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

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

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: www.midasplus.com. 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 85715 (800) 737 8835 Visit our Web site at: www.midasplus.com/

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 2005 1

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 2005 14th Annual MIDAS+ Symposium

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 2005 3

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 ANE2.02 11 Moving Data to Privilege Dictionaries Open Major Privileges Definition dictionary using icon on Seeker Menu Bar. 12 4 June 2005 14th Annual MIDAS+ Symposium

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. 15 14th Annual MIDAS+ Symposium June 2005 5

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. 18 6 June 2005 14th Annual MIDAS+ Symposium

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 2005 7

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. 24 8 June 2005 14th Annual MIDAS+ Symposium

Anesthesia Core Privilege Group Anesthesia Core Privilege Group CORE PRIVILEGES CORE CODPROCEDURES RANGE ANESTHESIA-1 ANE1 ANE1.01 - 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 ANE1.01 - 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-1.01 - 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-1.12 14th Annual MIDAS+ Symposium June 2005 9

OB-GYN Core Privilege Group Developing Privilege Dictionaries OB-GYN Core Privilege Group CORE PRIVILEGES CORE CODE PROCEDURES RANGE OB/GYN-1 OBS OBS-1.1 - 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-1.1 - 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 2005 14th Annual MIDAS+ Symposium

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-1.1 - 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-1.1 - 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-1.1 - 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 2005 11

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-1.1 - 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-1.1 - 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-1.1 12 June 2005 14th Annual MIDAS+ Symposium

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-1.1 - 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-1.1 - 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-1.1 - 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-1.5 14th Annual MIDAS+ Symposium June 2005 13

MTD Core Privilege Group Developing Privilege Dictionaries MTD Core Privilege Group CORE PRIVILEGES CORE CODE PROCEDURES RANGE MULTIDISCIPLINARY MTD MTD-1.01 - 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-1.12 14 June 2005 14th Annual MIDAS+ Symposium

AMA Parse Columns AMA Parse Columns 5640501 Incision and drainage of vulva or perineal abscess 5642001 Incision and drainage of Bartholin's gland abscess 5644001 Marsupialization of Bartholin's gland cyst 5644101 Lysis of labial adhesions 5650101 Destruction of lesion(s), vulva; simple (eg, laser surgery, 5650102 electrosurgery, cryosurgery, chemosurgery) 5651501 Destruction of lesion(s), vulva; extensive (eg, laser surgery, 5651502 electrosurgery, cryosurgery, chemosurgery) 5660501 Biopsy of vulva or perineum (separate procedure); one lesion 5660601 Biopsy of vulva or perineum (separate procedure); each separate 5660602 additional lesion (List separately in addition to code for primary 5660603 procedure) 5662001 Vulvectomy simple; partial 5662501 Vulvectomy simple; complete 5663001 Vulvectomy, radical, partial; 5663101 Vulvectomy, radical, partial; with unilateral inguinofemoral 5663102 lymphadenectomy 5663201 Vulvectomy, radical, partial; with bilateral inguinofemoral 5663202 lymphadenectomy 5663301 Vulvectomy, radical, complete; 5663401 Vulvectomy, radical, complete; with unilateral inguinofemoral 5663402 lymphadenectomy 5663701 Vulvectomy, radical, complete; with bilateral inguinofemoral 5663702 lymphadenectomy 5664001 Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic 5664002 lymphadenectomy 5670001 Partial hymenectomy or revision of hymenal ring 5672001 Hymenotomy, simple incision 5674001 Excision of Bartholin's gland or cyst 5680001 Plastic repair of introitus 5680501 Clitoroplasty for intersex state 5681001 Perineoplasty, repair of perineum, nonobstetrical (separate procedure) 5682001 Colposcopy of the vulva; 5682101 Colposcopy of the vulva; with biopsy(s) 5700001 Colpotomy; with exploration 5701001 Colpotomy; with drainage of pelvic abscess 5702001 Colpocentesis (separate procedure) 5702201 Incision and drainage of vaginal hematoma; obstetrical/postpartum 5702301 Incision and drainage of vaginal hematoma; non-obstetrical (eg, 5702302 post-trauma, spontaneous bleeding) 5706101 Destruction of vaginal lesion(s); simple (eg, laser surgery, 5706102 electrosurgery, cryosurgery, chemosurgery) 5706501 Destruction of vaginal lesion(s); extensive (eg, laser surgery, 5706502 electrosurgery, cryosurgery, chemosurgery) 5710001 Biopsy of vaginal mucosa; simple (separate procedure) 5710501 Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) 5710601 Vaginectomy, partial removal of vaginal wall; 5710701 Vaginectomy, partial removal of vaginal wall; with removal of 5710702 paravaginal tissue (radical vaginectomy) 5710901 Vaginectomy, partial removal of vaginal wall; with removal of 5710902 paravaginal tissue (radical vaginectomy) with bilateral total pelvic 5710903 lymphadenectomy and para-aortic lymph node sampling (biopsy) 5711001 Vaginectomy, complete removal of vaginal wall; 5711101 Vaginectomy, complete removal of vaginal wall; with removal of 5711102 paravaginal tissue (radical vaginectomy) 5711201 Vaginectomy, complete removal of vaginal wall; with removal of 5711202 paravaginal tissue (radical vaginectomy) with bilateral total pelvic 5711203 lymphadenectomy and para-aortic lymph node sampling (biopsy) 14th Annual MIDAS+ Symposium June 2005 15

AMA Parse Columns (cont.) Developing Privilege Dictionaries AMA Parse Columns (cont.) 5712001 Colpocleisis (Le Fort type) 5713001 Excision of vaginal septum 5713501 Excision of vaginal cyst or tumor 5715001 Irrigation of vagina and/or application of medicament for treatment of 5715002 bacterial, parasitic, or fungoid disease 5715501 Insertion of uterine tandems and/or vaginal ovoids for clinical 5715502 brachytherapy 5716001 Fitting and insertion of pessary or other intravaginal support device 5717001 Diaphragm or cervical cap fitting with instructions 5718001 Introduction of any hemostatic agent or pack for spontaneous or 5718002 traumatic nonobstetrical vaginal hemorrhage (separate procedure) 5720001 Colporrhaphy, suture of injury of vagina (nonobstetrical) 5721001 Colpoperineorrhaphy, suture of injury of vagina and/or perineum 5721002 (nonobstetrical) 5722001 Plastic operation on urethral sphincter, vaginal approach (eg, Kelly 5722002 urethral plication) 5723001 Plastic repair of urethrocele 5724001 Anterior colporrhaphy, repair of cystocele with or without repair of 5724002 urethrocele 5725001 Posterior colporrhaphy, repair of rectocele with or without 5725002 perineorrhaphy 5726001 Combined anteroposterior colporrhaphy; 5726501 Combined anteroposterior colporrhaphy; with enterocele repair 5726701 Insertion of mesh or other prosthesis for repair of pelvic floor defect, 5726702 each site (anterior, posterior compartment), vaginal approach (List 5726703 separately in addition to code for primary procedure) 5726801 Repair of enterocele, vaginal approach (separate procedure) 5727001 Repair of enterocele, abdominal approach (separate procedure) 5728001 Colpopexy, abdominal approach 5728201 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, 5728202 iliococcygeus) 5728301 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator 5728302 myorrhaphy) 5728401 Paravaginal defect repair (including repair of cystocele, stress urinary 5728402 incontinence, and/or incomplete vaginal prolapse) 5728701 Removal or revision of sling for stress incontinence (eg, fascia or 5728702 synthetic) 5728801 Sling operation for stress incontinence (eg, fascia or synthetic) 5728901 Pereyra procedure, including anterior colporrhaphy 5729101 Construction of artificial vagina; without graft 5729201 Construction of artificial vagina; with graft 5730001 Closure of rectovaginal fistula; vaginal or transanal approach 5730501 Closure of rectovaginal fistula; abdominal approach 5730701 Closure of rectovaginal fistula; abdominal approach, with concomitant 5730702 colostomy 5730801 Closure of rectovaginal fistula; transperineal approach, with perineal 5730802 body reconstruction, with or without levator plication 5731001 Closure of urethrovaginal fistula; 5731101 Closure of urethrovaginal fistula; with bulbocavernosus transplant 5732001 Closure of vesicovaginal fistula; vaginal approach 5733001 Closure of vesicovaginal fistula; transvesical and vaginal approach 5733501 Vaginoplasty for intersex state 5740001 Dilation of vagina under anesthesia 5741001 Pelvic examination under anesthesia 5741501 Removal of impacted vaginal foreign body (separate procedure) under 5741502 anesthesia 5742001 Colposcopy of the entire vagina, with cervix if present; 5742101 Colposcopy of the entire vagina, with cervix if present; with biopsy(s) 16 June 2005 14th Annual MIDAS+ Symposium

AMA Parse Columns (cont.) AMA Parse Columns (cont.) 5742501 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) 5745201 Colposcopy of the cervix including upper/adjacent vagina; 5745401 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) 5745402 of the cervix and endocervical curettage 5745501 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) 5745502 of the cervix 5745601 Colposcopy of the cervix including upper/adjacent vagina; with 5745602 endocervical curettage 5746001 Colposcopy of the cervix including upper/adjacent vagina; with loop 5746002 electrode biopsy(s) of the cervix 5746101 Colposcopy of the cervix including upper/adjacent vagina; with loop 5746102 electrode conization of the cervix 5750001 Biopsy, single or multiple, or local excision of lesion, with or without 5750002 fulguration (separate procedure) 5750501 Endocervical curettage (not done as part of a dilation and curettage) 5751001 Cautery of cervix; electro or thermal 5751101 Cautery of cervix; cryocautery, initial or repeat 5751301 Cautery of cervix; laser ablation 5752001 Conization of cervix, with or without fulguration, with or without 5752002 dilation and curettage, with or without repair; cold knife or laser 5752201 Conization of cervix, with or without fulguration, with or without 5752202 dilation and curettage, with or without repair; loop electrode excision 5753001 Trachelectomy (cervicectomy), amputation of cervix (separate procedure) 5753101 Radical trachelectomy, with bilateral total pelvic lymphadenectomy and 5753102 para-aortic lymph node sampling biopsy, with or without removal of 5753103 tube(s), with or without removal of ovary(s) 5754001 Excision of cervical stump, abdominal approach; 5754501 Excision of cervical stump, abdominal approach; with pelvic floor repair 5755001 Excision of cervical stump, vaginal approach; 5755501 Excision of cervical stump, vaginal approach; with anterior and/or 5755502 posterior repair 5755601 Excision of cervical stump, vaginal approach; with repair of enterocele 5770001 Cerclage of uterine cervix, nonobstetrical 5772001 Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach 5780001 Dilation of cervical canal, instrumental (separate procedure) 5782001 Dilation and curettage of cervical stump 5810001 Endometrial sampling (biopsy) with or without endocervical sampling 5810002 (biopsy), without cervical dilation, any method (separate procedure) 5812001 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) 5814001 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural 5814002 myoma(s) with total weight of 250 grams or less and/or removal of 5814003 surface myomas; abdominal approach 5814501 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural 5814502 myoma(s) with total weight of 250 grams or less and/or removal of 5814503 surface myomas; vaginal approach 5814601 Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural 5814602 myomas and/or intramural myomas with total weight greater than 250 5814603 grams, abdominal approach 5815001 Total abdominal hysterectomy (corpus and cervix), with or without 5815002 removal of tube(s), with or without removal of ovary(s); 5815201 Total abdominal hysterectomy (corpus and cervix), with or without 5815202 removal of tube(s), with or without removal of ovary(s); with 5815203 colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch) 5818001 Supracervical abdominal hysterectomy (subtotal hysterectomy), with or 5818002 without removal of tube(s), with or without removal of ovary(s) 5820001 Total abdominal hysterectomy, including partial vaginectomy, with 5820002 para-aortic and pelvic lymph node sampling, with or without removal of 5820003 tube(s), with or without removal of ovary(s) 14th Annual MIDAS+ Symposium June 2005 17

Parse Code Developing Privilege Dictionaries Parse Code 56405 Incision and drainage of vulva or perineal abscess 56420 Incision and drainage of Bartholin's gland abscess 56440 Marsupialization of Bartholin's gland cyst 56441 Lysis of labial adhesions 56501 Destruction of lesion(s), vulva; simple (eg, laser surgery, 56501 electrosurgery, cryosurgery, chemosurgery) 56515 Destruction of lesion(s), vulva; extensive (eg, laser surgery, 56515 electrosurgery, cryosurgery, chemosurgery) 56605 Biopsy of vulva or perineum (separate procedure); one lesion 56606 Biopsy of vulva or perineum (separate procedure); each separate 56606 additional lesion (List separately in addition to code for primary 56606 procedure) 56620 Vulvectomy simple; partial 56625 Vulvectomy simple; complete 56630 Vulvectomy, radical, partial; 56631 Vulvectomy, radical, partial; with unilateral inguinofemoral 56631 lymphadenectomy 56632 Vulvectomy, radical, partial; with bilateral inguinofemoral 56632 lymphadenectomy 56633 Vulvectomy, radical, complete; 56634 Vulvectomy, radical, complete; with unilateral inguinofemoral 56634 lymphadenectomy 56637 Vulvectomy, radical, complete; with bilateral inguinofemoral 56637 lymphadenectomy 56640 Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic 56640 lymphadenectomy 56700 Partial hymenectomy or revision of hymenal ring 56720 Hymenotomy, simple incision 56740 Excision of Bartholin's gland or cyst 56800 Plastic repair of introitus 56805 Clitoroplasty for intersex state 56810 Perineoplasty, repair of perineum, nonobstetrical (separate procedure) 56820 Colposcopy of the vulva; 56821 Colposcopy of the vulva; with biopsy(s) 57000 Colpotomy; with exploration 57010 Colpotomy; with drainage of pelvic abscess 57020 Colpocentesis (separate procedure) 57022 Incision and drainage of vaginal hematoma; obstetrical/postpartum 57023 Incision and drainage of vaginal hematoma; non-obstetrical (eg, 57023 post-trauma, spontaneous bleeding) 57061 Destruction of vaginal lesion(s); simple (eg, laser surgery, 57061 electrosurgery, cryosurgery, chemosurgery) 57065 Destruction of vaginal lesion(s); extensive (eg, laser surgery, 57065 electrosurgery, cryosurgery, chemosurgery) 57100 Biopsy of vaginal mucosa; simple (separate procedure) 57105 Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) 57106 Vaginectomy, partial removal of vaginal wall; 57107 Vaginectomy, partial removal of vaginal wall; with removal of 57107 paravaginal tissue (radical vaginectomy) 57109 Vaginectomy, partial removal of vaginal wall; with removal of 57109 paravaginal tissue (radical vaginectomy) with bilateral total pelvic 57109 lymphadenectomy and para-aortic lymph node sampling (biopsy) 18 June 2005 14th Annual MIDAS+ Symposium

Parse Code (cont.) Parse Code (cont.) 57110 Vaginectomy, complete removal of vaginal wall; 57111 Vaginectomy, complete removal of vaginal wall; with removal of 57111 paravaginal tissue (radical vaginectomy) 57112 Vaginectomy, complete removal of vaginal wall; with removal of 57112 paravaginal tissue (radical vaginectomy) with bilateral total pelvic 57112 lymphadenectomy and para-aortic lymph node sampling (biopsy) 57120 Colpocleisis (Le Fort type) 57130 Excision of vaginal septum 57135 Excision of vaginal cyst or tumor 57150 Irrigation of vagina and/or application of medicament for treatment of 57150 bacterial, parasitic, or fungoid disease 57155 Insertion of uterine tandems and/or vaginal ovoids for clinical 57155 brachytherapy 57160 Fitting and insertion of pessary or other intravaginal support device 57170 Diaphragm or cervical cap fitting with instructions 57180 Introduction of any hemostatic agent or pack for spontaneous or 57180 traumatic nonobstetrical vaginal hemorrhage (separate procedure) 57200 Colporrhaphy, suture of injury of vagina (nonobstetrical) 57210 Colpoperineorrhaphy, suture of injury of vagina and/or perineum 57210 (nonobstetrical) 57220 Plastic operation on urethral sphincter, vaginal approach (eg, Kelly 57220 urethral plication) 57230 Plastic repair of urethrocele 57240 Anterior colporrhaphy, repair of cystocele with or without repair of 57240 urethrocele 57250 Posterior colporrhaphy, repair of rectocele with or without 57250 perineorrhaphy 57260 Combined anteroposterior colporrhaphy; 57265 Combined anteroposterior colporrhaphy; with enterocele repair 57267 Insertion of mesh or other prosthesis for repair of pelvic floor defect, 57267 each site (anterior, posterior compartment), vaginal approach (List 57267 separately in addition to code for primary procedure) 57268 Repair of enterocele, vaginal approach (separate procedure) 57270 Repair of enterocele, abdominal approach (separate procedure) 57280 Colpopexy, abdominal approach 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, 57282 iliococcygeus) 57283 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator 57283 myorrhaphy) 57284 Paravaginal defect repair (including repair of cystocele, stress urinary 57284 incontinence, and/or incomplete vaginal prolapse) 57287 Removal or revision of sling for stress incontinence (eg, fascia or 57287 synthetic) 57288 Sling operation for stress incontinence (eg, fascia or synthetic) 57289 Pereyra procedure, including anterior colporrhaphy 57291 Construction of artificial vagina; without graft 57292 Construction of artificial vagina; with graft 57300 Closure of rectovaginal fistula; vaginal or transanal approach 57305 Closure of rectovaginal fistula; abdominal approach 57307 Closure of rectovaginal fistula; abdominal approach, with concomitant 57307 colostomy 57308 Closure of rectovaginal fistula; transperineal approach, with perineal 14th Annual MIDAS+ Symposium June 2005 19

Parse Code (cont.) Developing Privilege Dictionaries Parse Code (cont.) 57308 body reconstruction, with or without levator plication 57310 Closure of urethrovaginal fistula; 57311 Closure of urethrovaginal fistula; with bulbocavernosus transplant 57320 Closure of vesicovaginal fistula; vaginal approach 57330 Closure of vesicovaginal fistula; transvesical and vaginal approach 57335 Vaginoplasty for intersex state 57400 Dilation of vagina under anesthesia 57410 Pelvic examination under anesthesia 57415 Removal of impacted vaginal foreign body (separate procedure) under 57415 anesthesia 57420 Colposcopy of the entire vagina, with cervix if present; 57421 Colposcopy of the entire vagina, with cervix if present; with biopsy(s) 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) 57452 Colposcopy of the cervix including upper/adjacent vagina; 57454 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) 57454 of the cervix and endocervical curettage 57455 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) 57455 of the cervix 57456 Colposcopy of the cervix including upper/adjacent vagina; with 57456 endocervical curettage 57460 Colposcopy of the cervix including upper/adjacent vagina; with loop 57460 electrode biopsy(s) of the cervix 57461 Colposcopy of the cervix including upper/adjacent vagina; with loop 57461 electrode conization of the cervix 57500 Biopsy, single or multiple, or local excision of lesion, with or without 57500 fulguration (separate procedure) 57505 Endocervical curettage (not done as part of a dilation and curettage) 57510 Cautery of cervix; electro or thermal 57511 Cautery of cervix; cryocautery, initial or repeat 57513 Cautery of cervix; laser ablation 57520 Conization of cervix, with or without fulguration, with or without 57520 dilation and curettage, with or without repair; cold knife or laser 57522 Conization of cervix, with or without fulguration, with or without 57522 dilation and curettage, with or without repair; loop electrode excision 57530 Trachelectomy (cervicectomy), amputation of cervix (separate procedure) 57531 Radical trachelectomy, with bilateral total pelvic lymphadenectomy and 57531 para-aortic lymph node sampling biopsy, with or without removal of 57531 tube(s), with or without removal of ovary(s) 57540 Excision of cervical stump, abdominal approach; 57545 Excision of cervical stump, abdominal approach; with pelvic floor repair 57550 Excision of cervical stump, vaginal approach; 57555 Excision of cervical stump, vaginal approach; with anterior and/or 57555 posterior repair 57556 Excision of cervical stump, vaginal approach; with repair of enterocele 57700 Cerclage of uterine cervix, nonobstetrical 57720 Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach 57800 Dilation of cervical canal, instrumental (separate procedure) 57820 Dilation and curettage of cervical stump 58100 Endometrial sampling (biopsy) with or without endocervical sampling 58100 (biopsy), without cervical dilation, any method (separate procedure) 58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) 58140 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural 20 June 2005 14th Annual MIDAS+ Symposium