S455

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 725 / T5

UROGENITAL AND URINARY SURGICAL PROCEDURES
 KIDNEY AND UPPER URINARY TRACT
                                                                                                    Asst   Surg     Anae
    Ureterointestinal anastomosis
# S455 - unilateral.............................................................................     6     355.60    7
# S462 - bilateral...............................................................................    6     469.10    6
    Ureterostomy
      Cutaneous
# S458 - unilateral.............................................................................     6     530.55    6
# S463 - with lower third ureterotomy ...............................................                6     409.10    6
# S459 Ureterovaginal fistula ..............................................................     6 596.95 6
    Ureterolysis for periureteral fibrosis
# S460 - unilateral............................................................................. 6 480.25 6
# E792      - when performed laparoscopically, to S460 ........ add 25%
      Note:
      When a physician submits a claim for performing any insured surgical procedure on the same
      patient on the same day as the physician submits a claim for rendering S460, the S460 service
      is included (in addition to the common elements) as a specific element of that other insured
      service.
    Ureteroplasty (Hutch)
# S461 - unilateral.............................................................................     6     355.60    6
    Bladder flap (Boari)
# S427 - to include re-implantation of ureter.....................................                   6     705.80    6
# E792    - when performed laparoscopically, to S427 ........ add 25%
       SUTURE
    Traumatic rupture, or transection (partial or complete)
      Immediate
# S465 - upper 2/3 ............................................................................      6     409.10    6
# S466 - lower 1/3.............................................................................      6     468.70    6
      Late repair
# S467 - upper 2/3 ............................................................................      6     467.85    6
# S468 - lower 1/3.............................................................................      6     517.15    7

Master, record 5493. Record Layout PDF, page 1.

S45520260401999999990000355600000000774600000000000000000111720000001117200

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.