SURGICAL PROCEDURES OPERATIONS ON THE DIGESTIVE SYSTEM

Transcription

1 MOUTH Drainage of Ludwig s Angina, complete care Biopsy (IOP) Simple excision of lesion (IOP) of ranula Composite resection of lesion of oral cavity and/or oropharynx with partial resection of mandible Extended composite resection of lesion of oral cavity and oropharynx with partial resection of mandible and resection of maxilla of intra-oral tumour (greater than 2.0 cm. average diameter) Oro-pharyngeal carcinoma excision floor of mouth, mandible and glands of neck Cryosurgery or treatment of premalignant or malignant lesion(s) of oral cavity or sinuses minor intermediate major - initial repeat within 30 days LIPS Biopsy (IOP) Wedge resection of lip vermillion Resection of lip with plastic repair of lesion (IOP) Lip shave (Leukoplakia) Reconstruction Cleft lip - unilateral Reconstruction with lip switch flap Complex reconstruction or revision of previous repair and excision... IC IC IC IC Q-1

2 TONGUE (IOP) Biopsy Tongue tie, release of local anaesthetic general anaesthetic Glossectomy partial complete Wedge resection of lesion (IOP) Glossoplasty Extensive laceration IC 4 4 TEETH AND GUMS Drainage of alveolar abscess, general anaesthetic (IOP) Extraction of tooth (complete care) single each additional tooth... add PALATE AND UVULA Palate abscess (IOP) Fenestration of palate for radiotherapy Biopsy of palate (IOP) Uvulectomy or biopsy of local lesion (IOP) Cleft palate Removal of sutures Bone graft to palate Closure of fistula anterior alveolar palate Q-2

3 SALIVARY GLANDS AND DUCTS Sialolithotomy simple complicated Biopsy (IOP) Submaxillary gland Parotid gland total - with preservation of facial nerve without preservation of facial nerve subtotal - with preservation of facial nerve without preservation of facial nerve small tumour Plastic repair of duct Dilation of duct (IOP) Probing Duct (IOP) PHARYNX, ADENOIDS AND TONSILS Drainage of retropharyngeal, intra-oral or peritonsillar abscess (IOP) Drainage of lateral pharyngeal abscess Biopsy of pharynx (IOP) Branchial cyst sinus fistula Thyroglossal duct, cyst, sinus or fistula recurrent procedure Tonsillectomy, includes adenoidectomy child under adolescent or adult Adenoidectomy only - child or adult Secondary suture following T and A of parapharyngeal space lesions with mobilization of parotid gland Pharyngectomy - trans-hyoid or lateral Pharyngo-laryngectomy Pharyngoplasty Q-3

4 OESOPHAGUS For procedures on the oesophagus the following basic fees for Anaesthesiologists and Assistants will apply except for endoscopies cervical approach thoracic approach abdominal approach Endoscopies with or without biopsies (IOP) Oesophagoscopy with removal of foreign body... add with injection of varices initial... add subsequent... add with dilation... add with bronchoscopy... add with gastroscopy and gastric photography, same intubation... add with gastroscopy and gastric photography, separate intubation... add with gastroscopy with or without duodenoscopy.. add with gastroduodenoscopy with cannulation of pancreatic and/or common bile duct... add Oesophagostomy cervical - other than neonatal neonatal thoracic Intrathoracic diverticulum Crico pharyngeal diverticulum Partial oesophageal resection and reconstruction (including intestinal transposition) Resection of oesophagus Total resection of oesophagus with reconstruction... add Oesophago-gastrectomy Oesophagoplasty Heller procedure Oesophageal hiatus hernia abdominal or transthoracic approach with fundoplication recurrent with oesophagoplasty... add Ruptured oesophagus Oesophago-gastrostomy Oesophageal bypass, cervical Oesophageal stricture (Thal) - may include oesophageal hiatus hernia repair with or without gastroplasty, cervical Q-4

5 OESOPHAGUS (Cont d) Closure of oesophago-tracheal fistula Dilation of oesophagus without oesophagoscopy (IOP) (active) with or without guiding string (passive) using mercury filled tubes pneumatic dilatator retrograde dilatation STOMACH Endoscopies (IOP) Gastroscopy (with or without biopsy or photography) Gastroscopy, removal of foreign body subsequent (within 3 months following previous gastroscopy) Endoscopic removal of gastric polyp Gastrotomy with removal of tumour or foreign body with suture of bleeding peptic ulcer Pyloromyotomy (Ramstedt s) Gastrostomy Full thickness revision gastrostomy Biopsy (IOP) by gastroscopy by gastrotomy if sole procedure claim also by intubation Gastrectomy wedge resection for ulcer partial or subtotal, with or without vagotomy plus cholecystectomy at same time plus repair of hiatus hernia after previous gastroenterostomy after previous partial gastrectomy total gastrectomy of gastroduodenal lesion, recurrent ulcer of gastrojejunal lesion, recurrent ulcer Vagotomy Gastric bypass Q-5

6 STOMACH (Cont d) Pyloroplasty Pyloroplasty and vagotomy Gastroduodenostomy or gastrojejunostomy Either of above plus vagotomy Pyloroplasty and vagotomy plus repair of oesophageal hiatus hernia Pyloroplasty or gastroenterostomy with vagotomy and cholecystectomy Closure of gastrostomy or other external fistula of stomach Gastrorrhapy (for perforated ulcer or wound) Closure of gastrocolic fistula INTESTINES (EXCEPT RECTUM) Endoscopy, includes dilation for access (IOP) Duodenoscopy, with or without biopsy with cannulation of pancreatic and/or common bile duct Colonoscopy using flexible scope of sigmoid to descending colon to splenic flexure... add to hepatic flexure... add to caecum... add into terminal ileum... add if biopsy(s) and/or coagulation of angio-dysplastic lesion(s)... add Fulguration or snaring of polyp through colonscope each additional polyp, (max. of 4)... add of polyp through colonscope each additional polyp, (max of 2)... add Enterotomy Ileostomy Small intestine including excision of polyps or biopsy Insertion of feeding enterostomy when done with another intraabdominal procedure Large intestine including excision of polyps Colonoscopy with laparotomy Exteriorization of intestine (Mickulicz) Colostomy Caecostomy Revision of stenosis or obstruction more than 4 weeks after original operation Entero-enterostomy Q-6

7 INTESTINES (EXCEPT RECTUM) (Cont d) Biopsy by intubation (IOP) Local excision of lesion of intestine Resection of exteriorized intestine Enterectomy with anastomosis Small intestine duodenum other Small and large intestine terminal ileum, caecum and ascending colon Large intestine - any portion Ileostomy, subtotal colectomy Total colectomy with ileorectal anastomosis Ileostomy plus total colectomy plus abdomino-perineal resection stage procedure - (1 st stage) (2 nd stage) surgeon team - abdominal perineal Intestinal Obstruction Without resection - adult child With entero-enterostomy With resection Intestinal atresia (newborn) Meconium ileus Faecal fistula, radical with resection Revision of ileostomy or colostomy skin level full thickness Caecopexy or sigmoidopexy, independent operation Formation of an ileal pouch and primary anastomosis following total colectomy of intestine of intestine with choledocotomy Closure of colostomy or enterostomy with resection without resection Plication of small intestine for adhesions Manipulation (IOP) Reduction of prolapse Dilation of enterostomy, colostomy, etc Intubation of small intestine Q-7

8 MECKEL S DIVERTICULUM AND THE MESENTERY Meckel s diverticulum Local excision of lesion Resection of mesentery Biopsy through laparotomy APPENDIX Drainage of abscess, complete care Appendectomy with gross perforation and peritonitis RECTUM Endoscopy, includes dilation for access (IOP) Sigmoidoscopy - rigid scope with biopsy with anoscopy (separate instrumentation) Proctotomy with exploration with decompression (imperforate anus) with drainage (perirectal abscess) Proctectomy anterior resection Abdomino-perineal resection or pull through - 1 surgeon surgeon team abdominal surgeon perineal surgeon Hartmann procedure Proctosigmoidectomy for prolapse Biopsy of rectosigmoid for Hirschsprung s disease (IOP) Presacral or transsacral proctotomy and excision of lesion Polyps or tumours of rectum or sigmoid (max. 2 polyps any size or technique) (IOP) electrocoagulation - base under 2 cm excision - base under 2 cm electrocoagulation or excision - base over 2 cm Q-8

9 RECTUM (Cont d) Anastomosis of rectum Proctostomy Rectal prolapse of mucous membranes Perineal repair, major Abdominal approach Insertion of Thiersh wire of rectum, trauma external approach intraperitoneal approach Closure of fistula recto vaginal (any repair) recto vesical Manipulation (IOP) Dilation and/or disimpaction under general anaesthesia (sole procedure) Fecal disimpaction - no anaesthetic Removal of foreign body... IC IC IC IC OPERATIONS ON THE ANUS Endoscopy, includes dilation for access Proctoscopy (IOP) Biopsy (IOP) Thrombosed haemorrhoid (IOP) Sphincterotomy with repair of fissure Local excision of lesion, e.g., fissure Haemorrhoidectomy, with or without sigmoidoscopy or repair of fissure Complete haemorrhoidectomy using cryotherapy and/or Barron ligation(s) including rectal dilation (IOP) Barron non-operative haemorrhoidectomy (IOP) Local excision for malignancy Anal polyp, haemorrhoidal tags Fistula-in-ano Perineal pull through for imperforate anus Introduction Haemorrhoid injections, max. of 4 in any one year Injections for pruritus ani or fissure Q-9

10 OPERATIONS ON THE ANUS (Cont d) of scar for stenosis Anoplasty, for stenosis of anal sphincter of anal sphincter and ano-rectal ring Destruction (IOP) Curettage of fissure or fistula Cauterization of fissure Fulguration of condylomata Manipulation Dilation of anal sphincter (IOP) LIVER Biopsy - incisional (IOP) needle (IOP) Hepatotomy Hepatectomy local excision of lesion lobectomy (includes cholecystectomy) Laparotomy, cholangiogram and biopsy (neonatal jaundice) Liver transplant donor... IC IC recipient... IC IC IC IC Marsupialization of cyst or abscess Rupture or wound BILIARY TRACT Endoscopy, to include examination of stomach and duodenum (IOP) Manipulation and/or removal of common bile duct stones with or without sphincterotomy Subsequent procedure (within 3 months of previous endoscopic procedure) Q-10

11 BILIARY TRACT (Cont d) Biliary duct calculus manipulation and/or removal via T- tube tract - when sole procedure performed (IOP) Cholecystostomy Choledochotomy Transduodenal sphincterotomy and choledochotomy (previous cholecystectomy) Choledochoduodenostomy Cholecystogastrostomy Cholecystoenterostomy Hepatic choledochoenterostomy Cholecystectomy with or without cholangiogram Cholecystectomy and choledochotomy Cholecystectomy, choledochotomy and transduodenal sphincterotomy Cholecystectomy and hiatus herniorraphy Choledochectomy Common duct stricture PANCREAS Biopsy - needle (IOP) incisional (IOP) Pancreatotomy Pancreatectomy complete partial resection of head Whipple Type operation local excision of lesion islet cell tumour Resection of entire body and tail of pancreas, spleen pancreatic cyst Biopsy of other retroperitoneal lesion (IOP) Pancreatic - cystogastrostomy cystojejunostomy Marsupialization of cyst Anastomosis of body and tail of pancreas to intestine (Puestow operation) Q-11

12 ABDOMEN, PERITONEUM AND OMENTUM General Surgeon called to assist at an intra-procedural emergency, e.g., acute bleed during an abdominal procedure already in progress (claim IC) Paracentesis (IOP) Aspiration for diagnostic sample Aspiration with therapeutic drainage with or without diagnostic sample Paracentesis with lavage for diagnosis Biopsy of omentum (single or multiple) (IOP) Needle biopsy of peritoneum (IOP) Open lavage of peritoneal cavity for diagnosis without manual exploration of peritoneal cavity (IOP) Laparotomy (biopsy extra) Laparotomy for acute trauma with repair of intestine, single... add multiple or with resection... add with splenectomy... add with repair of lacerated liver... add with repair of diaphragm... add Peritoneal abscess subphrenic abdominal Pelvic abscess, incision drainage - rectal or vaginal approach (IOP) Removal of infected sutures from abdominal wall - general anaesthetic (IOP) Umbilical vein intraabdominal dissection and catheterization Insertion of peritoneo - jugular shunt for ascites primary revision within 30 days Desmoid tumour, depending on extent IC Umbilectomy - plastic Panniculectomy with repair of umbilical hernia... add Mesenteric cyst Endoscopy Peritoneoscopy or laparoscopy (IOP) without biopsy with biopsy and/or lysis of adhesions and/or removal of foreign body and/or cautery of endometrial implants Laser treatment of extensive pelvic disease (includes laparoscopy) Q-12

13 ABDOMEN, PERITONEUM AND OMENTUM (Cont d) Omentopexy, as independent operation Herniotomy Inguinal or femoral - single with hydrocele Unilateral with exploration of other side - infants and children Strangulated or incarcerated without resection of bowel with resection of bowel Inguinal and femoral - same side Umbilical adolescent or adult child (operative) Omphalocoele and gastrochisis stage repair multiple staged repair gross method of silon mesh second stage repair (completion of abdominal wall closure) Diaphragmatic, other than oesophageal hernia - 1 stage procedure trans-abdominal trans-thoracic Ventral Massive incisional hernia Recurrent - all types, excepting diaphragmatic Epigastric Secondary closure for evisceration Q-13