Bupa Schedule of ProceduresFirst edition published in 1989 by The British United Provident Association Limited. Second edition published in 1992 by The British United Provident Association Limited. Third edition published in 1993 by The British United Provident Association Limited. Fourth edition published in 1997 by The British United Provident Association Limited. Material contained in the Bupa Schedule is © Bupa Insurance Limited 1999-2012. This work is based on the CCSD Schedule of Procedures. The CCSD Schedule of Procedures © The Clinical Classification and Schedule Development Group 1999-2012. Material contained in the Office of Population Censuses and Surveys Classification of Operations and Surgical Procedures Consolidated Fourth Revision, is © Crown Copyright 1990 and has been reproduced by kind permission of the Controller of Her Majesty’s Stationery Office and the NHSIA. Bupa Schedule of Procedures V2012.9 20th August 2012 Valid until 17th September 2012 © Bupa Insurance Limited 1999-2012 Bupa Schedule of Procedures Licence Terms and Conditions Use of the Bupa Schedule is subject to the following licence terms and conditions: Bupa is a member of the Clinical Classification and Schedule Development Group A. About this Licence: Your use of the CCSD Schedule (as defined below) shall be governed by these licence terms (the “Licence”). By making use of the information contained in the CCSD Schedule (as defined below), in whole or in part, you indicate your acceptance of these licence terms and conditions (the “Licence”). B. Who this Licence is from: The Licence is granted to you by Bupa Insurance Limited, a company incorporated in England under number 3956433 and whose registered office is at Bupa House, 15-19 Bloomsbury Way, London, WC1A 2BA (“Bupa”). Bupa and the other Members (as defined below) have set up the Clinical Classification & Schedule Development Group (“CCSD”) to administer the licensing of the CCSD Schedule. This licence is granted with the knowledge and approval of CCSD. C. Other elements that make up the CCSD Schedule: You should also be aware that the CCSD Schedule has to a certain extent been derived from (i) the NHS Schedule (as defined below) (the copyright in which is owned by the Controller of Her Majesty’s Stationery Office) and for which responsibility for its administration, maintenance and revision were transferred from the Office of Population, Censuses and Surveys to the NHSIA on 1 April 1996, and (ii) the Bupa Schedule (as defined below). Each Member co-owns the CCSD Schedule and, to the extent that it contains information and data from the NHS Schedule and the Bupa Schedule, has permission from the Controller of Her Majesty’s Stationery Office (and, to the extent relevant, the NHSIA) and Bupa to sub-license the use of such elements upon the terms of this Licence. D. Contacting the CCSD if you want a wider licence or other information: If you would like any further information regarding the CCSD Schedule, please do not hesitate to contact the CCSD by email to
[email protected] or by letter to The CCSD Project Office, c/o Westhill Consulting Limited, Amadeus House, Floral Street, LONDON WC2E 9DP. The Licence terms are as follows: Definitions In this Licence unless the context otherwise requires: “Bupa Schedule” means the schedule of surgical and medical procedures issued by Bupa including the electronic version of the same and including all updates, editions, revisions, consolidations and replacements thereof that may be produced from time to time; “CCSD Schedule” means the Clinical Classification and Schedule Development Schedule containing lists of surgical and medical procedures defined by reference to unique identifying codes and known as the “Clinical Classification and Schedule Development Schedule” and/or “CCSD Schedule of Procedures” and/or “CCSD Schedule” and/or the “CCSD Mapping Tool” which provides a map between CCSD Schedule codes and narratives and Bupa Schedule codes and narratives and/or by reference to any of the other Trade Marks, which is based on the NHS Schedule and the Bupa Schedule and includes whatever format it is made available in (for example, hard copy, electronic, CD-ROM, diskette, database and internet versions) together with all modifications, additions, revisions, consolidations, replacements, developments, enhancements, translations or alterations to it and all Trade Marks; “CCSD Group” means the Clinical Classification and Schedule Development Group as its composition may from time to time vary but which, at the date of execution of this Licence compromises the following private healthcare insurers: Bupa Insurance Limited (registered in England, No. 3956433), Norwich Union Healthcare Limited (registered in England, No.2464270), Bristol Contributory Welfare Association Limited (registered in England, No.00557223) CIGNA European Services (UK) Limited (registered in England, No.199739), First Assist Group Limited (registered in England, No. 4617115, AXA PPP Healthcare Limited (registered in England, No. 3148199); “CCSD Services” means CCSD Services Limited (registered in England, No. 05399460) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 -2– © Bupa Insurance Limited 1999-2012 Licence Terms and Conditions (continued) _______________________________________________________________________________ “Confidential Information” means secret or confidential commercial, financial, marketing, technical or other information, including without limitation the CCSD Schedule and any information in or relating to the CCSD Schedule, know-how, trade secrets and other information in any form or medium whether disclosed orally or in writing before or after the date of this Licence, together with any reproductions of such information in any form or medium or any part(s) of this information (and “confidential” means that the information, either in its entirety or in the precise configuration or assembly of its components, is not publicly available); “IPRs” means any patent, copyright, database right, moral right, design right, registered design, trade mark (whether registered or not), service mark, domain name, know-how, utility model, unregistered design or, where relevant, any application for any such right, or other industrial or intellectual property right subsisting anywhere in the world; “Members” means all the member entities of the CCSD Group as from time to time subsist; “NHSIA” means The NHS Information Authority (formerly known as The NHS Centre for Coding and Classification) of Woodgate, Loughborough, Leicester LE11 2TG or any successor body thereto; “NHS Schedule” means the “Classification of Surgical Operations and Procedures” first issued by the Office of Population, Censuses and Surveys in loose-leaf form in 1987 but now administered, maintained and revised by the NHSIA (including the electronic version of the same) and all updates, editions, revisions, consolidations and replacements thereof that may be produced from time to time; “Purpose” means only the provision of health care services via you as either a hospital, hospital group, therapist, consultant or doctor in the UK solely for the purpose of invoicing Bupa in relation to services or goods provided to Bupa by you; “Trade Marks” means the “Clinical Classification and Schedule Development Group” and/or “CCSD Schedule” and/or “CCSD Schedule of Procedures” and/or “CCSD Mapping Tool” and any similar trade marks and such other trade marks, names or logos (whether any of the foregoing are registered or not) as the CCSD Group may from time to time own and use on or in relation to the CCSD Schedule; Grant of Licence Bupa grants you a non-exclusive, royalty free, non-transferable, licence to use the CCSD Schedule only in the United Kingdom for the Purpose on the terms of this Licence. The rights granted hereunder are personal to you and that you do not have any rights to license, sub-license, sub-contract, assign, mortgage or otherwise transfer in whole or in part any of your rights granted under this Licence to any third party. Subject to Clauses 5 and 6, you agree that the CCSD Schedule and all rights in it are the joint property of the current members of the CCSD Group from time to time and that you do not have any rights in or to the CCSD Schedule except as expressly set out hereunder. Your scope of use of the CCSD Schedule You will use the CCSD Schedule only for the Purpose. The CCSD Schedule may from time to time be updated by the CCSD Group. You will ensure that at all time you use the most up to date version of the CCSD Schedule as notified by Bupa or the CCSD Group. You undertake to use the codes in the CCSD Schedule to identify exactly the same surgical and medical procedures as they identify in the CCSD Schedule and you shall not develop, amend or modify the CCSD Schedule or any part of it in any way. You shall not commercially exploit the CCSD Schedule or any part of it. You will not in any way or by any means seek or obtain any financial or economic value from the CCSD Schedule or any part of it. FOR THE AVOIDANCE OF DOUBT, THE CCSD SCHEDULE IS NOT TO BE USED AS A CLINICAL TOOL AND NO CLINICAL RELIANCE IS TO BE PLACED ON IT. You will not use the CCSD Schedule in any way which is unsuitable or inappropriate or which in the opinion of Bupa or CCSD Services or any member of the CCSD Group, would or might damage the reputation or image of Bupa and/or the CCSD Group, or any Members (now and in the future), and/or the Trade Marks. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 -3– © Bupa Insurance Limited 1999-2012 Licence Terms and Conditions (continued) _______________________________________________________________________________ You warrant, represent and undertake that you are a provider of healthcare services and are either a hospital, hospital group, therapist, consultant or doctor and shall only be using the CCSD Schedule in the UK for the purpose of invoicing Bupa in relation to services or goods provided to Bupa by you. If you wish to use the CCSD Schedule in any other way you should contact CCSD via the email or postal address set out in Paragraph D above. Provisions relating to your use of the Trade Marks within the CCSD Schedule All goodwill in the Trade Marks which accrues in relation to your use of it under this Licence shall belong to each Member (to own as tenants in common in equal shares) and you will, at the request of Bupa or CCSD Services promptly execute an assignment (on terms satisfactory to CCSD Services) of such goodwill to each Member. Provisions relating to your use of the NHS Schedule You agree that the NHS Schedule and the rights in it are the property of the Crown and that the Controller of Her Majesty’s Stationery Office (“HMSO”) is free to use and deal with the NHS Schedule and the data and information comprised in it and that, under this Licence, you do not have any rights in or to the NHS Schedule or the data and information comprised in it unless expressly granted hereunder. Neither the HMSO nor the NHSIA has any responsibility for the accuracy or the completeness of the data and information comprised in it. Provisions relating to your use of the Bupa Schedule You agree that the Bupa Schedule and the rights in it are the property of Bupa and that, under this Licence, you do not have any rights in or to the Bupa Schedule or the data and information comprised in it unless expressly granted hereunder. Bupa does not have any responsibility for the accuracy or completeness of the data and information comprised in it. Notices you will use when you reproduce the CCSD Schedule You will ensure that ownership of the copyright and database rights in the CCSD Schedule is acknowledged each time you use or access the CCSD Schedule by ensuring that the following notice shall appear prominently on the front page in any paper reproduction or on the first page accessed by a user who is accessing an electronic copy (whether that be over the internet, by CD-Rom, diskette or otherwise): “The CCSD Schedule of Procedures © The Clinical Classification and Schedule Development Group 1999-2011.” “Material contained in the Office of Population Censuses and Surveys Classification of Operations and Surgical Procedures Consolidated Fourth Revision, is © Crown Copyright 1990 and has been reproduced by kind permission of the Controller of Her Majesty’s Stationery Office and the NHSIA.” Material contained in the Bupa Schedule is copyright Bupa Insurance Limited and is reproduced with kind permission of Bupa. You will place adjacent to representations of any Trade Marks you use on or in relation to the CCSD Schedule: a) the symbol “®” in respect of, and for so long as, any Trade Marks are or become registered trade marks in the UK during the term of this Licence; the symbol “TM” in respect of any unregistered Trade Marks. b) Without prejudice to Clauses 7.1 and 7.2, you will acknowledge in an appropriate way the ownership of any database rights, domain names and any other IPRs subsisting in or in relation to the CCSD Schedule each time and howsoever you use the CCSD Schedule. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 -4– © Bupa Insurance Limited 1999-2012 Licence Terms and Conditions (continued) _______________________________________________________________________________ IPR Infringement You will promptly report to Bupa and CCSD Services, or from time to time to the nominated representative of the CCSD Group, in writing particulars of any: c) threatened, suspected or actual use of the CCSD Schedule by any other third party, which would or might amount to infringement of the CCSD Schedule; claims by a third party that the use of the CCSD Schedule infringes its rights; and any other form of attack in relation to the CCSD Schedule. d) e) In respect of any third party claims or threatened claims outlined in Clause 8.1, you shall not make any admissions in relation to the alleged invalidity, infringement or other form of attack. Bupa shall decide whether proceedings relating to the alleged invalidity infringement or other form of attack referred to in Clause 8.1 shall be instituted or defended and it or CCSD Services will have the conduct of any such proceedings. You will use all reasonable endeavours to assist Bupa and the CCSD Group with any such proceedings. The costs and benefits of any such proceedings shall be respectively borne by, and for the benefit of, Bupa and/or the CCSD Group as appropriate. Indemnity from you You shall keep Bupa and CCSD Services and each member of the CCSD Group and their respective directors, officers, employees and agents (“Indemnified Parties”) fully indemnified against all costs (including all legal costs), claims, damages, expenses, losses or liabilities (including, without limitation, economic loss and loss of profit, whether direct or indirect, loss of business or contracts and any other losses arising other than directly and naturally from a breach of contract) made against or incurred or suffered by any and all of the Indemnified Parties relating directly or indirectly to your failure to comply with any and all of the provisions of this Licence. Each of the Indemnified Parties may enforce the provisions of the indemnity at Clause 9.1 against you notwithstanding that they (except Bupa) are not party to this Licence and, in any event, Bupa and/or CCSD Services may recover damages or claim under the indemnity at Clause 9.1 as trustee for and on behalf of the Indemnified Parties in relation to any matter in respect of which the Indemnified Parties are indemnified in accordance with Clause 9.1. Liability Exclusions and Limitations Losses neither party can exclude or limit: Nothing in this Licence shall exclude or limit the liability of either party for death or personal injury caused by its negligence or for its fraud or fraudulent misrepresentation. Certain types of loss Bupa are not liable to you for: The CCSD Schedule is made available to you on an “as is” basis and neither Bupa nor CCSD Services nor any other members of the CCSD Group, including their respective directors, officers, employees and agents (the “Limited Liability Group”), will in any circumstances be liable to you for: (a) the accuracy or completeness of the CCSD Schedule (including, without limitation, the NHS Schedule and the Bupa Schedule) or the data and information comprised in it; (b) the use by you (or on your behalf) of the Trade Marks, CCSD Schedule and/or the data and information comprised in it, including if used together with any other data or information, and, as such, the Limited Liability Group will not in any circumstances be liable to you for any types of loss, including those listed below in this Clause 10.2, whether arising from negligence, breach of contract or otherwise and whether arising directly or indirectly. Those types of loss are as follows: (i) (ii) (iii) (iv) (v) loss of profits or revenue; loss of business or contracts; loss of anticipated savings; losses arising from loss of data; and any losses which arise other than directly and naturally from a breach of contract. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 -5– © Bupa Insurance Limited 1999-2012 Licence Terms and Conditions (continued) _________________________________________________________________________ Cap on Liability: Subject to Clauses 10.1 and 10.2, you agree that the liability of each member of the Limited Liability Group for any loss arising from breach of contract, negligence or otherwise will be limited to £5,000.00 (five thousand Pounds Sterling or its equivalent in such other currency as may from time to time replace Pounds Sterling). Exclusion of implied terms: Other than the express provisions of this Licence, all warranties, conditions, undertakings and any other representations whether implied by statute or otherwise are excluded to the fullest extent permitted by law. Term and Termination This Licence shall come into force on the date on which you first accesses the CCSD Schedule and will continue until it is terminated in accordance with Clause 11.2. This Licence, and the rights granted to you under it, will terminate (without payment of compensation or other damages caused to you solely by such termination): a) upon you, Bupa, CCSD Services, or from time to time the nominated representative of the CCSD Group, (for any reason) giving the other party to this Licence 28 days notice of termination; b) c) d) immediately and automatically upon Bupa or CCSD Services ceasing to have the right to use (including to sublicense) the CCSD Schedule containing any data or information which is the subject of Crown or Bupa copyright; immediately upon Bupa giving you notice that you have committed a material breach of any of your obligations under this Licence which is incapable of remedy; immediately upon Bupa giving you notice that you have failed to remedy, where it was capable of remedy, or persisted in any breach of any of your obligations under this Licence after having been required in writing to remedy or desist from such breach within a period of 21 days; immediately on written notice upon becoming or are reasonably likely to become insolvent, enter into bankruptcy, individual voluntary arrangement, liquidation, receivership, administration or into a corporate voluntary arrangement as defined by the Insolvency Act 1986, or otherwise compromising any debts with your creditors. e) The termination or expiry of this Licence shall be without prejudice to the rights and remedies of Bupa, CCSD Services, the other members of the CCSD Group and you that may have accrued up to the date of termination or expiry. Consequences of Expiry and Termination Upon any expiry or termination of this Licence: f) except as provided in Clause 11.3, all rights to use the CCSD Schedule and the Trade Marks will immediately cease; the provisions of all Clauses shall continue in full force and effect; and you will immediately either return to Bupa or, if Bupa so requests by notice in writing, destroy) and expunge from your computer systems all copies of the CCSD Schedule and all of Bupa’s property (including its Confidential Information) in your possession at the date of such expiry or termination and which came into your possession under or in relation to this Licence, including the CCSD Schedule, together with all copies of the CCSD Schedule and you will certify that you have done so, and you shall make no further use of the CCSD Schedule. g) h) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 -6– © Bupa Insurance Limited 1999-2012 Licence Terms and Conditions (continued) _______________________________________________________________________________ General Provisions Entire Agreement: This Licence sets out the entire agreement between the parties relating to its subject matter and overrides any prior correspondence or representations. You will have no claim against CCSD Services or the members of the CCSD Group (as constituted now and in the future) for a misrepresentation unless that misrepresentation was made fraudulently. Invalidity & Severability: If any part of this Licence is or becomes void or otherwise unenforceable for any reason under any applicable law, then that shall not affect the rest of this Licence which will remain valid and enforceable in all respects. Third Party Rights: CCSD Services and all members of the CCSD Group may enforce this Licence. Except for CCSD Services and all members of the CCSD Group, the Contracts (Rights of Third Parties) Act 1999 shall not apply to this Licence. Other than CCSD Services or members of the CCSD Group, any person who is not a party to this Licence (including any employee, officer, agent, representative or sub-contractor of either party) shall not have the right (whether under the Contracts (Rights of Third Parties) Act 1999 or otherwise) to enforce any term of this Licence which expressly or by implication confers a benefit on that person without the express prior agreement in writing of the parties which agreement must refer to this Clause. Where a person who is not a party to this Licence (including, without limitation, any employee, officer, agent, representative or sub-contractor of either party) has a right to enforce any term of this Licence, the parties may, notwithstanding the Contracts (Rights of Third Parties) Act 1999 vary or cancel this Licence by agreement between them without requiring the consent of such third party. Waiver: The rights and remedies of either party in respect of this Licence shall not be diminished, waived or extinguished by the granting of any indulgence, forbearance or extension of time granted by such party to the other nor by any failure of, or delay by the said party in ascertaining or exercising any such rights or remedies. Any waiver of any breach of this Licence shall be in writing. The waiver by either party of any breach of this Licence shall not prevent the subsequent enforcement of that provision and shall not be deemed to be a waiver of any subsequent breach of that or any other provision. Notices: Any notice given under this Licence shall be in writing and delivered by special delivery to the address of the party indicated at the head of this Licence, or such other address as is notified to the other party from time to time and proof of posting will be proof of receipt three days thereafter. Changes: Any variation to this Licence must be in writing and signed by our respective authorised signatories. Further Assurance: You shall do all acts and execute all documents in such manner and in such locations (at your cost and expense) as Bupa may require in its sole discretion to give full effect to this Licence and to protect perfect or enforce any of the rights granted confirmed or assigned to Bupa pursuant to this Licence. Counterparts: This Licence may be entered into in the form of two counterparts, each executed by one of the parties, and, provided that both the parties shall so enter into the Licence, each of the executed counterparts, when duly exchanged or delivered, shall be deemed to be an original but, taken together, they shall constitute one instrument. Governing Law & Jurisdiction: This Licence is intended to be legally binding and shall be subject to English law and the exclusive jurisdiction of the English courts. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 -7– © Bupa Insurance Limited 1999-2012 Contents Licence Terms and Conditions................................................................................................................................................................. 2 Definitions ........................................................................................................................................................................................... 2 Licence Terms and Conditions (continued) ............................................................................................................................................. 3 Grant of Licence .................................................................................................................................................................................. 3 Licence Terms and Conditions (continued) ............................................................................................................................................. 4 Licence Terms and Conditions (continued) ............................................................................................................................................. 5 IPR Infringement ................................................................................................................................................................................. 5 Licence Terms and Conditions (continued) ............................................................................................................................................. 6 Term and Termination ......................................................................................................................................................................... 6 Consequences of Expiry and Termination ........................................................................................................................................... 6 Licence Terms and Conditions (continued) ............................................................................................................................................. 7 General Provisions ................................................................................................................................................................................... 7 Essential Notes to the Schedule ............................................................................................................................................................. 11 Essential Notes to the Schedule (continued) .......................................................................................................................................... 12 Essential Notes to the Schedule (continued) .......................................................................................................................................... 13 Essential Notes to the Schedule (continued) .......................................................................................................................................... 14 Essential Notes to the Schedule (continued) .......................................................................................................................................... 15 Essential Notes to the Schedule (continued) .......................................................................................................................................... 16 Essential Notes to the Schedule (continued) .......................................................................................................................................... 17 Essential Notes to the Schedule (continued) .......................................................................................................................................... 18 1 Simple Investigations and Procedures ........................................................................................................................................... 19 SIMPLE INVESTIGATIONS ........................................................................................................................................................... 19 SIMPLE PROCEDURES .................................................................................................................................................................. 19 GENERAL PROCEDURES .............................................................................................................................................................. 20 2 Brain, Cranium and Other Intracranial Organs.............................................................................................................................. 21 BRAIN............................................................................................................................................................................................... 21 CRANIUM ........................................................................................................................................................................................ 21 MENINGES ...................................................................................................................................................................................... 22 NERVES ........................................................................................................................................................................................... 22 VESSELS .......................................................................................................................................................................................... 22 OTHER .............................................................................................................................................................................................. 23 3 Spine, Spinal Cord & Peripheral Nerves ....................................................................................................................................... 24 SPINAL COLUMN (INCLUDING INTERVERTEBRAL DISC) CERVICAL ............................................................................... 24 SPINAL COLUMN (INCLUDING INTERVERTEBRAL DISC) THORACIC .............................................................................. 24 SPINAL COLUMN (INCLUDING INTERVERTEBRAL DISC) LUMBAR.................................................................................. 25 SCOLIOSIS, KYPHOSIS, FRACTURES, TUMOURS AND INFECTIONS .................................................................................. 25 SPINAL CORD ................................................................................................................................................................................. 26 PARASPINAL INJECTIONS ........................................................................................................................................................... 26 PARASPINAL INJECTIONS (continued) ........................................................................................................................................ 26 NERVE ROOTS ................................................................................................................................................................................ 26 SYMPATHETIC NERVES ............................................................................................................................................................... 26 PERIPHERAL NERVES................................................................................................................................................................... 27 OTHER NERVE BLOCKS ............................................................................................................................................................... 27 OTHER PROCEDURES ................................................................................................................................................................... 28 NEUROPHYSIOLOGICAL PROCEDURES ................................................................................................................................... 28 4 Eye & Orbital Contents ................................................................................................................................................................. 29 GLOBE & ORBIT ............................................................................................................................................................................. 29 EYEBROW & LID ............................................................................................................................................................................ 29 LACRIMAL SYSTEM ...................................................................................................................................................................... 30 MUSCLES......................................................................................................................................................................................... 30 CONJUNCTIVA ............................................................................................................................................................................... 30 CORNEA........................................................................................................................................................................................... 31 SCLERA............................................................................................................................................................................................ 31 IRIS & ANTERIOR CHAMBER ...................................................................................................................................................... 31 IRIS & ANTERIOR CHAMBER (continued)................................................................................................................................... 32 LENS ................................................................................................................................................................................................. 32 VITREOUS ....................................................................................................................................................................................... 32 RETINA ............................................................................................................................................................................................ 32 GENERAL ........................................................................................................................................................................................ 33 5 Ear, Nose & Throat ....................................................................................................................................................................... 34 EXTERNAL EAR ............................................................................................................................................................................. 34 MIDDLE EAR AND MASTOID ...................................................................................................................................................... 34 INNER EAR ...................................................................................................................................................................................... 35 NOSE AND NASAL CAVITY ......................................................................................................................................................... 35 NASAL SINUSES ............................................................................................................................................................................. 36 THROAT ........................................................................................................................................................................................... 36 LARYNX AND TRACHEA ............................................................................................................................................................. 37 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 -8– © Bupa Insurance Limited 1999-2012 FIBREOPTIC ENDOSCOPIC PROCEDURES (GA OR LA) .......................................................................................................... 37 Face, Mouth, Salivary & Thyroid.................................................................................................................................................. 38 FACE AND JAWS ............................................................................................................................................................................ 38 LIPS ................................................................................................................................................................................................... 38 TONGUE........................................................................................................................................................................................... 39 PALATE ............................................................................................................................................................................................ 39 MOUTH CAVITY ............................................................................................................................................................................ 39 SALIVARY GLANDS ...................................................................................................................................................................... 39 TEETH .............................................................................................................................................................................................. 40 NECK ................................................................................................................................................................................................ 40 THYROID AND PARATHYROID GLANDS ................................................................................................................................. 40 7 Breast ............................................................................................................................................................................................ 41 EXCISION / BIOPSY CODES ......................................................................................................................................................... 41 MASTECTOMY (EXCLUDING IMPLANT / RECONSTRUCTION) ........................................................................................... 41 RECONSTRUCTION ....................................................................................................................................................................... 41 OTHER .............................................................................................................................................................................................. 42 8 Thorax & Intra-Thoracic Organs ................................................................................................................................................... 43 OESOPHAGUS ................................................................................................................................................................................. 43 A2781 Laparoscopic vagotomy/seromyotomy MAJOR 4 MAJOR 3 MAJOR - .............................................. 43 CHEST WALL .................................................................................................................................................................................. 43 TRACHEA ........................................................................................................................................................................................ 44 FIBREOPTIC ENDOSCOPIC PROCEDURES (GA OR LA) .......................................................................................................... 44 BRONCHI / LUNGS / PLEURA ...................................................................................................................................................... 44 MEDIASTINUM ............................................................................................................................................................................... 45 VIDEO ASSISTED THORACIC SURGERY (VATS)..................................................................................................................... 45 HEART – CARDIAC SURGERY..................................................................................................................................................... 45 HEART – CARDIAC SURGERY..................................................................................................................................................... 46 HEART - CARDIOLOGY ................................................................................................................................................................ 47 GREAT VESSELS ............................................................................................................................................................................ 48 OTHER .............................................................................................................................................................................................. 48 9 Vascular System ............................................................................................................................................................................ 49 HEAD & NECK ................................................................................................................................................................................ 49 THORACIC ....................................................................................................................................................................................... 49 RENAL.............................................................................................................................................................................................. 50 ABDOMINAL VESSELS ................................................................................................................................................................. 50 ILEO-FEMORAL VESSELS ............................................................................................................................................................ 50 NON-SPECIFIC ................................................................................................................................................................................ 50 VARICOSE VEINS .......................................................................................................................................................................... 51 LYMPHATIC SYSTEM ................................................................................................................................................................... 52 10 Endoscopic GIT Procedures .................................................................................................................................................... 53 ENDOSCOPIC GIT PROCEDURES ................................................................................................................................................ 53 11 Abdomen (excl. Urinary & Reproductive Organs) .................................................................................................................. 55 OESOPHAGUS ................................................................................................................................................................................. 55 STOMACH ....................................................................................................................................................................................... 56 DUODENUM .................................................................................................................................................................................... 56 SMALL INTESTINE ........................................................................................................................................................................ 56 LARGE INTESTINE ........................................................................................................................................................................ 57 RECTUM / ANUS............................................................................................................................................................................. 57 OTHER ORGANS (MAINLY DIGESTIVE) ................................................................................................................................... 58 MAJOR VESSELS ............................................................................................................................................................................ 59 ABDOMINAL WALL ...................................................................................................................................................................... 60 PERITONEUM ................................................................................................................................................................................. 60 12 Urinary System and Male Reproductive Organs ..................................................................................................................... 61 KIDNEY / RENAL PELVIC............................................................................................................................................................. 61 URETER ........................................................................................................................................................................................... 62 BLADDER ........................................................................................................................................................................................ 63 URETHRA ........................................................................................................................................................................................ 64 PROSTATE ....................................................................................................................................................................................... 64 GENITALIA...................................................................................................................................................................................... 65 13 Pregnancy & Confinement ...................................................................................................................................................... 67 PREGNANCY & CONFINEMENT ................................................................................................................................................. 67 14 Female Reproductive Organs .................................................................................................................................................. 68 UTERUS / ADNEXA ........................................................................................................................................................................ 68 SUSPENSION ................................................................................................................................................................................... 69 CERVIX UTERI ............................................................................................................................................................................... 69 VAGINA / PERINEUM .................................................................................................................................................................... 69 VULVA / LABIA .............................................................................................................................................................................. 70 15 Skin & Subcutaneous Tissue ................................................................................................................................................... 71 LESIONS OF SKIN .......................................................................................................................................................................... 71 REPAIR ............................................................................................................................................................................................. 72 BURNS, SCARS & CONTRACTURES ........................................................................................................................................... 72 6 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 -9– © Bupa Insurance Limited 1999-2012 FLAPS ............................................................................................................................................................................................... 72 FREE SKIN GRAFTS ....................................................................................................................................................................... 73 16 Bones, Joints & Connective Tissue/Tendon Muscle................................................................................................................ 74 CONNECTIVE TISSUE / TENDON MUSCLE ............................................................................................................................... 74 BONE (NON-SPECIFIC).................................................................................................................................................................. 75 FRACTURES - LONG BONES ........................................................................................................................................................ 75 FRACTURES - SMALL BONES ..................................................................................................................................................... 75 FRACTURES - PELVIS / ACETABULUM & FEMUR .................................................................................................................. 76 FRACTURES - JOINTS.................................................................................................................................................................... 76 FRACTURES - FIXATION DEVICES ............................................................................................................................................ 76 NERVES ........................................................................................................................................................................................... 77 JOINTS, INCL. REPLACEMENT / RECONSTRUCTION (NOT LISTED ELSEWHERE) ........................................................ 77 HAND - INCISION / EXCISION ..................................................................................................................................................... 78 HAND - REPAIR / RECONSTRUCTION ....................................................................................................................................... 78 HAND - FIXATION / ARTHRODESIS ........................................................................................................................................... 79 HAND - OTHER (E.G. AMPUTATION) ......................................................................................................................................... 79 SHOULDER - INCISION / EXCISION............................................................................................................................................ 80 SHOULDER - REPAIR / RECONSTRUCTION .............................................................................................................................. 80 SHOULDER - FIXATION / ARTHRODESIS.................................................................................................................................. 81 SHOULDER - OTHER ..................................................................................................................................................................... 81 ELBOW - INCISION / EXCISION ................................................................................................................................................... 81 ELBOW - REPAIR / RECONSTRUCTION ..................................................................................................................................... 81 HIP, LEG AND PELVIS - INCISION / EXCISION ......................................................................................................................... 81 HIP, LEG AND PELVIS - REPAIR, RECONSTRUCTION & REPLACEMENT .......................................................................... 81 HIP, LEG AND PELVIS - FIXATION / ARTHRODESIS ............................................................................................................... 82 HIP, LEG AND PELVIS - OTHER .................................................................................................................................................. 82 KNEE - INCISION / EXCISION ...................................................................................................................................................... 83 KNEE - REPAIR / RECONSTRUCTION ........................................................................................................................................ 83 KNEE - FIXATION / ARTHRODESIS ............................................................................................................................................ 84 FOOT - ANKLE ................................................................................................................................................................................ 84 FOOT - HIND FOOT AND MID FOOT........................................................................................................................................... 84 FOOT - FOREFOOT ......................................................................................................................................................................... 85 FOOT - HALLUX ............................................................................................................................................................................. 85 FOOT - TOES ................................................................................................................................................................................... 85 FOOT - GENERAL FOOT ............................................................................................................................................................... 85 EXTERNAL FIXATION / TRACTION ........................................................................................................................................... 86 17 Interventional Radiology ......................................................................................................................................................... 87 BIOPSY ............................................................................................................................................................................................. 87 DRAINAGE ...................................................................................................................................................................................... 87 ANGIOPLASTY ............................................................................................................................................................................... 87 EMBOLIZATION ............................................................................................................................................................................. 87 THROMBOLYSIS ............................................................................................................................................................................ 88 DILATATION ................................................................................................................................................................................... 88 HEAD AND NECK........................................................................................................................................................................... 88 SPINE ................................................................................................................................................................................................ 88 THORAX .......................................................................................................................................................................................... 88 GASTRO-INTESTINAL ................................................................................................................................................................... 88 LIVER ............................................................................................................................................................................................... 89 URINARY ......................................................................................................................................................................................... 89 OTHER .............................................................................................................................................................................................. 89 18 Chemotherapy ......................................................................................................................................................................... 90 CHEMOTHERAPY .......................................................................................................................................................................... 90 Appendices............................................................................................................................................................................................. 91 Appendix A: ........................................................................................................................................................................................... 91 Appendix B: ........................................................................................................................................................................................... 92 Appendix C: ........................................................................................................................................................................................... 93 Appendix D:........................................................................................................................................................................................... 94 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 10 – © Bupa Insurance Limited 1999-2012 Essential Notes to the Schedule _______________________________________________________________________________ These Essential Notes should be used in conjunction with the Bupa Schedule of Procedures to explain its content in greater detail. About the Bupa Schedule of Procedures The prime purpose of the Bupa Schedule of Procedures is to set out codes, narratives and classifications for those procedures that are commonly performed on Bupa members. The Schedule is also used to make administration of claims easier and for data collection. As part of Bupa's commitment to keep up-to-date with clinical developments, we review the classification of procedures on an ongoing basis. Bupa’s medical directors benchmark the procedures against other relevant procedures to establish their relative complexity, time and skill required. The terms of each member's contract with Bupa are set out in documents called "Rules and Table of Benefits" as applicable to each scheme. These notes and any special notes within different sections of this schedule form a part of each member’s "Rules and Table of Benefits". Consultants and hospitals will be notified of any amendments. Bupa reserves the right to audit and reclaim funding, or take any other action as appropriate, where we discover inappropriate or unethical repetitive treatments. 1. Coding and Benefit Structure The Schedule is set out as follows: Code Description Surgeon’s category Anaesthetist’s Hospital category category Anticipated LOS Each procedure has been given a procedure code. When completing a claim form or an account for a Bupa patient, please include the procedure code as well as a description of the treatment. This will avoid any ambiguity about which procedures were performed, and enable Bupa to ensure accurate and prompt payment of the account. Some procedures have a published Bupa anticipated length of stay (LOS), which is either day-case (D/C), out-patient (O/P) or in-patient. The anticipated LOS, in nights, is shown in numbers for in-patient procedures. If there is not a code in the Schedule for a procedure, it may still be eligible for Bupa funding. Please call Bupa Provider Services on the telephone number at the foot of the page. Procedures are classified into the following 25 categories: Minor 1 Inter 1 Major 1 Major + 1 CMO 1 Minor 2 Inter 2 Major 2 Major + 2 CMO 2 Minor 3 Inter 3 Major 3 Major + 3 CMO 3 Minor 4 Inter 4 Major 4 Major + 4 CMO 4 Minor 5 Inter 5 Major 5 Major + 5 CMO 5 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 11 – © Bupa Insurance Limited 1999-2012 Essential Notes to the Schedule (continued) _______________________________________________________________________________ For each category of procedure there is a maximum figure up to which a member may claim for consultants' fees. These maxima are not standard fees for each case. In particularly complicated cases or unusual circumstances, Bupa is prepared to consider an enhanced payment, please see section 8.4 for details. 1.1 Consultations and procedures Bupa will fund eligible procedures carried out on the same day as an initial consultation. Bupa will not fund follow-up consultations carried out on the same day as most planned procedures. The procedure fee includes all component parts of that procedure including pre-operative assessment, the procedure itself and all routine aftercare, such as in-patient follow-up consultations and outpatient consultations on the same day. There are some exceptions where Bupa will fund follow-up consultations on the same day as planned procedures and these are identified in the Bupa Schedule of Procedures by “ii”. For example, a Bupa member who requires the insertion of a Mirena coil will be covered for the initial consultation and the cost of the procedure. If the coil cannot be inserted on the day of the initial consultation, the procedure itself is funded separately, but a follow-up consultation will not be funded. 1.2 In-patient care and consultations An initial in-patient consultation will be covered for eligible transfer from an emergency admission to private care, or when a consultant of a different medical specialty needs to review a patient. Any subsequent claims for in-patient care should be made using procedure code 20320: In-patient Care. In-patient care is paid at a daily rate of £55 which includes the day of discharge. A supplement of £80 per night is available up to 14 nights per membership year for Major Medical Illness (MMI) (please see appendix B for more information). Consultation procedure codes should not be used following the initial consultation until the patient has been discharged. When a patient needs to be admitted prior to surgery, the entire stay must be for eligible clinical reasons. In-patient care benefit is funded for any full day prior to surgery. After the surgery has been carried out, the cost of in-patient care benefit is included in the surgical benefit. When a member remains in hospital longer than the average length of stay for that particular procedure, Bupa will consider requests for further in-patient benefit when supported by clinical justification for delaying the member’s discharge. The consultant should contact Bupa Provider Services on the number at the foot of the page to discuss this further. 2. Using the Bupa Schedule of Procedures 2.1. Surgery The benefit maximum shown for a procedure encompasses all pre- and post-operative care associated with in-patient or day-case surgery and includes the management of all common complications related to the condition. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 12 – © Bupa Insurance Limited 1999-2012 Essential Notes to the Schedule (continued) _______________________________________________________________________________ These include, but are not restricted to: o Bleeding o IV fluids o Local anaesthesia (please see section 2.3) o Suction o Catheterisation o Uncomplicated sepsis o Removal of sutures Additional benefits may be available when it is necessary to call in a further consultant to attend to additional complications following surgery, eg the attendance of a physician to control unstable diabetes. 2.2 Anaesthesia The same anaesthetic category applies irrespective of whether general or regional anaesthetic has been administered by an anaesthetist and the benefit limit includes: • • • • routine pre-operative assessment and informed consent, including financial consent and information about fees and charges 1 induction, maintenance of anaesthesia and all support activities, both intra-and postoperative; pain control throughout the hospital stay; and post-operative care including 72 hours intensive therapy. 2.3. Regional anaesthesia/IV sedation administered by the operator • IV sedation and IV regional anaesthesia administered by the operator Bupa will pay a separate fee for IV sedation and IV regional anaesthesia to recognise that they are more complex than topical and infiltrative anaesthesia, and often require additional support to set up and administer. The following codes should be used for the administration of IV sedation and IV regional anaesthesia: X3510 IV sedation administered by operator 25040 IV regional anaesthesia (Bier’s Block) administered by operator There are a number of procedures where sedation or regional anaesthesia may be routinely required. These procedures will be clearly marked by “*” in the Bupa Schedule of Procedures. The above codes will be routinely paid when done in combination with the procedures marked with "*" in the Bupa Schedule of Procedures. Bupa may consider reimbursement for IV sedation or IV regional anaesthesia for other procedures. Bupa medical directors will assess these on a case-by-case basis on submission of a clinical rationale from the claiming consultant. 1 GMC Good Medical Practice; and CQC Essential Standards of Quality and Safety Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 13 – © Bupa Insurance Limited 1999-2012 Essential Notes to the Schedule (continued) _______________________________________________________________________________ • Ophthalmic local anaesthesia Bupa recognises that injected local anaesthesia for eye surgery is more complex and invasive than infiltrative local anaesthetic, so the following code should be used for the administration of local anaesthesia for eye surgery: X3800 Ophthalmic local anaesthetic injection administered by operator Claims for this code will be reimbursed when claimed in conjunction with eye surgery procedures. This code cannot be claimed for the application of topical anaesthesia; reimbursement for this is included in the cost of eye surgery procedures. • Topical and infiltrative anaesthesia administered by the surgeon Topical and infiltrative anaesthesia is included in the reimbursement for all procedures, so Bupa no longer reimburses for procedure code AC100. The codes listed above for IV sedation, IV regional anaesthesia and ophthalmic local anaesthetic should be used where appropriate. Bupa will not pay fees for anaesthesia administered by the consultant carrying out the operation if an anaesthetist has also provided anaesthesia. The cost of simple local anaesthesia (topical or infiltration) is included in the surgical procedure fee for all procedures. Consultants should not bill additional costs for it. • 2.4 Epidural analgesia When an epidural is administered in addition to general anaesthesia or within 24 hours either side of the operation, Bupa's multiple procedure policy applies (please see section 4 of these Essential Notes for further details). 3. Pre-admission consultations for anaesthesia There are occasions when Bupa will pay for a consultation with an anaesthetist prior to admission for surgery. This applies when the patient presents with co-morbidities which affect at least one of the following: • • • the choice of general or regional anaesthesia; the anaesthetic techniques for the procedure (eg induced hypotension); the decision to proceed with surgery. Anaesthetists should contact Bupa Provider Services on the number at the bottom of the page to apply for additional funding (please refer to section 8.4 of the Essential Notes). 4. Multiple Procedures • For consultants: When clearly separate procedures have been performed under the same anaesthetic, Bupa benefits are calculated in the following way: Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 14 – © Bupa Insurance Limited 1999-2012 Essential Notes to the Schedule (continued) _______________________________________________________________________________ 1st procedure = 100 percent reimbursement of the Bupa benefit limit for this procedure 2nd procedure = 50 percent of this procedure’s Bupa benefit limit Benefit is payable for a maximum of two procedures where they are performed at the same time under the same general or local anaesthetic, or where it would have been medically appropriate to carry out these procedures during the same theatre session. The highest classified procedure will be reimbursed at 100 percent of its Bupa benefit limit and the second procedure at 50 percent of its Bupa benefit limit. Bupa may consider paying for three or more procedures in one surgical session in exceptional circumstances. This is decided on a case-by-case basis through the surgical uplift process (please refer to section 8.4 of these Essential Notes for further details). • For hospitals: Unless the hospital agreement precludes additional charges for multiple procedures where more than one procedure is carried out, the theatre fee will be reimbursed at 100 percent of the most complex procedure, and 50 percent of the next most complex procedure only. The multiple procedure policy does not apply to incidental procedures performed at the same time as the main procedure, eg appendicectomy at the same time as hysterectomy (please refer to section 6 of these Essential Notes for further information). 5. Bilateral procedures Some procedures are invariably performed bilaterally and are referred to in the Bupa Schedule of Procedures as "...and bilateral". The benefit maxima payable takes into account the nature of these procedures. For example: E0380 (ii) Nasal septum cauterisation (and bilateral) Other procedures which may be performed bilaterally have been given separate bilateral procedure codes within the Bupa Schedule of Procedures. For example: Code Description Surgeon’s category MAJOR 2 Anaesthetist’s Hospital category category MAJOR 3 MAJOR B2780 Simple mastectomy (including axillary node biopsy) - unilateral Simple mastectomy including axillary node biopsy – bilateral B2781 MAJOR+5 MAJOR+ 2 MAJOR+ When procedures are performed bilaterally but there is no bilateral code in the Bupa Schedule of Procedures, they will be reimbursed as two unilateral procedures and are subject to the multiple procedures rule (please refer to section 4 of these Essential Notes for further detail). Exceptions to this must follow the surgical uplift process which is explained in section 8.4 of these Essential Notes. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 15 – © Bupa Insurance Limited 1999-2012 Essential Notes to the Schedule (continued) _______________________________________________________________________________ 6. Unbundling Some of the procedures in the Schedule, which appear in their own right, are also an integral part of other procedures and so are bundled together. Bupa will not pay additional benefits if a procedure is unbundled, ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. Please refer to the CCSD website at www.ccsd.org.uk for a list of unbundled codes (‘Coding Principles’). 7. Intensive therapy Bupa will pay benefit towards hospital charges for up to 72 hours of intensive therapy unless the hospital agreement precludes it. Where procedures are marked by “i” in the Bupa Schedule of Procedures, the benefit maxima for consultants includes provision for 72 hours post-operative intensive therapy. Intensive Therapy: Treatment which is necessary to receive in one of the following: • • • • • • • Intensive Care Unit (ICU), Intensive Therapy Unit (ITU) High Dependency Unit (HDU) Coronary Care Unit (CCU) Special Baby Care Unit (SBCU) Modified Care Unit (MCU) Paediatric ITU Where admission to intensive therapy is required unexpectedly or for a procedure not marked with (i), please contact the Clinical Support Team on 08456 00 09 71*. 8. What happens when: 8.1. …I want to use an unproven technique or enter patients in a clinical trial? Bupa benefits do not cover unproven procedures or treatment. Use of non-licenced drugs is also excluded. We will, however, consider benefit in exceptional cases upon receipt of full clinical details. Please contact Bupa Provider Services on the telephone number at the bottom of this page. 8.2. …the patient wants reassurance that all costs will be covered? Following Care Quality Commission and General Medical Council best practice guidelines, consultants should inform patients about their fees and charges, and specifically whether their fees will be in line with Bupa's Benefit Limits. Patients should be advised to contact Bupa to check their cover and warned of any likely shortfall. Please direct Bupa members to call Member Services on 08456 09 01 11*. If consultants wish to confirm a patient is covered, they should contact Bupa Provider Services on the number at the bottom of this page. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 16 – © Bupa Insurance Limited 1999-2012 Essential Notes to the Schedule (continued) _______________________________________________________________________________ 8.3. …I need further advice? Please contact Bupa Provider Services on the number at the bottom of this page. 8.4. …I have a complicated case – what is the benefit uplift process? We recognise that the Bupa Schedule of Procedures, while comprehensive and regularly reviewed, cannot address every potential situation for all Bupa members. Consultants can therefore request surgical uplifts on a case-by-case basis for variations from the Bupa Schedule of Procedures (and Bupa Benefit Maxima). • Initial requests for surgical uplift Please call the Bupa Provider Services team on 08457 55 33 33* to log a request for a surgical uplift for procedures which are unusually complex. • Pre-operative surgical uplift requests These need to be made at least three working days before the scheduled date of treatment to enable us to review the rationale and make a funding decision. Bupa recognises that it may not always be possible to submit a request at least three working days in advance. In such cases, we ask that consultants advise Bupa members that the procedure being undertaken is at the member’s own financial risk and that Bupa cannot guarantee that an uplift will be approved. If you are asked by the Bupa Provider Services team to send supporting information, please include the following: 1. lead surgeon’s name; 2. name(s) of any additional surgeon(s),where the request is for multi-handed surgery, and a clear description of the procedures the additional surgeon(s) will perform and the clinical rationale for why the lead surgeon cannot perform these; 3. nature of the surgery to be performed; 4. patient-specific complicating factors (eg co-morbidities, previous surgery etc); 5. likely duration of surgery (best and worst case scenarios); 6. Bupa procedure codes considered and why rejected; 7. whether the requested procedure is carried out by the lead surgeon in his/her NHS practice and, if not, why ; 8. supporting research evidence where treatments are new or novel; and 9. a clear description of factors complicating anaesthesia (in addition to the above). • Post-operative surgical uplift requests Bupa also recognises that not all surgical complications can be predicted and that, in some circumstances, consultants may need to make a post-operative surgical uplift request. To minimise anxiety for Bupa members, we ask that consultants submit a post-operative surgical uplift request as soon as possible after the procedure has taken place and ensure that all clinicians (surgeons and anaesthetists) have agreed the surgical uplift(s) before these are submitted to Bupa. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 17 – © Bupa Insurance Limited 1999-2012 Essential Notes to the Schedule (continued) _______________________________________________________________________________ If you are asked to provide supporting information for post-operative requests, please include all the points listed above for pre-operative surgical uplift requests and in addition: 1. complicating factors found during surgery (eg unexpected adhesions, scar tissue or abnormal anatomy); 2. complications arising during surgery (eg bleeding, tissue damage, perforation of viscus); 3. anaesthetic or non-surgical complications (eg unplanned need for ventilation or bypass); 4. where possible, a description of the additional time taken in comparison to a routine procedure; and 5. any other relevant supporting information. The information Bupa requires to make a decision about pre and post-operative uplifts should be easily accessed from the member’s out-patient consultation records, so Bupa does not make additional reimbursements for providing this information. Ensuring that all the supporting documentation is available when requested will make the process as easy as possible. Please do not use email to send patient-identifiable data as it is not necessarily a secure method of communication. If you have any questions please call Bupa Provider Services team on 08457 55 33 33*. 8.5. …I involve a second surgeon? There are a few occasions when two surgeons are involved in performing an operation, eg the excision of acoustic neuroma. In these cases full details should be given to Bupa Provider Services (following the uplift process as explained in section 8.4 of these Essential Notes) so that Bupa can consider an enhanced level of reimbursement. No additional benefit is payable for surgical assistants. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 18 – © Bupa Insurance Limited 1999-2012 Bupa Schedule of Procedures 1 Notes For certain procedures, follow-up consultation fees and procedure charges may both be eligible on the same day. This will only apply when the member has not been asked to return for a planned procedure. Procedures that fall into the above category are highlighted within the schedule by (ii). The consultation fee will be payable from the member's out-patient allowance for consultations (scheme and out-patient limit dependant). Investigations that do not have a surgical classification will pay from the member's out-patient allowance for diagnostic tests (scheme and out-patient limit dependant). Procedures listed with a surgical classification will be paid in the same manner as a surgical procedure for which there is normally no annual limit. Simple Investigations and Procedures SIMPLE INVESTIGATIONS Code Description 20110(ii) ECG (including reporting) 20150(ii) Patch testing (inclusive of application, reading and reporting) 20210(ii) Pure tone audiogram (air conduction) 20220(ii) Pure tone audiogram (air and bone conduction) 20230(ii) Impedance audiogram 20240(ii) Impedance audiogram as part of other procedure 20310 G2180 Follow-up outpatient consultation Ambulatory 24h pH and impedance monitoring Surgeon's Category MINOR 2 Anaesthetist's Hospital Anticipated Category Category LOS O/P INTER 1 MINOR O/P - SIMPLE PROCEDURES Code Description 25000(ii) Incision and drainage (not elsewhere covered) 25040 IV regional anaesthesia (Bier’s block) administered by operating consultant Surgeon's Category MINOR 1 MINOR 4 MINOR 2 MINOR 2 MINOR 1 MINOR 1 £50 MINOR 1 MINOR 1 MINOR 5 MINOR 4 £50 MINOR 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 1 MINOR O/P MINOR 5 MINOR 5 MINOR 5 MINOR 5 MINOR 5 MINOR 5 MINOR 5 INTER 2 MINOR 5 MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR O/P O/P O/P O/P O/P O/P - H5230(ii) Injection of sclerosing substance into haemorrhoids H5240(ii) Banding of haemorrhoids S1110(ii)Curettage/cryotherapy of lesion of skin including cauterisation - up to three S1500(ii) Biopsy of skin or subcutaneous tissue S5210(ii) Injection into subcutaneous tissue/painful trigger point under local anaesthetic S5240(ii) Two or more injections into subcutaneous tissue/painful trigger point under local anaesthetic S4780(ii) Aspiration of subcutaneous haematoma X3770(ii) Intramuscular injection with X-ray control (e.g. piriformis block) X3510 X3590 X3800 IV sedation administered by the operating consultant Intravenous infusion (as sole procedure) Ophthalmic local anaesthetic injection administered by operator Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 19 – © Bupa Insurance Limited 1999-2012 GENERAL PROCEDURES Code Description 20140(ii) 24 hour ECG Holter monitoring (including reporting) Surgeon's Category Anaesthetist's Hospital Anticipated Category Category LOS O/P MINOR 5 MINOR 5 MINOR 1 INTER 1 INTER INTER MINOR MINOR MINOR MINOR MINOR O/P D/C D/C O/P O/P D/C D/C O/P O/P O/P O/P 20141(ii) Long term ambulatory ECG monitoring (event recording) (including reporting) 20142(ii) Insertion of implantable ECG loop recorder (including reporting) 20143(ii) Removal of implantable ECG loop recorder (including reporting) 20130(ii) Exercise ECG (including reporting) 20300 20310 20320 20330 Initial outpatient consultation Follow up out-patient consultation Inpatient care Inpatient consultation by 2nd specialist or for emergency INTER 2 INTER 1 MINOR 4 MINOR 4 MINOR 3 MINOR 1 MINOR 4 64300(ii) Echocardiography 20132(ii) Exercise stress echocardiography (including reporting) 25022(ii) Stellate ganglion block (local anaesthetic) P2730(ii) Colposcopy (+/- biopsy) Q2020(ii) Endometrial biopsy or aspiration S4760(ii) Fine needle aspiration cytology S7010(ii) Wedge excision or avulsion of nail including chemical ablation of nail bed Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 20 – © Bupa Insurance Limited 1999-2012 2 Notes Brain, Cranium and Other Intracranial Organs 1. If a procedure is marked with an (i) Bupa’s policy on Intensive Therapy applies. (See note 7 in the Essential Notes to the Schedule and appendix A). 2. The surgeon’s benefit entitlement for complex neurosurgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy up to 72 hours. 3. The anaesthetist’s benefit entitlement for complex neurosurgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy/ventilation for up to 72 hours. 4. In circumstances where the Intensive Therapy exceeds 72 hours, further benefit may be considered on a case by case basis. 5. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: Lesser Procedure(s) which are included in the main procedure and should not be billed separately: A0180 - Excision of abscess of brain V0310 - Exploratory open craniotomy BRAIN Code Description A0110(i) Hemispherectomy A0180(i) Excision of abscess of brain A0200(i) Excision of lesion of tissue of brain A0280 Awake craniotomy with ablation of lesion of brain with or without cortical mapping/stereotaxy Surgeon's Category CMO 5 CMO 3 CMO 4 CMO 5 CMO 3 CMO 2 CMO 2 MAJOR 5 INTER 3 CMO 3 MINOR 5 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 1 INTER 5 MINOR 5 MAJOR+ 4 MINOR 5 MINOR 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 4 CMO 5 CMO 2 CMO 3 CMO 5 CMO 1 MAJOR+ 5 MAJOR+ 5 MAJOR 5 INTER 4 MAJOR 5 MAJOR 5 MAJOR 5 MAJOR 3 INTER 5 MAJOR 3 MAJOR 5 INTER 5 INTER 5 CMO 3 CMO 5 CMO 5 CMO 3 CMO 2 CMO 2 MAJOR INTER CMO 3 MINOR MAJOR MAJOR MAJOR MAJOR INTER MINOR MAJOR+ MINOR MINOR 4 D/C D/C 2 D/C - A0300(i) Stereotactic ablation of tissue of brain A0310(i) Stereotactic biopsy of lesion or tissue of brain A0400(i) Open biopsy of lesion of tissue of brain A0900(i) Implantation/removal of neurostimulator from brain (any route) A1060 A1070 A1080 Fiducial placement Robotic stereotactic radiosurgery, first/sole session using Cyberknife Robotic stereotactic radiosurgery, second to fifth sessions per course of treatment, including adjustments using Cyberknife A1220(i) Creation of ventriculovascular anastomosis A1240(i) Creation of ventriculoperitoneal shunt A1250(i) Creation of subcutaneous cerebrospinal fluid reservoir A1300(i) Maintenance of cerebroventricular shunt (including revision) A1430 A1440 Removal of cerebroventricular shunt Irrigation of cerebroventricular shunt A1700(i) Therapeutic endoscopic operations on ventricle of brain (including examination and biopsy of lesion) A2080(i) Ventricular puncture (as sole procedure) A2220(i) Puncture of cistern of brain CRANIUM Code Description A4280(i) Intracranial infection: burrhole V0110(i) Reconstructive cranioplasty Surgeon's Category MAJOR 3 MAJOR+ 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 INTER MAJOR+ 4 MAJOR+ 3 - V0130(i) Craniostenosis (for single suture) MAJOR 4 MAJOR 4 MAJOR Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 21 – © Bupa Insurance Limited 1999-2012 V0180(i) Craniostenosis (for more than one suture) V0310(i) Exploratory open craniotomy V0330(i) Exploratory burrhole of cranium V0382(i) Total petrosectomy (for tumour) V0383(i) Lateral petrosectomy (for tumour) V0390 Foramen Magnum decompression MAJOR+ 5 MAJOR+ 5 MAJOR 1 CMO 2 CMO 2 CMO 3 MAJOR 5 MAJOR 1 MAJOR+ 5 MAJOR+ 5 MAJOR+ 4 MAJOR 3 CMO 2 CMO 2 MAJOR+ 5 MAJOR 5 MAJOR 4 MAJOR+ 4 MAJOR+ MAJOR+ MAJOR CMO 5 CMO 5 CMO 3 MAJOR MAJOR MAJOR+ 2 D/C - V0510(i) Excision of lesion of cranium V0530(i) Elevation of depressed fracture of cranium V0580(i) Repair of compound fracture of cranium MENINGES Code Description A2210(i) Drainage of subarachnoid space of brain A3810(i) Excision of lesion of meninges of brain A3830(i) Operation for arachnoidal cyst A3900(i) Repair of dura A4010(i) Evacuation of extradural haematoma A4110(i) Evacuation of subdural haematoma or abscess A4180(i) Subdural haemorrhage - tap Surgeon's Category MAJOR 1 CMO 5 MAJOR+ 5 CMO 2 CMO 2 CMO 2 MINOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 MAJOR CMO 3 MAJOR+ 2 MAJOR+ 4 MAJOR+ 4 MAJOR+ 4 INTER 4 CMO 5 MAJOR+ CMO 2 CMO 2 CMO 2 MINOR 6 5 4 - NERVES Code Description A2500(i) Intracranial transection of cranial nerve A2600(i) Other intracranial destruction of cranial nerve A2900(i) Excision of lesion of cranial nerve (intracranial) A2952(i) Excision of acoustic and cerebellopontine angle neuroma tumours less than 2.5cms performed single surg A2953(i) Excison acoustic and cerebellopont angle neuroma - tumours >2.5 cms or compress brain stem -single surg A2954(i) Excision acoustic & cerebellopontine angle neuroma-managed by Oto-Neurosurg team irrespective size A3000(i) Repair of cranial nerve (intracranial) A3200(i) Decompression of cranial nerve (craniotomy) A3300(i) Neurostimulation of cranial nerve (intracranial) A3330(i) Removal of neurostimulator from cranial nerve A3680 Excision of cerebellopontine angle tumour Surgeon's Category CMO 4 CMO 4 CMO 5 CMO 5 CMO 5 CMO 5 CMO 1 CMO 4 MAJOR 5 MAJOR 3 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 4 CMO 4 CMO 4 CMO 4 CMO 4 CMO 4 CMO 4 CMO 1 CMO 1 MAJOR 4 INTER 5 CMO 4 CMO 4 CMO 5 CMO 5 CMO 5 CMO 5 CMO 1 CMO 4 MAJOR MAJOR CMO 5 3 7 7 7 4 1 1 7 VESSELS Code Description A4080(i) Craniotomy - post-operative haemorrhage A2223* Cerebral angiogram L3320(i) Ligation/clipping of aneurysm of cerebral artery L3380(i) Reinforcement of aneurysm of cerebral artery L3400(i) Open operations on cerebral artery L7510(i) Excision of arteriovenous malformation (excluding arteriovenous malformation of vessels of brain) A0260(i) Excision of arteriovenous malformation from vessels of brain Surgeon's Category MAJOR+ 5 INTER 1 CMO 4 CMO 4 CMO 4 CMO 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 4 MAJOR+ MINOR 5 CMO 2 CMO 2 CMO 2 CMO 2 CMO 2 INTER CMO 4 CMO 4 CMO 4 CMO 5 CMO 5 6 D/C - Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 22 – © Bupa Insurance Limited 1999-2012 OTHER Code A8300 Description Electro-convulsive therapy Surgeon's Category MINOR 1 CMO 4 MAJOR+ 4 CMO 4 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS MINOR 5 MINOR CMO 1 MAJOR+ 1 CMO 1 CMO 1 CMO 4 MAJOR+ CMO 4 CMO 5 4 - B0100(i) Hypophysectomy B0210 Cryotherapy to pituitary gland B0410(i) Excision of lesion of pituitary gland B0610(i) Excision of pineal gland Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 23 – © Bupa Insurance Limited 1999-2012 3 Notes Spine, Spinal Cord & Peripheral Nerves 1. If a procedure is marked with an ( i ) Bupa’s policy on Intensive Therapy applies. (See note 7 in the Essential Notes to the Schedule and appendix A). 2. The surgeon’s benefit entitlement for complex spinal surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy up to 72 hours. 3. The anaesthetist’s benefit entitlement for complex spinal surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy/ventilation for up to 72 hours. 4. In circumstances where the Intensive Therapy exceeds 72 hours, further benefit may be considered on a case by case basis. 5. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: Lesser Procedure(s) which are included in the main procedure and should not be billed separately: V2500 - (Primary posterior fusion +/- decompression +/- discectomy) A6700 - Release of entrapment of nerve 6. No additional benefit is available for the harvesting of the bone graft as it is considered to be an integral part of the overall procedure and is reflected in the classification of the main procedure. 7. The benefit maxima shown are applicable irrespective of whether surgery is performed on one or more levels. SPINAL COLUMN (INCLUDING INTERVERTEBRAL DISC) CERVICAL Surgeon's Category CMO 2 CMO 3 CMO 3 CMO 2 CMO 2 CMO 1 CMO 3 CMO 2 CMO 4 CMO 4 MAJOR 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 4 CMO 2 3 CMO 4 MAJOR+ 4 MAJOR+ 4 MAJOR+ 4 MAJOR+ 4 MAJOR+ 5 MAJOR+ 5 CMO 1 MAJOR+ 5 MAJOR 3 CMO 3 CMO 3 CMO 2 MAJOR+ MAJOR+ CMO 4 CMO 2 CMO 3 CMO 3 MAJOR 3 3 3 2 - Code V2200 V2282 V2300 V2990 V3720 V2900 Description Posterior decompression +/- foraminotomy (cervical region) Prosthetic intervertebral disc replacement - cervical spine Revisional posterior decompression +/- foraminotomy (cervical region) Open door laminoplasty of the cervical region (Hirobyashi) Posterior fusion (cervical region) Anterior discectomy (cervical region) V2902(i) Revisional anterior discectomy (cervical region) V2950(i) Anterior discectomy, decompression and fusion (including bone grafting / multiple levels) (cervical region) V2980(i) Combined anterior and posterior fusion of cervical spine V3730(i) Trans-oral surgery - including posterior fixation V4742 Spinal Endoscopy or Percutaneous spinal biopsy (Fluroscopy controlled) SPINAL COLUMN (INCLUDING INTERVERTEBRAL DISC) THORACIC Code A4860 Description Implantation/removal of epidural delivery system Surgeon's Category CMO 2 CMO 2 CMO 2 CMO 3 CMO 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 MAJOR MAJOR+ 4 MAJOR+ 4 MAJOR+ 4 MAJOR+ 4 CMO 5 MAJOR+ 1 MAJOR+ 4 MAJOR+ CMO 2 CMO 3 CMO 1 CMO 4 MAJOR+ CMO 3 3 4 - V2402(i) Posterior decompression (thoracic region) V2400(i) Posterior decompression with fusion (thoracic region) V2430 Revisional posterior decompression with fusion (thoracic region) V3120(i) Transthoracic/ anterolateral excision of intervertebral disc +/- fusion V3122 V3140 Revisional transthoracic/ anterolateral excision of intervertebral disc +/- fusion CMO 4 VATS percutaneous discectomy +/- fusion (thoracic region) MAJOR 5 CMO 3 V3100(i) Combined anterior discectomy and posterior fusion (thoracic region) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 24 – © Bupa Insurance Limited 1999-2012 V3102 Revisional combined anterior discectomy and posterior fusion (thoracic region) CMO 4 CMO 5 CMO 4 - SPINAL COLUMN (INCLUDING INTERVERTEBRAL DISC) LUMBAR Code V2540 V2544 V2542 V2543 V3300 V3472 V2560 V2562 V2660 V2500 V5002 V5230 V3362 V2652 Surgeon's Description Category Posterior excision of disc prolapse including microdiscectomy (lumbar region) MAJOR+ 4 Revision of posterior excision of disc prolapse (lumbar region) Posterior excision of disc prolapse with undercutting facetectomy (lumbar region) CMO 1 MAJOR+ 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 1 MAJOR+ 2 MAJOR+ 3 MAJOR+ 2 MAJOR+ 3 MAJOR+ 1 MAJOR+ 3 MAJOR+ 3 MAJOR+ 4 MAJOR+ 4 MAJOR+ 3 INTER 3 MINOR 5 MAJOR+ 5 MAJOR+ 3 MAJOR+ 5 CMO 1 CMO 4 MAJOR 2 MAJOR 3 INTER 4 INTER 5 CMO 1 MAJOR+ CMO 1 MAJOR MAJOR+ MAJOR+ CMO 2 CMO 2 CMO 1 MINOR MINOR CMO 1 CMO 2 MAJOR+ CMO 3 CMO 3 MAJOR MAJOR INTER INTER MINOR 2 3 3 D/C 3 3 3 4 3 4 5 3 5 2 D/C D/C 2 O/P Revision of posterior excision of disc prolapse with undercutting facetectomy CMO 2 (lumbar region) Minimally invasive intradiscal surgery (including laser/instrumentation) (lumbar region) Revision of minimally invasive intradiscal surgery (lumbar region) Decompression for central spinal stenosis (1 or 2 levels) Decompression for central spinal stenosis (3 or more levels) Revision of decompression for central spinal stenosis Primary posterior fusion +/- decompression +/- discectomy (lumbar region) Manipulation of spine under GA/IV sedation (as sole procedure) Discogram/diagnostic intervertebral disc injection under X-ray control Primary posterior fusion with instrumentation +/- decompression +/discectomy (including Graf Stabilisation) (lumbar region) Revision posterior fusion +/- instrumentation (lumbar region) MAJOR 5 CMO 2 MAJOR+ 4 CMO 1 CMO 2 CMO 1 MINOR 1 MINOR 5 CMO 3 CMO 3 CMO 2 CMO 4 CMO 3 MAJOR 1 MAJOR 3 MAJOR 3 INTER 5 £50 V3340(i) Primary anterior discectomy, decompression and anterior fusion (lumbar region) V3350(i) Combined anterior discectomy and fusion and posterior fusion (lumbar region) V3380 V4140 V4740 V5210 W0660 V5003 Prosthetic replacement of lumbar disc Removal of posterior spinal implant Percutaneous spinal biopsy (CT controlled) Chemonucleolysis (multiple levels) Coccygectomy (multiple levels) Manipulation of spine without GA/IV sedation (as sole procedure) SCOLIOSIS, KYPHOSIS, FRACTURES, TUMOURS AND INFECTIONS Code Description V4100(i) Posterior correction of scoliosis with instrumentation and fusion V4120(i) Anterior correction of scoliosis with instrumentation and fusion Surgeon's Category CMO 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 2 CMO 4 7 CMO 3 CMO 3 CMO 3 CMO 4 MAJOR 2 MAJOR 5 MAJOR 5 MAJOR+ 1 INTER 5 CMO 5 CMO 5 CMO 5 CMO 4 MAJOR MAJOR MAJOR+ MAJOR+ INTER 7 2 - V4000(i) Combined anterior and posterior correction and instrumentation of scoliosis CMO 5 V4300 V4302 V4142 V4451 V4452 V4453 W2912 Anterior vertebrectomy with decompression and implant CMO 5 Combined anterior vertebrectomy with posterior fusion and instrumentation CMO 5 Removal of posterior scoliosis instrumentation (as sole procedure) Balloon Kyphoplasty single level Balloon Kyphoplasty - two levels Balloon Kyphoplasty greater than 2 levels Application of halo (as sole procedure) MAJOR 1 MAJOR 5 MAJOR+ 3 CMO 1 MINOR 5 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 25 – © Bupa Insurance Limited 1999-2012 SPINAL CORD Code A4400 A4500 A4900 A5110 A5300 A5530 Description Partial excision of spinal cord Open operations on spinal cord Repair of spinal myelomeningocele Excision of intradural lesion Drainage of spinal canal (including insertion of shunt) Lumbar puncture (including spinal manometry) Surgeon's Category CMO 3 CMO 3 CMO 2 CMO 3 MAJOR+ 5 MINOR 2 INTER 2 CMO 3 MAJOR+ 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 CMO 3 MAJOR+ 5 MAJOR+ 4 MAJOR+ 5 MAJOR 5 MINOR 1 MINOR 5 MAJOR+ 5 MAJOR+ 1 CMO 3 CMO 2 CMO 3 MAJOR+ MINOR INTER CMO 3 MAJOR+ 4 3 6 3 5 - A5580(i) CSF Infusion Studies V4980 A4730 Excision of intramedullary tumour Percutaneous cordotomy of spinal cord PARASPINAL INJECTIONS Code A5200 Description Epidural injection (cervical) Surgeon's Category INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS MINOR 5 INTER D/C PARASPINAL INJECTIONS (continued) Code A5210 A5220 AA536 25140 A5420 A5750 A5760 A5770 A5720 A5730 A7085 AA597 AA598 Description Epidural injection (lumbar/caudal) Epidural injection (thoracic) Epidural injection (transforaminal) Intrathecal neurolysis Injection of therapeutic substance into CSF Facet joint injection (under X-ray control) - up to 2 joints Facet joint injection (under X-ray control) - 3 - 4 joints Facet Joint injection (under X-ray control) - 5 - 6 joints Facet or sacroiliac joint (RF) radio frequency thermocoagulation including rhizolysis (under x-ray control with sedation/GA) – up to 3 joints Facet or sacroiliac joint (RF) radiofrequency thermocoagulation incl Rhizolysis (under X-ray control with sedation/GA) - 4 - 6 joints Sacral nerve stimulation for faecal/urinary incontinence or constipation Sacroiliac joint injection Medial branch block Surgeon's Category MINOR 5 INTER 1 INTER 2 INTER 4 MINOR 2 MINOR 5 INTER 1 INTER 2 MAJOR 1 MAJOR 2 MAJOR 5 MINOR 5 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS MINOR 5 MINOR D/C MINOR 5 MINOR 5 MAJOR 5 MINOR 5 INTER 1 INTER 2 INTER 3 MAJOR 3 MAJOR 5 INTER INTER INTER MINOR INTER INTER INTER INTER MAJOR MAJOR MINOR MINOR D/C D/C D/C D/C D/C D/C D/C - NERVE ROOTS Code A5780 A7302 A7352 Description Rhizolysis (open) Continuous nerve block Ultrasound guided nerve block (as sole procedure) Surgeon's Category MAJOR+ 5 INTER 1 MINOR 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR+ MINOR 5 MINOR 5 INTER MINOR - SYMPATHETIC NERVES Code 25020 Description Intravenous regional sympathetic block (guanethidine block) - 1 injection Surgeon's Category MINOR 4 MINOR 4 MINOR 5 MAJOR+ 3 Anaesthetist's Hospital Anticipated Category Category LOS MINOR D/C MAJOR 5 MINOR MINOR MAJOR+ D/C D/C 1 25022(ii) Stellate ganglion block (local anaesthetic) 25030 A7510 Stellate ganglion block (neurolytic) Thorascopic cervical sympathectomy Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 26 – © Bupa Insurance Limited 1999-2012 A7520 A7620 A7500 A7600 A7530 A7682 A7683 25100 25110 A5540 Thoracic sympathectomy: diagnostic (local anaesthetic under X-ray control) Thoracic sympathectomy: therapeutic (neurolytic under X-ray control) Lumbar sympathectomy: diagnostic (local anaesthetic under X-ray control) Lumbar sympathectomy: therapeutic (neurolytic under X-ray control) Laparoscopic lumbar sympathectomy Presacral sympathectomy – diagnostic Presacral sympathectomy - therapeutic Coeliac plexus block, splanchnic nerve block, hypogastric block – diagnostic INTER 3 MAJOR 1 INTER 3 INTER 5 MAJOR 3 MAJOR 1 MAJOR 1 INTER 4 INTER 4 INTER 3 MAJOR 4 MAJOR 3 MAJOR 3 MINOR 5 INTER MAJOR INTER INTER MAJOR MAJOR MAJOR INTER INTER INTER D/C D/C D/C D/C D/C D/C - Coeliac plexus block, splanchnic nerve block, hypogastric block - therapeutic INTER 4 Spinal angiogram INTER 1 PERIPHERAL NERVES Code A6030 A6080 A6400 A6402 A6300 A6302 A6110 A6180 A6510 A6580 AA529 AA530 A6710 A6711 AA531 AA532 A6600 A6700 A6810 A6900 A7010 A7310 A7340 Description Transection of peripheral nerve for neuroma Neurectomy (major nerve) Repair of peripheral nerve Repair of major nerve Graft to peripheral nerve Graft to major nerve Excision of lesion of peripheral nerve (e.g. neurilemoma) Excision of lesion of major nerve Carpal tunnel release, including endoscopic Carpal tunnel release, including endoscopic-bilateral Carpal tunnel release (open) (BUPA code) Carpal tunnel release (open, bilateral) (BUPA code) Cubital tunnel release including endoscopic (without transposition) Surgeon's Category INTER 2 INTER 5 INTER 2 INTER 3 MAJOR+ 2 MAJOR+ 2 INTER 3 INTER 5 INTER 2 INTER 4 INTER 1 INTER 3 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C INTER 5 INTER 5 INTER 5 MAJOR 4 MAJOR 4 INTER 4 INTER 5 INTER 4 MAJOR 4 MAJOR 4 MAJOR 4 INTER 4 MAJOR 4 MAJOR 4 MAJOR 4 INTER 4 INTER 4 INTER 5 INTER 5 INTER 1 INTER 2 CMO 2 INTER INTER MAJOR MAJOR+ MAJOR+ INTER INTER INTER INTER INTER INTER INTER INTER INTER INTER INTER INTER INTER MAJOR MAJOR INTER CMO 2 D/C D/C D/C D/C 1 D/C D/C D/C D/C D/C D/C D/C D/C 1 D/C 1 Cubital tunnel release including endoscopic-bilateral (without transposition) INTER 4 Cubital tunnel release without transposition (open) (BUPA code) Cubital tunnel release without transposition (open, bilateral) (BUPA code Release of entrapment of deeply placed peripheral nerve Release of entrapment of peripheral nerve Neurolysis and transposition of peripheral nerve (includes ulnar at elbow) Revision of release of peripheral nerve Implantation of neurostimulator to peripheral nerve Biopsy of peripheral nerve Exploration and grafting of brachial plexus INTER 1 INTER 3 INTER 2 INTER 2 INTER 3 MAJOR 1 MAJOR 4 INTER 2 CMO 2 OTHER NERVE BLOCKS Code 25150 AA460 A7350 Description Trigeminal ganglion injection (local anaesthetic under X-ray control) Destruction of branch of trigeminal nerve (neurolytic/RF/cryoprobe) Surgeon's Category INTER 4 MAJOR 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MINOR 2 INTER INTER MINOR D/C D/C D/C Local anaesthetic blockade of major nerve trunk (including occipital block, MINOR 5 spheno-palatine block, diagnostic block of trigeminal branch, intercostal nerve block & supra-scapular nerve block) Permanent lesion of major nerve trunk (radiofrequency, cryoprobe or phenol) INTER 1 A7300 MAJOR 3 INTER D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 27 – © Bupa Insurance Limited 1999-2012 OTHER PROCEDURES Code 25160 Description Trigeminal ganglion radiofrequency lesion (under X-ray control) Surgeon's Category MAJOR 5 MINOR 5 MINOR 1 INTER 1 INTER 1 INTER 1 MINOR 1 INTER 5 MAJOR+ 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 INTER D/C INTER 2 MINOR 5 INTER 2 INTER 2 INTER 2 MINOR 5 INTER 4 MAJOR 4 MINOR MINOR INTER INTER INTER MINOR INTER MAJOR+ - X3770(ii) Intramuscular injection with X-ray control (e.g. piriformis block) X3750(ii) Botulinus toxin injections to muscle Y3800 Y3810 Y3820 Insertion of indwelling axillary catheter Insertion of indwelling pleural catheter Insertion of indwelling psoas catheter T6520(ii) Tendon sheath injection V5250 V5484 Radiofrequency lesioning of intervertebral disc under X-ray control Interspinous process distraction system (X Stop device) NEUROPHYSIOLOGICAL PROCEDURES Code 22000 22002 22003 22004 22005 22026 22027 22022 22023 22024 Description Routine Electroencephalography (EEG) in adult or child aged over 5 (including reporting) Surgeon's Category MINOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MINOR O/P MINOR MINOR MINOR MINOR MINOR INTER MINOR MINOR MINOR O/P O/P - Routine Electroencephalography (EEG),in child under 5 (including reporting) MINOR 1 Sleep Electroencephalography (EEG) 24 hour ambulatory Electroencephalography (EEG) (including reporting) MINOR 1 MINOR 1 24 hour video telemetry Electroencephalography (EEG) (including reporting) MINOR 1 Spinal monitoring - up to 4 hours Spinal monitoring - more than 4 hours INTER 1 INTER 5 Recording and reporting on electromyography and nerve conduction studies MINOR 5 (EMG); CTS (Bilateral U.L. only) or peripheral neuropathy Recording and reporting on electromyography and nerve conduction studies MINOR 5 (EMG); Mononeuropathy (e.g. ulnar), Cx/Lumbar radiculopathy, Myopathy Recording and reporting on electromyography and nerve conduction studies MINOR 5 (EMG); Mononeuritis Multiplex, MND AHC, Multiple Muscle Monitoring (e.g. mononeuritis, muscle monitor) Recording and reporting on electromyography and nerve conduction studies MINOR 5 (EMG); Myaesthenia Gravis (+SFEMG) Recording and reporting on evoked potential study Electro-convulsive therapy Transtympanic electro-cochleography MINOR 5 MINOR 1 INTER 1 22025 22011 A8300 A8480 MINOR 5 - MINOR MINOR MINOR INTER O/P O/P Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 28 – © Bupa Insurance Limited 1999-2012 4 Notes Eye & Orbital Contents Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: Lesser Procedure(s) which are included in the main procedure and should not be billed separately: C7180 - Extracapsular extraction with implant - unilateral C4050 - Suture of conjunctiva GLOBE & ORBIT Code C0110 C0120 C0122 C0212 C0213 C0512 C0513 C0514 C0610 C0620 C0630 C0640 C0650 Description Exenteration of orbit Enucleation/evisceration of eyeball Enucleation/evisceration of eyeball (with implant) Excision of lesion of orbit – anterior approach Excision of lesion of orbit – lateral orbitotomy Simple reconstruction of socket (not including implant or graft) Reconstruction of socket with either implant or graft Reconstruction of socket with implant and graft Biopsy of lesion of orbit Drainage of orbit Decompression of orbit Removal of foreign body from orbit Exploration of orbit (as sole procedure) Surgeon's Category CMO 2 MAJOR 4 MAJOR 5 MAJOR 3 MAJOR 4 MAJOR 4 MAJOR 5 MAJOR+ 1 INTER 4 INTER 5 MAJOR+ 1 MAJOR 3 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 4 MAJOR 4 MAJOR 4 INTER 5 INTER 2 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR MAJOR MAJOR MAJOR MAJOR CMO 1 CMO 1 INTER INTER MAJOR MAJOR MAJOR 1 1 D/C 1 1 1 1 D/C D/C 1 EYEBROW & LID Code C1010 C1040 C1110 C1130 C1140 C1150 C1160 C1910 Description Excision of lesion of eyebrow Suture of eyebrow Excision of lesion of canthus Correction of epicanthus Correction of telecanthus Graft of skin to canthus Canthotomy Drainage of lesion of eyelid Surgeon's Category MINOR 2 MINOR 1 MINOR 4 INTER 4 INTER 4 INTER 3 MINOR 3 MINOR 2 MINOR 3 MINOR 1 INTER 5 MAJOR 3 MAJOR+ 2 INTER 3 INTER 4 INTER 5 INTER 4 INTER 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER 3 MINOR O/P INTER 3 INTER 5 INTER 5 INTER 5 INTER 5 INTER 5 INTER 2 MINOR 5 MINOR 5 MAJOR 2 MAJOR 2 MAJOR+ 1 INTER 5 INTER 3 INTER 3 INTER 3 INTER 3 MINOR INTER INTER INTER INTER MINOR MINOR MINOR MINOR MAJOR MAJOR CMO 1 INTER INTER INTER INTER INTER D/C D/C 1 D/C O/P O/P O/P D/C D/C D/C D/C D/C C1210(ii) Excision of lesion of eyelid C1230(ii) Curettage/cryotherapy of lesion of eyelid C1320 C1340 C1341 C1420 C1512 C1513 C1522 C1523 Blepharoplasty – one eyelid Blepharoplasty – two eyelids Blepharoplasty – three or four eyelids Graft of skin to eyelid Correction of lower lid ectropion without graft/flap Correction of lower lid ectropion with graft/flap Correction of entropion – lower lid, including graft/flap Correction of entropion – upper lid, including graft/flap Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 29 – © Bupa Insurance Limited 1999-2012 C1532(ii) Correction of trichiasis by electrolysis/diathermy/cryotherapy/laser C1640 C1700 C1710 C1810 C1811 C1812 C1813 Tarsorrhaphy Total reconstruction of eyelid - unilateral Suture of eyelid (laceration) (as sole procedure) Correction of ptosis of eyelid - simple, including tarsomullerectomy Correction of ptosis of eyelid – bilateral Correction of ptosis of eyelid – complex Correction of ptosis of eyelid with autologous fascia lata MINOR 3 INTER 2 MAJOR 3 MINOR 3 INTER 4 MAJOR 5 INTER 5 MAJOR 2 MINOR 2 MINOR 1 INTER 3 INTER 3 INTER 5 INTER 3 MAJOR 2 MAJOR+ 1 MAJOR 2 MAJOR 2 INTER 1 MINOR 5 MINOR INTER MAJOR MINOR MAJOR CMO 1 MAJOR MAJOR MINOR MINOR D/C D/C D/C D/C D/C D/C O/P - C2220(ii) Biopsy of lesion of eyelid C2240 Injection into eyelid LACRIMAL SYSTEM Code C2540 C2542 C2550 C2610 C2640 Description Dacryocysto-rhinostomy, including insertion of tube Dacryocysto-rhinostomy (endoscopic/laser assisted) (including insertion and later removal of tube) Lacrimal intubation (as sole procedure) Excision/Biopsy of lacrimal sac Incision of lacrimal sac Surgeon's Category MAJOR 3 MAJOR 4 INTER 4 MINOR 4 MINOR 2 MINOR 1 INTER 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 1 MAJOR D/C MAJOR+ 1 INTER 3 INTER 5 INTER 3 MINOR 1 MINOR 5 MAJOR+ MINOR INTER MINOR MINOR MINOR 1 D/C D/C O/P O/P C2650(ii) Probing of nasolacrimal system with/without syringing and/or irrigation C2910 Puncto-canaliculoplasty MUSCLES Code C3112 C3113 C3114 C3115 C3180 C3530 Description Surgical correction of squint – horizontal 1 muscle Surgical correction of squint – horizontal 2 muscles (in one eye, or one muscle in each of two eyes) Surgical correction of squint – inferior oblique surgery Surgical correction of squint – other vertical muscles Revision of squint surgery Surgical correction of squint with adjustable sutures Surgeon's Category INTER 4 MAJOR 3 INTER 5 MAJOR 4 MAJOR 5 MAJOR 5 MINOR 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 MAJOR D/C MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 1 MAJOR 3 MAJOR MAJOR MAJOR MAJOR+ MAJOR+ INTER D/C D/C D/C D/C D/C O/P C3780(ii) Injection of botulinum toxin into extraocular or periocular muscles CONJUNCTIVA Code C3910 C3920 C3950 C4010 C4050 C4100 C4340 C4350 Description Excision/biopsy of conjunctival lesion Cauterisation including cryotherapy to conjunctival lesion Radiotherapy to conjunctival lesion Mucosal graft to conjunctiva Suture of conjunctiva Drainage of conjunctival cyst Subconjunctival injection Exploration of conjunctiva (including removal of foreign body) Surgeon's Category MINOR 3 MINOR 2 MINOR 5 INTER 4 MINOR 4 MINOR 1 MINOR 1 MINOR 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 5 MINOR D/C INTER 5 INTER 5 INTER 5 INTER 5 INTER 4 INTER 4 INTER 4 MINOR MINOR INTER MINOR MINOR MINOR MINOR D/C D/C O/P O/P O/P Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 30 – © Bupa Insurance Limited 1999-2012 CORNEA Code C4520 C4640 C4650 C4620 C4630 C4690 C4710 Description Excision of lesion of cornea Descemets stripping endothelial keratoplasty (DSEK) Revision of corneal graft Lamellar graft (keratoplasty) to cornea Perforating graft (keratoplasty) to cornea Implantation of synthetic corneal rings for keratoconus (including INTACS) Repair of corneal wound Surgeon's Category MINOR 4 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 INTER 4 MINOR 5 MINOR 1 MINOR 3 INTER 1 MINOR 3 MAJOR+ 3 MINOR 4 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 MINOR D/C MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 INTER 4 INTER 5 INTER 3 INTER 4 INTER 3 INTER 3 MAJOR+ 4 INTER 4 MAJOR+ MAJOR MAJOR+ MAJOR+ INTER MINOR MINOR MINOR INTER MINOR MAJOR+ MINOR D/C O/P D/C O/P D/C C4730(ii) Removal of corneal suture C4810 C5122 C5180 C5190 C3960 Removal of superficial corneal foreign body Chelation of cornea/photo therapeutic keratectomy Corneal scraping for culture Limbal Stem Cell Allograft Transplant Excision of pterygium SCLERA Code C5300 C5720 C5730 Description Excision of lesion of sclera Repair of scleral laceration Scleral graft Surgeon's Category INTER 1 INTER 1 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 1 INTER D/C MAJOR 1 MAJOR 1 INTER MAJOR D/C IRIS & ANTERIOR CHAMBER Code C5910 C5920 C6010 C6110 C6130 C6150 C6160 C6170 Description Iridocyclectomy Surgical iridectomy Surgical trabeculectomy or other penetrating glaucoma procedures Laser trabeculoplasty Goniotomy (surgical treatment of glaucoma) Revision of previous glaucoma surgery Complex glaucoma surgery (including anti-metabolites/insertion of seton Goniosynechialysis or goniopuncture (with laser or operatively) Surgeon's Category MAJOR+ 2 INTER 4 MAJOR 4 INTER 3 MAJOR 3 MAJOR 4 MAJOR 4 INTER 4 INTER 4 MAJOR 3 MAJOR 3 MAJOR 3 INTER 4 MAJOR 2 MAJOR 1 MINOR 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 1 MAJOR+ MAJOR 3 MAJOR 4 MAJOR 1 MAJOR 1 MAJOR 1 MAJOR 1 MAJOR 3 INTER 5 MAJOR 3 MAJOR 3 MAJOR 3 INTER 5 MAJOR 3 MAJOR 1 INTER 4 INTER MAJOR INTER MAJOR MAJOR MAJOR INTER INTER MAJOR MAJOR MAJOR INTER MAJOR MAJOR INTER D/C O/P D/C D/C D/C O/P D/C D/C D/C D/C D/C D/C C6230(ii) Laser iridotomy C6410 C6420 C6450 C6610 C6710 C6910 C6920 Repair of prolapsed iris Excision of lesion of iris Removal of foreign body from iris Ciliary body ablation Cyclodialysis (separation of ciliary body) Reformation of anterior chamber Paracentesis Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 31 – © Bupa Insurance Limited 1999-2012 IRIS & ANTERIOR CHAMBER (continued) Code C6990 C6930 C6940 C6980 Description Insertion of valve into anterior chamber of eye Injection into anterior chamber Irrigation/aspiration of anterior chamber Removal of foreign body from anterior chamber Surgeon's Category MAJOR 3 MINOR 3 MINOR 4 INTER 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 1 MAJOR INTER 4 INTER 4 INTER 4 MINOR MINOR INTER O/P D/C D/C LENS Code C7100 C7110 C7123 C7124 C7122 C7125 C7180 C7190 Description Extracapsular extraction without implant - bilateral Extracapsular extraction without implant - unilateral Phakoemulsification of lens without implant – unilateral Phakoemulsification of lens without implant - bilateral Phakoemulsification of lens with implant - unilateral Phakoemulsification of lens with implant - bilateral Extracapsular extraction with implant - unilateral Extracapsular extraction with implant - bilateral Surgeon's Category MAJOR 2 INTER 3 INTER 2 MAJOR 1 INTER 3 MAJOR 2 INTER 4 MAJOR 3 MINOR 4 INTER 1 MAJOR 1 MAJOR 5 MAJOR 2 INTER 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 4 MAJOR+ D/C MAJOR 5 INTER 5 MAJOR 5 MAJOR+ 1 MAJOR 5 MAJOR+ 1 MAJOR+ 5 INTER 5 MAJOR 5 MAJOR 3 MAJOR+ 2 MAJOR 3 INTER 5 MAJOR INTER MAJOR INTER MAJOR MAJOR MAJOR+ MINOR INTER MAJOR CMO 1 MAJOR INTER D/C D/C D/C D/C D/C D/C D/C O/P D/C D/C - C7340(ii) Yag laser photodisruption of posterior capsule of lens (including laser capsulotomy) C7341(ii) Yag laser photodisruption of posteria capsule of lens – bilateral C7510 C7511 C7520 C7530 Secondary insertion of lens implant Secondary insertion of lens implant – bilateral Lens implant/exchange Removal of lens implant VITREOUS Code C7910 C7922 Description Anterior vitrectomy Pars plana vitrectomy/vitreous biopsy Surgeon's Category INTER 2 MAJOR 2 MINOR 3 MINOR 3 MAJOR+ 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR D/C MAJOR+ 4 INTER 3 INTER 3 MAJOR+ 4 CMO 2 MAJOR MINOR MINOR MAJOR+ CMO 1 D/C O/P D/C D/C C7923(ii) Intravitreal injection of pharmaceutical for neovascular age related macular degeneration C7924 C7920 C7982 Intravitreal injection of pharmaceutical for central retinal vein occlusion Pars plana vitrectomy with internal tamponade, scleral buckling and retinopexy Pars plana vitrectomy with internal tamponade, scleral buckling and CMO 3 retinopexy, including dissection or excision of epiretinal membrane/macular RETINA Code C5432 C8240 C8440 C5480 C8200 Description Conventional retinal surgery (may include scleral buckling, injection of gas, drainage and retinopexy) Photodynamic therapy to the retina (PDT) Retinal examination under anaesthetic including retinopexy if necessary Removal of silicone oil Laser photocoagulation/cryotherapy of lesion of retina Surgeon's Category MAJOR 5 MINOR 4 MINOR 4 INTER 2 MINOR 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR+ D/C MINOR 5 INTER 2 INTER 3 INTER MINOR INTER INTER D/C D/C O/P Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 32 – © Bupa Insurance Limited 1999-2012 GENERAL Code Description C8650(ii) Fluorescein angiography of eye (including occular photography) C8654 Insertion of radioactive plaque into eye (including later removal) Surgeon's Category MINOR 1 MAJOR 3 £50 CMO 3 Anaesthetist's Hospital Anticipated Category Category LOS MINOR 1 MINOR O/P MAJOR+ 5 MAJOR+ MINOR CMO 3 - C8652(ii) Occular photography (as sole procedure) X6580 Proton beam therapy complete course of treatment Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 33 – © Bupa Insurance Limited 1999-2012 5 Notes Ear, Nose & Throat 1. If a procedure is marked with an ( i ) Bupa’s policy on Intensive Therapy applies. (See note 7 in the Essential Notes to the Schedule and appendix A). 2. The surgeon’s benefit entitlement for complex ENT surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy up to 72 hours. 3. The anaesthetist’s benefit entitlement for complex ENT surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy/ventilation for up to 72 hours. 4. In circumstances where the Intensive Therapy exceeds 72 hours, further benefit may be considered on a case by case basis. 5. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: D1510 - Myringotomy and insertion of tube through tympanic membrane (and bilateral) Lesser Procedure(s) which are included in the main procedure and should not be billed separately: D1520 - Suction clearance of middle ear EXTERNAL EAR Code D0110 D0140 D0132 D0210 D0280 D0410 D0610 D0812 D0310 D0342 D0340 Description Total excision of pinna Excision of preauricular sinus Excision accessory auricle/preauricular appendage Excision of lesion of pinna Removal of multiple bony exostoses external auditory canal Drainage of haematoma/abscess of pinna Biopsy of lesion of pinna (as sole procedure) Removal of solitary osteoma of external auditory canal Reconstruction of external ear for anotia/microtia using cartilage graft Bony meatoplasty Soft tissue meatoplasty of external auditory canal Surgeon's Category MAJOR 1 INTER 3 INTER 2 INTER 1 MAJOR 2 MINOR 3 MINOR 1 INTER 3 CMO 1 MAJOR 1 MAJOR 1 MINOR 1 MINOR 3 MINOR 2 MINOR 4 MAJOR+ 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR INTER 3 MINOR 5 INTER 3 INTER 5 INTER 3 MINOR 5 INTER 3 MAJOR+ 1 INTER 5 INTER 5 MINOR 1 INTER 3 MINOR 5 MAJOR 1 MAJOR+ 3 INTER MINOR INTER INTER MINOR MINOR INTER CMO 1 MAJOR INTER MINOR MINOR MINOR MINOR MAJOR+ D/C D/C O/P 1 O/P O/P D/C 1 D/C D/C O/P O/P O/P 1 D0702(ii) Aural toilet - including microsuction D0630 Repair of pinna D0730(ii) Removal of foreign body from external auditory canal (and bilateral) D0810 D0820 Excision of lesion of external auditory canal Reconstruction of external auditory canal MIDDLE EAR AND MASTOID Code D1010 D1020 D1040 D1060 D1240 D1540 D1440 Description Radical mastoidectomy (including meatoplasty) Modified radical mastoidectomy (including meatoplasty) Simple mastoidectomy Revision of mastoidectomy (including meatoplasty) Exploration of facial nerve, mastoid segment Exploration of entire middle ear course of VII Combined approach tympanoplasty - intact canal wall tympanoplasty Surgeon's Category MAJOR+ 3 MAJOR+ 3 MAJOR+ 1 MAJOR 4 MAJOR+ 3 CMO 2 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 1 MAJOR MAJOR+ 2 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 5 MAJOR+ 1 MAJOR+ MAJOR MAJOR MAJOR+ MAJOR+ MAJOR 1 1 1 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 34 – © Bupa Insurance Limited 1999-2012 D1420 D1510 Myringoplasty Myringotomy and insertion of tube through tympanic membrane (and bilateral) MAJOR 5 MINOR 4 MINOR 2 MINOR 2 MINOR 2 MAJOR+ 5 MINOR 5 MAJOR 4 MAJOR 4 MAJOR 4 MINOR 5 MAJOR 2 INTER 5 MAJOR 3 CMO 2 CMO 2 CMO 3 MAJOR 4 INTER 5 MINOR 5 MINOR 2 MINOR 5 MAJOR+ 2 INTER 5 MAJOR 4 MAJOR 4 MAJOR 4 MINOR 5 MAJOR 1 INTER 5 MAJOR+ 2 CMO 2 CMO 2 MAJOR+ 2 MAJOR MINOR MINOR MINOR MINOR MAJOR+ MINOR MAJOR MAJOR+ MAJOR MINOR MAJOR MAJOR+ MAJOR CMO 5 CMO 5 MAJOR+ D/C D/C O/P O/P 1 D/C D/C 1 D/C D/C 1 D1520(ii) Suction clearance of middle ear (as sole procedure) D2822 D1530 D1610 D2030 D1710 D1720 D1900 D1910 D2040 D2050 T8950 Examination of ear under general anaesthetic (as sole procedure) Myringotomy (and bilateral) Ossiculoplasty Removal of grommets Stapedectomy Revision stapedectomy Middle ear tumour excision Middle ear polypectomy Diagnostic tympanotomy (as sole procedure) Tympanic neurectomy Repair of peri-lymph fistula V0382(i) Total petrosectomy (for tumour) V0383(i) Lateral petrosectomy (for tumour) W1870 Drainage of petrous apex for sepsis INNER EAR Code A8480 D2610 D2620 D2630 D2420 AA489 Description Transtympanic electro-cochleography Operation(s) on endolymphatic sac Membranous labyrinthectomy Osseous labyrinthectomy Insertion of cochlea implant Transtympanic chemical labyrinthectomy Surgeon's Category INTER 1 MAJOR 5 MAJOR+ 2 MAJOR+ 3 CMO 2 MAJOR+ 2 CMO 5 CMO 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER O/P MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 4 MAJOR+ 1 CMO 4 CMO 4 CMO 4 MAJOR MAJOR+ MAJOR+ CMO 3 MAJOR CMO 5 CMO 5 CMO 5 1 1 7 7 7 A2952(i) Excision of acoustic and cerebellopontine angle neuroma tumours less than 2.5cms performed single surg A2953(i) Excision acoustic and cerebellopont angle neuroma - tumours >2.5 cms or compress brain stem -single surg A2954(i) Excision acoustic & cerebellopontine angle neuroma-managed by Oto-Neurosurg team irrespective size NOSE AND NASAL CAVITY Code E0110 E0230 E0260 E0310 E0330 E0340 E0360 Description Total excision of nose Septorhinoplasty +/- graft/implant following trauma or excision of tumour Rhinoplasty following trauma or excision of tumour Submucous resection of nasal septum Biopsy of septum of nose Closure of perforation of septum of nose Septoplasty of nose Surgeon's Category MAJOR 1 MAJOR+ 1 MAJOR 4 INTER 4 MINOR 2 INTER 5 MAJOR 1 MINOR 3 INTER 1 INTER 1 MINOR 2 INTER 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR MAJOR 2 MAJOR 2 INTER 3 INTER 2 INTER 3 INTER 5 MINOR 5 INTER 3 INTER 3 INTER 3 INTER 5 MAJOR MAJOR INTER MINOR INTER INTER MINOR MINOR INTER MINOR INTER 1 1 D/C D/C D/C D/C O/P D/C D/C D/C D/C E0380(ii) Nasal septum cauterisation (and bilateral) E0412 E0420 E0440 E0520 Reduction turbinates of nose (laser, diathermy, out fracture etc) Reduction turbinates of nose (trim,radical excision) Division of adhesions of turbinate of nose (and bilateral) Ligation of artery of internal nose (including endoscopic) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 35 – © Bupa Insurance Limited 1999-2012 E0610 E0810 E0820 E0830 Packing of cavity of nose (as sole procedure) Polypectomy of internal nose (and bilateral, including endoscopic) Excision of lesion of internal nose Correction of congenital atresia of choana (including endoscopic) MINOR 1 MINOR 4 MINOR 3 MAJOR 1 MINOR 1 MINOR 2 INTER 2 INTER 2 INTER 2 MAJOR 3 INTER 2 INTER 4 MINOR MINOR MINOR MAJOR MINOR MINOR D/C D/C D/C O/P D/C E0850(ii) Removal of foreign body from cavity of nose E0910 Excision of lesion of external nose NASAL SINUSES Code E1220 E1240 E1260 E1310 E1330 E1350 E1360 E1370 E1380 E1410 E1420 E1432 E1440 E1450 E1460 E1470 E1480 E1500 E1742 Description Caldwell-Luc Vidian neurectomy (including endoscopic) Image guided endoscopic frontal, sphenoid and/or ethmoid sinus surgery (FESS) Antral puncture and wash-out (and bilateral) Intranasal antrostomy including endoscopic (and bilateral) Closure of oro-antral fistula Endoscopic balloon dilation frontal sinuplasty (as sole procedure) Endoscopic balloon dilation maxillary sinuplasty (as sole procedure) Endoscopic balloon dilation sphenoid sinuplasty (as sole procedure) External frontoethmoidectomy Intranasal ethmoidectomy (and bilateral) FESS uncinectomy, ethmoidectomy, antrostomy or antral puncture inc polypectomy and attention to turbinates etc Transantral ethmoidectomy (and bilateral) Bone flap to frontal sinus (and bilateral) Trephining of frontal sinus Median drainage of frontal sinus (modified Lothrop procedure) Endoscopic exploration frontal sinus beyond frontoethmoid recess Operation(s) on sphenoid sinus (including endoscopic) Lateral rhinotomy into sinuses Surgeon's Category INTER 3 MAJOR 2 MAJOR+ 1 MINOR 4 INTER 2 INTER 5 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 5 MAJOR 1 MAJOR 3 MAJOR 1 MAJOR+ 3 MINOR 5 CMO 4 MAJOR+ 2 INTER 2 MAJOR 2 MINOR 1 CMO 2 MAJOR 4 MINOR 5 CMO 4 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER MAJOR 3 MAJOR 5 MINOR 5 INTER 5 INTER 4 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 4 INTER 5 MAJOR 3 MAJOR 3 MAJOR 2 MINOR 5 CMO 1 MAJOR+ 1 INTER 5 MAJOR 2 INTER 3 INTER 4 MAJOR+ 1 MINOR 5 CMO 5 MAJOR MAJOR MINOR INTER INTER MAJOR MAJOR MAJOR MAJOR INTER MAJOR MAJOR MAJOR MINOR CMO 4 MAJOR+ INTER INTER MINOR INTER MAJOR+ MINOR CMO 4 D/C D/C D/C D/C D/C D/C 1 D/C D/C 2 1 D/C 2 O/P 1 D/C - E1780(ii) Diagnostic endoscopy of sinus (as sole procedure) E1750 C2542 W2620 V0700 Transnasal repair of leaking CSF (including endoscopic) Dacryocysto-rhinostomy (endoscopic/laser assisted), including insertion of tube Manipulation under anaesthesia of fractured nose (as sole procedure) Cranio-facial resection THROAT Code Description E1910(i) Total pharyngectomy E1920(i) Partial pharyngectomy E2100 E2010 E2320 E2400 E2480 Repair of pharynx Adenoidectomy Operation(s) on pharyngeal pouch (exterior approach) Therapeutic endoscopic operation on pharynx Pharyngeal pouch - endoscopic procedures Surgeon's Category CMO 4 MAJOR+ 1 MAJOR 5 MINOR 3 MAJOR 3 MINOR 5 MAJOR 3 MINOR 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 1 CMO 4 CMO 1 MAJOR 5 MINOR 5 MAJOR 3 INTER 3 MAJOR 2 INTER 3 MAJOR+ MAJOR MINOR MAJOR MINOR MAJOR MINOR D/C 5 1 1 O/P E2500(ii) Diagnostic endoscopic examination of pharynx/larynx (including biopsy) (as sole procedure) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 36 – © Bupa Insurance Limited 1999-2012 E3680(ii) Endoscopic laryngo-pharyngoscopy as sole outpatient procedure F3400 F3440 F3480 F3620 E2330 F3650 Tonsillectomy - child (and bilateral) Tonsillectomy - adult (and bilateral) Adenotonsillectomy (and bilateral) Drainage of peritonsillar abscess ("quinsy") Removal of lesion of para-pharyngeal space Arrest of haemorrhage following tonsillectomy/adenoidectomy MINOR 2 INTER 4 INTER 5 INTER 5 MINOR 1 CMO 3 INTER 2 INTER 5 MAJOR 1 MAJOR 1 MAJOR 1 INTER 1 INTER 3 INTER 2 MINOR INTER INTER INTER MINOR INTER INTER O/P D/C D/C 1 1 1 LARYNX AND TRACHEA Code Description E2910(i) Total laryngectomy E2940(i) Partial laryngectomy E2920(i) Horizontal supra-glottic laryngectomy E2930(i) Vertical hemi-laryngectomy E2970(i) Sub-total laryngectomy E2950 E3400 E3410 E2952 E3010 Laryngofissure and cordectomy of vocal cord Cordectomy (endoscopic) Laser surgery to vocal cord (including microlaryngoscopy) Laryngofissure Glottoplasty Surgeon's Category CMO 2 CMO 2 CMO 2 CMO 2 CMO 2 MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 2 CMO 2 INTER 5 INTER 4 CMO 2 MAJOR 2 MAJOR 2 MAJOR 2 INTER 3 MINOR 5 CMO 4 CMO 4 CMO 4 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS CMO 1 CMO 2 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 2 CMO 1 MAJOR 1 INTER 5 CMO 2 MAJOR 2 MAJOR 2 MAJOR 5 MAJOR 1 INTER 3 CMO 1 CMO 5 CMO 4 INTER 5 CMO 2 CMO 2 CMO 2 CMO 2 MAJOR INTER INTER MAJOR MAJOR CMO 2 INTER INTER CMO 2 MAJOR CMO 2 MAJOR INTER MINOR CMO 5 CMO 4 CMO 4 INTER 1 1 1 1 D/C D/C 2 2 1 D/C E3100(i) Reconstruction of larynx with graft E3520 E3810 Microlaryngoscopy/laryngoscopy +/- endoscopic excision of lesion of larynx Injection into larynx E3900(i) Partial excision of trachea with reconstruction E4030(i) Tracheoplasty E4032(i) Tracheoplasty for congenital conditions E4100 Insertion of voice prosthesis (TOF) E4210(i) Tracheostomy E4230 Mini-tracheostomy (percutaneous) AA378(i) Pharyngolaryngectomy E2140 E2150 E2300 Reconstruction using stomach pull up following pharyngolaryngectomy Reconstruction free jejunal graft following pharyngolaryngectomy Pharyngeal myotomy FIBREOPTIC ENDOSCOPIC PROCEDURES (GA OR LA) Code E4840 Description Dilatation of tracheal stricture including insertion of stent Surgeon's Category INTER 2 INTER 1 INTER 3 INTER 2 INTER 1 INTER 3 Anaesthetist's Hospital Anticipated Category Category LOS INTER 1 INTER 5 INTER 5 INTER 5 INTER 5 MINOR MINOR MINOR MINOR INTER D/C D/C D/C D/C - E4510(ii)* Fibreoptic examination of trachea including biopsy/removal of foreign body E5180* E4800 E4850 E4991 Diagnostic bronchoscopy +/- biopsy Therapeutic bronchoscopy (including laser, cryotherapy, lavage, snare, dilatation of stricture, insertion of stent) Therapeutic bronchoscopy for removal of foreign body Rigid panendoscopy Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 37 – © Bupa Insurance Limited 1999-2012 6 Notes Face, Mouth, Salivary & Thyroid Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: Lesser Procedure(s) which are included in the main procedure and should not be billed separately: F0910 - Surgical removal of impacted/buried tooth/teeth F4040 - Suture of mouth (as sole procedure) FACE AND JAWS Code V0820 V0830 Description Open reduction and fixation of fractured jaw Closed reduction and fixation of fractured jaw Surgeon's Category INTER 5 INTER 1 INTER 3 MAJOR 1 MAJOR+ 5 MAJOR+ 4 MAJOR+ 4 MINOR 5 MINOR 3 MAJOR 4 MAJOR+ 2 MAJOR+ 2 INTER 4 MAJOR+ 5 INTER 3 MAJOR+ 5 INTER 5 MAJOR 5 MAJOR+ 1 MAJOR 3 INTER 4 INTER 1 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 INTER 1 MAJOR 1 INTER 5 MAJOR 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR 1 INTER 2 MAJOR+ 1 MAJOR+ 2 MAJOR+ 2 INTER 4 MAJOR+ 1 MAJOR 3 MAJOR+ 1 MAJOR 1 MAJOR+ 1 MAJOR 2 MAJOR 2 INTER 5 INTER 2 CMO 1 INTER INTER MAJOR MAJOR+ MAJOR+ MAJOR+ MINOR MINOR MAJOR MAJOR+ MAJOR+ INTER MAJOR+ INTER MAJOR+ INTER INTER MAJOR+ MAJOR INTER INTER CMO 1 1 1 2 D/C D/C 1 D/C 2 4 1 - V0930(i) Closed reduction of fracture of zygomatic complex of bones V0980 Open reduction of fracture of zygomatic complex of bones V1040(i) Osteotomy of maxilla (and bilateral) V1082(i) Partial maxillectomy for malignancy V1083(i) Hemi-maxillectomy for malignancy V1150 V1330 V1400 Removal of internal fixation and/or intermaxillary fixation from jaw Biopsy of lesion of facial bone Excision of mandible V1422(i) Extensive segmental excision of mandible V1423(i) Extensive excision of mandible with disarticulation V1440 V1622 V1730 Excision of lesion of jaw Backward/forward sliding mandibular osteotomy Extra-oral fixation of mandible V1910(i) Reconstruction of jaw (non-vascularised reconstruction) V1930 V1931 V2020 V2030 V2110 V2120 V0910 Alveolar bone graft - unilateral Alveolar bone graft - bilateral Prosthetic replacement of temporomandibular joint Arthroplasty of temporomandibular bone joint Temporomandibular Meniscectomy Reduction of dislocation of temporomandibular joint Open reduction and fixation of nasal ethmoidal fracture LIPS Code F0110 F0200 F0312 F0314 Description Excision of vermilion border of lip and advance of mucosa of lip Excision of lesion of lip Primary closure of cleft lip – unilateral Primary closure of cleft lip – unilateral including anterior palate Surgeon's Category INTER 3 INTER 2 MAJOR 2 MAJOR 2 MAJOR 5 MAJOR 4 MINOR 4 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C INTER 3 MAJOR 5 MAJOR 5 MAJOR 5 MAJOR 4 INTER 4 INTER MAJOR MAJOR MAJOR MAJOR MINOR D/C D/C 1 O/P F0320(i) Revision of primary closure of cleft lip F0420 F0530 Reconstruction of lip using skin flap Suture of lip Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 38 – © Bupa Insurance Limited 1999-2012 TONGUE Code Description F2210(i) Total glossectomy F2220(i) Partial glossectomy for malignancy F2310 F2620 F2640 F2660 Excision/destruction of lesion of tongue Frenotomy /frenectomy of tongue Freeing of adhesions of tongue Tongue flap - first stage and second stage Surgeon's Category MAJOR+ 3 MAJOR 5 INTER 2 MINOR 4 MINOR 1 MAJOR 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR+ MAJOR 5 INTER 5 INTER 4 INTER 3 MAJOR 5 MAJOR INTER MINOR MINOR MAJOR 2 D/C D/C D/C D/C PALATE Code F2810 Description Excision/destruction of lesion of palate Surgeon's Category INTER 2 MAJOR+ 1 MAJOR 1 MINOR 5 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 5 INTER D/C MAJOR 5 MAJOR 3 INTER 4 INTER 4 MAJOR+ MAJOR MINOR INTER 1 D/C F2910(i) Primary repair of cleft palate F2920 F3070 F3240 Revision of repair of cleft palate Suture of palate Operations on uvula MOUTH CAVITY Code F1140 F4210 F3810 F3920 F4050 Description Vestibuloplasty Biopsy of lesion of mouth Excision/destruction of lesion of mouth Reconstruction of mouth using graft Graft of skin or mucosa to mouth Surgeon's Category INTER 4 MINOR 2 MINOR 5 INTER 3 INTER 3 MAJOR 5 MINOR 5 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C INTER 2 INTER 3 MAJOR 4 MAJOR 2 MAJOR 4 INTER 5 INTER 4 MINOR MINOR INTER INTER MAJOR MINOR INTER D/C O/P D/C F3910(i) Reconstruction of mouth using flap F4040 F4230 Suture of mouth (as sole procedure) Removal of excess mucosa from mouth SALIVARY GLANDS Code F4400 F4410 F4430 F4440 F4450 F4600 F4810 F4640 F4830 F5010 F5020 F5110 F5120 F5510 F5610 Description Excision of parotid gland (other than F4410/F4430) Total excision of parotid gland and preservation of facial nerve Partial excision of parotid gland and preservation of facial nerve Excision of submandibular gland Excision of sublingual gland Incision or drainage of abscess or haematoma of salivary glands (i.e. including submandibular, parotid and sublingual glands) Open biopsy of lesion of salivary gland Fine needle aspiration of parotid gland Therapeutic sialendoscopy Transposition of parotid duct (including bilateral) Transposition of submandibular duct (including bilateral) Open extraction of calculus from parotid duct Open extraction of calculus from submandibular duct Dilatation of parotid duct Manipulative removal of calculus from parotid duct Surgeon's Category MAJOR 3 CMO 2 CMO 1 INTER 5 INTER 3 MINOR 3 MINOR 5 MINOR 1 INTER 2 INTER 4 INTER 4 INTER 2 INTER 1 MINOR 3 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MAJOR 1 MAJOR+ 2 MAJOR+ 2 MAJOR 1 INTER 5 INTER 3 INTER 4 MINOR 1 INTER 2 INTER 4 INTER 4 INTER 2 INTER 4 MINOR 5 INTER 1 MAJOR+ MAJOR+ INTER INTER MINOR MINOR MINOR INTER INTER INTER INTER INTER MINOR INTER 1 1 1 1 D/C D/C O/P 1 D/C D/C O/P D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 39 – © Bupa Insurance Limited 1999-2012 TEETH Code F0830 F0910 F0950 F1810 Description Replantation of natural tooth/teeth following trauma Surgical removal of impacted/buried tooth/teeth Surgical removal of complicated buried roots Enucleation of cyst of jaw Surgeon's Category INTER 2 INTER 3 INTER 1 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 2 INTER D/C INTER 5 INTER 4 INTER 4 INTER INTER INTER D/C D/C D/C NECK Code T8510 T8722 T8723 T8610 T9400 T9420 Description Radical dissection of cervical lymph nodes Selective dissection of cervical lymph nodes, Levels 1 to 4 Selective dissection of cervical lymph nodes, Levels 1 to 5 (+/-6) Biopsy/Sampling of cervical lymph nodes Operations on branchial cyst Operations on branchial fistula Surgeon's Category CMO 1 CMO 1 CMO 1 MINOR 3 INTER 5 MAJOR 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 2 CMO 1 3 MAJOR+ 2 MAJOR+ 2 INTER 5 MAJOR 5 MAJOR 5 MAJOR+ CMO 1 MINOR INTER MAJOR 1 1 D/C 1 - THYROID AND PARATHYROID GLANDS Code Description B0812(i) Total thyroidectomy/near total thyroidectomy B0813(i) Total thyroidectomy including block dissection of lymph nodes B0820 B0830 B0850 B0860 B1250 B0900 B1012 Bilateral subtotal thyroidectomy Total thyroid lobectomy & isthmectomy Isthmectomy of thyroid gland Partial thyroidectomy (not elsewhere classified) Thyroid : re-operation Operations on aberrant thyroid tissue (including excision/removal of retrosternal goitre) Excision of thyroglossal cyst/tract Surgeon's Category MAJOR 5 CMO 1 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 5 MAJOR+ 3 INTER 5 MINOR 1 MINOR 5 MAJOR+ 1 MAJOR+ 2 MAJOR+ 5 MAJOR 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR 2 MAJOR 5 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR+ 1 MAJOR 2 INTER 1 INTER 1 MAJOR+ 1 MAJOR+ 2 MAJOR+ 1 MAJOR 2 MAJOR MAJOR MAJOR MAJOR MAJOR CMO 1 MAJOR+ INTER MINOR MINOR MAJOR+ MAJOR+ CMO 1 MAJOR 3 2 2 1 1 3 2 1 O/P 1 2 3 - B1220(ii) Fine needle aspiration of thyroid gland B1230 B1450 B1680 B1690 E3180 Core biopsy of thyroid gland Parathyroidectomy Parathyroid: re-operation Mediastinal parathyroidectomy with sternotomy Thyroplasty (Isshiki type 1) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 40 – © Bupa Insurance Limited 1999-2012 7 Notes Breast Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: Lesser Procedure(s) which are included in the main procedure and should not be billed separately: B2710 - Radical mastectomy including block dissection T8520 - Block dissection of axillary lymph nodes (axillary clearance) levels 1 to 3 EXCISION / BIOPSY CODES Code B2800 B2801 B2811 B2820 B2821 B2830 B2880 B3282 B3220 B3212 B3593 B3594 B3595 T8620 T9000 T9020 Description Excision/biopsy of breast lump/fibroadenoma of breast Excision biopsy of breast lesion after localisation – bilateral Segmental resection or quadrantectomy – bilateral Wide local excision of lesion of breast Wide local excision of lesion of breast – bilateral Re-excision of lesion of breast if resection margins are not clear (as sole procedure) Excision biopsy of breast lesion after localisation Ultrasound guided vacuum assisted excision biopsy of breast lesion Core biopsy of lesion of breast Percutaneous suction core biopsy Microdochectomy or mammodochectomy (Hadfield’s procedure) Plastic procedures on nipple Excision of mammary fistula Sampling of axillary lymph nodes Sentinel node mapping with blue dye or radioactive probe for breast cancer Surgeon's Category INTER 3 MAJOR 2 MAJOR 5 INTER 4 MAJOR 4 INTER 3 INTER 3 INTER 3 MINOR 2 MINOR 2 INTER 3 INTER 2 INTER 3 MINOR 3 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 5 INTER D/C MAJOR 3 MAJOR MAJOR 5 MAJOR INTER 5 MAJOR 5 INTER 5 INTER 5 MINOR 5 MINOR 5 INTER 3 INTER 2 INTER 3 INTER 1 INTER 2 INTER 2 INTER MAJOR INTER MINOR INTER MINOR MINOR INTER INTER INTER MINOR INTER INTER 1 1 D/C 1 D/C 1 1 Sentinel node mapping with blue dye and radioactive probe for breast cancer INTER 3 MASTECTOMY (EXCLUDING IMPLANT / RECONSTRUCTION) Code B2710 B2742 B2743 B2744 B2780 B2781 B2752 B2760 T8520 Description Radical mastectomy including block dissection Modified radical mastectomy including lymph node sampling Modified radical mastectomy excluding lymph node sampling Modified radical mastectomy including lymph node clearance Simple mastectomy (including axillary node biopsy) unilateral Simple mastectomy including axillary node biopsy – bilateral Subcutaneous mastectomy Skin/nipple sparing mastectomy (including axillary node biopsy) Block dissection of axillary lymph nodes (axilliary clearance) levels 1 to 3 Surgeon's Category MAJOR+ 1 MAJOR 4 MAJOR 3 MAJOR 4 MAJOR 2 MAJOR+ 5 MAJOR 1 MAJOR+ 2 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR 4 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR+ 2 MAJOR 1 MAJOR+ 2 MAJOR 3 MAJOR MAJOR MAJOR MAJOR MAJOR+ MAJOR MAJOR+ MAJOR 4 4 4 2 3 RECONSTRUCTION Code B2912 B2913 Description Mastectomy and immediate reconstruction of breast using latissimus dorsi Reconstruction of Breast using Latissimus Dorsi (including delayed reconstruction) Surgeon's Category CMO 3 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 4 MAJOR+ 5 MAJOR+ 4 MAJOR+ 4 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 41 – © Bupa Insurance Limited 1999-2012 B2915 B2916 B3012 B3014 B3013 B3015 B3017 B3018 B3020 B2981 B2984 B2985 B2987 B2988 B2991 Reconstruction of breast using extended latissimus dorsi flap (delayed reconstruction) Mastectomy and immediate reconstruction of breast using extended latissimus dorsi flap Mastectomy and immediate reconstruction of breast using expandable Reconstruction of Breast using expandable prosthesis (including delayed reconstruction) Mastectomy and immediate reconstruction of breast using fixed prosthesis Reconstruction of Breast using fixed prosthesis (including delayed CMO 3 CMO 4 MAJOR 4 INTER 5 MAJOR 4 INTER 5 CMO 1 CMO 2 MAJOR 4 MAJOR 3 MAJOR 4 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 INTER 5 MAJOR+ 5 MAJOR+ 5 CMO 5 CMO 5 CMO 3 CMO 1 MAJOR+ MAJOR+ MAJOR MAJOR+ MAJOR MAJOR MAJOR MAJOR INTER CMO 3 CMO 3 MAJOR+ CMO 2 CMO 3 - 3 2 3 1 6 6 - Reconstruction of breast using fat transfer (including delayed reconstruction) INTER 5 Redo reconstruction of breast using fat transfer Fat transfer, including extraction and transfer for volume adjustment following mastectomy and reconstruction (as sole procedure) Local mobilisation of glandular breast tissue to fill surgical cavity Reconstruction of breast using pedicled TRAM (including delayed reconstruction ) INTER 5 INTER 5 INTER 5 CMO 3 Reconstruction of Breast using Free Tram (including delayed reconstruction ) CMO 3 Reconstruction of breast using transverse upper gracilis (TUG) flap (including £2,530 delayed reconstruction and nipple reconstruction) Reconstruction of breast using ALT (anteriolateral thigh) flap including delayed reconstruction Laparoscopic mobilisation of the greater omentum for reconstruction of breast (including delayed reconstruction) £2,530 CMO 3 B3100 Reduction mammoplasty – unilateral B3810 MAJOR 1 MAJOR+ 4 CMO 5 CMO 5 MAJOR 4 INTER 3 INTER 5 MAJOR 5 INTER 3 INTER 3 MAJOR CMO 2 CMO 5 MAJOR INTER INTER MAJOR+ INTER INTER 3 1 1 D/C Reconstruction of breast using SGAP (superior gluteal artery perforator) flap £2,530 including delayed reconstruction B2986(i) Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) £2,530 (including delayed reconstruction) B2700 B3033 B3034 B3035 B3032 B3580 Subcutaneous mastectomy with immediate implant Simple removal of prosthesis from breast Removal and/or reinsertion of prosthesis into the breast (including capsulectomy) – unilateral Removal and/or reinsertion of prosthesis into the breast (including capsulectomy) – bilateral Removal of prosthesis from breast, including capsulectomy Nipple reconstruction with or without liposuction and fat transfer MAJOR 4 MINOR 5 INTER 4 MAJOR 3 INTER 2 INTER 2 OTHER Code B3310 B3440 Description Drainage of breast abscess including haematoma and seroma Microdochotomy Surgeon's Category MINOR 5 INTER 3 MINOR 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 3 MINOR O/P INTER 3 MINOR 1 INTER MINOR D/C O/P S4760(ii) Fine needle aspiration cytology Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 42 – © Bupa Insurance Limited 1999-2012 8 Notes Thorax & Intra-Thoracic Organs 1. If a procedure is marked with an ( i ) Bupa’s policy on Intensive Therapy applies. (See note 7 in the Essential Notes to the Schedule and appendix A). 2. The surgeon’s benefit entitlement for complex cardio-thoracic surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy up to 72 hours. 3. The anaesthetist’s benefit entitlement for complex cardio-thoracic surgery includes fees for pre-operative/peri-operative/postoperative management including Intensive Therapy/ventilation for up to 72 hours. 4. In circumstances where the Intensive Therapy exceeds 72 hours, further benefit may be considered on a case by case basis. 5. Bupa will not pay additional benefits if a procedure is unbundled ie broken down’ into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: Lesser Procedure(s) which are included in the main procedure and should not be billed separately: E5430 - Pulmonary lobectomy including segmental resection T0320 - Exploratory thoracotomy OESOPHAGUS Code Description G0100(i) Oesophagectomy/Oesophagogastrectomy with anastomosis in chest G0300(i) Sub-total oesophagectomy with anastomosis in neck G0220(i) Total oesophagectomy and interposition of intestine G0260 Endoscopically assisted oesophagectomy Surgeon's Category CMO 5 CMO 2 CMO 5 CMO 5 MAJOR 3 CMO 2 MAJOR 5 CMO 2 MAJOR 4 MAJOR 5 INTER 2 CMO 1 CMO 2 CMO 1 MAJOR+ 1 MAJOR 5 CMO 1 CMO 1 CMO 2 CMO 2 MAJOR 4 Anaesthetist's Hospital Anticipated Category Category LOS CMO 3 CMO 3 12 CMO 3 CMO 5 CMO 3 MAJOR+ 3 MAJOR+ 5 MAJOR+ 3 MAJOR+ 4 MAJOR+ 2 MAJOR+ 2 MAJOR 3 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR 4 MAJOR 5 MAJOR+ 3 MAJOR+ 4 MAJOR+ 4 MAJOR 3 CMO 3 CMO 4 CMO 3 MAJOR MAJOR+ MAJOR CMO 2 MAJOR MAJOR INTER MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR CMO 1 CMO 1 CMO 2 CMO 2 MAJOR 12 2 D/C 5 2 1 3 - G0400(i) Open excision of lesion of oesophagus G0500(i) Bypass of oesophagus G0640 Closure of bypass of oesophagus G0740(i) Repair of ruptured oesophagus G0920(i) Oesophagocardiomyotomy (Heller's operation) G0980(i( Thorascopic oesophagogastric myotomy G1440 Injection sclerotherapy for oesophageal varices G2402(i) Transthoracic fundoplication G2400(i) Transthoracic fundoplication & gastroplasty G2312(i) Transthoracic repair of paraoesophageal hiatus hernia G2320(i) Transthoracic repair of diaphragmatic hernia (acquired) G2330 G2340 G2430 G2590 Transabdominal repair of hiatus hernia Transabdominal repair of diaphragmatic hernia Transabdominal anti-reflux operations Revision of anti-reflux operations G0730(i) Repair of congenital oesophageal atresia (with or without fistula) A2781 Laparoscopic vagotomy/seromyotomy - CHEST WALL Code Description T0110(i) Thoracoplasty Surgeon's Category MAJOR+ 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 2 MAJOR+ - T0132 Excision of chest wall tumour - with chest wall reconstruction MAJOR+ 2 MAJOR+ 1 MAJOR+ Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 43 – © Bupa Insurance Limited 1999-2012 T0133 Excision of chest wall tumour - without chest wall reconstuction MAJOR 2 CMO 1 CMO 1 MAJOR 3 MAJOR 1 MAJOR+ 4 CMO 1 MAJOR+ 2 MAJOR+ 5 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR 4 MAJOR 4 MAJOR+ 5 MAJOR+ 3 MAJOR+ 2 MAJOR+ 5 MAJOR+ CMO 1 CMO 5 MAJOR MAJOR MAJOR+ CMO 1 MAJOR+ MAJOR+ 1 2 T0210(i) Correction of pectus deformity of chest wall (or other congenital defect T0212(i) Secondary correction of scoliosis-related chest wall deformity (posterior costoplasty) (as sole procedure) T0320(i) Exploratory thoracotomy T0810(i) Resection of rib and open drainage of pleural cavity E4722 Thoracotomy and closure of bronchopleural fistula T1500(i) Repair of rupture of diaphragm T1620 Plication of paralysed diaphragm T1640(i) Repair of congenital diaphragmatic hernia TRACHEA Code Description E3900(i) Partial excision of trachea with reconstruction E4030(i) Tracheoplasty E4032(i) Tracheoplasty for congenital conditions E4100 Insertion of voice prosthesis (TOF) Surgeon's Category CMO 2 MAJOR 2 MAJOR 2 MAJOR 2 INTER 3 MINOR 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 2 CMO 2 MAJOR 2 MAJOR 2 MAJOR 5 MAJOR 1 INTER 3 MAJOR CMO 2 MAJOR INTER MINOR 2 2 1 - E4210(i) Tracheostomy E4230 Mini-tracheostomy (percutaneous) FIBREOPTIC ENDOSCOPIC PROCEDURES (GA OR LA) Code E4840 Description Dilatation of tracheal stricture including insertion of stent Surgeon's Category INTER 2 INTER 1 INTER 3 INTER 2 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 1 INTER 5 INTER 5 INTER 5 MINOR MINOR MINOR MINOR D/C D/C D/C D/C E4510(ii) Fibreoptic examination of trachea including biopsy/removal of foreign body E5180 E4800 E4850 Diagnostic bronchoscopy +/- biopsy Therapeutic bronchoscopy (including laser, cryotherapy, lavage, snare, dilatation of stricture, insertion of stent) Therapeutic bronchoscopy for removal of foreign body BRONCHI / LUNGS / PLEURA Code E4400 Description Carinal resection +/- pneumonectomy Surgeon's Category CMO 5 CMO 3 CMO 4 Anaesthetist's Hospital Anticipated Category Category LOS CMO 5 CMO 2 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 CMO 1 MAJOR+ 4 MAJOR+ 4 CMO 1 MAJOR+ 4 CMO 2 MAJOR+ 4 CMO 2 MAJOR+ 3 MAJOR+ 2 MAJOR+ 1 CMO 2 CMO 2 CMO 2 CMO 4 CMO 1 CMO 1 CMO 2 MAJOR+ CMO 1 CMO 1 CMO 3 CMO 1 MAJOR+ MAJOR+ 8 6 6 4 4 4 4 4 5 2 E5410(i) Pneumonectomy E5430(i) Pulmonary lobectomy including segmental resection E4600(i) Sleeve resection of bronchus or pulmonary artery with pulmonary resection CMO 4 E5480(i) Lung resection with resection of chest wall E5520(i) Open excision of lesion of lung E5532(i) Thoracotomy & Lung biopsy as sole procedure E5533 Percutaneous radiofrequency ablation of malignant lung tumour CMO 4 CMO 1 CMO 1 CMO 2 CMO 1 CMO 3 CMO 1 CMO 3 CMO 2 MAJOR+ 3 MAJOR+ 5 E5704(i) Thoracotomy bullectomy – unilateral +/- pleurodesis in presence of emphysema E5703(i) Thoracotomy bullectomy - bilateral E5702(i) Thoracotomy lung volume reduction - unilateral E5700(i) Thoracotomy lung volume reduction - bilateral T0710(i) Decortication of pleura of lung E5705 Thoracotomy pleurectomy/pleurodesis +/- ligation of bullae for pneumothorax T0910(i) Open pleural biopsy Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 44 – © Bupa Insurance Limited 1999-2012 T1480 T1220 T1240 T1300 T1410 E5910 Insertion of pleuro-peritoneal shunt Drainage of pleural cavity Insertion of tube drain into pleural cavity Introduction of substance into pleural cavity with chest drain Needle biopsy of pleura Needle biopsy of lung INTER 4 MINOR 5 MINOR 5 MINOR 1 MINOR 5 MINOR 4 MAJOR 1 INTER 1 INTER 1 MINOR 5 INTER 1 INTER 1 INTER MINOR MINOR MINOR MINOR MINOR D/C D/C D/C MEDIASTINUM Code B1690 Description Mediastinal parathyroidectomy with sternotomy Surgeon's Category MAJOR+ 5 MAJOR 5 MAJOR+ 1 MAJOR 1 MAJOR 1 MAJOR+ 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 1 CMO 1 3 MAJOR+ 5 CMO 1 INTER 5 INTER 5 CMO 3 MAJOR MAJOR+ INTER INTER MAJOR+ 1 - B1800(i) Thymectomy for myasthenia gravis E6110 E6300 E6310* E6100 Open excision of mediastinal tumour including congenital cysts/posterior chest wall lesions Diagnostic mediastinoscopy Endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) for mediastinal masses Open resection of invasive mediastinal tumour VIDEO ASSISTED THORACIC SURGERY (VATS) Code E5442 Description VATS wedge resection of lung Surgeon's Category MAJOR 5 INTER 4 INTER 3 MAJOR 1 MAJOR 5 INTER 4 INTER 4 MAJOR+ 3 MAJOR 3 MAJOR 5 MAJOR+ 3 CMO 2 MAJOR 3 CMO 1 MAJOR 2 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 4 MAJOR 2 INTER 5 INTER 5 MAJOR 5 INTER 5 INTER 5 INTER 5 MAJOR+ 2 MAJOR+ 3 MAJOR+ 2 MAJOR 5 MAJOR+ 4 MAJOR+ 2 MAJOR+ 5 MAJOR 1 MAJOR+ 4 INTER MAJOR CMO 1 MAJOR+ MINOR INTER MAJOR MAJOR+ MAJOR MAJOR MAJOR+ CMO 1 CMO 3 MAJOR MAJOR 1 4 1 1 E5932(i) VATS lung biopsy E5590(i) VATS bullectomy – unilateral E5591(i) VATS bullectomy – bilateral E6200(i) VATS excision lesion of mediastinum including thymectomy T1100(i) Diagnostic thoracoscopy (+/- biopsy) T1032(i) Thoracoscopy and drainage and chemical pleurodesis T1030 VATS pleurodesis/pleurectomy G1400(i) VATS excision lesion of oesophagus G0922(i) VATS oesophageal/oesophagogastric myotomy A7560 A7561 E5592 E5593 E5594 G2331 VATS sympathectomy – unilateral VATS sympathectomy - bilateral VATS lung volume reduction - unilateral VATS lung volume reduction - bilateral VATS debridement of empyema Laparoscopic repair of hiatus hernia with anti-reflux procedure (e.g. fundoplication) HEART – CARDIAC SURGERY Code Description K0400(i) Correction of tetralogy of Fallot K0500(i) Atrial inversion for transposition of great vessels K0700(i) Correction of total anomalous pulmonary venous connection K0900(i) Repair of complete atrioventricular septal defect K1000(i) Closure of defect of interatrial septum (secundum Atrial Septal Defect or Patent Foramen Ovale) K0930(i) Closure of partial atrioventricular septal defect K1100(i) Closure of defect of interventricular septum Surgeon's Category CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 4 CMO 5 CMO 4 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 10 1 5 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 45 – © Bupa Insurance Limited 1999-2012 K1180(i) Endovascular closure of perimembranous ventricular septal defect CMO 1 MAJOR+ 5 CMO 3 MAJOR+ 5 CMO 5 CMO 5 CMO 5 CMO 1 CMO 5 CMO 1 CMO 1 CMO 1 CMO 3 CMO 5 CMO 4 CMO 3 CMO 5 - K1600(i) Therapeutic transluminal operations on atrial septum of heart (including ASD CMO 1 closure) K1680(i) Transluminal closure of septal defect / patent foramen ovale K1690 Non-surgical reduction of the myocardial septum CMO 1 CMO 5 CMO 5 CMO 5 CMO 3 CMO 5 K1800(i) Placement of valve to cardiac conduit K1850(i) Redo operations for placement of valve to cardiac conduit K2280(i) Percutaneous occlusion of left artrial appendage K2310(i) Excision of cardiac tumour 8 HEART – CARDIAC SURGERY Code Description Surgeon's Category £2,275 £2,275 £2,400 £2,400 CMO 5 CMO 5 CMO 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 4 CMO 4 CMO 4 CMO 4 CMO 4 CMO 4 CMO 4 CMO 4 CMO 1 CMO 5 CMO 4 CMO 4 CMO 4 CMO 3 CMO 4 CMO 3 CMO 2 CMO 4 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 3 CMO 5 CMO 3 MAJOR+ CMO 5 CMO 5 8 8 9 8 8 9 6 6 7 K2540(i) Replacement of mitral valve with sub-valve preservation K2543(i) Minimally invasive replacement of mitral valve K2580(i) Repair of mitral valve K2542(i) Replacement of mitral valve – redo operation K2600(i) Replacement or repair of aortic valve K2602(i) Minimally invasive replacement of aortic valve K2612(i) Replacement of aortic valve with homograft or stentless porcine K2613(i) Replacement of aortic valve – redo operation L2382(i) Aortic root replacement with valve conduit or homograft and/or remodelling CMO 5 K2610(i) Ross procedure K2700(i) Replacement of tricuspid valve (including valvuloplasty) K2780(i) Repair of tricuspid valve, e.g. for Ebstein’s disease K2800(i) Replacement of pulmonary valve (including valvuloplasty/valvotomy) K2810 Percutaneous replacement of pulmonary valve CMO 5 CMO 5 CMO 5 CMO 5 CMO 3 CMO 5 CMO 3 MAJOR+ 5 CMO 5 £2,275 K3100(i) Open valvotomy K3210(i) Closed mitral valvotomy K3500(i) Therapeutic transluminal operation(s) on valve of heart K3580 Trans catheter aortic valve implantation (TAVI) K4100(i) Bypass for coronary artery(ies) including harvesting of grafts and endarterectomy K4180(i) Robot assisted bypass for coronary artery(ies) including harvesting of grafts and endarteretomy (CABG) K4410(i) Redo of bypass for coronary artery(ies) including harvesting of grafts K4600(i) Off-pump coronary artery bypass (OFCAB) K4880(i) Correction of anomalous coronary arteries K5000(i)* Coronary angiography as sole procedure K5020(i)* Coronary angiography proceeding to angioplasty on the same day K5050(i)* Coronary angioplasty following angiography with intravascular ultrasound on same day K5330(i) Repair of post infarction ventricular septal defect K5380(i) Repair of ventricular aneurysm K5283(i) Complex Cox lesion set maze operation K5530(i) Ventriculoplasty, including ventriculectomy (Batista operation) K6180(i) Short-term circ. support with left ventricular assist device K6220(i)* AF ablation including pulmonary vein angiogram K6580(i)* Coronary angiography including fractional flow study 2,275 £2,550 £2,275 CMO 5 INTER 5 CMO 2 CMO 3 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 CMO 3 MAJOR 2 CMO 5 CMO 5 CMO 5 CMO 5 MAJOR 4 MAJOR+5 CMO 1 CMO 4 CMO 4 CMO 4 CMO 4 CMO 5 MAJOR+5 MAJOR+1 CMO 5 CMO 5 CMO 5 CMO 5 INTER CMO 2 CMO 3 CMO 5 CMO 4 CMO 5 CMO 4 CMO 5 CMO 4 MAJOR 5 9 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 46 – © Bupa Insurance Limited 1999-2012 K6581(i)* Coronary angioplasty with fractional flow study on same day K6590(i)* Coronary angiography including intravascular ultrasound K6700(i) Pericardiectomy K6810 Decompression of cardiac tamponade or re-exploration for bleeding CMO 3 MAJOR 2 CMO 2 MAJOR+ 1 CMO 3 CMO 5 CMO 5 MAJOR 2 CMO 4 CMO 5 CMO 1 MAJOR +1 MAJOR+ 3 MAJOR+ 2 CMO 5 CMO 5 CMO 5 MAJOR 2 CMO 2 CMO 5 CMO 3 MAJOR CMO 2 MAJOR+ CMO 3 CMO 5 CMO 5 INTER CMO 5 CMO 5 7 8 7 L0110(i) Correction of truncus arteriosus K1200(i) Norwood stage 1 procedure K0530 Double switch procedure (arterial & atrial) L2560(i)* Percutaneous or open placement of intra-aortic balloon (including subsequent removal) L0610(i) Formation of atrio-pulmonary connection (or any modification of Fontan type procedure) L2360(i) Repair of interrupted aortic arch HEART - CARDIOLOGY Surgeon's Code Description Category K4900(i)* Percutaneous transluminal angioplasty of coronary artery(ies) (including laser) CMO 1 K4902(i)* Percutaneous transluminal angioplasty of coronary artery(ies) with intravascular ultrasound (including laser) K4910(i)* Percutaneous transluminal angioplasty of coronary artery(ies) with stent insertion K4912(i)* Percutaneous transluminal angioplasty of coronary artery(ies) with stent insertion and intravascular ultrasound K5040(i)* Rotablation of coronary vessel(s) percutaneous transluminal rotational atherectomy (PCRS) K5280(i)* Map guided surgery for ventricular arrhythmias (including mapping) K2340(i) Direct (laser) percutaneous myocardial revascularisation K5710(i)* Percutaneous transluminal ablation of atrio-ventricular junction K5750 K5760* Internal cardioversion Percutaneous pulmonary vein isolation CMO 1 CMO 2 CMO 2 CMO 2 MAJOR+ 5 CMO 1 MAJOR+ 2 MAJOR 1 CMO 3 CMO 3 CMO 3 MAJOR+ 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 CMO 1 1 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 CMO 5 MAJOR+ 5 MAJOR+ 2 MAJOR 5 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 MAJOR+ 2 MAJOR 5 CMO 1 CMO 2 CMO 2 CMO 2 MAJOR+ CMO 2 MAJOR+ MAJOR CMO 3 CMO 3 CMO 4 CMO 4 MAJOR 1 1 1 1 1 1 1 1 D/C K5780(i)* Percutaneous transluminal ablation of accessory pathway or selected modification of AV node (including mapping) K5730(i)* Ablation of atrial arrhythmia K5740(i)* Ablation of ventricular arrhythmia K5810(i)* Diagnostic intracardiac electrophysiological study including characterisation MAJOR 1 of intracardiac conduction and any testing of anti-arrhythmic drug efficacy by programmed stimulation K6000* K6010* K6015* Cardiac pacemaker system introduced through vein (single chamber) Cardiac pacemaker system introduced through vein (dual chamber) Implantation of bi-ventricular pacemaker MAJOR 1 MAJOR 5 CMO 2 INTER 5 MAJOR 2 INTER 2 CMO 5 MINOR 5 CMO 2 INTER 5 INTER 5 MAJOR 5 MAJOR 5 MAJOR+ 5 MAJOR 3 MAJOR 4 MAJOR 2 CMO 3 MAJOR+ 1 MAJOR+ 1 MAJOR 4 MAJOR 4 MAJOR MAJOR MAJOR INTER MAJOR INTER CMO 3 MINOR CMO 2 INTER INTER 1 1 1 1 D/C 6 1 1 D/C - K6020(i)* Resiting of intravenous cardiac pacemaker system K6030(i)* Replacement of generator for intravenous cardiac pacemaker system (without lead change) K6082 Removal of pacing system (generator only) K6040(i) Removal of pacing system with bypass K6080* Removal of pacing system without bypass (including leads) K6100(i)* Implantation of automatic cardioverter/defibrillator K6510(i)* Adult cardiac catheterisation (including coronary arteriography/ catheterisation of right/left side of heart/ contrast radiology) K6512* Pressure wire measurement study as sole procedure Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 47 – © Bupa Insurance Limited 1999-2012 K6820 K6520 Pericardiocentesis Paediatric cardiac catheterisation INTER 5 MAJOR 1 MAJOR 3 MAJOR 5 INTER MAJOR 1 D/C GREAT VESSELS Code Description L0200(i) Closed ligation of patent ductus arteriosus L0230(i) VATS closure of patent ductus arteriosus L0310(i) Percutaneous transluminal prosthetic occlusion of patent ductus arteriosus L0620(i) Creation of communication between pulmonary artery and aorta L0900 Formation of cavo-pulmonary shunt (Glenn) Surgeon's Category CMO 2 CMO 2 CMO 1 CMO 4 CMO 3 CMO 3 CMO 5 CMO 2 CMO 4 MAJOR+ 5 CMO 5 CMO 5 CMO 5 CMO 3 CMO 5 CMO 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 2 CMO 2 CMO 2 MAJOR+ 3 CMO 2 MAJOR+ 4 CMO 2 CMO 5 CMO 2 CMO 5 MAJOR+ 5 CMO 5 CMO 5 CMO 5 CMO 1 CMO 4 CMO 5 CMO 5 CMO 5 CMO 5 CMO 2 CMO 5 CMO 1 CMO 1 CMO 5 MAJOR 2 MAJOR+ 3 CMO 1 CMO 1 CMO 4 CMO 3 CMO 3 CMO 5 CMO 2 CMO 4 MAJOR+ CMO 5 CMO 5 CMO 5 CMO 5 CMO 3 CMO 5 CMO 5 CMO 5 CMO 5 CMO 3 CMO 5 CMO 3 CMO 4 CMO 5 MAJOR MAJOR+ 10 8 10 10 7 10 - L0710(i) Creation of shunt from subclavian artery to pulmonary artery L7042(i) Arterial switch procedure for transposition of great vessels L1080(i) Open operations/repair of pulmonary artery L1240(i) Pulmonary embolectomy L1300(i) Transluminal operations on pulmonary artery L1810(i) Repair of leaking aneurysm of ascending aorta L1880(i) Repair of leaking aneurysm of arch of aorta L1890(i) Repair of leaking aneurysm of thoracic aorta L1892(i) Immediate repair of aortic dissection (i.e. within two weeks of happening) L1910(i) Elective repair of aneurysm of ascending aorta L1980(i) Elective repair of aneurysm of arch of aorta L1990(i) Elective repair of aneurysm of thoracic aorta L1992(i) Delayed repair of aortic dissection (i.e. more than two weeks after happening) CMO 5 L2190(i) Replacement of thoraco-abdominal aneurysms L2200(i) Revision of prosthesis of abdominal aorta L2290(i) Excision of infected aortic graft with bypass L2302(i) Coarctation repair L2303(i) Coarctation repair involving prosthetic graft L2350(i) Redo procedures on ascending aorta and proximal descending aorta L2600(i) Percutaneous transluminal balloon operations on aorta W7042 Cannulation or decannulation for ECMO (Extracorporeal membrane oxygenation) CMO 5 £2,550 CMO 5 CMO 3 CMO 3 £2,550 MAJOR 2 MAJOR+ 1 OTHER Code A2720 A2730 A2780 X5020 Description Proximal gastric vagotomy Highly selective vagotomy Vagotomy with pyloroplasty External cardioversion Surgeon's Category MAJOR 4 MAJOR 4 MAJOR 5 MINOR 4 INTER 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MAJOR MAJOR 3 MAJOR 5 INTER 1 INTER 4 MAJOR MAJOR MINOR INTER D/C D/C 64302* Transoesophageal echocardiography (including reporting) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 48 – © Bupa Insurance Limited 1999-2012 9 Notes Vascular System 1. If a procedure is marked with an ( i ) Bupa’s policy on Intensive Therapy applies. (See note 7 in the Essential Notes to the Schedule and appendix A). 2. The surgeon’s benefit entitlement for complex vascular surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy up to 72 hours. 3. The anaesthetist’s benefit entitlement for complex vascular surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy/ventilation for up to 72 hours. 4. In circumstances where the Intensive Therapy exceeds 72 hours, further benefit may be considered on a case by case basis. 5. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: L8510 - Ligation/stripping of long or short saphenous vein (including local excision/multiple phlebectomy) Lesser Procedure(s) which are included in the main procedure and should not be billed separately: L8750 - Local excision (multiple phlebectomy) of varicose vein(s) of leg – unilateral 6. No additional benefit is available for the harvesting of the vein graft as it is considered to be an integral part of the overall procedure and is reflected in the classification of the main procedure. 7. All varicose vein procedures include pre-operative marking of varicosities. HEAD & NECK Code Description L2930(i) Bypass of carotid artery from the arch L2950(i) Carotid endarterectomy L3710(i) Bypass of subclavian artery from the arch L3711(i) Bypass of subclavian artery - extra-thoracic L3730(i) Endarterectomy and patch repair of subclavian artery Surgeon's Category CMO 3 CMO 2 CMO 3 CMO 1 CMO 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 CMO 3 MAJOR+ 5 MAJOR+ 5 MAJOR+ 4 MAJOR+ 5 CMO 3 CMO 3 CMO 1 CMO 3 2 4 5 THORACIC Code Description L1810(i) Repair of leaking aneurysm of ascending aorta L1880(i) Repair of leaking aneurysm of arch of aorta L1890(i) Repair of leaking aneurysm of thoracic aorta L1892(i) Immediate repair of aortic dissection (i.e. within two weeks of happening) L1910(i) Elective repair of aneurysm of ascending aorta L1980(i) Elective repair of aneurysm of arch of aorta L1990(i) Elective repair of aneurysm of thoracic aorta Surgeon's Category CMO 5 CMO 5 CMO 5 CMO 3 CMO 5 CMO 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS CMO 5 CMO 5 10 CMO 5 CMO 5 CMO 1 CMO 4 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 MAJOR 2 MAJOR+ 5 CMO 5 CMO 5 CMO 5 CMO 3 CMO 5 CMO 5 CMO 5 CMO 5 CMO 5 MAJOR MAJOR+ 8 10 10 7 - L1992(i) Delayed repair of aortic dissection (i.e. more than two weeks after happening) CMO 5 L2190(i) Replacement of thoraco-abdominal aneurysms L2290(i) Excision of infected aortic graft with bypass L2600(i) Percutaneous transluminal balloon operations on aorta L4292(i) Reconstruction of transplant renal artery CMO 5 CMO 5 MAJOR 2 CMO 3 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 49 – © Bupa Insurance Limited 1999-2012 RENAL Code Description L4140(i) Endarterectomy of renal artery L4190(i) Reconstruction of renal artery(ies) L4300(i) Transluminal operations on renal artery Surgeon's Category CMO 3 CMO 3 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 CMO 3 MAJOR+ 5 MAJOR 3 CMO 3 MAJOR 2 ABDOMINAL VESSELS Code L1620 L1680 Description Axillo-unifemoral bypass Axillo-bifemoral bypass Surgeon's Category CMO 1 CMO 1 CMO 3 CMO 4 £2,550 MAJOR 2 CMO 4 CMO 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 CMO 1 MAJOR+ 5 CMO 1 CMO 1 CMO 2 MAJOR 2 CMO 2 CMO 2 CMO 1 CMO 3 CMO 4 CMO 3 MAJOR CMO 4 CMO 4 8 8 - L1940(i) Infrarenal abdominal aortic aneurysm tube graft L1960(i) Infrarenal abdominal aortic aneurysm bifurcation graft L2200(i) Revision of prosthesis of abdominal aorta L2600(i) Percutaneous transluminal balloon operations on aorta L4530(i) Endarterectomy and patch repair of visceral branch of abdominal aorta L4600(i) Other open operations on other visceral branch of abdominal aorta ILEO-FEMORAL VESSELS Code Description L5100(i) Aorto-iliac, aorto-femoral, ileo-femoral bypass L5180(i) Aorto-bifemoral bypass L5210 L5300 L5400 L5910 L5922 L5923 L5924 L5950 L5960 L6000 L6230 L6300 L6530 Endarterectomy and patch repair of iliac artery Open operations on iliac artery Transluminal operations on iliac artery Femoro-femoral bypass Femoro-popliteal bypass using prosthesis Femoro-popliteal bypass using vein Femoro-popliteal bypass using vein cuff/patch Femoro-distal calf bypass using prosthesis +/- vein cuff/patch Femoro-distal calf bypass using vein Endarterectomy of femoral artery Reconstruction/bypass for popliteal aneurysm Transluminal procedures on femoral artery Revision of femoral bypass graft Surgeon's Category CMO 3 CMO 3 CMO 2 CMO 2 INTER 5 CMO 1 CMO 2 CMO 2 CMO 2 CMO 2 CMO 2 CMO 1 CMO 2 MAJOR 1 CMO 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 CMO 3 7 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 INTER 5 MAJOR+ 4 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 MAJOR+ 3 CMO 2 INTER 5 MAJOR+ 4 CMO 3 CMO 2 CMO 2 INTER CMO 1 CMO 2 CMO 2 CMO 2 CMO 2 CMO 2 CMO 1 CMO 2 MAJOR MAJOR+ 7 4 D/C 4 6 7 6 4 8 D/C - NON-SPECIFIC Code L6710 Description Biopsy of artery (including temporal) (as sole procedure) Surgeon's Category MINOR 5 MAJOR+ 1 MAJOR+ 5 MAJOR 5 INTER 5 INTER 5 INTER 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS MINOR 5 MINOR D/C MAJOR 3 MAJOR+ 1 MAJOR+ 1 MAJOR 2 MAJOR 5 MAJOR 5 CMO 2 MAJOR+ MAJOR+ MAJOR+ INTER INTER INTER CMO 5 D/C 3 1 D/C L6800(i)Repair of limb artery L6840 L7010 L7110 L7420 L7423 Repair of limb artery using vein graft Open embolectomy of artery Percutaneous transluminal angioplasty of artery Creation of arteriovenous fistula (including subsequent closure) Ligation of arteriovenous fistula for dialysis L7510(i) Excision of arteriovenous malformation (excluding arteriovenous malformation of vessels of brain) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 50 – © Bupa Insurance Limited 1999-2012 L7520 L7580 L7410 L7430 L8110 L9000 L9110 L9115 L9350 L9180* L9181 L9730 Repair of acquired arteriovenous fistula Repair of arteriovenous fistula Creation of arteriovenous shunt (synthetic graft) Removal of arteriovenous shunt (synthetic graft) Creation of peritoneo-venous shunt (Levine/Denver) Open removal of thrombus from vein Insertion of tunnelled central venous catheter (Hickman line) Implantation of port device (Power Port) Basilic vein transposition Insertion of portacath/port-a cath/vasoport unit Removal of Portacath/ Port-a-cath/ Vasoport Unit Isolated limb perfusion CMO 1 MAJOR 3 MAJOR 2 MAJOR 1 INTER 5 MAJOR 5 INTER 1 INTER 1 MAJOR 4 MINOR 5 MINOR 3 MAJOR+ 5 MAJOR+ 2 MAJOR+ 3 MAJOR 2 INTER 2 INTER 5 MAJOR 3 INTER 5 INTER 5 MAJOR+ 3 INTER 3 MINOR 3 MAJOR+ 4 CMO 1 CMO 1 MAJOR INTER INTER MAJOR INTER INTER MAJOR INTER MINOR MAJOR+ D/C D/C D/C 2 D/C D/C D/C - VARICOSE VEINS Code L8510 L8512 L8513 L8514 L8515 L8520 L8530 L8532 L8540 L8541 L8580 L8582 Description Ligation/stripping of long or short saphenous vein (including local excision/multiple phlebectomy) Endovenous laser treatment (EVLT) of single venous trunk +/- phlebectomies - unilateral Endovenous laser treatment (EVLT) of single venous trunk +/- phlebectomies - bilateral Endovenous laser treatment (EVLT) of more than –one venous trunk +/- phlebectomies - unilateral Endovenous laser treatment (EVLT) of more than one –venous trunk +/- phlebectomies - bilateral Ligation/stripping of long or short saphenous vein (including local excision/multiple phlebectomy) - bilateral Operations for recurrent varicose veins with re-exploration of groin and / or popliteal fossa - unilateral Operations for recurrent varicose veins without re-exploration of groin or popliteal fossa - unilateral Radiofrequency ablation (VNUS) of more than one venous trunk +/- phlebectomies - unilateral Radiofrequency ablation (VNUS) of more than one venous trunk +/- phlebectomies - bilateral Operations for recurrent varicose veins with re-exploration of groin and / or popliteal fossa - bilateral Operations for recurrent varicose veins without re-exploration of groin or popliteal fossa - bilateral Surgeon's Category INTER 2 INTER 2 INTER 5 INTER 5 MAJOR 4 INTER 5 INTER 3 INTER 2 INTER 2 INTER 5 MAJOR 1 INTER 5 MINOR 1 MINOR 3 INTER 1 MINOR 5 INTER 5 MINOR 5 INTER 2 MAJOR 4 MINOR 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 INTER D/C INTER 4 MAJOR 4 MAJOR 4 MAJOR+ 3 MAJOR+ 2 MAJOR 4 MAJOR 4 MAJOR 2 MAJOR+ 2 MAJOR+ 3 MAJOR+ 3 MINOR 5 MINOR 5 INTER 3 MINOR MAJOR 4 INTER 5 MAJOR 5 MAJOR+ 3 MINOR 3 INTER MAJOR MAJOR CMO 1 MAJOR MAJOR MAJOR INTER MAJOR MAJOR+ MAJOR+ MINOR MINOR INTER INTER MAJOR INTER INTER CMO 1 MINOR D/C D/C D/C D/C D/C D/C D/C D/C D/C O/P O/P D/C D/C D/C 1 O/P L8600(ii) Unilateral varicose vein injection sclerotherapy L8620 L8621 L8680 L8700 L8750 L8751 L8780 L9510 Ultrasound-guided foam sclerotherapy of varicose veins – unilateral Ultrasound-guided foam sclerotherapy of varicose veins – bilateral Bilateral varicose vein injection sclerotherapy Ligation/stripping of long and short saphenous veins (including local excision/multiple phlebectomy) Local excision (multiple phlebectomy) of varicose vein(s) of leg - unilateral Local excision (multiple phlebectomy) of varicose vein(s) of leg – bilateral Ligation/stripping of long and short saphenous veins (including local excision/multiple phlebectomy) - bilateral Venography (and bilateral) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 51 – © Bupa Insurance Limited 1999-2012 L9580 L8770 L8771 Varicography for recurrent varicose veins Subfascial endoscopic perforator surgery (SEPS) - unilateral Subfascial endoscopic perforator surgery (SEPS) - bilateral MINOR 5 INTER 2 INTER 5 MAJOR 4 MAJOR+ 4 MINOR MAJOR+ CMO 1 D/C 1 LYMPHATIC SYSTEM Code T8510 T8722 T8723 T8520 T8540 T8550 T8580 T8610 T8620 T8640 T8700 T8900 T9610 T9000 T9020 Description Radical dissection of cervical lymph nodes Selective dissection of cervical lymph nodes, Levels 1 to 4 Selective dissection of cervical lymph nodes, Levels 1 to 5 (+/-6) Block dissection of axillary lymph nodes (axilliary clearance) levels 1 to 3 Block dissection of para-aortic lymph nodes Block dissection of inguinal lymph nodes Block dissection of pelvic lymph nodes (as sole procedure) Biopsy/Sampling of cervical lymph nodes Sampling of axillary lymph nodes Sampling of internal mammary lymph nodes Excision biopsy of lymph node for diagnosis (cervical, inguinal, axillary) Operations on lymphatic duct not elsewhere classified Excision of cystic hygroma Sentinel node mapping with blue dye or radioactive probe for breast cancer Surgeon's Category CMO 1 CMO 1 CMO 1 MAJOR 4 MAJOR+ 4 MAJOR 2 MAJOR 4 MINOR 3 MINOR 3 INTER 1 INTER 1 MAJOR+ 1 MAJOR 1 MAJOR 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 2 CMO 1 3 MAJOR+ 2 MAJOR+ 2 MAJOR 3 MAJOR 4 MAJOR 3 MAJOR 4 INTER 5 INTER 1 INTER 5 INTER 4 MAJOR 5 MAJOR 4 INTER 2 INTER 2 MAJOR+ CMO 1 MAJOR MAJOR+ MAJOR MAJOR MINOR MINOR INTER INTER MAJOR+ MAJOR INTER INTER 1 1 3 5 5 3 D/C D/C D/C 1 - Sentinel node mapping with blue dye and radioactive probe for breast cancer MAJOR 2 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 52 – © Bupa Insurance Limited 1999-2012 10 Endoscopic GIT Procedures Notes 1. Bupa will not pay addition benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: H2002 - Diagnostic colonoscopy, includes forceps biopsy of colon and ileum Lesser Procedure(s) which are included in the main procedure and should not be billed separately: H4180 - Full or partial thickness rectal biopsy 2 The benefit entitlement payable towards laparoscopic procedures is inclusive of any fee for the laparoscopy. 3 For details of Bupa’s policy relating to local anaesthesia / IV sedation refer to Note 2 of the Essential Notes to the Schedule. ENDOSCOPIC GIT PROCEDURES Code G1900 Surgeon's Description Category Rigid Oesophagoscopy including any biopsy, laser or diathermy destruction INTER 2 of lesions Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 MINOR D/C INTER 1 INTER 4 INTER 4 INTER 4 INTER 4 MAJOR 3 INTER 1 INTER 1 INTER 1 INTER 1 MAJOR 1 MINOR MINOR INTER INTER INTER INTER INTER MINOR MINOR MINOR MINOR INTER INTER D/C D/C D/C D/C D/C D/C D/C O/P - G6500* Diagnostic Oesophago-gastro-duodenoscopy (OGD) includes forceps biopsy, MINOR 3 biopsy urease test & dye spray G4430* Therapeutic Oesophago-gastro- duodenoscopy (OGD) with Bougie dilation G4410* Therapeutic Oesophago-gastro- duodenoscopy (OGD) and insertion of Prosthesis,, therapy for acutely bleeding ulcer or banding of varices AA533 Therapeutic OGD with insertion of prosthesis and elective banding varices (BUPA code) MINOR 5 INTER 3 INTER 2 G4440* Therapeutic oesophagogastroduodenoscopy (OGD) with insertion INTER 1 percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunoscopy G4530* Catheterless Oesophageal PH monitoring ( e.g. Bravo) G1440* Injection sclerotherapy for oesophageal varices G2110* Oesophageal physiology studies (including pH measurement and manometry) G2180 Ambulatory 24h pH and impedance monitoring MINOR 4 INTER 3 MINOR 1 MINOR 2 MINOR 4 MINOR 5 £275 INTER 4 G8090* Small bowel physiology studies including manometry G7900* Ileoscopy via stoma with therapy G8080 Capsule endoscopy including interpretation and evaluation G8082* Diagnostic oesophago gastro duodenoscopy (OGD) and Immediate colonoscopy includes forceps biopsies, biopsy test and dye spray (as sole procedure) G8083* Therapeutic oesophago gastro-duodenoscopy (OGD) & immediate colonoscopy includes forceps biopsies, biopsy test and dye spray (as sole procedure) H2510(ii) Rigid sigmoidoscopy including proctoscopy and biopsy H2502(ii) Diagnostic flexible sigmoidoscopy including forceps biopsy and proctoscopy H2503* Therapeutic sigmoidoscopy with snare loop biopsy or excision of lesion H2002* Diagnostic colonoscopy, includes forceps biopsy of colon and ileum H2003* Therapeutic colonoscopy with snare loop biopsy or excision of lesion H2180* Fibreoptic colonoscopy and recanalisation of tumour H6260 J4300* Proctoscopy (+/- biopsy) Diagnostic ERCP (includes forceps biopsy) INTER 5 MAJOR 2 INTER - MINOR 1 MINOR 2 MINOR 5 INTER 2 INTER 3 MAJOR 1 £50 INTER 4 MINOR 5 INTER 5 INTER 5 INTER 5 INTER 5 INTER 5 INTER 5 MINOR MINOR MINOR INTER INTER MAJOR MINOR INTER O/P O/P O/P D/C D/C D/C D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 53 – © Bupa Insurance Limited 1999-2012 J3900* AA534 AA535 Therapeutic ERCP (including insertion of biliary or pancreatic prosthesis, sphincterotomy and stone extraction) Therapeutic ERCP (plus two of insertion of biliary/pancreatic prosthesis, sphincterotomy or stone prosthesis) (BUPA code) Therapeutic ERCP (plus one of insertion of biliary/pancreatic prosthesis, sphincterotomy or stone prosthesis) (BUPA code) MAJOR 2 MAJOR 1 INTER 5 MINOR 5 MINOR 4 INTER 4 INTER 4 INTER 3 INTER 5 INTER 5 INTER 5 INTER 4 INTER 1 MINOR 5 INTER 2 INTER 5 MAJOR MAJOR MAJOR INTER INTER MINOR INTER INTER - 1 G4480* Therapeutic enteroscopy G4520* Diagnostic enteroscopy H2220* Endoscopic ultrasound for tumour staging J6730* E4990* Endoscopic upper gastrointestinal ultrasound, e.g. for pancreatico-biliary diagnosis/transmucosal biopsy Flexible Panendoscopy D/C D/C D/C - Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 54 – © Bupa Insurance Limited 1999-2012 11 Abdomen (excl. Urinary & Reproductive Organs) Notes 1. If a procedure is marked with an (i) Bupa’s policy on Intensive Therapy applies. (See note 7 in the Essential Notes to the Schedule and appendix A). 2. The surgeon’s benefit entitlement for complex abdominal surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy up to 72 hours. 3. The anaesthetist’s benefit entitlement for complex abdominal surgery includes fees for pre-operative/peri-operative/post-operative management including Intensive Therapy/ventilation for up to 72 hours. 4. In circumstances where the Intensive Therapy exceeds 72 hours, further benefit may be considered on a case by case basis. 5. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: Lesser Procedure(s) which are included in the main procedure and should not be billed separately: H0210 — Appendicectomy H0310 - Drainage of abscess of appendix or drainage of intraabdominal abscess 6. The benefit entitlement payable towards laparoscopic procedures is inclusive of any fee for the laparoscopy. 7. For details of Bupa’s policy relating to local anaesthesia / IV sedation / epidural analgesia refer to Note 2 of the Essential Notes to the Schedule. 8. No additional benefit is payable for incidental procedures performed at the same time as the main procedure, eg prophylactic appendicectomy. 9. No additional benefit is payable for exploratory laparotomy and / or laparoscopy when combined with another abdominal procedure. OESOPHAGUS Code Description G0100(i) Oesophagectomy/Oesophagogastrectomy with anastomosis in chest G0300(i) Sub-total oesophagectomy with anastomosis in neck G0220(i) Total oesophagectomy and interposition of intestine G0260 Endoscopically assisted oesophagectomy Surgeon's Category CMO 5 CMO 5 CMO 5 CMO 5 MAJOR 3 MAJOR 3 CMO 2 CMO 2 MAJOR 4 MAJOR 5 INTER 3 CMO 1 CMO 2 CMO 1 MAJOR+ 1 MAJOR 5 CMO 1 CMO 1 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS CMO 3 CMO 3 12 CMO 3 CMO 5 CMO 3 MAJOR+ 3 MAJOR+ 3 MAJOR+ 5 MAJOR+ 4 MAJOR+ 2 MAJOR+ 2 MAJOR 3 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR 4 MAJOR+ 4 MAJOR 5 MAJOR+ 3 CMO 3 CMO 4 CMO 3 MAJOR MAJOR+ MAJOR+ CMO 2 MAJOR MAJOR INTER MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR MAJOR CMO 1 CMO 1 12 2 D/C 5 2 2 1 G0400(i) Open excision of lesion of oesophagus G1400(i) VATS excision lesion of oesophagus G0500(i) Bypass of oesophagus G0740(i) Repair of ruptured oesophagus G0920(i) Oesophagocardiomyotomy (Heller's operation) G0980(i) Thorascopic oesophagogastric myotomy G1440 Injection sclerotherapy for oesophageal varices G2402(i) Transthoracic fundoplication G2400(i) Transthoracic fundoplication & gastroplasty G2312(i) Transthoracic repair of paraoesophageal hiatus hernia G2320(i) Transthoracic repair of diaphragmatic hernia (acquired) G2330 G2331 G2340 G2430 Transabdominal repair of hiatus hernia Laparoscopic repair of hiatus hernia with anti-reflux procedure (e.g. fundoplication) Transabdominal repair of diaphragmatic hernia Transabdominal anti-reflux operations Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 55 – © Bupa Insurance Limited 1999-2012 G2590 Revision of anti-reflux operations CMO 2 CMO 2 MAJOR 4 MAJOR+ 4 MAJOR+ 4 MAJOR 3 CMO 2 CMO 2 MAJOR 3 - G0730(i) Repair of congenital oesophageal atresia (with or without fistula) A2781 Laparoscopic vagotomy/seromyotomy STOMACH Code A2720 A2730 A2780 Description Proximal gastric vagotomy Highly selective vagotomy Vagotomy with pyloroplasty Surgeon's Category MAJOR 4 MAJOR 4 MAJOR 5 CMO 2 MAJOR+ 4 MAJOR+ 5 MAJOR 5 MAJOR+ 1 CMO 1 INTER 4 MAJOR 1 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR+ 4 MAJOR 3 MAJOR 3 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MAJOR MAJOR 3 MAJOR 5 MAJOR+ 3 MAJOR 4 MAJOR 4 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 1 MAJOR 1 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 INTER 2 MAJOR MAJOR CMO 1 MAJOR+ CMO 1 MAJOR MAJOR+ CMO 1 MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR INTER 6 6 6 1 D/C 4 - G2710(i) Total gastrectomy and excision of surrounding tissue G2800 G2810 G3210 G3220 G3100 G3400 G3440 G3520 G3580 G3610 G3800 G4010 G4030 G4680 Partial gastrectomy Partial gastrectomy and excision of surrounding tissue Gastro-jejunostomy Revision of gastro-jejunostomy Laparoscopic biliary gastric bypass Gastrostomy Closure of gastrostomy Closure of perforated ulcer of stomach Laparoscopic closure of peptic ulcer Gastropexy (for reflux) Open operations on stomach not elsewhere classified Pyloromyotomy Pyloroplasty Fibreoptic endoscopic mucosal resection (EMR) of stomach lesion DUODENUM Code G5000 G5100 G5320 G5010 G6082 Description Open excision of lesion of duodenum Bypass of duodenum Closure of perforated ulcer of duodenum Open excision of congenital lesion of duodenum including mal-rotation Open resection of small intestine tumour Surgeon's Category MAJOR+ 1 MAJOR 3 MAJOR 3 MAJOR+ 1 MAJOR+ 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR+ MAJOR 4 MAJOR+ 2 MAJOR 4 MAJOR+ 1 MAJOR MAJOR CMO 1 MAJOR - SMALL INTESTINE Code G5810 G6000 G6080 G6100 Description Excision of jejunum Open formation of jejunostomy Laparoscopically assisted resection of small intestine Bypass of jejunum Surgeon's Category MAJOR 5 MAJOR 2 MAJOR+ 2 MAJOR 5 MAJOR 3 MAJOR 3 CMO 4 MAJOR 3 MAJOR 3 MAJOR 1 MAJOR 3 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 1 MAJOR MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR+ 5 MAJOR 3 MAJOR 3 MAJOR 1 MAJOR 1 MAJOR 1 MAJOR MAJOR MAJOR MAJOR MAJOR CMO 3 MAJOR MAJOR MAJOR MAJOR INTER 1 6 9 4 1 4 4 G6710* Intubation of jejunum for decompression of intestine (without laparotomy) G7100 G7250 G7402 G7403 G7512 G7513 G7530 Bypass of ileum Ileoanal anastomosis and creation of pouch Open formation of ileostomy Laparoscopic ileostomy Revision of ileostomy - local Revision of ileostomy - laparotomy Closure of ileostomy (as sole procedure) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 56 – © Bupa Insurance Limited 1999-2012 G7810 G7880 G4020 Open operations on ileum (including reduction of intussusception) Redo-operations on ileum/colon Surgery for correction of congenital intestinal atresias MAJOR 3 MAJOR 5 MAJOR 1 MAJOR 3 MAJOR 5 MAJOR 1 MAJOR CMO 2 MAJOR+ - LARGE INTESTINE Code H0210 H0280 H0310 H0510 H0610 H0700 H0750 H0800 H0900 H1000 H1200 H1300 H1542 H1581 H1590 H1700 H1880 Description Appendicectomy Laparoscopic appendicectomy Drainage of abscess of appendix or drainage of intra-abdominal abscess Total excision of colon and ileorectal anastomosis Extended excision of right hemicolon Right hemicolectomy Laparoscopically assisted right hemicolectomy Excision of transverse colon Excision of left hemicolon Excision of sigmoid colon Excision of lesion of colon (transabdominal) Bypass of colon Closure of colostomy Laparoscopic colostomy and stoma formation (including revision) Open formation of colostomy Intra abdominal manipulation of colon (including reduction of intussusception) Laparoscopically assisted left colon resection Surgeon's Category INTER 5 MAJOR 1 MAJOR 1 CMO 2 MAJOR+ 4 MAJOR+ 4 MAJOR+ 5 MAJOR+ 4 MAJOR+ 4 CMO 1 MAJOR 5 MAJOR 4 MAJOR 3 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR+ 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 1 MAJOR 1 MAJOR 1 MAJOR 2 MAJOR+ 4 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 MAJOR+ 2 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 3 MAJOR 5 MAJOR MAJOR CMO 2 MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR+ 1 8 7 7 5 7 7 7 10 4 7 6 4 RECTUM / ANUS Code G7250 H0410 Description Ileoanal anastomosis and creation of pouch Panproctocolectomy and ileostomy Surgeon's Category CMO 4 CMO 3 MINOR 1 CMO 4 CMO 3 CMO 4 CMO 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 CMO 3 9 CMO 1 MINOR 5 CMO 1 CMO 1 CMO 1 CMO 1 CMO 1 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 MAJOR+ 5 MAJOR+ 3 MAJOR+ 5 MAJOR+ 1 MAJOR+ 1 MAJOR 2 CMO 3 MINOR CMO 3 CMO 3 CMO 3 CMO 3 CMO 3 MAJOR+ MAJOR+ CMO 3 CMO 3 MAJOR+ CMO 2 MAJOR MAJOR MAJOR 10 O/P 12 9 8 8 8 6 6 5 8 2 3 1 H2510(ii)*Rigid sigmoidoscopy including biopsy H3310(i) Abdominoperineal pull through resection with colo-anal anastomosis +/colonic pouch and associated stoma H3320(i) Abdominoperineal resection of rectum and anus H3322(i) Laparoscopic abdominoperineal resection H3332(i) Anterior resection – high (i.e. colorectal anastomosis above the peritoneal reflection) H3334(i) Anterior resection – low (i.e. colorectal anastomosis at or below the peritoneal CMO 3 reflection) H3362(i) Hartmann’s procedure H3363(i) Colectomy and colostomy and preservation of rectum H3364 H3365 H3380 H3390 H3500 H3580 H4000 MAJOR+ 5 MAJOR+ 5 Laparoscopic anterior resection – high (i.e. colorectal anastomosis above the CMO 3 peritoneal reflection) Laparoscopic anterior resection – low (i.e. colorectal anastomosis at or below CMO 4 the peritoneal reflection) Partial excision of rectum and sigmoid colon for prolapse Reversal of Hartmann's procedure Fixation of rectum for prolapse Laparoscopic rectopexy Transanal resection for rectal cancer MAJOR+ 5 CMO 2 MAJOR 4 MAJOR 5 MAJOR 4 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 57 – © Bupa Insurance Limited 1999-2012 H4080 H4122 H4130 H4180 H4200 H4480 H4680 H4800 H4900 H5020 H5080 H5100 H5101 Injection of bulking agent for faecal incontinence Transanal endoscopic microsurgery Perianal excision of lesion of rectum (including sigmoidoscopy) Full or partial thickness rectal biopsy Perineal repair of prolapse of rectum Dilation of stricture of rectum Repair of faecal fistula Excision of lesion of anus Destruction of lesion of anus Repair of anal sphincter (including sigmoidoscopy) Repair of anal trauma Haemorrhoidectomy (including sigmoidoscopy) Laser Haemorrhoidectomy Including Sigmoidoscopy MINOR 3 MAJOR 4 INTER 1 MINOR 3 MAJOR 2 MINOR 2 INTER 3 MINOR 3 MINOR 2 MAJOR 1 INTER 5 INTER 1 MINOR 5 MINOR 2 MINOR 2 MINOR 5 MINOR 5 MINOR 2 INTER 2 INTER 3 MINOR 4 MINOR 3 MINOR 3 MAJOR+ 5 MAJOR 2 MINOR 5 MAJOR 3 MINOR 5 MAJOR 2 MINOR 5 MINOR 5 MAJOR 2 MAJOR 2 INTER 5 INTER 3 MINOR 5 MINOR 5 INTER 2 MINOR 5 MINOR 5 INTER 5 MAJOR 2 INTER 5 INTER 3 INTER 3 MAJOR 2 MINOR 5 MINOR 5 MINOR 5 CMO 1 MAJOR+ 5 CMO 2 CMO 2 MINOR CMO 1 INTER MINOR MAJOR MINOR INTER MINOR MINOR MAJOR INTER INTER INTER MINOR MINOR INTER MINOR MINOR INTER MAJOR MINOR MINOR MINOR INTER MINOR MINOR MINOR CMO 3 CMO 2 CMO 2 MAJOR+ D/C D/C 1 D/C 1 D/C D/C 3 D/C 1 O/P O/P D/C D/C 1 1 D/C D/C D/C 1 1 D/C - H5230(ii) Injection of sclerosing substance into haemorrhoids H5240(ii)*Banding of haemorrhoids H5250 L7032 H5400 H5510 H5520 H5620 H5640 H5800 H5940 H6020 H4430 H4420 H0480 Circular stapling haemorrhoidectomy Ultrasound Guided Haemorrhoidal artery ligation Anorectal stretch Laying open of low anal fistula (including sigmoidoscopy) Laying open of high anal fistula (including sigmoidoscopy) Lateral sphincterotomy of anus Excision of anal fissure Drainage through perineal region (including ischio-rectal abscess) (including MINOR 5 sigmoidoscopy) Excision of pilonidal sinus and suture/skin graft INTER 2 Laying open of pilonidal sinus Examination of rectum under anaesthetic (as sole procedure) Faecal disimpaction Abdominal revision of restorative proctocolectomy MINOR 5 £50 £50 CMO 3 MAJOR+ 5 CMO 4 MAJOR+ 5 H1550(i) Abdominal operation for Hirschsprung’s disease (e.g. Duhamel, Söave and Surcuson operations) H5042 H5043 Primary repair of high/intermediate congenital ano-rectal anomaly Primary repair of low congenital ano-rectal anomaly OTHER ORGANS (MAINLY DIGESTIVE) Code B2232 B2233 B2222 B2223 B2234 B2224 Description Adrenalectomy – unilateral (open) Adrenalectomy – unilateral (laparoscopic) Adrenalectomy – bilateral (open) Adrenalectomy – bilateral (laparoscopic) Robot-assisted laparoscopic adrenalectomy Robot-assisted laparoscopic adrenalectomy – bilateral Surgeon's Category MAJOR+ 1 MAJOR+ 2 CMO 1 CMO 2 MAJOR+ 1 CMO 2 CMO 3 CMO 3 CMO 4 MAJOR+ 3 INTER 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 1 MAJOR 3 MAJOR+ 1 MAJOR+ 3 MAJOR+ 3 MAJOR+ 1 CMO 2 MAJOR+ 5 CMO 2 CMO 1 MAJOR+ 2 MAJOR 3 MAJOR MAJOR+ MAJOR+ MAJOR+ CMO 2 CMO 2 CMO 4 CMO 1 MAJOR INTER 1 8 8 8 2 3 J0200(i) Partial excision of liver J0210(i) Hemihepatectomy J0310 J0400 J0510 Resection of Liver tumour Repair of liver (including therapeutic laparoscopic operations on liver) Open drainage of liver Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 58 – © Bupa Insurance Limited 1999-2012 J0740 Open liver resection and ablation CMO 5 CMO 3 INTER 5 MINOR 4 MAJOR 1 MAJOR 3 MAJOR 4 MAJOR 5 MAJOR+ 1 MAJOR+ 4 CMO 1 MAJOR 5 CMO 3 CMO 1 MAJOR 5 CMO 1 MAJOR 5 MAJOR 5 INTER 3 CMO 3 CMO 5 CMO 4 CMO 3 CMO 5 MAJOR+ 5 CMO 5 MAJOR+ 5 MAJOR 4 MAJOR+ 5 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 1 MAJOR 1 MAJOR 2 INTER 5 CMO4 MAJOR+ 5 INTER 5 INTER 1 MAJOR 1 MAJOR+ 3 MAJOR 4 MAJOR+ 4 MAJOR+ 5 MAJOR 4 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR 4 MAJOR+ 2 MAJOR+ 1 MAJOR 5 INTER 5 CMO 3 CMO 5 CMO 1 CMO 1 CMO 1 MAJOR+ 2 CMO 1 MAJOR+ 2 MAJOR+ 2 MAJOR+ 1 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 3 MAJOR 4 MAJOR 4 INTER 5 CMO CMO 2 INTER MINOR MAJOR MAJOR MAJOR MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR CMO 1 MAJOR MAJOR MAJOR+ MAJOR MAJOR INTER CMO 3 CMO 5 CMO 3 CMO 3 CMO 3 MAJOR+ CMO 3 MAJOR+ MAJOR MAJOR+ MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR INTER D/C D/C 3 5 D/C 1 1 D/C D/C D/C 12 6 5 1 2 J0780(i) Radiofrequency thermocoagulation of liver with scalpel liver resection J0900 J1300 J1400 J1800 J1820 J1830 J1880 J1900 J2720 J2800 J2900 J3000 J3100 J3200 J3300 J3500 J5000 J5480 J5481 Diagnostic laparoscopy (including any biopsy) Percutaneous biopsy of lesion of liver Open puncture of liver Cholecystectomy (including mini-cholecystectomy) Cholecystectomy with exploration of common bile duct Laparoscopic cholecystectomy Laparoscopic cholecystectomy with peri-operative cholangiogram Anastomosis of gall bladder (to another viscus) Partial excision of bile duct and anastomosis of bile duct to duodenum/jejunum Excision of lesion of bile duct Anastomosis of hepatic duct Anastomosis of common bile duct Open introduction of prosthesis into bile duct Repair of bile duct Incision of bile duct (including exploration for calculus removal) Sphincterotomy of bile duct and pancreatic duct using duodenal approach Percutaneous examination of bile duct Pancreatic transplant including sequential pancreatic transplant Pancreatic with kidney transplant (simultaneous pancreas SPK) J5500(i) Total pancreatectomy and excision of surrounding tissue J5520(i) Total pancreatectomy J5610(i) Pancreatoduodenectomy and excision of surrounding tissue (Whipple's procedure) J5700 J5711 J5750 J5800 J5900 J6100 J6180 J6200 J6300 J6600 J6900 J6980 L8110 Distal pancreatectomy Pancreatectomy with autologous islet cell transplantation Laparoscopic distal pancreatectomy Excision of lesion of pancreas Anastomosis of pancreatic duct (to another viscus) Open drainage of lesion of pancreas Drainage of pancreatic abscess Incision of pancreas Open examination of pancreas Therapeutic percutaneous operations on pancreas Open splenectomy Laparoscopic splenectomy Creation of peritoneo-venous shunt (Levine/Denver) MAJOR VESSELS Code L7040 L7710 L7920 L7980 Description Open cannulation of intra abdominal artery for infusion chemotherapy Creation of portocaval shunt Plication of vena cava Repair of wound of major artery or vein of abdomen (including aorta and vena cava) Surgeon's Category MAJOR 5 CMO 3 MAJOR+ 1 MAJOR 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MAJOR D/C MAJOR+ 4 MAJOR+ 1 MAJOR+ 4 CMO 3 MAJOR+ MAJOR - Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 59 – © Bupa Insurance Limited 1999-2012 ABDOMINAL WALL Code Description T1640(i) Repair of congenital diaphragmatic hernia T1900 T1910 T2000 T2010 T2080 T2100 T2110 T2002 T2012 T2102 T2112 T2200 T2280 T2300 T2400 T2500 T2600 T2502 T2710 T2720 T2730 T2740 T2750 T2781 T2830 T7972 Simple excision of inguinal hernial sac (herniotomy) - unilateral Simple excision of inguinal hernial sac (herniotomy) - bilateral Primary repair of inguinal hernia Primary repair of inguinal hernia - bilateral Primary repair of strangulated inguinal hernia Repair of recurrent inguinal hernia Repair of recurrent inguinal hernia - bilateral Laparoscopic repair of inguinal hernia - unilateral Laparoscopic repair of inguinal hernia - bilateral Laparoscopic repair of recurrent inguinal hernia - unilateral Laparoscopic repair of recurrent inguinal hernia - bilateral Primary repair of femoral hernia Primary repair of strangulated femoral hernia Repair of recurrent femoral hernia Repair of umbilical hernia (irrespective of age) Primary repair of incisional hernia Repair of recurrent incisional hernia Laparoscopic repair of incisional hernia Repair of ventral hernia not requiring mesh Repair of ventral hernia requiring mesh Repair of dorsal hernia including lumbar hernia Repair of perineal hernia including scrotal that are not inguinal Repair of sciatic hernia Repair of epigastric hernia Resuture of previous incision in abdominal wall (burst abdomen) Exploration and repair of groin disruption including repair of muscle fascia and tendons (Gilmore's groin repair) Surgeon's Category MAJOR+ 5 INTER 1 INTER 5 INTER 2 MAJOR 1 INTER 3 INTER 3 MAJOR 2 INTER 3 MAJOR 2 INTER 4 MAJOR 3 INTER 2 INTER 3 INTER 3 INTER 1 INTER 3 INTER 4 INTER 4 INTER 2 INTER 3 INTER 2 INTER 2 INTER 2 INTER 2 INTER 3 INTER 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 MAJOR+ 2 INTER 5 MAJOR 4 MAJOR 1 MAJOR 5 MAJOR 2 MAJOR 3 MAJOR+ 2 INTER 5 MAJOR 5 INTER 5 MAJOR 5 INTER 5 MAJOR 2 MAJOR 1 MAJOR 1 INTER 5 MAJOR 3 MAJOR 1 INTER 5 INTER 5 INTER 5 INTER 5 INTER 5 INTER 2 MAJOR 1 INTER 5 INTER MAJOR INTER MAJOR MAJOR MAJOR MAJOR+ INTER INTER INTER INTER INTER MAJOR MAJOR INTER INTER MAJOR INTER INTER INTER INTER INTER INTER INTER INTER INTER 2 D/C D/C D/C 1 1 D/C 1 D/C 1 D/C 1 D/C 1 D/C D/C 1 1 1 - PERITONEUM Code T3010 T3080 T3410 T3600 T3910 T3930 T3980 T3990 T4130 T4300 T4302 T4610 T4680 Description Laparotomy for post-operative haemorrhage Laparotomy and repair of multiple visceral trauma Open drainage of subphrenic abscess Operations on omentum Excision of retroperitoneal tumour Retroperitoneal abscess Excision of presacral tumour Excision of retroperitoneal neuro-endocrine lesion Freeing of adhesions of peritoneum Laparoscopic adhesiolysis (including biopsy) Open adhesiolysis (including biopsy) Paracentesis abdominis for ascites Suprapubic drainage of pelvic abscess Surgeon's Category MAJOR+ 4 CMO 2 MAJOR 2 MAJOR 3 MAJOR+ 5 INTER 4 INTER 5 MAJOR+ 5 INTER 4 INTER 4 INTER 4 MINOR 1 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR MAJOR+ 5 MAJOR 3 MAJOR 3 MAJOR+ 5 MAJOR 3 MAJOR+ 1 MAJOR+ 5 MAJOR 5 MAJOR 2 MAJOR 2 MINOR 1 INTER 5 CMO 2 MAJOR MAJOR MAJOR+ INTER INTER MAJOR+ MAJOR INTER INTER MINOR INTER 4 2 2 5 2 4 1 3 D/C 1 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 60 – © Bupa Insurance Limited 1999-2012 12 Urinary System and Male Reproductive Organs Notes 1. If a procedure is marked with an (i) Bupa’s policy on Intensive Therapy applies. (See note 7 in the Essential Notes to the Schedule and appendix A). 2. The surgeon’s benefit entitlement for complex urological I renal surgery includes fees for pre-operative/peri-operative/postoperative management including Intensive Therapy up to 72 hours. 3. The anaesthetist’s benefit entitlement for complex urological I renal surgery includes fees for pre-operative/peri-operative/postoperative management including Intensive Therapy/ventilation for up to 72 hours. 4. In circumstances where the Intensive Therapy exceeds 72 hours, further benefit may be considered on a case by case basis. 5. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: M6530 – Endoscopic resection of prostate (TUR) (including cystoscopy) Lesser Procedure(s) which are included in the main procedure and should not be billed separately: M4510 – Diagnostic endoscopic examination of bladder (including any biopsy) KIDNEY / RENAL PELVIC Code 65180 J5480 J5481 Description Renal cyst aspiration (and ablation) Pancreatic transplant including sequential pancreatic transplant Pancreatic with kidney transplant (simultaneous pancreas SPK) Surgeon's Category INTER 4 CMO 3 CMO 5 CMO 3 CMO 3 Anaesthetist's Hospital Anticipated Category Category LOS N/C CMO 3 CMO 5 CMO 3 CMO 3 CMO 3 MAJOR+ 3 MAJOR 5 MAJOR 5 MAJOR+ 3 MAJOR 4 MAJOR 5 MAJOR+ 5 CMO 1 MAJOR 3 MAJOR 3 INTER 2 MAJOR 3 MAJOR 5 MAJOR+ 5 INTER 3 MAJOR 3 MAJOR 4 MAJOR 3 MINOR CMO 3 CMO 5 MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR MAJOR MAJOR MAJOR+ CMO 1 INTER INTER MINOR MAJOR MAJOR CMO 2 MAJOR MAJOR MAJOR+ MAJOR 5 5 5 7 1 1 5 6 - M0102(i) Transplantation of kidney - 1st or 2nd transplant M0103(i) Transplantation of kidney - 3rd transplant M0104(i) Transplantation of kidney into patient with abnormal, augmented or absent CMO 3 bladder M0210(i) Nephrectomy and excision of perirenal tissue M0220 M0222 Nephro-ureterectomy - unilateral Nephro-ureterectomy for live donor transplantation MAJOR+ 2 MAJOR+ 5 MAJOR+ 5 MAJOR 4 MAJOR 4 MAJOR+ 1 CMO 1 CMO 1 MAJOR 3 MAJOR 3 MINOR 4 MAJOR 3 MAJOR+ 3 CMO 3 MAJOR 1 MAJOR 4 MAJOR+ 1 MAJOR 3 M0250(i) Nephrectomy - unilateral M0260 M0280 M0282 Transplant nephrectomy Laparoscopic nephrectomy Laparoscopic nephrectomy (including neproureterectomy) M0380(i) Laparoscopic upper or lower pole heminephrectomy M0840 M0812 M0813 M0814 Exploration of renal transplant for bleeding Open biopsy of renal transplant Percutaneous biopsy of renal transplant Open biopsy of native kidney M0300(i) Open partial excision of kidney M0312 M0412 M0510 M0550 M0610 Renal cryotherapy inc endoscopic insertion of catheter into ureter and endoscopic retrograde pyleography De-roofing and aspiration of renal para pelvic cyst Open pyeloplasty Repair of kidney wound Open removal of calculus from kidney Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 61 – © Bupa Insurance Limited 1999-2012 M0680 M0800 M1000 M1080 M1090 M0880 M0910 M0940 M1110 M1310 M1360 M1380 M1400 Drainage of pyonephrosis Other open operations on kidney Therapeutic endoscopic operations on kidney (include cystoscopy and retrograde catheterisation) Laparoscopic pyeloplasty Robot assisted laparoscopic pyeloplasty Open drainage of perinephric abscess Endoscopic fragmentation of calculus of kidney Percutaneous nephrolithotomy (including cystoscopy and retrograde catheterisation) Diagnostic endoscopic examination of kidney (including biopsy) Percutaneous fine needle biopsy of lesion of kidney Percutaneous insertion of nephrostomy tube Percutaneous tru-cut needle biopsy of lesion of kidney Extracorporeal fragmentation of calculus of kidney (lithotripsy) - single treatment MAJOR 2 MAJOR 3 MAJOR 4 CMO 2 CMO 2 MAJOR 2 MAJOR 3 CMO 2 MAJOR 3 MINOR 4 INTER 5 INTER 2 MINOR 5 MAJOR 4 MAJOR 3 MAJOR 1 CMO 1 CMO 1 MAJOR 3 MAJOR 3 MAJOR+ 2 MAJOR 3 INTER 2 INTER 3 INTER 5 INTER MAJOR MAJOR CMO 2 CMO 2 MAJOR MAJOR CMO 2 MAJOR MINOR INTER INTER INTER D/C 1 1 3 1 2 1 1 1 D/C D/C URETER Code M1820 M1910 M2030 M2080 M2100 M2130 M2160 M2202 M2200 M2210 M2280 M2510 M2511 M2310 M2530 M2580 M2600 M2730 M2890 M2920 Description Excision of segment of ureter Construction of ileal conduit including ureteric implantation Bilateral replantation of ureter into bladder Unilateral replantation of ureter into bladder (including cystoscopy) Other connection of ureter Ileal or colonic replacement of ureter Reconstruction of transplant ureter Ureterostomy - formation Ureterostomy - closure Open correction vesico-ureteric reflux - unilateral Open correction vesico-ureteric reflux - bilateral Excision of ureterocele (with or without ureteric reimplantation) - unilateral Excision of ureterocele (with or without ureteric reimplantation) - bilateral Open Ureterolithotomy (including cystoscopy) Ureterolysis - unilateral Ureterolysis - bilateral Therapeutic nephroscopic operations on ureter (including cystoscopy) Ureteroscopic extraction of calculus of ureter (including cystoscopy) Push manipulation of stone prior to lithotripsy (as sole procedure) Endoscopic insertion of prosthesis into ureter (including cystoscopy) Surgeon's Category MAJOR 2 MAJOR+ 2 MAJOR+ 3 MAJOR 3 MAJOR 5 CMO 1 MAJOR 5 MAJOR 5 MAJOR 5 MAJOR 5 CMO 2 MAJOR 5 MAJOR+ 5 MAJOR 3 MAJOR 5 MAJOR+ 4 MAJOR 2 MAJOR 2 INTER 3 INTER 3 MINOR 4 MINOR 4 INTER 2 INTER 2 MINOR 5 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 MAJOR MAJOR+ 2 MAJOR+ 1 MAJOR 5 MAJOR 5 MAJOR+ 1 MAJOR 5 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR+ 2 MAJOR+ 4 CMO 1 MAJOR 3 MAJOR 3 MAJOR+ 4 MAJOR 5 INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 MAJOR 3 INTER 5 MAJOR+ MAJOR+ MAJOR MAJOR CMO 1 MAJOR+ MAJOR MAJOR MAJOR MAJOR+ MAJOR MAJOR+ MAJOR MAJOR MAJOR+ MAJOR INTER INTER MAJOR MINOR MINOR INTER INTER MAJOR INTER 7 4 1 1 1 D/C D/C D/C D/C D/C O/P D/C M2930* Removal of prosthesis from ureter (including cystoscopy) M2932 M3000 M3010 M3110 M3202 Cystoscopy and removal of transplant stent Endoscopic examination of ureter (including cystoscopy) Endoscopic retrograde pyelography (including cystoscopy) Extracorporeal shockwave lithotripsy of calculus of ureter Operations on ureteric orifice (including endoscopic) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 62 – © Bupa Insurance Limited 1999-2012 BLADDER Code M2981 Description Endoscopic anti-reflux procedure (and bilateral) (including cystoscopy) Surgeon's Category INTER 5 CMO 4 CMO 4 MAJOR+ 2 MAJOR 2 CMO 1 MAJOR 5 MAJOR 5 CMO 4 MAJOR+ 1 INTER 4 INTER 1 MINOR 1 INTER 5 MAJOR 3 INTER 3 INTER 2 MAJOR 3 INTER 1 INTER 4 MAJOR 2 INTER 3 INTER 3 INTER 5 INTER 1 INTER 1 MINOR 4 MINOR 2 INTER 2 MAJOR 3 MAJOR 3 MAJOR 3 Anaesthetist's Hospital Anticipated Category Category LOS INTER 5 INTER D/C CMO 2 CMO 2 MAJOR 3 MAJOR 3 MAJOR+ 2 MAJOR 3 MAJOR 3 MAJOR+ 5 MAJOR 5 MAJOR 5 MAJOR 2 MINOR 5 INTER 5 MAJOR 3 MAJOR 3 INTER 4 MAJOR 3 MINOR 5 INTER 4 MAJOR 3 INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 MAJOR 5 MAJOR 5 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 INTER 3 MAJOR 2 MAJOR 3 CMO 3 CMO 3 MAJOR MAJOR CMO 1 MAJOR CMO 4 CMO 1 MAJOR+ INTER INTER MINOR INTER MAJOR MAJOR INTER MAJOR MINOR INTER MAJOR INTER INTER INTER MINOR MINOR MINOR MINOR INTER MAJOR MAJOR+ MAJOR MAJOR MAJOR INTER INTER INTER MAJOR 12 3 3 5 D/C D/C 1 1 1 D/C D/C D/C D/C 1 D/C D/C D/C D/C O/P 1 1 1 2 2 1 3 D/C 1 M3400(i) Open total cystectomy (with construction of intestinal conduit of bladder) M3420 M3500 M3510 M3600 M3700 M3640 Laparoscopic cystectomy Partial cystectomy (including cystoscopy) Diverticulectomy of bladder Enlargement of bladder (including cystoscopy) Repair of bladder (including cystoscopy) Repair of bladder exstrophy M3602(i) Enterocystoplasty (including cystoscopy) M3720 M3780 M3820 M3880 M3900 M4110 M4210 M4230 M4310 M4320 M4400 M4410 M4420 M4430 M4480 Repair of vesicocolic fistula Repair of cutaneous vesical fistula Cystostomy and insertion of suprapubic tube into bladder (including cystoscopy) Stab cystostomy Open removal of calculus from bladder (including cystoscopy) Open excision of lesion from bladder (including cystoscopy) Endoscopic resection of lesion of bladder (including cystoscopy) Endoscopic destruction of lesion of bladder (including cystoscopy) Endoscopic transection of bladder (including cystoscopy) Endoscopic hydrostatic distension of bladder (including cystoscopy) Sphincterotomy Litholapaxy (including cystoscopy) Endoscopic extraction of calculus of bladder (including cystoscopy) Endoscopic removal of foreign body from bladder (including cystoscopy) Resection of bladder neck (including cystoscopy) M4510* Diagnostic endoscopic examination of bladder (including any biopsy) M4512 Diagnostic examination of bladder using Hexaminolevulinate blue light Fluorescence cystoscopy M4712(ii) Bladder instillation of pharmacologic agent (including cystoscopy) M4780(ii) Urodynamic studies/urodynamic assessment M4910 M5100 M5180 M5220 M5280 M5300 M5250 M5630 M6582 Closure of cystostomy Combined abdominal and vaginal operations to support outlet of female bladder (including sling procedures) (including cystoscopy) Combined abdominal and vaginal operations to support outlet of female bladder (including sling procedures) - redo operation (including cystoscopy) Retropubic suspension of neck of bladder (incl colposuspension) (including cystoscopy) Retropubic suspension of neck of bladder (including colposuspension) - redo MAJOR 3 operation (including cystoscopy) Vaginal operations to support outlet of female bladder (incl Cystoscopy) Needle suspension of bladder neck (including cystoscopy) MAJOR 4 MAJOR 3 Therapeutic injection into bladder neck for treatment of stress incontinence INTER 3 (peri-urethral bulking agents), including cystoscopy Transperineal template-guided biopsies of the prostate INTER 1 MAJOR 4 M7590* Tension - free urethropexy, including administration of local anaesthetic by operating surgeon (including cystoscopy) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 63 – © Bupa Insurance Limited 1999-2012 M6480 M5520 M5820 M6620 P2510 Operation to support outlet of male bladder (including sling procedures) (including cystoscopy) Implantation of artificial urinary sphincter at bladder neck and/or removal (including cystoscopy) Dilatation of outlet of female bladder (with cystoscopy) Endoscopic incision of outlet of male bladder (with cystoscopy) Repair of vesicovaginal fistula (including cystoscopy) MAJOR 4 MAJOR 5 INTER 1 INTER 5 MAJOR 5 MAJOR 3 MAJOR 3 INTER 2 INTER 4 MAJOR 5 MAJOR MAJOR MINOR INTER MAJOR 3 D/C 1 3 URETHRA Code M5580 M5600 M7200 M7280 M7312 M7313 M7314 M7315 M7316 M7320 M7330 M7332 M7340 M7360 M7361 M7380 M7500 M7620 M7700 M7920 M7940 Description Excision of urethral caruncle Therapeutic endoscopic operations on outlet of female bladder (including cystoscopy) Urethrectomy Urethral valve resection Repair of penile/perineal hypospadias Repair of penile shaft hypospadias Repair of distal hypospadias Secondary adjustment of penile skin following hypospadias repair Complex secondary repair of hypospadias Repair of epispadias Closure of fistula of urethra (including cystoscopy) Closure of fistula of urethra after hypospadias Repair of urethrorectal fistula Surgeon's Category MINOR 2 INTER 3 MAJOR 2 MAJOR 1 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR 4 MAJOR+ 3 INTER 2 INTER 2 MAJOR 2 Anaesthetist's Hospital Anticipated Category Category LOS MINOR 5 MINOR D/C INTER 3 MAJOR 3 INTER 5 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 INTER 5 INTER 5 MAJOR 3 MAJOR 2 MAJOR 3 MAJOR 3 INTER 5 INTER 4 MINOR 5 INTER 2 INTER 4 INTER MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR+ MAJOR+ INTER MAJOR MAJOR MAJOR MAJOR MAJOR INTER MINOR MINOR MINOR INTER D/C 2 2 4 1 1 4 3 D/C D/C 2 3 D/C D/C D/C D/C D/C Simple urethroplasty i.e first attempt, anterior urethra (including cystoscopy) MAJOR 2 Complex urethroplasty i.e. posterior urethral repairs and second (or further ) MAJOR 4 anterior repairs (including cystoscopy) Repair of rupture of urethra (including cystoscopy) Excision of diverticulum of urethra (including cystoscopy) Removal of foreign body from urethra MAJOR 4 INTER 4 MINOR 3 Diagnostic endoscopic examination of urethra (as sole procedure) (including MINOR 3 cystoscopy) Dilation of Urethra (including cystoscopy) Internal urethrotomy (including cystoscopy) MINOR 1 INTER 3 PROSTATE Code M6100 Description Open excision of prostatic adenoma Surgeon's Category MAJOR 4 CMO 4 CMO 4 CMO 4 MAJOR 5 MAJOR+ 1 MAJOR+ 1 INTER 2 MAJOR+ 2 INTER 5 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MAJOR 6 MAJOR+ 5 CMO 1 CMO 1 MAJOR 5 MAJOR+ 1 MAJOR+ 1 INTER 4 MAJOR+ 5 INTER 5 MAJOR 1 CMO 3 CMO 4 CMO 4 MAJOR MAJOR+ MAJOR+ INTER CMO 3 INTER MAJOR 5 1 1 D/C D/C 1 M6180(i) Radical prostatectomy, reconstruction of bladder neck including bilateral pelvic lymphadenectomy (including cystoscopy) M6182 M6192 M6530 M6533 M6532 M6580 M6770 M6730 M6750 Laparoscopic radical prostatectomy Robot assisted laparoscopic prostatectomy (including cystectomy) Endoscopic resection of prostate (TUR) (including cystoscopy) Holmium Laser Enucleation of Prostatic Adenoma (HoLEP) Holmium laser resection of prostate (HoLRP) (including cystoscopy) Endoscopic biopsy of prostate (including cystoscopy) High intensity focused ultrasound of prostate (including cystoscopy) Drainage of prostatic abscess Transurethral needle ablation (TUNA) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 64 – © Bupa Insurance Limited 1999-2012 M6760 M6762 M6780 M6790 M7020 M7080 Photoselective vaporisation of prostate (green light/niagra laser pvp) (including cystoscopy) Photoselective vaporisation of prostate (KTP laser PVP) (including cystoscopy) Prostatic hyperthermia (up to six courses) Introduction of radio-active implant into prostate (brachytherapy stage II) Prostate, needle biopsy Insertion of urethral stent for relief of prostatic obstruction (including cystoscopy) MAJOR 5 MAJOR 5 MAJOR 1 CMO 1 MINOR 3 MAJOR 3 MAJOR 5 MAJOR 5 MAJOR 1 MAJOR+ 5 MINOR 5 MAJOR 3 MAJOR MAJOR MAJOR CMO 1 MINOR MAJOR 1 1 D/C O/P D/C GENITALIA Code M8120 M8130 N0500 N0630 N0680 N0700 N0820 N0920 N0930 N1000 N1100 N1320 N1340 N1350 N0702 N1352 N1380 N1510 N1520 N1580 N1900 N1910 N2050 N2200 N2610 N2620 N2710 N2740 N2780 N2820 N2840 N2842 N2880 N3010 N3020 N3030 Description Meatoplasty External meatotomy of urethral orifice Bilateral excision of testes Laparoscopic orchidectomy Orchidectomy and excision of spermatic cord Excision of lesion of testis Orchiopexy - bilateral Orchiopexy Abdominal undescended testis Prosthesis of testis (insertion or removal) Correction of hydrocele Fixation of testis Biopsy of testis Exploration of testis (including biopsy) Examination of testis under anaesthetic as sole procedure Laparoscopy for impalpable testis Bilateral fixation of testes Bilateral epididymectomy Unilateral epididymectomy Excision of epididymal cyst Operation(s) on varicocele Laparoscopic varicocelectomy Vasography (include scrotal exploration) Operation(s) on seminal vesicle Total amputation of penis Partial amputation of penis Excision of lesion of penis Extracorporeal shockwave therapy for Peyronies disease Operation for Peyronie's disease Reconstruction of penis Repair of avulsion of penis Frenuloplasty of penis Repair of injury to penis Preputioplasty Division of preputial adhesions Circumcision Surgeon's Category INTER 1 MINOR 5 MAJOR 2 INTER 5 INTER 5 INTER 1 MAJOR 2 INTER 3 MAJOR 1 INTER 1 INTER 2 INTER 2 MINOR 5 INTER 2 MINOR 2 INTER 2 INTER 2 INTER 5 INTER 2 INTER 2 INTER 2 INTER 2 MINOR 2 MAJOR 1 MAJOR 5 MAJOR 1 INTER 1 MINOR 4 MAJOR 3 MAJOR 2 MAJOR 5 MINOR 5 INTER 5 MINOR 3 MINOR 3 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 2 INTER D/C MINOR 5 MAJOR 2 INTER 4 INTER 4 INTER 5 MAJOR 5 INTER 5 MAJOR 2 INTER 3 INTER 4 INTER 4 INTER 1 INTER 4 MINOR 5 INTER 4 INTER 5 MAJOR 1 INTER 5 INTER 5 INTER 5 INTER 5 INTER 1 INTER 5 MAJOR 3 MAJOR 3 INTER 3 MINOR 4 INTER 4 MAJOR 3 MAJOR 3 MINOR 5 INTER 5 MINOR 5 MINOR 5 INTER 3 MINOR MAJOR INTER INTER INTER MAJOR INTER MAJOR INTER INTER INTER MINOR INTER MINOR INTER INTER INTER MINOR INTER INTER INTER MINOR MAJOR MAJOR MAJOR INTER MINOR INTER MAJOR MAJOR MINOR INTER INTER MINOR INTER D/C 1 D/C D/C D/C D/C D/C D/C D/C D/C D/C D/C D/C D/C D/C D/C D/C D/C D/C 2 1 1 1 D/C D/C D/C D/C D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 65 – © Bupa Insurance Limited 1999-2012 N3031 N3210 XR220 Circumcision with Plastibell Biopsy of lesion of penis Seminal vesicle injection INTER 1 MINOR 3 MINOR 5 INTER 3 MINOR 5 - INTER MINOR MINOR O/P - Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 66 – © Bupa Insurance Limited 1999-2012 13 Pregnancy & Confinement PREGNANCY & CONFINEMENT Code R1820 R2510 R2810 Description Caesarean delivery Caesarean hysterectomy Curettage of delivered uterus Surgeon's Category MAJOR 3 MAJOR+ 2 MINOR 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR 4 MAJOR 5 INTER 3 MAJOR+ MINOR D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 67 – © Bupa Insurance Limited 1999-2012 14 Female Reproductive Organs Notes 1. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: Q0740 – Total abdominal hysterectomy (+/- oophorectomy) Lesser Procedure(s) which are included in the main procedure and should not be billed separately: Q2230 – Oophorectomy and salpingectomy (as sole procedure) (including bilateral) 2. The benefit entitlement payable towards laparoscopic procedures is inclusive of any fee for the laparoscopy. 3. For details of Bupa’s policy relating to local anaesthesia / IV sedation and epidural analgesia refer to Note 2 of the Essential Notes to the Schedule. UTERUS / ADNEXA Code Q0710 Q0712 Q0740 Q0750 Q0751 Q0790 Q0800 Q0830 Q0880 Q0920 Q0950 Q1280 Q1700 Q1702 Q1703 Description Radical hysterectomy and lymphadenectomy (Wertheim's) Radical trachelectomy including laparoscopic and removal of lymph nodes Total abdominal hysterectomy (+/- oophorectomy) Subtotal abdominal hysterectomy (+/- oophorectomy) Laparoscopic subtotal hysterectomy (+/- oophorectomy) Total laparoscopic hysterectomy Vaginal hysterectomy without laparoscopic assistance Vaginal hysterectomy with laparoscopic assistance Surgeon's Category CMO 3 CMO 3 MAJOR 5 MAJOR 4 MAJOR 5 MAJOR+ 2 MAJOR+1 MAJOR+ 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 MAJOR+ 5 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR 4 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 INTER 5 MAJOR 3 MINOR 5 MAJOR 3 MAJOR 4 MAJOR 4 MAJOR 3 MAJOR 3 MAJOR 4 CMO 4 CMO 1 CMO 3 CMO 3 MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR+ MAJOR MAJOR MAJOR MAJOR MAJOR INTER MAJOR MINOR MAJOR MAJOR MAJOR INTER MINOR MAJOR MAJOR CMO 4 CMO 3 5 4 4 1 1 4 Hysterectomy with excision/biopsy and/or removal of omentum and uterine CMO 1 adnexa for ovarian malignancy Myomectomy (including laparoscopically) Plastic reconstruction of uterus Introduction of Mirena coil MAJOR+ 2 MAJOR+ 2 £50 2 D/C D/C O/P 1 D/C D/C D/C 2 3 - Therapeutic endoscopic operations on uterus (including endometrial ablation)MAJOR 3 Microwave endometrial ablation Impedence controlled bipolar radiofrequency ablation for menorrhagia MAJOR 3 MAJOR 3 INTER 1 MAJOR 1 MINOR 3 MAJOR 3 MAJOR 2 MAJOR 3 INTER 5 MINOR 4 MAJOR 3 MAJOR 4 CMO 4 CMO 3 Q1800* Hysteroscopy including biopsy, dilation, curettage and polypectomy with/without mirena coil insertion Q1802 Hysteroscopy with resection of fibroid Q2020(ii)*Endometrial biopsy or aspiration Q2230 Q3110 Q3800 Q3900 Q3980 Q4400 T8580 X1410 X1420 Oophorectomy and salpingectomy (as sole procedure) (including bilateral) Removal of products of conception from fallopian tube (ectopic pregnancy) including laparoscopically Laparoscopy and therapeutic procedures including laser,diathermy and destruction e.g.endometriosis,adhesiolysis,tubal surgery Laparoscopy (including e.g. puncture of ovarian cysts, +/- biopsy, minor endometriosis) Hysterosalpingo contrast echo sonography Ovarian cystectomy (as sole procedure) (and bilateral) Block dissection of pelvic lymph nodes (as sole procedure) Total exenteration of pelvis Anterior exenteration of pelvis Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 68 – © Bupa Insurance Limited 1999-2012 X1430 Posterior exenteration of pelvis CMO 3 CMO 1 CMO 3 - SUSPENSION Code M5100 M5180 M5220 M5280 M5300 M5250 M5630 M7590 Q2080 Description Combined abdominal and vaginal operations to support outlet of female bladder (including sling procedures) Combined abdominal and vaginal operations to support outlet of female bladder (including sling procedures) - redo operation Retropubic suspension of neck of bladder (including colposuspension) Surgeon's Category MAJOR 3 MAJOR 3 MAJOR 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR 1 MAJOR 5 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 INTER 3 MAJOR 3 MAJOR 2 MAJOR+ MAJOR MAJOR MAJOR INTER INTER MAJOR INTER 1 2 2 1 3 D/C 1 - Retropubic suspension of neck of bladder (including colposuspension) – redo MAJOR 3 operation Vaginal operations to support outlet of female bladder Needle suspension of bladder neck MAJOR 4 MAJOR 3 Therapeutic injection into bladder neck for treatment of stress incontinence INTER 3 (peri-urethral bulking agents), including cystoscopy Tension - free urethropexy, including administration of local anaesthetic by operating surgeon (including cystoscopy) Ventro-suspension of uterus including laparoscopic MAJOR 4 INTER 5 CERVIX UTERI Code Description P2730(ii) Colposcopy (+/- biopsy) Q0100 Amputation of cervix uteri Surgeon's Category MINOR 4 INTER 4 MINOR 5 MINOR 2 INTER 2 MINOR 1 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS MINOR 5 MINOR O/P INTER 5 MINOR 5 MINOR 5 INTER 5 MINOR 5 INTER 4 INTER 1 INTER MINOR MINOR INTER MINOR MINOR MINOR D/C O/P O/P D/C O/P D/C Q0220(ii) Laser destruction of lesion of cervix uteri Q0230(ii) Cauterisation of lesion of cervix uteri (including loop diathermy) Q0330 Q0340 Q1010 Q1030 Cone biopsy of cervix uteri (including laser) Punch biopsy of cervix uteri Dilation of cervix uteri and curettage of retained products of conception following spontaneous abortion Dilatation of cervix uteri and curettage of uterus including polypectomy and MINOR 4 diathermy of cervix VAGINA / PERINEUM Code M3710 M5580 M5582 P1300 P2932 P1400 P1800 P1920 P2000 P2100 P2210 P2230 P2310 Description Cystourethroplasty (including cystoscopy) Excision of urethral caruncle Diathermy of urethral caruncle Operations on female perineum Examination of vagina under anaes. as sole procedure Incision of introitus of vagina Other obliteration of vagina Excision of septum of vagina Excision of lesion of vagina (e.g. warts and cysts) Reconstruction of vagina Surgeon's Category MAJOR 2 MINOR 2 MINOR 2 MINOR 4 MINOR 3 MINOR 4 MAJOR 3 INTER 1 INTER 2 MAJOR+ 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MAJOR 1 MINOR 5 MINOR 5 MINOR 4 MINOR 5 INTER 5 MAJOR 4 INTER 5 INTER 5 MAJOR 5 MAJOR 3 MAJOR 2 MAJOR 3 MINOR MINOR MINOR MINOR MINOR CMO 1 INTER INTER MAJOR+ MAJOR INTER MAJOR D/C D/C D/C D/C D/C D/C D/C 3 Anterior +/- posterior colporrhaphy and amputation of cervix uteri (including MAJOR 5 primary repair of enterocele) Posterior colporrhaphy Anterior +/- posterior colporrhaphy (incuding primary repair of enterocele) (including cystoscopy) INTER 5 MAJOR 5 2 2 1 MAJOR 2 P2340 Repair of enterocele (+/- posterior colporrhaphy) (as sole procedure) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 69 – © Bupa Insurance Limited 1999-2012 P2380 P2420 P2450 P2510 P2520 P2530 Anterior (+/- posterior) colporrhaphy with vaginal hysterectomy (including primary repair of enterocele) Sacrocolpopexy Sacrospinous fixation Repair of vesicovaginal fistula Repair of urethrovaginal fistula (including cystoscopy) Repair of rectovaginal fistula MAJOR+ 5 MAJOR+ 4 MAJOR 5 MAJOR 5 MAJOR 3 MAJOR+ 3 MAJOR+ 2 MAJOR 5 MAJOR 1 MAJOR 5 MAJOR 5 MAJOR 5 MAJOR+ MAJOR MAJOR MAJOR MAJOR MAJOR+ 3 4 3 3 2 VULVA / LABIA Code P0310 P0320 P0510 P0580 P0600 Description Excision of Bartholin gland Marsupialisation of Bartholin cyst Simple vulvectomy Radical vulvectomy (including block dissection of inguinal gland) Excision of lesion of vulva Surgeon's Category INTER 2 INTER 2 MAJOR 5 CMO 1 MINOR 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER 2 INTER D/C INTER 2 MAJOR 4 MAJOR+ 2 INTER 2 INTER MAJOR CMO 1 MINOR D/C 3 5 D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 70 – © Bupa Insurance Limited 1999-2012 15 Skin & Subcutaneous Tissue Notes 1. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: S0632 – Excision of lesion of skin or subcutaneous tissue - up to three, Head & Neck Lesser Procedure(s) which are included in the main procedure and should not be billed separately: S0820 – Curettage/cryotherapy of lesions of skin including cauterisation - four or more 2. For details of Bupa’s policy relating to local anaesthesia / IV sedation refer to Note 2 of the Essential Notes to the Schedule. LESIONS OF SKIN Code H5680 S0520 Description Excision of pressure sore excluding repair Microscopically controlled excision of lesion of skin or subcutaneous tissue (including Moh's chemosurgery) Surgeon's Category INTER 2 MAJOR+ 3 INTER 3 INTER 2 INTER 4 INTER 3 INTER 2 INTER 3 MINOR 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 INTER 1 MAJOR 5 INTER 3 INTER 3 INTER 3 INTER 3 INTER 3 INTER 3 INTER 5 INTER 5 MAJOR 3 INTER 2 MINOR 5 MINOR 5 MINOR 5 INTER 1 MINOR 5 MINOR 5 INTER 2 MINOR 5 INTER 2 MINOR 5 INTER 3 INTER 4 INTER 1 MAJOR+ INTER INTER INTER INTER INTER MAJOR MINOR MINOR INTER INTER MAJOR INTER MINOR MINOR MINOR MINOR MINOR MINOR INTER MINOR INTER MINOR MINOR INTER MINOR D/C O/P O/P D/C D/C O/P O/P O/P O/P O/P O/P O/P O/P O/P O/P O/P D/C O/P D/C D/C O/P S0602(ii) Primary excision of malignant lesion – Head & Neck S0603(ii) Primary excision of malignant lesion – Trunk & Limbs S0604 S0605 S0606 S0607 Secondary excision of malignant lesion – Head & Neck Secondary excision of malignant lesion – Trunk & Limbs Photodynamic therapy to malignant lesion of skin - up to three Photodynamic therapy to malignant lesion of skin - four or more S0632(ii) Excision of lesion of skin or subcutaneous tissue - up to three, Head & Neck S0633(ii) Excision of lesion of skin or subcutaneous tissue - up to three, Trunk & Limbs MINOR 2 S0642(ii) Excision of lesion of skin or subcutaneous tissue - four or more, Head & Neck INTER 1 S0643(ii) Excision of lesion of skin or subcutaneous tissue - four or more, Trunk & Limbs S0410 S0430 S0922 S0923 Wide excision of sweat glands - bilateral axillae Excision of sweat gland bearing skin Laser destruction of lesion(s) of skin – up to 25cm² in area Laser destruction of lesion(s) of skin – over 25cm² in area MINOR 5 INTER 1 MINOR 2 MINOR 5 INTER 1 MINOR 1 MINOR 2 MINOR 1 MINOR 1 MAJOR 2 MINOR 1 MINOR 2 MINOR 2 MINOR 3 £150 MINOR 4 S1110(ii) Curettage/cryotherapy of lesion of skin including cauterisation - up to three S0820(ii) Curettage/cryotherapy of lesions of skin including cauterisation - four or more S1420(ii) Shave biopsy of lesion of skin S1500(ii) Biopsy of skin or subcutaneous tissue S0608 S1510 S4480 Sentinel lymph node biopsy for melanoma Needle/tru-cut biopsy of muscle Removal of foreign body in deeper tissue S4720(ii)Drainage of lesion of skin including abscess S4740 S6400 Drainage of large subcutaneous abscess/haematoma Excision of nail bed (Zadeks) (including anaesthetic) S7010(ii) Wedge excision or avulsion of nail including chemical ablation of nail bed Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 71 – © Bupa Insurance Limited 1999-2012 REPAIR Code S4212 S4213 S4182 S4183 S4230 S4812 S4930 S5710 S5712 T7790 Description Debridement and primary suture of wound without involvement of deeper tissue (skin & subcutaneous fat only) - Head & Neck Debridement and primary suture of wound without involvement of deeper tissue (skin & subcutaneous fat only) - Trunk & Limbs Debridement and primary suture of wound with involvement of deeper tissue – Head & Neck Debridement and primary suture of wound with involvement of deeper tissue – Trunk & Limbs Secondary suture of skin Insertion of skin expander into tissue Removal of skin expander or valve Debridement of wound (and surgical toilet) - up to 25cm2 in area Debridement of wound (and surgical toilet) - over 25cm2 in area Excision of benign soft tissue tumour (e.g. glomus, giant cell) Surgeon's Category INTER 5 INTER 5 INTER 5 INTER 5 MINOR 2 INTER 5 INTER 5 MINOR 4 MINOR 4 MAJOR 1 MAJOR+ 5 MAJOR+ 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 INTER O/P MAJOR 2 MAJOR 2 MAJOR 2 INTER 1 INTER 5 INTER 5 INTER 1 INTER 1 MAJOR 2 MAJOR 5 MAJOR 5 INTER INTER INTER MINOR INTER INTER MINOR MINOR MAJOR MAJOR+ CMO 1 O/P D/C D/C O/P D/C D/C D/C 1 D/C 1 - W0960(i) Excision of benign tumour of bone with bone grafting W0950(i) Radical clearance of malignant tumour of soft tissue or bone (not otherwise specified) BURNS, SCARS & CONTRACTURES Code S5520 S5522 S5523 S5524 S5525 S5526 S5532 S5533 S5534 S5535 Description Burn wound/scar excision, head, neck, hands, feet & genitalia, up to 9cm2 Surgeon's Category INTER 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER INTER 4 MAJOR 4 INTER 4 INTER 4 MAJOR 4 MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 2 INTER MAJOR INTER INTER MAJOR MINOR MINOR MINOR MINOR 1 1 1 O/P D/C - Burn wound/scar excision, head, neck, hands, feet & genitalia, 9cm2 - 25cm2 INTER 5 Burn wound/scar excision, head, neck, hands, feet & genitalia, greater than 25cm2 Burn wound/scar excision, trunk & limbs (not more than 2% body surface area) MAJOR 2 INTER 5 Burn wound/scar excision, trunk & limbs (between 2% and 10% of body area) INTER 5 Burn wound/scar excision, trunk & limbs (between 10% and 25% of body area) Dressing of burn of skin or subcutaneous tissue – less than 2% Dressing of burn of skin or subcutaneous tissue - 2%-10% Dressing of burn of skin or subcutaneous tissue – 10%-25% Dressing of burn of skin or subcutaneous tissue – greater than 25% MAJOR 2 MINOR 4 MINOR 4 MINOR 4 MINOR 4 FLAPS Code S2500 S2502 S2503 S1700 S2002 S2000 S1740 S1750 Description Local flap - less than 9cm2 Local flap – 9cm2 or more (excluding graft/flap to secondary defect) Local flap – 9cm2 or more (including graft/flap to secondary defect) Distant flap - delay/division/inset Small island flap (less than 9cm2) Surgeon's Category MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 3 MAJOR+ 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 5 MAJOR D/C INTER 5 INTER 5 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 4 MAJOR+ 1 MAJOR MAJOR+ MAJOR INTER MAJOR+ MAJOR+ MAJOR+ D/C D/C 1 1 Large island skin flap (9cm2 or more) (e.g. radial forearm) including closure of MAJOR+ 2 secondary defect Large myocutaneous (muscular/cutaneous) flap (9cm2 or more) including closure of secondary defect Large muscle flap (9cm2 or more) including skin graft and closure of secondary defect CMO 1 MAJOR 3 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 72 – © Bupa Insurance Limited 1999-2012 S1900 S2220 T7602 T7603 T7604 T7620 W3180 S3100 S3102 Distant pedicle flap – elevation including transfer (including closure/grafting to secondary defect) Neurovascular island flap Microvascular free tissue transfer (when added to other codes) including closure of secondary defect Microvascular free tissue transfer (as sole procedure including closure of secondary defect) Vein/artery graft as part of microvascular free tissue transfer Free functioning muscle transfer (as sole procedure) including closure of secondary defect Free composite (i.e. including bone) vascularised grafts Re-exploration of free flap Thinning of skin graft flap MAJOR 3 MAJOR+ 2 CMO 2 CMO 2 MAJOR+ 5 CMO 2 CMO 2 CMO 2 MINOR 5 MAJOR+ 1 MAJOR+ 1 CMO 2 CMO 2 MAJOR+ 1 CMO 2 CMO 2 CMO 2 MINOR 5 CMO 1 MAJOR+ CMO 2 CMO 2 MAJOR CMO 3 CMO 3 MAJOR+ MINOR 1 1 - FREE SKIN GRAFTS Code S3500 S3530 S3532 S3622 S3623 S3624 S3625 Description Split autograft of skin, trunk and limbs - up to 25cm2 in area Split autograft of skin, trunk and limbs - over 25cm2 and up to 5% of body surface area Split autograft of skin, trunk and limbs – each additional 5% of body surface area Full thickness graft, trunk and limbs – up to 9cm2 in area Full thickness graft, trunk and limbs – each additional 25cm2 in area Full thickness graft, head, neck, hands & genitalia – up to 9cm2 in area Surgeon's Category INTER 3 MAJOR 4 MAJOR 4 INTER 4 INTER 4 INTER 4 Anaesthetist's Hospital Anticipated Category Category LOS INTER 5 INTER 1 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR MAJOR INTER MINOR MAJOR MINOR 2 D/C D/C D/C D/C Full thickness graft, head, neck, hands & genitalia – each additional 16cm2 in INTER 4 area Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 73 – © Bupa Insurance Limited 1999-2012 16 Bones, Joints & Connective Tissue/Tendon Muscle Notes 1. If a procedure is marked with an (i) Bupa’s policy on Intensive Therapy applies. (See note 7 in the Essential Notes to the Schedule and appendix A). 2. The surgeon’s benefit entitlement for complex orthopaedic surgery includes fees for pre-operative/peri-operative!post-operative management including Intensive Therapy up to 72 hours. 3. The anaesthetist’s benefit entitlement for complex orthopaedic surgery includes fees for pre-operative/peri-operative!post-operative management including Intensive Therapy/ventilation for up to 72 hours. 4. In circumstances where the Intensive Therapy exceeds 72 hours, further benefit may be considered on a case by case basis. 5. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: W8600 – Therapeutic arthroscopic operation on cavity of joint (not otherwise specified) (as sole procedure) Lesser Procedure(s) which are included in the main procedure and should not be billed separately: W8700 – Diagnostic arthroscopic examination of joint, with or without biopsy (not otherwise specified) (as sole procedure) 6. For details of Bupa’s policy relating to local anaesthesia / IV sedation / epidural analgesia refer to Note 2 of the Essential Notes to the Schedule. 7. Arthroscopic techniques will be classified at the same level as open techniques. 8. No additional benefit is available for the harvesting of the bone graft as it is considered to be an integral part of the overall procedure and is reflected in the classification of the main procedure. CONNECTIVE TISSUE / TENDON MUSCLE Code S1510 W6960 T5230 T5250 T5900 T6000 T6220 T6400 T6580 T6800 T6910 T6980 T7010 T7050 T7110 T7230 T7440 X2130 T7910 Description Needle/tru-cut biopsy of muscle Needle biopsy of synovium Excision plantar fibroma Endoscopic plantar fascia release Excision of ganglion Repeat excision of ganglion Excision of bursa Transfer of tendon (not otherwise specified) Tendon graft, as sole procedure (not otherwise specified) Secondary repair of tendon (including graft,transfer and/or prosthesis) (not otherwise specified) Tenolysis, of extensor (not otherwise specified) Tenolysis, of flexor tendon (not otherwise specified) Percutaneous tenotomy Lengthening of tendon(s) or open tenotomy Tenosynovectomy Release of constriction of sheath of tendon (e.g. trigger finger) Injection into cord for Dupuytrens Contracture including post injection finger extension Release of joined or fused digit(s) Open subacromial decompression and extensive greater than 2 cm tear rotator cuff repair with excision of distal clavicle Surgeon's Category MINOR 1 MINOR 1 INTER 1 MAJOR 3 MINOR 5 MINOR 5 INTER 1 INTER 3 INTER 5 MAJOR 3 INTER 4 MAJOR 1 MINOR 3 INTER 4 INTER 3 INTER 3 INTER 2 MAJOR 1 MAJOR+ 2 Anaesthetist's Hospital Anticipated Category Category LOS MINOR 5 MINOR O/P MINOR 5 INTER 5 MAJOR 3 INTER 4 INTER 4 INTER 3 INTER 4 INTER 4 INTER 5 INTER 4 INTER 4 MINOR 5 INTER 4 INTER 4 INTER 4 N/A INTER 5 MAJOR 4 MINOR INTER INTER INTER INTER INTER INTER INTER MAJOR INTER MAJOR MINOR INTER INTER INTER MINOR MAJOR MAJOR D/C D/C D/C D/C 1 D/C 1 D/C D/C D/C D/C O/P 1 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 74 – © Bupa Insurance Limited 1999-2012 T8002 T8003 T8100 W8100 A8460 A8470 Minor release of muscle for pain or contracture (involving small joint) Major release of muscle for pain or contracture (e.g. Quadriceps) (involving large joint) Open biopsy of muscle or soft tissue lesion Open excision of calcific deposit (e.g. shoulder, hip) Static single measurement of muscle compartment pressures (including reporting) Dynamic laboratory investigation involving measurement of muscle compartment pressures with manometer INTER 1 INTER 4 MINOR 5 MINOR 5 MINOR 1 MINOR 4 MAJOR 1 MAJOR 1 INTER 1 INTER 3 MAJOR 1 - INTER INTER MINOR MINOR MINOR INTER D/C 1 D/C D/C O/P O/P BONE (NON-SPECIFIC) Code W0640 W0700 W0850 T7790 Description Total excision of sesamoid bone Excision of ectopic bone Partial excision of bone (including exostoses) Excision of benign soft tissue tumour (e.g. glomus, giant cell) Surgeon's Category INTER 1 MINOR 5 INTER 1 MAJOR 1 MAJOR+ 5 MAJOR+ 5 MAJOR 4 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C INTER 3 INTER 3 MAJOR 2 MAJOR 5 MAJOR 5 MAJOR 3 INTER 3 MAJOR 3 MAJOR 3 MINOR 5 INTER 1 INTER 3 INTER 2 INTER 3 MINOR INTER MAJOR CMO 1 MAJOR+ MAJOR INTER INTER INTER MINOR MINOR INTER MINOR MINOR MINOR D/C D/C D/C 1 2 1 O/P O/P D/C D/C - W0950(i) Radical clearance of malignant tumour of soft tissue or bone (not otherwise specified) W0960(i) Excision of benign tumour of bone with bone grafting W1080 W1800 W2700 W2702 W3510 Osteotomy of long bone, with/without fixation, including graft Drainage/debridement of bone(s), including sequestrectomy for osteomyelitis INTER 5 Fixation of epiphysis, including epiphysiodesis, correction of angular Epiphysiolysis (eg Langenskiold procedure) Introduction of therapeutic substance into bone INTER 4 INTER 4 MINOR 5 MINOR 3 INTER 1 MINOR 5 MINOR 5 MINOR 1 W3530(ii) Removal of percutaneous wire W3620 W3622 W3650 AA609 Open bone biopsy Needle biopsy of bone Diagnostic Aspiration and/or trephine biopsy of bone marrow Peripheral bone density measurement performed by physician FRACTURES - LONG BONES Code W1380 W1390 W1920 W2100 Description Arthroscopic femoro-acetabular surgery for hip impingement syndrome Open femoro-acetabular surgery for hip impingement syndrome Primary open reduction of long bone with fixation Surgeon's Category CMO 1 CMO 1 MAJOR 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 3 MAJOR+ MAJOR+ 3 MAJOR 4 MAJOR 4 MAJOR+ MAJOR MAJOR 1 - Primary open reduction of intra-articular fracture of long bone with internal MAJOR 5 fixation, eg proximal humerus or proximal tibia (with or without arthroscopic assistance) Secondary open reduction of fractured long bone-and intramedullary fixation MAJOR+ 1 or internal fixation for non-union/mal union - including intra-articular (including bone graft) Locked intramedullary nailing of fractured long bone Closed reduction of fracture of long bone with external fixation (excluding fixation by cast or percutaneous K-wires) Closed reduction of fracture of long bone, including cast or percutaneous K-wires MAJOR+ 5 MAJOR 2 MAJOR 2 W2310 MAJOR 3 MAJOR+ 1 W2380 W2500 W2502 MAJOR 5 MAJOR 3 MAJOR 3 MAJOR+ MAJOR INTER 3 1 1 FRACTURES - SMALL BONES Code W1940 Surgeon's Description Category Primary open reduction of small bone with fixation, including intra-articular MAJOR 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 1 INTER D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 75 – © Bupa Insurance Limited 1999-2012 W2300 W2580 W2582 Secondary open reduction of fracture of small bone, including intra-articular MAJOR 5 fracture for delayed/non-union (including bone graft) Closed reduction of fracture of small bone with external fixator Closed reduction of fracture of small bone, including cast or percutaneous K-wires INTER 2 INTER 2 INTER 5 INTER 5 INTER 5 MAJOR INTER INTER 1 D/C D/C FRACTURES - PELVIS / ACETABULUM & FEMUR Code W1910 W1320 Description Primary reduction of fracture of neck of femur and internal fixation Osteotomy of proximal Femur Surgeon's Category MAJOR+ 1 MAJOR+ 4 CMO 2 CMO 2 CMO 1 CMO 4 CMO 2 CMO 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR+ 9 MAJOR+ 1 MAJOR+ 1 MAJOR+ 4 MAJOR+ 4 CMO 1 MAJOR+ 2 MAJOR+ 4 MAJOR 4 MAJOR+ MAJOR CMO 2 CMO 2 CMO 2 CMO 2 CMO 2 MAJOR+ 3 6 6 6 6 6 7 W1640(i) Simple pelvic osteotomy and fixation, e.g. Salter or Chiari osteotomies W1642(i) Open reduction/internal fixation of posterior rim of acetabulum W1643(i) Open reduction/internal fixation of either posterior wall/column of acetabulum or anterior column of acetabulum W1644(i) Open reduction/internal fixation of both columns of acetabulum W1645(i) Open reduction/internal fixation plus bone graft symphysis pubis W1646(i) Open reduction/internal fixation of sacro-iliac joint W1647 Open reduction/internal fixation of fractures of the greater trochanter, MAJOR+ 1 including fixation of non-union of greater trochanter after trochanteric osteotomy FRACTURES - JOINTS Code W6630 W6522 W6523 W6702 W6703 Description Primary closed reduction of fracture or dislocation of joint, with or without fixation including cast application Primary open reduction of dislocation of small joint Primary open reduction of dislocation of large joint Secondary open reduction of dislocation of small joint Secondary open reduction of dislocation of large joint Surgeon's Category INTER 3 MAJOR 3 MAJOR 4 INTER 2 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 3 MAJOR 3 MAJOR 3 INTER 3 INTER 3 INTER INTER INTER INTER INTER 1 1 3 1 1 FRACTURES - FIXATION DEVICES Code T7981 W2830 W3020 W3040 W3050 W3032 Description Extensive (greater than 2cm tear) repair of large muscle (excluding rotator cuff) Removal of internal fixation from bone / joint, excluding K-wires Adjustments to IIizarov frame/rings Application of IIizarov frame for secondary non-union / mal-union including osteotomy Adjustments to pin sites secondary for non-union / mal-union Removal of fixator/frame/pins/wires and change of plaster Surgeon's Category MAJOR 2 INTER 5 MAJOR 3 CMO 4 INTER 4 MINOR 5 MINOR 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 INTER 4 INTER 5 MAJOR+ 5 INTER 1 INTER 1 MAJOR INTER MAJOR CMO 3 MINOR INTER MINOR D/C D/C O/P O/P W3530(ii) Removal of percutaneous wire FRACTURES - OTHER (E.G. POP) Code X2280 X4822 Description Manipulation of hip and casting Change of cast under general anaesthetic Surgeon's Category MINOR 5 MINOR 3 MINOR 1 MAJOR 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 3 MINOR D/C MINOR 5 MINOR 5 MAJOR 2 MINOR 5 MINOR MINOR MAJOR MINOR D/C O/P 1 D/C X4810(ii) Change of cast without general anaesthetic T5540 S5730 Fasciotomy of limb Surgical toilet and debridement of deep wound, including traumatic or post- MINOR 4 operative aetiology Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 76 – © Bupa Insurance Limited 1999-2012 W3100 Bone graft (except where part of another procedure) MAJOR 1 MAJOR 1 MAJOR 1 NERVES Code A6030 A6080 A6400 A6402 A6300 A6302 A6110 A6180 A6510 A6580 A6710 A6711 A6600 A6700 A6810 A6900 A7010 A7310 A7340 Description Transection of peripheral nerve for neuroma Neurectomy (major nerve) Repair of peripheral nerve Repair of major nerve Graft to peripheral nerve Graft to major nerve Excision of lesion of peripheral nerve (e.g. neurilemoma) Excision of lesion of major nerve Carpal tunnel release, including endoscopic Carpal tunnel release, including endoscopic-bilateral Cubital tunnel release including endoscopic (without transposition) Surgeon's Category INTER 2 INTER 5 INTER 2 INTER 3 MAJOR+ 2 MAJOR+ 2 INTER 3 INTER 5 INTER 2 INTER 4 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C INTER 5 INTER 5 INTER 5 MAJOR 4 MAJOR 4 INTER 4 INTER 5 INTER 4 MAJOR 4 INTER 4 MAJOR 4 INTER 4 INTER 4 INTER 5 INTER 5 INTER 1 INTER 2 CMO 2 INTER INTER MAJOR MAJOR+ MAJOR+ INTER INTER INTER INTER INTER INTER INTER INTER INTER MAJOR MAJOR INTER CMO 2 D/C D/C D/C D/C 1 D/C D/C D/C D/C D/C D/C D/C D/C 1 D/C 1 Cubital tunnel release including endoscopic-bilateral (without transposition) INTER 4 Release of entrapment of deeply placed peripheral nerve Release of entrapment of peripheral nerve Neurolysis and transposition of peripheral nerve (includes ulnar at elbow) Revision of release of peripheral nerve Implantation of neurostimulator to peripheral nerve Biopsy of peripheral nerve Exploration and grafting of brachial plexus INTER 2 INTER 2 INTER 3 MAJOR 1 MAJOR 4 INTER 2 CMO 2 JOINTS, INCL. REPLACEMENT / RECONSTRUCTION (NOT LISTED ELSEWHERE) Code W6912 W6913 W7400 W7800 W8150 Description Total synovectomy of small joint Total synovectomy of large joint Reconstruction of ligament Release of contracture of joint Arthrotomy of large joint, including removal of loose body from joint Surgeon's Category MAJOR 1 MAJOR 2 MAJOR 1 INTER 4 INTER 4 INTER 1 £50 MINOR 3 £50 MINOR 1 MINOR 1 MINOR 2 MINOR 3 MINOR 2 MINOR 3 MINOR 4 MAJOR 1 MAJOR 2 MAJOR 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 MAJOR D/C MAJOR 2 INTER 5 INTER 3 INTER 3 MINOR 5 MINOR 1 MINOR 5 MINOR 1 MINOR 5 MINOR 5 MINOR 5 INTER 3 MINOR 5 INTER 3 INTER 3 MAJOR 2 MAJOR 2 MAJOR+ 1 MAJOR MAJOR INTER INTER MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR MINOR MAJOR MAJOR MAJOR D/C 1 D/C O/P O/P O/P D/C O/P D/C 6 W8180 Arthrotomy of small joint( including removal of loose body from joint) AA663(ii) Injection of viscosupplementation into joint (with or without x-ray control) (BUPA code) W9030 Injection(s) into joint(s) under X-ray control W9040(ii) Injection(s) into joint(s) without X-ray control W9282(ii Joint fluid examination (e.g. polarising microscopy) performed by consultant including aspiration of fluid W9240 Examination/ manipulation of joint under anaesthetic +/- injection (as sole procedure) W9012(ii) Therapeutic local anaesthetic/aspiration- large joint - single W9013(ii) Therapeutic local anaesthetic/aspiration- large joint - more than 1 joint W9014(ii) Therapeutic local anaesthetic/aspiration- small joint - single W9015(ii) Therapeutic local anaesthetic/aspiration- small joint - more than 1 joint W9016(ii) Therapeutic local anaesthetic/aspiration of joint under imaging control W5722 W5723 W5540 Excision reconstruction of small joint Excision reconstruction of large joint Debridement of infected total joint replacement Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 77 – © Bupa Insurance Limited 1999-2012 W8300 W8380 W8600 W8680 W8700 W8780 W8782 W9020 W3122 W3123 Therapeutic arthroscopic operation on articular cartilage (other than W8200 INTER 4 and W8230) (as sole procedure) Therapeutic arthroscopic operation on articular cartilage (other than W8200 MAJOR 3 and W8230) - bilateral (as sole procedure) Therapeutic arthroscopic operation on cavity of joint (not otherwise specified) (as sole procedure) Therapeutic arthroscopic operation on cavity of joint - bilateral (not otherwise specified) (as sole procedure) Diagnostic arthroscopic examination of joint, with or without biopsy (not otherwise specified) (as sole procedure) Diagnostic arthroscopic examination of joint, with or without biopsy bilateral (not otherwise specified) (as sole procedure) Flexible arthroscopy, +/- biopsy (as sole procedure) Dynamic arthrogram of joint Harvesting for autologous chondrocyte transplantation into knee including arthroscopy INTER 3 MAJOR 3 INTER 2 INTER 5 INTER 1 MINOR 1 INTER 4 MAJOR 4 MAJOR+ 3 MAJOR 4 MAJOR+ 3 MAJOR 3 MAJOR 4 INTER 2 MINOR 5 MAJOR 4 MAJOR+ 3 INTER MAJOR MAJOR CMO 1 INTER INTER INTER INTER MAJOR MAJOR+ D/C D/C D/C D/C D/C O/P - Implantation of autologous chondrocyte transplantation into knee including CMO 2 knee surgery, debridement and periosteal flap or membrane cover HAND - INCISION / EXCISION Code T5202 T5203 T5210 T5222 T5223 T5410 W0230 W0282 W0283 W0284 W0285 W4441 W0390 Description Dupuytren's fasciectomy palm only Dupuytren's fasciectomy single digit with proximal interphalangeal joint Surgeon's Category INTER 4 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C INTER 4 MAJOR 4 MAJOR 5 MAJOR 5 INTER 1 MAJOR 5 MAJOR 5 MAJOR 5 MAJOR 5 MAJOR 5 MAJOR 3 MAJOR 2 INTER MAJOR MAJOR MAJOR MINOR MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR INTER MAJOR D/C D/C D/C D/C D/C D/C 1 1 1 1 - Dupuytren's fasciectomy multiple digits with proximal interphalangeal joints MAJOR 5 Dupuytren's dermofasciectomy and graft, or for recurrent disease - single digit MAJOR+ 1 Dupuytren's dermofasciectomy and graft, or for recurrent disease - multiple MAJOR+ 3 digits Dupuytren's subcutaneous fasciotomy Soft tissue procedures on joints of hand including synovectomy Total excision of trapezium Total excision of trapezium with spacer Total excision of trapezium and ligament reconstruction Trapezio-metacarpal joint surface replacement Harvesting for autologous chondrocyte transplantation into ankle MTP1 Joint (metatarsophalangeal joint inter) resurfacing arthroplasty with implant (eg Salu-Cartilage) INTER 1 MAJOR+ 2 MAJOR+2 MAJOR+ 2 MAJOR+ 3 MAJOR+ 3 MAJOR 3 MAJOR 2 HAND - REPAIR / RECONSTRUCTION Code T6710 T6820 T6914 T6750 T6752 W1641 Description Primary repair of extensor of hand Secondary repair or reconstruction of extensor of hand/forearm Tenolysis of extensor tendon of hand Primary repair of flexor of hand (excluding Zone II) Primary repair of flexor of hand in Zone II Osteotomy of small bone of hand including fixation and bone grafting Surgeon's Category INTER 5 MAJOR 1 INTER 4 MAJOR 2 MAJOR 2 INTER 4 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 MAJOR INTER INTER MAJOR INTER D/C 1 - Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 78 – © Bupa Insurance Limited 1999-2012 T6830 T6832 T6982 T6402 T6410 T6580 T6910 W0120 W0512 W0513 W0514 W5310 W8830 W8602 W7482 W7483 W7484 W7485 W7486 W6230 W0110 Secondary repair or 1st stage reconstruction of flexor of hand Second stage reconstruction of flexor of hand Tenolysis of flexor tendon of hand Tendon transfer of hand - single Tendon transfer of hand - multiple (e.g. for radial nerve injury) Tendon graft, as sole procedure (not otherwise specified) Tenolysis, of extensor (not otherwise specified) Pollicisation of finger for thumb reconstruction Interpositional silastic arthroplasty of MCP/PIP joint- single Prosthetic interpositional silastic arthroplasty of MCP/PIP joints - multiple Prosthetic surface arthroplasty of interphalangeal/ metacarpo-phalangeal joint - single joint (both cemented and uncemented) Total prosthetic replacement of wrist joint Diagnostic arthroscopic examination of wrist joint, with or without biopsy (as sole procedure) Therapeutic arthroscopy of wrist joint (as sole procedure) Scaphoid lunate ligament reconstruction Triquetrolunate ligament reconstruction Multiple ligament reconstruction Small joint (e.g. interphalangeal/ metacarpo-phalangeal joint) ligament reconstruction Carpo-metacarpal joint ligament reconstruction Vascular implantation to carpal bone Toe to hand transfer (as sole procedure) including closure of secondary defect MAJOR 3 MAJOR 3 MAJOR 1 INTER 3 MAJOR 5 INTER 5 INTER 4 CMO 2 MAJOR 3 MAJOR 5 MAJOR 3 MAJOR+ 3 INTER 2 INTER 5 MAJOR+ 3 MAJOR+ 3 MAJOR+ 4 MAJOR 4 MAJOR 4 MAJOR+ 3 CMO 2 MAJOR 1 MAJOR 1 INTER 4 INTER 4 MAJOR 3 INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 MAJOR 5 INTER 3 MAJOR 3 MAJOR 1 MAJOR 1 MAJOR 2 MAJOR 1 MAJOR 2 MAJOR+ 3 INTER 4 MAJOR MAJOR INTER MAJOR MAJOR INTER INTER CMO 2 MAJOR MAJOR MAJOR MAJOR+ INTER INTER MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR+ CMO 3 D/C D/C 1 D/C 1 D/C 1 1 1 2 D/C 1 1 2 - HAND - FIXATION / ARTHRODESIS Code W3200 W3202 W3203 W6202 W6200 W5930 Description Open reduction and internal fixation of cancellous bone graft scaphoid Open reduction and internal fixation wedge reconstruction bone graft scaphoid nonunion Early open reduction and internal fixation of scaphoid fracture, i.e. within 6 weeks of fracture Partial fusion of wrist Total fusion of all joints of wrist with or without graft & with or without internal fixation Fusion of digit joint(s) of hand with or without graft & with or without internal fixation Surgeon's Category MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 4 MAJOR+ 1 INTER 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 MAJOR 1 MAJOR 2 MAJOR 2 MAJOR 5 MAJOR 5 MAJOR 1 MAJOR MAJOR INTER MAJOR INTER 1 1 1 1 D/C HAND - OTHER (E.G. AMPUTATION) Code X0710 X0720 X0750 X0820 X0822 X0880 Description Forequarter amputation Disarticulation of shoulder Amputation of arm Partial amputation of digit Amputation of whole ray Amputation through mid-carpal/transmetacarpal Surgeon's Category CMO 2 MAJOR+ 1 INTER 5 INTER 3 INTER 3 INTER 3 CMO 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 3 CMO 2 MAJOR 4 MAJOR 3 INTER 5 INTER 5 INTER 4 MAJOR+ 4 MAJOR+ INTER INTER MAJOR INTER CMO 2 8 D/C 1 - X0910(i) Hindquarter amputation Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 79 – © Bupa Insurance Limited 1999-2012 SHOULDER - INCISION / EXCISION Code W0610 W0890 Description Total excision of cervical rib Excision distal clavicle, as sole procedure Surgeon's Category MAJOR 5 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR 2 MAJOR 2 MAJOR 1 SHOULDER - REPAIR / RECONSTRUCTION Code A7340 W4900 W4930 W4902 W5000 W5030 W4920 W5050 W5060 W5600 W5630 W7712 W7713 W7715 W7760 W7780 W7810 W7872 W8110 T7480 T7910 T7915 T7982 T7983 T7990 T8052 W8192 W8193 W8194 W8603 W8820 T6450 Description Exploration and grafting of brachial plexus Shoulder hemiarthroplasty, as sole procedure Revisional shoulder hemiarthroplasty Shoulder hemiarthroplasty with reconstruction for fracture Primary total shoulder replacement Revision total shoulder replacement Conversion of hemiarthroplasty to total shoulder replacement Reverse polarity arthroplasty of shoulder Resurfacing arthroplasty of shoulder Primary repair of rupture of acromioclavicular or sternoclavicular joint (including internal fixation) Secondary repair of acromioclavicular or sternoclavicular joint +/- internal fixation Surgeon's Category CMO 2 MAJOR+ 1 MAJOR+ 4 MAJOR+ 4 CMO 1 CMO 3 CMO 1 CMO 2 MAJOR+ 5 MAJOR+ 2 MAJOR+ 3 Anaesthetist's Hospital Anticipated Category Category LOS CMO 2 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR+ 1 MAJOR+ 5 MAJOR 3 MAJOR+ 3 MAJOR+ 1 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR+ 2 MAJOR 3 MAJOR 4 MAJOR 3 INTER 3 MAJOR 4 MAJOR 4 MAJOR+ 2 MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 5 MAJOR 5 MAJOR+ 2 MAJOR 3 INTER 3 INTER 4 CMO 2 MAJOR+ MAJOR+ MAJOR+ MAJOR+ CMO 2 CMO 1 MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR MAJOR MAJOR+ MAJOR MAJOR+ MAJOR MAJOR MAJOR INTER MAJOR MAJOR+ INTER INTER MAJOR INTER MAJOR MAJOR MAJOR MAJOR INTER MAJOR 1 3 4 4 4 5 6 1 1 1 1 1 1 D/C 1 1 1 1 1 1 1 D/C D/C D/C Stabilisation of unidirectional instability of shoulder joint, including anterior, MAJOR 4 posterior and arthroscopic Stabilisation of multi-directional instability of shoulder joint Coracoid bone block transfer for recurrent instability of shoulder Labral repair (shoulder stabilisation) Revision stabilisation of shoulder joint Open arthrolysis of shoulder contracture Arthroscopic arthrolysis of shoulder contracture Arthroscopic excision of calcific deposits from shoulder Extracorporeal shockwave lithotripsy of calcific tendonitis of the shoulder Open subacromial decompression and extensive greater than 2 cm tear rotator cuff repair with excision of distal clavicle Arthroscopic rotator cuff repair greater than 2cm (as sole procedure) Arthroscopic sub-acromial decompression and limited, less than 2cm tear rotator cuff repair (including arthroscopic procedures in glenohumeral joint Open subacromial decompression and limited, less than 2cm tear rotator cuff repair Revision rotator cuff repair Extracorporeal shockwave lithotripsy of lateral epicondylitis Open sub-acromial decompression, as sole procedure Arthroscopic sub-acromial decompression as sole procedure Arthroscopic sub-acromial decompression and excision of distal clavicle (including arthroscopic procedures in glenohumeral joint) Therapeutic arthroscopy of shoulder (as sole procedure) MAJOR 4 MAJOR+ 5 MAJOR 4 MAJOR+ 2 MAJOR 4 MAJOR 5 MAJOR 3 MINOR 2 MAJOR+ 2 MAJOR+ 3 MAJOR 4 MAJOR 3 MAJOR+ 3 MINOR 2 MAJOR 2 MAJOR 3 MAJOR 4 INTER 3 Diagnostic arthroscopic examination of shoulder joint, with or without biopsy INTER 2 (as sole procedure) Tenodesis of biceps tendon (as sole procedure) INTER 3 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 80 – © Bupa Insurance Limited 1999-2012 SHOULDER - FIXATION / ARTHRODESIS Code W6012 W6030 W2810 W4940 Description Primary arthrodesis of joint with or without graft & with or without internal fixation - shoulder Revision or conversion to arthrodesis of shoulder Plating and bone grafting for non-union of clavicle Scapulo-thoracic fusion Surgeon's Category MAJOR+ 3 MAJOR+ 5 MAJOR 4 MAJOR+ 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR 2 MAJOR 5 MAJOR 3 MAJOR 4 MAJOR+ MAJOR MAJOR+ 5 1 - SHOULDER - OTHER Code W9111 W9112 Surgeon's Description Category Manipulation of joint (including intra-articular injection) for Frozen Shoulder INTER 1 (as sole procedure) - bilateral Manipulation of joint (including intra-articular injection) for Frozen Shoulder MINOR 3 (as sole procedure) Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 INTER D/C INTER 3 MINOR D/C ELBOW - INCISION / EXCISION Code W5550 Description Excision of radial head (as sole procedure) Surgeon's Category MAJOR+ 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR 1 ELBOW - REPAIR / RECONSTRUCTION Code W5510 W5520 T7230 T8050 W5560 W5512 T6782 W7850 W5502 W5040 W8880 W7860 Description Total prosthetic replacement of elbow Revisional prosthetic replacement of elbow Release of constriction of sheath of tendon (e.g. trigger finger) Surgeon's Category CMO 1 CMO 3 INTER 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 5 MAJOR+ 3 CMO 1 INTER 4 MAJOR 1 MAJOR+ 1 MAJOR+ 5 INTER 4 INTER 3 MAJOR 5 CMO 4 INTER 3 MAJOR 4 CMO 2 INTER INTER MAJOR MAJOR+ MAJOR MAJOR MAJOR+ CMO 4 INTER MAJOR 4 D/C D/C 4 1 2 - Surgical release of humeral epicondylitis (lateral or medial) (e.g. Tennis Elbow) INTER 4 OK (Outerbridge and Kashiwagi) procedure Prosthetic replacement of radial head Repair of distal biceps tendon Open arthrolysis of elbow Interposition arthroplasty of elbow Replacement of elbow and shoulder (single operation) Arthroscopy of elbow (as sole procedure) Arthroscopic arthrolysis of elbow (as sole procedure) MAJOR 3 CMO 1 INTER 5 MAJOR 2 MAJOR+ 1 CMO 4 INTER 2 MAJOR 3 HIP, LEG AND PELVIS - INCISION / EXCISION Code W0702 Description Excision of ectopic bone around a total hip replacement Surgeon's Category MINOR 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER 3 INTER D/C HIP, LEG AND PELVIS - REPAIR, RECONSTRUCTION & REPLACEMENT Code W1911 W3712 W3713 W3714 Description Core decompression of hip Primary total hip replacement +/- cement Complex primary total hip replacement requiring bone grafting or femoral osteotomy Surgeon's Category MAJOR+ 1 MAJOR+ 5 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR+ 3 MAJOR+ 3 MAJOR+ 3 MAJOR+ MAJOR+ MAJOR+ MAJOR+ 5 5 6 Total hip replacement, with or without cement, after excision arthroplasty or CMO 1 arthrodesis, including conversion of hemiarthroplasty or revision of other previous hip surgery which involved internal fixation Metal on metal hip resurfacing arthroplasty CMO 1 W3715 MAJOR+ 3 MAJOR+ 5 - W3717 Minimally invasive hip replacement (one incision) CMO 1 MAJOR+ 3 MAJOR+ Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 81 – © Bupa Insurance Limited 1999-2012 W3718 W3719 W3732 W3733 W3734 W3942 W3943 W3944 W3780 W4600 W1700 T7930 Minimally invasive hip resurfacing Metal on Metal Hip Resurfacing Arthroplasty (Bilateral) Revision of uncemented or cemented total hip replacement without adjunctive procedures CMO 2 CMO 4 CMO 2 MAJOR+ 3 CMO 1 CMO 2 CMO 2 CMO 2 MAJOR+ 4 CMO 2 CMO 2 CMO 1 MAJOR 5 CMO 3 MAJOR 2 MAJOR+ 1 INTER 3 MAJOR+ 2 MAJOR 5 MAJOR+ 1 MAJOR+ CMO 4 CMO 2 CMO 2 CMO 2 MAJOR+ CMO 1 CMO 2 CMO 3 MAJOR MAJOR+ MAJOR MAJOR+ INTER MAJOR INTER MAJOR+ 1 7 7 7 7 7 8 9 1 1 1 Revision of total hip replacement (including insertion of reconstruction rings, CMO 3 plates, screws, etc., and/or impaction bone grafting to acetabulum and/or femur) Second, third or further revision total hip replacement or proximal femoral replacement (excluding acetabular liner and head changes) Removal of total hip replacement and creating a pseudarthrosis Removal of total hip replacement and complete clearance of cement Acetabular liner and head changes Total prosthetic replacement of the hip, +/- cement, bilateral Prosthetic replacement of head of femur Shelf augmentation of acetabulum, e.g. Wainwright or Trillat Repair of abductor mechanism of hip CMO 3 MAJOR+ 5 CMO 4 CMO 4 CMO 3 MAJOR 5 MAJOR+ 3 INTER 1 CMO 1 INTER 3 MAJOR 4 W1648(i) Osteotomy/transfer of greater trochanter as sole procedure W6600 W6540 W8800 W8620 Closed reduction of dislocated hip prosthesis Open reduction of dislocated hip prosthesis Diagnostic arthroscopic examination of hip joint including wash-out, with or MAJOR 3 without biopsy (as sole procedure) Therapeutic arthroscopic examination of hip joint, with or without biopsy MAJOR+ 4 HIP, LEG AND PELVIS - FIXATION / ARTHRODESIS Code W6013 W1320 Description Primary arthrodesis of hip joint with or without graft & with or without internal fixation - hip Osteotomy of proximal Femur Surgeon's Category MAJOR+ 3 MAJOR+ 4 CMO 2 CMO 3 MAJOR+ 1 MAJOR+ 4 MAJOR+ 1 MAJOR+ 5 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR 7 MAJOR+ 1 MAJOR+ 1 CMO 2 MAJOR 4 MAJOR+ 3 MAJOR 4 MAJOR 3 MAJOR 3 MAJOR+ MAJOR CMO 2 MAJOR MAJOR+ MAJOR+ CMO 2 CMO 4 3 5 9 - W1640(i) Simple pelvic osteotomy and fixation, e.g. Salter or Chiari osteotomies W1649(i) Complex pelvic osteotomies and fixation, e.g. triple osteotomy, periacetabular osteotomy W1912 W1913 W3945 W4542 W4543 Pinning of head of femur - open or percutaneous (e.g. slipped femoral epiphysis, undisplaced neck fracture) Pinning for bilateral slipped upper femoral epiphysis Open reduction and internal fixation for periprosthetic fracture around hip Open reduction, internal fixation and revision of femoral component for periprosthetic fracture Open reduction, internal fixation and complete revision for peri-prosthetic fracture HIP, LEG AND PELVIS - OTHER Code X0930 X2280 T6213 T6290 W9018 X2200 Description Amputation of leg/foot (including Symes Lisfranc & Chopart) Manipulation of hip and casting Soft tissue operations in the region of the greater trochanter (trochanteric bursitis, snapping hip) Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome Percutaneous biopsy/ arthrography/ aspiration in assessment of total hip replacement Surgeon's Category MAJOR 4 MINOR 5 INTER 1 MINOR 4 MINOR 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MAJOR 4 INTER 3 INTER 3 MINOR 4 MINOR 5 MINOR MAJOR MINOR MINOR D/C 1 O/P - Closed reduction and Frog POP for congenital dislocation of hip (including MAJOR+ 2 MAJOR+ 2 MAJOR dynamic arthrogram, traction and soft tissue release) Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 82 – © Bupa Insurance Limited 1999-2012 X2260 X2262 Open reduction and Frog POP for congenital dislocation of hip (including traction and innominate/femoral ostetotomy) Complex open reduction for congenital dislocation of hip (i.e. pelvic & femoral or Pemberton osteotomy or revision of open reduction) CMO 2 CMO 3 CMO 1 CMO 3 CMO 1 CMO 2 - KNEE - INCISION / EXCISION Code W1660 Description Tibial osteotomy Surgeon's Category MAJOR 4 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 3 MAJOR 3 KNEE - REPAIR / RECONSTRUCTION Code W3090 W4210 W4212 W5200 W4280 W4230 W4200 W4240 W4242 W7580 W7582 W0632 W7583 W8700 W8520 W8200 W8280 W8500 W8580 W8230 W7492 W0630 W8400 W7420 W7490 W7410 W7470 W7480 W3110 Description Core decompression of knee Total prosthetic replacement of knee joint, with or without cement, +/Minimally invasive knee replacement Unicompartmental knee replacement Total prosthetic replacement of knee joint - bilateral Revision of total replacement of knee joint Complex primary total knee replacement (i.e. including bone graft, augmentation or osteotomy) 2 stage revision of total knee replacement for infection - first stage 2 stage revision of total knee replacement for infection - second stage Open surgical stabilisation of patella, including application of cast (adult) Open surgical stabilisation of patella, including application of cast (child) Prosthetic patello-femoral replacement (as sole procedure) Repair of patellar/quadricep tendon Diagnostic arthroscopic examination of joint, with or without biopsy (not otherwise specified) (as sole procedure) Surgeon's Category MAJOR+ 1 CMO 1 CMO 2 MAJOR+ 5 CMO 3 CMO 3 CMO 2 CMO 2 CMO 4 MAJOR+ 3 MAJOR+ 3 MAJOR+ 5 MAJOR 1 INTER 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR+ 3 MAJOR+ 3 MAJOR+ 1 CMO 1 CMO 1 MAJOR+ 3 CMO 1 CMO 1 MAJOR+ 1 MAJOR+ 1 MAJOR+ 1 MAJOR 2 MAJOR 3 MAJOR 4 MAJOR 4 MAJOR+ 3 MAJOR 4 MAJOR+ 3 MAJOR 4 MAJOR 1 INTER 5 MAJOR 1 MAJOR+ 1 MAJOR 1 MAJOR+ 3 MAJOR+ 3 MAJOR+ 1 MAJOR+ 2 MAJOR+ MAJOR+ MAJOR+ MAJOR+ CMO 3 CMO 2 CMO 1 MAJOR+ MAJOR+ MAJOR+ MAJOR+ MAJOR MAJOR INTER MINOR MAJOR CMO 1 MAJOR CMO 1 MAJOR INTER MAJOR MAJOR MAJOR+ MAJOR CMO 1 MAJOR+ MAJOR+ MAJOR+ 5 1 2 7 6 5 7 7 1 1 4 1 D/C D/C D/C D/C D/C D/C D/C D/C 2 1 1 1 1 2 Arthroscopy of knee (including examination under anaesthetic, washout and INTER 2 biopsy) (as sole procedure) Arthroscopic meniscectomy (including debridement) Arthroscopic meniscectomy (including debridement) - bilateral Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or microfracture) Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or microfracture) - bilateral Arthroscopic meniscal repair Arthroscopic lateral release Patellectomy Repair of knee ligaments (open or arthroscopic) Autograft anterior cruciate ligament reconstruction Reconstruction of posterior lateral corner of knee Multiple ligament reconstruction of knee including posterior cruciate ligament Revision of anterior cruciate ligament reconstruction Posterior cruciate ligament reconstruction (including arthroscopic) Osteochondral grafting as single stage procedure INTER 3 MAJOR 3 INTER 4 MAJOR 5 INTER 4 MAJOR 1 MAJOR 1 MAJOR 3 MAJOR+ 5 MAJOR 1 CMO 2 CMO 1 MAJOR+ 4 CMO 1 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 83 – © Bupa Insurance Limited 1999-2012 KNEE - FIXATION / ARTHRODESIS Code W6014 Description Primary arthrodesis of knee joint with or without graft & with or without internal fixation Surgeon's Category MAJOR+ 3 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 5 MAJOR 7 FOOT - ANKLE Code T6720 T6722 T6723 T6780 T6810 T6822 T7250 W8840 W8630 W8640 W4410 W4420 W4430 W6019 T6770 W7530 W7430 W6015 W6016 W6017 W6018 Description Tendo achilles lengthening percutaneous Tendo achilles lengthening primary open Tendo achilles lengthening repeat procedure Primary repair of Achilles tendon Secondary repair of Achilles tendon Secondary repair of Achilles tendon with tendon or fascial graft Extracorporeal shockwave therapy for achilles tendonitis Diagnostic arthroscopic examination of ankle, including anterior synovectomy to gain vision (as sole procedure) Therapeutic arthroscopy of ankle with either soft tissue procedures or bony +/ or joint surface procedures (as sole procedure) Complex therapeutic arthroscopy of ankle, with multiple bony, joint surface and soft tissue procedures Total prosthetic replacement of ankle joint Complex total replacement of ankle (i.e. including custom prosthesis, wedges, internal fixation of fractures) Revision of total prosthetic replacement of ankle joint Ankle syndesmosis reconstruction Peroneal sling/groove reconstruction & replacement of dislocated peroneal tendons Repair of lateral collateral ligament complex Reconstruction of lateral collateral ligament complex Ankle arthrodesis - open Ankle arthrodesis with autogenous graft Ankle arthrodesis with internal fixation (arthroscopic) Ankle arthrodesis - revision, including conversion from total ankle replacement Surgeon's Category INTER 4 INTER 4 INTER 4 INTER 5 MAJOR+ 1 MAJOR+ 2 MINOR 2 INTER 2 INTER 3 INTER 5 CMO 1 CMO 2 CMO 3 MAJOR+ 3 INTER 5 MAJOR 3 MAJOR+ 2 MAJOR 5 MAJOR+ 2 MAJOR+ 3 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C INTER 4 INTER 4 INTER 4 INTER 4 INTER 4 INTER 3 MAJOR 3 MAJOR 3 MAJOR+ 1 MAJOR+ 1 MAJOR+ 5 MAJOR 5 INTER 4 MAJOR 1 MAJOR 2 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 4 MAJOR MAJOR INTER MAJOR MAJOR+ MINOR INTER INTER MAJOR MAJOR+ CMO 1 CMO 2 MAJOR+ MAJOR MAJOR MAJOR INTER INTER INTER INTER 1 2 1 1 1 D/C D/C D/C 5 5 6 1 1 1 5 4 4 5 FOOT - HIND FOOT AND MID FOOT Code W8850 W8650 W0432 W0434 W0420 W0422 W0460 W0462 Surgeon's Description Category Diagnostic subtalar arthroscopy including synovectomy to gain vision (as sole INTER 3 procedure) Therapeutic subtalar arthroscopy including synovectomy to gain vision Isolated subtalar fusion or mid foot fusion with autogenous graft (adult) Isolated subtalar fusion or mid foot fusion without autogenous graft (adult) Triple fusion of joints of hindfoot without autogenous graft Triple fusion of joints of hindfoot with autogenous graft Complex procedure to mid foot or hindfoot without autogenous bone graft (osteotomy/fusion +/- tendon transfers) Complex procedure to mid foot or hindfoot with autogenous bone graft (osteotomy/fusion +/- tendon transfers/fixation) INTER 4 MAJOR+ 4 MAJOR+ 2 MAJOR+ 2 MAJOR+ 4 MAJOR+ 4 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER MAJOR 1 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 3 MAJOR 5 MAJOR+ 1 MAJOR MAJOR MAJOR MAJOR MAJOR MAJOR+ MAJOR+ - W0463 Complex procedure to mid foot and hindfoot without autogenous graft Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 MAJOR+ 5 - 84 – © Bupa Insurance Limited 1999-2012 (osteotomy/fusion +/- tendon transfers/fixation) W0464 Complex procedure to mid foot and hindfoot with autogenous graft (osteotomy/fusion +/- tendon transfers, fixation) CMO 2 MAJOR+ 3 CMO 2 - FOOT - FOREFOOT Code W0300 W0310 W1590 W1040 Description Multiple procedures on forefoot Multiple procedures on forefoot - bilateral Correction of retracted/dislocated metatarso-phangeal joint including tendon transfer, division/realignment of bone and internal fixation Osteotomy of small bone of foot (including internal fixation) Surgeon's Category MAJOR 5 MAJOR+ 5 MAJOR 3 MAJOR 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 4 MAJOR+ 1 MAJOR+ 3 MAJOR 5 MAJOR 3 CMO 2 MAJOR INTER 1 1 D/C FOOT - HALLUX Code W0860 W0861 W7910 W7980 W5700 W5701 W5710 W5780 W0330 W0380 Description Metatarso-phalangeal cheilectomy - unilateral Metatarso-phalangeal cheilectomy - bilateral Surgeon's Category MAJOR 1 MAJOR+ 4 Anaesthetist's Hospital Anticipated Category Category LOS INTER 5 MAJOR D/C MAJOR 5 MAJOR 4 MAJOR+ 2 MAJOR 2 MAJOR+ 2 INTER 5 MAJOR 5 INTER 5 MAJOR 5 MAJOR+ MAJOR MAJOR+ MAJOR MAJOR+ INTER MAJOR INTER MAJOR D/C D/C D/C D/C D/C D/C D/C 1 1 Metatarsal osteotomy for Hallux valgus, with or without internal fixation and MAJOR 3 soft tissue correction Metatarsal osteotomy for Hallux valgus, with or without internal fixation and MAJOR 5 soft tissue correction-bilateral Excision arthroplasty of first metatarso-phalangeal joint with prosthetic implantation or interposition arthroplasty Excision arthroplasty of first metatarso-phalangeal joint with prosthetic implantation or interposition arthroplasty - bilateral Excision arthroplasty of first metatarso-phalangeal joint, including Keller's Excision arthroplasty of first metatarso-phalangeal joint, including Keller'sbilateral Fusion of first metatarso-phalangeal joint Fusion of first metatarso-phalangeal joint - bilateral MAJOR 2 CMO 1 INTER 4 MAJOR 3 MAJOR 1 MAJOR 5 FOOT - TOES Code T6460 T6461 W5940 W5980 T6462 Description Tendon transfer of toe - unilateral Tendon transfer of toe - bilateral Fusion of interphalangeal joint(s) of toe (including internal fixation) Surgeon's Category INTER 3 MAJOR 1 INTER 3 Anaesthetist's Hospital Anticipated Category Category LOS INTER 4 INTER D/C MAJOR 3 INTER 4 MAJOR 4 INTER 4 MAJOR INTER MAJOR INTER D/C D/C D/C - Fusion of interphalangeal joint(s) of toe (including internal fixation) - bilateral MAJOR 2 Excision or partial excision of IP joint of lesser toe with tendon transfer MAJOR 1 FOOT - GENERAL FOOT Code T5780 T6762 T6763 X1110 X0822 X0930 W7900 Description Extracorporeal shockwave lithotripsy plantar fasciitis Repair of tendon of foot - flexor Repair of tendon of foot - extensor Amputation of toe Amputation of whole ray Amputation of leg/foot (including Symes Lisfranc & Chopart) Excision of medial eminence 1st or 5th MT head with soft tissue repair (bunionectomy) Surgeon's Category MINOR 2 MINOR 4 MINOR 4 INTER 3 INTER 3 MAJOR 4 INTER 1 Anaesthetist's Hospital Anticipated Category Category LOS MINOR INTER 4 INTER 4 INTER 4 INTER 5 MAJOR 3 INTER 2 MINOR MINOR INTER MAJOR MAJOR INTER 1 4 D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 85 – © Bupa Insurance Limited 1999-2012 EXTERNAL FIXATION / TRACTION Code W2910 W2930 W3010 W3030 Description Application of skeletal traction to bone Removal of skeletal traction from bone Application of external fixation to bone Removal of external fixation from bone Surgeon's Category MINOR 5 MINOR 3 MAJOR 2 MINOR 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER 5 MINOR INTER 1 INTER 5 INTER 1 MINOR MAJOR MINOR D/C D/C Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 86 – © Bupa Insurance Limited 1999-2012 17 Interventional Radiology Notes 1. Although similar Procedure Narratives may be found elsewhere in the Schedule, this section has been designed for use by radiologists, therefore new codes have been devised to reflect this. 2. Bupa will not pay additional benefits if a procedure is unbundled ie broken down into its separate components and then charged on an itemised basis, if this results in a higher overall charge. An example of unbundling in this speciality is: Main Procedure: XR254 – Angioplasty of other arteries (e.g. sub-clavian, tibial, femoropopliteal) Lesser Procedure(s) which are included in the main procedure and should not be billed separately: XR280 – Insertion of aortic metallic stent - graft BIOPSY Code XR100* XR110* XR120* XR121* XR130* XR140* B3282 XR670* Description Fluoroscopically guided biopsy(ies) Ultrasound guided biopsy(ies) CT/MRI guided biopsy(ies) Image-guided vacuum assisted excision biopsy breast lesion Transjugular/Transfemoral/plugged liver biopsy(ies) Unilateral stereotactic core biopsy breast Ultrasound guided vacuum assisted excision biopsy of benign breast lesion Radiofrequency kidney ablation Surgeon's Category INTER 1 INTER 2 INTER 3 INTER 3 INTER 5 INTER 3 INTER 3 CMO 2 Anaesthetist's Hospital Anticipated Category Category LOS INTER O/P INTER 4 MAJOR+ 3 INTER INTER INTER INTER INTER INTER CMO 2 O/P D/C D/C - DRAINAGE Code XR170* Description Fluoroscopically guided drainage of fluid collection Surgeon's Category INTER 1 INTER 5 MAJOR 1 MINOR 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER D/C INTER MAJOR MINOR D/C 1 - XR180(ii)* Ultrasound guided drainage of fluid collection XR190* XR220 CT/MRI guided drainage of fluid collection Seminal vesicle injection ANGIOPLASTY Code XR516* XR252* XR254* XR430* XR260* XR270* Description Angioplasty of iliac artery Venoplasty Angioplasty of other arteries (e.g. sub-clavian, tibial, femoro-popliteal) Renal angioplasty Angioplasty with insertion of metallic stent Angioplasty with insertion of metallic stent - graft Surgeon's Category MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 2 MAJOR 3 MAJOR 4 CMO 3 CMO 3 CMO 2 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 1 MAJOR+ 5 MAJOR+ 3 MAJOR+ 5 MAJOR MAJOR MAJOR MAJOR MAJOR CMO 3 CMO 3 CMO 2 D/C 1 1 1 1 3 1 - XR280(i)* Insertion of aortic metallic stent - graft XR290(i)* Cerebral angioplasty with or without insertion of metallic stent XR967* CT guided thermocoagulation of Osteoid Osteoma EMBOLIZATION Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 87 – © Bupa Insurance Limited 1999-2012 Code XR442 XR352* XR360* XR370* XR380* XR306* XR390* XR302* XR303* Description Embolisation of varicocele of gonadal vein Embolisation of artery/vein Embolisation of vascular mass (including uterine Embolisation) Embolisation of bronchial artery Embolisation of aneurysm Endovascular treatment of cerebral aneurysm Embolisation of arteriovenous malformation Endovascular management of brain arteriovenous malformation (including two separate interventions) Surgeon's Category MAJOR 3 MAJOR 3 CMO 1 CMO 2 CMO 4 CMO 4 CMO 5 CMO 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR D/C MAJOR 2 MAJOR+ 2 MAJOR+ 4 CMO 2 CMO 2 CMO 2 CMO 2 CMO 2 MAJOR CMO 1 CMO 2 CMO 4 MAJOR+ CMO 5 CMO 2 1 1 1 2 2 3 3 - Additional management of brain arteriovenous malformation (per additional CMO 5 intervention) THROMBOLYSIS Code XR410* Description Thrombolysis or aspiration of thrombus under imaging control Surgeon's Category INTER 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER 1 DILATATION Code XR450* XR565* Description Dilatation of stricture under imaging control Percutaneous dilatation of biliary stricture under imaging control Surgeon's Category INTER 4 MAJOR+ 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR+ 3 INTER D/C MAJOR 4 MAJOR+ 1 HEAD AND NECK Code XR315 XR320 Description Endoluminal stone extraction from salivary duct under imaging control Dilatation/stenting of nasolacrimal duct under imaging control Surgeon's Category INTER 1 MAJOR 4 Anaesthetist's Hospital Anticipated Category Category LOS INTER MAJOR D/C SPINE Code XR500* XR510* XR520* XR530* XR540* Description Chemonucleolysis Fluoroscopically guided discectomy (including laser) CT guided discectomy (including laser) Fluoroscopically guided percutaneous vertebroplasty CT guided percutaneous vertebroplasty Surgeon's Category INTER 4 MAJOR 5 CMO 1 MAJOR 5 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS INTER 2 INTER MAJOR 3 MAJOR+ 2 MAJOR 3 MAJOR+ 2 MAJOR CMO 1 MAJOR CMO 1 D/C D/C 1 THORAX Code XR595* XR600* Description Insertion of tracheal/bronchial metallic stent Insertion of oesophageal metallic stent under imaging control Surgeon's Category MAJOR 2 MAJOR 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 1 MAJOR 1 MAJOR 1 GASTRO-INTESTINAL Code XR585* XR590* Description Percutaneous gastrostomy Percutaneous gastrojejunostomy Surgeon's Category MAJOR 2 MAJOR 5 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR MAJOR - Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 88 – © Bupa Insurance Limited 1999-2012 LIVER Code XR580* XR570* XR575* XR576* XR610* Description Percutaneous cholecystostomy Percutaneous insertion of plastic biliary endoprosthesis Percutaneous insertion of metallic biliary endoprosthesis Biliary drainage with occluded stent in place Transjugular intrahepatic portosystemic shunt Surgeon's Category MAJOR 3 MAJOR 2 MAJOR+ 2 MAJOR+ 2 CMO 1 Anaesthetist's Hospital Anticipated Category Category LOS MAJOR 2 MAJOR 1 MAJOR 1 MAJOR 5 MAJOR 5 CMO 1 MAJOR MAJOR+ MAJOR CMO 1 1 3 URINARY Code XR630* XR640* XR650* XR660* XR661* XR620 Description Percutaneous nephrostomy Percutaneous removal of calculus Percutaneous pyelolysis Insertion of stent into ureter (unilateral) Insertion of stent into ureter (bilateral) Renal/adrenal vein sampling Surgeon's Category INTER 5 MAJOR+ 5 MAJOR+ 5 INTER 3 MAJOR 2 INTER 5 Anaesthetist's Hospital Anticipated Category Category LOS INTER 1 MAJOR+ 1 MAJOR+ 1 INTER 4 MAJOR 3 INTER 5 MAJOR+ MAJOR+ MAJOR MAJOR INTER D/C - OTHER Code XR910* XR917* XR915* XR920* XR935* XR940 XR950* XR960* XR962* XR963* Description Insertion of central venous catheter - non-tunnelled (X-ray guided) Peripherally inserted central venous catheters (PICCs) under X-ray guidance Insertion of central venous catheter - tunnelled (X-ray guided) Cyst ablation under imaging control Insertion/Removal of vena cava filter Retrieval of foreign body under X-ray guidance Occlusion of fistula under imaging control Percutaneous thermal coagulation of mass Percutaneous chemical ablation of tumour - Ultrasound guided Percutaneous chemical ablation of tumour - CT guided Surgeon's Category INTER 1 INTER 1 INTER 4 INTER 4 INTER 5 MAJOR 1 MAJOR 5 CMO 2 CMO 2 CMO 2 CMO 2 MAJOR 3 Anaesthetist's Hospital Anticipated Category Category LOS INTER D/C MAJOR+ 4 MAJOR+ 4 MAJOR+ 4 MAJOR+ 4 INTER 5 INTER INTER INTER INTER MAJOR MAJOR CMO 2 INTER INTER CMO 2 MAJOR D/C D/C O/P 1 D/C D/C 1 1 1 - XR964(i)* Liver ablation (radiofrequency) XR968* Colonic stent insertion Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 89 – © Bupa Insurance Limited 1999-2012 18 Chemotherapy CHEMOTHERAPY Code X0001 X0002 X0003 X0004 Description Clinical supervision & planning for delivery of chemotherapy cycle for 0-7 days Clinical supervision & planning for delivery of chemotherapy cycle for 1-14 days Clinical supervision & planning for delivery of chemotherapy cycle for 1-21 days Clinical supervision & planning for delivery of chemotherapy cycle for1-28 days Surgeon's Category £137 £257 £386 £515 Anaesthetist's Hospital Anticipated Category Category LOS - Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 90 – © Bupa Insurance Limited 1999-2012 Appendices Appendix A: Bupa Intensive Therapy Policy A. Where the Intensive Therapy is an expected continuation of private in-patient or day-case treatment: Surgical procedure Bupa will pay benefit towards hospital charges for up to 72 hours Intensive Therapy following one of the surgical procedures indicated by “(i)” in the Schedule. If it is indicated that the length of stay will exceed 72 hours you should contact The Clinical Support Team on the number below and provide full clinical details. If the clinical information confirms the medical necessity of additional Intensive Therapy future benefit will be confirmed. Major Medical Illness For a Major Medical Illness, e.g. acute myocardial infarction following minor surgery, Bupa will pay benefit towards Intensive Therapy for up to 72 hours. As above, further benefit may be confirmed on receipt of clinical details should the need arise for an extension of stay in an Intensive Therapy Unit B. Where the Intensive Therapy is a continuation of a private in-patient or day-case treatment but not one of the listed procedures or a Major Medical Illness: Pre-admission information If a consultant (or hospital) knows in advance before the patient is admitted that they are likely to require Intensive Therapy for a procedure or condition not listed, they should contact Clinical Support Team on the number below for consideration of benefit. For example, if the patient has an existing medical condition which may complicate a surgical procedure. Unexpected problem If, during a routine procedure a patient develops an unexpected problem that necessitates Intensive Therapy the patient should be transferred to the appropriate environment. Wherever possible The Clinical Support Team should be contacted before the transfer. Bupa acknowledges, however, that these incidents may occur outside of our office hours and that the speed of transfer may not allow contact beforehand. In these circumstances, Bupa would expect that the patient is transferred as clinical need requires and for The Clinical Support Team to be contacted with the appropriate medical information, at the earliest opportunity In both situations described above Bupa will be looking at the medical reason for the patient requiring Intensive Therapy. If the information received confirms the medical necessity for Intensive Therapy then Bupa will pay benefit for up to 72 hours. C. In those cases where the patient is admitted straight into an NHS Intensive Therapy Unit, not following private in-patient or day-case treatment. If a Bupa member is admitted via an Accident and Emergency Department directly into an NHS Intensive Therapy Unit, this will not be eligible for benefit. Should an account be received by Bupa for such an event benefit will not be paid. Health Care Services Clinical 0845 60 00 971 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 91 – © Bupa Insurance Limited 1999-2012 Appendix B: Bupa Major Medical Illnesses The Bupa table of benefits makes provision for a supplementary benefit to be paid to Physicians for a maximum of 14 days a year during the acute phase of certain medical illnesses. The following are some examples of possible signs and symptoms of a patient fulfilling Bupa's interpretation of the 'acute' phase of a major medical illness. It is not expected that the patient should present with the following clinical signs and symptoms these are just examples. Body System CARDIOVASCULAR Acute cardiac failure Acute myocardial infarction Acute circulatory failure Example Signs & Symptoms The patient may have one or more of the following: Vasoactive drugs used to support arterial pressure Occurrence of atrial or ventricular tachycardia/fibrillation Acute complete heart block Mean arterial BP = <60 RESPIRATORY The patient may have one or more of the following: Pneumonia Respiratory rate >40 per minute Respiratory distress syndrome PaCO2 >6-7KPa (50 mmHg) in the absence of opioid Other respiratory conditions of the new-born or metabolic alkalosis Some form of assisted ventilation RENAL Acute Renal failure The patient may have one or more of the following: Oliguria = <0.5ml / kg/ hr with a rising creatinine, despite adequate fluids Serum urea = >35mMol/L Serum cieatinine = > 300 u Mol / L NEUROLOGICAL The patient may have either of the following: Meningitis Best GCS =<10 in the absence of sedative drugs CVA Haemorrhage/Thrombosis or metabolic cause Intra cerebral haemorrhage Neuropathy/myopathy/cord lesion limiting Serious brain injury (paraplegia, brain damage) respiratory reserve or mobility Raised ICP METABOLIC/HEPATIC Septicaemia Acute - subacute necrosis of liver Diseases of the pancreas Diabetic coma The patient may have either of the following: Blood levels outside the normal limits over a 24 hour period (U&Es + FBC) Clinical hepatic failure causing other OSFs / complications, or PT prolonged 3 sees > control and LFTs twice the upper limit of normal The patient may have either of the following: Prolonged ileus/uncontrollable diarrhoea requiring intervention Haemorrhage requiring acute blood transfusion Dependant on Parenteral Nutrition GASTROINTESTINAL Gastrointestinal haemorrhage OTHERS/CANCERS Leukaemia Aplastic anaemias Acute lymphadenitis Necrotising fasciitis N.B. The above lists the most common conditions for which the supplementary benefit will be automatically available. Consideration will be given to the allocation of this supplement to other conditions on a case by case basis. Consultants are requested to provide details in the form of a medical report where appropriate. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 92 – © Bupa Insurance Limited 1999-2012 Appendix C: Guide to Bupa Benefit Maxima Benefit sheet (specialists' fees) The Tables below provide details of the maximum reimbursement for surgeons' and anaesthetists' fees. Surgeons Minor Inter Major Major Plus Complex Major 1 £91.00 £208.00 £452.00 £665.00 £837.00 2 £107.00 £249.00 £508.00 £690.00 £1,040.00 3 £117.00 £289.00 £548.00 £716.00 £1,370.00 4 £137.00 £335.00 £589.00 £741.00 £1,725.00 5 £167.00 £386.00 £619.00 £782.00 £2,030.00 Please note that some procedures reflect a lower complexity than Minor 1 and are reimbursed at £50. Anaesthetists Minor Inter Major Major Plus Complex Major 1 £102.00 £102.00 £165.00 £270.00 £523.00 2 £102.00 £115.00 £180.00 £284.00 £609.00 3 £102.00 £125.00 £195.00 £325.00 £770.00 4 £102.00 £125.00 £220.00 £381.00 £930.00 5 £102.00 £145.00 £235.00 £447.00 £1,050.00 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 93 – © Bupa Insurance Limited 1999-2012 Appendix D: Chemotherapy and Radiotherapy Services All codes relating to the clinical supervision and planning for the delivery of chemotherapy and radiotherapy regimens include: all regime prescription, supervision of all planning and treatment delivery procedures, expected side-effect management, and the supervision of all in-patient, outpatient and day-patient care for the duration of the prescribed regime. A consultation is defined as: A meeting between a patient and their consultant to evaluate the nature and progress of a disease, and to establish a diagnosis, prognosis and treatment plan. A consultation should be carried out on a face-to-face basis and not remotely. Course 1-7 days 1-14 days 1-21 days 1-28 days Code X0001 X0002 X0003 X0004 Fee £137 £257 £386 £515 Consultants who supervise eligible courses of radiotherapy will be reimbursed on the following basis: Course 15 fractions of radiotherapy Fee £380 Please ensure that the patient has pre-authorised their treatment. If you have any queries about Bupa cover for cancer treatment or about eligibility for a particular patient, please telephone the Bupa Provider Services Team on 08457 55 33 33†. † Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored. Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 94 – © Bupa Insurance Limited 1999-2012 Bupa Provider Services telephone: 08457 55 33 33* *Lines are open 8am to 6pm Monday to Friday, 8am and 1pm Saturday. Calls may be recorded and may be monitored Bupa Schedule of Procedures V2012.8 20th August 2012 Valid until 17th September 2012 - 95 – © Bupa Insurance Limited 1999-2012 Bupa Insurance Limited Bupa House, 15-19 Bloomsbury Way, London WC1A 2BA Registered in England and Wales: No 3956433 Bupa and the heartbeat symbol are registered trademarks http://www.bupa.co.uk Bupa Schedule of Procedures V2012.9 20th August 2012 Valid until 17th September 2012 © Bupa Insurance Limited 1999-2012