Developing Privilege Dictionaries. Presented by: Robin J. Neel Manager, Medical Staff Services Froedtert Hospital, Milwaukee, WI

Transcription

1 Developing Privilege Dictionaries Presented by: Robin J. Neel Manager, Medical Staff Services Froedtert Hospital, Milwaukee, WI

2 Track Session Description Post-Symposium Availability This detailed presentation includes sources and shortcuts you can use to glean your privilege lists. For example, get data from your surgery scheduling system, your finance department, and more. See how to organize using Microsoft Excel, how to transfer this data to the privilege dictionaries, and how to provide access to the information for the clinical areas in your organization. Shortly after the conclusion of the Symposium, most General Session and Track Session presentations will be available for viewing and downloading by licensed MIDAS+ clients from our Web site: The presentations are available both in PDF and native Microsoft PowerPoint format. This document contains confidential information which is proprietary to MidasPlus, Inc. Possession and use of this document or any part thereof, in any form, is limited to licensed MIDAS+ clients only and is regulated by specific license agreement provisions. Any other use or unauthorized disclosure is strictly prohibited. MIDAS+, the MIDAS+ logo, DataVision, ReporTrack, Seeker, and SmarTrack are trademarks of MidasPlus, Inc. The ACS logo is a registered trademark of ACS, Inc. Third party trademarks, trade names, product names and logos may be the trademarks or registered trademarks of their respective owners. Contact us at: ACS MIDAS+, 2500 North Pantano Road, Suite 200, Tucson, AZ (800) Visit our Web site at:

3 14th Annual MIDAS+ User Symposium Developing Privilege Dictionaries Robin J. Neel Manager, Medical Staff Services Froedtert Hospital Milwaukee, WI Introduction Imagination is a poor substitute for experience. -Havelock Ellis Proper dictionary management is key to data integrity. Avoid pitfalls of experimentation by taking advantage of the lessons others have learned through experience. Seek help from credible sources: Midas+ On-Line Training User Support Group Seeker Clients 2 Introduction In this presentation, we will review: The principals of good dictionary management Using Microsoft Excel to manage privilege dictionaries 3 14th Annual MIDAS+ Symposium June

4 Dictionary Management Consistency, consistency, consistency! Define in advance case style to be used (UL, U, L) and maintain that standard. Define acceptable abbreviations and standards for truncating terms. Avoid using characters that could be problematic: ( ), ( ), ( ), ( ), etc. 4 Dictionary Management Consider using Excel to manage all Midas+ and Seeker dictionaries. Advantages: Flexibility - ability to insert rows and columns, sort multiple columns, copy and past text Reduced likelihood of error through cell ability to recognize duplicative terms and values Easy to maintain effective history Easy to update 5 Getting Started Determine approach to privileging: what is best method for your organization? laundry list categorization descriptive approach delineation by codes combination of the above 6 2 June th Annual MIDAS+ Symposium

5 Getting Started Sources for procedure descriptions can be gleaned from: Existing paper privilege forms OR scheduling database Billing documents Midas+ Dictionary 43 (PROCEDURES ICD-9 and CPT-4) Web sources such as amapress.com, Greeley clinical white papers, etc. 7 Getting Started Don t forget to predetermine format rules to ensure consistency. Label columns appropriate to content. Enter data according to process recommended by Midas+ training staff. 8 Getting Started Process flow for privilege development Determine Core Privilege Groups Determine the Individual Privileges Code Individual Privileges Assign Code Ranges Assign Major Privileges 9 14th Annual MIDAS+ Symposium June

6 Populating Excel Spreadsheet Determine Core Privilege Groups, e.g., Allergy, Anesthesia, Cardiology, Dermatology, etc. Label column A on spreadsheet Core Privileges Label column B - Core Code Label column C - Procedures Label column D Range 10 Populating Excel Spreadsheet A CORE PRIVILEGES B CORE CODE C PROCEDURES D RANGE Anesthesia-1 ANE1 ANE1.01 ANE1.Z Airway management ANE1.01 Ability to provide general anesthesia ANE1.02 Acute post-operative pain management ANE1.03 Anesthesia-2 ANE2 ANE1.01 ANE2.Z Comprehensive pain management ANE2.01 Critical Care Medicine ANE Moving Data to Privilege Dictionaries Open Major Privileges Definition dictionary using icon on Seeker Menu Bar June th Annual MIDAS+ Symposium

7 Moving Data to Privilege Dictionaries Select Add New. Enter datum from column A2 into Description. Enter datum from column B2 into Code. Copy and paste from Excel into dictionary. 13 Moving Data to Privilege Dictionaries Toggling between windows: minimize Excel window and Seeker window so both appear side by side on screen. 14 Moving Data to Privilege Dictionaries Click in cell to be copied from Excel to Seeker, right mouse click, select copy (or Ctrl C). Place cursor in Seeker in Description dialogue box, right mouse click, select paste (or Ctrl V). Repeat process to copy code from Excel to Seeker th Annual MIDAS+ Symposium June

8 Moving Data to Privilege Dictionaries 16 Moving Data to Privilege Dictionaries Open Individual Privileges dictionary. Copy and paste from Excel to Seeker. 17 Moving Data to Privilege Dictionaries Assign code ranges June th Annual MIDAS+ Symposium

9 Moving Data to Privilege Dictionaries Click on magnifying glass to view all privileges in category. Final step: assign provider privileges (dictionary 259) 19 Moving Data to Privilege Dictionaries Process may be used to populate remaining privilege dictionaries or any Seeker dictionary. 20 Importing Dictionary Files from Midas+ into Excel From Midas+ Function, Standard Reporting, Standard Reports Report = Dictionary Data Report Output Device = File, browse for directory and/or name file, select okay. Dictionary = 43 (PROCEDURES (ICD-9 AND CPT-4) Leave remaining selections as default Compile 21 14th Annual MIDAS+ Symposium June

10 Importing Dictionary Files from Midas+ into Excel Open Excel Open file, choose Fixed width, select next Select next Select finish File will open with codes and descriptions in separate columns 22 Importing Dictionary Files from Midas+ into Excel Can delete unwanted rows and delete unwanted language, i.e., Code: and Description:. Can parse columns when necessary. 23 In Summary Good dictionary maintenance ensures currency and integrity of data. Excel provides versatility. No need to maintain paper copies of dictionaries June th Annual MIDAS+ Symposium

11 Anesthesia Core Privilege Group Anesthesia Core Privilege Group CORE PRIVILEGES CORE CODPROCEDURES RANGE ANESTHESIA-1 ANE1 ANE ANE1.Z Medical management of all adult patients who are rendered unconscious or insensible to patient and emotional stress during surgical, and certain other medical procedures Medical management of pediatric patients ( 2 4 y/o, ASA 1-2; 5-7 y/o; ASA 1-3; 9 y/o ASA 1-5) who are rendered unconscious or insensible to patient and emotional stress during surgical, and certain other medical procedures Protection of life functions and vital organs ANE1.01 ANE1.02 ANE1.03 Management of problems in cardiopulmonary resuscitation ANE1.04 Performance and documentation of the history and physical examination ANE1.05 Ordering of diagnostic studies and procedures ANE1.06 Airway management ANE1.07 Ability to provide general anesthesia ANE1.08 Monitored anesthesia care ANE1.09 Regional and local anesthesia ANE1.10 Labor and delivery anesthesia ANE1.11 Acute post-operative pain management ANE1.12 Cardiopulmonary resuscitation ANE1.13 ANESTHESIA-2 ANE2 ANE ANE2.Z Comprehensive pain management ANE2.01 Critical care medicine ANE2.02 Cardiac anesthesia, including heart and/or lung transplantation ANE2.03 High risk pediatric anesthesia < 2 yrs; 4 yrs, ASA 3; 5-7 yrs, ASA 4) ANE2.04 Transplant anesthesia: kidney, liver, pancreas ANE2.05 MULTIDISCIPLINARY MTD MTD MTD-1.Z Acupuncture MTD-1.01 Epiduroscopy MTD-1.02 Evoked potential monitoring MTD-1.03 Fluoroscopy MTD-1.04 Infusion pump and intraspinal catheter implantation MTD-1.05 Nerve stimulator implementation MTD-1.06 Radiofrequency neurolysis MTD-1.07 Transcranial doppler MTD-1.08 Transesophageal echocardiography MTD-1.09 Laser, Nd YAG MTD-1.10 Laser, KTP MTD-1.11 Laser, CO2 MTD th Annual MIDAS+ Symposium June

12 OB-GYN Core Privilege Group Developing Privilege Dictionaries OB-GYN Core Privilege Group CORE PRIVILEGES CORE CODE PROCEDURES RANGE OB/GYN-1 OBS OBS OBS-1..Z Admission, work up, consultation, diagnosis and treatment of females of all ages presenting with illness, injuries, disorders and medical complications (heart, lungs, kidney, anemia, diabetets, etc.) of pregnancy. History and physical examination, performance and documentation Diagnostic studies and procedures, ordering of Spontaneous vaginal delivery, episiotomy and repair, repair of vaginal, cerfical and perineal lacerations, 1st and 2nd degree), internal monitor placement, vaginal delivery after cesaran (VBAC) Repair of perineal lacerations (3rd and 4th degree), manual removal of placenta, vacuum extraction, outlet/low forceps delivery, mid-forceps delivery Vaginal breech delivery, spontaneous, vaginal breech delivery-assisted or total extraction, vaginal twin delivery External cephalic version Internal podalic version Amniocentesis for lung maturity Cesarean section Cesarean hysterectomy Uterine artery ligation Hypogastric arter ligation Post-partum tubal ligation Pregnancy termination Management of pre-term labor Management of pre-term premature rupture of membranes Management of pre-eclampsia dn eclampsia Management of twins Management of placenta previa and abruptio placentae Cervical cerclage Management of surgical complications of pregnancy Management of selected maternal medical conditions Obstetrical ultrasound OB/GYN-2 GYN GYN GYN-1.Z Admission, work up, consultation, diagnosis, and pre-, intra-, and postoperative care necessary to correct or treat female patients of all ages presenting with illnesses, injuries, and disorders of the reproductive system and lower urinary tract, and non-surgical treatment of illnesses and injuries of the breasts. History and physical examinaion, performance and documentation Diagnostic studies and procedures, ordering of 10 June th Annual MIDAS+ Symposium

13 OB-GYN Core Privilege Group Abdominal hysterectomy, vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, enterocele repair-vaginal, enterocele repairabdominal, salpingo-oophorectomy-open, ovarian cystectomy-open, myomectomy-open, marsupilization or excision of Bartholin s gland, dilation and curettage, cold knife conization, repair of cystotomy, treatment of rectovaginal fistula, sacrospinous ligament fixation, simple vulvectomy, colpocleisis Hysteroscopy-diagnostic and operative including but not limited to removal of polyps and fibroids, and endometrial ablation Laparoscopy-diagnostic and operative including but not limited to tubal ligation, treatment of ectopic pregnancy, adhesiolysis, salpingooophorectomy, ovarian cystectomy, myomectomy, assisted vaginal hysterectomy, hysterectomy Tension-free vaginal tape placement Cystoscopy, diagnostic OB/GYN-S1 UGYN UROGYN UROGYN-1.Z Suburethral Sling procedure, any type Retropubic bladder suspension Repair of ureterovaginal fistula Repair of vesicovaginal fistula Diagnostic and operative cystoscopy Abdominal colposacropexy Interstim placement Collagen injections, suburethral OB/GYN-S2 INFERT INFERT INFERT-1.Z Tubal reanastomosis Treatment of congenital anomalies of the genitourinary tract McIndoe vaginoplasty Resection of bowel, bladder and ureteral endometriosis Tubal cannulation-fluoroscopic or hysteroscopic Transvaginal aspiration of adnexal masses or ovaries Gonadotropin stimulation OB/GYN-S3 GYNONC GYNONC GYNONC-1.Z Radical vulvectomy and reconstruction Inguinal lymph node dissection Radical hysterectomy (open and laparoscopic) Pelvic lymph node dissection (open and Laparoscopic) Periaortic lymph node dissection (open and laparoscopic) Omentectomy Ovarian cancer debulking and associated procedures Bowel resection, ileostomy and colostomy Pelvic exenteration with reconstruction Splenectomy 14th Annual MIDAS+ Symposium June

14 OB-GYN Core Privilege Group - Alpha with Code Developing Privilege Dictionaries OB-GYN Core Privilege Group - Alpha with Code CORE PRIVILEGES CORE CODE PROCEDURES RANGE OB/GYN-1 OBS OBS OBS-1.Z Admission, work up, consultation, diagnosis and treatment of females of all ages presenting with illness, injuries, disorders and medical complications (heart, lungs, kidney, anemia, diabetets, etc.) of pregnancy. Amniocentesis for lung maturity Cervical cerclage Cesarean hysterectomy Cesarean section OBS-1.1 OBS-1.2 OBS-1.3 OBS-1.4 OBS-1.5 Diagnostic studies and procedures, ordering of OBS-1.6 External cephalic version OBS-1.7 History and physical examination, performance and documentation OBS-1.8 Hypogastric arter ligation OBS-1.9 Internal podalic version OBS-1.10 Management of placenta previa and abruptio placentae OBS-1.11 Management of pre-eclampsia dn eclampsia OBS-1.12 Management of pre-term labor OBS-1.13 Management of pre-term premature rupture of membranes OBS-1.14 Management of selected maternal medical conditions OBS-1.15 Management of surgical complications of pregnancy OBS-1.16 Management of twins OBS-1.17 Obstetrical ultrasound OBS-1.18 Post-partum tubal ligation OBS-1.19 Pregnancy termination OBS-1.20 Repair of perineal lacerations (3rd and 4th degree), manual removal of placenta, vacuum extraction, outlet/low forceps delivery, midforceps delivery OBS-1.21 Spontaneous vaginal delivery, episiotomy and repair, repair of vaginal, cerfical and perineal lacerations, 1st and 2nd degree), internal monitor placement, vaginal delivery after cesaran (VBAC) OBS-1.23 Uterine artery ligation OBS-1.24 Vaginal breech delivery, spontaneous, vaginal breech delivery-assisted or total extraction, vaginal twin delivery OBS-1.25 OB/GYN-2 GYN GYN GYN-1.Z Admission, work up, consultation, diagnosis, and pre-, intra-, and postoperative care necessary to correct or treat female patients of all ages presenting with illnesses, injuries, and disorders of the reproductive system and lower urinary tract, and non-surgical treatment of illnesses and injuries of the breasts. GYN June th Annual MIDAS+ Symposium

15 OB-GYN Core Privilege Group - Alpha with Code Abdominal hysterectomy, vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, enterocele repair-vaginal, enterocele repairabdominal, salpingo-oophorectomy-open, ovarian cystectomy-open, myomectomy-open, marsupilization or excision of Bartholin s gland, dilation and curettage, cold knife conization, repair of cystotomy, treatment of rectovaginal fistula, sacrospinous ligament fixation, simple vulvectomy, colpocleisis Cystoscopy, diagnostic GYN-1.2 GYN-1.3 OB/GYN-S1 OB/GYN-S2 OB/GYN-S3 UGYN INFERT GYNONC Diagnostic studies and procedures, ordering of GYN-1.4 History and physical examinaion, performance and documentation GYN-1.5 Hysteroscopy-diagnostic and operative including but not limited to removal of polyps and fibroids, and endometrial ablation GYN-1.6 Laparoscopy-diagnostic and operative including but not limited to tubal ligation, treatment of ectopic pregnancy, adhesiolysis, salpingooophorectomy, ovarian cystectomy, myomectomy, assisted vaginal hysterectomy, hysterectomy GYN-1.7 Tension-free vaginal tape placement GYN-1.8 UROGYN UROGYN- 1.Z Abdominal colposacropexy UROGYN-1.1 Collagen injections, suburethral UROGYN-1.2 Diagnostic and operative cystoscopy UROGYN-1.3 Interstim placement UROGYN-1.4 Repair of ureterovaginal fistula UROGYN-1.5 Repair of vesicovaginal fistula UROGYN-1.6 Retropubic bladder suspension UROGYN-1.7 Suburethral Sling procedure, any type UROGYN-1.8 INFERT INFERT- 1.Z Gonadotropin stimulation INFERT-1.1 McIndoe vaginoplasty INFERT-1.2 Resection of bowel, bladder and ureteral endometriosis INFERT-1.3 Transvaginal aspiration of adnexal masses or ovaries INFERT-1.4 Treatment of congenital anomalies of the genitourinary tract INFERT-1.5 Tubal cannulation-fluoroscopic or hysteroscopic INFERT-1.6 Tubal reanastomosis INFERT-1.7 GYNONC GYNONC- 1.Z Bladder and ureteral repair, reimplantation or reconstruction GYNONC-1.1 Bowel resection, ileostomy and colostomy GYNONC-1.2 Gastostomy or cystostomy tube placement GYNONC-1.3 Inguinal lymph node dissection GYNONC-1.4 Omentectomy GYNONC th Annual MIDAS+ Symposium June

16 MTD Core Privilege Group Developing Privilege Dictionaries MTD Core Privilege Group CORE PRIVILEGES CORE CODE PROCEDURES RANGE MULTIDISCIPLINARY MTD MTD MTD-1.Z Acupuncture MTD-1.01 Epiduroscopy MTD-1.02 Evoked potential monitoring MTD-1.03 Fluoroscopy MTD-1.04 Infusion pump and intraspinal catheter implantation MTD-1.05 Nerve stimulator implementation MTD-1.06 Radiofrequency neurolysis MTD-1.07 Transcranial doppler MTD-1.08 Transesophageal echocardiography MTD-1.09 Laser, Nd YAG MTD-1.10 Laser, KTP MTD-1.11 Laser, CO2 MTD June th Annual MIDAS+ Symposium

17 AMA Parse Columns AMA Parse Columns Incision and drainage of vulva or perineal abscess Incision and drainage of Bartholin's gland abscess Marsupialization of Bartholin's gland cyst Lysis of labial adhesions Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Biopsy of vulva or perineum (separate procedure); one lesion Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) Vulvectomy simple; partial Vulvectomy simple; complete Vulvectomy, radical, partial; Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete; Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy Partial hymenectomy or revision of hymenal ring Hymenotomy, simple incision Excision of Bartholin's gland or cyst Plastic repair of introitus Clitoroplasty for intersex state Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Colposcopy of the vulva; Colposcopy of the vulva; with biopsy(s) Colpotomy; with exploration Colpotomy; with drainage of pelvic abscess Colpocentesis (separate procedure) Incision and drainage of vaginal hematoma; obstetrical/postpartum Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma, spontaneous bleeding) Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Biopsy of vaginal mucosa; simple (separate procedure) Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) Vaginectomy, partial removal of vaginal wall; Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy) Vaginectomy, complete removal of vaginal wall; Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy) 14th Annual MIDAS+ Symposium June

18 AMA Parse Columns (cont.) Developing Privilege Dictionaries AMA Parse Columns (cont.) Colpocleisis (Le Fort type) Excision of vaginal septum Excision of vaginal cyst or tumor Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy Fitting and insertion of pessary or other intravaginal support device Diaphragm or cervical cap fitting with instructions Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure) Colporrhaphy, suture of injury of vagina (nonobstetrical) Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical) Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication) Plastic repair of urethrocele Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy Combined anteroposterior colporrhaphy; Combined anteroposterior colporrhaphy; with enterocele repair Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure) Repair of enterocele, vaginal approach (separate procedure) Repair of enterocele, abdominal approach (separate procedure) Colpopexy, abdominal approach Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus) Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy) Paravaginal defect repair (including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse) Removal or revision of sling for stress incontinence (eg, fascia or synthetic) Sling operation for stress incontinence (eg, fascia or synthetic) Pereyra procedure, including anterior colporrhaphy Construction of artificial vagina; without graft Construction of artificial vagina; with graft Closure of rectovaginal fistula; vaginal or transanal approach Closure of rectovaginal fistula; abdominal approach Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication Closure of urethrovaginal fistula; Closure of urethrovaginal fistula; with bulbocavernosus transplant Closure of vesicovaginal fistula; vaginal approach Closure of vesicovaginal fistula; transvesical and vaginal approach Vaginoplasty for intersex state Dilation of vagina under anesthesia Pelvic examination under anesthesia Removal of impacted vaginal foreign body (separate procedure) under anesthesia Colposcopy of the entire vagina, with cervix if present; Colposcopy of the entire vagina, with cervix if present; with biopsy(s) 16 June th Annual MIDAS+ Symposium

19 AMA Parse Columns (cont.) AMA Parse Columns (cont.) Laparoscopy, surgical, colpopexy (suspension of vaginal apex) Colposcopy of the cervix including upper/adjacent vagina; Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) Endocervical curettage (not done as part of a dilation and curettage) Cautery of cervix; electro or thermal Cautery of cervix; cryocautery, initial or repeat Cautery of cervix; laser ablation Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision Trachelectomy (cervicectomy), amputation of cervix (separate procedure) Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tube(s), with or without removal of ovary(s) Excision of cervical stump, abdominal approach; Excision of cervical stump, abdominal approach; with pelvic floor repair Excision of cervical stump, vaginal approach; Excision of cervical stump, vaginal approach; with anterior and/or posterior repair Excision of cervical stump, vaginal approach; with repair of enterocele Cerclage of uterine cervix, nonobstetrical Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach Dilation of cervical canal, instrumental (separate procedure) Dilation and curettage of cervical stump Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myomas; abdominal approach Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myomas; vaginal approach Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than grams, abdominal approach Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch) Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s) 14th Annual MIDAS+ Symposium June

20 Parse Code Developing Privilege Dictionaries Parse Code Incision and drainage of vulva or perineal abscess Incision and drainage of Bartholin's gland abscess Marsupialization of Bartholin's gland cyst Lysis of labial adhesions Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Biopsy of vulva or perineum (separate procedure); one lesion Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) Vulvectomy simple; partial Vulvectomy simple; complete Vulvectomy, radical, partial; Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete; Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy Partial hymenectomy or revision of hymenal ring Hymenotomy, simple incision Excision of Bartholin's gland or cyst Plastic repair of introitus Clitoroplasty for intersex state Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Colposcopy of the vulva; Colposcopy of the vulva; with biopsy(s) Colpotomy; with exploration Colpotomy; with drainage of pelvic abscess Colpocentesis (separate procedure) Incision and drainage of vaginal hematoma; obstetrical/postpartum Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma, spontaneous bleeding) Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Biopsy of vaginal mucosa; simple (separate procedure) Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) Vaginectomy, partial removal of vaginal wall; Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy) 18 June th Annual MIDAS+ Symposium

21 Parse Code (cont.) Parse Code (cont.) Vaginectomy, complete removal of vaginal wall; Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy) Colpocleisis (Le Fort type) Excision of vaginal septum Excision of vaginal cyst or tumor Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy Fitting and insertion of pessary or other intravaginal support device Diaphragm or cervical cap fitting with instructions Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure) Colporrhaphy, suture of injury of vagina (nonobstetrical) Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical) Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication) Plastic repair of urethrocele Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy Combined anteroposterior colporrhaphy; Combined anteroposterior colporrhaphy; with enterocele repair Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure) Repair of enterocele, vaginal approach (separate procedure) Repair of enterocele, abdominal approach (separate procedure) Colpopexy, abdominal approach Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus) Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy) Paravaginal defect repair (including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse) Removal or revision of sling for stress incontinence (eg, fascia or synthetic) Sling operation for stress incontinence (eg, fascia or synthetic) Pereyra procedure, including anterior colporrhaphy Construction of artificial vagina; without graft Construction of artificial vagina; with graft Closure of rectovaginal fistula; vaginal or transanal approach Closure of rectovaginal fistula; abdominal approach Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy Closure of rectovaginal fistula; transperineal approach, with perineal 14th Annual MIDAS+ Symposium June

22 Parse Code (cont.) Developing Privilege Dictionaries Parse Code (cont.) body reconstruction, with or without levator plication Closure of urethrovaginal fistula; Closure of urethrovaginal fistula; with bulbocavernosus transplant Closure of vesicovaginal fistula; vaginal approach Closure of vesicovaginal fistula; transvesical and vaginal approach Vaginoplasty for intersex state Dilation of vagina under anesthesia Pelvic examination under anesthesia Removal of impacted vaginal foreign body (separate procedure) under anesthesia Colposcopy of the entire vagina, with cervix if present; Colposcopy of the entire vagina, with cervix if present; with biopsy(s) Laparoscopy, surgical, colpopexy (suspension of vaginal apex) Colposcopy of the cervix including upper/adjacent vagina; Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) Endocervical curettage (not done as part of a dilation and curettage) Cautery of cervix; electro or thermal Cautery of cervix; cryocautery, initial or repeat Cautery of cervix; laser ablation Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision Trachelectomy (cervicectomy), amputation of cervix (separate procedure) Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tube(s), with or without removal of ovary(s) Excision of cervical stump, abdominal approach; Excision of cervical stump, abdominal approach; with pelvic floor repair Excision of cervical stump, vaginal approach; Excision of cervical stump, vaginal approach; with anterior and/or posterior repair Excision of cervical stump, vaginal approach; with repair of enterocele Cerclage of uterine cervix, nonobstetrical Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach Dilation of cervical canal, instrumental (separate procedure) Dilation and curettage of cervical stump Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural 20 June th Annual MIDAS+ Symposium