SURGICAL PROCEDURES OPERATIONS ON THE NERVOUS SYSTEM

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1 98100 Hypothermia - when employed, basic fee for any procedure on nervous system BRAIN Astrocytoma, oligodendroglioma, glioblastoma or metastatic tumour Craniotomy plus excision supratentorial infratentorial Craniotomy plus lobectomy Microsurgical removal...add Meningioma and other tumourous lesions Craniotomy plus excision supratentorial infratentorial plus basal microsurgical removal...add lesion greater than 4 cm. diameter...add team fee for acoustic neuroma...add Intracranial aneurysm repair carotid circulation vertebrobasilar circulation (including aneurysm of vein of Galen) microsurgical approach...add Cerebral arteriovenous malformation Craniotomy for obliteration and/or excision supratentorial infratentorial microsurgical approach...add Extracranial approach to include balloon catheter or embolization techniques Extracranial-intracranial microvascular anastomosis superficial temporal artery occipital artery use of graft (autogenous vessel or synthetic)...add Carotid-cavernous fistula intracranial obliteration (to include combined cervical and intracranial procedure) extracranial approach Spontaneous Intracerebral Haemorrhage Craniotomy plus removal supratentorial infratentorial Burr hole plus drainage V-1

2 BRAIN (Cont d) Intracranial Cyst Craniotomy plus evacuation, to include interventriculostomy supratentorial infratentorial Burr hole plus aspiration Brain Abscess crainiotomy and excision burr hole and aspiration subsequent aspiration through existing burr hole within 30 days Miscellaneous Procedures Craniotomy for brain biopsy (other than for tumour) Hemispherectomy Temporal lobectomy and/or excision of cortical scar for epilepsy Craniotomy plus midline commissurotomy Repair of encephalocoele Posterior fossa decompression for Arnold Chiari malformation Stereotaxis - intracranial, to include ventriculography Burr hole plus needling of brain for biopsy (IOP) Ventriculogram, includes burr holes, air or positive contrast (IOP) Ventricular puncture through previous burr hole or fontanelle, or puncture and/or aspiration of cisterna magna (IOP) Ventriculoscopy, to include burr hole (IOP) with interventriculostomy... add External ventricular drainage (IOP) Insertion of intracranial catheter or transducer for purposes of monitoring (IOP) Subsequent revisions or replacements within 30 days (IOP) - each Re-opening of craniotomy for post-operative haematoma or infection, or for removal of bone flap Intracranial duraplasty (greater than 2 cm. diameter) to any intracranial procedure... add Intra-operative electrophysiological monitoring and/or stimulation... add Repeat craniotomy (excluding 98254), add to benefit for above surgery involving craniotomy Cranio-Cerebral Injuries Reduction of skull fracture simple, depressed compound with repair of dural laceration... add Extracerebral haematoma drainage of burr hole(s) - unilateral drainage and/or removal by craniotomy V-2

3 BRAIN (Cont d) Cerebral Injury Removal of intracerebral haematoma and/or debridement of traumatized brain (includes management of any skull fracture) Removal of foreign body from brain CSF leak - intracranial repair Decompressive craniectomy (frontal, sub-temporal) Subdural tap(s) - unilateral (IOP) Diagnostic burr hole(s), uni or bilateral (IOP) SKULL Repair of skull defect: acrylic or metal cranioplasty replacement of bone flap Skull tumour, excision Craniosynostosis Linear Craniectomy suture multiple sutures Morcellation procedure suture multiple sutures Lateral canthal advancement - unilateral surgeon surgeons - major portion of surgery lesser portion of surgery bilateral surgeon surgeons - major portion of surgery lesser portion of surgery Craniotomy for craniofacial repair with repair of frontonasal encephalocoele...add ORBIT Craniotomy plus removal of orbital tumour plus orbital decompression (roof of orbit with or without lateral wall) for decompression of optic nerve(s) V-3

4 PITUITARY Hypophysectomy or excision of tumour, any technique except transpenoidal Hypophysectomy, transphenoidal, team fee CAROTID AND VERTEBRAL ARTERIES Temporal artery - biopsy, ligation or crysurgery (IOP) Carotid endarterectomy - with or without bypass with patch or graft Progressive carotid occlusion by Selverstone clamp (IOP) CSF SHUNTING PROCEDURES Lumbo-peritoneal shunt revision peritoneal end revision lumbar end revision entire shunt Meningocoele-peritoneal shunt Ventriculo-peritoneal shunt revision ventricular end revision peritoneal end revision entire shunt Ventriculo-atrial shunt revision ventricular end revision atrial end revision entire shunt removal Insertion CSF reservoir (Ommaya including burr holes) Third ventriculostomy CRANIAL NERVES Percutaneous coagulation of gasserian (trigeminal) ganglion or root - unilateral Decompression gasserian ganglion Rhizotomy or differential section trigeminal nerve temporal approach posterior fossa approach avulsion supraorbital nerve avulsion infraorbital nerve avulsion mandibular nerve V-4

5 CRANIAL NERVES (Cont d) Anastomosis hypoglossal to facial nerve Occipital and/or suboccipital craniectomy for compression, decompression or section of cranial nerves Division vestibular nerve Division of glossopharyngeal nerve Division of nerves to sternomastoid in neck PERIPHERAL NERVES Biopsy and/or avulsion of peripheral nerve (IOP) Brachial plexus exploration in posterior triangle in axilla in posterior triangle and axilla Decompression by scalenotomy excision of cervical rib Exploration of major nerve (median, ulna, radial, sciatic, etc.) with or without neurolysis Removal tumour major peripheral nerve Suture of major peripheral nerve epineural repair fascicular technique, first fascicle each additional fascicle repaired...add Graft of major peripheral nerve epineural grafting fascicular grafting, first fascicle each additional fascicle grafted...add Suture or decompression of small peripheral nerve (e.g., digital) epineural technique fascicular repair, first fascicle. Use fee code to claim for additional fascicles repaired Graft of small peripheral nerve epineural technique fascicular technique, including first fascicle. Use fee code to claim additional fascicles grafted Delayed repair of graft (more than 4 weeks from date of injury),...add Microsurgical technique used...add Decompression median nerve at wrist Decompression ulnar nerve at elbow Transposition of ulnar nerve at elbow Decompression lateral femoral cutaneous nerve Division obturator nerve Morton s neuroma - excision Excision of glomus tumour (IOP) Neuroma - single, subcutaneous (IOP) Implantation of electrode for peripheral nerve stimulation (IOP) V-5

6 AUTONOMIC NERVOUS SYSTEM Sympathectomy Cervical Cervicodorsal - unilateral thoracic approach Lumbar - unilateral bilateral SPINAL CORD AND NERVE ROOTS For operations on the spinal cord and nerve roots, the basic Assistants and Anaesthesiologists fees will depend on the surgical approach cervical dorsal or lumbar Tumours - partial or total extradural intradural (extramedullary) segments or more... add Intramedullary biopsy and/or decompression removal segments or more... add with operating microscope (applies to intradural or intramedullary tumours)... add AV malformation of cord Excision or operative obliteration with or without evacuation of haematoma segments or more... add with operating microscope... add Insertion/revision of implantable infusion pump Implantation of permanent subcutaneous reservoir including laminectomy Note: is not eligible for payment when rendered with any decompressive codes Laminectomy for intradural neurolysis or unusual lesions, e.g., diastematomyelia, tethered conus, intramedullary haematoma etc. - uni or bilateral laminectomy extending over 3 segments or more (applies to tethered conus, diastematomyelia extradural, intradural or intramedullary tumour, AVM, or other decompressive laminectomy)... add with operating microscope... add V-6

7 SPINAL CORD AND NERVE ROOTS (Cont d) Laminectomy and decompression of spinal cord no opening of dura with opening of dura (with or without dentate ligament section) no tumour With fusion by same surgeon level (payable in addition to fee codes above) levels or more (payable in addition to fee codes above) Fusion by separate surgeon level or more levels Refusion of any of above Re-opening of laminectomy for post-op haematoma, infection or CSF leak Medullary spinal trigeminal tractotomy with operating microscope...add Percutaneous cordotomy or tractotomy Open myelotomy for lesion (e.g., tractotomy, midline commissurotomy, Bischoff s longitudinal myelotomy, etc.) - uni or bilateral Spinal intradural anterior and/or posterior rhizotomy - uni or bilateral, any number of roots segments or more...add with operating microscope...add Repair of meningocoele Repair of meningomyelocoele surgeon surgeons neurosurgeon reconstructive surgeon Lumbar puncture (IOP) with instillation of medication (IOP) Percutaneous lumbar rhizotomy or neurectomy (IOP) first level additional levels - (to a max. of 4 additional levels) - each Interpretation of CSF smear in malignancy (IOP) V-7