M137

PDF page 654 / P14

INCISION
# Z340 Biopsy of lung, needle ............................................................                      243.30          7
# Z336 Biopsy of pleura, needle - including diagnostic aspiration ......                                         59.15          6
# Z341 Tube thoracostomy for closed drainage (chest tube) .............            76.80                                        6
# Z352 Intrapleural administration of thrombolytic or fibrinolytic agent
          via thoracostomy tube (chest tube) ....................................  50.00
# Z363 Removal of thoracostomy tube (chest tube) ...........................       20.00
      Payment rules:
      Z363 is not eligible for payment for the same patient on the same day as Z341.
# Z349 Intrapleural administration of chemotherapy or sclerosing
          agent - by any method........................................................                           23.25
# M133 Thoracotomy for removal of foreign body ...............................                        9         390.65          13
# M137 Thoracotomy with or without biopsy .......................................                     9         390.65          13
# M134 Thoracotomy for post-operative haemorrhage or empyema ..                                       9         390.65          13
# M132 Repair of ruptured diaphragm or plication of diaphragm by
         thoracic approach...............................................................             9         900.00          13
# M130 Closure of broncho-pleural fistula (transthoracic or
         trans-sternal) ......................................................................        9         584.75          13
# E609   - with intercostal muscle bundle, pericardium, Azygos vein,
           or pericardial fat pad, to M130 ................................... add                              121.70
# E610   - with myovascular flap (pectoralis major, latissimus dorsi,
           rectus abdominus) ..................................................... add                          263.80
# M135 Major decortication of lung for empyema or tumour ...............                             11         848.80          15
# Z339 Intercostal drainage with insufflation of sclerosing agent under
          general anaesthesia ...........................................................             6         182.90          6

PDF page 663 / Q5

CARDIOVASCULAR SURGICAL PROCEDURES
 HEART AND PERICARDIUM
                                                                                                    Asst   Surg      Anae
    Thoracotomy
# M137 - with or without biopsy..........................................................            9      390.65    13
# M134 - for post-operative haemorrhage ..........................................                   9      390.65    13
# Z401 Aspiration of pericardium.........................................................                   131.70
# Z414 Injection of pericardial sclerosing agents.................................                           23.10
# R750 Open biopsy of pericardium and drainage (transthoracic or
          epigastric)............................................................................   13      317.85    13
    Pericardiectomy
# R748 - one side open......................................................................        13      635.45    20
# R749 - both sides open or sternal split ...........................................               13     1097.90    20
    Pericardiotomy for Drainage
# R707 Surgical drainage of pericardial effusion for cardiac tamponade,
          by open or video-assisted thoracic surgery (VATS) approach                                13      600.00    13
         Note:
         1.R707 is not eligible for payment in the setting of pericardial effusion with no evidence of
           tamponade and clinical instability
         2.R707 is not eligible for payment in addition to pericardiocentesis or pericardiectomy
    Cardiotomy
# R712 - with exploration ...................................................................       18      525.75    20
# R713 - with removal of foreign body ...............................................               18      635.45    20
# R714 - with removal of tumour ........................................................            18      576.40    20
# E660   - epicardial E.P.S. mapping ...........................................add                         185.15
# E661   - endocardial E.P.S. mapping........................................add                            185.15
# E658   - HIS Bundle ablation ....................................................add                      278.10
# R711 Division of accessory conduction pathway (to include
          cardiotomy, mapping with or without HIS bundle) ...............                            nil    741.55    20
# R709 Left atrial ablative procedure for surgical treatment of atrial
          arrhythmia (either Cox-Maze procedure or performed using
          an energy source) ...............................................................         18      778.65    20
         Note:
         R709 includes all left atrial ablation sites, internal exclusion or external excision of the left atrial
         appendage, and the ablation procedure involving the pulmonary veins.
# R706 Right and left atrial ablative procedure for treatment of atrial
         arrhythmia - surgical procedure or performed with an energy
         source .................................................................................   18     1245.85    20
         Note:
         R706 includes all the required elements of R709 and also includes the ablation procedure
         involving any endocardial and epicardial right atrial ablation lines.
         [Commentary:
         Examples of energy sources used for ablation may include cryoablation, microwave, or
         radiofrequency (unipolar or bipolar) ablation.]

PDF page 785 / Z1

OTHER TERMS AND DEFINITIONS
                  1. The preamble to the Musculoskeletal System Surgical Procedures section also applies to this
                     section as applicable (e.g. fractures).
                  2. Fusion of one disc level (one motion segment) includes two levels of instrumentation.
                  3. Obtaining bone for grafting is included as a component of all fusion procedures and is not
                     eligible for payment when performed with any fusion procedure.
                  4. Thoracotomy performed in conjunction with spinal procedures by a surgeon not performing the
                     spinal surgery constitutes M137 (P14).
                  5. Laparotomy performed in conjunction with spinal procedures by a surgeon not performing the
                     spinal surgery constitutes S312 (S34).
                  6. Three-dimensional (3D) computer-assisted stereotactic navigation (E378) must include the pre-
                     operative or intra-operative generation of axial, sagittal and coronal reformatted images that are
                     processed and virtually represented in 3D by a surgical navigational system. In addition, the
                     surgical navigational system must be used to reflect the position of an image-guided (tracked)
                     surgical tool(s) relative to the patient's anatomy. This may be performed by either frame or
                     frameless technique and applies to any spinal level.
                  7. Two-dimensional (2D) computer-assisted stereotactic navigation (E379) must include the intra-
                     operative generation of antero-posterior, lateral or multiple oblique 2D views that are processed
                     and virtually represented in 2D by a surgical navigational system. In addition, the surgical
                     navigational system must be used to reflect the position of an image-guided (tracked) surgical
                     tool(s) relative to the patient's anatomy. This may be performed by either frame or frameless
                     technique and applies to any spinal level.
                     Note:
                     The use of an intra-operative imaging tool such as a portable x-ray, fluoroscope (2D or 3D), CT,
                     MRI or ultrasound for "live" localization without a surgical navigational system as defined
                     above does not constitute E378 or E379 and is not eligible for payment.
                  8. Acute spinal cord injury premium (E383) is only eligible for payment when rendered to patients
                     who are described under ASIA impairment scale ratings A to C and have acute conditions
                     which have been present for 6 weeks or less.

Master, record 3699. Record Layout PDF, page 1.

M13720260401999999990000390650000001161900000000000000000207480000002074800

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.