M157

PDF page 657 / P17

RESPIRATORY SURGICAL PROCEDURES
 LUNGS AND PLEURA
                                                                                                          Asst    Surg     Anae
    The following E codes may apply to the preceding M prefix excision codes:
# E612     - total extra-pleural pneumonectomy............................ add                        338.35
# E613     - sleeve pneumonectomy ............................................. add                   500.00
# E614     - omental graft .............................................................. add         162.45
# E615     - intra-pericardial dissection ......................................... add               250.00
# E611     - with resection of diaphragm and direct suture closure
              ................................................................................... add 145.00
# E849     - with resection of diaphragm and reconstruction requiring
             repair with mesh or equivalent synthetic material ...... add                             220.00
# E848     - with reconstruction of pericardium requiring repair with
             synthetic graft material .............................................. add               80.00
# E616     - bi-lobectomy on right side, or segmentectomy plus
             lobectomy (same side)............................................... add                 305.50
# E617     - with pleural tent.......................................................... add           78.80
# E618     - with decortication of remaining lobe(s) or major thoracic
             lysis of adhesions (requiring at least 60 minutes of
             additional dedicated operative time) .......................... add                      426.50
# E619     - sleeve lobectomy ....................................................... add             162.45
      Payment rules:
      E618 is only eligible for payment when a minimum of 60 minutes is dedicated to decortication
      of remaining lobes and/or major thoracic lysis of adhesions, exclusive of time spent rendering
      any other service or procedure to the patient.
         Medical record requirements:
         The physician must record on the patient’s permanent medical record the time when the
         decortication or lysis of adhesions started and ended. If the patient’s permanent medical record
         does not include this required information, the service is not eligible for payment.
# E620         - with wedge bronchoplasty.......................................... add                            78.80
# E621         - with diagnostic wedge resection ................................ add                              45.85
# E624         - with completion pneumonectomy for positive resection
                 margin ........................................................................ add              111.20
# E625         - with sleeve resection of pulmonary artery.................. add                                  142.20
# E608         - each additional wedge resection of lung (to a maximum of
                 3)................................................................................ add            84.15
# E607         - re-operation more than 30 days subsequent to previous
                 excision, to appropriate excision fee.......................... add                              152.30
# M155 Lung transplant (one lung)......................................................                    18    2773.25    40
   M156 Repeat lung transplant (one lung) ..........................................                       24    2670.55    40
   M157 Donor Heart - Lung removal ...................................................                     8      906.45    8

PDF page 666 / Q8

CARDIOVASCULAR SURGICAL PROCEDURES
HEART AND PERICARDIUM
                                                                                              Asst         Surg          Anae
    Percutaneous transluminal catheter assisted closure for Secundum atrial septal defect
  Z465 - device closure of a single defect ........................................ 198.55
  Z466 - device closure of two or more defects................................      347.45
      Note:
      A maximum of 2 services of either Z465 or Z466 are eligible for payment if the services are
      rendered by 2 different physicians, same patient same day.
# R870 Orthotopic cardiac transplantation ..........................................            18         1659.50         28
# R872 Donor cardiectomy .................................................................      7           527.80         8
# R874 Cardiopulmonary transplantation............................................              18         2565.30         28
# M157 Donor Heart - Lung removal ...................................................           8           906.45          8

Master, record 3709. Record Layout PDF, page 1.

M15720260401999999990000906450000001032800000000000000000127680000001276800

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.