S121

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 695 / S13

DIGESTIVE SYSTEM SURGICAL PROCEDURES
 STOMACH
                                                                                              Asst   Surg     Anae
    Vagotomy
# S131 - truncal or selective .............................................................    7     375.80    7
# S124 - highly selective (as sole procedure without pyloroplasty or
         gastroenterostomy) ............................................................       7     572.85    7
# S121 Transabdominal vagotomy after previous vagotomy ..............                          7     416.50    8
      Note:
      For suture of duodenal ulcer, refer to S139 on next page.
# S120 Gastric bypass with Roux-en-Y anastomosis, for morbid
           obesity ................................................................................ 7 1350.00 10
# S115 Reversal of previous vertical banded gastroplasty .................                          7  820.00 10
# S114 Sleeve gastrectomy ................................................................          7  820.00 10
      Note:
      1.S114 Sleeve gastrectomy is only eligible for payment when:
          a.a Roux-en-Y gastric bypass is not possible due to small bowel disease/adhesions or
            previous surgery; or
          b.performed as a planned staged surgery in patients with a BMI > 60 to enable the patient
            to lose weight.
      2.S120 is an insured service only when all of the conditions set out in the Surgical Preamble
        are satisfied.
      3.S189 is not eligible for payment in conjunction with S120.
      4.S160 is not eligible for payment in conjunction with S120.
      5.Mini-gastric bypass (loop gastric bypass) does not constitute gastric bypass or partition for
        the purpose of S120.
         [Commentary:
         The second stage would be a gastric bypass with Roux-en-Y.]
# S113 Removal of gastric band ........................................................ 7 341.60               10
      Note:
      S113 is only eligible for payment when the gastric band requires removal due to:
      1.Complications related to the gastric band; or
      2.Conversion to gastric bypass.
# E793        - laparoscopic or laparoscopic assisted, to S113, S114,
                S115 or S120 ..................................................... add 25%
         [Commentary:
         1.S120 does not include the service described as adjustable gastric banding by laparoscopic
           or open surgical method. See section 37.1 of Regulation 552 under the Health Insurance
           Act.
         2.Morbid obesity refers to patients with a Body Mass Index (BMI) > 40.]

Master, record 5264. Record Layout PDF, page 1.

S12120260401999999990000416500000000903700000000000000000127680000001276800

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.