December 22, 2015 (effective March 1, 201) INTESTINES (EXCEPT RECTUM) Z513 Hydrostatic - Pneumatic dilatation of colon stricture(s) through colonoscope... 10.50 Z50 Fulguration of first polyp through colonoscope... 4.0 4 E1 - each additional polyp (maximum of 4)...add 24.25 Z51 Excision of first polyp greater than or equal to 3mm through colonoscope... nil 150.15 4 E20 - each additional polyp greater than or equal to 3mm (maximum of 2)...add.50 Excision of obstructive tumour or stricture through colonoscopy Z4 - less than 2 cm....0 Z5-2 cm or greater... 131.5 E - with laser debulking...add.0 E5 - total excision of very large sessile polyp (> 3 cm) through colonoscope, and may include fulguration, each...add 22.5 Z50 payable at nil if claimed with E5 or Z51 for same polyp. INCISION Enterotomy S14 Ileostomy... 40.5 S150 Small intestine - including excision of polyps or biopsy... 40.5 S151 Insertion of feeding enterostomy... 35.50 E3 - when done with another intra-abdominal procedure...add 2.35 S154 Large intestine - including excision of polyps... 40.5 S155 Colonoscopy with laparotomy... 3.40 S15 Exteriorization of intestine (Mickulicz)... 40.5 S15 Colostomy... 40.5 S15 Cecostomy... 3.40 S10 Entero-enterostomy... 40.5 E3 - laparoscopic or laparoscopic assisted, to S14 or S15...add 25% S1 December 22, 2015 (effective March 1, 201)
INTESTINES (EXCEPT RECTUM) EXCISION E14 - repair of entero-cutaneous fistula in conjunction with bowel resection...add 2.35 S12 Local excision of lesion of intestine... 52.5 Z50 Resection of exteriorized intestine... 2.35 Resection with anastomosis Small intestine S14 - duodenum... 4.10 S15 - other....55 S1 S1 E Small and large intestine terminal ileum, cecum and ascending colon (right hemicolectomy)... Large intestine - any portion... - with mobilization of splenic flexure, to S1...add.55.55 102.40 S1 S12 Total colectomy with ileo-rectal anastomosis... Total colectomy with mucosal proctectomy with ileal pouch, ileoanal anastomosis and loop ileostomy... 1242.0 224.0 10 S11 E0 E3 Left hemicolectomy with anterior resection or proctosigmoidectomy (anastomosis below peritoneal reflection & mobilization of splenic flexure)... - neo-rectal pouch formation, to S1 or S11...add - laparoscopic or laparoscopic assisted, to S15, S1, S1, S1, S11 or S12...add 25% 102.5 150.00 Ileostomy S1 - subtotal colectomy... S10 - plus total colectomy plus abdomino-perineal resection... E3 - laparoscopic or laparoscopic assisted, to S1 or S10... add 25% 105.0 10.0 10 Two-surgeon team S13 - abdominal... 132.0 10 S14 - perineal... 41.00 E3 E1 - with continent ileostomy, to either S1, S1, S10, S13 or S14...add - bowel resection following previous resection with anastomosis, or following S21, S213, S214 or S215...add E1 is not to be added to S11, S12, S15, S11, S12 or S13. 3.40 142.40 S1 Bowel resection without anastomosis (colostomy and mucous fistula)... 544.35 S1 E3 Intestinal bypass for morbid obesity... - laparoscopic or laparoscopic assisted, to S1...add 25% 51.20 10 1. S1 is an insured service only when all of the conditions set out in the Surgical Preamble are satisfied. 2. Mini-gastric bypass (loop gastric bypass) does not constitute intestinal bypass for the purpose of S1. December 22, 2015 (effective March 1, 201) S1
December 22, 2015 (effective March 1, 201) INTESTINES (EXCEPT RECTUM) Intestinal obstruction (mechanical) One stage S15 - without resection... S1 - with entero-enterostomy... S1 - with resection... S10 - with enterotomy... 20.00 4.00 00.00 2.00 If staged procedure, refer to Surgical Preamble SP2. S1 S1 Intestinal atresia (newborn)... Meconium ileus... 2.0 2.0 REPAIR Revision of ileostomy or colostomy S11 - skin level... S12 - full thickness... 131.5 350.5 S12 S11 S13 S13 Simple revision of continent ileostomy pouch... Complete reconstruction of continent ileostomy to include valve repair... Revision of standard ileostomy into continent ileostomy pouch... Cecopexy or sigmoidopexy (as sole procedure)... 3.40 51.20 3.50 314.0 S14 E21 SUTURE Suture of intestine... - with choledochotomy...add 314.0 122.05 S15 Closure of colostomy or enterostomy - with or without resection and/or anastomosis 40.5 S1 Plication of small intestine for adhesions... 52.5 For division or removal of adhesions only, use S312. Z53 Z53 MANIPULATION Reduction of prolapse... Dilation of gastrostomy, enterostomy, colostomy, etc.... Intubation of small intestine (therapeutic or diagnostic) Z540 - with or without fluoroscopy... E32 - with biopsy...add 25.25 25.25.0 2.10 S1 December 22, 2015 (effective March 1, 201)
MISCELLANEOUS MECKEL'S DIVERTICULUM S14 Meckel s diverticulum excision... 35.50 S15 - with small bowel resection... 40.5 MESENTERY S15 Local excision of lesion... 305.05 S1 Resection of mesentery... 325.40 APPENDIX S204 Incision and drainage of abscess... 23.20 S205 S20 Appendectomy... - with gross perforation and peritonitis... 33.0 451.50 TRANSPLANT Small bowel transplant S201 - donor... S202 - recipient... 20 4.50 24.5 30 Multivisceral transplant S1 S1 E0 - donor... - recipient, without evisceration... - recipient, with evisceration, to S1...add 25 24.5 34.35 244.5 35 Payment rules: 1. S1 must include transplant of the small bowel and liver, with or without transplant of the duodenum, stomach, pancreas and large bowel. 2. S1 must include removal of the small bowel and liver, with or without removal of the duodenum, stomach, pancreas and large bowel. 3. Surgical fees for transplant procedures represent payment in full for the surgical services required to perform the described procedure. In the event the transplant procedure described by S201/S202/S1/S1 is performed by more than one surgeon, only one surgical service is eligible for payment; the components of the surgical service are not divisible among the physicians for claims purposes. [Commentary: Where the surgical service is performed by more than one surgeon, the physicians are responsible for apportioning payment amongst themselves.] December 22, 2015 (effective March 1, 201) S1
December 22, 2015 (effective March 1, 201) RECTUM ENDOSCOPY Sigmoidoscopy with or without anoscopy Z535 - with rigid scope... Z53 - with biopsy(ies)... Z52 - with decompression of volvulus... E4 - when Z535, Z53 or Z52 performed outside hospital...add E41 - endoscopic placement of stent in rectum...add E - management of uncomplicated upper or lower gastrointestinal bleeding, by any technique (e.g. laser, injection, diathermy, banding etc.)...add Z535 not to be billed with Z555 or Z50. 3.0 44.55 4.40 5.5 13.05 4.30 4 4 4 EXCISION Proctectomy S213 Anterior resection or proctosigmoidectomy (anastomosis below peritoneal reflection)... E0 - neo-rectal pouch formation, to S213...add 1100.00 150.00 S214 E3 Abdomino-perineal resection or pull through... - laparoscopic or laparoscopic assisted, to S213 or S214...add 25% 1300.00 10 Two surgeon team S215 - abdominal surgeon... S21 - perineal surgeon... 100.5 45.05 10 S21 S21 E Hartmann procedure... Colon reconstruction following Hartmann procedure... - with mobilization of splenic flexure, to S21...add 0.00 1030.00 102.40 E3 - laparoscopic or laparoscopic assisted, to S215, S21 or S21...add 25% Z52 E10 Biopsy of rectosigmoid or above for Hirschsprung s disease... - each additional biopsy...add 2.35 45.55 S222 Presacral or trans-sacral proctotomy and excision of lesion... 350.5 Polyps or tumours of rectum or sigmoid * Z53 - electrocoagulation - base under 2 cm... Z54 - excision - base under 2 cm... Z4 - excision and suture - base 2 to 5 cm, inclusive... Z5 - excision and suture - base over 5 cm... Z55 - electrocoagulation - base 2 to 5 cm, inclusive... Z1 - electrocoagulation - base over 5 cm... E - with laser debulking...add 1. * To a maximum of 2, any size or technique. 2. For fulguration or excision of tumours through the colonoscope, use codes Z50, Z51 (page S1). 24.25 2.35 213.50 32.5 142.40 21.0.0 S20 December 22, 2015 (effective March 1, 201)
December 22, 2015 (effective March 1, 201) RECTUM REPAIR S223 Anastomosis of rectum... 4.20 Rectal prolapse S225 S22 S22 S22 - excision of mucous membrane... - perineal repair - major... - abdominal approach... - insertion of Thiersh wire... 23.20 35.50 554.10 10.5 SUTURE S22 Suture of rectum, trauma-external approach... 23.20 Closure of fistula S231 S525 - rectovaginal (any repair)... - rectovesical... 33.55 44.0 MANIPULATION Z541 Dilation and/or disimpaction or removal of foreign body under general anaesthetic (as sole procedure)... 5.15 Z5 Fecal disimpaction - no anaesthetic... 3.0 The fees for excision, ligation, injection of haemorrhoids and treatment of intra or perianal condylomata acuminata include anoscopy. ENDOSCOPY Z543 Anoscopy (proctoscopy)....0 INCISION Z544 Biopsy... 34.0 Z545 Thrombosed haemorrhoid(s)... 25.25 E542 - when performed outside hospital...add 11.15 S241 Sphincterotomy(ies) under local anaesthesia....20 S243 Sphincterotomy(ies) under general anaesthesia... 200.00 December 22, 2015 (effective March 1, 201) S21
RECTUM EXCISION S24 Haemorrhoidectomy, with or without sigmoidoscopy or repair of fissure(s) and/or sphincterotomy and/or anal dilation... Z55 Complete haemorrhoidectomy using cryotherapy and/or Barron ligation(s) including rectal dilation... 20.15.0 Z54 Z5 Barron ligation(s) (not to exceed in any one year)... Barron ligation(s) plus cryotherapy (not to exceed in any one year)... nil nil 34.0 3.10 S24 Z5 E542 Local excision for malignancy... Excision of benign anal lesion(s)... - when performed outside hospital...add 153.05 4.15 11.15 S251 Fistula-in-ano... 213.15 Z55 Z5 INJECTION Haemorrhoid injections (to a maximum of per year)... Injections for anal fissure... 2.05 35.0 REPAIR S253 S20 Low imperforate anus repair... High imperforate anus repair (supra-levator)... 1224.00 101.00 S25 S25 Excision of scar, for stenosis... Anoplasty, for stenosis... 142.40 25.05 S25 S25 Repair of anal sphincter... Repair of anal sphincter and ano-rectal ring... 25.05 35.50 DESTRUCTION Z54 Cauterization of fissure... 34.0 Fulguration of condylomata Z54 - local anaesthetic... Z5 - general anaesthetic... 30.5.5 Z550 S24 MANIPULATION Dilation of anal sphincter... Peter Lord procedure... 12.05 43.0 S22 December 22, 2015 (effective March 1, 201)