Z553

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 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 719 / S37

DIGESTIVE SYSTEM SURGICAL PROCEDURES
      ABDOMEN, PERITONEUM AND OMENTUM
                                                                                                      Asst   Surg     Anae
      ENDOSCOPY
      Peritoneoscopy, culdoscopy or 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
      REPAIR
  # S325 Omentopexy - as sole operative procedure............................                          6     305.05    7
      HERNIOTOMY
  # E725  - recurrent - all types of hernia, except oesophageal ... add                                4     130.00
      Inguinal and/or femoral
  # S322 - infants.................................................................................    6     522.60    7
  # S326 - children...............................................................................     6     442.20    6
  # S323 - adolescents and adults.......................................................               6     357.80    7
        Unilateral with exploration of other side
  # S328 - infants and children ............................................................           6     458.40    7
        Strangulated or incarcerated
  # S329 - without resection of bowel ..................................................               6     425.00    7
  # S330 - with resection of bowel .......................................................             6     660.50    7
  # S345 Massive sliding inguinal hernia ...............................................               6     491.15    7
    E726     - repeat recurrent inguinal hernia (more than 2 repairs), to
               S322, S323, S326, S329 or S330.............................. add                        4     257.35
      Umbilical
  # S332 - adolescent or adult, with or without resection of
            incarcerated/strangulated contents ....................................         6 324.20  6
  # S333 - child (operative), with or without resection of incarcerated/
            strangulated contents ......................................................... 6 240.75  6
  # E764    - umbilical hernia repair when done in conjunction with
              other abdominal surgery, to other surgery ................. add                  27.55
        Payment rules:
        1.E764 is only eligible for payment for services related to a pre-existing umbilical hernia that is
          documented in the patient’s permanent medical record prior to the service being provided.

PDF page 740 / U8

INCISION
# Z712 Biopsy, needle ........................................................................                   91.60         6
# E821    - when performed by transperineal method, to Z712 .........                                            20.00
# Z713 Biopsy, needle with drainage abscess....................................                      6           98.70         6
    EXCISION
    Prostatectomy
# S650 - simple, by retropubic or suprapubic approach, with or
           without removal of bladder stones......................................                6  689.75                     6
# S651 - radical, with or without removal of bladder stones .............                         6 1174.70                    10
# E792     - when performed laparoscopically, to S650 or S651
              ........................................................................... add 25%
      Note:
      1. Prostatectomy (S650, S651) does not include investigative cystoscopy but includes
         vasectomy when rendered.
      2. S651 includes S519 - plastic repair of bladder neck when rendered and/or S636 -
         vesiculectomy when rendered.
# S652 Staging pelvic lymphadenectomy for prostatic cancer
           (laparoscopic or open) must include at a minimum bilateral
           obturator nodes .................................................................. 7 431.20 10
# E792     - when performed laparoscopically, to S652 .........add 25%
      [Commentary:
      A sampling of nodes does not constitute a complete staging lymphadenectomy. When only a
      sampling of nodes is performed, either S312 - laparotomy or Z553 - laparoscopic biopsy, may
      be eligible for payment depending on procedure performed.]

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 7281. Record Layout PDF, page 1.

Z55320260401999999990000196650000001032800000000000000000127680000001276800

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.