ACTIVE IMMUNIZING AGENTS

Transcription

1 Therapeutic Injections and Immunizations Immunizations Immunizations are an excluded service for purposes of travel, employment and emigration, and may only be claimed if the injection is for a publicly funded vaccine administered in accordance with the eligibility criteria as is determined from time to time by the Communicable Disease Control Branch of Manitoba Health. The eligibility criteria for most publicly funded vaccines can be found on Manitoba Health s website at ACTIVE IMMUNIZING AGENTS BCG Bacillus Calmette Guérin 8731 single dose DTaP IPV Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus paediatric 8924 single dose DTaP IPV Hib Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus influenza type b paediatric 8802 single dose HA Hepatitis A 8904 single dose HAHB Hepatitis A and B 8899 single dose HB Hepatitis B 8913 single dose Hib Haemophilus influenzae type b 8901 single dose HPV 9 Human Papillomavirus type 6, 11, 16, 18, 31, 33, 45, 52, single dose Inf(s) Influenza seasonal 8791 single dose Inf ITN Influenza Intranasal 8969 single dose Inf ph1n1(adj) Influenza pandemic H1N1 adjuvanted Inf ph1n1 (unadj) Influenza pandemic H1N1 unadjuvanted IPV Inactivated Polio Virus 8931 single dose Men B Multicomponent Meningococcal B 8970 single dose B-30 April 1, 2019

2 Anesthesia April 1, 2019 C-23

3 Anesthesia C-28 April 1, 2019

4 Musculoskeletal System Knee Arthroplasty Rules: 1) All arthroplasty fees include associated bone and soft tissue procedures, including but not limited to synovectomy, ligament and tendon release and lengthening and repair, and injection of medications. 2) Revision fees include insertion of PROSTALAC type components. UNIT VAULE 1402 Total knee arthroplasty, with patellar resurfacing Total knee arthroplasty without patellar resurfacing Unicondylar knee arthroplasty, medial or lateral compartment Patellar resurfacing only Total knee arthroplasty with removal of previous partial prosthesis... 1, Revision knee arthroplasty with removal and replacement of modular tibial bearing surface (with or without patellar revision)... 1, Revision of knee arthroplasty with removal and replacement of one or both femoral or tibial components (with or without patellar component revision)... 1, Removal of knee prosthesis with or without spacer insertion Removal of knee prosthesis with knee arthrodesis, with or without bone graft... 1, Structural bone graft and bone graft substitutes, including fixation of graft e.g. Tantalum type, to one or more sites, add Morsellized bone graft, to one or more sites, add Impaction bone graft to femur (Exeter/Ling technique), add Tibial tubercle osteotomy, add Non-structural bone substitute, to one or more sites, add Tariffs 1440, 1442, 1444, 1448 and 1449 are add-ons that apply to Knee Arthroplasty only. Foot and Ankle Arthroplasty 1152 Ankle, distraction includes application of frame ~1500 Total ankle arthroplasty ~1501 Revision total ankle arthroplasty with exchange of liner ~1502 Removal of ankle prosthesis with or without spacer insertion ~1503 Revision of one or both components of ankle arthroplasty... 1, ~1504 Removal of ankle prosthesis with ankle arthrodesis, with or without bone graft... 1, ~1505 Total ankle arthroplasty with take down of arthrodesis... 1, ~1506 Morsellized bone graft, to one or more sites, add F-20 April 1, 2019

5 Musculoskeletal System ~1507 Impaction bone graft or structural bone graft to one or more sites, add ) All arthroplasty fees include associated bone and soft tissue procedures including but not limited to synovectomy, ligament lengthening and injection of medications. 2) Other procedures, e.g., subtular fusion, deltoid and/or lateral ligament repair, tendon repair and/or release and calcaneous osteotomy performed away from the ankle, at the same sitting, are claimable in accordance with the Surgical Rules of Application. 3) ~1506 and ~1507 are not claimable together. ~1506 and ~1507 may only be claimed as add-ons to tariffs ~1500, ~1503 and ~1505. UNIT VAULE 1153 Toe, one (1) joint (50% for each additional) First Metatarsophalangeal joint, all methods including hallux valgus correction with bunionectomy and medial placation Proximal phalanx osteotomy, add Shaft metatarsal osteotomy, add st TMT fusion, add Reconstruction, all metacarpophalangeal joints, one (1) hand all metatarsophalangeal joints, one (1) foot both feet ARTHROTOMY OR CAPSULOTOMY With exploration, drainage, or removal of loose body, (e.g. for osteochondritis, foreign body or synovial biopsy) Shoulder Elbow Wrist Finger, one (1) Other joints of upper extremity Hip Knee Ankle Toe, great toe Other joints lower extremity DISLOCATION 1251* Dislocation, temporomandibular joint, closed reduction Vertebrae, cervical, closed reduction open reduction dorsal, simple, closed reduction April 1, 2019 F-21

6 Digestive System ESOPHAGUS 3055* Esophagoscopy, diagnostic, with or without biopsy * subsequent, same hospital admission with foreign body removal * with injection of varices or band ligation STOMACH 3121* Gastroscopy, diagnostic with or without biopsy * with polypectomy * Esophagogastroduodenoscopy (EGD) with or without biopsy SMALL INTESTINE ~3215 Balloon assisted enteroscopy, oral route ~3216 Balloon assisted enteroscopy, rectal route ) Patients will have previously undergone some or all of the following: a capsule endoscopy, CT scan, or present exceptional clinical circumstances as per by report, such as small bowel bleeding. 2) Payable only for services performed at a facility to be designated by Manitoba Health (Health Sciences Centre) by a gastroenterologist who has been approved by the Gastroenterology Section Head at the Winnipeg Regional Health Authority. 3) Tariffs 3055, 3057, 3063, 3065, 3121, 3122, 3123, 3185, 3186, 3187, 3188, 3189, 3190, 3196 cannot be claimed concurrently with tariff ~3215 or ~ * Small bowel enteroscopy by mouth using designated enteroscope or colonoscope Pathology report may be required Capsule Endoscopy Includes the review of imaging of the small bowel and report to the referring physician ) A visit cannot be claimed at the same sitting as the initiation of capsule endoscopy. 2) Minimum time for the service is one (1) hour including the assessment of referrals to determine indication for procedure. 3) Patients will have previously undergone some or all of the following: Esophagogastroduodenoscopy (EGD), colonoscopy, small bowel enteroscopy and/or small bowel series radiography & fluoroscopy. 4) Payable only for services provided by a Gastroenterologist or by a qualified physician with training in capsule endoscopy, at a facility to be designated by Manitoba Health (Health Science Centre and Brandon Regional Health Centre). J-8 April 1, 2019

7 Renal Transplants P RENAL TRANSPLANTS These benefits cannot be correctly interpreted without reference to the Rules of Application Renal transplant... 1, Cadaver nephrectomy single for local implant or export... 1, Cadaver nephrectomy double for local implants or export... 1, ~5900 Donor nephrectomy after cardiac death... 2, Tariff ~5900 is for all procedures performed including but not limited to: unilateral or bilateral nephrectomy, aortic and venous cannulation, supra renal clamping and incisional or excisional biopsy of the spleen Live donor nephrectomy... 1, Laparoscopic live donor nephrectomy... 1, Rejection transplant nephrectomy... 1, Pre-transplant nephrectomy (recipient) unilateral bilateral Marsupialization of post transplant lymphocele The above fees represent the total fees of those surgeons in actual attendance and will be divided among the team in accordance with their involvement. They do not include Nephrologists fees which are listed below. NEPHROLOGISTS BENEFITS Recipient related services; including nephrological management of transplantation including examination, supervision of allocation, tissue typing and interpretation of cross-match and immunological risk, determining induction and maintenance immunosuppression and complete patient care for the first three (3) day of postoperative care. 1) One of each service may be billed per patient. 2) 5871, 5872 and 5873 are payable to the attending physician of record for the day Day Day Day Donor related services; including the nephrological management of organ procurement, management of the neurologically dead donor on life support systems, the assessment of renal functions pre-nephrectomy, immunotherapy prenephrectomy, and assessment of potential recipients, etc Subsequent postoperative routine care at daily care rates, per day Management of rejection crises, care ordinarily equivalent to that of the first three (3) postoperative days, per day Management of rejection crises requiring dialysis; as for acute renal failure (includes daily care by a Nephrologist); equivalent to repeat hemodialysis in acute renal failure, per dialysis See existing schedule April 1, 2019 P-1