint

9055900 Arthrodesis of toe

4840600 Osteotomy of fibula

4840900 Osteotomy of fibula with internal fixation

9056900 Osteotomy, not elsewhere classified

4840915 Osteotomy of tarsal bone with internal fixation

4840915 Osteotomy of tarsal bone with internal fixation

4983300 Correction of hallux valgus by osteotomy of 1st metatarsal, unilateral

4840302 Ostectomy of metatarsal bone with internal fixation

4980900 Open tenotomy of foot

4433800 Amputation of toe

4984801 Correction of hammer toe

4971801 Repair of Achilles' tendon

4971801 Repair of Achilles' tendon

4972700 Lengthening of Achilles' tendon

MBSE Codes for Elective Surgery Services 13/14 Page 1


MBSE Codes for Elective Surgery Services 13/14

Core

Item ID

AFT45

AFT46

AFT47

AFT48

AFT49

AFT50

Description

Tendo Achilles Reconstruction (FHL graft, v/y lengthening)

Tendon Transfer including Tibialis anterior

Tendon Transfer involving FDL, FHL or peroneal tendons, < level 2

Tendon Transfer involving FDL, FHL or peroneal tendons, > level 2

Tendon Transfer Toes

Arthroscopy Ankle/Foot + additional procedure simple (removal of loose body, debridement) - includes:

Biopsy synovium, and/or

Loose body/osteophyte, and/or

Plica excision, and/or

AFT51

Excision of os trigonium, and/or

Grade I –IV chondral debridement, and/or

Soft tissue impingement debridement

Arthroscopy Ankle/Foot proceed to open surgery- simple -includes:



AFT52



Grade I –IV chondral debridement, and/or


Ankle open surgery - simple- includes:


Procedure

Type

Block

[1545]

[1542]

[1542]

[1542]

[1542]

[1572]

[1560]

[1531]

[1531]

[1563]

[1561]

[1566]

[1560]

[1529]

[1531]

[1563]

[1561]

[1566]

[1560]


4972401 Reconstruction of Achilles' tendon

5033900 Transfer of anterior tibialis tendon to lateral column

5033900 Tendon Transfer Tibialis

Posterior - complete or split

4981200 Transfer of tendon or ligament of foot

4981200 Transfer of tendon or ligament of foot

4796600 Transfer of tendon or ligament, not elsewhere classified

3007501 Biopsy Synovium

4970301 Arthroscopic removal loose body of ankle

4970001 Arthroscopic trimming osteophyte, ankle

9057200 Ostectomy, not elsewhere classified

9057400 Grade I - II chondral debridement

3002300 Soft tissue impingement debridement


4970302 Arthroscopic removal loose body of ankle

4970301 Arthroscopic trimming osteophyte, ankle





Page 2



Core

Item ID

AFT60

Description




Grade I – IV chondral debridement, and/or


Arthroscopy Ankle/Foot + additional procedure - complex – includes any combination of procedures found in

AFT50 except chondral debridement

Synovectomy

Internal fixation of os trigonium

AFT61

AFT62

Grade I - IV Chondroplasty (includes drilling or microfracture)

Internal fixation fragment

Arthroscopy Ankle proceed to open surgery - complex- includes any combination of procedures found in

AFT50 together with any procedures found in AFT51 except chondral debridement

Synovectomy




Ankle Open Surgery - complex – includes any combination of procedures found in AFT52 except chondral debridement


Procedure

Type

Block

[1529]

[1561]

[1563]

[1544]

[1566]

[1531]

[1571]

[1544]

[1554]

[1561]

[1571]

[1544]

[1554]

[1571]


4970602 Removal loose body of ankle

9057400 Trimming osteophyte, ankle




4970304 Arthroscopic synovectomy of ankle

9058900 Repair of bone, not elsewhere classified

9059900 Grade III - IV Chondroplasty

(includes drilling or microfracture)

4792100 Internal fixation fragment

5010400 Synovectomy


9059900 Grade III - IV Chondroplasty




Page 3


Specialist

Dental Surgery

Oral-Maxillofacial

Core

Item ID

AFT63

Description

Synovectomy



Repair Flexor Tendon Ankle/Foot

AFT64

AFT65

AFT66

AFT67

AFT68

AFT69

AFT70

AFT71

AFT72

AFT73

Procedure

Type

Repair Extensor Tendon Ankle/Foot

Ankle Ligament Reconstruction without graft

Ankle Ligament Reconstruction with graft

Subtalar Ligament Repair or ankle ligament reconstruction redo graft

Plantar Fascia Release

Decompression Fasciotomy Foot

Tarsal Tunnel Release

Botox for release of spasm/contractures

(includes 1 x 100 unit vial) Not to be used as an equivalent

Ankle replacement

ORIF tarsal fracture

Red

Red

Block

[1561]

[1544]

[1554]

[1544]

[1542]

[1542]

[1542]

[1542]

[1534]

[1530]

[76]

[1552]

[1544]

[1538]

AFT74

AFT75

ORIF uni-malleolar fracture

ORIF bi-malleolar fracture

AFT76

AFT77

ORIF metatarsal fracture

ORIF phalanx fracture

Open reduction fx phalanx of great toe w

IF

DNS01 lntra-oral Dental Implant x1-stage

1(includes bone graft)

DNS02 Intra-oral Dental Implant x2-stage

1(includes bone graft)

[1538]

[1539]

[1538]

[1539]

[1539]

[400]

[478]

[400]



5010400 Synovectomy

9059900 Grade I - IV Chondroplasty



4980000 Primary repair of flexor or extensor tendon of foot

4980000 Primary repair of flexor or extensor tendon of foot

4971800 Other repair of tendon of ankle

4970900 Ankle Ligament Reconstruction with graft

4971800 Other repair of tendon of ankle

4985401 Plantar fasciectomy

4985400 Plantar fasciotomy

3933001 Release of tarsal tunnel

9056000 Injection into ligament, tendon or soft tissue

4971500 Total arthroplasty of ankle

4763001 Open reduction fracture of tarsus w IF

4763001 Open reduction fx ank IF diats/fib/malus

4760301 Open reduction fx ank Ifx 2 diats/fib/malus

4763901 Open reduction fracture metatarsus w IF

4766601 Open reduction fx phalanx of great toe w IF

4767203 Open reduction fx phalanx not great toe w IF

4584500 Intra-oral OI dental implant, 1st stage

9778700 Insertion of endodontic stabiliser

4584500 Intra-oral OI dental implant, 1st stage

Page 4


Orthopaedic Elbow/Forearm

ELF07

ELF08

ELF09

Core

Item ID

Description

DNS03 Bone Graft-Alveolar Osseous

DNS04 Surgical Extraction of Teeth

DNS06 Removal of Metalware - Wire, Screw or

Plate

ELF01 Excision Un-united Olecranon Process

ELF02

ELF03

ELF06

Excision Radial Head

Arthroplasty - Radial Head

Epicondylitis Release

Ulnar Nerve Transposition - Elbow

Posterior Interosseus Nerve Release for

Radial Tunnel Syndrome

ORIF Fracture Radius or Ulna

Procedure

Type

Block

[456]

[458]

[1554]

[1426]

[1426]

[1426]

[1418]

[1557]

[83]

[77]

[1429]

[1429]

[1429]

[1430]

[1430]

[1431]

[1432]



9723400 Alveolar osseous graft

9732200 Surgical removal of erupted teeth

9732200 Surg R/O unerptd teeth wo R/O bone/div

9732301 Surg R/O unerptd teethw R/O bone/div

9732408 Surg R/O unerptd teeth w R/O bone & div

9732301 Surg R/O tooth fragment involving bone

4792700 Removal of pin, screw or wire,

NEC

4793000 Removal of plate, rod or nail

4840605 Ostectomy of ulna

4840905 Ostectomy of ulna with internal fixation

4840603 Ostectomy of radius

4840903 Ostectomy radius with internal fixation

9053600 Other repair of elbow

4796300 Open tenotomy, not elsewhere classified

3932100 Transposition of nerve

3933000 Open neurolysis of peripheral nerve, NEC

4736602 Open reduct fracture distal radius w IF

4738402 Open reduct fracture shaft radius w IF

4740801 Open reduct fracture radial head/neck IF

4736603 Open reduction fracture distal ulna w IF

4739901 Open reduction fracture olecranon w IF

4739301 Open reduct fx shaft radius & ulna IF

4738601 Open reduct fx shaft radius w disloc IF

Page 5


ELF25

ELF50

ELF51

Core

Item ID

ELF10

ELF11

ELF21

ELF22

ELF23

ELF24

Description Procedure

Type

Total Elbow Replacement

Reconstruction/Corrective Osteotomy

Radius

Removal of plate and screws – radius, includes any excision/revision of initial scar including hypertrophic or keloid scarring

Removal of plate and screws – ulna, includes any excision/revision of initial scar including hypertrophic or keloid scarring

Removal of flexible intramedullary nail- radius/ulna (includes Titanium Elastic Nail

TEN), includes any excision/revision of initial scar including hypertrophic or keloid scarring

Removal of tension band wiring elbow, includes any excision/revision of initial scar including hypertrophic or keloid scarring

Distal Biceps tendon repair

Elbow Arthroscopic Surgery - Simple.

Includes:

Plica excision and/or,

Biopsy synovium and/or,

Partial synovectomy and/or,

Removal of loose body and/or,

Removal of osteophyte and/or,

Chondral debridement

Elbow Arthroscopy Proceed to Open

Surgery - Simple






Red

Block

[1432]

[1418]

[1424]

[1554]

[1554]

[1554]

[1554]

[1572]

[1410]

[1418]

[1411]

[1412]

[1410]

[1561]

[1561]

[1418]

[1411]

[1410]

[1561]

[1561]


4738603 Open reduct fx shaft ulna w disloc & IF

4911500 Total arthroplasty of elbow

4840902 Osteotomy radius with internal fixation

4793000 Removal of plate and screws - radius

4793000 Removal of plate and screws - ulna

4793000 Removal of flexible intramedullary nail- radius/ulna

(includes Titanium Elastic Nail

TEN)

4792700 Removal of tension band wiring elbow

4795400 Distal Biceps tendon repair

4911800 Arthroscopy of elbow

9053600 Other repair elbow

4911801 Biopsy synovium

4910901 Synovectomy of elbow

4910001 Removal of loose body

9057400 Removal of osteophyte

9057400 Chondral debridement







Specialty Type Body Site Code Core

Item ID

ELF52

ELF60

ELF61

ELF62

Description

Elbow Open Surgery - Simple.

Includes:



Partial synovectomy and/or,




Elbow Arthroscopic Surgery -

Complex. Includes:

Synovectomy and/or,

Arthroscopic release of elbow contracture and/or,

Chondroplasty (drilling or microfracture) and/or,

Any combination of codes found in ELF50 except chondral debridement

Elbow Arthroscopy proceed to Open

Surgery - Complex. Includes:

Synovectomy and/or,



Any combination of codes found in ELF50 together with any procedures found in

ELF51 except chondral debridement

Elbow Open Surgery - Complex.

Includes:

Synovectomy and/or,



Any combination of codes found in ELF52 except chondral debridement

Procedure

Type

Block

[1412]

[1410]

[1418]

[1412]

[1410]

[1418]

[1412]

[1410]

[1418]

[1418]

[4388]

[1412]

[1410]

[1561]

[1561]




4910901 Synovectomy of elbow




4910901 Synovectomy

4912104 Arthroscopic release of elbow contracture

4912102 Arthroscopic chondroplasty of elbow

4910901 Synovectomy


4912102 Arthroscopic chondroplasty of elbow

4910901 Synovectomy





General

Surgery

Generic

Abdomen

Core

Item ID

Description

GNS01 Inguinal Hernia Repair (unilateral)

GNS02 Incisional Hernia Repair

GNS03 Laparoscopic Inguinal Hernia Repair -

Primary or Recurrent

GNS04 Umbilical Hernia Repair

GNS05 Femoral Hernia Repair (unilateral)

GNS06 Ventral Hernia Repair

GOP01 Bone Graft – if bone graft comes from operation site – is built in to cost. Any site other than iliac crest use GOP01

GOP02 Bone Graft - any area, major e.g. spinal fusions, arthrodesis but not limited to.

*from a site other than the initial surgical site

GOP03 Excision Exostosis - superficial

GOP04 Excision Exostosis - deep

GOP05 Excision Bursa (not to be used for excision ganglion)

Procedure

Type

Block

[990]

[993]

[990]

[992]

[991]

[1569]

[996]

[1569]

[1449]

[1532]

[1563]

[1566]

[1566]


3061402 Repair of inguinal hernia, unilateral

3040300 Repair of incisional hernia

3040500 Rep incisional hernia w muscle trnspostn

3040501 Repair incisional hernia with prosthesis

3040502 Rep incisnl hernia resect strangd intest

3060902 Lap repair inguinal hernia, unilateral

3061700 Repair of umbilical hernia

3060900 Lap repair of femoral hernia, unilateral

3061400 Repair of femoral hernia, unilateral

3040301 Repair of other abdominal wall hernia

3040503 Rep oth abdo wall hernia musc trnspostn

3040504 Repair other abdo wall hernia w prosth

3040505 Rep oth abdo hrn w resect strangd intest

4823900 Bone graft, not elsewhere classified

4823900 Bone graft, not elsewhere classified

4793300 Excision of exostosis of hand

4793301 Excision of exostosis of foot

4793600 Excision of exostosis of large bone

3010701 Excision of small bursa

3011100 Excision of large bursa



Orthopaedic Hip/Thigh


Core

Item ID

Description

GOP07 Diagnostic Arthroscopy any joint

(excluding wrist and hip)

GOP20 Removal of plate and screws not elsewhere specified, includes any excision/revision of initial scar including hypertrophic or keloid scarring

GOP21 Removal of screws (including diastasis screws not elsewhere specified )up to 3 in combined total, includes any excision/revision of initial scar including hypertrophic or keloid scarring

GOP22 Removal wires/pins not elsewhere specified 1 - 3 includes excision/revision of initial scar including hypertrophic or keloid scarring

GOP23 Removal wires/pins not elsewhere specified >3 includes excision/revision of initial scar including hypertrophic or keloid scarring,

GOP24 Removal of screws/staples (including diastasis screws not elsewhere specified

) >3 in combined total, includes any excision/revision of initial scar including hypertrophic or keloid scarring

HIT01 Primary Total Hip Replacement

Code not to be used for partial hip replacement or hip resurfacing procedure

HIT02

HIT03

Hemi-arthroplasty HIP (Partial Hip

Replacement - femoral stem only, excludes acetabulum)

Revision Total Hip Replacemen t

Not to be used for Staged Revision or for a Partial Revision

Procedure

Type

Block

[1364]

[1395]

[1410]

[1501]

[1529]

[1555]

[1554]

[1554]

[1554]

[1554]

[1554]

1489

1489

1492


4585500 Arthroscopy of temporomandibular joint

4894500 Arthroscopy of shoulder

4911800 Arthroscopy of elbow

4955700 Arthroscopy of knee

4970000 Arthroscopy of ankle

5010000 Arthroscopy joint, NEC

4793000 Removal of plate, rod or nail, not elsewhere classified

4792700 Removal of pin, screw or wire not elsewhere classified




4931800 Total arthroplasty of hip, unilateral

Total joint replacement of the hip

4752200 Hemi-arthroplasty of femur

Austin Moore arthroplasty

4932400 Revision of total arthroplasty of hip

Page 9


Item ID

Description

HIT05

HIT06

HIT07

HIT08

HIT09

HIT17

HIT18

HIT19

ORIF Fracture Femur

Osteotomy - Distal Femur with or without

Fixation

Adductor/Hamstring Tendon Release,

Percutaneous

Lateral Cutaneous Nerve of Thigh

Release

Decompression Fasciotomy –

Thigh/Knee

Primary Removal compression hip screw and plate

Includes: any excision/revision of initial scar including hypertrophic or keloid scarring

Primary removal of cannulated hip screws

( Not to be used in combination with hip arthroplasty)


Intraoperative removal of cannulated hip screws (For use in combination with hip arthroplasty)


Procedure

Type

Block

1492

1492

1486

1499

1499

1480

1480

77

1558

1554

1554

1554


4932700 Revision of total arthroplasty of hip with bone graft to acetabulum

4933000 Revision of total arthroplasty of hip with bone graft to femur

4752801 Open reduction of fracture of femur with internal fixation

4842706 Osteotomy of distal femur with internal fixation

4842406 Osteotomy of distal femur

5037500 Medial release of hip contracture, unilateral

5038100 Anterior release of hip contracture, unilateral

3933000 Open neurolysis of peripheral nerve, not elsewhere classified

3022600 Fasciotomy, not elsewhere classified

Decompression fasciotomy NOS


4792700 Removal of pin, screw or wire, not elsewhere classified




Item ID

HIT20

HIT21

HIT22

HIT50


Type

Primary Removal of plate and screws femur,


Removal of intramedullary femoral rod

( Includes removal of all locking screws at time of procedure),


Removal intramedullary femoral rod locking screws x 1-3

( Not to be used in combination with removal of intramedullary femoral rod)


Hip Arthroscopy - Simple – Includes:

Hip Arthroscopy and/or

Arthroscopic Biopsy synovium and/or,

Arthroscopic removal of osteochondral fragment/loose body and/or,

Arthroscopic chondral debridement irrespective of Grade and/or,

Red list

Hip

Block

1554

1554

1554

1481

1482

1481

1561

Arthroscopic labral debridement and/or,

Arthroscopic tendon release (adductor) and/or,

Arthroscopic tendon debridement

(abductor) and/or,

Arthroscopic soft tissue impingement debridement and/or,

1566

1579

1555

1566





4936000 Arthroscopy of hip

4936300 Arthroscopic biopsy of hip

4936600 Arthroscopic removal of loose body from hip

9057401 Excision of joint, not elsewhere classified

Debridement of joint NOS;

Excision of: Cartilage, Ligament

9057500 Excision of soft tissue, not elsewhere classified

9059301 Other procedures on muscle, tendon, fascia or bursa, not elsewhere classified

5011200 Division of joint contracture, not elsewhere classified




Item ID

Description

HIT51

Arthroscopic bursa (i.e.

Trochanteric/Psoas) debridement

Hip Arthroscopy Proceed to Open

Surgery - Simple Includes:

Hip Arthroscopy and

Hip Arthrotomy and/or


HIT52

Removal of osteochondral fragment/loose body and/or,


Removal of osteochondral fragment/loose body and/or,

Chondral debridement irrespective of

Grade and/or,

Labral debridement and/or,

Tendon debridement (abductor) and/or,

Soft tissue impingement debridement and/or,

Bursa ( i.e. Trochanteric/Psoas) debridement

Hip Open Surgery Simple

Hip Arthrotomy and/or

– Includes:

Open biopsy synovium and/or,

Procedure

Type

Block

1579

Red list

Hip

Red list

Hip

1481

1481

1481

1481

1481

1561

1566

1572

1566

1579

1481

1481



4936000 Arthroscopy of hip

4930300 Arthrotomy of hip

Includes: biopsy removal of loose body










4796301 Tenoplasty, not elsewhere classified

Tenodesis NOS







Page 12


Item ID

Description

Open removal of osteochondral fragment/loose body and/or,

Open chondral debridement irrespective of Grade and/or,

Procedure

Type

Block

1481

1561

HIT60

Open labral debridement and/or,

Open tendon debridement (abductor) and/or,

Open soft tissue impingement debridement and/or,

Open bursa (i.e. Trochanteric/Psoas) debridement

Hip Arthroscopy Complex 1 - includes a HIT50 and/or

Arthroscopic labral repair and/or,

Arthroscopic chondroplasty (must include drilling or microfracture)

Red list

Hip

HIT61 Hip Arthroscopy Proceed to Open

Surgery Complex. Includes a HIT51 and/or

Labral repair and/or,

Chondroplasty (must include drilling or microfracture)

Red list

Hip

1566

1572

1566

1579

1491

1561

1491

1561







4796301 Tenoplasty, not elsewhere classified

Tenodesis NOS



9055200 Other repair of hip

9057400 Excision of lesion of joint, not elsewhere classified

Excision of lesion of: Cartilage,

Ligament

HIT62 Hip Open Surgery – Complex –

Includes a HIT52 and/or

Surgical dislocation and/or,

Open labral repair and/or,

Red list

Hip

1579

1491




Ligament

9059-00 Other procedures on musculoskeletal system, not elsewhere classified




Item ID

Description

Open chondroplasty (must include drilling or microfracture)

Procedure

Type

Block

1561

HIT70

HIT71

HIT72

Hip Arthroscopic Surgery - Complex 2

- Includes a HIT50 or a HIT60 and/or

Arthroscopic debridement of CAM lesion on femoral neck (includes osteophytes, subchondral cysts, herniation pits and fibrocortical defects of the head neck junction) and/or,

Arthroscopic resection of PINCER lesion

(includes arthroscopic removal of pincer osteophyte/os acetabuli) and/or,

Hip Arthroscopy Proceed to Open

Surgery - Complex 2 - Includes a HIT51 or a HIT61 and/or

Debridement of CAM lesion on femoral neck (includes osteophytes, subchondral cysts, herniation pits and fibrocortical defects of the head neck junction) and/or,

Resection of PINCER lesion (includes arthroscopic and/or open removal of pincer osteophyte/os acetabuli) and/or,

Internal fixation of: osteochondral fracture, os acetabuli and/or,

Hip Open Surgery - Complex 2

Includes a HIT52 or a HIT62 and/or

Debridement of CAM lesion on femoral neck (includes osteophytes, subchondral cysts, herniation pits and fibrocortical defects of the head neck junction) and/or,

Open resection of PINCER lesion

(includes removal of pincer osteophyte/os acetabuli) and/or,

Internal fixation of: osteochondral fracture, os acetabuli and/or,

Red list

Hip

Red list

Hip

Red list

Hip

1563

1563

1563

1563

1554

1563

1563

1554




Ligament


Excision of bone NOS

4840001

4840001

4792100

Ostectomy of accessory bone




4792100 Insertion of internal fixation device, not elsewhere classified

4840001




Insertion of internal fixation device, not elsewhere classified



Orthopaedic Knee/Lower leg

Core

Item ID

Description

KNE01 MUA - Knee Joint +/- injection IF USED

IN COMBINATION WITH OTHER

CODES GOOD REASONING MUST BE

SUPPLIED

Procedure

Type

Block


KNE03

KNE07

KNE09

Reconstruction Collateral Ligament

Patellectomy

Primary Total Knee Replacement

KNE10 Partial Knee Replacement

(hemiarthroplasty – e.g. Oxford)

KNE11 Revision Total Knee Replacement

Single stage revision (can be used for revision of a hemiarthroplasty)

Not to be used for:

Staged Revision or for bearing exchange and/or patella resurfacing

(Staged Revision is Non-Core; Bearing exchange and/or patella resurfacing is

KNE99)

KNE12 Arthrodesis Knee

1905

1552

1552

1504

1520

1518

1518

1524

1512

1512


5011500

5012401

Manipulation/mobilisation of joint, not elsewhere classified: Manual rupture of joint NOS; Release or stretching of joint NOS:

Note: Manipulation - the forceful passive movement of a joint beyond it's active limit of motion;

Mobilisation - freeing body part(s) with the aim of increasing movement Manipulation - the forceful passive movement of a joint beyond it's active limit of motion; Mobilisation - freeing body part(s) with the aim of increasing movement

Administration of agent into joint or other synovial cavity, not elsewhere classified

4953901

Reconstruction of knee Includes: repair or reconstruction of ligaments: - collateral

4950304 Patellectomy

4758200

4951800

4951700

Patellectomy with reattachment of tendon

Total arthroplasty of knee, unilateral

Hemi-arthroplasty of knee

Revision of total arthroplasty of knee

4952700

4950901

4951200

Arthrodesis of knee

Arthrodesis of knee with removal of prosthesis

Page 15


Item ID

Description

KNE13 ORIF # Tibia or Fibula (includes tibial plateau fracture)

Not to be used for:

Ankle Fractures (i.e. Distal tibia and fibula fractures – These are covered by the AFT codes)

(For intra-articular osteochondral fracture of the knee - see KNE26)

KNE14 Amputation - Below Knee

KNE15 Revision of Below Knee Amputation

(Not to be used as an equivalent code)

KNE16 Osteotomy - Proximal Tibia with Fixation

(Not to be used in combination with

KNE124, KNE125, KNE126, KNE127)

Not To be used for Tibial tubercle transfer

KNE17 Lateral Popliteal Nerve Decompression

Procedure

Type

KNE18 Fasciotomy Calf

Block

1510

1505

1566

1499

77

1497

KNE20 Removal of plate and screws Tibia

(includes removal of diastasis screws)


KNE21 Removal of Intramedullary Tibial Rod

(includes removal of all locking screws at time of procedure),


1554

1554

MBS-E

4757000

Short Description

Open reduction of fracture of tibia

Includes: that with fracture of fibula

4436702 Amputation below knee

4437600 Re-amputation of amputation stump

4842100 Osteotomy of tibia with internal fixation

3933000 Open neurolysis of peripheral nerve, not elsewhere classified

4797801 Decompression fasciotomy of calf for chronic compartment syndrome






Core

Item ID

Description

KNE22 Removal of Locking Screws from

Intramedullary Tibial Rod (includes removal of any number of locking screws at time of procedure).

Not to be used in combination with

KNE21 Removal of Intramedullary Tibial

Rod)


KNE23 Removal of Tension Wiring Patella


KNE26 ORIF intra-articular osteochondral fracture of the knee

KNE27 Posterolateral corner reconstruction

KNE50 Knee Arthroscopic Surgery - Simple –

Includes Arthroscopy of the Knee and chondral debridement with one of the following listed procedures :

Arthroscopic Biopsy synovium or

Arthroscopic removal of loose bodies or

Procedure

Type

Block

1554

1554

1521

1510

1501

1502

1501

Arthroscopic removal of osteophytes or

Arthroscopic Meniscectomy medial and/or lateral or

Arthroscopic Plica Excision or

Arthroscopic Excision of intra-articular scar or

Arthroscopic Fat Pad excision or

Arthroscopic notchplasty and excision of any ACL remnants or

Arthroscopic Patella tendon debridement or

1566

1503

1503

1566

1503

1503

1561

MBS-E

4792700

4792700

4759100 Internal fixation of intra-articular fracture of knee

4953901 Reconstruction of knee

49557-00 Arthroscopy of knee

4955701

4840000


Removal of pin, screw or wire, not elsewhere classified

Removal of pin, screw or wire, not elsewhere classified

Arthroscopic biopsy of knee

4956000 Arthroscopic removal of loose body of knee

Osteotomy of accessory bone

4956003 Arthroscopic meniscectomy of knee

4955702 Arthroscopic excision of meniscal margin or plica of knee



Ligament


4956001 Arthroscopic trimming of ligament of knee


Page 17


Item ID

Description

Arthroscopic lateral Retinacular release or

Arthroscopic meniscal cyst drainage

Procedure

Type

Block

1501

1561

1501


4956002 Arthroscopic lateral release of knee



Ligament

4955700 Arthroscopy of knee KNE51 Knee Arthroscopy Proceed to Open

Surgery - Simple -includes: Arthroscopy of the Knee and Arthrotomy of the Knee and chondral debridement with one of the following listed procedures:

Biopsy synovium or

Removal of loose bodies or

Removal of osteophytes or

Meniscectomy medial and/or lateral or

Plica Excision or

Excision of intra-articular scar or

Fat Pad excision or

Notchplasty and excision of any ACL remnants or

Patella tendon debridement or

Lateral Retinacular release or

Meniscal cyst drainage

1501

1502

1501

1566

1503

1503

1561

1566

1503

1503

1501

1561

4950001 Arthrotomy of knee

4955701 Arthroscopic biopsy of knee


4840000 Osteotomy of accessory bone





Ligament







Ligament



Item ID

Description

KNE52 Knee Open surgery - Simple -Includes:

Arthrotomy of the knee and chondral debridement with one of the following listed procedures:

Biopsy synovium or

Removal of loose bodies or

Procedure

Type

Block

1501

1502

1501

Removal of osteophytes or

Meniscectomy medial and/or lateral or

Plica Excision or

Excision of intra-articular scar or

1566

1503

1503

1561

Fat Pad excision or

Notchplasty and excision of any ACL remnants or

Patella tendon debridement or

Lateral Retinacular release or

Meniscal cyst drainage

KNE60 Knee Arthroscopic Surgery - Complex

1 Includes more than one procedure listed under KNE50 OR one of the following listed procedures:

Arthroscopic Meniscal repair

Arthroscopic Grade III - IV Chondroplasty

(drilling or microfracture)

1566

1503

1503

1501

1561

ICD-9-

CM

1520

1561

MBS-E

4950001


Arthrotomy of knee

4955701 Arthroscopic biopsy of knee


4840000 Osteotomy of accessory bone





Ligament







Ligament

80.26 Other Arthroscopy Knee

4956300

9057401

Arthroscopic repair of meniscus of knee

Excision of joint, not elsewhere classified

Debridement of joint NOS




Item ID

Description

Arthroscopic Synovectomy

KNE61 Knee Arthroscopy Proceed to Open

Surgery Complex 1 – Includes more than one procedure listed under KNE51

OR one of the following listed procedures:

Meniscal repair

Grade III - IV Chondroplasty (drilling or microfracture)

Procedure

Type

Block

1520

ICD-9-

CM

1520

1561

Synovectomy

KNE62 Knee Open Surgery Complex 1

Includes more than one procedure listed under KNE52 OR one of the following listed procedures:

Open meniscal repair

Open Grade III - IV Chondroplasty

(drilling or microfracture)

Open Synovectomy

KNE70 Knee Arthroscopic Surgery - Complex

2 - Includes:

More than one procedure listed under

KNE50 AND one or more of the procedures listed under KNE60

OR

MORE than one procedure listed under

KNE60

1561

ICD-9-

CM

1501

1520

1561

1561

ICD-9-

CM


4956600 Arthroscopic synovectomy of knee

80.2 Other Arthroscopy/Arthrotomy

Procedures (Unspecified site)

9059800 Other repair of knee




5010400 Synovectomy of joint, not elsewhere classified

80.16 Other Arthrotomy Knee

4950001

9059800




5010400 Synovectomy of joint, not elsewhere classified

Multiple Arthroscopic/Arthrotomy procedures (Other Arthroscopy other specified sites)

80.29

Arthrotomy of knee

Other repair of knee



Item ID

Description

KNE71 Knee Arthroscopy Proceed to Open

Surgery Complex 2 - Includes:



OR


KNE61

KNE72 Knee Surgery Open Surgery Complex

2 - Includes:



OR


KNE62

KNE81 Primary Knee ACL Reconstruction

(Anterior Cruciate Ligament)

Primary and Simple: Arthroscopic and/or Open – Includes:

Harvesting, preparation of GRAFT and any combination of:


Grade (including notchplasty, chondromalacia) and/or debridement of any soft tissue impingement (including Patella Tendon, ganglion, Hoffa's fat pad) and/or loose body removal and/or Meniscal debridement and/or lateral retinacular release

Procedure

Type

Block

ICD-9-

CM

ICD-9-

CM

1522

MBS-E

80.19

80.99


Multiple Arthroscopy/Arthrotomy

Procedures (Other Arthrotomy, other specified sites)

Multiple Arthrotomy Procedures

(Other Excision of Joint, other specified sites)

4953900 Arthroscopic reconstruction of knee



Item ID

Description

KNE83 Revision Knee ACL Reconstruction


Simple: Arthroscopic and/or Open –

Includes:

Removal of previous IMPLANTS,

Harvesting, preparation of GRAFT and any combination of:



KNE85 Primary Knee PCL Reconstruction

(Posterior Cruciate Ligament) - arthroscopic and/or open - Simple

Includes:

Harvesting, preparation of GRAFT and any combination of:



KNE91 Primary Knee ACL Reconstruction


Complex Includes a KNE81 with:

Meniscal Repair and/or

Procedure

Type

Block

1524

1522

1522

1522


4955100 Revision of reconstructive surgery of knee

4953900 Arthroscopic reconstruction of knee

4954200 Arthroscopic reconstruction of cruciate ligament of knee with repair of meniscus

4954201 Reconstruction of cruciate ligament of knee with repair of meniscus



Item ID

Description

Outerbridge III - IV Drilling or microfracture

KNE93 Revision Knee ACL Reconstruction


Complex Includes a microfracture

KNE83


Includes: a KNE85 with:


Outerbridge III - IV Drilling or microfracture

Outerbridge III - IV Drilling or with:

(Posterior Cruciate Ligament)

KNE95 Primary Knee PCL Reconstruction arthroscopic and/or open - Complex

Red List

KNE99 Revision of Knee Components - including bearing exchange and/or patella resurfacing

KNE124 Repair of Patella Tendon – Primary

( Not to be used in combination with:

KNE126 and/or KNE127 and/or KNE16)

KNE125 Patella Tendon Reconstruction

(Includes harvesting of graft)

Not to be used in combination with:

KNE126 and/or KNE127 and/or KNE16

Procedure

Type

Block

1561

1522

1561

1522

1522

1561

1524

1520

1572

1569

MBS-E








4954200 Arthroscopic reconstruction of cruciate ligament of knee with repair of meniscus


90574-01 Excision of joint, not elsewhere classified



9056200 Patella resurfacing

9059800

4795400

9058300


Other repair of knee

Repair of tendon, not elsewhere classified

Tendon graft, not elsewhere classified



Neurosurgery Nervous system


Core

Item ID

Description

KNE126 Arthroscopic examination of the patellofemoral joint

AND

Patella realignment - soft tissue repair/reconstruction

Includes any procedure found in a

KNE50, KNE51, KNE52

AND

1. Primary repair of medial retinacular soft tissues

2. Treatment of articular cartilage

CAN ONLY BE USED IN

COMBINATION WITH KNE26

KNE127 Arthroscopic examination of the patellofemoral joint

AND

Patella Realignment –

Reconstruction/distal realignment/ bony procedure

Includes any procedure found in a

KNE126 AND

1. Medial Patellofemoral ligament soft tissue reconstruction with/without hamstring graft.

OR

2. Tibial tubercle realignment – medial transfer and internal fixation +/- excision lateral patellar osteophyte

If both procedures; 1. and 2. are to be done then surgery becomes a noncore procedure.

This is not to be used in combination with KNE126 above

NRV01 Delayed Repair of Major Nerve

NRV02 Delayed Repair of Digital Nerve

NRV03 Excision of Neuroma

Procedure

Type

Block

1520

1573

[84]

[84]

[80]

MBS-E

4950301

4796600


Patellofemoral stabilisation

Transfer of tendon or ligament, not elsewhere classified

3930300 Secondary repair of nerve


3932402 R/O tumour from superficial perph nerve

Page 24


Opthalmology Eye

Core

Item ID

Description

NRV04 Reconstruction Digital Nerve with Nerve

Graft

NRV05 Reconstruction Single Major Nerve with

Nerve Grafts

NRV06 Neurolysis

NRV07 Suture of Nerve requiring extensive mobilisation

NRV09 Excision of Neurofibroma Major

Peripheral Nerve

OPT01 Cataract Extraction & Insertion of IOL

OPT02 Cataract Extraction - Insertion IOL with

Anterior Vitrectomy

OPT03 Cataract - Secondary Intraocular Lens with Anterior Vitrectomy

OPT04 YAG Laser Capsulotomy

OPT05 Repair of Blepharoptosis

OPT06 Lid/Adnexa - lid surgery - minor

OPT07 Lid/Adnexa - lid surgery - major

OPT08 Dacryocystorhinostomy with intubation

Procedure

Type

Red

Block

[83]

Red

Red

[197]

[198]

[83]

[77]

[83]

[84]

[80]

[200]

[200]

[207]

[193]

[207]

[188]

[201]

[1677]

[240]

[240]

[247]


3932702 R/O tumour from deep peripheral nerve

3931800 Nerve graft

3931800 Nerve graft

3933000 Open neurolysis of peripheral nerve, NEC

3930000 Primary repair of nerve


3932702 R/O tumour from deep peripheral nerve

4270204 Phacoem & aspr cataract w IOL foldable

4270205 Phacoem & aspr cataract w IOL other

4270206 Phacofragmtn & aspr cataract w

IOL, fold

4270207 Phacofragmtn & aspr cataract w

IOL other

4270211 Other extraction lens w IOL, other

4270211 Other extraction lens w IOL, other

4271901 Removal of vitreous, anterior approach

4270101 Insertion of other artificial lens

4271901 Removal of vitreous, anterior approach

4278500 Iridotomy by laser

4278800 Capsulotomy of lens by laser

4562305 Correction of ptosis by other techniques

9008600 Other procedures on eyelid

9008600 Other procedures on eyelid

4262300 Dacryocystorhinostomy [DCR]



Otolaryngology Ear/Nose/Throat


Core

Item ID

Description

OPT09 Strabismus Surgery - one muscle

OPT10 Strabismus Surgery - two muscles

OPT11 Strabismus Surgery - more than two muscles

OPT12 Corneal Transplant

OPT13 Phototherapeutic Keratectomy (PTK)

OPT14 Trabeculectomy with Antimetabolite

Application

OPT15 Enucleation/Evisceration with implant

OTY01 Reduction of Fractured Nose

OTY02 Cauterisation +/-Ablation Mucosa of

Turbinates (not to be used in combination with OTY03 or 0TY04 or

0TY05 or 0TY06 )

OTY03 Septoplasty/SMR (Submucous

Resection)

( Includes: Cauterisation +/-Ablation

Mucosa of Turbinates)

Red

Red

Procedure

Type

Block

[249]

[216]

Red

[216]

[216]

[173]

[170]

[191]

[161]

[1365]

[374]

[378]


4259900 Clsd proc est patency lacrim canalr, eye

4283300 Strabismus proc inv 1 or 2 muscles 1 eye

4283300 Strabismus proc inv 1 or 2 muscles 1 eye

4283900 Strabismus proc inv >=3 muscles, 1 eye

4265300 Full thickness transplantation of cornea

4265900 Superficial transplantation of cornea

9006401 Refractive keratoplasty

9006402 Refractive keratoplasty by laser

9006400 Other keratoplasty

4281000 Phototherapeutic keratectomy

[PTK]

4274604 Trabeculectomy

4250601 Enucleation of eyeball w sphere implant

4250900 Enucleation eyeball w integrated implant

4251000 Enucleation eyeball w apatite implant

4251500 Evisceration of eyeball w ins implant

4773800 Closed reduction fracture of nasal bone

4774100 Open reduction of fracture of nasal bone

4167400 Cauterisation/diathermy nasal turbinates

4167103 Septoplasty with submucous resection of nasal septum

Page 26


Orthopaedic Shoulder/Upper arm


Core

Item ID

Description

OTY04 Septorhinoplasty – Intranasal

( Includes : Cauterisation +/-Ablation


OTY05 Septorhinoplasty - External Approach



OTY06 Major Revision Septorhinoplasy



OTY07 Nasal/Sinus Endoscopy +/- Polypectomy

(FESS - Functional endoscopic sinus surgery)

OTY08 Tympanostomy/Myringotomy

OTY09 Myringoplasty-simple +/- patch

Procedure

Type

Block

[379]

[1679]

[379]

378

1679

1679

379

378

[1687]

370

[309]

[313]

OTY10 Myringoplasty-

Endaural/Transcanal/Postauricular

OTY11 Tympanoplasty -Ossicular Reconstruction

SHU01

+/- prosthesis

MUA Shoulder Joint +/- injection NOT

TO BE USED IN COMBINATION WITH

OTHER CODES (not to be used as an equivalent)


4167102 Septoplasty

4563800 Total rhinoplasty

4167102 Septoplasty


4563200 Rhinoplasty involving correction of cartilage

4563800 Total rhinoplasty

4167102 Septoplasty


4565000 Revision of rhinoplasty

Secondary revision of rhinoplasty

4176401 Sinoscopy

[313]

[315]

[1552]

4162600 Myringotomy, unilateral

4153000 Myringoplasty, transcanal approach

Tympanoplasty, type 1

4153000 Myringoplasty postaural or endaural appr

Tympanoplasty, type 1

4154200 Myringoplasty with ossicular chain reconstruction

Tympnoplasty, types II, II, IV and

V

Includes: graft

5012401 Injection into jt/oth synovl cavity

NEC

[1905] 5011500 Manipulation of joint, NEC

Page 27



Core

Item ID

Description

SHU06 Excision Outer End of Clavicle - NOT TO

BE USED IN COMBINATION WITH

OTHER CODES

Procedure

Type

Block

[1398]

[1398]

SHU07 ORIF Clavicle

SHU08 Open Reduction of AC Dislocation

[1401]

[1402]

[1402]

[1402]

[1557] SHU09 Proximal Biceps Tendon Tenotomy/

Tenolysis/ Release

NOT TO BE USED IN COMBINATION

WITH OTHER CODES

SHU13 Partial Shoulder Replacement

SHU14 Total Shoulder Replacement

SHU15 Arthrodesis Shoulder

SHU16 ORIF Humeral Fracture

SHU17 Reverse Total Shoulder Replacement

SHU20 Removal of plate and screws Humerus

Includes:

Any excision/revision of initial scar including hypertrophic or keloid scarring

[1404]

[1404]

[1403]

[1403]

[1414]

[1414]

[1414]

[1414]

[1571]

[1554]

MBS-E

4840608


Ostectomy of clavicle

4840908 Ostectomy clavicle w internal fixation

4746501 Open reduction fracture clavicle w IF

4700600 Open reduction dislocation of clavicle

4701200 Open reduction dislocation of shoulder

4701201 Open reduction dislocation shoulder w IF

4796300 Open tenotomy, not elsewhere classified

4891500 Hemi-arthroplasty of shoulder

4891800 Total arthroplasty of shoulder

4893900 Arthrodesis of shoulder

4894200 Arthrodesis shoulder, removal prosthesis

4742901 Open reduct fx proximal humerus w IF

4743201 Open reduct intrartr fx prx humerus IF

4745001 Open reduction fracture shaft humerus IF

4745901 Open reduct fracture distal humerus w IF

5012700 Arthroplasty of joint, not elsewhere classified


Page 28


Item ID

Description

SHU21 Removal Intramedullary Humeral Rod

Includes:

Removal of all locking screws at time of procedure;

Excision/revision of initial scar

SHU22 Removal Intramedullary Humeral Rod

Locking Screws x 1-3

Includes: Excision/revision of initial scar.

(Not to be used in combination with

Removal of Intramedullary

Humeral Rod)

SHU23 Removal of Plate and Screws Clavicle , includes excision/revision of initial scar

Procedure

Type

Block

[1554]

[1554]

[1554]

[1554]

SHU50 Shoulder Arthroscopic Surgery -

Simple-

Includes: Arthroscopy of the shoulder

AND any combination of the following listed arthroscopic procedures:

Biopsy synovium

Removal of loose bodies

1395

1396

1395

Removal of osteophytes/spurs

Chondral debridement Grades 1 - 4 only,

(excludes microfracture and drilling)

1563

1561

1395




4894500 Arthroscopy of shoulder

4894501 Arthroscopic biopsy of shoulder

4894801 Arthroscopic removal of loose body of shoulder

4840001 Ostectomy of accessory bone




4894500 Arthroscopy of shoulder SHU51 Shoulder Arthroscopy Proceed to

Open Surgery - Simple

Includes : Arthroscopy and Arthrotomy of the shoulder AND any combination of the following listed procedures:






Core

Item ID

SHU52

Description

Biopsy synovium


Chondral debridement Grades 1-4 only, excludes microfracture and drilling

Shoulder Open surgery

Includes: Arthrotomy of the shoulder

AND any combination of the following listed open procedures:

Biopsy synovium

– Simple


Chondral debridement Grades 1-4 only excludes microfracture and drilling

SHU60 Shoulder Arthroscopic Surgery -

Complex 1

Includes: Any combination of the procedures listed under SHU50 AND:

Arthroscopic debridement of SLAP tear and/or,

Arthroscopic debridement of Rotator Cuff tear and/or

Soft tissue debridement glenohumeral joint includes release of adhesions or contracture

Procedure

Type

Block

1395

1560

1563

1561

1395


4891200 Arthrotomy of shoulder

Includes: removal of loose or foreign body

3007501 Biopsy of soft tissue

Includes: bursa, fascia, muscle, tendon




Ligament


Includes: removal of loose or foreign body

1560

1563

1561

1397

1397

1566

3007501 Biopsy of soft tissue

Includes: bursa, fascia, muscle, tendon




Ligament

4894800

4894800

9057500

Arthroscopic debridement of shoulder

Arthroscopic debridement of shoulder

Excision of soft tissue, not elsewhere classified

Page 30



Core

Item ID

Description

SHU61 Shoulder Arthroscopy Proceed to

Open Surgery - Complex 1

Includes: Any combination of the procedures listed under SHU51 AND:

Synovectomy and/or,

Debridement of SLAP tear and/or,

Debridement of Rotator Cuff tear and/or


SHU62 Shoulder Open Surgery - Complex 1

Includes: Any combination of the procedures listed under SHU52 AND:

Synovectomy and/or,

Debridement of SLAP tear and/or,

Debridement of Rotator Cuff tear and/or


SHU70 Shoulder Arthroscopic Surgery -

Complex 2

Includes:

Any combination of procedures listed under SHU60 AND:

Arthroscopic Acromionectomy/

Acromioplasty and/or :

Arthroscopic excision outer end clavicle

( Not to be used as single code in place of a SHU06) and/or,

Arthroscopic excision of subacromial bursa and/or,

Procedure

Type

Block

1397

1404

1404

1566

1397

1404

1404

1566

1400

1395

1579


4893600 Synovectomy of shoulder

9053300 Other repair of shoulder



4893600 Synovectomy of shoulder




4895100 Arthroscopic acromioplasty of shoulder

4840608 Ostectomy of clavicle

Claviculectomy


Page 31



Core

Item ID

Description

Arthroscopic excision of coracoacromial ligament and/or,

Arthroscopic Proximal Biceps Tendon

Tenotomy/Tenolysis/Release

( Not to be used as single code in place of a SHU09)

SHU71 Shoulder Arthroscopy Proceed to

Open Surgery - Complex 2

Includes:


Acromionectomy/ Acromioplasty and/or

Excision outer end clavicle ( Not to be used as single code in place of a SHU06) and/or,

Excision of subacromial bursa and/or,

Procedure

Type

Block

1400

1579

1400

1395

1579

Excision of coracoacromial ligament and/or,

Proximal Biceps Tendon



SHU72 Shoulder Open Surgery - Complex - 2

Includes:


Open Acromionectomy/ Acromioplasty and/or

Excision outer end clavicle ( Not to be used as single code in place of a SHU06) and/or,

1400

1579

1400

1395


48900-00 Excision of coraco-acromial ligament

90593-01 Other procedures on muscle, tendon, fascia or bursa, not elsewhere classified

48951-00

48406-08 Ostectomy of clavicle


48900-00 Excision of coraco-acromial ligament


48951-00

Acromioplasty of shoulder

Claviculectomy

Acromioplasty of shoulder

48406-08 Ostectomy of clavicle

Claviculectomy

Page 32


Item ID

Description

Excision of subacromial bursa and/or,

Excision of coracoacromial ligament and/or,

Proximal Biceps Tendon



SHU80 Shoulder Arthroscopic Repair - 1

(if majority of procedure is arthroscopic then SHU80 applies)

Includes:

Any combination of procedures listed under SHU70 AND:

Single Tendon rotator cuff repair or

Biceps Tenodesis *

* Note: Tenodesis means the actual removal of the long head of biceps from its normal attachment and re-anchoring it along its length to the humerus including within the bicipital groove

Procedure

Type

Block

1579

1400

1579

1405

1572



4890000 Excision of coraco-acromial ligament


4896000

9058401

Arthroscopic reconstruction of shoulder Includes: rotator cuff repair

Re-attachment of tendon, not elsewhere classified



Item ID

Description

SHU81 Shoulder Arthroscopy and Proceed to

Open Repair 1

Includes:



Biceps Tenodesis *


Procedure

Type

SHU82 Shoulder Open Repair 1

Includes:



Biceps Tenodesis *


Block

1405

1395

1572

1404

1395

1572


4896000 Arthroscopic reconstruction of shoulder Includes: rotator cuff repair


9058401


Repair of rotator cuff with decompression of subacromial space

4890900


9058401




Item ID

Description

SHU85 Shoulder Instability Repair – Simple

Arthroscopic and/or Open

Includes:

Any procedure listed in SHU70; SHU71;

SHU72 and capsular shift AND:

Repair of Recurrent Dislocation Shoulder

Single labral region:

Anterior including inferior or;

Posterior including inferior

OR

Repair of SLAP lesion and/or labral tear

Single labral region:

Superior including posterosuperior and anterosuperior.

Procedure

Type

Block

1404

1404

SHU90 Shoulder Arthroscopic Repair 2 (if majority of procedure is arthroscopic then

SHU90 applies)

Rotator Cuff Repair two or more tendons (one of which may include tenodesis of the Biceps tendon)

Includes:


Rotator Cuff repair two or more tendons and may include

Biceps Tenodesis *


1405

MBS-E

4895700

4896000


Arthroscopic Stabilisation of shoulder

Includes: labral repair or reattachment

Note: performed for recurrent dislocation or multidirectional instability

4893000

Stabilisation of shoulder







Core

Item ID

Description

SHU91 Shoulder Arthroscopy and Proceed to

Open Repair 2


Includes:



Biceps Tenodesis *


SHU92 Shoulder Open Repair 2


Includes:



Biceps Tenodesis *


Procedure

Type

Block

1572

1405

1395

1572

1404

1572

MBS-E

9058401

4896000





9058401


Repair of rotator cuff with decompression of subacromial space

4890900

9058401 Re-attachment of tendon, not elsewhere classified

Page 36


Item ID

Description

SHU95 Shoulder Instability Repair – Complex

1

Includes:

Any combination of procedures listed under SHU85 and rotator cuff repair one or more tendons (one of which may include tenodesis of the biceps tendon)

AND/OR:

Repair of extensive labral tear – More than one region and/or,

Revision Repair of Recurrent Dislocation

Shoulder and/or

Labral repair and Remplissage of Hill

Sachs defect

*Remplissage is defined as a posterior capsulotenodesis int o a Hill Sach’s lesion

Procedure

Type

Block

1404

1404

Plastic-

Reconstructive

Surgery

Skin-Subcutanious

Tissue

SHU96 Shoulder Instability Repair – Complex

2:

Latarjet Procedure

Includes:

Osteotomy, transfer and fixation of the coracoid process and attachments and/or other bone graft to glenoid)

NOT TO BE USED IN COMBINATION

WITH OTHER CODES.

NOT TO BE USED AS AN EQUIVALENT

SKP01 Removal of foreign body


1404

[1559]

[1605]

MBS-E

4895700 Arthroscopic Stabilisation of shoulder


4893000

Stabilisation of shoulder



Other repair of shoulder

9053300



3006800 Removal FB in muscle, tendon or deep tis

3006400 R/O foreign body from SSCT w incision

Page 37


Item ID

Description

SKP02 Debridement of skin and subcutaneous tissue

SKP03 Debridement of skin-partial thickness

SKP04 Revision of Scar of Face

SKP05 Revision of Scars of Face (2-4 scars)

SKP06 Revision of Scar Trunk/limbs

SKP07 Revision of Scars Trunk/Limbs (2-4 scars)

SKP09 Split skin graft face and /or neck

SKP10 Split skin graft trunk and/or limbs

Procedure

Type

Block

[1628]

[1628]

[1657]

[1657]

[1657]

[1657]

[1643]

[1645]

[1641]



9066500 Excisional debridement wound

SSCT

9066500 Excisional debridement wound

SSCT

4550600 Revision scar face <= 3cm in length

4550601 Revision scar neck <= 3cm in length

4551200 Revision scar face > 3cm in length

4551500 Revision scar of other site <=

7cm

4550600 Revision scar face <= 3cm in length

4550601 Revision scar neck <= 3cm in length

4551200 Revision scar face > 3cm in length


7cm


7cm

4551800 Revision scar of other site > 7cm


7cm

4551800 Revision scar of other site > 7cm

4548500 Split skin graft to burn of eyelid

4548501 Split skin graft to burn of nose

4548502 Split skin graft to burn of lip

4548503 Split skin graft to burn of ear

4548600 Split skin graft to burn of neck

4544800 Small split skin graft of eyelid

4544801 Small split skin graft of nose

4544802 Small split skin graft of lip

4544803 Small split skin graft of ear

4544804 Small split skin graft of neck

4540001 SSG sm granulating brn site

<3% BSA gftd

Page 38



Core

Item ID

Description

SKP11 Full thickness skin graft,<20cm

SKP12 Insertion of tissue expander

SKP13 Removal of tissue expander(s) and reconstruction

Red

Red

Procedure

Type

Block

[1645]

[1648]

[1649]

[1661]

[1661]


4540301 SSG extsv granu brn site >=3%

BSA gftd

4543900 Small split skin graft of other site

4545110 Full thickness skin gft to burn, eyelid

4545111 Full thickness skin graft to burn, nose

4545112 Full thickness skin graft to burn of lip

4545113 Full thickness skin graft to burn of ear

4545114 Full thickness skin graft to burn, neck

4545115 Full thickness skin graft to burn, hand

4545116 Full thickness skin graft to burn, thumb

4545117 Full thickness skin gft to burn, finger

4545118 Full thickness skin gft to burn, genitals

4545119 Full thickness skin gft to burn oth site

4545101 Full thickness skin graft of nose

4545102 Full thickness skin graft of lip

4545103 Full thickness skin graft of ear

4545104 Full thickness skin graft of neck

4545105 Full thickness skin graft of hand

4545106 Full thickness skin graft of thumb

4545107 Full thickness skin graft of finger

4545108 Full thickness skin graft of genitals

4545109 Full thickness skin graft of other site

4556600 Insertion of tissue expander

4557200 Intra-op insertion of tissue expander

4556800 Removal of tissue expander

Page 39


Orthopaedic Spine

Core

Item ID

Description

SKP14 Minor finger surgery(stump revision/cyst)

Procedure

Type

Block

[1471]

[1474]

SKP15 Excision of Nail and Nail bed (Toe) [1631]

[1632]

SPN201 Posterior Fusion - C1/2 with instrumentation

SPN202 Posterior Cervical Fusion Simple - Single

Level

(excl C1/2 with instrumentation)

SPN203 Posterior Cervical Fusion Complex -

Single Level


Includes:

Discectomy and/or Decompression and

Posterior Laminectomy or Foraminotomy

1389

1389

1389

1389

46

1389

4864200 Posterior spinal fusion, 1 level

4033100 Decompression of cervical spinal cord 1 level (Includes cervical discectomy, laminectomy)

4864500 Posterior spinal fusion, 2 or more levels

SPN204 Posterior Cervical Fusion Simple - Two or more Levels


If the procedure involves more than two levels and the procedure is more complex, non-core pricing can be used.


4648300 Revision amputation stump of hand/finger

4649500 Excision of mucous cyst of digit of hand

4649501 Excision ganglion distal digit of hand

4651601 Removal of fingernail

4790601 Removal of toenail

4791500 Wedge resection of ingrown toenail

4864200 Posterior spinal fusion, 1 or 2 levels

4868100 Non segmental internal fixation of spine




Item ID


Type

SPN205 Posterior Cervical Fusion Complex - Two or more Levels



Includes:

Discectomy and/or Decompression and

Posterior Laminectomy or Foraminotomy

Block

1389

46

SPN206 Posterior Cervical Decompression

Laminoplasty

SPN207 Posterior Cervical Decompression -

Simple

Includes:

Laminectomy, Foraminotomy

Red List

Red List

1383

46

49

4033400 Decompression of cervical spinal cord >= 2 levels (Includes cervical discectomy, laminectomy)

4863900 Excision of vertebra

(Vertebrectomy NOS)

4033100 Decompression of cervical spinal cord 1 level (Includes cervical discectomy, laminectomy)

4033000 Spinal rhizolysis (Decompression of spinal nerve roots. Includes: exposure of nerve roots at 1 or more levels)

4033400 Decompression of cervical spinal cord, 2 or more levels

SPN208 Posterior Cervical Decompression -

Complex

Includes:

Foraminotomy/foraminectomy with laminectomy, bilateral formaminectomy or double level foraminectomy

Red List 46

49


4864500 Posterior spinal fusion, 2 or more levels

SPN210 Anterior Cervical Discectomy Without

Fusion

52

4033000 Spinal rhizolysis (Decompression of spinal nerve roots. Includes: exposure of nerve roots at 1 or more levels)

4033300 Cervical discectomy, 1 level



Item ID


Type

Block MBS-E Short Description

SPN211 Anterior Cervical Discectomy With Fusion

- Single Level

Includes:

46 4033200 Decompression of cervical spinal cord with anterior fusion, 1 level

Foramen Decompression, without instrumentation

SPN212

Discectomy and/or Decompression

Anterior Cervical Discectomy With Fusion 46

- Two or More Levels

4033500 Decompression of cervical spinal cord with anterior fusion, 2 or more levels

If the procedure involves more than two levels and the procedure is more complex, non core pricing can be used.

Includes:

Foramen Decompression, without instrumentation


SPN213 Anterior Cervical Discectomy and

Instrumented Fusion With Graft - Single

Level

Includes:


46 4033200 Decompression of cervical spinal cord with anterior fusion, 1 level

1390 4868400 Segmental internal fixation of spine, 1 level

SPN214 Anterior Cervical Discectomy and

Instrumented Fusion With Graft - Two or more Levels

If the procedure involves more than two

46 4033400 Decompression of cervical spinal cord, 2 or more levels levels and the procedure is more complex, non core pricing can be used.

Includes:


1390 4868700 Segmental internal fixation of spine, 2 or more levels




Core

Item ID


Type


SPN215 Cervical Disc Replacement (Arthroplasty)

- Single Level

Includes:


59

52

9619200 Insertion of intervertebral disc prosthesis 1 level

4033300 Cervical discectomy, 1 level

SPN216 Cervical Disc Replacement

(Arthroplasty) - Two or more Levels

59 9619201 Insertion of intervertebral disc prosthesis ≥ 2 level


Includes:


Hybrid operation (a single level anterior cervical intervertebral fusion in combination with a single level disc replacement)

SPN220 Posterior Thoracic/Thoracolumbar Fusion

With Instrumentation - Simple

SPN221 Posterior Thoracic/Thoracolumbar Fusion

With Instrumentation - Complex

Includes:


Red List

52

1389

1389

4033301 Cervical discectomy, >= 2 levels

4864200 Posterior spinal fusion, 1 or 2 levels

4865700 Posterior spinal fusion with laminectomy

SPN222 Posterolateral Lumbar Fusion Without

Instrumentation Simple - Single Level


Instrumentation Complex - Single Level

Includes:


(Including Laminectomy)

52

1389

1389

48

4030001 Discectomy, 2 or more levels



9002400 Decompression of lumbar spinal canal, - 1 level (Includes decompression, discectomy, laminectomy)

Page 43


Red

Red

Core

Item ID


Type



Instrumentation Simple - Two or More

1389 4864500 Posterior spinal fusion, 2 or more levels levels



Instrumentation Complex - Two or More levels

1389 4864500 Posterior spinal fusion, 2 or more levels


Includes:


48

1389

9002401 Decompression of lumbar spinal canal ≥2 levels (Includes decompression, discectomy, laminectomy)

4864200 Posterior spinal fusion, 1 level SPN226 Posterolateral Lumbar Fusion with instrumentation single level – Simple

1389

1389

4868100 Nonsegmental internal fixation of spine

4864800 Posterior spinal fusion, 1 level SPN227 Posterolateral Lumbar Fusion With

Instrumentation Complex - Single Level

Includes:


1389

48





Red

Core

Item ID


Type


SPN228 Revision Posterolateral Lumbar Fusion

With Instrumentation - Single Level

Includes:

Removal of existing spinal implants

Red List 1389 4864800 Posterior spinal fusion, 1 level

1389

1393


9002501 Revision of spinal procedure with removal of spinal fixation

4864800 Posterior spinal fusion, 1 level SPN229 Revision Posterolateral Lumbar Fusion

With Instrumentation - Single Level

Includes:

Removal of existing spinal implants and

Discectomy and/or decompression

1389

1389

1393

48




SPN230 Posterolateral Lumbar Fusion With

Instrumentation Simple - Two or More


Levels


1389 4868100 Nonsegmental internal fixation of spine



Item ID


Type


SPN231 Posterolateral Lumbar Fusion With

Instrumentation Complex - Two or More

1389 4865701 Posterolateral spinal fusion with laminectomy, 2 or more levels

Levels


Includes:



48


With Instrumentation - Two or More

Red List 1389 4865701 Posterolateral spinal fusion with laminectomy, 2 or more levels

Levels


Includes:

Removal of existing spinal implants

1390

1393






Item ID


Type



With Instrumentation - Two or More

1389 4865701 Posterolateral spinal fusion with laminectomy, 2 or more levels

Levels


Includes:

Removal of existing spinal implants and

Discectomy and/or decompression


1393

Red List

48

1389



4866000 Anterior spinal fusion, 1 level SPN240 Anterior Lumbar Fusion Simple - Single

Level

Anterior Lumbar Interbody Fusion (ALIF), or

Lateral lumbar interbody fusion (LLIF) or

Direct lateral interbody fusion (DLIF).

Includes:


Not to be used for laproscopic/endoscopic techniques.

These should be done non core.



Item ID


Type


SPN241 Anterior and Posterior Lumbar Fusion

Complex - Single Level




4866000 Anterior spinal fusion, 1 level

(Includes: Discectomy and

Decompression)

Includes:

Discectomy and/or Decompression AND

Posterior fusion with or without instrumentation (SPN222,SPN223 or

SPN226,SPN227)

Not to be used in combination.

Not to be used for laparoscopic/endoscopic techniques.


1389

1389 4864200 Posterior spinal fusion, 1 levels

1389 4866000 Anterior spinal fusion, 1 level

(Includes: Discectomy and

Decompression)

SPN242 Revision Anterior Lumbar Fusion - Single

Level




Includes:

Removal of instrumentation


These should be done non core

1393 9002501 Revision of spinal procedure with removal of spinal fixation



Item ID


Type


SPN243 Anterior Lumbar Fusion Simple - Two or

More Levels




Red List 1389 4866900 Anterior spinal fusion, 2 or more levels (Includes: Discectomy and

Decompression)


Includes:



These should be done non core

SPN244 Anterior and Posterior Lumbar Fusion

Complex - Two or More Levels

1389 4866900 Anterior spinal fusion, 2 or more levels (Includes: Discectomy and

Decompression)





Includes:

Discectomy and/or Decompression AND

Posterior fusion with or without instrumentation (SPN224, SPN225 orSPN230,SPN231)

Not to be used in combination.




Item ID


Type


SPN245 Revision Anterior Lumbar Fusion -Two or more Levels

Includes:

Removal of instrumentation

1389





1393

4866900 Anterior spinal fusion, 2 or more levels (Includes: Discectomy and

Decompression)


SPN246 Lumbar Disc Replacement (Arthroplasty)

– Single Level

Includes:


59 9619200 Insertion of intervertebral disc prosthesis 1 level

Insertion of artificial intervertebral disc prosthesis 1 level

Includes: discectomy; internal fixation

SPN247 Lumbar Disc Replacement (Arthroplasty)


If the procedure involves more than two levels and the procedure is more

59 9619201 Insertion of intervertebral disc prosthesis ≥ 2 level

Insertion of artificial intervertebral disc prosthesis ≥2 level

Includes: discectomy; internal complex, non core pricing can be used. fixation

Includes:

Discectomy and/or Decompression;

Hybrid operation (a single level anterior lumbar intervertebral fusion in combination with a single level disc replacement)

SPN250 Lumbar Discectomy Simple - Single Level

SPN251 Lumbar Discectomy Simple - Two Levels

52

52

4030000 Discectomy, 1 level

4030001 Discectomy, 2 or more levels




Core

Item ID


Type


SPN252 Lumbar Discectomy Complex - Single

Level

Includes:

Extensive foraminal and/or extraforaminal and/or far lateral disc protrusions/extrusions and/or central disc protrusions/extrusions requiring bilateral approach

Note:

If the majority of the procedure is to address spinal stenosis, use the appropriate spinal stenosis decompression codes (SPN256 or

SPN258).

52 4030000 Discectomy, 1 level

SPN253 Lumbar Discectomy Complex - Two or

More Levels

52 4030000 Discectomy, 1 level


Includes:

Extensive foraminal and/or extraforaminal and/or far lateral disc protrusions/extrusions and/or central disc protrusions/extrusions requiring bilateral approach

Note:

If the majority of the procedure is to address spinal stenosis, use the appropriate spinal stenosis decompression codes (SPN257 or

SPN259).

SPN254 Revision Lumbar Discectomy - Single

Level

51 4030300 Discectomy for recurrent disc lesion, 1 level

Page 51


Item ID

Description

SPN255 Revision Lumbar Discectomy - Two or

More Levels

SPN256 Spinal Stenosis Decompression - Single

Level

Includes:

Discectomy

Note:

If the majority of the procedure is to address the disc, use discectomy codes.

SPN257 Spinal Stenosis Decompression - Two or

More Levels

If the procedure involves more than two levels and the procedure is more complex, non core pricing can be used

Includes:

Discectomy

Note:


SPN258 Revision Spinal Stenosis Decompression

- Single Level

Includes:

Discectomy

Note:

If the majority of the procedure is to address the disc, use discectomy codes

Procedure

Type

Block

51

Red List

48

48

48

1393


4030301 Discectomy for recurrent disc lesion, 2 or more levels


9002401 Decompression of lumbar spinal canal, - >= 2 levels (Includes decompression, discectomy, laminectomy)


9002503 Other revision of spinal procedure



Item ID

SPN259

Description

Revision Spinal Stenosis Decompression



Includes:

Discectomy

Note:


Procedure

Type

Red List

Block

48

1393

SPN260 Transforaminal Lumbar Interbody

Fusion (TLIF) Simple - Single Level

Includes:

Posterior lumbar interbody fusion (PLIF) -

(Unilateral approach)



Red List 1389

1390



9002503 Other revision of spinal procedure

4864800 Posterolateral spinal fusion, 1 level

4868400 Segmental internal fixation of spine, 1 level




Core

Item ID

Description


Fusion (TLIF) Complex - Single Level

Includes:


(Bilateral approach) or

TLIF if any combination of the following is present:

- Discectomy and/or Decompression for neurological symptoms

- Revision discectomy for neurological symptoms

- Large central disc prolapse causing bilateral compression symptoms

- Ossified disc



Procedure

Type

Block

1389

1390

48

4868400 Segmental internal fixation of spine, 1 level


4865100 Posterolateral spinal fusion, 2 or more levels


Fusion (TLIF) Simple - Two or More

Levels


Includes:


(Unilateral approach)



Red List 1389


4864800 Posterolateral spinal fusion, 1 or

2 levels

Page 54


Item ID

Description


Fusion (TLIF) Complex - Two or More

Levels


Includes:


(Bilateral approach) or

TLIF if any combination of the following is present:

- Discectomy and/or Decompression

- Revision discectomy

- Large central disc prolapse causing bilateral compression symptoms

- Ossified disc



Procedure

Type

Block

1390

1389

1390

48

SPN290 Coccygectomy

SPN291 Removal of Spinal Instrumentation

(Anterior or Posterior)

Not to be used in combination (See

Revision codes)

SPN292 Anterior Endoscopic Interbody Fusion –

Single Level

Red List

1385

1393

1389


4868700 Segmental internal fixation of spine, 2 or more levels

4865100 Posterolateral spinal fusion, 2 or more levels

4868700 Segmental internal fixation of spine, 2 or more levels


3067200 Excision of coccyx


4866000 Anterior spinal fusion, 1 level



Orthopaedic Wrist/Hand


Core

Item ID

Description

SPN293 Interspinous spacer

WAH01 ORIF - Phalangeal fracture or dislocation

Procedure

Type

Block

[1457]

WAH02

WAH03

WAH05

WAH06

WAH07

ORIF - Metacarpal fracture

Corrective Osteotomy of Phalanx

WAH04 Corrective osteotomy of Metacarpal

Arthrodesis IP joint

Arthrodesis CMC joint

Arthrodesis MCP joint

WAH08 Arthrolysis/ Synovectomy joint

[1457]

[1457]

[1457]

[1456]

[1456]

[1441]

[1441]

[1441]

[1441]

[1441]

[1441]

[1460]

[1460]

[1468]

[1460]

[1468]

[1440]

[1445]

[1445]

[1426]


84.80 (ICD-

9-CM)

4733001

4732101

4730601

4730900

4734201

4734501

4639600

4639900

4639600

4639601

4639900

4639901

4630000

4630300

4920000

4630001

4920000

9054400

4633600

4633601

4634200

Insertion or replacement of interspinous process device(s)

Open reduction fracture proximal phalanx hand with internal fixation

Open reduction fracture middle phalanx hand with internal fixation

Open reduction fracture distal phalanx hand with internal fixation

Open reduction dislocation interphalangeal joint

Open reduction fracture metacarpal with internal fixation

Open reduct intrartr fx metacarpus w IF

Osteotomy of finger

Osteotomy finger with internal fixation

Osteotomy of finger

Osteotomy of metacarpal bone

Osteotomy finger with internal fixation

Osteotomy of metacarpal bone with IF

Arthrodesis interphalangeal joint

Arthrodesis of carpometacarpal joint

Arthrodesis of radiocarpal joint

Arthrodesis metacarpophalangeal joint

Arthrodesis of radiocarpal joint

Division of adhesions of hand

Synovectomy interphalangeal joint hand

Synovectomy of metacarpal joint

Synovectomy of distal radioulnar joint

Page 56


Item ID

WAH09 CMC Joint Arthroplasty

WAH10 Replacement - MCP/ IP joint

WAH11

WAH12 Reconstruction Collateral Ligament - joint

WAH13

Description

Repair Collateral Ligament Joint- Wrist

Simple Amputation Digit

Procedure

Type

Block

[1468]

[1462]

[1462]

[1462]

[1462]

[1463]

[1463]

[1463]

[1463]

[1464]

[1464]

[1464]

[1464]

[1465]

[1465]

[1465]

[1465]

[1465]

[1448]

MBS-E

4632400

4630900

4631200

4631500

4631800

4631201

4631501

4631801

4632101

4630600

4630601

4630700

4630701

4633000

4633001

4633300

4633301

4633000

4633001

4633300

4633301

4646500


Arthroplasty of carpal bone

Arthroplasty of IPJ hand, 1 joint

Arthroplasty of IPJ hand, 2 joints



Arthroplasty of MCP joint, 2 joints



Arthroplasty of MCP joint, >=5 joints

Interposition arthroplasty of IPJ hand

Interposition arthroplasty of MCP joint

Volar plate arthroplasty of IPJ hand

Volar plate arthroplasty of MCP joint

Repair ligament or capsule of IPJ hand

Repair ligament or capsule of

MCP joint

Repair ligament/capsule IPJ joint with graft/implant

Repair ligament/capsule MCP joint with graft/implant

Reconstruction ligament or capsule of IPJ hand

Reconstruction ligament or capsule of MCP joint

Rep ligmt/capsule IPJ hand w gft/implant

Rep ligmt/capsule MCP jt w gft/implant

Amputation of finger




Core

Item ID

Description

WAH14 Ray Amputation Digit

WAH15 Repair Flexor Tendon in Digit or Palm

WAH16 Repair Flexor Tendon Wrist or Forearm

WAH17 Extensor Tendon Repair - Hand/Finger

WAH18 Reconstruction Extensor Tendon

WAH19 Reconstruction Flexor Tendon

WAH20 Tenolysis Flexor Tendon

WAH21 Tenolysis Extensor Tendon

WAH22 Tenotomy Hand/Wrist

WAH23 Pulley Reconstruction

Procedure

Type

Block

[1448]

[1466]

Red

Red

Red

Red

[1466]

[1466]

[1466]

[1466]

[1466]

[1466]

[1466]

[1469]

[1469]

[1469]

[1440]

[1440]

[1448]

[1440]

[1440]

[1557]

[1469]

MBS-E

4648000

4642600

4642900

4643200

4643500

4642600

4642900

4642000

4642300

4640800

4640800

4641100

4636300

4645300

4646400

4645000

4636300

9054500

4796300

4641100


Amputation finger incl metacarpal bone

Primary repair flexor tendon hand proximal A1 pulley

Secondary repair flexor tendon hand proximal to A1 pulley

Primary repair flexor tendon hand distal to A1 pulley

Secondary repair flexor tendon hand distal to A1 pulley

Primary repair flexor tendon hand proximal to A1 pulley

Secondary repair flexor tendon hand proximal to A1 pulley

Primary repair extensor tendon of hand

Secondary repair extensor tendon of hand

Reconstruction tendon hand by tend graft

Reconstruction tendon hand by tend graft

Recon flexor tend pully hand by tend gft

Release of tendon sheath of hand

Tenolysis of flexor tendon of hand

Amputation supernumerary digit of hand

Tenolysis of extensor tendon of hand

Release of tendon sheath of hand

Incision of soft tissue of hand

Open tenotomy, not elsewhere classified

Reconstruction flexor tend pulley hand by tend graft

Page 58



Core

Item ID

Description

WAH24 Tendon Transfer

WAH25 Reconstruction for Radial Nerve Palsy

WAH26 Reconstruction for Ulnar Nerve

Palsy(Claw hand)

WAH27 Reconstruction Median Nerve Palsy

WAH28 Carpal Tunnel Release

WAH29 ORIF Scaphoid Fracture

WAH30 Revascularisation Carpal Bone

WAH31 Reconstruction Carpal Bone

WAH32 Repair Ligament Injury for Carpal

Instability

WAH33 Reconstruction for Carpal Instability

WAH34 Open Triangular Fibro-Cartilage Repair

WAH35 Reconstruction DRUJ for Instability

WAH36 Sauve Kapandji procedure

WAH37 Intercarpal Fusion/Partial Wrist Fusion

WAH38 Arthrodesis – Wrist with Bone Graft

WAH39 Wrist – Proximal Row Carpectomy

WAH41 Reconstruction/Corrective Ulnar

Osteotomy with Internal Fixation

Procedure

Type

Red

Block

[1466]

[1468]

[1468]

Red

Red

Red

[1468]

[76]

[1455]

[1470]

[1470]

[1470]

[1470]

[1467]

[1469]

[1469]

[1460]

[1460]

[1451]

[1451]

[1468]

[1424]

[1424]

[1451]

[1467]

MBS-E

4641700

9054200

9054200

9054200

3933100

3933101

4735701

4921500

4921500

4921500

4921500

9054700

4634500

4634500

4920300

4920300

4840614

4840914

4920600

4840902

4840904

4922100

4922400

4922401

9054700


Transfer of tendon of hand

Other repair of wrist



Endoscopic release of carpal tunnel

Open release of carpal tunnel

Open reduction fracture carpal scaphoid with internal fixation

Reconstruction of wrist




Repair of muscle or fascia of hand, NEC

Reconstruction distal radioulnar joint

Reconstruction distal radioulnar joint

Arthrodesis of intercarpal joint

Arthrodesis of intercarpal joint

Ostectomy of carpal bone

Ostectomy carpal bone, internal fixation

Excision arthroplasty of wrist

Osteotomy of radius with internal fixation

Osteotomy of ulna with internal fixation

Arthroscopic drilling of defect of wrist

Arthroscopic debridement of wrist

Arthroscopic synovectomy of wrist


Page 59


Item ID

Description

WAH42 Diagnostic Arthroscopy Wrist

WAH43 Arthroscopic Debridement/Repair

TFC/Repair Carpal Ligament injury

WAH44 Release of Scar/Fasiectomy - hand, major

WAH45 Release of Scar/Fasiectomy - palm/finger, minor

WAH46 Excision Pisiform

WAH47 Excision Hook of Hamate

WAH48 Repair Nail Bed

WAH49 Reconstruction Nail Bed

Procedure

Type

Red

Red

Block

[1443]

[1443]

[1451]

[1467]

[1447]

[1657]

[1447]

[1451]

[1451]

[1636]

[1636]

MBS-E

4921800

4921800

4922100

4922400

4922401

9054700

4636900

4637800

4551500

4551800

4637200

4637500

4840614

4840914

4840614

4840914

4648600

4648900

4648900


Arthroscopy of wrist

Arthroscopy of wrist

Arthroscopic drilling of defect of wrist

Arthroscopic debridement of wrist

Arthroscopic synovectomy of wrist


Palmar fasciectomy Dupuytren's contract

Palmar fasciectomy Dupuytrens

>=3 digits

Revision scar of other site <=

7cm

Revision scar of other site > 7cm

Palmar fasciectomy Dupuytren's,

1 digit

Palmar fasciectomy Dupuytren's,

2 digits





Primary repair of fingernail or nail bed

Secondary repair, fingernail or nail bed

Reconstruction of fingernail or nail bed



SCHEDULE 1 - GENERAL TERMS AND CONDITIONS

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