E860

PDF page 452 / J38

Note:
         1.E860 is not eligible for payment with R852 or R885, except in circumstances described in
           paragraph 23 of Surgical Preamble.
         2.Z552, Z553 and S312 are not eligible for payment in association with R852 or R885.

PDF page 547 / SP5

A major or minor peripheral nerve block, major plexus block, neuraxial injection (with or without
        catheter) or intrapleural block (with or without catheter) for post-operative pain control (with a
        duration of action more than 4 hours) is eligible for payment as G224 when rendered in
        conjunction with a procedure which the physician performs on the same patient.
         [Commentary:
         For additional information, refer to the Nerve Blocks - Acute Pain Management, Nerve Blocks -
         Interventional Pain Injections or Nerve Blocks - Peripheral/Other sections of the Schedule.]
    21. If claims are being submitted in coded form, the surgeon should add the suffix A to the listed
        procedural code, the surgical assistant should add the suffix B to the listed procedural code and
        the anaesthesiologist should add the suffix C to the listed procedural code.
    22. When Z222/Z223 is claimed for a patient for whom the physician submits a claim for rendering
        another insured service on the same day, the amount payable for Z222/Z223 is reduced to nil.
    23. When a surgical procedure is attempted laparoscopically in the digestive system or the female
        genital system, but requires conversion to a laparotomy, unless otherwise specified, the
        diagnostic laparoscopic fee E860 is payable in addition to the procedural fee.

PDF page 548 / SP6

SURGICAL PREAMBLE
PREAMBLE
 24. Morbidly obese patients
     E676 is eligible for payment once per patient per physician in addition to the amount eligible for
     payment for the major surgical procedure(s) where a morbidly obese patient undergoes major
     surgery to the neck, thorax, peritoneal cavity, retroperitoneum, pelvis, or hip and:
    a. the patient has a Body Mass Index (BMI) greater than 40
    b. the surgery is rendered under general anaesthesia using either an open technique for the
       neck, thorax, or hip, or an open or laparoscopic technique for the peritoneal cavity, pelvis,
       retroperitoneum; and
    c. the principal surgical technique is neither aspiration, core or fine needle biopsy, dilation,
       endoscopy, mediastinoscopy, thoracoscopy, cautery, ablation nor catheterization.
E676A Morbidly obese patient, surgeon, to procedural fee(s)...... add                      25%
E676B Morbidly obese patient, surgical assistant, to major procedure
        add                                                                               6 units
     Note:
     E676A/B is only payable with the following procedures: D043, D046, D047, D052, E090, E499,
     E500, E505, E546, E589, E593, E626, E627, E655, E664, E673, E686, E697, E704, E706,
     E707, E708, E709, E711, E712, E713, E714, E718, E721, E722, E725, E728, E729, E731,
     E733, E734, E735, E736, E737, E738, E739, E743, E745, E748, E752, E754, E762, E764,
     E765, E766, E767, E768, E769, E771, E794, E796, E852, E853, E854, E855, E857, E860,
     E880, E882, E883, E884, E885, F100, F101, F135, M081, M082, M084, M090, M099, M100,
     M142, M143, M144, P018, P041, P042, P050, P055, P056, P057, P058, P059, P060, R108,
     R109, R216, R241, R269, R330, R423, R439, R440, R443, R470, R481, R488, R491, R553,
     R569, R590, R627, R628, R639, R686, R786, R800, R802, R803, R805, R806, R807, R811,
     R814, R815, R817, R823, R825, R826, R834, R839, R852, R855, R856, R858, R860, R861,
     R910, R885, R905, R913, R914, R915, R932, R933, R934, R935, R936, R937, S089, S090,
     S114, S115, S116, S117, S118, S120, S121, S122, S123, S124, S125, S128, S129, S131,
     S132, S133, S134, S137, S138, S139, S140, S149, S150, S154, S157, S158, S159, S160,
     S162, S164, S165, S166, S167, S168, S169, S170, S171, S172, S173, S175, S176, S177,
     S180, S182, S183, S184, S185, S187, S188, S189, S191, S192, S193, S194, S195, S196,
     S197, S199, S204, S207, S213, S214, S215, S217, S218, S222, S227, S265, S266, S267,
     S269, S270, S271, S274, S275, S276, S278, S280, S281, S282, S285, S287, S291, S292,
     S294, S295, S297, S298, S299, S300, S301, S302, S303, S304, S305, S306, S307, S308,
     S309, S310, S311, S312, S313, S314, S315, S318, S319, S321, S323, S325, S329, S332,
     S340, S342, S343, S344, S345, S405, S411, S416, S420, S422, S424, S427, S431, S432,
     S433, S434, S435, S436, S438, S440, S441, S445, S446, S447, S448, S449, S450, S451,
     S452, S453, S454, S455, S457, S460, S461, S462, S465, S466, S467, S468, S471, S482,
     S483, S488, S490, S491, S512, S513, S546, S549, S561, S590, S650, S651, S652, S710,
     S714, S727, S728, S729, S731, S733, S735, S736, S738, S739, S740, S741, S743, S745,
     S747, S748, S750, S751, S757, S758, S759, S760, S761, S763, S764, S766, S775, S776,
     S778, S780, S781, S782, S784, S788, S789, S790, S792, S793, S795, S798, S799, S800,
     S813, Z427, Z526, Z552, Z553, Z564, Z569, Z577, Z594, Z737, Z738

PDF page 715 / S33

PREAMBLE
    1. Unless otherwise specified, when the laparoscope is used as a means of entrance to perform
       an intra-abdominal procedure, the laparoscopy is not eligible for payment.
                   2. When a diagnostic laparoscopy is performed prior to laparotomy, the initial procedure should be
                      claimed as E860.
                   3. When an exploratory laparotomy is performed followed by a colostomy through another incision
                      in the abdomen, the colostomy fee should be claimed at 100% and the laparotomy at 85% of the
                      listed fee.

PDF page 741 / V1

FEMALE GENITAL SURGICAL PROCEDURES
      PREAMBLE
                                                                                                                                               Asst   Surg     Anae
                  1. In composite operations such as anterior and posterior repair and D&C or anterior and posterior
                     repair and cauterization of cervix and biopsy, the amount payable is equal to the fee for the
                     major procedure(s).
                  2. A D&C is not eligible for payment if rendered with hysterectomy or management of ectopic
                     pregnancy (S784) or if rendered routinely with tubal occlusion.
  # E857                                                              - if a D&C is required for abnormal uterine bleeding and
                                                                        rendered with tubal occlusion or with diagnostic
                                                                        laparoscopy, to other procedure ................................ add           78.45
                  3. The amount payable for a D&C for pregnancy termination (S752, S756 or S785) is reduced to
                     85% of the full fee when rendered with tubal occlusion (S741).
                  4. Unless otherwise specified, when the laparoscope is used as a means of entrance to perform
                     an intra-abdominal procedure, the laparoscopy is not eligible for additional payment.
                  5. A diagnostic laparoscopy is eligible for payment as E860 when rendered prior to laparotomy.

PDF page 749 / V9

FEMALE GENITAL SURGICAL PROCEDURES
 FALLOPIAN TUBE
                                                                                               Asst   Surg     Anae
    EXCISION, SUTURE OR REPAIR
    Ectopic pregnancy
# S784 - management by any surgical technique............................                       6     462.20    7
# E852   - with tuboplasty ........................................................... add             49.25
# E860         - diagnostic laparoscopy prior to laparotomy ............... add                       131.45
# S738 Salpingectomy or salpingo-oophorectomy (uni- or bilateral) ..                            8     366.20    8
# S741 Tubal occlusion or interruption for the purpose of sterilization,
         by any method or approach................................................              8     155.70    8
    Tubal plastic operation with/without operating microscope (unilateral or bilateral)
# S735 - fimbriolysis.......................................................................... 6 334.35        6
# S736 - salpingostomy ....................................................................     6 359.55        7
# S739 - fimbriolysis and salpingostomy...........................................              6 434.55        7
# E862    - when performed laparoscopically, to S735, S736 or S739
            ........................................................................... add 25%
    Repair of extensive unilateral or bilateral tubal and peritubal disease
      For infertility, pelvic inflammatory disease or endometriosis with or without laser treatment and
      ureterolysis
# S743 - laparotomy.......................................................................... 8 657.00 8
# E862     - when performed laparoscopically, to S743 ........ add 25%
      Note:
      1.Z737 or E854 are not eligible for payment when rendered same patient same day as S743 by
        any surgeon.
         2.Reconstruction or repair for infertility following previous sterilization is not an insured service.
         3.S162 is only eligible for payment in addition to S743 when records document that a
           transmural intestinal resection was rendered.
    Laparoscopy
# Z552 - without biopsy.....................................................................    6     160.50    6
# Z553 - with biopsy and/or lysis of adhesions and/or removal of
         foreign body and/or cautery of endometrial implants .........                          8     196.65    8
# E855   - with dye injection........................................................ add              25.85
# E857   - with D&C .................................................................... add           78.45
# Z737 Laser treatment of extensive pelvic disease...........................                   8     215.80    8

Master, record 1554. Record Layout PDF, page 1.

E86020250401999999990000131450000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.