2009
20
0
9
Surgicom Billing Tables
Medihelp
2009
2009
2009
Surgicom-ASSA Correct Coding Help Desk
Medihelp CPT contract
From 1st April 2008 the latest version of CPT in South Africa (CCSA2008) came into
operation. This resulted in major changes to the relative value units (RVU) of procedures. In
addition a correction to the rand converison factor has been implemented to effect a 15%
increase overall above last years remuneration status.
9
Medihelp granted a 10.0% general increase that was implemented on 1st January 2009.
An electronic version can be downloaded from the Surgicom and ASSA websites.
20
0
Medihelp CPT Payout (guaranteed to the surgeon) is significantly above NHRPL. Medihelp
will advise the surgeon if an account is rendered below guaranteed rate so that a revised
account can be submitted; if overcharge on the account the guaranteed amount as per contract
will be paid direct to the surgeon and the excess must be discounted and not claimed from the
patient.
Please do not hesitate to contact us for advice on any billing or coding matter.
Surgicom-ASSA Office: PO Box 1105 Cramerview 2060
Telephone : 011 706 4815
Telefax : 011 463 1041
Email : surgicom@worldonline.co.za / assa@worldonline.co.za
Website : http://www.surgicom.co.za / http://www.southafricansurgeons.co.za
Stephen Grobler 051-4442878 / 051-4442889 / fax 051-4440267 or 0866-412178 /
sgrobler@global.co.za
Jan Mook 0825790654
Mike Wellsted 083 307 1373
CCSA2008 COPYRIGHT NOTICE
Any Physicians’ Current Procedural Terminology (CPT®) five digit numeric codes,
descriptions, numeric modifiers, instructions, guidelines and other material are copyright 2007
American Medical Association (AMA). All rights reserved. Complete CPT® for SA is the
subject of copyright owned by the SA Medical Association exclusive of CPT® and any
derivative work of CPT® which is the subject of copyright owned by the American Medical
Association. No fee schedules, basic unit values, relative value guides, related lists, conversion
factors or scales are included in CPT®. AMA and SAMA assume no responsibility for the
consequences attributable to or related to any use or interpretation of any information
contained in or not contained in CPT®. AMA and SAMA do not directly or indirectly practise
medicine or dispense medical services. AMA and SAMA assume no liability for data contained
2009
2009
Breast Endocrine
Code
Surgicom Description
Facility
Nonfacility
Global
period
Assistant
code
BREAST
Aspiration
10021
Fine needle aspiration; without imaging guidance
R415.03
R221.11
0
10022
Fine needle aspiration; with imaging guidance
R444.59
R206.93
0
19000
Puncture aspiration of cyst of breast;
R338.17
R143.07
0
R83.95
R70.95
add-on
R1,251.01
R821.79
90
+19001 Puncture aspiration of cyst of breast; each additional cyst; (+) add-on
Biopsy
Mastotomy with exploration or drainage of abscess, deep
19100
Biopsy of breast; percutaneous, needle core, not using imaging guidance
R413.85
R216.38
0
19101
Biopsy of breast; open incisional
R950.67
R645.61
10
19102
Biopsy of breast, percutaneous, needle core, using imaging guidance
R688.17
R328.72
0
19103
Biopsy breast; percut, ABBI
R1,773.65
R611.32
0
19105
Ablation, cryosurgical, of fiboadenoma , including ultrasound guidance, each fibroadenoma
R5,902.69
R590.03
0
19110
Nipple exploration, +/- excision solitary lactiferous duct or papilloma
R1,282.94
R931.75
90
A
19112
Excision of lactiferous duct fistula
R1,217.90
R827.70
90
A
19120
Excision benign lesion breast, open, male or female, one or more lesions
R1,329.05
R1,148.14
90
A
19125
Excision breast lesion; preop radiological marker; single lesion
R1,461.48
R1,272.29
90
A
R502.53
R502.53
add-on
A
R490.71
R206.93
0
R217.57
R102.87
add-on
R305.07
R240.03
add-on
R517.90
R248.31
0
9
19020
+19126 Excision additional breast lesion, each separately id by radiol marker; (+) add-on
Pre-operative placement of needle localisation wire, breast;
20
0
19290
Pre-operative placement of needle localisation wire, breast; each additional lesion (List separately in addition to
+19291 code for primary procedure); (+) add-on code
Image guided placement, metallic localisation clip, percutaneous, during breast biopsy (List separately in
+19295 addition to code for primary procedure); (+) add-on code
A
A
A
Ductogram
19030
Injection procedure only for mammary ductogram or galactogram
Mastectomy
19300
Mastectomy for gynaecomastia
R1,564.35
R1,110.30
90
A
19301
Mastectomy, partial
R1,216.72
R1,216.72
90
A
19302
Mastectomy, partial with axillary lymphadenectomy
R2,597.80
R2,597.80
90
B
19303
Mastectomy, simple, complete
R2,645.10
R2,645.10
90
A
19304
Mastectomy, subcutaneous
R1,614.02
R1,614.02
90
A
19305
Mastectomy, radical, including pectoral muscles, axillary lymph nodes
R3,212.66
R3,212.66
90
B
19306
Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes
R3,341.55
R3,341.55
90
B
19307
Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle.
R3,360.47
R3,360.47
90
B
19260
Excision, chest wall tumour + ribs
R3,626.51
R3,626.51
90
B
19271
Excision, chest wall tumour + ribs + reconstruction
R4,956.75
R4,956.75
90
B
19272
Excision, chest wall tumour + ribs + reconstruction + mediastinal lymphadenectomy
R5,471.10
R5,471.10
90
B
R14,060.28
R643.24
0
R294.43
R294.43
add-on
R5,181.41
R1,039.36
Placement radiotherapy afterloading balloon catheter into breast for interstitial radioelement application after
19296
partial mastectomy, incl. imaging guidance; on date separate from mastectomy
Placement radiotherapy afterloading balloon catheter into breast for interstitial radioelement application
+19297 concurrent with partial mastectomy, incl. imaging guidance (List in addition to primary code); (+) add-on code
Placement of radiotherapy afterloading brachytherapy catheters into breast for interstitial radioelement
19298
application, at time of or subsequent to, partial mastectomy, incl. imaging guidance
Breast Endocrine
2009
0
2009
Breast Endocrine
Code
Surgicom Description
Facility
Nonfacility
Global
period
Assistant
code
Reconstruction
Mastopexy
R2,373.14
R2,373.14
90
B
19318
Reduction mammaplasty
R3,521.28
R3,521.28
90
B
19324
Mammaplasty, augmentation; without prosthetic implant
R1,457.94
R1,457.94
90
A
19325
Mammaplasty, augmentation; with prosthetic implant
R1,939.19
R1,939.19
90
A
19328
Removal of intact mammary implant
R1,455.57
R1,455.57
90
A
19330
Removal of mammary implant material
R1,863.51
R1,863.51
90
A
19340
Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
R1,235.64
R1,235.64
90
A
19342
Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
R2,747.97
R2,747.97
90
B
19350
Nipple/areola reconstruction
R2,755.06
R2,065.71
90
A
19355
Correction of inverted nipples
R2,239.52
R1,663.68
90
A
19357
Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion
R4,635.13
R4,635.13
90
B
19361
Breast reconstruction with latissimus dorsi flap, with or without prosthetic implant
R4,700.16
R4,700.16
90
C
19364
Breast reconstruction with free flap
19366
Breast reconstruction with other technique
19367
9
19316
R8,535.96
90
C
R4,281.58
R4,281.58
90
C
Breast reconstruction with TRAM flap, single pedicle, including closure of donor site;
R5,568.06
R5,568.06
90
C
19368
Breast reconstruction with TRAM flap, single pedicle, including closure of donor site; with microvascular
anastomosis (supercharging)
R6,862.82
R6,862.82
90
C
19369
Breast reconstruction with TRAM flap, double pedicle, including closure of donor site
R6,317.72
R6,317.72
90
C
19370
Open periprosthetic capsulotomy, breast
R2,034.96
R2,034.96
90
A
19371
Periprosthetic capsulectomy, breast
R2,351.85
R2,351.85
90
A
19380
Revision of reconstructed breast
R2,292.73
R2,292.73
90
A
19396
Preparation of moulage for custom breast implant
R522.63
R417.40
90
19499
Unlisted procedure, breast
20
0
R8,535.96
Breast Endocrine
2009
YYY
2009
Breast Endocrine
Code
Surgicom Description
Facility
Nonfacility
Global
period
Assistant
code
ENDOCRINE
60540
60545
60650
Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, trans-abdominal,
lumbar or dorsal (separate procedure);
Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, trans-abdominal,
lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumour
Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without
biopsy, trans-abdominal, lumbar or dorsal
R3,237.49
R3,237.49
90
C
R3,727.02
R3,727.02
90
C
R3,660.80
R3,660.80
90
C
60500
Para-thyroidectomy or exploration of para-thyroid(s);
R3,066.04
R3,066.04
90
B
60502
Para-thyroidectomy or exploration of para-thyroid(s); re-exploration
R3,864.18
R3,864.18
90
B
60505
Para-thyroidectomy or exploration of para-thyroid(s); with mediastinal exploration, sternal split or transthoracic
approach
R4,263.84
R4,263.84
90
C
R766.21
R766.21
R3,218.57
R3,218.57
90
B
R3,683.27
R3,683.27
90
B
R4,437.66
R4,437.66
90
C
A
+60512 Para-thyroid auto-transplantation (List separately in addition to code for primary procedure); (+) add-on code
60520
60521
60522
Thymectomy, partial or total; trans-cervical approach (separate procedure)
Thymectomy, partial or total; sternal split or transthoracic approach, without radical mediastinal dissection
(separate procedure)
Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection
(separate procedure)
add-on
Incision and drainage of thyroglossal cyst, infected
R458.78
R429.22
10
60001
Aspiration and/or injection, thyroid cyst
R302.70
R160.81
0
60100
Biopsy thyroid, percutaneous core needle
60200
9
60000
R256.59
0
Excision of cyst or adenoma of thyroid, or transection of isthmus
R1,977.02
R1,977.02
90
B
60210
Partial thyroid lobectomy, unilateral; with or without isthmusectomy
R2,113.00
R2,113.00
90
B
60212
Partial thyroid lobectomy, unilateral; with contra-lateral subtotal lobectomy, including isthmusectomy
R3,041.21
R3,041.21
90
B
60220
Total thyroid lobectomy, unilateral; with or without isthmusectomy
R2,314.02
R2,314.02
90
B
60225
Total thyroid lobectomy, unilateral; with contra-lateral subtotal lobectomy, including isthmusectomy
R2,782.26
R2,782.26
90
B
60240
Thyroidectomy, total or complete
R2,988.00
R2,988.00
90
B
60252
Thyroidectomy, total or subtotal for malignancy; with limited neck dissection
R4,003.71
R4,003.71
90
B
60254
Thyroidectomy, total or subtotal for malignancy; with radical neck dissection
R5,216.88
R5,216.88
90
C
60260
Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid
R3,353.37
R3,353.37
90
B
60270
Thyroidectomy, including substernal thyroid gland; sternal split or transthoracic approach
R4,195.26
R4,195.26
90
C
60271
Thyroidectomy, including substernal thyroid gland; cervical approach
R3,243.41
R3,243.41
90
C
60280
Excision of thyroglossal duct cyst or sinus;
R1,314.86
R1,314.86
90
A
60281
Excision of thyroglossal duct cyst or sinus; recurrent
R1,771.28
R1,771.28
90
A
60659
Unlisted laparoscopy procedure, endocrine system
R0.00
R0.00
YYY
60699
Unlisted procedure, endocrine system
R0.00
R0.00
YYY
20
0
R355.91
Breast Endocrine
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
LIPS
Biopsy of lip
R357.09
R222.30
0
40500
Vermilionectomy (lip shave), with mucosal advancement
R1,401.18
R1,070.10
90
40510
Excision of lip; transverse wedge excision with primary closure
R1,398.81
R1,078.38
90
40520
Excision of lip; V-excision with primary direct linear closure
R1,491.04
R1,094.93
90
40525
Excision of lip; full thickness, with local flap (e.g. Estlander or fan)
R1,716.89
R1,716.89
90
A
40527
Excision of lip; full thickness, with cross lip flap (Abbe-Estlander)
R2,031.41
R2,031.41
90
A
40530
Resection of lip, more than one-fourth, without reconstruction
R1,619.93
R1,238.00
90
A
40650
Repair lip, full thickness; vermilion only
R1,259.29
R866.72
90
A
40652
Repair lip, full thickness; up to half vertical height
R1,467.40
R1,070.10
90
A
40654
Repair lip, full thickness; over one-half vertical height, or complex
R1,708.61
R1,282.94
90
A
40700
Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral
R2,843.74
R2,843.74
90
A
40701
Plastic repair of cleft lip/nasal deformity; primary bilateral, one stage procedure
R3,552.02
R3,552.02
90
A
40702
Plastic repair of cleft lip/nasal deformity; primary bilateral, one of two stages
R2,759.79
R2,759.79
90
A
40720
Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure
R3,081.41
R3,081.41
90
A
40761
Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including sectioning
and inserting of pedicle
R3,263.51
R3,263.51
90
A
R392.57
R269.59
10
MOUTH
9
40490
Biopsy of floor of mouth
42100
Biopsy of palate, uvula
R422.13
R329.90
10
40820
Destruction of lesion or scar of vestibule of mouth by physical methods (e.g., laser, thermal, cryo, chemical)
R666.89
R467.06
10
42160
Destruction of lesion, palate or uvula (thermal, cryo or chemical)
R720.10
R485.98
10
42104
Excision, lesion of palate, uvula; without closure
R541.55
R399.66
10
42106
Excision, lesion of palate, uvula; with simple primary closure
R696.45
R558.11
10
42107
Excision, lesion of palate, uvula; with local flap closure
R1,275.84
R1,038.17
90
42120
Resection of palate or extensive resection of lesion
R2,829.55
R2,829.55
90
40804
Removal of embedded foreign body, vestibule of mouth; simple
R569.93
R378.38
10
40805
Removal of embedded foreign body, vestibule of mouth; complicated
R908.11
R686.99
10
40800
Drainage of abscess, cyst, haematoma, vestibule of mouth; simple
R532.09
R368.92
10
40801
Drainage of abscess, cyst, haematoma, vestibule of mouth; complicated
R840.71
R659.80
10
41000
Intraoral I & D; lingual
R449.32
R334.63
10
41005
Intraoral I & D; sublingual, superficial
R585.30
R368.92
10
41006
Intraoral I & D; sublingual, deep, supramylohyoid
R1,010.98
R792.23
90
41007
Intraoral I & D; submental space
R1,021.62
R756.76
90
41008
Intraoral I & D; submandibular space
R1,027.53
R819.42
90
41009
Intraoral I & D; masticator space
R1,097.30
R895.10
90
41015
Extraoral I & D; sublingual
R1,190.71
R1,010.98
90
41016
Extraoral I & D; submental
R1,228.54
R1,042.90
90
41017
Extraoral I & D; submandibular
R1,235.64
R1,051.18
90
41018
Extraoral I & D; masticator space
R1,426.01
R1,222.63
90
41800
Drainage of abscess, cyst, haematoma from dentoalveolar structures
R527.36
R333.45
10
42000
Drainage of abscess of palate, uvula
R458.78
R307.43
10
20
0
41108
GI, HPB, Abdomen, Hernia
2009
A
A
A
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
40806
Incision of labial frenum (frenotomy)
R274.32
R100.51
0
40808
Biopsy, vestibule of mouth
R467.06
R306.25
10
40810
Excision lesion mucosa/submucosa, vestibule mouth; without repair
R533.28
R368.92
10
40812
Excision lesion mucosa/submucosa, vestibule mouth; with simple repair
R772.13
R588.85
10
40814
Excision lesion mucosa/submucosa, vestibule mouth; with complex repair
R1,060.64
R909.29
90
A
40816
Excision lesion mucosa/submucosa + muscle, vestibule mouth; complex
R1,115.03
R949.49
90
A
40818
Excision of mucosa of vestibule of mouth as donor graft
R975.50
R808.78
90
40819
Excision of frenum, labial or buccal
R830.07
R689.36
90
41010
Incision of lingual frenum (frenotomy)
R539.19
R318.07
10
40830
Repair laceration, vestibule of mouth, <=2.5cm
R683.44
R477.70
10
40831
Repair laceration, vestibule of mouth, >2.5cm or complex
R902.19
R683.44
10
42180
Repair, laceration of palate; up to 2 cm
R690.54
R561.65
10
42182
Repair, laceration of palate; over 2 cm or complex
R964.86
R841.89
10
Biopsy of tongue; anterior two-thirds
R472.97
R341.72
10
41105
Biopsy of tongue; posterior one-third
R465.88
R336.99
10
41110
Excision of lesion of tongue without closure
R562.84
R387.84
10
41112
Excision of lesion of tongue with closure; anterior two-thirds
R908.11
R740.20
90
41113
Excision of lesion of tongue with closure; posterior one-third
R1,002.70
R828.88
90
A
41114
Excision of lesion of tongue with closure; with local tongue flap
R1,943.91
R1,943.91
90
A
41115
Excision of lingual frenum (frenectomy)
R646.79
R445.78
10
41116
Excision, lesion of floor of mouth
R861.99
R646.79
90
A
41120
Glossectomy; less than one-half tongue
R3,134.62
R3,134.62
90
A
41130
Glossectomy; hemiglossectomy
R3,813.34
R3,813.34
90
B
41135
Glossectomy; partial, with unilateral radical neck dissection
R6,405.22
R6,405.22
90
C
41140
Glossectomy; complete or total, +/- tracheostomy, no radical neck dissection
R6,677.18
R6,677.18
90
C
41145
Glossectomy; complete or total, +/- trache, + unilateral radical neck dissection
R8,241.54
R8,241.54
90
C
41150
Glossectomy; composite incl. floor mouth, mandible, no neck dissection
R6,543.57
R6,543.57
90
C
41153
Glossectomy; composite, with suprahyoid neck dissection
R7,046.10
R7,046.10
90
C
41155
Glossectomy; composite & radical neck dissection (Commando type)
R8,605.73
R8,605.73
90
C
41250
Repair laceration <=2.5cm; mouth floor +/or anterior two-thirds of tongue
R604.22
R400.84
10
41251
Repair laceration <=2.5cm; posterior one-third of tongue
R679.90
R483.61
10
41252
Repair of laceration of tongue, floor of mouth, >2.5 cm or complex
R861.99
R645.61
10
41500
Fixation of tongue, mechanical, other than suture (e.g. K-wire)
R1,331.42
R1,331.42
90
41510
Suture of tongue to lip for micrognathia (Douglas type procedure)
R1,343.24
R1,343.24
90
41520
Frenoplasty (revision of frenum e.g. Z-plasty)
R938.85
R775.67
90
20
0
41100
9
TONGUE
A
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
SALIVARY GLANDS
Biopsy of salivary gland; needle
R301.52
R180.91
0
42405
Biopsy of salivary gland; incisional
R890.37
R701.18
10
42300
Drainage of abscess; parotid, simple
R586.49
R457.60
10
42305
Drainage of abscess; parotid, complicated
R1,325.50
R1,325.50
90
42310
Drainage of abscess; submaxillary or sublingual, intraoral
R467.06
R378.38
10
42320
Drainage of abscess; submaxillary, external
R700.00
R542.74
10
42330
Sialolithotomy; submandibular, sublingual or parotid, uncomplicated, intraoral
R659.80
R497.80
10
42335
Sialolithotomy; submandibular, complicated, intraoral
R1,026.35
R788.68
90
42340
Sialolithotomy; parotid, extraoral or complicated intraoral
R1,320.77
R1,042.90
90
42500
Plastic repair of salivary duct, sialodochoplasty; primary or simple
R1,238.00
R1,040.54
90
A
42505
Plastic repair of salivary duct, sialodochoplasty; secondary or complicated
R1,634.12
R1,407.09
90
A
42507
Parotid duct diversion, bilateral (Wilke type procedure);
R1,541.89
R1,541.89
90
A
42508
Parotid duct diversion, bilateral (Wilke); + excision 1 submandibular gland
R2,176.85
R2,176.85
90
A
42509
Parotid duct diversion, bilateral (Wilke); + excision both submandibular glands
R2,649.83
R2,649.83
90
A
42510
Parotid duct diversion, bilateral (Wilke); + ligation both submandibular ducts
R1,935.64
R1,935.64
90
A
42550
Injection procedure for sialography
R502.53
R203.38
0
42600
Closure salivary fistula
R1,401.18
R1,091.38
90
42650
Dilation salivary duct
R232.94
R180.91
0
42660
Dilation & catheterisation of salivary duct, +/- injection
R306.25
R241.22
0
42665
Ligation salivary duct, intraoral
R840.71
R626.69
90
42408
Excision of sublingual salivary cyst (ranula)
R1,299.49
R1,006.25
90
42409
Marsupialisation of sublingual salivary cyst (ranula)
R919.93
R684.63
90
42410
Excision parotid tumour or parotid gland; lateral lobe, without nerve dissection
R1,925.00
R1,925.00
90
A
42415
Excision parotid; lateral lobe, with dissection & preservation of facial nerve
R3,491.72
R3,491.72
90
A
42420
Excision parotid; total, with dissection & preservation of facial nerve
R4,017.90
R4,017.90
90
A
42425
Excision parotid; total, en bloc removal with sacrifice of facial nerve
R2,643.91
R2,643.91
90
B
42426
Excision parotid; total, with unilateral radical neck dissection
R4,298.13
R4,298.13
90
B
42440
Excision of submandibular (submaxillary) gland
R1,433.11
R1,433.11
90
A
42450
Excision of sublingual gland
R1,298.31
R1,086.65
90
A
20
0
9
42400
A
Cystic hygroma
38550
Excision of cystic hygroma, axillary or cervical
R1,402.36
R1,402.36
90
A
38555
Excision of cystic hygroma; with deep neurovascular dissection
R3,003.37
R3,003.37
90
B
PHARYNX, TONSILS
42800
Biopsy; oropharynx
R441.05
R339.36
10
42802
Biopsy; hypopharynx
R734.29
R426.86
10
42804
Biopsy; nasopharynx, visible lesion, simple
R591.22
R354.73
10
42806
Biopsy; nasopharynx, survey for unknown primary lesion
R670.44
R419.76
10
42808
Excision or destruction of lesion of pharynx, any method
R659.80
R511.99
10
42809
Removal of foreign body from pharynx
R504.90
R390.20
10
42810
Excision branchial cleft cyst or vestige, confined to skin/subcut
R1,100.84
R839.53
90
GI, HPB, Abdomen, Hernia
2009
A
A
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Excision branchial cleft cyst or vestige, deep
42820
Nonfacility
Global Assistant
period
code
R1,666.04
R1,666.04
90
Tonsillectomy and adenoidectomy; younger than age 12
R897.46
R897.46
90
42821
Tonsillectomy and adenoidectomy; age 12 or over
R942.40
R942.40
90
42825
Tonsillectomy, primary or secondary; younger than age 12
R791.05
R791.05
90
42826
Tonsillectomy, primary or secondary; age 12 or over
R775.67
R775.67
90
42860
Excision of tonsil tags
R562.84
R562.84
90
42870
Excision or destruction lingual tonsil, any method (separate procedure)
R1,692.06
R1,692.06
90
42955
Pharyngostomy (fistulisation of pharynx, external for feeding)
R2,253.71
R2,253.71
90
A
42890
Limited pharyngectomy
R4,029.72
R4,029.72
90
B
42892
Resection lateral pharyngeal wall/pyriform sinus, advancement flap
R5,241.71
R5,241.71
90
B
42894
Resection of pharyngeal wall requiring closure with myocutaneous flap
R6,780.05
R6,780.05
90
C
42900
Suture pharynx for wound or injury
R1,086.65
R1,086.65
10
A
42950
Pharyngoplasty (plastic or reconstructive operation on pharynx)
R2,407.43
R2,407.43
90
B
42953
Pharyngoesophageal repair
42960
Control oropharyngeal haemorrhage; simple
42961
9
42815
Facility
R3,127.53
90
R521.45
R521.45
10
Control oropharyngeal haemorrhage; complicated, requiring hospitalisation
R1,288.85
R1,288.85
90
42962
Control oropharyngeal haemorrhage; with secondary surgical intervention
R1,598.65
R1,598.65
90
42970
Control nasopharyngeal haemorrhage; simple
R1,202.53
R1,202.53
90
42971
Control nasopharyngeal haemorrhage; complicated, requiring hospitalisation
R1,410.64
R1,410.64
90
42972
Control nasopharyngeal haemorrhage; with secondary surgical intervention
R1,602.19
R1,602.19
90
42700
Incision & drainage abscess; peritonsillar
R526.18
R405.57
10
42720
I & D abscess; retropharyngeal or parapharyngeal, intraoral approach
R1,355.06
R1,220.27
10
42725
I & D abscess; retropharyngeal or parapharyngeal, external approach
R2,486.65
R2,486.65
90
20
0
R3,127.53
A
A
A
A
A
OESOPHAGUS
Dilate
43450
Dilation oesophagus, by unguided sound or bougie, single or multiple passes
R488.34
R264.86
0
43453
Dilation of oesophagus, over guide wire
R915.20
R286.15
0
43456
Dilation of oesophagus, by balloon or dilator, retrograde
R1,929.73
R469.42
0
43458
Dilation of oesophagus with balloon (30 mm diameter or larger) for achalasia
R1,184.79
R552.19
0
A
Excision
43100
Excision of lesion, oesophagus, with primary repair; cervical approach
R1,941.55
R1,941.55
90
B
43101
Excision of lesion, oesophagus, with primary repair; thoracic or abdominal
R3,196.11
R3,196.11
90
B
Foreign body
43020
Oesphagotomy, cervical approach, with removal of foreign body
R1,674.32
R1,674.32
90
43045
Oesophagotomy, thoracic approach, with removal of foreign body
R4,118.40
R4,118.40
90
B
Injury
43405
Ligation/stapling gastroesophageal junction - oesophageal perforation
R4,395.09
R4,395.09
90
B
43410
Suture of oesophageal wound or injury; cervical approach
R3,028.20
R3,028.20
90
B
43415
Suture of oesophageal wound or injury; transthoracic or transabdominal
R5,205.06
R5,205.06
90
B
R3,241.04
R3,241.04
90
C
Hiatus hernia, Fundoplication
43280
Laparoscopic oesophagogastric fundoplication (e.g. Nissen, Toupet)
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
43320
Oesophago-gastrostomy (cardioplasty), +/-vagotomy & pyloroplasty, transabdominal or transthoracic
R4,142.05
R4,142.05
90
B
43324
Oesophagogastric fundoplication (e.g. Nissen, Belsey, Hill procedures)
R4,054.55
R4,054.55
90
B
43325
Oesophagogastric fundoplasty; with Thal fundic patch
R3,990.70
R3,990.70
90
B
43326
Oesophagogastric fundoplasty; with gastroplasty (e.g. Collis)
R4,055.73
R4,055.73
90
B
39502
Repair, paraoesophageal hiatus hernia, transabdominal, +/- vagotomy +/or pyloroplasty, except neonatal
R3,106.24
R3,106.24
90
B
39520
Repair, diaphragmatic hernia (oesophageal hiatal); transthoracic
R3,148.81
R3,148.81
90
B
39530
Repair, diaphragmatic hernia (oesophageal hiatal); thoraco-abdominal
R2,989.18
R2,989.18
90
B
39531
Repair, diaphragmatic hernia (oesophageal hiatal); thoraco-abdominal + dilation stricture (+/-gastroplasty)
R3,148.81
R3,148.81
90
B
Injury
Ligation/stapling gastroesophageal junction - oesophageal perforation
R4,395.09
R4,395.09
90
B
43410
Suture of oesophageal wound or injury; cervical approach
R3,028.20
R3,028.20
90
B
43415
Suture of oesophageal wound or injury; transthoracic or transabdominal
R5,205.06
R5,205.06
90
B
43350
Oesophagostomy, fistulisation of oesophagus, external; abdominal approach
R3,437.32
R3,437.32
90
B
43351
Oesophagostomy, fistulisation of oesophagus, external; thoracic approach
R4,029.72
R4,029.72
90
B
43352
Oesophagostomy, fistulisation of oesophagus, external; cervical approach
R3,319.08
R3,319.08
90
B
Myotomy / Diverticulum
9
43405
Diverticulectomy hypopharynx/oesophagus, +/-myotomy; cervical approach
R2,452.36
R2,452.36
90
B
43030
Cricopharyngeal myotomy
R1,629.39
R1,629.39
90
A
43135
Diverticulectomy hypopharynx/oesophagus, +/- myotomy; transthoracic
R4,374.99
R4,374.99
90
B
32665
Thoracoscopy, surgical; with oesophagomyotomy (Heller type); also use for laparoscopic approach
R3,768.40
R3,768.40
90
C
43330
Oesophagomyotomy (Heller type); abdominal approach (includes Dor anterior fundoplasty)
R3,919.76
R3,919.76
90
B
43331
Oesophagomyotomy (Heller type); thoracic approach
R4,208.27
R4,208.27
90
B
20
0
43130
Bypass
42955
Pharyngostomy (fistulisation of pharynx, external for feeding)
R2,253.71
R2,253.71
90
A
43340
Oesophagojejunostomy (without total gastrectomy); abdominal approach
R4,056.92
R4,056.92
90
B
43341
Oesophagojejunostomy (without total gastrectomy); thoracic approach
R4,380.90
R4,380.90
90
B
R7,928.19
R7,928.19
90
D
R12,277.17
R12,277.17
90
D
Oesophagectomy
43107
Transhiatal oesophagectomy & oesophagogastrostomy, +/- pyloroplasty
43108
Transhiatal oesophagectomy; with colon interposition or small bowel reconstruction
43112
Transthoracic oesophagectomy & oesophagogastrostomy, +/-pyloroplasty
R8,498.12
R8,498.12
90
D
43113
Transthoracic oesophagectomy; with colon or small bowel reconstruction
R12,128.18
R12,128.18
90
D
43116
Partial oesophagectomy, cervical, with free intestinal graft
R13,667.71
R13,667.71
90
D
R7,743.73
R7,743.73
90
D
R10,245.76
R10,245.76
90
D
R8,271.10
R8,271.10
90
D
R7,847.79
R7,847.79
90
D
R12,311.46
R12,311.46
90
D
R10,449.13
R10,449.13
90
D
43117
43118
43121
43122
43123
Partial oesophagectomy, distal 2/3 & thoracotomy +/- proximal gastrectomy; thoracic anastomosis +/pyloroplasty (Ivor Lewis)
Partial oesophagectomy, distal 2/3 & thoracotomy +/- proximal gastrectomy; + colon/small bowel
reconstruction
Partial oesophagectomy, distal 2/3, with thoracotomy only, +/-proximal gastrectomy, with thoracic
oesophagogastrostomy, +/- pyloroplasty
Partial oesophagectomy, thoracoabdominal or abdominal approach, +/- proximal gastrectomy; with
oesophagogastrostomy, +/- pyloroplasty
Partial oesophagectomy, thoracoabdominal or abdominal +/- prox gastrectomy + colon/small bowel
reconstruction
43124
Total or partial oesophagectomy & oesophagostomy, no reconstruction
43360
Gastrointestinal reconstruction prior oesophagectomy; stomach
R7,109.95
R7,109.95
90
C
43361
Gastrointestinal reconstruction prior oesophagectomy; colon or small bowel, including bowel mobilisation,
preparation & anastomosis(es)
R7,908.09
R7,908.09
90
C
43496
Free jejunum transfer with microvascular anastomosis
R0.00
R0.00
90
C
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Oesophageal fistula/stoma
43350
Oesophagostomy, fistulisation of oesophagus, external; abdominal approach
R3,437.32
R3,437.32
90
B
43351
Oesophagostomy, fistulisation of oesophagus, external; thoracic approach
R4,029.72
R4,029.72
90
B
43352
Oesophagostomy, fistulisation of oesophagus, external; cervical approach
R3,319.08
R3,319.08
90
B
43420
Closure of oesophagostomy or fistula; cervical approach
R2,999.82
R2,999.82
90
B
43425
Closure of oesophagostomy or fistula; transthoracic or transabdominal
R4,494.42
R4,494.42
90
B
43300
Oesophagoplasty, cervical; without repair TOF
R1,940.37
R1,940.37
90
B
43305
Oesophagoplasty, cervical approach; with repair of TOF
R3,482.26
R3,482.26
90
B
43310
Oesophagoplasty, thoracic approach; without repair of TOF
R4,801.85
R4,801.85
90
C
43312
Oesophagoplasty, thoracic approach; with repair of TOF
R5,279.55
R5,279.55
90
C
43313
Oesophagoplasty, thoracic approach; without repair of congenital TOF
R8,521.77
R8,521.77
90
B
43314
Oesophagoplasty, thoracic approach; with repair of congenital TOF
R9,315.18
R9,315.18
90
B
Varices
43400
Ligation, direct, oesophageal varices
43401
43460
9
TOF
R4,486.14
R4,486.14
90
B
Transection of oesophagus with repair, for oesophageal varices
R4,597.29
R4,597.29
90
B
Oesophago-gastric tamponade, with balloon (Sengstaken type)
R668.07
R668.07
0
20
0
DIAPHRAGM
39501
Repair, laceration of diaphragm, any approach
R2,600.16
R2,600.16
90
B
39502
Repair, paraoesophageal hiatus hernia, transabdominal, +/- vagotomy +/or pyloroplasty, except neonatal
R3,106.24
R3,106.24
90
B
39503
Repair, neonatal diaphragmatic hernia, +/-chest tube +/- ventral hernia
R18,017.87
R18,017.87
90
C
39520
Repair, diaphragmatic hernia (oesophageal hiatal); transthoracic
R3,148.81
R3,148.81
90
B
39530
Repair, diaphragmatic hernia (oesophageal hiatal); thoraco-abdominal
R2,989.18
R2,989.18
90
B
39531
Repair, diaphragmatic hernia (oesophageal hiatal); thoraco-abdominal + dilation stricture (+/-gastroplasty)
R3,148.81
R3,148.81
90
B
39540
Repair, diaphragmatic hernia (other than neonatal), traumatic; acute
R2,646.28
R2,646.28
90
B
39541
Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic
R2,847.29
R2,847.29
90
B
39545
Imbrication diaphragm for eventration, transthoracic or transabdominal
R2,823.64
R2,823.64
90
B
39560
Resection, diaphragm; with simple repair (e.g., primary suture)
R2,442.90
R2,442.90
90
39561
Resection, diaphragm; with complex repair (e.g., prosthetic material, local muscle flap)
R3,729.38
R3,729.38
90
STOMACH
Minor surgery
43500
Gastrotomy; with exploration or foreign body removal
R2,270.27
R2,270.27
90
A
43501
Gastrotomy; with suture repair of bleeding ulcer
R3,946.95
R3,946.95
90
B
43502
Gastrotomy; suture repair oesophagogastric laceration (e.g. Mallory-Weiss)
R4,493.23
R4,493.23
90
B
43510
Gastrotomy; & oesophageal dilation & insertion permanent tube (e.g. Celestin)
R2,736.14
R2,736.14
90
A
43520
Pyloromyotomy, cutting of pyloric muscle (Ramstedt type)
R2,095.27
R2,095.27
90
A
43600
Biopsy of stomach; by capsule, tube, peroral (one or more specimens)
R325.17
R325.17
0
43605
Biopsy of stomach; by laparotomy
R2,428.71
R2,428.71
90
A
43653
Laparoscopy, surgical; gastrostomy (separate procedure)
R1,610.47
R1,610.47
90
A
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Major surgery
43610
Excision, local; ulcer or benign tumour of stomach
R2,876.85
R2,876.85
90
B
43611
Excision, local; malignant tumour of stomach
R3,567.39
R3,567.39
90
B
43620
Gastrectomy, total; with oesophagoenterostomy
R5,851.85
R5,851.85
90
C
43621
Gastrectomy, total; with Roux-en-Y reconstruction
R6,567.22
R6,567.22
90
C
43622
Gastrectomy, total; with formation of intestinal pouch, any type
R6,715.02
R6,715.02
90
C
43631
Gastrectomy, partial, distal; with gastro-duodenostomy
R4,302.86
R4,302.86
90
C
43632
Gastrectomy, partial, distal; with gastro-jejunostomy
R5,640.19
R5,640.19
90
C
43633
Gastrectomy, partial, distal; with Roux-en-Y reconstruction
R5,413.16
R5,413.16
90
C
43634
Gastrectomy, partial, distal; with formation of intestinal pouch
R5,955.90
R5,955.90
90
C
43635
Vagotomy when performed with partial distal gastrectomy
R353.55
R353.55
43638
Gastrectomy, partial, proximal, thoracic or abdominal & vagotomy;
R0.00
R0.00
90
C
43639
Gastrectomy, partial, prox, thoracic/abdominal & vagotomy; & pyloroplasty
R0.00
R0.00
90
C
43640
Vagotomy including pyloroplasty, +/- gastrostomy
R3,425.50
R3,425.50
90
B
43641
Highly selective vagotomy
R3,473.98
R3,473.98
90
B
43651
Laparoscopy, surgical; transection of vagus nerves, truncal
R1,914.35
R1,914.35
90
B
43652
Laparoscopy, surgical; transection of vagus nerves, selective or HSV
R2,280.91
R2,280.91
90
B
43800
Pyloroplasty
R2,726.68
R2,726.68
90
A
43810
Gastroduodenostomy
R2,948.98
R2,948.98
90
B
43820
Gastrojejunostomy; without vagotomy
R3,698.64
R3,698.64
90
B
43825
Gastrojejunostomy; with vagotomy, any type
R3,802.69
R3,802.69
90
B
43840
Gastrorrhaphy, suture perforated duodenal/gastric ulcer, wound, or injury
R3,770.77
R3,770.77
90
B
43850
Revision gastro-duodenal anastomosis with reconstruction; no vagotomy
R4,782.93
R4,782.93
90
C
43855
Revision gastro-duodenal anastomosis with reconstruction; with vagotomy
R4,992.22
R4,992.22
90
C
43860
Revision gastro-jejunal anastomosis, +/- partial gastrectomy or intestine resection; no vagotomy
R4,838.50
R4,838.50
90
C
43865
Revision gastro-jejunal anastomosis, +/- partial gastrectomy or intestine resection; with vagotomy
R5,065.53
R5,065.53
90
C
43870
Closure of gastrostomy, surgical
R2,042.06
R2,042.06
90
A
43880
Closure of gastrocolic fistula
R4,739.18
R4,739.18
90
B
43770
Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and
subcutaneous port components)
R3,274.15
R3,274.15
90
C
43771
Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only
R3,744.76
R3,744.76
90
C
43772
Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band component only
R2,821.28
R2,821.28
90
C
R3,745.94
R3,745.94
90
C
R2,834.28
R2,834.28
90
C
20
0
9
C
Bariatric
43773
43774
Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band
component only
Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port
components
43644
Laparoscopy, surgical, RYGB (Roux limb <150cm)
R5,128.20
R5,128.20
90
C
43645
Laparoscopy, gastric restrictive bypass & small intestine reconstruction
R5,521.95
R5,521.95
90
C
43842
Gastric restrictive procedure, without gastric bypass, morbid obesity; VBG
R3,651.34
R3,651.34
90
C
43843
Gastric restrictive procedure, without gastric bypass; other than VBG
R3,702.19
R3,702.19
90
C
43845
Gastric restrictive procedure; partial gastrectomy & BPD-duodenal switch
R5,719.41
R5,719.41
90
C
43846
Gastric restrictive procedure, RYGB for morbid obesity; short limb (<150cm)
R4,782.93
R4,782.93
90
C
43847
Gastric restrictive procedure, gastric bypass; with small bowel reconstruction
R5,261.81
R5,261.81
90
C
43848
Revision of gastric restrictive procedure for morbid obesity
R5,693.40
R5,693.40
90
C
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
43886
Gastric restrictive procedure, open; revision of subcutaneous port component only
R943.58
R943.58
90
C
43887
Gastric restrictive procedure, open; removal of subcutaneous port component only
R893.92
R893.92
90
C
43888
Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only
R1,280.57
R1,280.57
90
C
STOMAS & TUBES
Pharyngostomy (fistulisation of pharynx, external for feeding)
R2,253.71
R2,253.71
90
A
43350
Oesophagostomy, fistulisation of oesophagus, external; abdominal approach
R3,437.32
R3,437.32
90
B
43351
Oesophagostomy, fistulisation of oesophagus, external; thoracic approach
R4,029.72
R4,029.72
90
B
43352
Oesophagostomy, fistulisation of oesophagus, external; cervical approach
R3,319.08
R3,319.08
90
B
43420
Closure of oesophagostomy or fistula; cervical approach
R2,999.82
R2,999.82
90
B
43425
Closure of oesophagostomy or fistula; transthoracic or transabdominal
R4,494.42
R4,494.42
90
B
43752
Naso- or oro-gastric tube placement & fluoroscopy (includes radiology)
R127.70
R127.70
0
43761
Reposition gastric feeding tube, through duodenum for enteric nutrition
R384.29
R328.72
0
43246
Upper gastro-intestinal endoscopy; with PEG
43750
Percutaneous placement of gastrostomy tube
43830
9
42955
R763.85
0
R847.80
R847.80
10
A
Gastrostomy, open (e.g. Stamm procedure) (separate procedure)
R2,001.85
R2,001.85
90
A
43831
Gastrostomy, open e.g. (separate procedure); neonatal, for feeding
R1,664.86
R1,664.86
90
A
43832
Gastrostomy, open; with gastric tube (e.g. Janeway procedure)
R3,093.24
R3,093.24
90
B
43653
Laparoscopy, surgical; gastrostomy (separate procedure)
R1,610.47
R1,610.47
90
A
43760
Change of gastrostomy tube
R704.73
R192.74
0
43870
Closure of gastrostomy, surgical
R2,042.06
R2,042.06
90
44015
Tube or needle catheter jejunostomy for enteral alimentation, any method
R449.32
R449.32
44500
Introduction of long gastro-intestinal tube (separate procedure)
R80.41
R80.41
0
44186
Laparoscopy, surgical; jejunostomy (e.g. tube for decompression or feeding)
R1,923.81
R1,923.81
90
B
44310
Ileostomy or jejunostomy, non-tube (separate procedure)
R3,087.32
R3,087.32
90
B
44187
Laparoscopy, surgical; ileostomy or jejunostomy, non-tube
R3,249.32
R3,249.32
90
B
R527.36
R527.36
20
0
R763.85
+44701 Intra-operative colonic lavage; (+) add-on code
A
A
add-on
44300
Enterostomy or caecostomy, tube (separate procedure)
R2,454.72
R2,454.72
90
A
44310
Ileostomy or jejunostomy, non-tube (separate procedure)
R3,087.32
R3,087.32
90
B
44312
Revision of ileostomy; simple (release of superficial scar) (separate procedure)
R1,703.88
R1,703.88
90
A
44314
Revision of ileostomy; (reconstruction in-depth) (separate procedure)
R2,954.89
R2,954.89
90
A
44316
Continent ileostomy (Kock procedure) (separate procedure)
R4,088.84
R4,088.84
90
B
44320
Colostomy or skin level caecostomy; (separate procedure)
R3,507.09
R3,507.09
90
B
44188
Laparoscopy, surgical, colostomy or skin level cecostomy
R3,578.03
R3,578.03
90
B
44322
Colostomy; with multiple biopsies (e.g. Hirschsprung's) (separate procedure)
R2,775.16
R2,775.16
90
B
44340
Revision of colostomy; simple (separate procedure)
R1,720.44
R1,720.44
90
A
44345
Revise colostomy; complicated (reconstruction in-depth) (separate procedure)
R3,066.04
R3,066.04
90
A
44346
Revise colostomy; + repair paracolostomy hernia (separate procedure)
R3,432.59
R3,432.59
90
B
44620
Closure of enterostomy, large/small bowel
R2,511.48
R2,511.48
90
B
44625
Close enterostomy, large/small bowel; resection & anastomosis
R2,996.28
R2,996.28
90
B
44227
Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis
R4,993.40
R4,993.40
90
B
44626
Close Hartmann enterostomy; resection & rectal anastomosis
R4,812.49
R4,812.49
90
B
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
SMALL BOWEL
Biopsy/foreign body
44010
Duodenotomy, for exploration, biopsy(s), or foreign body removal
R2,517.39
R2,517.39
90
A
44020
Enterotomy, small intestine, not duodenum; exploration, biopsy, or FB removal
R2,833.10
R2,833.10
90
B
44100
Biopsy of intestine by capsule, tube, peroral (one or more specimens)
R347.63
R347.63
0
44800
Excision of Meckels diverticulum or omphalomesenteric duct
R2,226.52
R2,226.52
90
A
Meckels
Obstruction
Enterolysis (freeing of intestinal adhesion) (separate procedure)
R3,218.57
R3,218.57
90
B
44180
Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
R2,736.14
R2,736.14
90
B
44021
Enterotomy, small intestine, not duodenum; for decompression
R2,855.57
R2,855.57
90
B
44050
Reduction of volvulus, intussusception, internal hernia, by laparotomy
R2,746.78
R2,746.78
90
B
44055
Correction malrotation, lysis duodenal bands &/or reduction volvulus
44500
Introduction of long gastro-intestinal tube (separate procedure)
44615
9
44005
R4,389.18
R4,389.18
90
R80.41
R80.41
0
Stricturoplasty +/- dilation, for intestinal obstruction
R3,170.09
R3,170.09
90
B
44680
Intestinal plication (separate procedure)
R3,116.89
R3,116.89
90
B
44700
Exclusion, small intestine from pelvis (mesh/prosthesis/native tissue)
R3,051.85
R3,051.85
90
B
20
0
Suture
B
44602
Suture small bowel (ulcer, diverticulum, injury); single perforation
R3,958.78
R3,958.78
90
A
44603
Suture small bowel; multiple perforations
R4,513.34
R4,513.34
90
B
Resection
44126
Resection & anastomosis, congenital atresia; without tapering
R7,185.63
R7,185.63
90
B
44127
Resection & anastomosis, congenital atresia; with tapering
R8,317.21
R8,317.21
90
B
44128
Resection congenital atresia; each additional anastomosis, +/- tapering
R763.85
R763.85
44110
Excision, 1 or more lesions, small/large bowel; single enterotomy
R2,461.82
R2,461.82
90
A
44111
Excision, 1 or more lesions, small/large bowel; multiple enterotomies
R2,888.68
R2,888.68
90
B
44120
Enterectomy, resection, small intestine; single resection & anastomosis
R3,559.11
R3,559.11
90
B
R762.67
R762.67
R4,125.50
R4,125.50
R759.12
R759.12
+44121 Enterectomy, resection, small intestine; additional resection & anastomosis; (+) add-on code
44202
Laparoscopy, surgical; intestinal resection, with anastomosis
+44203 Laparoscopy, surgical enterectomy, each additional resection & anastomosis; (+) add-on code
B
add-on
90
C
add-on
44125
Enterectomy, small intestine; with enterostomy
R3,477.53
R3,477.53
90
B
44130
Entero-enterostomy +/- cutaneous enterostomy (separate procedure)
R3,608.78
R3,608.78
90
B
A
APPENDIX
44900
Incision & drainage of appendiceal abscess; open
R2,193.41
R2,193.41
90
44901
Incision & drainage of appendiceal abscess; percutaneous
R3,452.70
R551.01
0
44950
Appendectomy;
R1,901.35
R1,901.35
90
R264.86
R264.86
+44955 Appendectomy; for indicated purpose at time of other major procedure; (+) add-on code
A
add-on
44960
Appendectomy; for ruptured appendix with abscess or generalised peritonitis
R2,528.04
R2,528.04
90
A
44970
Laparoscopy, surgical, appendectomy
R1,726.35
R1,726.35
90
B
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
FISTULA
44640
Closure of intestinal cutaneous fistula
R4,181.07
R4,181.07
90
B
44650
Closure of enteroenteric or enterocolic fistula
R4,343.07
R4,343.07
90
B
44660
Closure of enterovesical fistula; without intestinal or bladder resection
R4,099.48
R4,099.48
90
B
44661
Closure of enterovesical fistula; with intestine &/or bladder resection
R4,683.61
R4,683.61
90
B
COLON
Colon Suture
44604
Suture large bowel, (single or multiple); without colostomy
R3,139.35
R3,139.35
90
B
44605
Suture large bowel, (single or multiple); with colostomy
R3,878.37
R3,878.37
90
B
Colon resection
Reduction of volvulus, intussusception, internal hernia, by laparotomy
R2,746.78
R2,746.78
90
B
44025
Colotomy, for exploration, biopsy(s), or foreign body removal
R2,883.95
R2,883.95
90
B
44110
Excision, 1 or more lesions, small/large bowel; single enterotomy
R2,461.82
R2,461.82
90
A
44111
Excision, 1 or more lesions, small/large bowel; multiple enterotomies
R2,888.68
R2,888.68
90
B
+44139 separately in addition to primary procedure); (+) add-on code
R380.74
R380.74
add-on
Laparoscopic, mobilisation (take-down) of splenic flexure performed in conjunction with partial colectomy (List
+44213 separately in addition to primary procedure); (+) add-on code
R600.67
R600.67
add-on
R3,983.61
R3,983.61
90
B
9
44050
Open, mobilisation (take-down) of splenic flexure performed in conjunction with partial colectomy (List
Colectomy, partial; with anastomosis
44204
Laparoscopic colectomy, partial, with anastomosis
R4,624.48
R4,624.48
90
C
44205
Laparoscopic colectomy, partial + terminal ileum with ileocolostomy
R4,045.09
R4,045.09
90
C
44141
Colectomy, partial; with skin level caecostomy or colostomy
R5,059.62
R5,059.62
90
B
44143
Colectomy, partial; with end colostomy & Hartmann closure distal segment
R4,881.07
R4,881.07
90
B
44206
Laparoscopy; colectomy, partial, with end colostomy & Hartmann closure distal segment
R5,222.79
R5,222.79
90
C
44144
Colectomy, partial; with colostomy or ileostomy & mucofistula
R5,024.15
R5,024.15
90
B
44145
Colectomy, partial; with coloproctostomy (low pelvic anastomosis)
R4,994.58
R4,994.58
90
C
44207
Laparoscopic colectomy, partial; with coloproctostomy (low pelvic anastomosis)
R5,513.67
R5,513.67
90
C
44146
Colectomy, partial; with coloproctostomy (low pelvic anast) + colostomy
R6,094.24
R6,094.24
90
C
44208
Laparoscopic colectomy, partial with coloproctostomy (low pelvic anast) + colostomy
R5,986.64
R5,986.64
90
C
44147
Colectomy, partial; abdominal & transanal approach
R5,367.05
R5,367.05
90
C
44150
Colectomy, total, abdominal; with ileostomy or ileoproctostomy
R5,346.95
R5,346.95
90
C
44210
Laparoscopic colectomy, total, abdominal, with ileostomy or ileoproctostomy
R5,323.30
R5,323.30
90
C
44151
Colectomy, total, abdominal; with continent ileostomy
R6,123.80
R6,123.80
90
C
44156
Colectomy, total, abdominal, with proctectomy; with continent ileostomy
R6,639.34
R6,639.34
90
C
44155
Proctocolectomy, with ileostomy
R6,016.20
R6,016.20
90
C
44212
Laparoscopic proctocolectomy, with ileostomy
R6,116.71
R6,116.71
90
C
44157
Proctocolecotmy; with ileoanal anastomosis, includes loop ileostomy and rectal mucosectomy, when performed
R6,514.01
R6,514.01
90
C
R6,683.09
R6,683.09
90
C
R6,563.67
R6,563.67
90
C
R3,647.80
R3,647.80
90
B
R380.74
R380.74
add-on
R600.67
R600.67
add-on
R527.36
R527.36
add-on
20
0
44140
44158
44211
44160
Proctocolectomy; with ileoanal anastomosis, creation of ileal reservoir (S or W), includes loop ileostomy and
rectal mucosectomy, when performed
Laparoscopic proctocolectomy; with ileoanal anastomosis, creation of ileal reservoir (S or W), includes loop
ileostomy and rectal mucosectomy, when performed
Colectomy with removal of terminal ileum & ileocolostomy
Open, surgical, mobilisation (take-down) of splenic flexure performed in conjunction with partial colectomy
+44139 (List separately in addition to primary procedure); (+) add-on code
Laparoscopy, surgical, mobilisation (take-down) of splenic flexure performed in conjunction with partial
+44213 colectomy (List separately in addition to primary procedure); (+) add-on code
+44701 Intra-operative colonic lavage; (+) add-on code
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Ileo-anal pouch repair/removal
46710
Repair of ileoanal pouch fistula/sinus (e.g., perineal or vaginal), pouch advancement; transperineal approach
R3,093.24
R3,093.24
90
A
46712
Repair of ileoanal pouch fistula/sinus (e.g., perineal or vaginal), pouch advancement; combined transperineal
and transabdominal approach
R6,484.45
R6,484.45
90
A
45136
Excision of ileoanal reservoir with ileostomy
R5,417.89
R5,417.89
90
B
R326.35
R326.35
0
R813.51
R813.51
90
R917.57
R655.07
10
RECTUM
EUA
45990
Anorectal exam, surgical, requiring anaesthesia (general, spinal, or epidural), diagnostic; separate procedure; do
not use with other related perineal or pelvic codes
Biopsy
45100
Biopsy of anorectal wall, anal approach (e.g. congenital megacolon)
A
Foreign body
45915
Removal of faecal impaction or foreign body under anaesthesia
Incision, anal septum (infant)
R598.31
R598.31
90
46705
Anoplasty, plastic operation for stricture; infant
R1,418.92
R1,418.92
90
A
46715
Repair of low imperforate anus; with ano-perineal fistula (cut-back procedure)
R1,427.19
R1,427.19
90
A
46716
Repair low imperforate anus; + transposition of ano-perineal/vestibular fistula
R3,204.39
R3,204.39
90
A
46730
Repair high imperforate anus without fistula; perineal or sacroperineal
R5,266.54
R5,266.54
90
C
46735
Repair high imperforate anus without fistula; combined abdominal & sacroperineal approach
R6,199.48
R6,199.48
90
C
46740
Repair high imperforate anus with fistula; perineal or sacro-perineal
R5,841.20
R5,841.20
90
C
46742
Repair high imperforate anus with fistula; combined abdominal & sacroperineal approach
R7,085.12
R7,085.12
90
C
46744
Repair cloacal anomaly by ano-recto-vagino-urethroplasty, sacro-perineal
R10,173.63
R10,173.63
90
C
46746
Repair cloacal anomaly by ano-recto-vag-urethroplasty, combined abdominal & sacroperineal approach
R11,399.81
R11,399.81
90
C
46748
Repair cloacal anomaly by ano-recto-vag-urethroplasty, combined abdominal & sacroperineal approach; plus
vaginal lengthening (intestinal graft/pedicle flaps)
R11,501.50
R11,501.50
90
C
20
0
46070
9
Congenital anomaly anorectal
Destruction
45160
Excision of rectal tumour by proctotomy, transsacral or transcoccygeal
R2,894.59
R2,894.59
90
B
45170
Excision of rectal tumour, trans-anal approach
R2,259.62
R2,259.62
90
B
45190
Destruction of rectal tumour (electro, laser, cryo); transanal approach
R1,926.18
R1,926.18
90
A
46937
Cryosurgery of rectal tumour; benign
R704.73
R500.17
10
46938
Cryosurgery of rectal tumour; malignant
R1,149.32
R1,002.70
90
Fistula
45800
Closure of rectovesical fistula;
R3,539.01
R3,539.01
90
B
45805
Closure of rectovesical fistula; with colostomy
R4,098.30
R4,098.30
90
B
45820
Closure of rectourethral fistula;
R3,533.10
R3,533.10
90
B
45825
Closure of rectourethral fistula; with colostomy
R4,309.96
R4,309.96
90
B
R741.38
R452.87
10
R1,485.13
R1,485.13
90
A
I&D
45005
Incision & drainage of submucosal abscess, rectum
45020
Incision & drainage of deep supralevator, pelvirectal, or retrorectal abscess
Injury
45562
Exploration, repair & presacral drainage for rectal injury;
R3,185.47
R3,185.47
90
B
45563
Exploration, repair & presacral drainage for rectal injury; with colostomy
R4,723.81
R4,723.81
90
B
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Proctectomy
45111
Proctectomy; partial resection of rectum, trans-abdominal approach
R3,203.20
R3,203.20
90
B
45113
Proctectomy, partial, + ileal pouch-anal anastomosis +/- loop ileostomy
R5,786.81
R5,786.81
90
C
45114
Proctectomy, partial, with anastomosis; abdominal & transsacral approach
R5,291.37
R5,291.37
90
C
45123
Proctectomy, partial, without anastomosis, perineal approach
R3,249.32
R3,249.32
90
B
45116
Proctectomy, partial, with anastomosis; transsacral only (Kraske type)
R4,767.56
R4,767.56
90
C
45110
Proctectomy; complete, combined abdomino-perineal, with colostomy
R5,465.19
R5,465.19
90
C
45395
Laparoscopic proctectomy, complete, combined abdominoperineal, with colostomy
R5,903.87
R5,903.87
90
C
45112
Proctectomy, combined abdominoperineal pull-through procedure with colo-anal anastomosis
R5,665.02
R5,665.02
90
C
R5,793.91
R5,793.91
90
C
R6,393.40
R6,393.40
90
C
R4,624.48
R4,624.48
90
C
R5,095.09
R5,095.09
90
C
45397
45120
45121
45126
Rectal Prolapse
9
45119
Proctectomy, combined abdominoperineal pull-through procedure (e.g. colo-anal anastomosis), with colonic
reservoir (e.g. J-pouch), ± diverting enterostomy
Laparoscopic proctectomy, combined abdominoperineal pull-through procedure (e.g. colo-anal anastomosis),
with colonic reservoir (e.g. J-pouch), ± diverting enterostomy
Proctectomy, complete (for congenital megacolon), abdominal & perineal pull-through & anastomosis
(Swenson, Duhamel, Soave)
Proctectomy, complete (for congenital megacolon), abdominal & perineal approach; with subtotal or total
colectomy, with multiple biopsies
Pelvic exenteration for colo-rectal malignancy, with proctectomy (+/- colostomy), with removal of bladder &
ureteral transplantations &/or hysterectomy, +/- adnexae, or any combination thereof
R8,509.95
R8,509.95
90
C
Reduction of prolapse (separate procedure) under anaesthesia
R568.75
R568.75
10
45520
Perirectal injection of sclerosing solution for prolapse
R306.25
R115.88
0
45130
Excision of rectal prolapse, with anastomosis; perineal approach
R3,185.47
R3,185.47
90
B
45135
Excision of rectal prolapse, with anastomosis; abdominal & perineal
R3,920.94
R3,920.94
90
B
45541
Rectopexy for prolapse; perineal approach
R2,646.28
R2,646.28
90
B
45540
Rectopexy for prolapse; abdominal approach
R3,123.98
R3,123.98
90
B
45400
Laparoscopic rectopexy for prolapse
R3,431.41
R3,431.41
90
C
45550
Rectopexy, with sigmoid resection, abdominal approach
R4,311.14
R4,311.14
90
B
45402
Laparoscopic rectopexy (for prolapse), with sigmoid resection
R4,600.84
R4,600.84
90
C
45560
Repair of rectocoele (separate procedure)
R2,096.45
R2,096.45
90
A
20
0
45900
Stenosis
45108
Anorectal myectomy
R1,001.52
R1,001.52
90
A
45150
Division of stricture of rectum
R1,118.58
R1,118.58
90
A
45500
Proctoplasty; for stenosis
R1,435.47
R1,435.47
90
A
45505
Proctoplasty; for prolapse of mucous membrane
R1,564.35
R1,564.35
90
A
45905
Dilation anal sphincter (separate procedure) under anaesthesia
R482.43
R482.43
10
45910
Dilation of rectal stricture (separate procedure) under anaesthesia
R569.93
R569.93
10
ANUS
Abscess-fistula
46020
Placement of seton
R686.99
R618.41
10
46030
Removal of anal seton, other marker
R338.17
R250.68
10
46040
Incision & drainage of ischiorectal &/or perirectal abscess
R1,375.17
R1,130.40
90
46045
I & D, intramural, intramuscular, or submucosal abscess, under anaesthesia
R1,120.94
R1,120.94
90
46050
I & D, perianal abscess, superficial
R478.88
R263.68
10
GI, HPB, Abdomen, Hernia
2009
A
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
46060
I & D, of ischioanal abscess, + fistulectomy/fistulotomy +/- seton
46210
Cryptectomy; single
46211
Facility
Nonfacility
Global Assistant
period
code
R1,235.64
R1,235.64
90
R988.51
R691.72
90
Cryptectomy; multiple (separate procedure)
R1,255.74
R997.97
90
46270
Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous
R1,251.01
R988.51
90
46275
Surgical treatment of anal fistula (fistulectomy/fistulotomy); submuscular
R1,294.76
R1,070.10
90
46280
Surgical treatment of anal fistula; complex or multiple, +/- seton
R1,235.64
R1,235.64
90
A
46285
Surgical treatment of anal fistula; second stage
R1,206.08
R1,040.54
90
A
46288
Closure of anal fistula with rectal advancement flap
R1,466.21
R1,466.21
90
A
46706
Repair of anal fistula with fibrin glue
R471.79
R471.79
10
A
A
Destruction
Destruction of lesions, simple; chemical
R581.76
R397.30
10
46910
Destruction of lesions, simple; electrodessication
R617.23
R374.83
10
46916
Destruction of lesions, simple; cryosurgery
R626.69
R406.76
10
46917
Destruction of lesions, simple; laser surgery
46922
Destruction of lesions, simple; surgical excision
46924
Destruction lesions, extensive
Stricture
46700
Anoplasty, plastic operation for stricture; adult
R1,311.31
R381.92
10
R659.80
R378.38
10
R1,413.00
R525.00
10
A
R1,781.92
R1,781.92
90
A
20
0
Fissura
9
46900
46080
Sphincterotomy, anal, division of sphincter (separate procedure)
R630.24
R464.69
10
A
46200
Fissurectomy, +/- sphincterotomy
R984.96
R821.79
90
A
46505
Chemodenervation of internal anal sphincter
R753.21
R629.05
10
46940
Curettage anal fissure, incl anal dilation (separate procedure); initial
R562.84
R430.40
10
46942
Curettage anal fissure, incl anal dilation (separate procedure); subsequent
R509.63
R384.29
10
Haemorrhoids
46250
Haemorrhoidectomy, external, complete
R1,195.44
R865.54
90
46255
Haemorrhoidectomy, internal & external, simple;
R1,351.52
R988.51
90
A
46257
Haemorrhoidectomy, internal & external, simple; with fissurectomy
R1,115.03
R1,115.03
90
A
46258
Haemorrhoidectomy, int & ext, simple; with fistulectomy, +/- fissurectomy
R1,232.09
R1,232.09
90
A
46260
Haemorrhoidectomy, internal & external, complex or extensive;
R1,278.21
R1,278.21
90
A
46261
Haemorrhoidectomy, int & ext, complex or extensive; with fissurectomy
R1,443.75
R1,443.75
90
A
46262
Haemorrhoidectomy, int & ext, complex; + fistulectomy, +/- fissurectomy
R1,489.86
R1,489.86
90
A
46947
Haemorrhoidopexy by stapling (e.g. PPH)
R1,070.10
R1,070.10
90
A
46083
Incision of thrombosed haemorrhoid, external
R478.88
R295.61
10
46220
Papillectomy or excision of single tag, anus (separate procedure)
R497.80
R323.99
10
46221
Haemorrhoidectomy, by simple ligature (e.g. rubber band ligation)
R644.42
R514.36
10
46230
Excision of external haemorrhoid tags &/or multiple papillae
R717.74
R495.44
10
46320
Enucleation or excision of external thrombotic haemorrhoid
R471.79
R314.53
10
46500
Injection of sclerosing solution, haemorrhoids
R506.08
R352.36
10
46934
Destruction of haemorrhoids, any method; internal
R1,094.93
R831.25
90
46935
Destruction of haemorrhoids, any method; external
R731.92
R455.24
10
46936
Destruction of haemorrhoids, any method; internal & external
R1,091.38
R775.67
90
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
46945
Ligation of internal haemorrhoids; single procedure
R705.91
R581.76
90
46946
Ligation of internal haemorrhoids; multiple procedures
R806.42
R630.24
90
Incontinence Surgery
46750
Sphincteroplasty, anal, for incontinence or prolapse; adult
R2,172.12
R2,172.12
90
A
46751
Sphincteroplasty, anal, for incontinence or prolapse; child
R1,807.94
R1,807.94
90
A
46753
Graft (Thiersch operation) for rectal incontinence &/or prolapse
R1,630.57
R1,630.57
90
A
46754
Removal of Thiersch wire or suture, anal canal
R791.05
R578.21
10
46760
Sphincteroplasty, anal, for incontinence, adult; muscle transplant
R3,094.42
R3,094.42
90
A
46761
Sphincteroplasty, anal, for incontinence, adult; levatorplasty (Park's post-anal)
R2,686.48
R2,686.48
90
A
46762
Sphincteroplasty, anal, for incontinence, adult; implantation artificial sphincter
R2,571.79
R2,571.79
90
A
R2,232.43
R2,232.43
90
B
ABDOMEN, OTHER
Drainage of extraperitoneal lymphocoele to peritoneal cavity, open
49080
Peritoneocentesis, or peritoneal lavage (diagnostic or therapeutic); initial
R598.31
R222.30
0
49081
Peritoneocentesis or peritoneal lavage (diagnostic or therapeutic); subsequent
R472.97
R210.47
0
49324
Laparoscopy, surgical; + insertion of intraperitoneal cannula or catheter, permanent
R1,158.78
R1,158.78
90
A
49325
Laparoscopy, surgical; + revision intraperitoneal cannula or catheter
R1,248.65
R1,248.65
90
A
49326
Laparoscopy, surgical; + omentopexy
R574.66
R574.66
90
A
49419
Insertion intraperitoneal catheter, + subcutaneous reservoir, permanent
R1,343.24
R1,343.24
90
A
49420
Insertion intraperitoneal catheter for drainage or dialysis; temporary
R418.58
R418.58
0
A
49421
Insertion intraperitoneal catheter for drainage or dialysis; permanent
R1,154.05
R1,154.05
90
A
49422
Removal of permanent intraperitoneal cannula or catheter
R1,171.79
R1,171.79
10
A
49425
Insertion of peritoneal-venous shunt
R2,267.90
R2,267.90
90
A
49426
Revision of peritoneal-venous shunt
R1,928.54
R1,928.54
90
A
49427
Injection procedure evaluation of previously placed peritoneal-venous shunt
R147.80
R147.80
0
49428
Ligation of peritoneal-venous shunt
R1,336.15
R1,336.15
10
A
49429
Removal of peritoneal-venous shunt
R1,388.17
R1,388.17
10
A
49435
Insertion of subcutaneous extension to intraperitoneal cannula or catheter
R370.10
R370.10
ZZZ
A
49436
Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter
R543.92
R543.92
10
A
49320
Laparoscopy, abdomen, peritoneum & omentum; diagnostic (separate proc)
R984.96
R984.96
10
B
49321
Laparoscopy, abdomen, peritoneum, & omentum; + biopsy (single or multiple)
R1,029.90
R1,029.90
10
A
49322
Laparoscopy, surgical, + aspiration cavity/cyst (e.g. ovarian) (single/multiple)
R1,131.59
R1,131.59
10
A
49323
Laparoscopy, surgical, + drainage of lymphocoele to peritoneal cavity
R1,876.52
R1,876.52
90
A
49324
Laparoscopy, surgical; + insertion of intraperitoneal cannula or catheter, permanent
R1,158.78
R1,158.78
90
A
49325
Laparoscopy, surgical; + revision intraperitoneal cannula or catheter
R1,248.65
R1,248.65
90
A
49326
Laparoscopy, surgical; + omentopexy
R574.66
R574.66
90
A
49400
Injection of air or contrast into peritoneal cavity (separate procedure)
R580.57
R310.98
0
49000
Exploratory laparotomy +/- biopsy(s) (separate procedure)
R2,280.91
R2,280.91
90
B
49002
Reopening of recent laparotomy
R2,872.12
R2,872.12
90
B
49010
Exploration, retroperitoneal area +/- biopsy(s) (separate procedure)
R2,777.53
R2,777.53
90
B
49085
Removal of peritoneal foreign body from peritoneal cavity
R0.00
R0.00
90
A
49180
Biopsy, abdominal or retroperitoneal mass, percutaneous needle
R558.11
R281.42
0
20
0
9
49062
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
49200
Excision/destruction, open, abdominl/retroperitonl tumour/cyst/endometrioma
R2,029.05
R2,029.05
90
B
49201
Excision/destruction, open, abdominal/retroperitoneal tumours/cysts/endometriomas; extensive
R2,888.68
R2,888.68
90
B
49215
Excision of presacral or sacrococcygeal tumour
R6,593.23
R6,593.23
90
B
49220
Staging laparotomy Hodgkins disease/lymphoma (includes splenectomy, needle/open biopsy liver, biopsy
abdominal nodes, bone marrow, ovarian repositioning)
R2,852.02
R2,852.02
90
B
49255
Omentectomy, epiploectomy, resection of omentum (separate procedure)
R2,299.83
R2,299.83
90
A
49402
Removal of peritoneal foreign body from peritoneal cavity
R2,499.66
R2,499.66
90
A
49900
Suture, secondary, of abdominal wall for evisceration or dehiscence
R2,379.05
R2,379.05
90
A
49904
Omental flap, extra-abdominal (e.g. reconstruction sternal/chest wall defects)
R4,652.86
R4,652.86
90
B
49905
Omental flap, intra-abdominal (List separately in addition to primary code)
R1,117.40
R1,117.40
49906
Free omental flap with microvascular anastomosis
R0.00
R0.00
90
44820
Excision of lesion of mesentery (separate procedure)
R2,452.36
R2,452.36
90
A
44850
Suture of mesentery (separate procedure)
R2,179.22
R2,179.22
90
A
45000
Transrectal drainage of pelvic abscess
R1,161.15
R1,161.15
90
A
49020
Drainage peritoneal abscess/ localised peritonitis, not appx abscess; open
R4,659.96
R4,659.96
90
B
49021
Drainage peritoneal abscess/localised peritonitis, not appx; percutaneous
R2,837.83
R548.65
0
A
49040
Drainage of sub-diaphragmatic or subphrenic abscess; open
R2,902.87
R2,902.87
90
A
49041
Drainage of sub-diaphragmatic or subphrenic abscess; percutaneous
R2,785.81
R650.34
0
A
49060
Drainage of retroperitoneal abscess; open
R3,255.23
R3,255.23
90
A
49061
Drainage of retroperitoneal abscess; percutaneous
R2,753.88
R600.67
0
A
49423
Exchange abscess/cyst drainage catheter under radiological guidance
R1,799.66
R243.58
0
49424
Contrast injection assessment abscess/cyst via previously placed catheter
R509.63
R127.70
0
49250
Umbilectomy, omphalectomy, excision of umbilicus (separate procedure)
R1,688.51
R1,688.51
90
A
20
0
9
B
LIVER
Ablation
47370
Laparoscopy, ablation of one or more liver tumour(s); radiofrequency
R3,695.09
R3,695.09
90
B
47371
Laparoscopy, ablation of one or more liver tumour(s); cryotherapy
R3,715.20
R3,715.20
90
B
47380
Ablation, open, one or more liver tumour(s); radiofrequency
R4,308.77
R4,308.77
90
B
47381
Ablation, open, one or more liver tumour(s); cryotherapy
R4,376.17
R4,376.17
90
B
47382
Ablation, one or more liver tumour(s), percutaneous, radiofrequency
R2,598.98
R2,598.98
10
B
R726.01
R312.16
0
R326.35
R326.35
add-on
R3,477.53
R3,477.53
90
B
R600.67
R600.67
0
A
Minor
47000
Biopsy of liver, needle; percutaneous
+47001 Biopsy of liver, needle; at time of other major procedure; (+) add-on code
47010
Hepatotomy; for open drainage of abscess or cyst, one or two stages
47011
Hepatotomy; for percutaneous drainage of abscess or cyst, one or two stages
47015
Laparotomy, with aspiration &/or inj hepatic parasitic cyst(s) or abscess(es)
R3,283.61
R3,283.61
90
B
47100
Biopsy of liver, wedge
R2,414.52
R2,414.52
90
A
47300
Marsupialisation of cyst or abscess of liver
R3,231.58
R3,231.58
90
B
Trauma
47350
Management of liver haemorrhage; simple suture of liver wound or injury
R3,998.98
R3,998.98
90
B
47360
Management of liver haemorrhage; complex suture +/- hepatic artery ligation
R5,448.64
R5,448.64
90
D
47361
Management of liver haemorrhage; exploration, extensive debridement, coagulation &/or suture, +/- packing of
liver
R9,037.31
R9,037.31
90
D
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
47362
Management of liver haemorrhage; re-exploration for removal of packing
Facility
Nonfacility
Global Assistant
period
code
R4,112.49
R4,112.49
90
B
Resection
47120
Hepatectomy, resection of liver; partial lobectomy
R6,900.66
R6,900.66
90
D
47122
Hepatectomy, resection of liver; trisegmentectomy
R10,328.53
R10,328.53
90
D
47125
Hepatectomy, resection of liver; total left lobectomy
R9,256.06
R9,256.06
90
D
47130
Hepatectomy, resection of liver; total right lobectomy
R9,963.16
R9,963.16
90
D
BILIARY
Gallbladder
Cholecystostomy
R2,439.35
R2,439.35
90
A
47490
Percutaneous cholecystostomy
R1,631.75
R1,631.75
90
A
47562
Laparoscopic cholecystectomy
R2,146.11
R2,146.11
90
B
47563
Laparoscopic cholecystectomy with cholangiography
R2,228.88
R2,228.88
90
B
47564
Laparoscopic cholecystectomy with exploration of common duct
R2,591.89
R2,591.89
90
B
47600
Cholecystectomy;
R3,021.11
R3,021.11
90
B
47605
Cholecystectomy; with cholangiography
R2,875.67
R2,875.67
90
B
47610
Cholecystectomy with exploration of common duct (CBDE);
R3,689.18
R3,689.18
90
B
47612
Cholecystectomy + CBDE + choledochoenterostomy
R3,718.74
R3,718.74
90
B
47620
Cholecystectomy + CBDE + transduodenal sphincterotomy/-plasty
R4,040.36
R4,040.36
90
B
20
0
9
47480
Exploration-drainage
47400
Hepaticotomy/hepaticostomy with exploration/drainage/removal calculus
R6,226.68
R6,226.68
90
B
47420
Choledochotomy/choledochostomy, + CBDE (+/- cholecystectomy)
R3,933.94
R3,933.94
90
B
47425
Choledocho(s)tomy + CBDE + transduodenal sphincteroplasty (+/-chole)
R3,969.42
R3,969.42
90
B
47460
Transduodenal sphincterotomy/-plasty +/- transduodenal extraction calculus
R3,682.09
R3,682.09
90
B
47500
Injection procedure for percutaneous transhepatic cholangiography
R319.26
R319.26
0
47505
Injection procedure for cholangiography through existing catheter
R122.97
R122.97
0
47510
Introduction of percutaneous transhepatic catheter for biliary drainage
R1,556.08
R1,556.08
90
A
47511
Introduction percutaneous transhepatic stent for int & ext biliary drainage
R1,919.08
R1,919.08
90
A
47525
Change of percutaneous biliary drainage catheter
R2,445.27
R1,010.98
10
A
47530
Revision &/or reinsertion of transhepatic tube
R4,598.47
R1,165.88
90
A
47560
Laparoscopy; with guided transhepatic cholangiography
R839.53
R839.53
0
A
47561
Laparoscopy; with guided transhepatic cholangiography, with biopsy
R904.56
R904.56
0
A
47570
Laparoscopy, surgical; cholecystoenterostomy
R2,304.56
R2,304.56
90
B
47630
Biliary duct stone extraction, percutaneous via T-tube tract, basket, or snare
R1,765.37
R1,765.37
90
A
47700
Exploration congenital atresia, no repair, +/- biopsy or cholangiography
R3,054.22
R3,054.22
90
B
47701
Portoenterostomy (e.g. Kasai procedure)
R5,135.29
R5,135.29
90
C
47720
Cholecystoenterostomy; direct
R3,293.07
R3,293.07
90
B
47721
Cholecystoenterostomy; with gastroenterostomy
R3,897.29
R3,897.29
90
B
47740
Cholecystoenterostomy; Roux-en-Y
R3,774.32
R3,774.32
90
B
47741
Cholecystoenterostomy; Roux-en-Y with gastroenterostomy
R4,278.03
R4,278.03
90
B
47760
Anastomosis, of extrahepatic biliary ducts & gastrointestinal tract
R6,263.33
R6,263.33
90
B
47765
Anastomosis, of intrahepatic ducts & gastrointestinal tract
R7,997.96
R7,997.96
90
B
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
47780
Anastomosis, Roux-en-Y, of extrahepatic biliary ducts & gastrointestinal tract
R6,807.25
R6,807.25
90
B
47785
Anastomosis, Roux-en-Y, of intrahepatic biliary ducts & gastrointestinal tract
R8,781.91
R8,781.91
90
C
47800
Reconstruction, extrahepatic biliary ducts with end-to-end anastomosis
R4,623.30
R4,623.30
90
B
47801
Placement of choledochal stent
R3,149.99
R3,149.99
90
B
47802
U-tube hepaticoenterostomy
R4,408.10
R4,408.10
90
B
47900
Suture of extrahepatic biliary duct for pre-existing injury (separate procedure)
R3,995.43
R3,995.43
90
B
47711
Excision of bile duct tumour, +/- primary repair of bile duct; extrahepatic
R4,570.09
R4,570.09
90
C
47712
Excision of bile duct tumour, +/- primary repair of bile duct; intrahepatic
R5,879.04
R5,879.04
90
C
47715
Excision of choledochal cyst
R3,827.53
R3,827.53
90
B
47719
Anastomosis, choledochal cyst, without excision
R3,437.32
R3,437.32
90
B
Resection
9
PANCREAS
48100
Biopsy of pancreas, open, any method (e.g. FNA, needle core, wedge)
R2,561.14
R2,561.14
90
A
48102
Biopsy of pancreas, percutaneous needle
R1,557.26
R805.23
10
A
R3,258.78
R3,258.78
90
B
R3,115.70
R3,115.70
90
B
Cyst/pseudocyst
Marsupialisation of cyst of pancreas
48510
External drainage, pseudocyst of pancreas; open
48511
External drainage, pseudocyst of pancreas; percutaneous
R2,915.87
R650.34
0
A
48520
Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct
R3,174.82
R3,174.82
90
B
48540
Internal anastomosis of pancreatic cyst to gastrointestinal tract; Roux-en-Y
R3,841.72
R3,841.72
90
B
20
0
48500
Excision
48120
Excision of lesion of pancreas (e.g. cyst, adenoma)
R3,226.85
R3,226.85
90
B
48140
Pancreatectomy, distal subtotal, +/- splenectomy; no pancreaticojejunostomy
R4,577.19
R4,577.19
90
C
48145
Pancreatectomy, distal subtotal, +/- splenectomy; + pancreaticojejunostomy
R4,758.10
R4,758.10
90
C
48146
Pancreatectomy, distal, near-total with preservation of duodenum
R5,423.81
R5,423.81
90
C
48148
Excision of ampulla of Vater
R3,580.40
R3,580.40
90
B
R9,233.60
R9,233.60
90
C
R8,521.77
R8,521.77
90
C
R9,230.05
R9,230.05
90
C
R8,566.71
R8,566.71
90
C
R5,234.62
R5,234.62
90
C
R0.00
R0.00
XXX
C
R4,886.98
R4,886.98
90
C
48150
48152
48153
48154
Pancreaticoduodenectomy, partial gastrectomy, choledochoenterostomy & gastrojejunostomy (Whipple-type
procedure); with pancreatojejunostomy
Pancreaticoduodenectomy, partial gastrectomy, choledochoenterostomy & gastrojejunostomy (Whipple-type
procedure); without pancreatojejunostomy
Pancreaticoduodenectomy, choledochoenterostomy & duodenojejunostomy (pylorus-sparing); with
pancreatojejunostomy
Pancreaticoduodenectomy, choledochoenterostomy & duodenojejunostomy (pylorus-sparing); without
pancreatojejunostomy
48155
Pancreatectomy, total
48160
Pancreatectomy, total/subtotal, + autologous transplantation pancreas or islets
48548
Pancreaticojejunostomy, side-to-side anastomosis (Puestow-type operation)
Pancreatitis
48000
Placement of drains, peripancreatic, for acute pancreatitis;
R5,514.85
R5,514.85
90
B
48001
Drain + with cholecystostomy, gastrostomy & jejunostomy for pancreatitis
R6,837.99
R6,837.99
90
B
48005
Resection/debridement pancreas/peripancreatic; acute necrotising pancreatitis
R0.00
R0.00
90
B
48020
Removal of pancreatic calculus
R3,366.38
R3,366.38
90
B
48105
Resection or debridement of pancreas and peripancreatic tissue for acute necrotising pancreatitis
R8,397.62
R8,397.62
90
C
R329.90
R329.90
Pancreatography
48400
Injection procedure for intra-operative pancreatography
GI, HPB, Abdomen, Hernia
2009
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Trauma
48545
Pancreatorrhaphy for injury
R3,841.72
R3,841.72
90
B
48547
Duodenal exclusion with gastrojejunostomy for pancreatic injury
R5,214.52
R5,214.52
90
B
HERNIA
Repair initial femoral hernia, any age; reducible
R1,675.50
R1,675.50
90
A
49553
Repair initial femoral hernia, any age; incarcerated or strangulated
R1,831.58
R1,831.58
90
A
49555
Repair recurrent femoral hernia; reducible
R1,745.27
R1,745.27
90
A
49557
Repair recurrent femoral hernia; incarcerated or strangulated
R2,123.64
R2,123.64
90
B
49565
Repair recurrent incisional or ventral hernia; reducible
R2,246.62
R2,246.62
90
B
49566
Repair recurrent incisional or ventral hernia; incarcerated or strangulated
R2,769.25
R2,769.25
90
B
49491
Repair, initial inguinal hernia, preterm infant, +/- hydrocelectomy; reducible
R2,243.07
R2,243.07
90
A
49492
Repair, initial inguinal hernia, preterm infant, +/- hydrocelectomy; incarcerated or strangulated
R2,739.69
R2,739.69
90
A
49495
Repair, initial inguinal hernia, <6 months old, +/- hydrocelectomy; reducible
R1,164.69
R1,164.69
90
A
49496
Repair, initial inguinal hernia, <6 months old; incarcerated or strangulated
R1,735.81
R1,735.81
90
A
49500
Repair initial inguinal hernia, 6 months to 5 yrs, +/- hydrocelectomy; reducible
R1,148.14
R1,148.14
90
A
49501
Repair initial inguinal hernia, 6 months to 5 yrs; incarcerated or strangulated
R1,727.53
R1,727.53
90
A
49505
Repair initial inguinal hernia, >5 years; reducible
R1,500.50
R1,500.50
90
A
49507
Repair initial inguinal hernia, >5 years; incarcerated or strangulated
R1,856.42
R1,856.42
90
A
49520
Repair recurrent inguinal hernia, any age; reducible
R1,845.77
R1,845.77
90
A
49521
Repair recurrent inguinal hernia, any age; incarcerated or strangulated
R2,261.99
R2,261.99
90
A
49525
Repair inguinal hernia, sliding, any age
R1,663.68
R1,663.68
90
A
49650
Laparoscopy, surgical; repair initial inguinal hernia
R1,236.82
R1,236.82
90
A
49651
Laparoscopy, surgical; repair recurrent inguinal hernia
R1,598.65
#REF!
90
A
49540
Repair lumbar hernia
R1,980.57
R1,980.57
90
A
49568
Implantation of mesh or other prosthesis for incisional or ventral hernia repair
R838.34
R838.34
49580
Repair umbilical hernia, under age 5 years; reducible
R901.01
R901.01
90
A
49582
Repair umbilical hernia, under age 5 years; incarcerated or strangulated
R1,351.52
R1,351.52
90
A
49585
Repair umbilical hernia, age 5 years or over; reducible
R1,262.84
R1,262.84
90
A
49587
Repair umbilical hernia, age 5 years or over; incarcerated or strangulated
R1,504.05
R1,504.05
90
A
49590
Repair spigelian hernia
R1,660.13
R1,660.13
90
A
49600
Repair of small omphalocele, with primary closure
R2,137.83
R2,137.83
90
B
49605
Repair of large omphalocele or gastroschisis; +/- prosthesis
R14,689.33
R14,689.33
90
B
49606
Repair of large omphalocele or gastroschisis; with removal of prosthesis, final reduction & closure, in operating
room
R3,405.40
R3,405.40
90
A
49610
Repair of omphalocele (Gross type operation); first stage
R2,006.58
R2,006.58
90
A
49611
Repair of omphalocele (Gross type operation); second stage
R1,913.17
R1,913.17
90
B
49659
Unlisted laparoscopy procedure, hernia
R0.00
R0.00
0
49560
Repair initial incisional or ventral hernia; reducible
R2,180.40
R2,180.40
90
B
49561
Repair initial incisional or ventral hernia; incarcerated or strangulated
R2,742.06
R2,742.06
90
B
49570
Repair epigastric hernia (e.g. preperitoneal fat); reducible (separate procedure)
R1,174.15
R1,174.15
90
A
49572
Repair epigastric hernia (e.g. preperitoneal fat); incarcerated or strangulated
R1,446.11
R1,446.11
90
A
20
0
9
49550
GI, HPB, Abdomen, Hernia
2009
A
2009
GI, HPB, Abdomen, Hernia
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
UNLISTED
Unlisted procedure, diaphragm
R0.00
R0.00
40799
Unlisted procedure, lips
R0.00
R0.00
40899
Unlisted procedure, vestibule of mouth
R0.00
R0.00
41599
Unlisted procedure, tongue, floor of mouth
R0.00
R0.00
42299
Unlisted procedure, palate, uvula
R0.00
R0.00
42699
Unlisted procedure, salivary glands or ducts
R0.00
R0.00
42999
Unlisted procedure, pharynx, adenoids, or tonsils
R0.00
R0.00
43289
Unlisted laparoscopic procedure, oesophagus
R0.00
R0.00
43499
Unlisted procedure, oesophagus
R0.00
R0.00
43659
Unlisted laparoscopy procedure, stomach
R0.00
R0.00
43999
Unlisted procedure, stomach
R0.00
R0.00
44238
Unlisted laparoscopic procedure, intestine (except rectum)
R0.00
R0.00
44239
Unlisted laparoscopic procedure, rectum
44799
Unlisted procedure, intestine
44899
9
39599
R0.00
R0.00
R0.00
Unlisted procedure, Meckels diverticulum & the mesentery
R0.00
R0.00
44979
Unlisted laparoscopic procedure, appendix
R0.00
R0.00
45499
Unlisted laparoscopy procedure, rectum
R0.00
R0.00
45999
Unlisted procedure, rectum
R0.00
R0.00
46999
Unlisted procedure, anus
R0.00
R0.00
49329
Unlisted laparoscopy procedure, abdomen, peritoneum & omentum
R0.00
R0.00
49999
Unlisted procedure, abdomen, peritoneum and omentum
R0.00
R0.00
47379
Unlisted laparoscopic procedure, liver
R0.00
R0.00
47399
Unlisted procedure, liver
R0.00
R0.00
47579
Unlisted laparoscopic procedure, biliary tract
R0.00
R0.00
47999
Unlisted procedure, biliary tract
R0.00
R0.00
48999
Unlisted procedure, pancreas
R0.00
R0.00
20
0
R0.00
GI, HPB, Abdomen, Hernia
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
THORACIC
Excision rib
21600
Excision of rib, partial
R1,641.21
R1,641.21
90
A
21610
Costotransversectomy (separate procedure)
R3,256.41
R3,256.41
90
B
21615
Excision first &/or cervical rib;
R2,144.93
R2,144.93
90
B
21616
Excision first &/or cervical rib; with sympathectomy
R2,626.18
R2,626.18
90
B
21700
Division of scalenus anticus; without resection of cervical rib
R1,287.67
R1,287.67
90
A
21705
Division of scalenus anticus; with resection of cervical rib
R1,965.20
R1,965.20
90
A
Rib fracture
Closed treatment of rib fracture, uncomplicated, each
R284.97
R284.97
90
21805
Open treatment of rib fracture without fixation, each
R763.85
R763.85
90
21810
Treatment of rib fracture requiring external fixation (flail chest)
R1,524.15
R1,524.15
90
21820
Closed treatment of sternum fracture
R389.02
R383.11
90
21825
Open treatment of sternum fracture with or without skeletal fixation
R1,764.19
R1,764.19
90
A
21620
Ostectomy of sternum, partial
R1,636.48
R1,636.48
90
A
21627
Sternal debridement
R1,695.60
R1,695.60
90
A
21750
Closure of sternotomy separation with or without debridement (separate procedure)
R2,237.16
R2,237.16
90
A
20
0
Thoracic, minor
9
21800
A
32000
Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent
R529.73
R245.95
0
32002
Thoracentesis with insertion of tube with or without water seal (e.g. for pneumothorax) (separate procedure)
R638.51
R394.93
0
32005
Chemical pleurodesis (e.g. for recurrent or persistent pneumothorax)
R1,007.43
R365.37
0
32019
Insertion of indwelling tunnelled pleural catheter with cuff
R2,760.97
R730.74
0
32020
Tube thoracostomy with or without water seal (e.g. for abscess, hemothorax, empyema) (separate procedure)
R587.67
R587.67
0
A
32035
Thoracostomy; with rib resection for empyema
R2,172.12
R2,172.12
90
A
32036
Thoracostomy; with open flap drainage for empyema
R2,371.95
R2,371.95
90
A
32400
Biopsy, pleura; percutaneous needle
R282.60
R282.60
0
32402
Biopsy, pleura; open
R1,772.46
R1,772.46
90
32405
Biopsy, lung or mediastinum, percutaneous needle
R313.34
R313.34
0
A
Thoracoscopy
32601
Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, without biopsy
R1,009.80
R1,009.80
0
A
32602
Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, with biopsy
R1,096.11
R1,096.11
0
A
32605
Thoracoscopy, diagnostic (separate procedure); mediastinal space, without biopsy
R1,268.75
R1,268.75
0
A
32606
Thoracoscopy, diagnostic (separate procedure); mediastinal space, with biopsy
R1,520.60
R1,520.60
0
A
32650
Thoracoscopy, surgical; with pleurodesis, any method
R2,215.87
R2,215.87
90
A
32651
Thoracoscopy, surgical; with partial pulmonary decortication
R3,302.53
R3,302.53
90
B
32652
Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis
R4,982.76
R4,982.76
90
B
32653
Thoracoscopy, surgical; with removal of intrapleural foreign body or fibrin deposit
R3,202.02
R3,202.02
90
B
32657
Thoracoscopy, surgical; with wedge resection of lung, single or multiple
R2,616.72
R2,616.72
90
B
32663
Thoracoscopy, surgical; with lobectomy, total or segmental
R4,461.31
R4,461.31
90
C
32664
Thoracoscopy, surgical; with thoracic sympathectomy
R2,822.46
R2,822.46
90
B
32665
Thoracoscopy, surgical; with oesphagomyotomy (Heller type)
R3,768.40
R3,768.40
90
C
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Thoracotomy
Thoracotomy, limited, for biopsy of lung or pleura
R1,962.83
R1,962.83
90
A
32100
Thoracotomy, major; with exploration and biopsy
R3,068.41
R3,068.41
90
B
32110
Thoracotomy, major; with control of traumatic haemorrhage and/or repair of lung tear
R4,602.02
R4,602.02
90
B
32120
Thoracotomy, major; for postoperative complications
R2,710.13
R2,710.13
90
B
32124
Thoracotomy, major; with open intrapleural pneumonolysis
R2,885.13
R2,885.13
90
B
32140
Thoracotomy, major; with cyst(s) removal, with or without a pleural procedure
R3,089.69
R3,089.69
90
B
32141
Thoracotomy, major; with excision-plication of bullae, with or without any pleural procedure
R4,417.56
R4,417.56
90
B
32150
Thoracotomy, major; with removal of intrapleural foreign body or fibrin deposit
R3,108.61
R3,108.61
90
B
32151
Thoracotomy, major; with removal of intrapulmonary foreign body
R3,198.47
R3,198.47
90
B
32160
Thoracotomy, major; with cardiac massage
R2,334.12
R2,334.12
90
B
32200
Pneumonostomy; with open drainage of abscess or cyst
R3,460.97
R3,460.97
90
B
32201
Pneumonostomy; with percutaneous drainage of abscess or cyst
R2,889.86
R649.15
0
B
32215
Pleural scarification for repeat pneumothorax
32220
9
32095
R2,529.22
90
B
Decortication, pulmonary (separate procedure); total
R5,050.16
R5,050.16
90
B
32225
Decortication, pulmonary (separate procedure); partial
R3,112.16
R3,112.16
90
B
32310
Pleurectomy, parietal (separate procedure)
R2,889.86
R2,889.86
90
B
32320
Decortication and parietal pleurectomy
R5,033.60
R5,033.60
90
C
32800
Repair lung hernia through chest wall
R2,945.43
R2,945.43
90
B
32810
Closure of chest wall following open flap drainage for empyema (Clagett type procedure)
R2,860.30
R2,860.30
90
B
32815
Open closure of major bronchial fistula
R7,808.77
R7,808.77
90
C
32820
Major reconstruction, chest wall (posttraumatic)
R4,367.90
R4,367.90
90
C
32900
Resection of ribs, extrapleural, all stages
R4,314.69
R4,314.69
90
C
20
0
R2,529.22
Trachea/bronchus
31500
Intubation, endotracheal, emergency procedure
R357.09
R357.09
0
31502
Tracheotomy tube change prior to establishment of fistula tract
R113.51
R113.51
0
31600
Tracheostomy, planned (separate procedure);
R1,291.21
R1,291.21
0
A
31601
Tracheostomy, planned (separate procedure); under two years
R833.61
R833.61
0
A
31603
Tracheostomy, emergency procedure; transtracheal
R727.19
R727.19
0
A
31605
Tracheostomy, emergency procedure; cricothyroid membrane
R599.49
R599.49
0
A
31610
Tracheostomy, fenestration procedure with skin flaps
R2,136.65
R2,136.65
90
A
31800
Suture of tracheal wound or injury; cervical
R2,116.55
R2,116.55
90
A
31805
Suture of tracheal wound or injury; intrathoracic
R2,620.26
R2,620.26
90
B
31820
Surgical closure tracheostomy or fistula; without plastic repair
R1,249.83
R999.15
90
B
31825
Surgical closure tracheostomy or fistula; with plastic repair
R1,770.10
R1,485.13
90
B
31830
Revision of tracheostomy scar
R1,266.38
R1,041.72
90
A
R0.00
R0.00
0
R387.84
R387.84
0
R6,903.03
R6,903.03
90
D
R11,143.22
R11,143.22
90
D
CARDIAC
33010
Pericardiocentesis; initial
33011
Pericardiocentesis; subsequent
33300
Repair of cardiac wound; without bypass
33305
Repair of cardiac wound; with cardiopulmonary bypass
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
VASCULAR
Angioplasty - open
35450
Transluminal balloon angioplasty, open; renal or other visceral artery
R1,746.45
R1,746.45
0
B
35452
Transluminal balloon angioplasty, open; aortic
R1,220.27
R1,220.27
0
B
35454
Transluminal balloon angioplasty, open; iliac
R1,074.83
R1,074.83
0
B
35456
Transluminal balloon angioplasty, open; femoral-popliteal
R1,303.04
R1,303.04
0
A
35458
Transluminal balloon angioplasty, open; brachiocephalic, each vessel
R1,663.68
R1,663.68
0
B
35459
Transluminal balloon angioplasty, open; tibioperoneal trunk & branches
R1,518.24
R1,518.24
0
A
35460
Transluminal balloon angioplasty, open; venous
R1,065.37
R1,065.37
0
A
Angioplasty-percutaneous
Transluminal balloon angioplasty, percutaneous; tibioperoneal trunk or branches, each vessel
R10,770.75
R1,499.32
0
A
35471
Transluminal balloon angioplasty, percutaneous; renal or visceral artery
R12,098.62
R1,755.91
0
A
35472
Transluminal balloon angioplasty, percutaneous; aortic
R7,984.95
R1,209.63
0
A
35473
Transluminal balloon angioplasty, percutaneous; iliac
R7,442.21
R1,060.64
0
A
35474
Transluminal balloon angioplasty, percutaneous; femoral-popliteal
R10,478.69
R1,279.39
0
A
35475
Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel
R7,573.46
R1,605.74
0
A
35476
Transluminal balloon angioplasty, percutaneous; venous
R5,772.62
R1,020.44
0
A
R1,494.59
R1,494.59
0
A
R696.45
R696.45
add-on
A
R1,468.58
R1,468.58
0
A
R710.64
R710.64
add-on
A
R371.28
R371.28
0
20
0
Transcatheter procedures
9
35470
37205
Transcatheter placement vascular stent(s), (non-coronary), percut; 1st vessel
+37206 Placement vascular stent(s), percutaneous; each additional vessel
37207
Transcatheter placement vascular stent(s), (non-coronary), open; 1st vessel
+37208 Placement vascular stent(s), open; each additional vessel
37209
Exchange of a previously placed arterial catheter during thrombolytic therapy
37215
Stenting, cervical carotid a, percut; with distal embolic protection
R3,548.47
R3,548.47
90
A
37216
Stenting, cervical carotid a, percut; without distal embolic protection
R3,303.71
R3,303.71
90
A
37184
Primary percutaneous transluminal mechanical thrombectomy, 1st vessel
R8,848.12
R1,468.58
0
A
R2,896.95
R539.19
add-on
+37185 Primary percutaneous transluminal mechanical thrombectomy, subsequent vessel
37186
Secondary percutaneous transluminal thrombectomy
R5,961.81
R808.78
0
37187
Percutaneous transluminal mechanical thrombectomy, vein(s),
R8,602.18
R1,364.52
0
A
37188
Percutaneous transluminal mechanical thrombectomy, vein(s), repeat
R7,410.29
R984.96
0
A
37195
Thrombolysis, cerebral, by intravenous infusion
R0.00
R0.00
37201
Transcatheter therapy, infusion for thrombolysis other than coronary
R916.38
R916.38
0
37202
Transcatheter therapy, infusion other than for thrombolysis, any type
R1,091.38
R1,091.38
0
37203
Transcatheter retrieval, percutaneous, of intravascular foreign body
R4,396.27
R861.99
0
A
37204
Transcatheter occlusion or embolisation, percut, not CNS, head or neck
R2,996.28
R2,996.28
0
C
36550
Declotting by thrombolytic agent of implanted vascular access device/catheter
R87.50
R80.41
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Embolectomy
34001
Embolectomy/thrombectomy; carotid, subclavian, innominate - neck incision
R3,112.16
R3,112.16
90
B
34051
Embolectomy/thrombectomy; innominate, subclavian - thoracic incision
R3,154.72
R3,154.72
90
B
34101
Embolectomy/thrombectomy; axillary, brachial, subclav - arm incision
R2,053.88
R2,053.88
90
B
34111
Embolectomy/thrombectomy; radial or ulnar artery - arm incision
R2,055.06
R2,055.06
90
B
34151
Embolect/thrombect; renal, celiac, mesentery, aortoiliac - abdominal incision
R4,726.17
R4,726.17
90
B
34201
Embolectomy/thrombectomy; femoropopliteal, aortoiliac artery - leg incision
R3,142.90
R3,142.90
90
B
34203
Embolectomy/thrombectomy; popliteal-tibio-peroneal artery - leg incision
R3,283.61
R3,283.61
90
B
Endarterectomy
Thromboendarterectomy: carotid, vertebral, subclavian, by neck incision
R3,576.85
R3,576.85
90
C
35302
Thromboendarterectomy; superficial femoral artery
R3,711.65
R3,711.65
90
B
35303
Thromboendaterectomy; popliteal artery
R4,079.38
R4,079.38
90
B
35304
Thromboendarterectomy, tibioperoneal trunk artery
R4,244.92
R4,244.92
90
B
35305
Thromboendarterectomy, tibial/peroneal artery 1st vessel
9
35301
+35306 Thromboendarterectomy, tibial/peroneal artery, each additional vessel
R4,079.38
R4,079.38
90
B
R1,533.61
R1,533.61
add-on
B
Thromboendarterectomy; subclavian, innominate, by thoracic incision
R5,103.37
R5,103.37
90
C
35321
Thromboendarterectomy; axillary-brachial
R3,049.49
R3,049.49
90
B
35331
Thromboendarterectomy; abdominal aorta
R4,979.21
R4,979.21
90
C
35341
Thromboendarterectomy; mesenteric, celiac, or renal
R4,748.64
R4,748.64
90
C
35351
Thromboendarterectomy; iliac
R4,382.09
R4,382.09
90
C
35355
Thromboendarterectomy; iliofemoral
R3,563.84
R3,563.84
90
C
35361
Thromboendarterectomy; combined aortoiliac
R5,375.33
R5,375.33
90
C
35363
Thromboendarterectomy; combined aortoiliofemoral
R5,748.97
R5,748.97
90
C
35371
Thromboendarterectomy; common femoral
R2,831.92
R2,831.92
90
B
35372
Thromboendarterectomy; deep (profunda) femoral
R3,398.30
R3,398.30
90
B
R551.01
R551.01
20
0
35311
+35390 Re-operation, carotid thromboendarterectomy, >1 month after original op
add-on
Explore
35701
Exploration (not followed by surgical repair), +/- lysis of artery; carotid artery
R1,792.56
R1,792.56
90
A
35721
Exploration (not followed by surgical repair), +/- lysis of artery; femoral artery
R1,531.25
R1,531.25
90
A
35741
Exploration (not followed by surgical repair), +/- lysis of artery; popliteal art
R1,681.42
R1,681.42
90
A
35761
Exploration (not followed by surgical repair), +/- lysis of artery; other vessels
R1,238.00
R1,238.00
90
A
35800
Exploration for postoperative haemorrhage, thrombosis or infection; neck
R1,586.82
R1,586.82
90
A
35820
Exploration for postoperative haemorrhage, thrombosis or infection; chest
R5,611.81
R5,611.81
90
B
35840
Exploration for postoperative haemorrhage, thrombosis, infection; abdomen
R2,056.25
R2,056.25
90
B
35860
Exploration for postoperative haemorrhage, thrombosis or infection; extremity
R1,346.79
R1,346.79
90
A
+35500 Harvest of upper extremity vein
R1,100.84
R1,100.84
add-on
A
+35572 Harvest of femoropopliteal vein
R1,176.52
R1,176.52
add-on
A
R859.63
R859.63
add-on
A
Harvest vessel
+35600 Harvest of upper extremity artery
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Ligation vessel
37565
Ligation, internal jugular vein
R2,221.79
R2,221.79
90
A
37600
Ligation; external carotid artery
R2,356.58
R2,356.58
90
A
37605
Ligation; internal or common carotid artery
R2,691.21
R2,691.21
90
A
37606
Ligation; internal or common carotid artery, with gradual occlusion
R1,725.17
R1,725.17
90
A
37607
Ligation or banding of angioaccess arteriovenous fistula
R1,239.19
R1,239.19
90
A
37609
Ligation or biopsy, temporal artery
R923.48
R627.87
10
A
37615
Ligation, major artery (e.g. post-traumatic, rupture); neck
R1,476.86
R1,476.86
90
A
37616
Ligation, major artery (e.g. post-traumatic, rupture); chest
R3,459.79
R3,459.79
90
B
37617
Ligation, major artery (e.g. post-traumatic, rupture); abdomen
R4,202.36
R4,202.36
90
B
37618
Ligation, major artery (e.g. post-traumatic, rupture); extremity
R1,202.53
R1,202.53
90
A
R3,166.55
R3,166.55
90
B
35201
Repair blood vessel, direct; neck
35206
Repair blood vessel, direct; upper extremity
35207
Repair blood vessel, direct; hand, finger
35211
9
Repair blood vessel
R2,588.34
90
B
R2,308.10
R2,308.10
90
B
Repair blood vessel, direct; intrathoracic, with bypass
R4,514.52
R4,514.52
90
C
35216
Repair blood vessel, direct; intrathoracic, without bypass
R5,831.74
R5,831.74
90
C
35221
Repair blood vessel, direct; intra-abdominal
R4,669.42
R4,669.42
90
B
35226
Repair blood vessel, direct; lower extremity
R2,872.12
R2,872.12
90
B
35261
Repair blood vessel with graft other than vein; neck
R3,464.52
R3,464.52
90
B
35266
Repair blood vessel with graft other than vein; upper extremity
R2,900.50
R2,900.50
90
B
35271
Repair blood vessel with graft other than vein; intrathoracic, with bypass
R4,488.50
R4,488.50
90
C
35276
Repair blood vessel with graft other than vein; intrathoracic, without bypass
R4,730.90
R4,730.90
90
C
35281
Repair blood vessel with graft other than vein; intra-abdominal
R5,335.12
R5,335.12
90
C
35286
Repair blood vessel with graft other than vein; lower extremity
R3,199.66
R3,199.66
90
B
35231
Repair blood vessel with vein graft; neck
R3,928.03
R3,928.03
90
B
35236
Repair blood vessel with vein graft; upper extremity
R3,300.16
R3,300.16
90
B
35241
Repair blood vessel with vein graft; intrathoracic, with bypass
R4,711.98
R4,711.98
90
C
35246
Repair blood vessel with vein graft; intrathoracic, without bypass
R5,153.03
R5,153.03
90
C
35251
Repair blood vessel with vein graft; intra-abdominal
R5,586.98
R5,586.98
90
B
35256
Repair blood vessel with vein graft; lower extremity
R3,491.72
R3,491.72
90
B
20
0
R2,588.34
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Aneurysm: non-ruptured
Repair aneurysm; carotid, subclavian artery, neck incision
R3,852.36
R3,852.36
90
C
35005
Repair aneurysm; vertebral artery
R3,484.62
R3,484.62
90
C
35011
Repair aneurysm; axillary-brachial artery, by arm incision
R3,386.48
R3,386.48
90
C
35021
Repair aneurysm; innominate, subclav, thoracic incision
R4,042.73
R4,042.73
90
C
35045
Repair aneurysm; radial or ulnar artery
R3,269.42
R3,269.42
90
B
33877
Repair of thoracoabdominal aortic aneurysm with graft, with or without cardiopulmonary bypass
R10,932.75
R10,932.75
90
D
35081
Repair aneurysm; abdominal aorta
R5,763.16
R5,763.16
90
D
35091
Repair aneurysm; abdominal aorta & visceral arteries (mesenteric, coeliac, renal)
R6,297.62
R6,297.62
90
D
35102
Repair aneurysm; abdominal aorta involving iliac vessels
R6,269.24
R6,269.24
90
D
35111
Repair aneurysm; splenic artery
R4,685.97
R4,685.97
90
D
35121
Repair aneurysm; hepatic, celiac, renal, or mesenteric artery
R5,628.37
R5,628.37
90
D
35131
Repair aneurysm; iliac artery (common, hypogastric, external)
R4,773.47
R4,773.47
90
D
35141
Repair aneurysm; common femoral artery (profunda femoris, superficial femoral)
R3,806.24
R3,806.24
90
C
35151
Repair aneurysm; popliteal artery
R4,293.40
R4,293.40
90
C
Aneurysm: ruptured
9
35001
Repair ruptured aneurysm; carotid, subclavian artery, neck incision
R4,060.46
R4,060.46
90
C
35013
Repair ruptured aneurysm; axillary-brachial artery, by arm incision
R4,190.53
R4,190.53
90
C
35022
Repair ruptured aneurysm; innominate, subclavian, thoracic incision
R4,557.09
R4,557.09
90
C
35082
Repair ruptured aneurysm; abdominal aorta
R7,345.26
R7,345.26
90
D
35092
Repair ruptured aneurysm; abdominal aorta & visceral arteries
R8,772.45
R8,772.45
90
D
35103
Repair ruptured aneurysm; abdominal aorta involving iliac vessels
R7,619.58
R7,619.58
90
D
35112
Repair ruptured aneurysm; splenic artery
R5,688.67
R5,688.67
90
D
35122
Repair ruptured aneurysm; hepatic, celiac, renal, or mesenteric artery
R6,607.42
R6,607.42
90
D
35132
Repair ruptured aneurysm; iliac artery (common, hypogastric, external)
R5,745.43
R5,745.43
90
D
35142
Repair ruptured aneurysm; common femoral artery
R4,523.98
R4,523.98
90
C
35152
Repair ruptured aneurysm; popliteal artery
R4,957.93
R4,957.93
90
C
20
0
35002
EVAR
33880
Endovascular repair of descending thoracic aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating
ulcer, intramural haematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial
endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin
R5,907.42
R5,907.42
90
C
33881
Endovascular repair of descending thoracic aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating
ulcer, intramural haematoma, or traumatic disruption); not involving coverage of left subclavian artery origin,
initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin
R5,096.27
R5,096.27
90
C
33883
Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (e.g., aneurysm,
pseudoaneurysm, dissection, penetrating ulcer, intramural haematoma, or traumatic disruption); initial extension
R3,750.67
R3,750.67
90
C
R1,358.61
R1,358.61
add-on
C
R3,252.86
R3,252.86
90
C
R2,721.95
R2,721.95
0
C
R3,491.72
R3,491.72
0
C
Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (e.g., aneurysm,
+33884 pseudoaneurysm, dissection, penetrating ulcer, intramural haematoma, or traumatic disruption); each additional
proximal extension (List separately in addition to code for primary procedure)
33886
33889
33891
Placement of distal extension prosthesis(s) delayed after endovascular repair of descending thoracic aorta
Open subclavian to carotid artery transposition performed in conjunction with endovascular repair of
descending thoracic aorta, by neck incision, unilateral
Bypass graft, with other than vein, transcervical retropharyngeal carotid-carotid, performed in conjunction with
endovascular repair of descending thoracic aorta, by neck incision
34800
EVAR AAA or dissection; using aorto-aortic tube prosthesis
R3,859.45
R3,859.45
90
B
34802
EVAR; using modular bifurcated prosthesis (one docking limb)
R4,188.17
R4,188.17
90
B
34803
EVAR; using modular bifurcated prosthesis (two docking limbs)
R4,307.59
R4,307.59
90
B
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
34804
EVAR; using unibody bifurcated prosthesis
R4,183.44
R4,183.44
90
B
34805
EVAR; using aorto-uniiliac or aorto-unifemoral prosthesis
R3,977.69
R3,977.69
90
B
R710.64
R710.64
add-on
B
R1,184.79
R1,184.79
0
C
R820.61
R820.61
add-on
C
+34808 Endovascular placement of iliac artery occlusion device
34812
Open femoral exposure endovascular prosthesis - groin incision, unilateral
+34813 Placement of fem-fem graft during EVAR
34820
Open iliac exposure during EVAR, unilateral
R1,688.51
R1,688.51
0
C
34825
Placement of proximal or distal extension prosthesis for EVAR; initial vessel
R2,351.85
R2,351.85
90
C
+34826 Placement prox or dist extension prosthesis for EVAR; each additional vessel
R694.09
R694.09
add-on
C
34830
Open repair of AAA/dissection + ass arterial trauma; failed EVAR
R6,220.76
R6,220.76
90
C
34831
Open repair of unsuccessful EVAR; aorto-bi-iliac prosthesis
R6,451.34
R6,451.34
90
C
34832
Open repair of unsuccessful EVAR; aorto-bifemoral prosthesis
R6,689.01
R6,689.01
90
C
R2,108.27
R2,108.27
0
C
R962.50
R962.50
0
B
34834
34900
9
34833
Open iliac artery exposure with conduit to deliver infrarenal aortic or iliac endovascular prosthesis - abdominal
or retroperitoneal incision, unilat
Open brachial artery exposure to assist in the deployment of infrarenal aortic or iliac endovascular prosthesis by
arm incision, unilateral
Endovascular graft replacement for repair iliac art (aneurysm, AVM, trauma)
Atherectomy
R3,075.50
R3,075.50
90
B
Transluminal peripheral atherectomy, open; renal or other visceral artery
R1,935.64
R1,935.64
0
B
35481
Transluminal peripheral atherectomy, open; aortic
R1,360.98
R1,360.98
0
B
35482
Transluminal peripheral atherectomy, open; iliac
R1,180.07
R1,180.07
0
B
35483
Transluminal peripheral atherectomy, open; femoral-popliteal
R1,442.56
R1,442.56
0
A
35484
Transluminal atherectomy, open; brachiocephalic or branches, each vessel
R1,806.75
R1,806.75
0
B
35485
Transluminal peripheral atherectomy, open; tibioperoneal trunk & branches
R1,682.60
R1,682.60
0
A
35490
Transluminal peripheral atherectomy, percut; renal or other visceral artery
R1,995.94
R1,995.94
0
A
35491
Transluminal peripheral atherectomy, percutaneous; aortic
R1,395.27
R1,395.27
0
A
35492
Transluminal peripheral atherectomy, percutaneous; iliac
R1,226.18
R1,226.18
0
A
35493
Transluminal peripheral atherectomy, percutaneous; femoral-popliteal
R1,482.77
R1,482.77
0
A
35494
Transluminal atherectomy, percut; brachiocephalic or branches, each vessel
R1,850.50
R1,850.50
0
B
35495
Transluminal peripheral atherectomy, percut; tibioperoneal trunk & branches
R1,728.71
R1,728.71
0
A
20
0
35480
AV Fistula
35180
Repair, congenital arteriovenous fistula; head & neck
R2,678.20
R2,678.20
90
B
35182
Repair, congenital arteriovenous fistula; thorax & abdomen
R5,731.24
R5,731.24
90
B
35184
Repair, congenital arteriovenous fistula; extremities
R3,452.70
R3,452.70
90
B
35188
Repair, acquired or traumatic arteriovenous fistula; head & neck
R2,895.77
R2,895.77
90
B
35189
Repair, acquired or traumatic arteriovenous fistula; thorax & abdomen
R5,362.32
R5,362.32
90
B
35190
Repair, acquired or traumatic arteriovenous fistula; extremities
R2,519.76
R2,519.76
90
B
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Bypass
Adjuvant techniques
35685
Vein patch/cuff at distal anastomosis of bypass graft, synthetic conduit
R695.27
R695.27
B
35686
Creation distal AV fistula during lower extremity bypass (non-haemodialysis)
R575.84
R575.84
B
R275.51
R275.51
Composite, reimplantation, transposition
35681
Bypass graft; composite, prosthetic & vein
35682
Bypass graft; autogenous composite, 2 segments of veins from 2 locations
R1,235.64
R1,235.64
35683
Bypass graft; autogenous composite, >2 segments of vein from >=2 locations
R1,457.94
R1,457.94
R516.72
R516.72
+35697 Reimplantation, visceral artery to infrarenal aortic prosthesis, each artery
add-on
C
Transposition &/or reimplantation; vertebral to carotid artery
R3,403.03
R3,403.03
90
C
35693
Transposition &/or reimplantation; vertebral to subclavian artery
R2,974.99
R2,974.99
90
C
35694
Transposition &/or reimplantation; subclavian to carotid artery
R3,544.93
R3,544.93
90
C
35695
Transposition &/or reimplantation; carotid to subclavian artery
R3,638.34
R3,638.34
90
C
Explore, revision
9
35691
+35700 Re-operation, femoral-popliteal or distal bypass, >1 month after original op
R530.91
R530.91
add-on
B
Thrombectomy of arterial or venous graft (other than haemodialysis access);
R2,013.68
R2,013.68
90
A
35876
Thrombectomy arterial or venous graft with revision of graft
R3,228.03
R3,228.03
90
B
35879
Revision, lower extremity arterial bypass, open; with vein patch angioplasty
R3,176.01
R3,176.01
90
B
35881
Revision, lower extremity art bypass, open; with segmental vein interposition
R3,541.38
R3,541.38
90
B
35883
Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft
R4,164.52
R4,164.52
90
B
35884
Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with autogenous vein patch graft
R4,423.47
R4,423.47
90
B
20
0
35875
Prosthetic
35631
Bypass graft, with other than vein; aortocoeliac, aortomesenteric, aortorenal
R6,382.76
R6,382.76
90
C
35636
Bypass graft, with other than vein; splenorenal
R5,605.90
R5,605.90
90
C
35637
Bypass graft, with other than vein aortoiliac
R5,708.77
R5,708.77
90
C
35638
Bypass graft with other than vein, aortobi-iliac
R5,799.82
R5,799.82
90
C
35663
Bypass graft, with other than vein; ilioiliac
R4,305.23
R4,305.23
90
B
35621
Bypass graft, with other than vein; axillary-femoral
R3,797.97
R3,797.97
90
B
35623
Bypass graft, with other than vein; axillary-popliteal or -tibial
R4,643.40
R4,643.40
90
B
35646
Bypass graft, with other than vein; aortofemoral or bifemoral
R5,887.32
R5,887.32
90
C
35651
Bypass graft, with other than vein; aortofemoral-popliteal
R4,678.88
R4,678.88
90
C
35654
Bypass graft, with other than vein; axillary-femoral-femoral
R4,708.44
R4,708.44
90
C
35656
Bypass graft, with other than vein; femoral-popliteal
R3,712.83
R3,712.83
90
C
35661
Bypass graft, with other than vein; femoral-femoral
R3,718.74
R3,718.74
90
B
35665
Bypass graft, with other than vein; iliofemoral
R4,045.09
R4,045.09
90
B
35666
Bypass graft, with other than vein; femoral - ant tibial, post tibial, or peroneal
R4,357.25
R4,357.25
90
C
35671
Bypass graft, with other than vein; popliteal-tibial or -peroneal artery
R3,834.62
R3,834.62
90
B
35601
Bypass graft, with other than vein; carotid
R4,706.07
R4,706.07
90
B
35606
Bypass graft, with other than vein; carotid-subclavian
R3,988.34
R3,988.34
90
B
35612
Bypass graft, with other than vein; subclavian-subclavian
R3,109.79
R3,109.79
90
B
35616
Bypass graft, with other than vein; subclavian-axillary
R3,758.94
R3,758.94
90
B
35626
Bypass graft, with other than vein; aortosubclavian or carotid
R5,281.91
R5,281.91
90
C
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Bypass graft, with other than vein; carotid-vertebral
R3,495.26
R3,495.26
90
B
35645
Bypass graft, with other than vein; subclavian-vertebral
R3,413.68
R3,413.68
90
B
35647
Bypass graft, with other than vein; subclavian-vertebral
R5,306.75
R5,306.75
90
B
35650
Bypass graft, with other than vein; axillary-axillary
R3,637.15
R3,637.15
90
B
35531
Bypass graft, with vein; aortocoeliac or aortomesenteric
R6,856.91
R6,856.91
90
C
35533
Bypass graft, with vein; axillary-femoral-femoral
R5,311.48
R5,311.48
90
C
35536
Bypass graft, with vein; splenorenal
R5,978.37
R5,978.37
90
C
35537
Bypass graft, with vein, aortoiliac
R7,176.17
R7,176.17
90
C
35538
Bypass graft, with vein, aortobi-iliac
R8,018.06
R8,018.06
90
C
35539
Bypass graft with vein-aortofemoral
R7,535.63
R7,535.63
90
C
35540
Bypass graft with vein, aortobifemoral
R8,402.35
R8,402.35
90
C
35548
Bypass graft, with vein; aortoiliofemoral, unilateral
R4,088.84
R4,088.84
90
C
35549
Bypass graft, with vein; aortoiliofemoral, bilateral
R4,458.94
R4,458.94
90
C
35551
Bypass graft, with vein; aortofemoral-popliteal
35556
Bypass graft, with vein; femoral-popliteal
35558
Bypass graft, with vein; femoral-femoral
35560
Bypass graft, with vein; aortorenal
35563
Bypass graft, with vein; ilioiliac
35565
Bypass graft, with vein; iliofemoral
35566
9
35642
R5,031.24
90
C
R4,638.67
R4,638.67
90
C
R4,158.61
R4,158.61
90
C
R6,068.23
R6,068.23
90
C
R4,675.33
R4,675.33
90
B
R4,494.42
R4,494.42
90
B
Bypass graft, with vein; femoral - ant tibial, post tibial, peroneal or distal
R5,571.61
R5,571.61
90
C
35571
Bypass graft, with vein; popliteal - tibial, -peroneal artery or distal
R4,617.39
R4,617.39
90
C
35583
In-situ vein bypass; femoral-popliteal
R4,805.40
R4,805.40
90
C
35585
In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery
R5,673.30
R5,673.30
90
C
35587
In-situ vein bypass; popliteal-tibial, peroneal
R4,771.11
R4,771.11
90
C
35501
Bypass graft, with vein; carotid
R5,002.86
R5,002.86
90
C
35506
Bypass graft, with vein; carotid-subclavian
R4,411.65
R4,411.65
90
C
35508
Bypass graft, with vein; carotid-vertebral
R4,507.42
R4,507.42
90
C
35509
Bypass graft, with vein; carotid-carotid
R4,865.70
R4,865.70
90
C
35510
Bypass graft, with vein; carotid-brachial
R4,254.38
R4,254.38
90
C
35511
Bypass graft, with vein; subclavian-subclavian
R4,003.71
R4,003.71
90
B
35512
Bypass graft, with vein; subclavian-brachial
R4,171.61
R4,171.61
90
B
35515
Bypass graft, with vein; subclavian-vertebral
R4,473.13
R4,473.13
90
B
35516
Bypass graft, with vein; subclavian-axillary
R3,959.96
R3,959.96
90
B
35518
Bypass graft, with vein; axillary-axillary
R4,043.91
R4,043.91
90
B
35521
Bypass graft, with vein; axillary-femoral
R4,319.42
R4,319.42
90
C
35522
Bypass graft, with vein; axillary-brachial
R4,061.65
R4,061.65
90
B
35525
Bypass graft, with vein; brachial-brachial
R3,845.26
R3,845.26
90
B
35526
Bypass graft, with vein; aortosubclavian or carotid
R5,802.18
R5,802.18
90
C
20
0
R5,031.24
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Graft sepsis
35870
Repair of graft-enteric fistula
R4,347.80
R4,347.80
90
B
35901
Excision of infected graft; neck
R1,709.79
R1,709.79
90
B
35903
Excision of infected graft; extremity
R1,954.56
R1,954.56
90
B
35905
Excision of infected graft; thorax
R5,959.45
R5,959.45
90
C
35907
Excision of infected graft; abdomen
R6,562.49
R6,562.49
90
C
Carotid body
60600
Excision of carotid body tumour; without excision of carotid artery
R4,445.94
R4,445.94
90
C
60605
Excision of carotid body tumour; with excision of carotid artery
R5,511.31
R5,511.31
90
C
Catheterise
9
Arterial catheterisation
36600
Arterial puncture, withdrawal of blood for diagnosis
R98.14
R50.84
36620
Arterial catheterisation or cannulation; percutaneous
R170.27
R170.27
0
36625
Arterial catheterisation or cannulation; cutdown
R341.72
R341.72
0
R3,728.20
R779.22
0
R4,038.00
R875.00
0
R7,021.27
R1,052.36
0
Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a
vascular family
Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a
36216
vascular family
Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic
36217
branch, within a vascular family
Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or
+36218 brachiocephalic branch, within a vascular family
Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery
36245
branch, within a vascular family
Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery
36246
branch, within a vascular family
Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower
36247
extremity artery branch, within a vascular family
Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal,
+36248 pelvic, or lower extremity artery branch, within a vascular family
20
0
36215
36660
Catheterisation, umbilical artery for diagnosis or therapy, newborn
R685.81
(+) add-on
R167.91
code
R4,274.48
R799.32
0
R4,118.40
R885.64
0
R6,501.00
R1,055.91
0
R578.21
(+) add-on
R169.09
code
R227.03
R227.03
0
R86.32
R28.38
0
R1,040.54
R156.08
0
Venous catheterisation
36000
Introduction of needle or intracatheter into vein
36005
Injection procedure for contrast venography (incl introduction of catheter)
36400
Venipuncture, <3 years; femoral or jugular vein
R82.77
R60.30
0
36405
Venipuncture, <3 years; scalp vein
R72.13
R49.66
0
36406
Venipuncture, <3 years; other vein
R56.76
R29.56
0
36410
Venipuncture, >=3 years, for diagnostic or therapeutic purposes
R57.94
R28.38
0
36415
Collection of blood by venipuncture
R0.00
R0.00
36416
Collection of capillary blood specimen
R0.00
R0.00
36420
Venipuncture, cutdown; under age 1 year
R158.45
R158.45
0
36425
Venipuncture, cutdown; age 1 or over
R122.97
R122.97
0
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Central venous access
Insertion non-tunnelled centrally inserted central venous catheter; >=5 years
R901.01
R400.84
0
36568
Insertion of peripherally inserted central venous catheter (PICC), <5
R1,071.28
R307.43
0
36569
Insertion PICC, without subcutaneous port or pump; >=5 years
R1,012.16
R305.07
0
36570
Insertion of PICC, with subcutaneous port; <5 years
R4,300.50
R1,006.25
10
36571
Insertion PICC, with subcutaneous port; >=5 years
R4,360.80
R1,005.07
10
36575
Repair of tunnelled or non-tunnelled central venous access catheter
R556.92
R132.43
0
36576
Repair of central venous access device, with subcutaneous port/pump
R1,185.98
R610.13
10
36578
Replacement, catheter only, of central venous access device with port/pump
R1,681.42
R695.27
10
36580
Replacement, non-tunnelled central venous catheter, same venous access
R905.74
R225.84
0
36581
Replacement, tunnelled central venous catheter, same venous access
R2,597.80
R646.79
10
36582
Replacement, complete tunnelled access device & port, same venous access
R3,536.65
R957.77
10
36583
Replacement, complete tunnelled access device & pump, same venous access
R3,544.93
R967.23
10
36584
Replacement, complete, PICC, through same venous access
36585
Replacement, complete PICC with subcutaneous port, same venous access
36589
9
36556
R228.21
0
R3,699.82
R897.46
10
Removal tunnelled central venous catheter, without subcutaneous port/pump
R548.65
R455.24
10
36590
Removal tunnelled central venous access device, with subcut port/pump
R848.98
R643.24
10
36597
Repositioning central venous catheter, fluoroscopic guidance
R420.95
R202.20
0
36598
Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy,
image documentation and report
R391.38
R334.63
0
36557
Insertion of tunnelled centrally inserted central venous catheter; <5 years
R2,969.08
R973.14
10
36558
Insertion of tunnelled centrally inserted central venous catheter; >=5 years
R2,926.51
R927.03
10
36560
Insertion tunnelled central venous access device, with subcutaneous port; <5
R4,052.19
R1,150.50
10
36561
Insertion tunnelled central venous access device, with subcutaneous port; >=5
R4,045.09
R1,115.03
10
36563
Insertion tunnelled central venous access device with subcutaneous pump
R3,879.55
R1,175.34
10
36565
Insertion tunnelled, 2 catheters via 2 separate venous sites, no port/pump(s)
R3,484.62
R1,112.67
10
36566
Insertion tunnelled, 2 separate catheters; with subcutaneous port/pumps(s)
R6,414.68
R1,190.71
10
20
0
R892.73
Dialysis access
36800
Insertion of cannula for haemodialysis; vein to vein
R522.63
R522.63
0
36810
Insertion of cannula for haemodialysis; A-V, external
R710.64
R710.64
0
A
36815
Insertion of cannula e.g. haemodialysis; AV, external revision, or closure
R485.98
R485.98
0
A
36818
Arteriovenous anastomosis, open; by upper arm cephalic vein transposition
R2,298.64
R2,298.64
90
A
36819
Arteriovenous anastomosis, open; by basilic vein transposition
R2,652.19
R2,652.19
90
A
36820
Arteriovenous anastomosis by forearm vein transposition
R2,654.56
R2,654.56
90
A
36821
Arteriovenous anastomosis, direct, any site
R1,758.27
R1,758.27
90
A
36822
Insertion of cannula(s) for ECMO
R1,245.10
R1,245.10
90
A
36823
Insertion AV cannulas for isolated extracorporeal circulation & chemotherapy, +/- hyperthermia, with removal
& repair
R4,131.41
R4,131.41
90
A
36825
Creation of AV fistula; autogenous graft
R1,917.90
R1,917.90
90
B
36830
AV fistula; nonautogenous e.g. biological collagen, thermoplastic graft
R2,204.05
R2,204.05
90
B
36831
Thrombectomy, open, AV fistula, dialysis graft
R1,521.79
R1,521.79
90
A
36832
Revision, open, AV fistula; without thrombectomy, dialysis graft
R1,943.91
R1,943.91
90
B
36833
Revision, open, AV fistula; with thrombectomy, dialysis graft
R2,194.59
R2,194.59
90
B
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Plastic repair of arteriovenous aneurysm (separate procedure)
R2,029.05
R2,029.05
90
B
36835
Insertion of Thomas shunt (separate procedure)
R1,492.23
R1,492.23
90
A
36838
Distal revascularisation & interval ligation, haemodialysis access (steal snd)
R3,951.68
R3,951.68
90
A
36860
External cannula declotting (separate procedure); without balloon catheter
R506.08
R329.90
0
A
36861
External cannula declotting (separate procedure); with balloon catheter
R497.80
R497.80
0
A
36870
Thrombectomy, percutaneous, AV fistula graft
R6,503.37
R999.15
90
A
20
0
9
36834
Chest, Cardio Vascular Procedures
2009
2009
Chest, Cardio Vascular Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Portal Hypertension
37140
Portocaval shunt
R4,399.82
R4,399.82
90
C
37145
Venous anastomosis, open; renoportal
R4,706.07
R4,706.07
90
C
37160
Mesocaval shunt
R4,129.05
R4,129.05
90
C
37180
Proximal splenorenal shunt
R4,663.50
R4,663.50
90
C
37181
Distal splenorenal shunt
R4,995.77
R4,995.77
90
C
37182
Transvenous intrahepatic portosystemic shunt(s) (TIPS)
R2,813.00
R2,813.00
0
37183
Revision of TIPS
R1,342.06
R1,342.06
0
38200
Injection procedure for splenoportography
R436.32
R436.32
0
Venous surgery
Single or multiple injections sclerosing solutions, spider veins; limb or trunk
R0.00
R0.00
0
36469
Single or multiple injections sclerosing solutions, spider veins; face
R0.00
R0.00
0
36470
Injection of sclerosing solution; single vein
36471
Injection of sclerosing solution; multiple veins, same leg
37620
9
36468
R227.03
10
R559.29
R320.44
10
Interruption, partial or complete, IVC, any method, incl. umbrella device
R2,118.91
R2,118.91
90
B
37650
Ligation of femoral vein
R1,653.04
R1,653.04
90
A
37660
Ligation of common iliac vein
R3,958.78
R3,958.78
90
A
34501
Valvuloplasty, femoral vein
R3,215.03
R3,215.03
90
B
34502
Reconstruction of vena cava, any method
R5,131.75
R5,131.75
90
C
34510
Venous valve transposition, any vein donor
R3,665.53
R3,665.53
90
B
34520
Cross-over vein graft to venous system
R3,546.11
R3,546.11
90
B
34530
Saphenopopliteal vein anastomosis
R3,303.71
R3,303.71
90
B
37500
Ligation, subfascial endoscopic perforator surgery (SEPS)
R2,314.02
R2,314.02
90
A
37700
Ligation & division long saphenous vein at SF junction, or distal interruptions
R826.52
R826.52
90
A
37718
Ligation, division, and stripping, short saphenous vein
R1,313.68
R1,313.68
90
A
37722
Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below
R1,559.63
R1,559.63
90
A
37735
Ligation, division & complete stripping long or short saphenous + excision ulcer & skin graft &/or interruption
perforators, with excision deep fascia
R2,078.71
R2,078.71
90
A
37760
Ligation perforator veins, subfascial, radical (Linton type), +/- skin graft, open
R2,042.06
R2,042.06
90
A
37765
Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions
R1,474.49
R1,474.49
90
A
37766
Stab phlebectomy of varicose veins, one extremity; more than 20 incisions
R1,781.92
R1,781.92
90
A
37780
Ligation & divisn short saph at saphen-popliteal junction - separate procedure
R846.62
R846.62
90
A
37785
Ligation, division &/or excision of varicose vein cluster(s), one leg
R1,126.86
R839.53
90
A
34401
Thrombectomy; vena cava, iliac vein - abdominal incision
R4,717.90
R4,717.90
90
B
34421
Thrombectomy; vena cava, iliac, femoropopliteal vein - leg incision
R2,466.55
R2,466.55
90
B
34451
Thrombectomy; vena cava, iliac, fem-pop vein - abdominal & leg incision
R5,114.01
R5,114.01
90
B
34471
Thrombectomy, direct or with catheter; subclavian vein - neck incision
R3,319.08
R3,319.08
90
B
34490
Thrombectomy; axillary & subclavian vein - arm incision
R2,059.79
R2,059.79
90
B
20
0
R452.87
Chest, Cardio Vascular Procedures
2009
2009
Lymph, Spleen Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Drain abscess
38300
Drainage of lymph node abscess or lymphadenitis; simple
38305
Drainage of lymph node abscess or lymphadenitis; extensive
R786.32
R532.09
10
R1,372.80
R1,372.80
90
A
A
Lymph node biopsy
Biopsy or excision of lymph node(s); open superficial
R940.03
R747.30
10
38505
Biopsy lymph node(s); by needle, superficial (e.g. cervical, inguinal, axillary)
R386.65
R234.12
0
38510
Biopsy or excision of lymph node(s); open, deep cervical node(s)
R1,521.79
R1,273.48
10
A
38520
Biopsy or excision of lymph node(s); open, deep cervical + scalene fat pad
R1,389.36
R1,389.36
90
A
38525
Biopsy or excision of lymph node(s); open, deep axillary node(s)
R1,239.19
R1,239.19
90
A
38530
Biopsy or excision of lymph node(s); open, internal mammary node(s)
R1,619.93
R1,619.93
90
A
38542
Dissection, deep jugular node(s)
R1,298.31
R1,298.31
90
A
38562
Limited lymphadenectomy for staging (separate procedure); pelvic, para-aortic
R2,115.37
R2,115.37
90
A
38564
Limited lymphadenectomy for staging (separate procedure); retroperitoneal
R2,110.64
R2,110.64
90
A
38570
Laparoscopic retroperitoneal lymph node biopsy, single or multiple
Block dissection
9
38500
R1,701.52
R1,701.52
10
B
R2,315.20
R2,315.20
90
B
R3,816.88
R3,816.88
90
B
Suprahyoid lymphadenectomy
38720
Cervical lymphadenectomy (complete)
38724
Cervical lymphadenectomy (modified radical neck dissection)
R4,123.13
R4,123.13
90
B
38740
Axillary lymphadenectomy; superficial
R1,992.39
R1,992.39
90
B
38745
Axillary lymphadenectomy; complete
R2,544.59
R2,544.59
90
B
38746
Thoracic lymphadenectomy, regional, incl mediastinal & peritracheal nodes
R847.80
R847.80
B
38747
Abdominal lymphadenectomy, regional
R838.34
R838.34
B
38760
Inguinofemoral lymphadenectomy, superficial, including Cloquets node
R2,518.58
R2,518.58
90
B
38765
Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, incl iliac &
obturator nodes (separate procedure)
R3,905.57
R3,905.57
90
B
38770
Pelvic lymphadenectomy, incl iliac & obturator nodes (separate procedure)
R2,533.95
R2,533.95
90
B
38780
Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic & renal nodes (separate
procedure)
R3,264.69
R3,264.69
90
B
38571
Laparoscopic bilateral total pelvic lymphadenectomy
R2,580.06
R2,580.06
10
B
38572
Laparoscopic bilateral total pelvic lymphadenectomy & peri-aortic lymph node sampling
R3,030.57
R3,030.57
10
B
20
0
38700
Bone marrow
38220
Bone marrow; aspiration only
R542.74
R192.74
38221
Bone marrow; biopsy, needle or trocar
R600.67
R244.76
Cystic hygroma
38550
Excision of cystic hygroma, axillary or cervical
R1,402.36
R1,402.36
90
A
38555
Excision of cystic hygroma; with deep neurovascular dissection
R3,003.37
R3,003.37
90
B
Lymphatic duct
38308
Lymphangiotomy or other operations on lymphatic channels
R1,332.60
R1,332.60
90
A
38380
Suture &/or ligation of thoracic duct; cervical approach
R1,716.89
R1,716.89
90
A
38381
Suture &/or ligation of thoracic duct; thoracic approach
R2,583.61
R2,583.61
90
B
38382
Suture &/or ligation of thoracic duct; abdominal approach
R2,076.35
R2,076.35
90
A
38790
Injection procedure; lymphangiography
R256.59
R256.59
0
38792
Injection procedure; for identification of sentinel node
R121.79
R121.79
0
38794
Cannulation, thoracic duct
R961.32
R961.32
90
Lymph, Spleen Procedures
2009
A
2009
Lymph, Spleen Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Spleen
38100
Splenectomy; total (separate procedure)
R3,280.06
R3,280.06
90
B
38101
Splenectomy; partial (separate procedure)
R3,339.18
R3,339.18
90
B
R824.15
R824.15
add-on
C
+38102 Splenectomy; total, en bloc, extensive disease, with other procedure; (+) add-on code
38115
Repair of ruptured spleen (splenorrhaphy) +/- partial splenectomy
R3,637.15
R3,637.15
90
B
38120
Laparoscopic splenectomy
R3,132.26
R3,132.26
90
B
Unlisted
Unlisted laparoscopic procedure, spleen
R0.00
R0.00
0
38589
Unlisted laparoscopy procedure, lymphatic system
R0.00
R0.00
0
38999
Unlisted procedure, haemic or lymphatic system
R0.00
R0.00
0
20
0
9
38129
Lymph, Spleen Procedures
2009
2009
Skin, Soft Tissue Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
FNA
10021
Fine needle aspiration; without imaging guidance
R415.03
R221.11
0
10022
Fine needle aspiration; with imaging guidance
R444.59
R206.93
0
I&D
10060
Incision & drainage of abscess; simple or single
R307.43
R269.59
10
10061
Incision & drainage of abscess; complicated or multiple
R540.37
R495.44
10
10120
Incision & removal of foreign body, subcutaneous tissues; simple
R410.30
R274.32
10
10121
Incision & removal of foreign body, subcutaneous tissues; complicated
R774.49
R566.38
10
10140
Incision & drainage of haematoma, seroma or fluid collection
R429.22
R358.28
10
10160
Puncture aspiration of abscess, haematoma, bulla, or cyst
R357.09
R288.51
10
10180
Incision & drainage, complex, postoperative wound infection
R671.62
R539.19
10
R148.99
R89.86
0
Inject lesion
Injection, intralesional; up to & including seven lesions
11901
Injection, intralesional; more than seven lesions
15860
Intravenous injection of agent (e.g., fluorescein) to test blood flow in flap or graft
Dressings
9
11900
R186.82
R141.89
0
R352.36
R352.36
0
Removal of sutures under anaesthesia (other than local), same surgeon
R271.96
R130.07
15851
Removal of sutures under anaesthesia (other than local), other surgeon
R296.79
R143.07
0
15852
Dressing change (for other than burns) under anaesthesia (other than local)
R148.99
R148.99
0
16000
Initial treatment, 1st degree burn, when no more than local treatment required
R212.84
R145.44
0
16020
Dressings &/or debridement, initial or subsequent; without anaesthesia, office or hospital, small
R251.86
R172.63
0
16025
Dressings &/or debridement, initial or subsequent; without anaesthesia, medium (e.g. whole face or whole
extremity)
R444.59
R352.36
0
16030
Dressings &/or debridement, initial or subsequent; without anaesthesia, large (e.g. more than one extremity)
R525.00
R402.03
0
20
0
15850
Dehiscence
12020
Treatment of superficial wound dehiscence; simple closure
R796.96
R571.11
10
12021
Treatment of superficial wound dehiscence; with packing
R464.69
R412.67
10
13160
Secondary closure of surgical wound or dehiscence, extensive or complicated
R2,427.53
R2,427.53
90
A
Drug implant
11981
Insertion, non-biodegrable drug delivery implant
R397.30
R267.23
0
A
11982
Removal, non-biodegrable drug delivery implant
R463.51
R326.35
0
A
11983
Removal with insertion, non-biodegrable drug delivery implant
R698.82
R587.67
0
A
Nails
11720
Debridement of nail(s) by any method(s); one to five
R86.32
R55.57
0
11721
Debridement of nail(s) by any method(s); six or more
R127.70
R95.78
0
11730
Avulsion of nail plate, partial or complete, simple; single
R277.87
R193.92
0
+11732 Avulsion of nail plate, partial or complete, simple; each additional nail plate (+) add-on code
R131.25
R99.32
add-on
add-on
Evacuation of subungual haematoma
R120.61
R92.23
0
11750
Excision of nail/nail matrix, partial or complete, for permanent removal;
R590.03
R521.45
10
11752
As above plus amputation of tuft of distal phalanx
R840.71
R801.69
10
11755
Biopsy of nail unit, any method (separate procedure)
R371.28
R262.50
0
11760
Repair of nail bed
R548.65
R415.03
10
11762
Reconstruction of nail bed with graft
R753.21
R645.61
10
Skin, Soft Tissue Procedures
2009
A
A
2009
Skin, Soft Tissue Procedures
Code
11765
Surgicom Description
Facility
Wedge excision of skin of nail fold (e.g. for ingrown toenail)
Nonfacility
Global Assistant
period
code
R331.08
R191.55
10
Pilonidal
10080
Incision & drainage of pilonidal cyst; simple
R507.26
R284.97
10
10081
Incision & drainage of pilonidal cyst; complicated
R783.95
R496.62
10
11770
Excision of pilonidal cyst or sinus; simple
R761.48
R528.55
10
A
11771
Excision of pilonidal cyst or sinus; extensive
R1,492.23
R1,197.80
90
A
11772
Excision of pilonidal cyst or sinus; complicated
R1,861.14
R1,572.63
90
A
Debridement
11004
Debridement, necrotizing soft tissue infection; genitalia & perineum
R1,797.29
R1,797.29
0
A
11005
Debridement, necrotizing soft tissue infection; abdominal wall +/- fascial closure
R2,415.70
R2,415.70
0
A
11006
Debridement, necrotizing soft tissue infection; genitalia, perineum & abdominal wall
R2,243.07
R2,243.07
0
A
R883.28
R883.28
add-on
A
R1,381.08
R875.00
10
A
+11008 Removal prosthetic material, abdominal wall for necrotizing soft tissue infection (+) add-on code
Debridement associated with open fracture/dislocation: skin
11011
Debridement associated with open fracture/dislocation: skin & muscle
R1,603.38
R940.03
10
A
11012
Debridement associated with open fracture/dislocation: skin, muscle & bone
R2,288.00
R1,383.44
10
A
11000
Debridement of extensive eczematous or infected skin; <10% of body surface
R152.53
R104.05
0
R67.40
R52.03
add-on
R132.43
R89.86
0
R163.18
R118.24
0
9
11010
+11001 Debridement of extensive eczematous or infected skin; each additional 10% (+) add-on code
Debridement; skin, partial thickness
11041
Debridement; skin, full thickness
11042
Debridement; skin & subcutaneous tissue
R224.66
R156.08
0
11043
Debridement; skin, subcutaneous tissue & muscle
R805.23
R707.09
10
A
11044
Debridement; skin, subcutaneous tissue, muscle & bone
R1,078.38
R977.87
10
A
R266.05
R144.26
0
R92.23
R74.49
add-on
20
0
11040
Biopsy
11100
Biopsy skin or mucous membrane (including simple closure); single lesion
+11101 Biopsy skin or mucous memb (including simple closure); each additional lesion (+) add-on code
Removal of skin tags
11200
Removal skin tags, any area; up to 15 lesions
R227.03
R192.74
10
11201
Removal skin tags; each additional 10 lesions
R55.57
R50.84
add-on
R204.56
R146.62
10
R22.47
R16.55
add-on
R503.72
R410.30
10
Destruction
17000
17003
Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curretment), benign or
premalignant lesions (e.g., actinic keratoses); first lesion
Destruction; second through 14 lesions, each (List separately in addition to code for first lesion) (+) add-on
code
17004
Destruction; 15 or more lesions
17106
Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); less than 10 sq cm
R1,135.13
R981.42
90
17107
Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); 10.0 - 50.0 sq cm
R2,017.23
R1,800.84
90
17108
Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); over 50.0 sq cm
R2,731.41
R2,512.66
90
17110
Destruction any method warts; <=14
R281.42
R172.63
10
17111
Destruction any method warts; >=15
R333.45
R222.30
10
17250
Chemical cauterisation of granulation tissue
R214.02
R107.60
0
17280
Destruction, malignant lesion, face, ear, eyelid, nose, lip, muc memb; ≤0.5cm
R359.46
R249.49
10
17281
Destruction, malignant lesion, face, ear, eyelid, nose, lip, muc memb; 0.6 - 1.0cm
R464.69
R351.18
10
17282
Destruction, malignant lesion, face, ear, eyelid, nose, lip, muc memb; 1.1 - 2.0 cm
R538.01
R407.94
10
17283
Destruction, malignant lesion, face, ear, eyelid, nose, lip, muc memb; 2.1 - 3.0cm
R659.80
R513.17
10
Skin, Soft Tissue Procedures
2009
A
2009
Skin, Soft Tissue Procedures
Code
Surgicom Description
Facility
Destruction, malignant lesion, face, ear, eyelid, nose, lip, muc memb; 3.1 - 4.0cm
17286
Destruction, malignant lesion, face, ear, eyelid, nose, lip, muc memb; >4.0cm
17270
Global Assistant
period
code
R775.67
R614.86
10
A
R1,010.98
R844.26
10
A
Destruction, malignant lesion, scalp, neck, hand, foot, genital; ≤0.5cm
R387.84
R274.32
10
17271
Destruction, malignant lesion, scalp, neck, hands, feet, genitalia; 0.6 - 1.0cm
R422.13
R309.80
10
17272
Destruction, malignant lesion, scalp, neck, hands, foot, genitals; 1.1 - 2.0cm
R484.80
R359.46
10
17273
Destruction, malignant lesion, scalp, neck, hands, foot, genitals; 2.1 - 3.0cm
R545.10
R406.76
10
17274
Destruction, malignant lesion, scalp, neck, hands, foot, genitals; 3.1 - 4.0cm
R656.25
R501.35
10
A
17276
Destruction, malignant lesion, scalp, neck, hands, foot, genitals; >4.0cm
R776.86
R608.95
10
A
17260
Destruction, malignant lesion, any method, trunk, arms, legs; lesion ≤0.5cm
R270.78
R196.28
10
17261
Destruction, malignant lesion, any method, trunk, arms, legs; 0.6 - 1.0cm
R364.19
R253.04
10
17262
Destruction, malignant lesion, any method, trunk, arms, legs; 1.1 - 2.0cm
R448.14
R325.17
10
17263
Destruction, malignant lesion, any method, trunk, arms, legs; 2.1 - 3.0cm
R495.44
R360.64
10
17264
Destruction, malignant lesion, any method, trunk, arms, legs; 3.1 - 4.0cm
R535.64
R384.29
10
17266
Destruction, malignant lesion, any method, trunk, arms, legs; >4.0cm
Excision - benign lesion
9
17284
Nonfacility
R617.23
R446.96
10
A
Face, ears, eyelids, nose, lips, mucous membrane; ≤0.5 cm
R384.29
R284.97
10
11441
Face, ears, eyelids, nose, lips, mucous membrane; 0.6 to 1.0 cm
R470.61
R371.28
10
11442
Face, ears, eyelids, nose, lips, mucous membrane; 1.1 to 2.0 cm
R527.36
R412.67
10
11443
Face, ears, eyelids, nose, lips, mucous membrane; 2.1 to 3.0 cm
R642.06
R514.36
10
11444
Face, ears, eyelids, nose, lips, mucous membrane; 3.1 to 4.0 cm
R813.51
R664.53
10
A
11446
Face, ears, eyelids, nose, lips, mucous membrane; >4.0 cm
R1,091.38
R937.67
10
A
11420
Scalp, neck, hands, feet, genitalia; excised diameter ≤0.5 cm
R339.36
R238.85
10
11421
Scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
R433.95
R319.26
10
11422
Scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
R484.80
R377.20
10
11423
Scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
R571.11
R441.05
10
11424
Scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm
R655.07
R514.36
10
11426
Scalp, neck, hands, feet, genitalia; excised diameter >4.0 cm
R944.76
R785.13
10
11400
Trunk, arms or legs; excised diameter ≤0.5 cm
R341.72
R216.38
10
11401
Trunk, arms or legs; excised diameter 0.6 to 1.0 cm
R405.57
R283.78
10
11402
Trunk, arms or legs; excised diameter 1.1 to 2.0 cm
R450.51
R314.53
10
11403
Trunk, arms or legs; excised diameter 2.1 to 3.0 cm
R521.45
R397.30
10
11404
Trunk, arms or legs; excised diameter 3.1 to 4.0 cm
R594.76
R443.41
10
11406
Trunk, arms or legs; excised diameter >4.0 cm
R822.97
R656.25
10
20
0
11440
A
Hidradenitis
11450
Excision of axillary hidradenitis, axillary; with simple or intermediate repair
R1,009.80
R662.16
90
A
11451
Excision of axillary hidradenitis; complex repair
R1,343.24
R884.46
90
A
11462
Excision of inguinal hidradenitis; with simple or intermediate repair
R993.24
R634.96
90
A
11463
Excision of inguinal hidradenitis; with complex repair
R1,378.71
R904.56
90
A
11470
Excision of perineal or umbilical hidradenitis; simple or intermediate repair
R1,093.75
R760.30
90
A
11471
Excision of perineal or umbilical hidradenitis; with complex repair
R1,422.46
R970.78
90
A
Skin, Soft Tissue Procedures
2009
2009
Skin, Soft Tissue Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Excision - malignant lesion
Face, ears, eyelids, nose, lips; ≤0.5 cm
R529.73
R341.72
10
11641
Face, ears, eyelids, nose, lips; 0.6 to 1.0 cm
R645.61
R454.05
10
11642
Face, ears, eyelids, nose, lips; 1.1 to 2.0 cm
R747.30
R533.28
10
11643
Face, ears, eyelids, nose, lips; 2.1 to 3.0 cm
R892.73
R665.71
10
11644
Face, ears, eyelids, nose, lips; 3.1 to 4.0 cm
R1,116.21
R841.89
10
A
11646
Face, ears, eyelids, nose, lips,; >4.0 cm
R1,489.86
R1,207.26
10
A
11620
Scalp, neck, hands, feet, genitalia; excised diameter ≤0.5 cm
R513.17
R318.07
10
11621
Scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
R597.13
R410.30
10
11622
Scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
R673.99
R471.79
10
11623
Scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
R802.87
R584.12
10
A
11624
Scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm
R917.57
R673.99
10
A
11626
Scalp, neck, hands, feet, genitalia; excised diameter >4.0 cm
R1,149.32
R873.82
10
A
11600
Trunk, arms or legs; excised diameter ≤0.5 cm
11601
9
11640
R319.26
10
Trunk, arms or legs; excised diameter 0.6 to 1.0 cm
R594.76
R406.76
10
11602
Trunk, arms or legs; excised diameter 1.1 to 2.0 cm
R640.88
R439.86
10
11603
Trunk, arms or legs; excised diameter 2.1 to 3.0 cm
R739.02
R520.27
10
11604
Trunk, arms or legs; excised diameter 3.1 to 4.0 cm
R820.61
R573.48
10
A
11606
Trunk, arms or legs; excised diameter >4.0 cm
R1,152.87
R857.26
10
A
20
0
R513.17
Pressure ulcer
15920
Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture
R1,752.36
R1,752.36
90
15922
Excision, coccygeal pressure ulcer, with coccygectomy; with flap closure
R2,227.70
R2,227.70
90
15931
Excision, sacral pressure ulcer, with primary suture;
R1,993.58
R1,993.58
90
15933
Excision, sacral pressure ulcer, with primary suture; with ostectomy
R2,466.55
R2,466.55
90
15934
Excision, sacral pressure ulcer, with skin flap closure;
R2,753.88
R2,753.88
90
15935
Excision, sacral pressure ulcer, with skin flap closure; with ostectomy
R3,311.99
R3,311.99
90
15936
Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;
R2,705.40
R2,705.40
90
15937
Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with
ostectomy
R3,159.45
R3,159.45
90
15940
Excision, ischial pressure ulcer, with primary suture;
R2,072.80
R2,072.80
90
15941
Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)
R2,737.33
R2,737.33
90
15944
Excision, ischial pressure ulcer, with skin flap closure;
R2,658.10
R2,658.10
90
15945
Excision, ischial pressure ulcer, with skin flap closure; with ostectomy
R2,954.89
R2,954.89
90
15946
Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft
closure
R4,884.62
R4,884.62
90
15950
Excision, trochanteric pressure ulcer, with primary suture;
R1,699.15
R1,699.15
90
15951
Excision, trochanteric pressure ulcer, with primary suture; with ostectomy
R2,461.82
R2,461.82
90
15952
Excision, trochanteric pressure ulcer, with skin flap closure;
R2,545.77
R2,545.77
90
15953
Excision, trochanteric pressure ulcer, with skin flap closure; with ostectomy
R2,867.39
R2,867.39
90
15956
Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;
R3,469.25
R3,469.25
90
15958
Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with
ostectomy
R3,513.00
R3,513.00
90
Skin, Soft Tissue Procedures
2009
2009
Skin, Soft Tissue Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Repair - simple, superficial wounds
Face, ears, eyelids, nose, lips &/or mucous membranes; ≤2.5 cm
R474.15
R321.62
10
12013
Face, ears, eyelids, nose, lips &/or mucous membranes; 2.6 cm to 5.0 cm
R521.45
R367.74
10
12014
Face, ears, eyelids, nose, lips &/or mucous membranes; 5.1 cm to 7.5 cm
R616.05
R443.41
10
12015
Face, ears, eyelids, nose, lips &/or mucous membranes; 7.6 cm to 12.5 cm
R773.31
R558.11
10
12016
Face, ears, eyelids, nose, lips &/or mucous membranes; 12.6 cm to 20.0 cm
R917.57
R683.44
10
A
12017
Face, ears, eyelids, nose, lips &/or mucous membranes; 20.1 cm to 30.0 cm
R825.34
R825.34
10
A
12018
Face, ears, eyelids, nose, lips &/or mucous membranes; >30.0 cm
R989.69
R989.69
10
A
12001
Scalp, neck, axillae, genitalia, trunk, extremities, hands & feet; ≤2.5 cm
R448.14
R310.98
10
12002
Scalp, neck, axillae, genitalia, trunk, extremities, hands & feet; 2.6 cm to 7.5 cm
R476.52
R347.63
10
12004
Scalp, neck, axillae, genitalia, trunk, extremities, hands & feet; 7.6 cm - 12.5 cm
R559.29
R409.12
10
12005
Scalp, neck, axillae, genitalia, trunk, extremities, hands & feet; 12.6 cm-20.0 cm
R697.63
R510.81
10
12006
Scalp, neck, axillae, genitalia, trunk, extremities, hands & feet; 20.1 cm-30.0 cm
R866.72
R649.15
10
12007
Scalp, neck, axillae, genitalia, trunk, extremities, hands & feet; >30.0 cm
9
12011
R980.23
R746.11
10
A
A
Repair - intermediate, layer closure
Face, ears, eyelids, nose, lips &/or mucous membranes; ≤2.5 cm
R729.56
R503.72
10
12052
Face, ears, eyelids, nose, lips &/or mucous membranes; 2.6 cm to 5.0 cm
R782.77
R555.74
10
12053
Face, ears, eyelids, nose, lips &/or mucous membranes; 5.1 cm to 7.5 cm
R844.26
R597.13
10
A
12054
Face, ears, eyelids, nose, lips &/or mucous membranes; 7.6 cm to 12.5 cm
R921.11
R651.52
10
A
12055
Face, ears, eyelids, nose, lips &/or mucous membranes; 12.6 cm to 20.0 cm
R1,154.05
R830.07
10
A
12056
Face, ears, eyelids, nose, lips &/or mucous membranes; 20.1 cm to 30.0 cm
R1,473.31
R1,032.26
10
A
12057
Face, ears, eyelids, nose, lips &/or mucous membranes; >30.0 cm
R1,537.16
R1,189.52
10
A
12041
Neck, hands, feet &/or external genitalia; ≤2.5 cm
R644.42
R457.60
10
12042
Neck, hands, feet &/or external genitalia; 2.6 cm to 7.5 cm
R768.58
R539.19
10
12044
Neck, hands, feet &/or external genitalia; 7.6 cm to 12.5 cm
R847.80
R605.40
10
12045
Neck, hands, feet &/or external genitalia; 12.6 cm to 20.0 cm
R1,096.11
R743.75
10
A
12046
Neck, hands, feet &/or external genitalia; 20.1 cm to 30.0 cm
R1,310.13
R879.73
10
A
12047
Neck, hands, feet &/or external genitalia; >30.0 cm
R1,364.52
R968.41
10
A
12031
Scalp, axillae, trunk, extremities (excluding hands & feet); ≤2.5 cm
R594.76
R415.03
10
12032
Scalp, axillae, trunk, extremities (excluding hands & feet); 2.6 cm to 7.5 cm
R808.78
R540.37
10
12034
Scalp, axillae, trunk, extremities (excluding hands & feet); 7.6 cm - 12.5 cm
R795.78
R565.20
10
12035
Scalp, axillae, trunk, extremities (excluding hands & feet); 12.6 cm-20.0 cm
R1,068.92
R705.91
10
A
12036
Scalp, axillae, trunk, extremities (excluding hands & feet); 20.1 cm-30.0 cm
R1,196.62
R837.16
10
A
12037
Scalp, axillae, trunk, extremities (excluding hands & feet); >30.0 cm
R1,346.79
R971.96
10
A
20
0
12051
Repair - complex
13150
Eyelids, nose, ears &/or lips; ≤1.0 cm
R1,063.00
R818.24
10
A
13151
Eyelids, nose, ears &/or lips; 1.1 cm to 2.5 cm
R1,154.05
R938.85
10
A
13152
Eyelids, nose, ears &/or lips; 2.6 cm to 7.5 cm
R1,556.08
R1,273.48
10
A
R541.55
R441.05
add-on
+13153 Eyelids, nose, ears &/or lips; each additional 5 cm (+) add-on code
13131
Forehead, cheek, chin, mouth, neck, axilla, genitals, hand, foot; 1.1 cm - 2.5 cm
R1,015.71
R804.05
10
A
13132
Forehead, cheek, chin, mouth, neck, axilla, genitals, hand, foot; 2.6 cm - 7.5 cm
R1,563.17
R1,321.96
10
A
R483.61
R400.84
+13133 Forehead, cheek, chin, mouth, neck, axilla, genitals, hand, foot; per addt'l 5cm (+) add-on code
Skin, Soft Tissue Procedures
2009
add-on
2009
Skin, Soft Tissue Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
13120
Scalp, arms &/or legs; 1.1 cm to 2.5 cm
R927.03
R708.28
10
A
13121
Scalp, arms &/or legs; 2.6 cm to 7.5 cm
R1,174.15
R902.19
10
A
R363.01
R262.50
add-on
+13122 Scalp, arms &/or legs; each additional ≤5 cm (+) add-on code
13100
Trunk; 1.1 cm to 2.5 cm
R892.73
R679.90
10
13101
Trunk; 2.6 cm to 7.5 cm
R1,085.47
R822.97
10
R306.25
R229.39
add-on
+13102 Trunk; each additional 5 cm or less (+) add-on code
A
Flap (adjacent tissue transfer or rearrangement)
14000
Adjacent tissue transfer or rearrangement, trunk; defect ≤10cm2
R1,839.86
R1,543.07
90
A
14001
Adjacent tissue transfer or rearrangement, trunk; defect 10.1 to 30.0 sq cm
R2,397.97
R2,085.81
90
A
R2,043.24
R1,766.55
90
A
R2,674.66
R2,412.16
90
A
R2,155.57
R1,919.08
90
A
R2,928.88
R2,634.45
90
B
2
14020
Adjacent tissue transfer, scalp, arms, legs; defect ≤10cm
14021
Adjacent tissue transfer, scalp, arms, legs; defect 10.1 sq cm to 30.0 sq cm
2
Forehead, cheek, chin, mouth, neck, axilla, genitals, hands, feet; ≤10cm
14041
Forehead, cheek, chin, mouth, neck, axilla, genitals, hands, feet; 10.1 - 30.0cm2
14060
Eyelids, nose, ears &/or lips; defect ≤10cm2
14061
9
14040
R2,026.69
90
A
Eyelids, nose, ears &/or lips; defect 10.1 sq cm to 30.0 sq cm
R3,178.37
R2,855.57
90
B
14300
Adjacent tissue transfer, >30 sq cm, unusual, complicated, any area
R3,096.78
R2,802.36
90
B
14350
Filleted finger or toe flap, including preparation of recipient site
R2,279.73
R2,279.73
90
15570
Formation of direct or tubed pedicle, with or without transfer; trunk
R2,652.19
R2,134.29
90
15572
Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs
R2,451.18
R2,089.35
90
15574
Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae,
genitalia, hands or feet
R2,643.91
R2,284.45
90
15576
Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral
R2,347.12
R2,000.67
90
15600
Delay of flap or sectioning of flap (division and inset); at trunk
R1,093.75
R614.86
90
15610
Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs
R914.02
R726.01
90
15620
Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands,
or feet
R1,349.15
R928.21
90
15630
Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips
R1,339.69
R1,002.70
90
15650
Transfer, intermediate, of any pedicle flap (e.g., abdomen to wrist, Walking tube), any location
R1,442.56
R1,098.48
90
15731
Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead flap)
R3,255.23
R2,951.35
90
15732
Muscle, myocutaneous, or fasciocutaneous flap; head and neck (e.g., temporalis, masseter, sternocleidomastoid,
levator scapulae)
R4,607.93
R3,985.97
90
15734
Muscle, myocutaneous, or fasciocutaneous flap; trunk
R4,708.44
R4,086.48
90
C
15736
Muscle, myocutaneous, or fasciocutaneous flap; upper extremity
R4,321.78
R3,587.49
90
B
15738
Muscle, myocutaneous, or fasciocutaneous flap; lower extremity
R4,566.54
R3,905.57
90
B
15740
Flap; island pedicle
R2,744.42
R2,457.09
90
B
15750
Flap; neurovascular pedicle
R2,742.06
R2,742.06
90
B
15756
Free muscle or myocutaneous flap with microvascular anastomosis
R7,273.13
R7,273.13
90
C
15757
Free skin flap with microvascular anastomosis
R7,249.48
R7,249.48
90
C
15758
Free fascial flap with microvascular anastomosis
R7,254.21
R7,254.21
90
C
15760
Graft; composite (e.g. full thickness of external ear or nasal ala), incl. primary closure donor area
R2,439.35
R2,097.63
90
20
0
R2,219.42
Skin, Soft Tissue Procedures
2009
2009
Skin, Soft Tissue Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Skin grafts, burns
Excision, wound preparation, dressings (only for burns)
15002
15003
15004
15005
Wound preparation, cheeks, inf, trunk, arms and legs 1st 100 sq cm or 1% BA of child
Wound preparation, cheeks, inf, trunk, arms and legs each additional 100 sq cm or 1% BA of child (+) add-on
code
Wound preparation, face, scalp, eyelids, mouth, neck, ears, orbits, genetalia, hands, feet and/or multiple digits;
1st 100 sq cm or 1% BA of child)
Wound preparation, face, scalp, eyelids, mouth, neck, ears, orbits, genetalia, hands, feet and/or multiple digits;
each additional 100 sq cm or 1% BA of child) (+) add-on code
R976.69
R684.63
0
R216.38
R140.71
add-on
R1,178.88
R847.80
0
R366.55
R281.42
add-on
16000
Initial treatment, 1st degree burn, when no more than local treatment required
R212.84
R145.44
0
16020
Dressings &/or debridement, initial or subsequent, burns only; without anaesthesia, office or hospital, small
R251.86
R172.63
0
R444.59
R352.36
0
R525.00
R402.03
0
16025
16030
Dressings &/or debridement, burns only, initial or subsequent; without anaesthesia, medium (e.g. whole face or
whole extremity)
Dressings &/or debridement, initial or subsequent, burns only; without anaesthesia, large (e.g. more than one
extremity)
16035
Escharotomy; initial incision
R675.17
R675.17
90
16036
Escharotomy; each additional incision (+) add-on code
R268.41
R268.41
add-on
9
Full thickness skin graft
Full thickness graft, free, incl. direct closure donor site, trunk; up to 20 sq cm
15201
Full thickness graft, free, trunk; each additional 20 sq cm (+) add-on code
15220
Full thickness graft, free, scalp, arms, or legs; up to 20 sq cm
15221
Full thickness graft, free, scalp, arms &/or legs; each additional 20 sq cm (+) add-on code
15240
Full thickness graft, free, forehead, cheek, chin, mouth, neck, axilla, genitals, hand, foot; up to 20 sq cm
15241
Full thickness graft, free, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet; each additional 20
sq cm (+) add-on code
15260
Full thickness graft, free, nose, ears, eyelids, or lips; 20 sq cm or less
15261
Full thickness graft, free, nose, ears, eyelids, or lips; each additional 20 sq cm (+) add-on code
R2,304.56
R1,916.72
R468.24
R250.68
R2,162.66
R1,830.40
R425.67
R224.66
R2,569.42
R2,278.54
R539.19
R352.36
R2,720.77
R2,467.73
R614.86
R446.96
R1,543.07
R1,306.59
90
A
R2,711.31
R2,198.14
90
A
R637.33
R361.82
R2,718.41
R2,344.76
R859.63
R561.65
R1,221.45
R1,053.55
R286.15
R276.69
R1,680.23
R1,509.96
R454.05
R436.32
R2,104.73
R1,721.62
R318.07
R274.32
R2,593.07
R2,367.22
R300.34
R276.69
R2,654.56
R2,257.26
R390.20
R339.36
R2,551.68
R2,312.83
R511.99
R461.15
R2,200.50
R1,982.94
20
0
15200
90
A
add-on
90
A
add-on
90
A
add-on
90
A
add-on
Pinch graft
15050
Pinch graft, single or multiple, (except on face), up to defect 2cm diameter
Split skin graft
15100
Split graft, trunk, arms, legs; 1st 100 sq cm or 1% BA of child
15101
Split graft, trunk, arms, legs; each additional 100 sq cm, or 1% BA of child (+) add-on code
15120
15121
Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet &/or multiple digits; 1st 100 sq
cm or 1% BA of child
Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet &/or multiple digits; each
additional 100 sq cm, or 1% BA child (+) add-on code
add-on
0
A
add-on
Other grafts
15170
15171
15175
15176
Acellular dermal replacement, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants
and children
Acellular dermal replacement, trunk, arms, legs; each additional 100 sq cm, or each additional one percent of
body area of infants and children, or part thereof (+) add-on code
Acellular dermal replacement, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or
multiple digits; first 100 sq cm or less, or one percent of body area of infants and children
Acellular dermal replacement, face, scalp, eyelid, mouth, neck, ear, orbit, genital, hand, feet, &/or digits; each
additional 100 sq cm, or each additional 1% BSA infant/child, or part thereof (+) add-on code
15130
Dermal autograft, trunk, arms and legs 1st 100sq cm or 1% BA of child
15131
Dermal autograft, trunk, arms and legs each additional 100sq cm or 1% BA of child (+) add-on code
15135
15136
Dermal autograft, face,scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet &/or multiple digits; 1st
100sq cm or 1% BA of child
Dermal autograft, face,scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet &/or multiple digits; each
additional 100sq cm or 1% BA of child (+) add-on code
15110
Epidermal autograft,trunk, arms and legs, 100sq cm or 1% BA of child
15111
Epidermal autograft,trunk, arms and legs, each additional 100sq cm or 1% BA of child (+) add-on code
15115
15116
15150
Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits
1st 100sq cm or 1% BA of child
Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits
each additional 100sq cm or 1% BA of child (+) add-on code
Tissue cultured epidermal autograft, trunk, arms, legs; first 25 sq cm or less
Skin, Soft Tissue Procedures
2009
90
A
add-on
90
A
add-on
90
A
add-on
90
A
add-on
90
A
add-on
90
A
add-on
90
A
2009
Skin, Soft Tissue Procedures
Code
15152
15155
15156
15157
15040
15300
15301
15320
15321
15330
15331
15335
15336
Facility
Tissue cultured epidermal autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (+) add-on code
Tissue cultured epidermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional one
percent of body area of infants and children, or part thereof
Tissue cultured epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or
multiple digits; first 25 sq cm or less
Tissue cultured epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or
multiple digits; additional 1 sq cm to 75 sq cm (+) add-on code
Tissue cultured epidermal autograft, face, scalp, eyelid, mouth, neck, ear, orbit, hand, feet,digits; each additional
100 sq cm, or each additional 1% BSA infants/child, or part thereof (+) add-on code
Harvest of skin for tissue cultured skin autograft, ≤100 sq cm
Allograft skin for temporary wound closure, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of
infants and children
Allograft skin for temporary wound closure, trunk, arms, legs; each additional 100 sq cm, or each additional 1%
of body area of infants and children, or part thereof
Allograft skin for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet,
and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children
Allograft skin for temporary wound closure, face, scalp, eyelid, mouth, neck, ear, orbit, genital, hand, feet,
digits; each additional 100 sq cm, or each additional 1% BSA infants/child, or part thereof (+) add-on code
Acellular dermal allograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children
Acellular dermal allograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of
infants and children, or part thereof (+) add-on
Acellular dermal allograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple
digits; first 100 sq cm or less, or 1% of body area of infants and children
Acellular dermal allograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple
digits; each additional 100 sq cm, or each additional 1% BSA infant/child (+) add-on
Nonfacility
Global Assistant
period
code
R412.67
R366.55
add-on
R507.26
R457.60
add-on
R2,234.79
R2,118.91
R541.55
R507.26
add-on
R599.49
R553.38
add-on
R783.95
R396.11
add-on
R992.06
R869.09
90
R190.37
R180.91
add-on
R1,135.13
R996.79
90
R283.78
R269.59
add-on
R905.74
R783.95
90
R189.19
R180.91
add-on
R1,006.25
R875.00
90
90
9
15151
Surgicom Description
R275.51
R257.77
add-on
15340
Tissue cultured allogeneic skin substitute; first 25 sq cm or less
R960.13
R818.24
10
15341
Tissue cultured allogeneic skin substitute; each additional 25 sq cm (+) add-on
R141.89
R88.68
add-on
R1,044.09
R885.64
90
R221.11
R204.56
add-on
R1,084.29
R930.57
90
R274.32
R257.77
add-on
R1,076.01
R1,040.54
R332.26
R184.46
R1,214.36
R1,092.57
R354.73
R273.14
R1,601.01
R1,558.44
R0.00
R0.00
R0.00
R0.00
15360
15361
20
0
15365
Tissue cultured allogeneic dermal substitute; trunk, arms, legs, first 100 sq cm or less, or 1% of body area of
infants and children
Tissue cultured allogeneic dermal substitute; each additional 100 sq cm, or each additional 1% of body area of
infants and children, or part thereof (+) add-on
Tissue cultured allogeneic dermal substitute, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet,
and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children
Tissue cultured allogeneic dermal substitute, face, scalp, eyelid, mouth, neck, ear, orbit, genital, hand, feet,
digits; each additional 100 sq cm, or each additional 1% BSAinfant/child (+) add-on
15366
15400
Application of xenograft, skin; 100 sq cm or less
15401
Application of xenograft, skin; each additional 100 sq cm (+) add-on
15420
15421
Xenograft skin (dermal), for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia,
hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area infants/child
Xenograft skin (dermal), for temp wound closure, face, scalp, eyelids, mouth, neck, ear, orbit, genital, hand,
feet, digits; each additional 100 sq cm, or additional 1% BSA infant/child (+) add-on
15430
Acellular xenograft implant; first 100 sq cm or less, or 1% of body area of infants and children
15431
Acellular xenograft implant; each additional 100 sq cm, or each additional 1% of body area of infants and
children, or part thereof (+) add-on
Unlisted
15999
Unlisted procedure, excision pressure ulcer
17999
Unlisted procedure, skin, mucous membrane and subcutaneous tissue
Skin, Soft Tissue Procedures
2009
90
A
A
A
A
A
A
A
A
A
add-on
90
A
add-on
90
add-on
A
2009
Musculoskeletal Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Spinal - second surgeon for exposure
When 2 surgeons work together as primary surgeons, append modifier -62 at 62.5% to the procedure code to
report to report his/her distinctive operative work
22548
Antero-lateral exposure neck spinal fusion
R5,693.40
R5,693.40
90
C
22554
Antero-lateral exposure neck spinal fusion
R4,016.71
R4,016.71
90
C
22556
Antero-lateral exposure thoracic spinal fusion
R5,106.92
R5,106.92
90
C
22558
Antero-lateral exposure lumbar spinal fusion
R4,652.86
R4,652.86
90
C
R1,110.30
R1,110.30
add-on
C
+22585 Antero-lateral exposure, additional level; (+) add-on code
Amputation
Ankle
R2,238.34
R2,238.34
90
B
27889
Ankle disarticulation
R2,172.12
R2,172.12
90
B
28140
Metatarsectomy
R1,813.85
R1,486.31
90
28150
Phalangectomy, toe, each toe
R1,171.79
R934.12
90
28153
Resection, condyle(s), distal end of phalanx, each toe
R1,060.64
R818.24
90
28160
Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each
R1,100.84
R890.37
90
28800
Amputation, foot; midtarsal (e.g., Chopart type procedure)
R1,823.31
R1,823.31
90
A
28805
Amputation, foot; transmetatarsal
R2,302.19
R2,302.19
90
A
28810
Amputation, metatarsal, with toe, single
R1,391.72
R1,391.72
90
A
28820
Amputation, toe; metatarsophalangeal joint
R1,548.98
R1,092.57
90
A
28825
Amputation, toe; interphalangeal joint
R1,330.23
R899.83
90
A
25920
Wrist disarticulation
R2,110.64
R2,110.64
90
A
25922
Wrist disarticulation; secondary closure or scar revision
R1,843.41
R1,843.41
90
A
25924
Wrist disarticulation; re-amputation
R2,102.36
R2,102.36
90
A
25927
Hand transmetacarpal amputation;
R2,503.20
R2,503.20
90
A
25929
Hand transmetacarpal amputation; secondary closure or scar revision
R1,728.71
R1,728.71
90
A
25931
Hand transmetacarpal amputation; re-amputation
R2,343.58
R2,343.58
90
A
26910
Finger or thumb (ray amputation)
R2,285.64
R2,285.64
90
A
26951
Finger or thumb
R1,923.81
R1,923.81
90
A
26952
Finger or thumb; with flap
R2,135.47
R2,135.47
90
A
27290
Hindquarter
R4,908.27
R4,908.27
90
C
27295
Hip disarticulation
R3,954.05
R3,954.05
90
C
27590
Thigh, any level
R2,557.60
R2,557.60
90
B
27591
Amputation, thigh, through femur, any level; immediate fitting technique including first cast
R2,860.30
R2,860.30
90
27592
Thigh, guillotine
R2,165.03
R2,165.03
90
A
27594
Thigh, any level; secondary closure or scar revision
R1,567.90
R1,567.90
90
A
27596
Amputation, thigh, any level; re-amputation
R2,286.82
R2,286.82
90
A
27598
Knee disarticulation
R2,315.20
R2,315.20
90
B
27880
Leg, through tibia and fibula
R2,842.56
R2,842.56
90
B
27881
Amputation, leg, through tibia and fibula; with immediate fitting technique including application of first cast
R2,815.37
R2,815.37
90
27882
Leg, guillotine
R2,033.78
R2,033.78
90
A
27884
Leg, through tibia and fibula; secondary closure or scar revision
R1,826.85
R1,826.85
90
A
27886
Leg, through tibia and fibula; re-amputation
R2,081.08
R2,081.08
90
A
20
0
9
27888
Musculoskeletal Procedures
2009
2009
Musculoskeletal Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Interthoracoscapular amputation (forequarter)
R4,165.70
R4,165.70
90
C
23920
Disarticulation of shoulder;
R3,351.01
R3,351.01
90
C
23921
Disarticulation of shoulder; secondary closure or scar revision
R1,350.34
R1,350.34
90
A
24900
Arm; with primary closure
R2,186.31
R2,186.31
90
A
24920
Arm, guillotine
R2,182.77
R2,182.77
90
A
24925
Arm, secondary closure or scar revision
R1,670.77
R1,670.77
90
A
24930
Arm; re-amputation
R2,283.27
R2,283.27
90
A
24931
Amputation, arm through humerus; with implant
R2,556.41
R2,556.41
90
25900
Forearm, through radius and ulna;
R2,660.47
R2,660.47
90
A
25905
Forearm, guillotine
R2,627.36
R2,627.36
90
A
25907
Forearm; secondary closure or scar revision
R2,347.12
R2,347.12
90
A
25909
Forearm; re-amputation
R2,614.35
R2,614.35
90
A
25915
Krukenberg procedure
R4,317.05
R4,317.05
90
Biopsy
Biopsy, muscle; superficial
R561.65
R287.33
0
20205
Biopsy, muscle; deep
R774.49
R455.24
0
20206
Biopsy, muscle, percutaneous needle
R848.98
R196.28
0
20220
Biopsy, bone, trocar, or needle; superficial
R640.88
R248.31
0
20225
Biopsy, bone, trocar, or needle; deep
R2,788.17
R377.20
0
20240
Biopsy, bone, open; superficial
R724.83
R724.83
10
20245
Biopsy, bone, open; deep
R1,946.28
R1,946.28
10
21550
Biopsy, soft tissue of neck or thorax
R708.28
R468.24
10
21920
Biopsy, soft tissue of back or flank; superficial
R684.63
R449.32
10
21925
Biopsy, soft tissue of back or flank; deep
R1,227.36
R996.79
90
23065
Biopsy, soft tissue of shoulder area; superficial
R600.67
R488.34
10
23066
Biopsy, soft tissue of shoulder area; deep
R1,478.04
R1,031.08
90
24065
Biopsy, soft tissue of upper arm or elbow area; superficial
R676.35
R480.07
10
24066
Biopsy, soft tissue upper arm or elbow; deep (subfascial or intramuscular)
R1,752.36
R1,198.98
90
25065
Biopsy, soft tissue of forearm &/or wrist; superficial
R668.07
R482.43
10
25066
Biopsy, soft tissue of forearm &/or wrist; deep (subfascial or intramuscular)
R1,357.43
R1,357.43
90
27040
Biopsy, soft tissue of pelvis & hip area; superficial
R984.96
R604.22
10
27041
Biopsy, soft tissue of pelvis & hip area; deep, subfascial or intramuscular
R2,108.27
R2,108.27
90
27323
Biopsy, soft tissue of thigh or knee area; superficial
R733.11
R523.82
10
27324
Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)
R1,158.78
R1,158.78
90
27613
Biopsy, soft tissue of leg or ankle area; superficial
R683.44
R494.26
10
27614
Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)
R1,632.94
R1,280.57
90
A
20
0
20200
9
23900
A
A
A
A
A
A
Bursa
24105
Excision, olecranon bursa
R1,014.52
R1,014.52
90
A
26030
Drainage of palmar bursa; multiple bursa
R1,493.41
R1,493.41
90
A
27340
Excision, prepatellar bursa
R1,109.12
R1,109.12
90
A
27345
Excision of synovial cyst of popliteal space (e.g. Baker's cyst)
R1,468.58
R1,468.58
90
A
Musculoskeletal Procedures
2009
2009
Musculoskeletal Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Remove implant
20670
Removal of implant; superficial, (e.g., buried wire, pin or rod) (separate procedure)
R1,461.48
R477.70
10
20680
Removal of implant; deep
R1,784.29
R1,215.54
90
R1,482.77
R1,482.77
90
Coccyx
27080
Coccygectomy, primary
Drain abscess
Incision of soft tissue abscess
R603.04
R481.25
10
20005
Incision of deep soft tissue abscess
R892.73
R734.29
10
21501
Incision and drainage, deep abscess or haematoma, soft tissues of neck or thorax;
R1,266.38
R949.49
90
A
21502
Incision and drainage, deep abscess or haematoma, soft tissues of neck or thorax; with partial rib ostectomy
R1,634.12
R1,634.12
90
A
21510
Incision, deep, with opening of bone cortex (e.g., for osteomyelitis or bone abscess), thorax
R1,453.21
R1,453.21
90
A
22010
Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracic
R2,712.49
R2,712.49
90
22015
Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbosacral
R2,690.03
R2,690.03
90
23030
Incision & drainage, shoulder area; deep abscess or haematoma
R1,314.86
R802.87
10
23031
Incision & drainage, shoulder area; infected bursa
R1,268.75
R688.17
10
23035
Incision, bone cortex (e.g., osteomyelitis or bone abscess), shoulder area
R2,183.95
R2,183.95
90
23930
Incision & drainage, upper arm or elbow area; deep abscess or haematoma
R1,107.94
R664.53
10
23931
Incision & drainage, upper arm or elbow area; bursa
R898.65
R491.89
10
23935
Incision, deep, with opening of bone cortex (e.g., for osteomyelitis or bone abscess), humerus or elbow
R1,541.89
R1,541.89
90
25028
Incision & drainage, forearm &/or wrist; deep abscess or haematoma
R1,630.57
R1,630.57
90
25031
Incision & drainage, forearm &/or wrist; bursa
R1,433.11
R1,433.11
90
25035
Incision, deep, bone cortex, forearm and/or wrist (e.g., osteomyelitis or bone abscess)
R2,505.57
R2,505.57
90
26010
Drainage of finger abscess; simple
R817.06
R394.93
10
26011
Drainage of finger abscess; complicated (e.g. felon)
R1,266.38
R565.20
10
26020
Drainage of tendon sheath, digit &/or palm, each
R1,290.03
R1,290.03
90
A
26025
Drainage of palmar bursa; single, bursa
R1,266.38
R1,266.38
90
A
26034
Incision, bone cortex, hand or finger (e.g., osteomyelitis or bone abscess)
R1,615.20
R1,615.20
90
26990
Incision and drainage pelvis/hip joint
R1,896.62
R1,896.62
90
26991
Incision and drainage, pelvis or hip joint area; infected bursa
R2,198.14
R1,580.91
90
26992
Incision, bone cortex, pelvis and/or hip joint (e.g., osteomyelitis or bone abscess)
R3,014.01
R3,014.01
90
27301
Incision & drainage, deep abscess, bursa, or haematoma, thigh or knee
R1,505.23
R1,505.23
90
27303
Incision, deep, with opening of bone cortex, femur or knee (e.g., osteomyelitis or bone abscess)
R1,975.84
R1,975.84
90
27603
Incision & drainage, leg or ankle; deep abscess or haematoma
R1,564.35
R1,177.70
90
A
27604
Incision & drainage, leg or ankle; infected bursa
R1,345.61
R1,067.73
90
A
27607
Incision (e.g., osteomyelitis or bone abscess), leg or ankle
R1,880.06
R1,880.06
90
28001
Incision & drainage, bursa, foot
R748.48
R586.49
10
A
28002
I & D below fascia, +/- tendon sheath involvement, foot; single bursal space
R1,398.81
R1,197.80
10
A
28003
I & D below fascia, +/- tendon sheath involvement, foot; multiple areas
R1,975.84
R1,791.38
90
A
28005
Incision, bone cortex (e.g., osteomyelitis or bone abscess), foot
R1,936.82
R1,936.82
90
20
0
9
20000
Musculoskeletal Procedures
2009
A
A
A
A
2009
Musculoskeletal Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Excision tumour
Excision tumour, soft tissue of neck or thorax; subcutaneous
R1,245.10
R970.78
90
A
21556
Excision tumour, soft tissue of neck or thorax; deep, subfascial, intramuscular
R1,225.00
R1,225.00
90
A
21557
Radical resection of tumour (e.g., malignant neoplasm), soft tissue of neck or thorax
R1,787.83
R1,787.83
90
A
21930
Excision, tumour, soft tissue of back or flank
R1,360.98
R1,089.02
90
A
21935
Radical resection tumour (e.g. malignant neoplasm), soft tissue back or flank
R3,574.49
R3,574.49
90
B
22900
Excision, abdominal wall tumour, subfascial (e.g., desmoid)
R1,206.08
R1,206.08
90
A
23075
Excision, soft tissue tumour, shoulder area; subcutaneous
R759.12
R534.46
10
23076
Excision, soft tissue tumour, shoulder area; deep, subfascial, or intramuscular
R1,702.70
R1,702.70
90
A
23077
Radical resection of tumour (e.g. malignant neoplasm), soft tissue of shoulder area
R3,611.14
R3,611.14
90
B
23140
Excision or curettage of bone cyst or benign tumour of clavicle or scapula;
R1,561.99
R1,561.99
90
23145
Excision or curettage of bone cyst or benign tumour of clavicle or scapula; with autograft (includes obtaining
graft)
R2,105.91
R2,105.91
90
23146
Excision or curettage of bone cyst or benign tumour of clavicle or scapula; with allograft
R1,908.44
R1,908.44
90
23150
Excision or curettage of bone cyst or benign tumour of proximal humerus;
R1,988.85
R1,988.85
90
23155
Excision or curettage of bone cyst or benign tumour of proximal humerus; with autograft (includes obtaining
graft)
R2,438.17
R2,438.17
90
23156
Excision or curettage of bone cyst or benign tumour of proximal humerus; with allograft
R2,085.81
R2,085.81
90
24075
Excision, tumour, upper arm or elbow area; subcutaneous
R1,397.63
R932.94
90
A
24076
Excision, tumour, upper arm or elbow area; deep, subfascial or intramuscular
R1,431.92
R1,431.92
90
A
24077
Radical resection of tumour, soft tissue of upper arm or elbow area
R2,511.48
R2,511.48
90
B
25075
Excision, tumour, forearm &/or wrist area; subcutaneous
R1,178.88
R1,178.88
90
A
25076
Excision, tumour, forearm &/or wrist area; deep, subfascial or intramuscular
R1,725.17
R1,725.17
90
A
25077
Radical resection of tumour, soft tissue of forearm &/or wrist area
R2,674.66
R2,674.66
90
A
R2,152.02
R2,152.02
90
R2,415.70
R2,415.70
90
R2,465.37
R2,465.37
90
20
0
9
21555
25120
25125
25126
Excision or curettage of bone cyst or benign tumour of radius or ulna (excluding head or neck of radius and
olecranon process);
Excision or curettage of bone cyst or benign tumour of radius or ulna (excluding head or neck of radius and
olecranon process); with autograft (includes obtaining graft)
Excision or curettage of bone cyst or benign tumour of radius or ulna (excluding head or neck of radius and
olecranon process); with allograft
25130
Excision or curettage of bone cyst or benign tumour of carpal bones;
R1,447.29
R1,447.29
90
25135
Excision or curettage of bone cyst or benign tumour of carpal bones; with autograft (includes obtaining graft)
R1,792.56
R1,792.56
90
25136
Excision or curettage of bone cyst or benign tumour of carpal bones; with allograft
R1,583.27
R1,583.27
90
26115
Excision, tumour or vascular malformation, hand or finger; subcutaneous
R1,984.12
R1,081.92
90
A
26116
Excision, tumour or vascular malformation, hand or finger; deep, subfascial, intramuscular
R1,453.21
R1,453.21
90
A
26117
Radical resection of tumour (e.g., malignant neoplasm), soft tissue of hand or finger
R1,980.57
R1,980.57
90
27047
Excision, tumour, pelvis & hip area; subcutaneous tissue
R1,849.32
R1,567.90
90
A
27048
Excision, tumour, pelvis & hip area; deep, subfascial, intramuscular
R1,433.11
R1,433.11
90
A
27049
Radical resection of tumour, soft tissue of pelvis & hip area
R3,030.57
R3,030.57
90
B
27065
Excision of bone cyst or benign tumour; superficial (wing of ilium, symphysis pubis, or greater trochanter of
femur) with or without autograft
R1,514.69
R1,514.69
90
27066
Excision of bone cyst or benign tumour; deep, with or without autograft
R2,490.20
R2,490.20
90
27327
Excision, tumour, thigh or knee area; subcutaneous
R1,319.59
R1,046.45
90
A
27328
Excision, tumour, thigh or knee area; deep, subfascial, or intramuscular
R1,271.11
R1,271.11
90
A
27329
Radical resection of tumour, soft tissue of thigh or knee area
R3,161.82
R3,161.82
90
B
27355
Excision or curettage of bone cyst or benign tumour of femur;
R1,863.51
R1,863.51
90
27365
Radical resection of tumour, bone, femur or knee
R3,799.15
R3,799.15
90
27615
Radical resection of tumour, soft tissue of leg or ankle area
R2,818.91
R2,818.91
90
Musculoskeletal Procedures
2009
B
2009
Musculoskeletal Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
27618
Excision, tumour, leg or ankle area; subcutaneous tissue
R1,414.19
R1,158.78
90
A
27619
Excision, tumour, leg or ankle area; deep (subfascial or intramuscular)
R2,290.37
R1,833.95
90
A
27635
Excision or curettage of bone cyst or benign tumour, tibia or fibula;
R1,856.42
R1,856.42
90
27638
Excision or curettage of bone cyst or benign tumour, tibia or fibula; with allograft
R2,446.45
R2,446.45
90
28043
Excision, tumour, foot; subcutaneous tissue
R958.95
R841.89
90
28045
Excision, tumour, foot; deep, subfascial, intramuscular
R1,325.50
R1,055.91
90
28046
Radical resection of tumour (e.g., malignant neoplasm), soft tissue of foot
R2,496.11
R2,156.75
90
Explore wound
Exploration of penetrating wound; neck
R1,868.24
R1,868.24
10
A
20101
Exploration of penetrating wound; chest
R1,145.77
R620.78
10
A
20102
Exploration of penetrating wound; abdomen/flank/back
R1,390.54
R748.48
10
A
20103
Exploration of penetrating wound; extremity
R1,705.06
R1,098.48
10
A
20520
Removal of foreign body in muscle or tendon sheath; simple
20525
Removal of foreign body in muscle or tendon sheath; deep or complicated
23330
Removal of foreign body, shoulder; subcutaneous
23331
9
20100
R444.59
10
R1,494.59
R773.31
10
R675.17
R462.33
10
Removal of foreign body, shoulder; deep (e.g., Neer hemiarthroplasty removal)
R1,815.03
R1,815.03
90
23332
Removal of foreign body, shoulder; complicated (e.g., total shoulder)
R2,751.51
R2,751.51
90
28190
Removal of foreign body, foot; subcutaneous
R679.90
R431.59
10
28192
Removal of foreign body, foot; deep
R1,312.50
R1,046.45
90
28193
Removal of foreign body, foot; complicated
R1,486.31
R1,227.36
90
R2,092.90
R2,092.90
90
R1,868.24
R1,868.24
90
R3,526.01
R3,526.01
90
R2,293.91
R2,293.91
90
R3,471.61
R3,471.61
90
20
0
R580.57
Fasciotomy
24495
25020
25023
25024
25025
Decompression fasciotomy, forearm, with brachial artery exploration
Decompression fasciotomy, forearm and/or wrist; flexor OR extensor compartment; without debridement of
nonviable muscle and/or nerve
Decompression fasciotomy, forearm and/or wrist; flexor OR extensor compartment; with debridement of
nonviable muscle and/or nerve
Decompression fasciotomy, forearm and/or wrist, flexor AND extensor compartment; with debridement of
noviable muscle and/or nerve
Decompression fasciotomy, forearm and/or wrist, flexor AND extensor compartment; with debridement of
nonviable muscle and/or nerve
26035
Decompression fingers and/or hand, injection injury (e.g., grease gun)
R2,428.71
R2,428.71
90
26037
Decompressive fasciotomy, hand (excludes 26035)
R1,742.90
R1,742.90
90
26040
Fasciotomy, palmar (e.g., Dupuytrens contracture); percutaneous
R929.39
R929.39
90
26045
Fasciotomy, palmar (e.g., Dupuytrens contracture)
R1,420.10
R1,420.10
90
27025
Fasciotomy, hip or thigh, any type
R2,713.68
R2,713.68
90
27305
Fasciotomy, iliotibial (tenotomy), open
R1,435.47
R1,435.47
90
27600
Decompression fasciotomy, leg; anterior &/or lateral compartments only
R1,319.59
R1,319.59
90
A
27601
Decompression fasciotomy, leg; posterior compartment(s) only
R1,352.70
R1,352.70
90
A
27602
Decompression fasciotomy, leg; ant +/or lat & post compartment(s)
R1,625.84
R1,625.84
90
A
R1,694.42
R1,694.42
90
R1,686.15
R1,686.15
90
R2,570.60
R2,570.60
90
R1,187.16
R974.32
90
27892
27893
27894
28008
Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable
muscle and/or nerve
Decompression fasciotomy, leg; posterior compartment(s) only, with debridement of nonviable muscle and/or
nerve
Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of
nonviable muscle and/or nerve
Fasciotomy, foot and/or toe
Musculoskeletal Procedures
2009
A
2009
Musculoskeletal Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Sequestrectomy (e.g., for osteomyelitis or bone abscess)
Sequestrectomy (e.g., for osteomyelitis or bone abscess), clavicle
R1,656.58
R1,656.58
90
23172
Sequestrectomy (e.g., for osteomyelitis or bone abscess), scapula
R1,676.69
R1,676.69
90
23174
Sequestrectomy (e.g., for osteomyelitis or bone abscess), humeral head to surgical neck
R2,323.47
R2,323.47
90
24134
Sequestrectomy (e.g., for osteomyelitis or bone abscess), shaft or distal humerus
R2,395.60
R2,395.60
90
24136
Sequestrectomy (e.g., for osteomyelitis or bone abscess), radial head or neck
R1,952.19
R1,952.19
90
24138
Sequestrectomy (e.g., for osteomyelitis or bone abscess), olecranon process
R2,032.60
R2,032.60
90
25145
Sequestrectomy (e.g., for osteomyelitis or bone abscess), forearm and/or wrist
R2,189.86
R2,189.86
90
20
0
9
23170
Musculoskeletal Procedures
2009
2009
Urology, Gynaecology
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Gynae
Adnexae
R2,522.12
R2,522.12
90
59121
Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy
R2,543.41
R2,543.41
90
59130
Surgical treatment of ectopic pregnancy; abdominal pregnancy
R2,776.35
R2,776.35
90
59135
Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy
R2,933.61
R2,933.61
90
59136
Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus
R2,798.81
R2,798.81
90
59140
Surgical treatment of ectopic pregnancy; cervical, with evacuation
R1,126.86
R1,126.86
90
59150
Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy
R2,457.09
R2,457.09
90
59151
Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy
R2,425.16
R2,425.16
90
58805
Drainage of ovarian cyst(s), unilateral or bilateral, (separate procedure); abdominal approach
R1,242.73
R1,242.73
90
58820
Drainage of ovarian abscess; vaginal approach, open
R984.96
R984.96
90
58822
Drainage of ovarian abscess; abdominal approach
R2,133.10
R2,133.10
90
58823
Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous (e.g., ovarian, pericolic)
R2,880.40
R554.56
0
58660
Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)
R2,129.56
R2,129.56
90
58661
Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)
R2,066.89
R2,066.89
10
58662
Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface
by any method
R2,251.35
R2,251.35
90
58670
Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
R1,149.32
R1,149.32
90
58671
Laparoscopy, surgical; with occlusion of oviducts by device (e.g., band, clip, or Falope ring)
R1,150.50
R1,150.50
90
58672
Laparoscopy, surgical; with fimbrioplasty
R2,400.33
R2,400.33
90
58673
Laparoscopy, surgical; with salpingostomy (salpingoneostomy)
R2,591.89
R2,591.89
90
58700
Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)
R2,390.87
R2,390.87
90
58720
Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)
R2,254.89
R2,254.89
90
58740
Lysis of adhesions (salpingolysis, ovariolysis)
R2,764.52
R2,764.52
90
58770
Salpingostomy (salpingoneostomy)
R2,725.50
R2,725.50
90
58900
Biopsy of ovary, unilateral or bilateral (separate procedure)
R1,268.75
R1,268.75
90
58920
Wedge resection or bisection of ovary, unilateral or bilateral
R2,221.79
R2,221.79
90
58925
Ovarian cystectomy, unilateral or bilateral
R2,284.45
R2,284.45
90
58940
Oophorectomy, partial or total, unilateral or bilateral;
R1,551.35
R1,551.35
90
58943
Oophorectomy, partial or total, unilateral or bilateral; for ovarian tubal or primary peritoneal malignancy, with
para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic
assessments, with or without salpingectomy(s), with or without omentectomy
R3,540.20
R3,540.20
90
R3,360.47
R3,360.47
90
R4,348.98
R4,348.98
90
R4,902.35
R4,902.35
90
R6,106.07
R6,106.07
90
R6,629.89
R6,629.89
90
20
0
9
59120
Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy,
abdominal or vaginal approach
58950
58951
58952
58953
58954
Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and
omentectomy;
Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and
omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy
Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and
omentectomy; with radical dissection for debulking (i.e., radical excision or destruction, intra-abdominal or
retroperitoneal tumours)
Bilateral salpingo-oophorectomy with omenttectomy, total abdominal hysterectomy and radical dissection for
debulking;
Bilateral salpingo-oophorectomy with omenttectomy, total abdominal hysterectomy and radical dissection for
debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy
58956
Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy
R4,321.78
R4,321.78
90
58957
Resection (tumour debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intraabdominal, retroperitoneal tumours), with omentectomy, if performed;
R4,568.91
R4,568.91
90
58958
Resection (tumour debulking) of recurrent ovarian, tubal primary peritoneal, uterine malignancy (intraabdominal retroperitoneal tumours), with omentectomy, if performed; with pelvic lymphadenectomy and limited
para-aortic lymphadenectomy
R5,059.62
R5,059.62
90
58960
Laparotomy, for staging or restaging of ovarian, tubal, primary or primary peritoneal malignancy (second look),
with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic
assessment with pelvic and limited para-aortic lymphadenectomy
R2,905.23
R2,905.23
90
Urology, Gynaecology
2009
2009
Urology, Gynaecology
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Colporrhaphy
57200
Colporrhaphy, suture of injury of vagina (non-obstetrical)
R910.47
R910.47
90
57210
Colpoperineorrhaphy, suture of injury of vagina and/or perineum (non-obstetrical)
R1,139.86
R1,139.86
90
57250
Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy
R1,891.89
R1,891.89
90
57267
Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment),
vaginal approach (List separately in addition to code for primary procedure)
R872.63
R872.63
57268
Repair of enterocele, vaginal approach (separate procedure)
R1,474.49
R1,474.49
90
57270
Repair of enterocele, abdominal approach (separate procedure)
R2,493.74
R2,493.74
90
57280
Colpopexy, abdominal approach
R3,023.47
R3,023.47
90
57287
Removal or revision of sling for stress incontinence (e.g., fascia or synthetic)
R2,142.56
R2,142.56
90
R439.86
R230.57
0
R2,454.72
R2,454.72
90
ZZZ
Uterus
Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)
57540
Excision of cervical stump, abdominal approach;
57545
Excision of cervical stump, abdominal approach; with pelvic floor repair
58120
Dilation and curettage, diagnostic and/or therapeutic (non-obstetrical)
58140
58145
58146
Myomectomy, excision of fibroid tumour(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250
grams or less and/or removal of surface myomas; abdominal approach
Myomectomy, excision of fibroid tumour(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250
grams or less and/or removal of surface myomas; vaginal approach
Myomectomy, excision of fibroid tumour(s) of uterus, 5 or more intramural myomas and/or intramural myomas
with total weight greater than 250 grams, abdominal approach
Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal
of ovary(s);
Supra-cervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or
without removal of ovary(s)
Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling,
with or without removal of tube(s), with or without removal of ovary(s)
Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node
sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)
Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or
without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral
transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination
thereof
R2,610.81
R2,610.81
90
R748.48
R679.90
10
R2,883.95
R2,883.95
90
R1,706.25
R1,706.25
90
R3,683.27
R3,683.27
90
R3,110.97
R3,110.97
90
R2,992.73
R2,992.73
90
R4,149.15
R4,149.15
90
R5,525.50
R5,525.50
90
R8,383.43
R8,383.43
90
20
0
58150
9
57500
58180
58200
58210
58240
Vagina
57106
Vaginectomy, partial removal of vaginal wall;
R1,452.02
R1,452.02
90
57107
Vaginectomy, partial removal of vaginal wall; with removal of para-vaginal tissue (radical vaginectomy)
R4,406.92
R4,406.92
90
56620
Vulvectomy simple; partial
R1,660.13
R1,660.13
90
56625
Vulvectomy simple; complete
R1,862.33
R1,862.33
90
56630
Vulvectomy, radical, partial;
R2,703.03
R2,703.03
90
56631
Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy
R3,465.70
R3,465.70
90
56632
Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy
R3,957.59
R3,957.59
90
56633
Vulvectomy, radical, complete;
R3,529.55
R3,529.55
90
56634
Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy
R3,756.58
R3,756.58
90
56637
Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy
R4,469.59
R4,469.59
90
56640
Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy
R4,466.04
R4,466.04
90
56405
Incision and drainage of vulva or perineal abscess
R345.27
R327.53
10
56420
Incision and drainage of Bartholin's gland abscess
R431.59
R300.34
10
56440
Marsupialisation of Bartholin's gland cyst
R577.03
R577.03
10
57291
Construction of artificial vagina; without graft
R1,684.96
R1,684.96
90
57292
Construction of artificial vagina; with graft
R2,624.99
R2,624.99
90
57295
Revision (including removal) of prosthetic vaginal graft, vaginal approach
R1,534.79
R1,534.79
90
Urology, Gynaecology
2009
2009
Urology, Gynaecology
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Revision (including removal) of prosthetic vaginal graft; open abdominal approach
R2,943.07
R2,943.07
90
57300
Closure of rectovaginal fistula; vaginal or transanal approach
R1,629.39
R1,629.39
90
57305
Closure of rectovaginal fistula; abdominal approach
R2,744.42
R2,744.42
90
57307
Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy
R3,079.05
R3,079.05
90
57308
Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without
levator plication
R1,969.93
R1,969.93
90
57310
Closure of urethrovaginal fistula;
R1,447.29
R1,447.29
90
57311
Closure of urethrovaginal fistula; with bulbocavernosus transplant
R1,637.67
R1,637.67
90
57320
Closure of vesicovaginal fistula; vaginal approach
R1,666.04
R1,666.04
90
57330
Closure of vesicovaginal fistula; transvesical and vaginal approach
R2,395.60
R2,395.60
90
57335
Vaginoplasty for intersex state
R3,644.25
R3,644.25
90
57400
Dilation of vagina under anaesthesia
R426.86
R426.86
0
57410
Pelvic examination under anaesthesia
R334.63
R334.63
0
57415
Removal of impacted vaginal foreign body (separate procedure) under anaesthesia
R487.16
R487.16
10
UROLOGY
Bladder
9
57296
52000
Cystourethroscopy (separate procedure)
52001
Cystourethroscopy with irrigation and evacuation of multiple obstructing clots
R682.26
R387.84
0
R1,291.21
R932.94
0
Cystourethroscopy, with ureteral catheterisation, with or without irrigation, instillation, or ureteropyelography,
exclusive of radiologic service;
Cystourethroscopy, with ureteral catheterisation, with or without irrigation, instillation, or ureteropyelography,
exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis
Cystourethroscopy, with ejaculatory duct catheterisation, with or without irrigation, instillation, or duct
radiography, exclusive of radiologic service
R963.68
R420.95
0
R2,157.93
R534.46
0
R1,576.18
R533.28
0
52204
Cystourethroscopy, with biopsy(s)
R1,859.96
R448.14
0
51000
Aspiration of bladder by needle
R297.97
R127.70
0
51005
Aspiration of bladder; by trocar or intracatheter
R620.78
R171.45
0
51010
Aspiration of bladder; with insertion of suprapubic catheter
R1,175.34
R774.49
10
51040
Cystostomy, cystotomy with drainage
R916.38
R916.38
90
51045
Cystotomy, with insertion of ureteral catheter or stent (separate procedure)
R1,473.31
R1,473.31
90
51080
Drainage of perivesical or prevesical space abscess
R1,273.48
R1,273.48
90
51500
Excision of urachal cyst or sinus, with or without umbilical hernia repair
R2,030.23
R2,030.23
90
51520
Cystotomy; for simple excision of vesical neck (separate procedure)
R1,882.43
R1,882.43
90
51525
Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure)
R2,726.68
R2,726.68
90
51530
Cystotomy; for excision of bladder tumour
R2,457.09
R2,457.09
90
51535
Cystotomy for excision, incision, or repair of ureterocele
R2,539.86
R2,539.86
90
51550
Cystectomy, partial; simple
R3,038.85
R3,038.85
90
51555
Cystectomy, partial; complicated (e.g., postradiation, previous surgery, difficult location)
R4,035.63
R4,035.63
90
51565
Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy)
R4,126.68
R4,126.68
90
51570
Cystectomy, complete; (separate procedure)
R4,696.61
R4,696.61
90
51575
Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and
obturator nodes
R5,845.93
R5,845.93
90
51580
Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations;
R6,056.41
R6,056.41
90
51585
Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic
lymphadenectomy, including external iliac, hypogastric, and obturator nodes
R6,757.59
R6,757.59
90
51590
Cystectomy, complete, with uretero-ileal conduit or sigmoid bladder, including intestine anastomosis;
R6,185.29
R6,185.29
90
51595
Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with
bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
R7,015.36
R7,015.36
90
20
0
52005
52007
52010
Urology, Gynaecology
2009
2009
Urology, Gynaecology
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large
intestine to construct neobladder
R7,522.62
R7,522.62
90
51597
Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral
transplantations, with or without hysterectomy and/or abdomino-perineal resection of rectum and colon and
colostomy, or any combination thereof
R7,288.50
R7,288.50
90
51700
Bladder irrigation, simple, lavage and/or instillation
R297.97
R146.62
0
51701
Insertion of non-indwelling bladder catheter (e.g., straight catheterisation for residual urine)
R235.30
R88.68
0
51702
Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)
R293.24
R95.78
0
51703
Insertion of temporary indwelling bladder catheter; complicated (e.g., altered anatomy, fractured
catheter/balloon)
R495.44
R260.13
0
51705
Change of cystostomy tube; simple
R391.38
R209.29
10
51710
Change of cystostomy tube; complicated
R566.38
R294.43
10
51860
Cystorrhaphy, suture of bladder wound, injury or rupture; simple
R2,327.02
R2,327.02
90
51865
Cystorrhaphy, suture of bladder wound, injury or rupture; complicated
R2,844.93
R2,844.93
90
51880
Closure of cystostomy (separate procedure)
R1,499.32
R1,499.32
90
51900
Closure of vesico-vaginal fistula, abdominal approach
R2,632.09
R2,632.09
90
51920
Closure of vesico-uterine fistula;
51925
51940
9
51596
R2,439.35
R2,439.35
90
Closure of vesico-uterine fistula; with hysterectomy
R3,362.83
R3,362.83
90
Closure, exstrophy of bladder
R5,268.91
R5,268.91
90
Kidney
Renal exploration, not necessitating other specific procedures
R2,211.14
R2,211.14
90
50020
Drainage of perirenal or renal abscess; open
R3,210.30
R3,210.30
90
50021
Drainage of perirenal or renal abscess; percutaneous
R2,932.43
R548.65
0
50040
Nephrostomy, nephrotomy with drainage
R2,937.16
R2,937.16
90
50045
Nephrotomy, with exploration
R2,954.89
R2,954.89
90
50060
Nephrolithotomy; removal of calculus
R3,646.61
R3,646.61
90
50100
Transection or repositioning of aberrant renal vessels (separate procedure)
R3,193.74
R3,193.74
90
50120
Pyelotomy; with exploration
R3,023.47
R3,023.47
90
50200
Renal biopsy; percutaneous, by trocar or needle
R476.52
R476.52
0
50205
Renal biopsy; by surgical exposure of kidney
R2,205.23
R2,205.23
90
50220
Nephrectomy, including partial ureterectomy, any open approach including rib resection;
R3,280.06
R3,280.06
90
R3,801.51
R3,801.51
90
R4,097.12
R4,097.12
90
20
0
50010
50225
50230
Nephrectomy, including partial ureterectomy, any open approach including rib resection; complicated because
of previous surgery on same kidney
Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional
lymphadenectomy and/or vena caval thrombectomy
50234
Nephrectomy with total ureterectomy and bladder cuff; through same incision
R4,162.15
R4,162.15
90
50236
Nephrectomy with total ureterectomy and bladder cuff; through separate incision
R4,701.34
R4,701.34
90
50240
Nephrectomy, partial
R4,202.36
R4,202.36
90
50250
Ablation, open, one or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound, if performed
R3,903.20
R3,903.20
90
50280
Excision or unroofing of cyst(s) of kidney
R3,015.20
R3,015.20
90
50290
Excision of perinephric cyst
R2,875.67
R2,875.67
90
Prostate
55700
Biopsy, prostate; needle or punch, single or multiple, any approach
R800.51
R415.03
0
55705
Biopsy, prostate; incisional, any approach
R869.09
R869.09
10
55720
Prostatotomy, external drainage of prostatic abscess, any approach; simple
R1,501.69
R1,501.69
90
55725
Prostatotomy, external drainage of prostatic abscess, any approach; complicated
R1,838.68
R1,838.68
90
Urology, Gynaecology
2009
2009
Urology, Gynaecology
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Testis/scrotum
Biopsy of testis, needle (separate procedure)
R240.03
R240.03
0
54505
Biopsy of testis, incisional (separate procedure)
R683.44
R683.44
10
54512
Excision of extra-parenchymal lesion of testis
R1,706.25
R1,706.25
90
54520
Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach
R1,038.17
R1,038.17
90
54522
Orchiectomy, partial
R1,908.44
R1,908.44
90
54530
Orchiectomy, radical, for tumour; inguinal approach
R1,736.99
R1,736.99
90
54535
Orchiectomy, radical, for tumour; with abdominal exploration
R2,374.32
R2,374.32
90
54550
Exploration for undescended testis (inguinal or scrotal area)
R1,550.17
R1,550.17
90
54560
Exploration for undescended testis with abdominal exploration
R2,166.21
R2,166.21
90
54600
Reduction of torsion of testis, surgical, with or without fixation of contra-lateral testis
R1,420.10
R1,420.10
90
54620
Fixation of contra-lateral testis (separate procedure)
R967.23
R967.23
10
54640
Orchiopexy, inguinal approach, with or without hernia repair
R1,462.67
R1,462.67
90
54650
Orchiopexy, abdominal approach, for intra-abdominal testis (e.g., Fowler-Stephens)
R2,293.91
R2,293.91
90
54660
Insertion of testicular prosthesis (separate procedure)
R1,116.21
R1,116.21
90
54670
Suture or repair of testicular injury
R1,290.03
R1,290.03
90
54700
Incision and drainage of epididymis, testis and/or scrotal space (e.g., abscess or haematoma)
R682.26
R682.26
10
54830
Excision of local lesion of epididymis
R1,148.14
R1,148.14
90
54840
Excision of spermatocele, with or without epididymectomy
R1,021.62
R1,021.62
90
54860
Epididymectomy; unilateral
R1,303.04
R1,303.04
90
54861
Epididymectomy; bilateral
R1,776.01
R1,776.01
90
54865
Exploration of epididymis, with or without biopsy
R1,106.75
R1,106.75
90
55040
Excision of hydrocele; unilateral
R1,063.00
R1,063.00
90
55041
Excision of hydrocele; bilateral
R1,588.00
R1,588.00
90
55060
Repair of tunica vaginalis hydrocele (Bottle type)
R1,175.34
R1,175.34
90
55100
Drainage of scrotal wall abscess
R733.11
R504.90
10
55110
Scrotal exploration
R1,198.98
R1,198.98
90
55120
Removal of foreign body in scrotum
R1,099.66
R1,099.66
90
55150
Resection of scrotum
R1,517.06
R1,517.06
90
20
0
9
54500
Ureter
50600
Ureterotomy with exploration or drainage (separate procedure)
R2,996.28
R2,996.28
90
50605
Ureterotomy for insertion of indwelling stent, all types
R2,976.18
R2,976.18
90
50840
Replacement of all or part of ureter by intestine segment, including intestine anastomosis
R3,902.02
R3,902.02
90
50845
Cutaneous appendico-vesicostomy
R3,971.78
R3,971.78
90
50860
Ureterostomy, transplantation of ureter to skin
R3,011.65
R3,011.65
90
50900
Ureterorrhaphy, suture of ureter (separate procedure)
R2,680.57
R2,680.57
90
50920
Closure of ureterocutaneous fistula
R2,804.72
R2,804.72
90
50930
Closure of ureterovisceral fistula (including visceral repair)
R3,534.28
R3,534.28
90
50940
Deligation of ureter
R2,827.19
R2,827.19
90
Urology, Gynaecology
2009
2009
Urology, Gynaecology
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Urethra/penis
Amputation of penis; partial
R1,985.30
R1,985.30
90
54125
Amputation of penis; complete
R2,581.24
R2,581.24
90
54130
Amputation of penis, radical; with bilateral inguinofemoral lymphadenectomy
R3,807.42
R3,807.42
90
54135
Amputation of penis, radical; in continuity with bilateral pelvic lymphadenectomy, including external iliac,
hypogastric and obturator nodes
R4,862.15
R4,862.15
90
54150
Circumcision, using clamp or other device with regional dorsal penile or ring block
R420.95
R372.47
10
54160
Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less)
R794.59
R458.78
10
54161
Circumcision, surgical excision other than clamp, device or dorsal slit; older than 28 days of age
R620.78
R620.78
10
54162
Lysis or excision of penile post-circumcision adhesions
R942.40
R606.59
10
54163
Repair incomplete circumcision
R675.17
R675.17
10
54164
Frenulotomy of penis
R590.03
R590.03
10
53600
Dilation of urethral stricture by passage of sound or urethral dilator, male; initial
R289.70
R209.29
0
53601
Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent
R277.87
R172.63
0
54015
Incision and drainage of penis, deep
54050
54055
54056
54057
Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple;
chemical
Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple;
electrodesiccation
Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple;
cryosurgery
Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple;
laser surgery
Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple;
surgical excision
Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive
(e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery)
R996.79
R996.79
10
R367.74
R290.88
10
R353.55
R263.68
10
R376.01
R301.52
10
R432.77
R273.14
10
R612.50
R389.02
10
R634.96
R472.97
10
20
0
54060
9
54120
54065
54100
Biopsy of penis; (separate procedure)
R584.12
R350.00
0
54105
Biopsy of penis; deep structures
R943.58
R689.36
10
53040
Drainage of deep periurethral abscess
R1,256.92
R1,256.92
90
53080
Drainage of perineal urinary extravasation; uncomplicated (separate procedure)
R1,543.07
R1,543.07
90
53085
Drainage of perineal urinary extravasation; complicated
R2,207.60
R2,207.60
90
53200
Biopsy of urethra
R497.80
R456.42
0
Urology, Gynaecology
2009
2009
ENT Neuro Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
ENT
Nasal
30124
Excision dermoid cyst, nose; simple, skin, subcutaneous
R828.88
R828.88
90
30125
Excision dermoid cyst, nose; complex, under bone or cartilage
R1,872.97
R1,872.97
90
30300
Removal foreign body, intranasal; office type procedure
R668.07
R357.09
10
30310
Removal foreign body, intranasal; requiring general anaesthesia
R608.95
R608.95
10
30320
Removal foreign body, intranasal; by lateral rhinotomy
R1,386.99
R1,386.99
90
30901
Control nasal haemorrhage, anterior, simple (limited cautery and/or packing) any method
R312.16
R192.74
0
30903
Control nasal haemorrhage, anterior, complex (extensive cautery and/or packing) any method
R528.55
R253.04
0
30905
Control nasal haemorrhage, posterior, with posterior nasal packs and/or cauterisation, any method; initial
R675.17
R334.63
0
30906
Control nasal haemorrhage, posterior, with posterior nasal packs and/or cauterisation, any method; subsequent
R775.67
R439.86
0
Tracheostomy, planned (separate procedure);
R1,291.21
R1,291.21
0
A
31601
Tracheostomy, planned (separate procedure); under two years
R833.61
R833.61
0
A
31603
Tracheostomy, emergency procedure; transtracheal
R727.19
R727.19
0
A
31605
Tracheostomy, emergency procedure; cricothyroid membrane
R599.49
R599.49
0
A
31610
Tracheostomy, fenestration procedure with skin flaps
R2,136.65
R2,136.65
90
31612
Tracheal puncture, percutaneous with transtracheal aspiration and/or injection
R245.95
R156.08
0
31613
Tracheostoma revision; simple, without flap rotation
R1,299.49
R1,299.49
90
31614
Tracheostoma revision; complex, with flap rotation
R2,105.91
R2,105.91
90
31615
Tracheobronchoscopy through established tracheostomy incision
R561.65
R400.84
0
20
0
31600
9
Trachea
NEURO
Sympathectomy
64802
Sympathectomy, cervical
R1,943.91
R1,943.91
90
64804
Sympathectomy, cervicothoracic
R2,932.43
R2,932.43
90
64809
Sympathectomy, thoracolumbar
R2,611.99
R2,611.99
90
64818
Sympathectomy, lumbar
R2,081.08
R2,081.08
90
64795
Biopsy of nerve
R598.31
R598.31
0
64420
Injection, anaesthetic agent; intercostal nerve, single
R562.84
R199.83
0
64421
Injection, anaesthetic agent; intercostal nerves, multiple, regional block
R853.71
R273.14
0
64430
Injection, anaesthetic agent; pudendal nerve
R477.70
R256.59
0
64450
Injection, anaesthetic agent; other peripheral nerve or branch
R313.34
R223.48
0
64530
Injection, anaesthetic agent; celiac plexus, with or without radiologic monitoring
R669.26
R273.14
0
64722
Decompression; unspecified nerve(s) (specify)
R970.78
R970.78
90
64774
Excision of neuroma; cutaneous nerve, surgically identifiable
R1,219.09
R1,219.09
90
64784
Excision of neuroma; major peripheral nerve, except sciatic
R2,173.31
R2,173.31
90
64788
Excision of neurofibroma or neurolemmoma; cutaneous nerve
R1,116.21
R1,116.21
90
64790
Excision of neurofibroma or neurolemmoma; major peripheral nerve
R2,506.75
R2,506.75
90
64792
Excision of neurofibroma or neurolemmoma; extensive (including malignant type)
R3,185.47
R3,185.47
90
Nerve
ENT Neuro Procedures
2009
2009
ENT Neuro Procedures
Code
Surgicom Description
Facility
Nonfacility
Global Assistant
period
code
Nerve Suture
64834
Suture of one nerve, hand or foot; common sensory nerve
R2,275.00
R2,275.00
90
64835
Suture of one nerve, hand or foot; median motor thenar
R2,478.37
R2,478.37
90
64836
Suture of one nerve, hand or foot; ulnar motor
R2,460.64
R2,460.64
90
64837
Suture of each additional nerve, hand or foot (List separately in addition to code for primary procedure)
R1,221.45
R1,221.45
ZZZ
64840
Suture of posterior tibial nerve
R2,686.48
R2,686.48
90
64856
Suture of major peripheral nerve, arm or leg, except sciatic; including transposition
R3,090.87
R3,090.87
90
64857
Suture of major peripheral nerve, arm or leg, except sciatic; without transposition
R3,239.86
R3,239.86
90
64858
Suture of sciatic nerve
R3,749.49
R3,749.49
90
64859
Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure)
R833.61
R833.61
64861
Suture of; brachial plexus
R4,280.40
R4,280.40
90
64862
Suture of; lumbar plexus
R4,244.92
R4,244.92
90
64864
Suture of facial nerve; extracranial
R2,712.49
R2,712.49
90
64865
Suture of facial nerve; infratemporal, with or without grafting
R3,561.48
R3,561.48
90
64866
Anastomosis; facial-spinal accessory
R3,751.85
R3,751.85
90
64868
Anastomosis; facial-hypoglossal
R3,204.39
R3,204.39
90
64870
Anastomosis; facial-phrenic
R3,184.28
R3,184.28
90
R390.20
R390.20
add-on
R574.66
R574.66
add-on
R631.42
R631.42
add-on
Suture of nerve; requiring secondary or delayed suture (List separately in addition to code for primary
neurorrhaphy)
Suture of nerve; requiring extensive mobilisation, or transposition of nerve (List separately in addition to code
for nerve suture)
20
0
64874
9
64872
add-on
64876
Suture of nerve; requiring shortening of bone of extremity (List separately in addition to code for nerve suture)
64885
Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length
R3,557.93
R3,557.93
90
64886
Nerve graft (includes obtaining graft), head or neck; more than 4 cm length
R4,192.90
R4,192.90
90
64890
Nerve graft (includes obtaining graft), single strand, hand or foot; up to 4 cm length
R3,335.64
R3,335.64
90
64891
Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm length
R3,198.47
R3,198.47
90
64892
Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length
R3,193.74
R3,193.74
90
64893
Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm length
R3,456.24
R3,456.24
90
64895
Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to 4 cm length
R3,860.63
R3,860.63
90
64896
Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more than 4 cm length
R4,283.94
R4,283.94
90
64897
Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to 4 cm length
R3,839.35
R3,839.35
90
64898
Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more than 4 cm length
R4,176.34
R4,176.34
90
64901
Nerve graft, each additional nerve; single strand (List separately in addition to code for primary procedure)
R1,951.01
R1,951.01
add-on
64902
Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary
procedure)
R2,238.34
R2,238.34
add-on
64910
Nerve repair; with synthetic conduit or vein allograft (e.g., nerve tube), each nerve
R2,147.29
R2,147.29
90
64911
Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve
R2,611.99
R2,611.99
90
Shunt
62220
Creation of shunt; ventriculo-atrial, -jugular, -auricular
R3,010.47
R3,010.47
90
62223
Creation of shunt; ventriculo-peritoneal, -pleural, other terminus
R3,027.02
R3,027.02
90
62225
Replacement or irrigation, ventricular catheter
R1,413.00
R1,413.00
90
62230
Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system
R2,454.72
R2,454.72
90
62256
Removal of complete cerebrospinal fluid shunt system; without replacement
R1,657.77
R1,657.77
90
62258
Removal of complete cerebrospinal fluid shunt system; with replacement by similar or other shunt at same
operation
R3,329.72
R3,329.72
90
ENT Neuro Procedures
2009
2009
Laparoscopic Procedures
Code
Laparoscopic and Thoracoscopic Procedures
Global
period
Assistant
Oesophagus
Thoracoscopic oesophagomyotomy (Heller); also use for laparoscopic approach
R3,768.40
90
C
43280
Laparoscopic oesophagogastric fundoplication (e.g. Nissen, Toupet)
R3,241.04
90
C
43289
Unlisted laparoscopic procedure, oesophagus
09
32665
Gastric
43651
Laparoscopy, surgical; transection of vagus nerves, truncal
R1,914.35
90
B
43652
Laparoscopy, surgical; transection of vagus nerves, selective or HSV
R2,280.91
90
B
43653
Laparoscopy, surgical; gastrostomy (separate procedure)
R1,610.47
90
A
43659
Unlisted laparoscopy procedure, stomach
Bariatric
Laparoscopy, surgical, RYGB (Roux limb <150cm)
R5,128.20
90
C
43645
Laparoscopy, gastric restrictive bypass & small intestine reconstruction
R5,521.95
90
C
43770
Laparoscopy, placement of adjustable gastric band (gastric band and subcutaneous port components)
R3,274.15
90
C
43771
Laparoscopy, revision of adjustable gastric band component only
R3,744.76
90
C
43772
Laparoscopy, removal of adjustable gastric band component only
R2,821.28
90
C
43773
Laparoscopy, removal and replacement of adjustable gastric band component only
R3,745.94
90
C
43774
Laparoscopy, removal of adjustable gastric band and subcutaneous port components
R2,834.28
90
C
R1,726.35
90
B
20
43644
Appendix
44970
Laparoscopy, surgical, appendectomy
44979
Unlisted laparoscopy procedure, appendix
Bowel
44180
Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
R2,736.14
90
B
44186
Laparoscopy, surgical; jejunostomy (e.g., for decompression or feeding)
R1,923.81
90
B
44187
Laparoscopy, surgical; ileostomy or jejunostomy, non-tube
R3,249.32
90
B
44188
Laparoscopy, surgical, colostomy or skin level cecostomy
R3,578.03
90
B
44202
Laparoscopy, surgical; intestinal resection, with anastomosis
R4,125.50
+44203
44204
Laparoscopy, surgical enterectomy, each additional resection & anastomosis; (+) add-on code
Laparoscopy, surgical; colectomy, partial, with anastomosis
Laparoscopic Procedures
2009
R759.12
R4,624.48
90
C
add-on
C
90
C
2009
Laparoscopic Procedures
Code
Laparoscopic and Thoracoscopic Procedures
Global
period
Assistant
Oesophagus
Laparoscopy, surgical, colectomy, partial + terminal ileum with ileocolostomy
R4,045.09
90
C
44206
Laparoscopy; colectomy, partial, + end colostomy + closure distal segment
R5,222.79
90
C
44207
Laparoscopy; colectomy, partial, + coloproctostomy (low pelvic anastomosis)
R5,513.67
90
C
44208
Laparoscopy; colectomy, partial, + coloproctostomy with colostomy
R5,986.64
90
C
44210
Laparoscopy; colectomy, total, abdominal, with ileostomy or ileoproctostomy
R5,323.30
90
C
44211
Laparoscopy; proctocolectomy + ileal pouch-anal anastomosis, + ileostomy
R6,563.67
90
C
44212
Laparoscopy; proctocolectomy, with ileostomy
R6,116.71
90
C
+44213
09
44205
Laparoscopy, mobilisation of splenic flexure in conjunction with partial colectomy; (+) add-on code
44227
Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis
44238
Unlisted laparoscopic procedure, intestine (except rectum)
45395
R600.67
add-on
R4,993.40
90
C
Laparoscopy, surgical; abdominoperineal resection with colostomy
R5,903.87
90
C
45397
Laparoscopy, proctectomy with colo-anal anastomosis +/- colonic +/- diverting enterostomy
R6,393.40
90
C
45400
Laparoscopy, surgical; proctopexy (for prolapse)
R3,431.41
90
B
45402
Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resection
R4,600.84
90
C
45499
Unlisted laparoscopy procedure, rectum
20
Rectum
Liver
47370
Laparoscopy, ablation of one or more liver tumour(s); radiofrequency
R3,695.09
90
B
47371
Laparoscopy, ablation of one or more liver tumour(s); cryotherapy
R3,715.20
90
B
49321
Laparoscopy, abdomen, peritoneum, & omentum, with biopsies (e.g. liver)
R1,029.90
10
A
47379
Unlisted laparoscopic procedure, liver
47560
Laparoscopy; with guided transhepatic cholangiography
R839.53
0
B
47561
Laparoscopy; with guided transhepatic cholangiography, with biopsy
R904.56
0
B
47562
Laparoscopy, surgical; cholecystectomy
R2,146.11
90
B
47563
Laparoscopy, surgical; cholecystectomy with cholangiography
R2,228.88
90
B
47564
Laparoscopy, surgical; cholecystectomy with exploration of common duct
R2,591.89
90
B
47570
Laparoscopy, surgical; cholecystoenterostomy
R2,304.56
90
B
Biliary
Laparoscopic Procedures
2009
2009
Laparoscopic Procedures
Code
47579
Global
period
Assistant
R984.96
10
A
Laparoscopic and Thoracoscopic Procedures
Oesophagus
Unlisted laparoscopic procedure, biliary tract
Laparoscopy general
Laparoscopy, abdomen, peritoneum, omentum; diagnostic
49321
Laparoscopy, abdomen, peritoneum, & omentum, with biopsy (single or multiple)
R1,029.90
10
A
49322
Laparoscopy, surgical, + aspiration cavity/cyst (e.g. ovarian) (single/multiple)
R1,131.59
10
A
49323
Laparoscopy, surgical, + drainage of lymphocoele to peritoneal cavity
R1,876.52
90
A
49324
Laparoscopy, surgical; with insertion of intraperitoneal cannula or catheter, permanent
R1,158.78
90
A
49325
Laparoscopy, revision intraperitoneal cannula/catheter +/- removal intraluminal obstructive material
R1,248.65
+49326
09
49320
Laparoscopy, omentopexy (Add on - list separately in addition to the code for primary procedure)
R574.66
90
A
add-on
A
49329
Unlisted laparoscopy procedure, abdomen, peritoneum & omentum
49650
Laparoscopy, surgical; repair initial inguinal hernia
R1,236.82
90
A
49651
Laparoscopy, surgical; repair recurrent inguinal hernia
R1,598.65
90
A
49659
Unlisted laparoscopy procedure, hernia
60650
Laparoscopic adrenalectomy
60659
Unlisted laparoscopy procedure, endocrine system
38120
Laparoscopic splenectomy
38129
Unlisted laparoscopic procedure, spleen
Hernia
A
20
Adrenal
R3,660.80
90
C
C
Spleen
R3,132.26
90
B
Lymphatic
38570
Laparoscopy, surgical; with retroperitoneal LN biopsy, single or multiple
R1,701.52
10
B
38571
Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy
R2,580.06
10
B
38572
Laparoscopy, bilateral total pelvic lymphadenectomy & peri-aortic lymph node biopsy, single or multiple
R3,030.57
10
B
38589
Unlisted laparoscopy procedure, lymphatic system
32601
Thoracoscopy, diagnostic (separate procedure)
R1,009.80
0
A
32602
Thoracoscopy, diagnostic (separate procedure); with biopsy
R1,096.11
0
A
Thoracic
Laparoscopic Procedures
2009
2009
Laparoscopic Procedures
Code
Global
period
Assistant
R1,268.75
0
A
Laparoscopic and Thoracoscopic Procedures
Oesophagus
Thoracoscopy, diagnostic (separate procedure); mediastinal
32606
Thoracoscopy, diagnostic (separate procedure); mediastinal, with biopsy
R1,520.60
0
A
32650
Thoracoscopy, surgical; with pleurodesis, any method
R2,215.87
90
A
32651
Thoracoscopy, surgical; with partial pulmonary decortication
R3,302.53
90
B
32657
Thoracoscopy, surgical; with wedge resection of lung, single or multiple
R2,616.72
90
B
32662
Thoracoscopy, surgical; with excision of mediastinal cyst, tumour or mass
R3,001.01
90
B
32663
Thoracoscopy, surgical; with lobectomy, total or segmental
R4,461.31
90
B
32664
Thoracoscopy, surgical; with thoracic sympathectomy
R2,822.46
90
B
32665
Thoracoscopy, surgical; with oesophagomyotomy (Heller type)
R3,768.40
90
C
09
32605
Urologic
Laparoscopy, surgical; ablation of renal cysts
R2,952.53
90
C
50542
Laparoscopy, surgical; ablation of renal mass lesion(s)
R3,724.65
90
C
50543
Laparoscopy, surgical; partial nephrectomy
R4,756.92
90
C
50544
Laparoscopy, surgical; pyeloplasty
R4,039.18
90
C
50545
Laparoscopy, surgical; radical, nephrectomy
R4,333.61
90
C
50546
Laparoscopy, surgical; nephrectomy including partial ureterectomy
R3,832.26
90
C
50547
Laparoscopic donor nephrectomy (including cold preservation)
R4,790.02
90
C
50548
Laparoscopy, surgical; nephrectomy with total ureterectomy
R4,372.63
90
C
50549
Unlisted laparoscopy procedure, renal
50945
Laparoscopy, surgical, ureterolithotomy
R3,160.64
90
C
50947
Laparoscopic; ureteroneocystostomy (with cystoscopy + ureteral stent)
R4,519.25
90
C
50948
Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement
R4,133.78
90
C
50949
Unlisted laparoscopy procedure, ureter
51990
Laparoscopy, surgical; urethral suspension for stress incontinence
R2,453.54
90
C
51992
Laparoscopy, surgical; sling operation for stress incontinence
R2,660.47
90
C
51999
Unlisted laparoscopy procedure, bladder
54690
Laparoscopy, surgical; orchiectomy
R2,114.18
90
B
54692
Laparoscopy, surgical; orchiopexy for intra-abdominal testis
R2,476.01
90
B
20
50541
Laparoscopic Procedures
2009
2009
Laparoscopic Procedures
Code
Global
period
Assistant
R1,334.96
90
B
R5,591.71
90
C
Laparoscopic and Thoracoscopic Procedures
Oesophagus
Unlisted laparoscopy procedure, testis
55550
Laparoscopy, surgical, with ligation of spermatic veins for varicocoele
55559
Unlisted laparoscopy procedure, spermatic cord
55866
Laparoscopic prostatectomy, retropubic radical, including nerve sparing
09
54699
Gynae
Laparoscopy, surgical, colpopexy (suspension of vaginal apex)
R3,003.37
90
C
58541
Laparoscopy, surgical, supracervical hysterectomy, for uterus <250g
R2,647.46
90
B
58542
Laparoscopy, surgical, supracervical hysterectomy, uterus <250g; with removal of tube(s) and/or ovary(s)
R2,930.06
90
B
58543
Laparoscopy, surgical, supracervical hysterectomy, for uterus >250g
R2,979.72
90
B
58544
Laparoscopy, surgical, supracervical hysterectomy, uterus >250g; with removal of tube(s) and/or ovary(s)
R3,226.85
90
B
58545
Laparoscopy, surgical, myomectomy, 1-4
R2,849.66
90
C
58546
Laparoscopy, surgical, myomectomy, excision; >5 myomas. total >250g
R3,619.42
90
C
58548
Laparoscopy, surgical, radical, hysterectomy
R5,641.37
90
C
58550
Laparoscopy surgical, with vaginal hysterectomy, uterus <250g
R2,803.54
90
C
58552
Laparoscopy surgical, with vaginal hysterectomy, uterus <250g + adnexae,
R3,094.42
90
C
58553
Laparoscopy, surgical, with vaginal hysterectomy, uterus >250g
R3,634.79
90
C
58554
Laparoscopy, surgical, with vaginal hysterectomy, uterus >250g + adnexae
R4,155.06
90
C
58578
Unlisted laparoscopy procedure, uterus
58660
Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis)
R2,129.56
90
A
58661
Laparoscopy; removal adnexal structures (oophorectomy &/or salpingectomy)
R2,066.89
10
A
58662
Laparoscopy, fulguration/excision lesions ovary, pelvis, peritoneum, by any method
R2,251.35
90
A
58670
Laparoscopy, surgical; with fulguration of oviducts (+/- transection)
R1,149.32
90
A
58671
Laparoscopy, surgical; occlusion of oviducts (e.g. band, clip, or Falope ring)
R1,150.50
90
A
58672
Laparoscopy, surgical; with fimbrioplasty
R2,400.33
90
A
58673
Laparoscopy, surgical; with salpingostomy (salpingoneostomy)
R2,591.89
90
A
58679
Unlisted laparoscopy procedure, oviduct, ovary
59150
Laparoscopic treatment ectopic pregnancy
R2,457.09
90
A
59151
Laparoscopic treatment ectopic; + salpingectomy &/or oophorectomy
R2,425.16
90
A
20
57425
Laparoscopic Procedures
2009
2009
Endoscopic Procedures
Code
Description Endoscopic Procedures
NonFacility
facility
Notes
Oesophagoscopy - rigid or flexible
43200
Oesophagoscopy; diagnostic (separate procedure)
R673.99
R326.35
+99141 Cons. sedatn
43201
Oesophagoscopy; & submucosal injection, any substance
R839.53
R397.30
+99141 Cons. sedatn
43202
Oesophagoscopy; with biopsy, single or multiple
R884.46
R353.55
+99141 Cons. sedatn
43204
Oesophagoscopy; with sclerotherapy varices
R672.80
R672.80
+99141 Cons. sedatn
43205
Oesophagoscopy; with band ligation varices
R676.35
R676.35
+99141 Cons. sedatn
43215
Oesophagoscopy; with removal of foreign body
R477.70
R477.70
+99141 Cons. sedatn
43216
Oesophagoscopy; & hot biopsy or bipolar cautery
43217
Oesophagoscopy; & snare resection
43219
43220
R437.50
+99141 Cons. sedatn
R521.45
+99141 Cons. sedatn
Oesophagoscopy; with insertion plastic tube or stent
R525.00
R525.00
+99141 Cons. sedatn
Oesophagoscopy; with balloon dilation (<30 mm diameter)
R387.84
R387.84
+99141 Cons. sedatn
43226
Oesophagoscopy; with subsequent dilatation over guide wire
R429.22
R429.22
+99141 Cons. sedatn
43227
Oesophagoscopy; with control of bleeding, any method
R640.88
R640.88
+99141 Cons. sedatn
43228
Oesophagoscopy; with ablation of lesion, other techniques
R677.53
R677.53
+99141 Cons. sedatn
43231
Oesophagoscopy; with endoscopic ultrasound examination
R572.30
R572.30
+99141 Cons. sedatn
43232
Oesophagoscopy; with transendoscopic ultrasound-FNA/bx
R800.51
R800.51
+99141 Cons. sedatn
43458
Dilation oesophagus with balloon (≥30 mm Ø) for achalasia
R1,184.79
R552.19
+99141 Cons. sedatn
9
R437.50
R1,183.61
20
0
Upper gastro-intestinal endoscopy / oesophago-gastro-duodenoscopy (EGD)
43234
EGD (small diameter) (separate procedure)
R876.18
R365.37
+99141 Cons. sedatn
43235
EGD, diagnostic (separate procedure)
R918.75
R436.32
+99141 Cons. sedatn
43236
EGD with submucosal injection, any substance
R1,135.13
R527.36
+99141 Cons. sedatn
43237
EGD; & endo-ultrasound oesophagus only
R727.19
R727.19
43238
EGD & endoscopic US & FNA/bx oesophagus
R893.92
R893.92
43239
EGD; with biopsy, single or multiple
R1,050.00
R517.90
+99141 Cons. sedatn
43240
EGD; with transmural drainage of pseudocyst
R1,209.63
R1,209.63
+99141 Cons. sedatn
43241
EGD; & intraluminal tube or catheter placement
R470.61
R470.61
+99141 Cons. sedatn
43242
EGD; & endo-US FNA/biopsy stomach/duod/jej
R1,278.21
R1,278.21
+99141 Cons. sedatn
43243
EGD; with sclerotherapy oesophageal and/or gastric varices
R807.60
R807.60
+99141 Cons. sedatn
43244
EGD; with banding oesophageal and/or gastric varices
R892.73
R892.73
+99141 Cons. sedatn
43245
EGD; with dilation of gastric outlet obstruction
R571.11
R571.11
+99141 Cons. sedatn
43246
EGD; with PEG
R763.85
R763.85
+99141 Cons. sedatn
43247
EGD; with removal of foreign body
R606.59
R606.59
+99141 Cons. sedatn
43248
EGD; with dilation oesophagus over guide wire
R568.75
R568.75
+99141 Cons. sedatn
43249
EGD; with balloon dilation oesophagus (<30mm)
R525.00
R525.00
+99141 Cons. sedatn
43250
EGD; with hot biopsy
R574.66
R574.66
+99141 Cons. sedatn
43251
EGD; with snare resection
R659.80
R659.80
+99141 Cons. sedatn
43255
EGD ; with control of bleeding
R852.53
R852.53
+99141 Cons. sedatn
43256
EGD; with trans-endoscopic stent (incl dilation)
R769.76
R769.76
+99141 Cons. sedatn
43257
Upper gastrointestinal endoscopy; with Stretta radiofrequency
R948.31
R948.31
+99141 Cons. sedatn
43258
EGD; with ablation lesion - other techniques
R805.23
R805.23
+99141 Cons. sedatn
43259
EGD; with endoUS EGD or jejunum
R911.65
R911.65
+99141 Cons. sedatn
Gastroscope (own equipment in own procedure room)
R387.20
+99070-252
Endoscopic Procedures
2009
(+) add-on
2009
Endoscopic Procedures
Code
Description Endoscopic Procedures
NonFacility
facility
Notes
Anoscopy
46600
Anoscopy; diagnostic
46604
Anoscopy; with dilation, any method
46606
Anoscopy; with biopsy, single or multiple
46608
R245.95
R106.42
R1,347.97
R241.22
R556.92
R158.45
Anoscopy; with removal of foreign body
R703.55
R273.14
46610
Anoscopy; with removal of single lesion - hot biopsy
R652.70
R248.31
46611
Anoscopy; with removal of single lesion - snare
R614.86
R327.53
46612
Anoscopy; with removal of multiple lesions - hot biopsy, snare, cautery
R924.66
R425.67
46614
Anoscopy; with control of bleeding
R542.74
R360.64
46615
Anoscopy; with ablation lesions - other techniques
R643.24
R480.07
Proctosigmoidoscopy - rigid
45300
Procto-sigmoidoscopy, rigid; diagnostic
45303
Procto-sigmoidoscopy, rigid; with dilation, any method
45305
45307
R85.13
R98.14
+99141 Cons. sedatn
Procto-sigmoidoscopy, rigid; with biopsy, single or multiple
R461.15
R192.74
+99141 Cons. sedatn
Procto-sigmoidoscopy, rigid; with removal of foreign body
R490.71
R182.09
+99141 Cons. sedatn
45308
Procto-sigmoidoscopy, rigid; removal single lesion - hot biopsy
R381.92
R161.99
+99141 Cons. sedatn
45309
Procto-sigmoidoscopy, rigid; removal single lesion - snare
R624.32
R363.01
+99141 Cons. sedatn
45315
Procto-sigmoidoscopy, rigid; removal multiple lesions - hot biopsy or snare
R542.74
R258.95
+99141 Cons. sedatn
45317
Proctosigmoidoscopy, rigid; with control of bleeding
R513.17
R273.14
+99141 Cons. sedatn
45320
Procto-sigmoidoscopy, rigid; with ablation lesion(s) - other techniques
R580.57
R290.88
+99141 Cons. sedatn
20
0
9
R242.40
R2,288.00
45321
Procto-sigmoidoscopy, rigid; with decompression of volvulus
R222.30
R222.30
45327
Procto-sigmoidoscopy, rigid; diagnostic; + stent (includes predilation)
R299.15
R299.15
+99070-343
Sigmoidoscope (rigid adult)
R68.30
(+) add-on
+99070-345
Sigmoidoscope (rigid paediatric)
R55.00
(+) add-on
+99141 Cons. sedatn
Proctosigmoidoscopy - flexible
45330
Sigmoidoscopy, flexible; diagnostic
R398.48
R185.64
45331
Sigmoidoscopy, flexible; with biopsy, single or multiple
R514.36
R222.30
45332
Sigmoidoscopy, flexible; with removal of foreign body
R839.53
R332.26
+99141 Cons. sedatn
45333
Sigmoidoscopy, flexible; with removal lesions - hot biopsy
R827.70
R329.90
+99141 Cons. sedatn
45334
Sigmoidoscopy, flexible; with control of bleeding
R493.07
R493.07
+99141 Cons. sedatn
45335
Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance
R627.87
R274.32
45337
Sigmoidoscopy, flexible; with decompression of volvulus, any method
R429.22
R429.22
+99141 Cons. sedatn
45338
Sigmoidoscopy, flexible; with removal lesions - snare
R934.12
R425.67
+99141 Cons. sedatn
45339
Sigmoidoscopy, flexible; with ablation lesions - other techniques
R878.55
R565.20
+99141 Cons. sedatn
45340
Sigmoidoscopy, flexible; with dilation by balloon, 1 or more strictures
R1,090.20
R346.45
+99141 Cons. sedatn
45341
Sigmoidoscopy, flexible; diagnostic, with endo-ultrasound examination
R468.24
R468.24
+99141 Cons. sedatn
45342
Sigmoidoscopy, flexible; endo-ultrasound guided FNA/biopsy
R716.55
R716.55
+99141 Cons. sedatn
45345
Sigmoidoscopy, flexible; diagnostic, + stent (includes predilation)
R521.45
R521.45
+99141 Cons. sedatn
Sigmoidoscope (flexible) (own equipment/rooms)
R332.80
+99070-255
(+) add-on
Colonoscopy (proximal to splenic flexure)
45355
Colonoscopy, transabdominal via colotomy, single or multiple
45378
Colonoscopy; diagnostic
R626.69
R626.69
+99141 Cons. sedatn
R1,204.90
R657.43
+99141 Cons. sedatn
45379
Colonoscopy; with removal of foreign body
R1,519.42
R826.52
+99141 Cons. sedatn
45380
Colonoscopy; with biopsy, single or multiple
R1,431.92
R786.32
+99141 Cons. sedatn
45381
Colonoscopy; with submucosal injection(s)
R1,389.36
R742.57
+99141 Cons. sedatn
45382
Colonoscopy; with control of bleeding
R1,907.26
R1,000.34
+99141 Cons. sedatn
45383
Colonoscopy; ablation lesion(s) - other techniques
R1,705.06
R1,026.35
+99141 Cons. sedatn
Endoscopic Procedures
2009
2009
Endoscopic Procedures
Code
Description Endoscopic Procedures
NonFacility
facility
Notes
Colonoscopy; ablation lesion(s) - hot biopsy
R1,415.37
R827.70
+99141 Cons. sedatn
45385
Colonoscopy; ablation lesion(s) - snare
R1,615.20
R934.12
+99141 Cons. sedatn
45386
Colonoscopy; with balloon dilation, one or more strictures
R2,049.15
R809.96
+99141 Cons. sedatn
45387
Colonoscopy; with stent (includes predilation)
R1,048.82
R1,048.82
+99141 Cons. sedatn
45391
Colonoscopy; with endo-ultrasound
R903.38
R903.38
+99141 Cons. sedatn
45392
Colonoscopy; with endo-US with FNA/biopsy
R1,136.32
R1,136.32
+99141 Cons. sedatn
44388
Colonoscopy through stoma; diagnostic
R995.61
R507.26
+99141 Cons. sedatn
44389
Colonoscopy through stoma; with biopsy, single or multiple
R1,197.80
R561.65
+99141 Cons. sedatn
44390
Colonoscopy through stoma; with removal of foreign body
R1,355.06
R675.17
+99141 Cons. sedatn
44391
Colonoscopy through stoma; with control of bleeding
R1,588.00
R766.21
+99141 Cons. sedatn
44392
Colonoscopy through stoma; with ablation lesion(s) - hot biopsy
R1,292.40
R673.99
+99141 Cons. sedatn
44393
Colonoscopy through stoma; with ablation lesion(s) - other tech
R1,465.03
R846.62
+99141 Cons. sedatn
44394
Colonoscopy through stoma; with ablation lesion(s) - snare
R1,509.96
R781.59
+99141 Cons. sedatn
44397
Colonoscopy through stoma; + stent (includes predilation)
R830.07
R830.07
+99141 Cons. sedatn
+99070-253
Colonoscope (own equipment in own procedure room)
R433.10
9
45384
(+) add-on
20
0
Enteroscopy
44360
Enteroscopy, beyond 2nd part of duodenum, not to ileum; diagnostic
R471.79
R471.79
+99141 Cons. sedatn
44361
Enteroscopy, >D2, not ileum; with biopsy, single or multiple
R520.27
R520.27
+99141 Cons. sedatn
44363
Enteroscopy, >D2, not ileum; with removal of foreign body
R625.51
R625.51
+99141 Cons. sedatn
44364
Enteroscopy, >D2, not ileum + removal lesion(s) - snare
R665.71
R665.71
+99141 Cons. sedatn
44365
Enteroscopy, >D2, not ileum + ablation lesion(s) - hot biopsy
R593.58
R593.58
+99141 Cons. sedatn
44366
Enteroscopy, >D2, not ileum; with control of bleeding
R782.77
R782.77
+99141 Cons. sedatn
44369
Enteroscopy, >D2, not ileum + ablation lesion(s) - other techniques
R798.14
R798.14
+99141 Cons. sedatn
44370
Enteroscopy, >D2, not ileum; + stent (includes predilation)
R860.81
R860.81
+99141 Cons. sedatn
44372
Enteroscopy, >D2, not ileum; + PEJ
R779.22
R779.22
+99141 Cons. sedatn
44373
Enteroscopy, >D2, not ileum; convert PEG to PEJ
R621.96
R621.96
+99141 Cons. sedatn
44376
Enteroscopy, beyond 2nd part of duodenum, including ileum; diagnostic
R923.48
R923.48
+99141 Cons. sedatn
44377
Enteroscopy, >D2, including ileum; with biopsy, single or multiple
R973.14
R973.14
+99141 Cons. sedatn
44378
Enteroscopy, >D2, including ileum; with control of bleeding
R1,248.65
R1,248.65
+99141 Cons. sedatn
44379
Enteroscopy, >D2, including ileum; + stent (includes predilation)
R1,312.50
R1,312.50
+99141 Cons. sedatn
44380
Ileoscopy, through stoma; diagnostic (separate procedure)
R204.56
R204.56
+99141 Cons. sedatn
44382
Ileoscopy, through stoma; with biopsy, single or multiple
R243.58
R243.58
+99141 Cons. sedatn
44383
Ileoscopy, through stoma; + stent (includes predilatation)
R533.28
R533.28
+99141 Cons. sedatn
44385
Endoscopy small intestinal (abdominal or pelvic) pouch; diagnostic
44386
Endoscopy small intestinal (abdominal or pelvic) pouch; with biopsy
44500
Introduction of long gastro-intestinal tube (separate procedure)
Endoscopic Procedures
2009
R673.99
R326.35
+99141 Cons. sedatn
R1,061.82
R384.29
+99141 Cons. sedatn
R80.41
R80.41
+99141 Cons. sedatn
2009
Endoscopic Procedures
Code
Description Endoscopic Procedures
NonFacility
facility
Notes
ERCP; biliary endoscopy
Endoscopic retrograde cholangio-pancreatography (ERCP); diagnostic
R1,048.82
R1,048.82
+99141 Cons. sedatn
43261
ERCP; with biopsy, single or multiple
R1,103.21
R1,103.21
+99141 Cons. sedatn
43262
ERCP; with sphincterotomy/papillotomy
R1,294.76
R1,294.76
+99141 Cons. sedatn
43263
ERCP; with sphincter of Oddi manometry
R1,281.75
R1,281.75
+99141 Cons. sedatn
43264
ERCP; with removal of stone(s) from biliary &/or pancreatic ducts
R1,554.90
R1,554.90
+99141 Cons. sedatn
43265
ERCP; with lithotripsy of stone(s), any method
R1,745.27
R1,745.27
+99141 Cons. sedatn
43267
ERCP; with nasobiliary or nasopancreatic drainage tube
R1,292.40
R1,292.40
+99141 Cons. sedatn
43268
ERCP; with pancreatic or bile duct stent
R1,308.95
R1,308.95
+99141 Cons. sedatn
43269
ERCP; with removal of foreign body &/or change of tube or stent
R1,436.65
R1,436.65
+99141 Cons. sedatn
43271
ERCP; with balloon dilation of ampulla, biliary &/or pancreatic duct
R1,294.76
R1,294.76
+99141 Cons. sedatn
43272
ERCP; with ablation lesion - other techniques
R1,297.13
R1,297.13
+99141 Cons. sedatn
+99070-254
+47550
9
43260
Duodenoscope (add-on for own equipment)
R410.20
(+) add-on
Biliary endoscopy, intra-operative (choledochoscopy)
R517.90
R517.90
(+) add-on
Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic
R1,034.63
R1,034.63
47553
Biliary endoscopy, percutaneous via T-tube or other tract; with biopsy
R1,031.08
R1,031.08
47554
Biliary endoscopy, percutaneous via T-tube or other tract; removal stone(s)
R1,566.72
R1,566.72
47555
Biliary endoscopy, percutaneous via T-tube or other tract; with dilation
R1,229.73
R1,229.73
47556
Biliary endoscopy, percut via T-tube or other tract; with dilation + stent
R1,389.36
R1,389.36
31505
Laryngoscopy, indirect; diagnostic (separate procedure)
R245.95
R148.99
31615
Tracheobronchoscopy through established tracheostomy incision
R561.65
R400.84
+99141 Cons. sedatn
31622
Bronchoscopy, rigid or flexible, diagnostic, +/- cell washing
R1,006.25
R470.61
+99141 Cons. sedatn
31623
Bronchoscopy, rigid or flexible; with brushing or protected brushings
R1,103.21
R476.52
+99141 Cons. sedatn
31624
Bronchoscopy, rigid or flexible; with biopsy(s), single or multiple sites
R1,026.35
R476.52
+99141 Cons. sedatn
20
0
47552
Laryngo-tracheo-bronchoscopy
Add-on for own endoscopic equipment in own endoscopic procedure
+99070-252
Gastroscope
R387.20
(+) add-on
+99070-253
Colonoscope
R433.10
(+) add-on
+99070-254
Duodenoscope
R410.20
(+) add-on
+99070-255
Sigmoidoscope (flexible)
R332.80
(+) add-on
+99070-343
Sigmoidoscope (rigid adult)
R68.30
(+) add-on
+99070-345
Sigmoidoscope (rigid paediatric)
R55.00
(+) add-on
+99141
Conscious sedation; (+) add on code
R321.62
Endoscopic Procedures
2009
R145.44
(+) add-on
2009
Diagnostic Procedures
Category
Code
Diagnostic Procedures
PC
TC
Total Value
76536
Ultrasound, soft tissues head & neck (e.g. thyroid, parathyroid, parotid)
R88.68
R205.74
R294.43
Ultrasound
76645
Ultrasound, breast(s) (unilateral or bilateral)
R86.32
R153.72
R240.03
Ultrasound
76700
Ultrasound, abdominal; complete
R131.25
R264.86
R396.11
Ultrasound
76705
Ultrasound, abdominal; limited (e.g. single organ, quadrant)
R95.78
R196.28
R292.06
Ultrasound
76770
Ultrasound, retroperitoneal (e.g. renal, aorta, nodes); complete
R119.43
R263.68
R383.11
Ultrasound
76775
Ultrasound, retroperitoneal (e.g. renal, aorta, nodes); limited
R94.59
R196.28
R290.88
Ultrasound
76776
Ultrasound, of transplanted kidney, +/- duplex Doppler study
R120.61
R275.51
R396.11
Ultrasound
76870
Ultrasound, scrotum and contents
R104.05
R219.93
R323.99
Ultrasound
76872
Ultrasound, transrectal
R113.51
R282.60
R396.11
Ultrasound
76880
Ultrasound, extremity, nonvascular, real time with image documentation
R94.59
R221.11
R315.71
Ultrasound
76936
Ultrasound guided compression repair arterial pseudo-aneurysm / AV fistula (incl. evaluation, compression & imaging)
R328.72
R750.84
R1,079.56
Ultrasound
76937
Ultrasound guidance for vascular access, realtime ultrasound visualisation of vascular needle entry
R50.84
R60.30
R111.15
Ultrasound
76940
Ultrasound guidance for, and monitoring of, parenchymal tissue ablation
R347.63
R0.00
R347.63
Ultrasound
76942
Ultrasonic guided needle placement (e.g., biopsy, aspiration, injection, localisation device), imaging & interpretation
R108.78
R391.38
R500.17
Ultrasound
76948
Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation
R61.49
R156.08
R217.57
Ultrasound
76950
Ultrasonic guidance for placement of radiation therapy fields
R94.59
R154.90
R249.49
Ultrasound
76965
Ultrasonic guidance for interstitial radioelement application
R221.11
R548.65
R769.76
Ultrasound
76970
Ultrasound study follow-up (specify)
R65.03
R158.45
R223.48
Ultrasound
76975
Gastro-intestinal endoscopic ultrasound, supervision and interpretation
R133.61
R0.00
R133.61
Ultrasound
76998
Ultrasound guidance, intraoperative
09
Ultrasound
R0.00
R61.49
77001
Fluoroscopic guidance for central venous access device placement, replacement or removal
R61.49
R201.01
R262.50
Fluoroscopy
77002
Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localisation device)
R85.13
R154.90
R240.03
Fluoroscopy
77003
Fluoroscopic guidance and localisation needle/catheter tip for spine or paraspinous diagnostic or therapeutic injection
R92.23
R141.89
R234.12
Fluoroscopy
77071
Manual application of stress performed by medical practitioner for joint radiography
R72.13
R29.56
R101.69
Mammography
77031
Stereotactic localisation guidance for breast biopsy or needle placement, each lesion
R257.77
R716.55
R974.32
Mammography
77032
Mammographic guidance for needle placement, breast (e.g., for wire localisation or for injection), each lesion
R89.86
R135.98
R225.84
Mammography
77051
Computer-aided lesion detection: diagnostic mammography (List separately in addition of code for primary procedure)
R10.64
R43.75
R54.39
Mammography
77052
Computer-aided lesion detection: screening mammography (List separately in addition of code for primary procedure)
R10.64
R43.75
R54.39
Mammography
77053
Mammary ductogram or galactogram, single duct, radiological supervision and interpretation
R59.12
R263.68
R322.80
Mammography
77054
Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation
R73.31
R389.02
R462.33
Mammography
77055
Mammography; unilateral
R29.56
R139.53
R169.09
Mammography
77056
Mammography; bilateral
R139.53
R175.00
R314.53
Mammography
77057
Screening mammography, bilateral (2-view film study of each breast)
R112.33
R151.35
R263.68
DXA
77080
DXA bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
R36.66
R91.05
R127.70
DXA
77081
DXA bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
R28.38
R82.77
R111.15
DXA
77082
Dual-energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment
R33.11
R81.59
R114.70
20
R61.49
Fluoroscopy
2009
Diagnostic Procedures
2009
Diagnostic Procedures
Code
Diagnostic Procedures
PC
TC
Total Value
91010
Oesophageal motility
R210.47
R1,058.88
R1,269.35
Gastroenterology
91011
Oesophageal motility study; with stimulation
R254.22
R1,314.56
R1,568.78
Gastroenterology
91012
Oesophageal motility study; with acid perfusion studies
R245.95
R1,445.18
R1,691.13
Gastroenterology
91034
Ambulatory pH study, nasal catheter
R164.36
R1,295.11
R1,459.46
Gastroenterology
91035
Ambulatory pH study, mucosal telemetry electrode
R266.05
R2,884.81
R3,150.86
Gastroenterology
91037
Oesophageal Impedance study 1st hour
R164.36
R761.50
R925.86
Gastroenterology
91038
Oesophageal Impedance study 1- 24 hours
R186.82
R555.84
R742.66
Gastroenterology
91040
Oesophageal balloon distension provocation study
R163.18
R2,884.81
R3,047.98
Gastroenterology
91065
Breath hydrogen test
R33.11
R380.75
R413.86
Gastroenterology
91110
Capsule endoscopy, bowel, interpretation and report
R605.40
R5,683.46
R6,288.87
Gastroenterology
91111
Capsule endoscopy, oesophagus, interpretation and report
R176.18
R5,060.92
R5,237.11
Gastroenterology
91120
Rectal sensation, tone, and compliance test
R161.99
R2,834.78
R2,996.78
Gastroenterology
91122
Anorectal manometry
R293.24
R1,183.94
R1,477.18
Vascular
93875
Non-invasive physiologic tests extracranial arteries, complete bilateral.
R36.66
R669.79
R706.44
Vascular
93880
Duplex scan extracranial arteries; complete bilateral study
R99.32
R1,617.49
R1,716.82
Vascular
93882
Duplex scan extracranial arteries; unilateral or limited study
R67.40
R1,033.86
R1,101.26
Vascular
93886
Transcranial Doppler, intracranial arteries; complete
R159.63
R1,892.64
R2,052.26
Vascular
93888
Transcranial Doppler study of the intracranial arteries; limited study
R105.24
R1,225.63
R1,330.86
Vascular
93922
Non-invasive studies upper/lower extremity arteries, single level, bilateral
R41.39
R786.51
R827.90
Vascular
93923
Non-invasive studies upper/lower extremity arteries, multiple levels/manoeuvres, complete bilateral study
R75.68
R1,181.16
R1,256.84
20
Gastroenterology
09
Category
Vascular
93924
Non-invasive studies lower extremity arteries, treadmill stress testing, complete bilateral study
R85.13
R1,425.73
R1,510.86
Vascular
93925
Duplex scan lower extremity arteries or grafts; complete bilateral study
R96.96
R2,001.02
R2,097.98
Vascular
93926
Duplex scan lower extremity arteries or grafts; unilateral or limited study
R66.22
R1,225.63
R1,291.84
Vascular
93930
Duplex scan upper extremity arteries or grafts; complete bilateral study
R78.04
R1,598.04
R1,676.08
Vascular
93931
Duplex scan upper extremity arteries or grafts; unilateral or limited study
R52.03
R1,050.54
R1,102.56
Vascular
93965
Non-invasive studies extremity veins, complete bilateral study
R57.94
R786.51
R844.45
Vascular
93970
Duplex scan extremity veins; complete bilateral study
R113.51
R1,561.91
R1,675.42
Vascular
93971
Duplex scan extremity veins; unilateral or limited study
R74.49
R1,053.32
R1,127.81
Vascular
93975
Duplex scan arterial inflow & venous outflow abdominal, pelvic, scrotal &/or retro-peritoneal organs; complete study
R299.15
R2,114.97
R2,414.13
Vascular
93976
Duplex scan arterial inflow & venous outflow abdominal, pelvic, scrotal &/or retro-peritoneal organs; limited study
R195.10
R1,178.38
R1,373.48
Vascular
93978
Duplex scan aorta, IVC, iliac vessels or grafts; complete study
R109.97
R1,389.60
R1,499.57
Vascular
93979
Duplex scan aorta, IVC, iliac vessels or grafts; unilateral or limited study
R73.31
R986.62
R1,059.93
Vascular
93979
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study
R73.31
R986.62
R1,059.93
Vascular
93980
Duplex scan of arterial inflow and venous outflow of penile vessels; complete study
R208.11
R814.31
R1,022.41
Vascular
93981
Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study
R72.13
R836.54
R908.67
Vascular
93990
Duplex scan of haemodialysis access
R42.57
R1,231.19
R1,273.75
2009
Diagnostic Procedures
2009
Transplant Surgery
Category
Code
Description Transplant Service
R
Heart-lung
32850
Donor pneumonectomy(ies) with preparation & maintenance of allograft (cadaver)
Heart-lung
32851
Lung transplant, single; without cardiopulmonary bypass
Heart-lung
32852
Lung transplant, single; with cardiopulmonary bypass
Heart-lung
32853
Lung transplant, double (bilateral sequential or en bloc); no cardiopulmonary bypass
R 10,265.86
Heart-lung
32854
Lung transplant, double (bilateral sequential or en bloc); + cardiopulmonary bypass
R 11,088.83
Heart-lung
32855
Backbench standard preparation cadaver donor lung allograft; unilateral
R 0.00
Heart-lung
32856
Backbench standard preparation of cadaver donor lung allograft; bilateral
R 0.00
Heart-lung
33930
Donor cardiectomy-pneumonectomy (including cold preservation)
R 0.00
Heart-lung
33933
Backbench standard preparation of cadaver donor heart/lung allograft
R 0.00
Heart-lung
33935
Heart-lung transplant with recipient cardiectomy-pneumonectomy
Heart-lung
33940
Donor cardiectomy (including cold preservation)
Heart-lung
33944
Backbench standard preparation of cadaver donor heart allograft
Heart-lung
33945
Heart transplant, with or without recipient cardiectomy
Intestine
44715
Backbench standard preparation of cadaver or living donor intestine allograft
Intestine
44720
Backbench reconstruction cadaver/living donor intestine allograft; venous anast, ea
Intestine
44721
Backbench reconstruction cadaver/living donor intestine allograft; art anastom, ea
Liver
47133
Donor hepatectomy (including cold preservation), from cadaver donor
Liver
47135
Liver allotransplantation; orthotopic, partial or whole, cadaver or living donor
R 14,643.21
Liver
47136
Liver allotransplantation; heterotopic, partial or whole, cadaver or living donor
R 12,419.06
R 0.00
R 8,571.44
R 9,633.26
R 11,603.19
R 0.00
R 0.00
20
0
9
R 14,080.38
R 0.00
R 824.15
R 1,208.44
R 0.00
Liver
47140
Donor hepatectomy (incl cold preservation), living donor; L lat segment only (II + III)
R 10,233.93
Liver
47141
Donor hepatectomy, + preparation & preservation allograft, living donor; total L lobectomy (II, III + IV)
R 12,180.21
Liver
47142
Donor hepatectomy, + preparation & preservation allograft, living donor; R lobectomy (V, VI, VII,+ VIII)
R 13,406.39
Liver
47143
Backbench prep cadaver donor whole liver graft, incl chole, prep cava, portal v, hepatic a & bile duct
R 0.00
Liver
47144
Backbench prep cadaver donor whole liver graft, + trisegment split whole liver graft into 2 partial grafts
R 0.00
Liver
47145
Backbench prep cadaver donor whole liver graft, + lobe split into 2 partial grafts
R 0.00
Liver
47146
Backbench reconstruction of cadaver or living donor liver graft; venous anastomosis, each
R 1,034.63
Liver
47147
Backbench reconstruction of cadaver or living donor liver graft; arterial anastomosis, each
R 1,207.26
Pancreas
48550
Donor pancreatectomy (including cold preservation), +/- duodenal segment for transplantation
R 0.00
Pancreas
48551
Backbench prep cadaver donor pancreas
R 0.00
Pancreas
48552
Backbench reconstruction of cadaver donor pancreas, venous anastomosis, each
Pancreas
48554
Transplantation of pancreatic allograft
R 7,099.31
Pancreas
48556
Removal of transplanted pancreatic allograft
R 3,514.18
Kidney
50300
Donor nephrectomy (including cold preservation); cadaver donor, unilat or bilat
Kidney
50320
Donor nephrectomy (including cold preservation); open, from living donor
Kidney
50323
Backbench standard preparation cadaver donor renal allograft
R 0.00
Kidney
50325
Backbench standard preparation living donor renal allograft (open or laparoscopic)
R 0.00
Kidney
50327
Backbench reconstruction cadaver/living donor renal allograft; venous anastom, ea
R 659.80
Kidney
50328
Backbench reconstruction of cadaver/living donor renal allograft; art anastom, ea
R 578.21
Kidney
50329
Backbench reconstruction cadaver/living donor renal allograft; ureteral anastom, ea
Kidney
50340
Recipient nephrectomy (separate procedure)
R 2,635.64
Kidney
50360
Renal allotransplantation, implantation of graft; without recipient nephrectomy
R 7,164.34
Kidney
50365
Renal allotransplantation, implantation of graft; with recipient nephrectomy
R 8,116.20
Kidney
50370
Removal of transplanted renal allograft
R 3,315.53
Kidney
50380
Renal autotransplantation, reimplantation of kidney
R 5,355.23
Transplant Surgery
2009
R 708.28
R 0.00
R 4,226.00
R 553.38
2009
Modifiers
Code
21
22
24
25
Long Description
Short Description
Prolonged Evaluation and Management Services: When the face-to-face or floor/unit service(s)
Prolonged Evaluation and Management Services.
provided is prolonged or otherwise greater than that usually required for the highest level of E/M
Report required.
service within a given category, it may be identified by adding modifier -21 to the E/M code. A
report may also be appropriate.
Unusual Procedural Services. This applies when the service(s) provided is greater than usually
Unusual Procedural Services. Report required.
required for the listed procedure, it may be identified by adding modifier -22 to the usual
procedure number. A report may also be appropriate.
Unrelated Evaluation and Management Service by the Same Medical Practitioner During a
Unrelated Evaluation and Management Service by
Postoperative Period: The medical practitioner may need to indicate that an evaluation and
Same Surgeon during Postoperative Period: different management service was performed during a postoperative period for a reason(s) unrelated to the
ICD 10 code required
original procedure. This circumstance may be reported by adding the modifier -24 to the
appropriate level of E/M service.
Significant, Separately Identifiable Evaluation and Management Service by Same Medical
Practitioner on Same Day of a Procedure or Other Service: The medical practitioner may need to
Significant, Separately Identifiable Evaluation and
indicate that on the day a procedure or service identified by a code was performed, the patient’s
Management Service by the Same Surgeon on the
condition required a significant, separately identifiable E/M service above and beyond the other
Same Day of a Procedure or Other Service: Note:
service provided or beyond the usual preoperative and postoperative care associated with the
This modifier is not used to report an E/M service
procedure that was performed. The E/M service may be prompted by the symptom or condition
that resulted in a decision to perform surgery. See
for which the procedure and/or service was provided. As such, different diagnoses are not
modifier -57.
required for reporting of the E/M services on the same date. This circumstance may be reported by
adding the modifier -25 to the appropriate level of E/M service. Note: This modifier is not used to
report an E/M service that resulted in a decision to perform surgery. See modifier -57.
Mandated services
Mandated services: Services related to mandated consultation and/or related services e.g., E/M
services mandated by a medical scheme, may be identified by adding the modifier -32 to the
appropriate level of E/M service.
47
Anaesthesia by surgeon
Anaesthesia by Surgeon: Regional or general anaesthesia provided by the surgeon may be
reported by adding the modifier -47 to the basic service. (This does not include local anaesthesia.)
Note: Modifier -47 would not be used as a modifier for the anaesthesia procedures.
50
Bilateral Procedure, unless otherwise identified in the
listings. The fee is 150% of the global amount. If
additional procedures are performed under the same
anaesthetic as the bilateral surgery, they should be
reported with modifier -51.
9
32
20
0
Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are
performed at the same operative session should be identified by adding the modifier -50 to the
appropriate five digit code. The fee for a bilateral procedure (if not otherwise indicated) is 150%
of the global amount when the bilateral modifier is applicable. If additional procedures are
performed under the same anaesthetic as the bilateral surgery, they should be reported with
modifier -51. The multiple rules apply with the bilateral procedure considered the first highest
valued procedure.
Multiple Procedures. When multiple procedures, other than evaluation and management services,
are performed at the same session by the same provider, the primary procedure or service may be
reported as listed. The additional procedure(s) or service(s) may be identified by appending the
Multiple Procedures: additional procedure(s) or
modifier -51 to the additional procedure or service code(s). Example: Local or regional nerve
service(s) identified by appending modifier –51 to
blocks performed for postoperative pain relief. (When these nerve blocks are administered as the
additional procedure or service code(s). Not for “add- primary anaesthetic technique they may not be reported in addition to the anaesthetic codes.)
on” codes. Major procedure charged at 100%, while Note: This modifier should not be appended to designated “add-on” codes (e.g., 22585, 22614
2nd to 5th procedures charged at 50%. Not
identified by a “+” symbol).The major procedure is charged for at 100% of the fee, while the
applicable in poli-trauma where 100% of fee for all second to the fifth procedures performed under the same anaesthetic, are charged for at 50% of
procedures may be charged.
the fee. Additional surgical procedures beyond the fifth should be negotiated with the funder on a
“by-report” basis.This modifier is not applicable if two or more surgeons of different specialities
(e.g., multiple trauma cases) each performs distinctly different procedures on the same patient at
the same time. Should multiple procedures be performed by some of the said surgeons, modifier Reduced Services: Under certain circumstances a service or procedure is partially reduced or
eliminated at the medical practitioner’s discretion. Under these circumstances the service provided
can be identified by its usual procedure number and the addition of the modifier -52’, signifying
Reduced Services: Under certain circumstances a
that the service is reduced. This provides a means of reporting reduced services without disturbing
service or procedure is partially reduced or
the identification of the basic service. Notes: For hospital out-patient reporting of a previously
eliminated at the Surgeon’s discretion.
scheduled procedure/service that is partially reduced or cancelled as a result of extenuating
circumstances or those that threaten the well-being of the patient prior to or after administration
of anaesthesia, see modifiers -73 and -74.
51
52
53
Discontinued Procedure: Under certain
circumstances, the Surgeon may elect to terminate a
surgical or diagnostic procedure.
54
Surgical Care Only.
55
56
57
Discontinued Procedure: Under certain circumstances, the medical practitioner may elect to
terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that
threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic
procedure was started but discontinued. This circumstance may be reported by adding the
modifier -53 to the code reported by the medical practitioner for the discontinued procedure.
Note: This modifier is not used to report the elective cancellation of a procedure prior to the
patient’s anaesthesia induction and/or surgical preparation in the operating suite. For outpatient
hospital/day clinic reporting of a previously scheduled procedure/service that is partially reduced
or cancelled as a result of extenuating circumstances or those that threaten the well -being of the
patient prior to or after administration of anaesthesia, see modifiers -73 and -74.
Surgical Care Only: When one medical practitioner performs a surgical procedure and another
provides pre-operative and/or post-operative management, surgical services may be identified by
adding the modifier -54 to the usual procedure number.
Postoperative Management Only. When one medical practitioner performs the postoperative
management and another medical practitioner has performed the surgical procedure, the
Postoperative Management Only
postoperative component may be identified by adding the modifier '-55 to the usual procedure
number. Post-operative pain management procedures applied by the anaesthetist form no part of
surgical post-operative management.
Pre-operative Management Only: When one medical practitioner performs the pre-operative care
and evaluation and another medical practitioner performs the surgical procedure, the preoperative component may be identified by adding the modifier -56 to the usual procedure number.
Pre-operative Management Only
When a medical practitioner performs only part of a global surgical procedure (pre-operative care,
intra-operative care, or post-operative care) services are chargeable using a percentage of the
global amount that is service specific.
Decision for Surgery: Add modifier -57 to an E & M Decision for Surgery: An evaluation and management service that resulted in the initial decision to
service that resulted in the decision to perform the
perform the surgery, may be identified by adding the modifier -57 to the appropriate level of E/M
surgery.
service.
Modifiers
2009
2009
Modifiers
Code
Long Description
Short Description
Staged or Related Procedure or Service by the Same Medical Practitioner: The treating medical
practitioner may want to indicate that the performance of a procedure or service during the postoperative period was: a) planned prospectively at the time of the original procedure (staged); b)
more extensive than the original procedure; or c) for therapy following a diagnostic surgical
procedure. This circumstance may be reported by adding the modifier -58 to the staged or related
procedure. Note: This modifier is not used to report the treatment of a problem that requires a
return to the operating room. See modifier -78. Full payment for the procedure (not just the intraoperative services), is allowed for situations when distinctly separate, but related procedures are
performed during the global period of another surgery (e.g., reconstructive and burn surgery), in
which the patient is admitted to the hospital for treatment, discharged, and then readmitted for
further treatment.
59
Distinct Procedural Service. Under certain circumstances the medical practitioner may need to
indicate that a procedure or service was distinct or independent from other services performed on
the same day. Modifier -59 is used to identify procedure services that are not normally reported
Distinct Procedural Service. Certain circumstances together but are appropriate under the circumstances.This may represent a different session or
patient encounter, different procedure or surgery, different site or organ system, seperate
may dictate that a procedure or service was distinct
or independent from other services performed on the incision/excision, seperate lesion, or seperate injury (or area of injury in extensive injuries) not
ordinarily encountered or performed on the same day by the same medical practitioner. However,
same day.
when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier -59 best explains the
circumstances, should modifier -59 be used.
62
Two Surgeons: When two surgeons work together as primary surgeons performing distinct part(s)
of a procedure, each surgeon should report his/her distinct operative work by adding the modifier Two Surgeons working together as primary surgeons 62 at 62.5% to the procedure code and any associated add-on code(s) for that procedure as long
as both surgeons continue to work to together as primary surgeons. Each surgeon should report
performing distinct part(s) of procedure, each
surgeon should report his/her distinct operative work the co-surgery once using the same procedure code. If additional procedure(s) (including add-on
procedure(s)) are performed during the same surgical session, separate code(s) may also be
by adding modifier -62 to the procedure code and
reported with the modifier -62 added. Note: If a co-surgeon acts as an assistant in the performance
any associated add-on code(s) for that procedure.
of additional procedure(s) during the same surgical session, those services may be reported using
separate procedure code(s) with the modifier -80 or modifier -82 added, as appropriate.
20
0
9
58
Staged or Related Procedure or Service by Same
Surgeon. Note: This modifier is not used to report
treatment of a problem that requires return to the
operating room. See modifier -78.
63
Procedures Performed on Infants less than 4 kg
Procedures Performed on Infants less than 4 kg: Procedures performed on neonates and infants up
to a present body weight of 4 kg may involve significantly increased complexity and medical
practitioner work commonly associated with these patients. This circumstances may be reported
by adding the modifier -63 to the procedure number. Note: Unless otherwise designated, this
modifier may only be appended to procedures/services listed in the 20000-69999 code series.
Modifier -63 should not be appended to any CPT codes listed in the Evaluation and Management
Services, Anaesthesia, Radiology, Pathology/Laboratory, or Medicine sections.
66
Surgical Team: Under some circumstances, highly
complex procedures are carried out under the
“surgical team” concept.
Surgical Team: Under some circumstances, highly complex procedures (requiring the concomitant
services of several medical practitioners, often of different specialities, plus other highly skilled,
specially trained personnel, various types of complex equipment) are carried out under the
“surgical team” concept. Such circumstances may be identified by each participating medical
practitioner with the addition of the modifier -66 to the basic procedure number used for
reporting services.
76
Repeat Procedure by Same Surgeon
Repeat Procedure by Same Medical Practitioner: The medical practitioner may need to indicate
that a procedure or service was repeated subsequent to the original procedure or service. This
circumstance may be reported by adding the modifier -76 to the repeated procedure/service.
77
Repeat Procedure by Another Medical Practitioner
Repeat Procedure by Another Medical Practitioner: The medical practitioner may need to indicate
that a basic procedure or service performed by another medical practitioner had to be repeated.
This situation may be reported by adding modifier -77 to the repeated procedure/service.
78
Return to the Operating Theatre for a Related
Procedure During the Post-operative Period
Return to the Operating Theatre for a Related Procedure During the Post-operative Period: The
medical practitioner may need to indicate that another procedure was performed during the postoperative period of the initial procedure. When this subsequent procedure is related to the first,
and requires the use of the operating theatre, it may be reported by adding the modifier -78 to the
related procedure. (For repeat procedures on the same day, see -76). If complications following
surgery require the patient’s return to the operating theatre for any reason for care determined to
be medically necessary, modifier -78 would be applicable. Charges for re-operations must be for
the intra-operative services only, and not for additional pre- and post-operative care. Separate
payment is allowed for treatment for complications requiring expertise beyond that of the
surgeon. Full payment is made to the medical practitioner who provided such treatment. Separate
payment is allowed for treatment for complications requiring expertise beyond that of the
surgeon. Full payment is made to the medical practitioner who provided such treatment.
79
Unrelated Procedure or Service by Same Medical Practitioner during Post-operative Period: may
Unrelated Procedure or Service by the Same Surgeon need to indicate that the performance of a procedure or service during the post-operative period
during the Post-operative Period
was unrelated to the original procedure. This circumstance may be reported by using the modifier 79. (For repeat procedures on the same day, see -76’).
99
Multiple modifiers: add -99 to the basic procedure; Multiple modifiers: Under certain circumstances two or more modifiers may be necessary to
other applicable modifiers listed in the description of completely delineate a service. In such situations modifier -99 should be added to the basic
the service.
procedure, and other applicable modifiers may be listed as part of the description of the service.
Modifiers
2009
2009
Modifiers
Code
Long Description
Short Description
80
Assistant Surgeon: 20% of the surgeon’s fee
82
Specialist Surgeon: 40%
Assistant Surgeon: 20% of the surgeon’s fee with a minimum of R354.73 (3 RVUs).
Specialist Surgeon Acting as Assistant Surgeon in procedures of a specialised nature: 40% Note:
for most major surgical procedures reimbursement will be limited to one specialist surgeon or 2
general practitioners. A report is required if the circumstances warrant a different arrangement of
assistants.
Unusual Procedural Services. This applies when the
09922 service(s) provided is greater than usually required
for the listed procedure. A report usually required.
Unrelated Evaluation and Management Service by
09924 the Same Surgeon During a Postoperative Period:
09950
Bilateral Procedure, unless otherwise identified in the
listings. The fee is 150% of the global amount. If
additional procedures are performed under the same
anaesthetic as the bilateral surgery, they should be
reported with modifier 09951.
09951
Multiple Procedures, performed at the same session,
additional procedure(s) or service(s) identified by
appending modifier 09951 to the additional
procedure or service code(s). Note: This modifier
should not be appended to “add-on” codes. The
major procedure charged at 100%, while the 2nd to
5th procedures charged at 50%. Additional surgical
procedures beyond the fifth to be negotiated with
funder “by-report”. Modifier 09951 not applicable in
poli-trauma where 100% of fee for all procedures is
to be charged.
9
09925
different ICD 10 code required
Significant, Separately Identifiable Evaluation and
Management Service by the Same Surgeon on the
Same Day of a Procedure or Other Service: Note:
This modifier is not used to report an E/M service
that resulted in a decision to perform surgery. See
modifier 09957.
Reduced Services: Under certain circumstances a
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0
09952 service or procedure is partially reduced or
09953
eliminated at the Surgeon’s discretion.
Discontinued Procedure: Under certain
circumstances, the Surgeon may elect to terminate a
surgical or diagnostic procedure.
Surgical Care Only.
09954
09955 Postoperative Management Only
09956 Pre-operative Management Only
09957
09958
Decision for Surgery: An E & M service that resulted
in the initial decision to perform the surgery
identified by adding the modifier 09957 to the E/M
service.
Staged or Related Procedure or Service by Same
Surgeon. Note: This modifier is not used to report
treatment of a problem that requires return to the
operating room. See modifier 09978.
09959
Distinct Procedural Service. Certain circumstances
may dictate that a procedure or service was distinct
or independent from other services performed on the
same day. Modifier 09959 used to identify procedure
services that not normally reported together but are
appropriate under the circumstances. This may
represent a different session or patient encounter,
different procedure or surgery, different site or organ
system, separate incision/excision/lesion/injury (or
area of injury in extensive injuries) not ordinarily
encountered or performed on the same day.
09962
Two Surgeons working together as primary surgeons
performing distinct part(s) of procedure, each
surgeon should report his/her distinct operative work
by adding modifier 09962 to the procedure code and
any associated add-on code(s) for that procedure as
long as both surgeons continue to work to together as
primary surgeons.
09963 Procedures Performed on Infants less than 4 kg
09966
Surgical Team: Under some circumstances, highly
complex procedures (requiring concomitant services
of several medical practitioners, often of different
specialities, + other specially trained personnel,
various types of complex equipment) carried out
under the “surgical team” concept.
09976 Repeat Procedure by Same Surgeon
09977 Repeat Procedure by Another Medical Practitioner
Modifiers
2009
2009
Modifiers
Code
09979
09980
09982
09999
Upper left, eyelid
Lower left, eyelid
Upper right, eyelid
Lower right, eyelid
Left hand, second digit
Left hand, third digit
Left hand, fourth digit
Left hand, fifth digit
Right hand, thumb
Right hand, second digit
Right hand, third digit
Right hand, fourth digit
Right hand, fifth digit
Left hand, thumb
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0
-E1
-E2
-E3
-E4
-F1
-F2
-F3
-F4
-F5
-F6
-F7
-F8
-F9
-FA
-LC
9
09978
Long Description
Short Description
Return to the Operating Theatre for a Related
Procedure During the Post-operative Period
Unrelated Procedure or Service by the Same Surgeon
during the Post-operative Period
Assistant Surgeon: 20% of the surgeon’s fee with a
minimum of R286.80 (3 RVUs).
Specialist Surgeon Acting as Assistant Surgeon in
procedures of a specialised nature: 40% Note: for
most major surgical procedures reimbursement will
be limited to one specialist surgeon or 2 general
practitioners. A report is required if the
circumstances warrant a different arrangement of
assistants.
Multiple modifiers: Under certain circumstances two
or more modifiers may be necessary to completely
delineate a service. In such situations modifier
09999 should be added to the basic procedure, and
other applicable modifiers may be listed as part of the
description of the service.
-LD
-RC
-LT
-RT
-T1
-T2
-T3
-T4
-T5
-T6
-T7
-T8
-T9
-TA
LEFT CIRCUMFLEX CORONARY ARTERY
LEFT ANTERIOR DESCENDING CORONARY
ARTERY
RIGHT CORONARY ARTERY
Left circumflex coronary artery
Left anterior descending coronary artery
Right coronary artery
Left side
Right side
Left foot, second digit
Left foot, third digit
Left foot, fourth digit
Left foot, fifth digit
Right foot, great toe
Right foot, second digit
Right foot, third digit
Right foot, fourth digit
Right foot, fifth digit
Left foot, great toe
A
1 non-specialist assistant
B
2 non-specialist assistants OR 1 specialist assistant
C
1 non-specialist assistant AND 1 specialist assistant
Assistant code D allows reimbursement of 1 non-specialist assistant AND 1 specialist assistant
D
2 specialist assistants
Assistant code D allows reimbursement of 2 specialist assistants
26
Professional Component
09926 Professional Component
Assistant code A allows reimbursement of 1 non-specialist assistant at operation
Assistant code B allows reimbursement of 2 non-specialist assistants OR 1 specialist assistant at
the operation
Professional Component: Certain procedures are a combination of a medical practitioner
component and a technical component. When the medical practitioner component is reported
separately, the service may be identified by adding the modifier’-26 to the usual procedure
number.
Professional Component: Certain procedures are a combination of a medical practitioner
component and a technical component. When the medical practitioner component is reported
separately, the service may be identified by adding the modifier’-26 to the usual procedure
number.
-TC
Technical component
Equipment, facility and staff costs
-TC
Technical component
Equipment, facility and staff costs
Office (includes out-patient facility e.g. endoscopy
suite)
Office (includes out-patient facility e.g. endoscopy suite)
POS-11
POS-21 Inpatient hospital e.g. theatre
Inpatient hospital e.g. theatre
Modifiers
2009