Z594

PDF page 320 / A192

Consultation
       A diagnostic radiology consultation is the service rendered when:
      a. radiographs or ultrasounds made at one institution or facility are referred to a radiologist at a
          different institution or facility for his/her written opinion. In this case, the specific elements are
          as for diagnostic radiology professional component (see page D1);
      b. a radiologist is required to make a special visit at evening or night (17:00h to 07:00h) or on a
         Saturday, Sunday or holiday to consult on the advisability of performing a diagnostic
         radiological procedure which eventually is not done. In this case, the specific elements are
         the same as for consultations; or
      c. when a radiologist is required to render an opinion prior to an interventional procedure and
         all of the following requirements are met. In this case, the specific elements are the same as
         for consultations:
           i.   the consultation is performed in an area remote from the radiologist’s normal procedural
                suite;
           ii. the requirements for a consultation are met;
           iii. the consultation is not solely for the purpose of clarifying or obtaining consent; and
           iv. the associated procedure is one of the following: J021, J025, J040, J041, J046, J048,
               J049, J050, J055, J056, J057, J058, J059, J063, J065, J066, N107, N118, N122, N125,
               S233, Z446, Z456, Z562, Z594.
 A335 Consultation............................................................................                 57.90
       Payment rules:
       1.A diagnostic radiology consultation is not eligible for payment when radiographs made in a
         different institution or facility are used for comparison purposes with radiographs or
         ultrasounds made in the consultant’s institution or facility.
       2.A335 is not eligible for payment for CT and MRI services.
       [Commentary:
       For a second opinion by a radiologist of CT and MRI studies, see A330 and A332 respectively.]

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 705 / S23

APPENDIX
# S204 Incision and drainage of abscess ...........................................                  6      273.60    7
# S207 Appendectomy with or without perforation.............................. 6 524.60                                7
      Payment rules:
      1.S204, S313, S314, Z594 and E686 are not eligible for payment with S207.
         [Commentary:
         S207 is to be claimed for an appendectomy regardless of whether the appendix is intact or
         ruptured.]

PDF page 717 / S35

Peritoneal abscess
# S313 - subphrenic..........................................................................        7     370.95    7
# S314 - abdominal...........................................................................        6     301.10    7
# Z569 Pelvic abscess, incision and drainage - rectal or vaginal
         approach ............................................................................             122.05    7
# Z594 Percutaneous abdominal abscess drainage including daily
         supervision, for one or more abscesses within the same
         abdominal quadrant or the pelvis .......................................                          508.80
# E686   - within each other abdominal quadrant, or the pelvis (if the
           initial abscess was not in the pelvis) .......................... add                           144.10
   Z595 Replacement of drainage catheter in abdominal abscess ......                                        54.05
# Z574 Removal of infected sutures from abdominal wall or re-
         exploration of wound for bleeding - general anaesthetic....                                 6      94.85    7
# S311 Umbilical vein intra-abdominal dissection and catheterization    6       232.50      6
      Note:
      For vascular newborn - see Diagnostic & Therapeutic Procedures - Vascular Cannulation.
# S320 Insertion of antabuse into abdominal wall...............................                             58.15
    Insertion of peritoneo-jugular shunt for ascites
# S203 - primary ...............................................................................     7     281.85    7
# S209 - revision ...............................................................................    7     237.00    7
# S310 Insertion of intraperitoneal chemotherapy port by laparotomy
          or laparoscopy.................................................................... 6 215.10 6
# S315 Removal of intraperitoneal chemotherapy port by laparotomy
          or laparoscopy.................................................................... 6 215.10 6
      Payment rules:
      S310 or S315 are not eligible for payment in addition to any open or laparoscopic abdominal
      procedure.

Master, record 7321. Record Layout PDF, page 1.

Z59420260401999999990000508800000000000000000000000000000000000000000000000

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.