Amd 12 Draft 1

DIGESTIVE SYSTEM SURGICAL PROCEDURES MISCELLANEOUS

Asst Surg Anae

MECKEL'S DIVERTICULUM

# S194 Meckel’s diverticulum excision................................................................................. 6 356.50 7 # S159 - with small bowel resection ................................................................................. 6 406.85 7

MESENTERY

# S195 Local excision of lesion............................................................................................ 6 305.05 7 # S199 Resection of mesentery ........................................................................................... 6 325.40 6

APPENDIX

# S204 Incision and drainage of abscess ............................................................................ 6 239.20 7

# S205 # S206

Appendectomy......................................................................................................... - with gross perforation and peritonitis .................................................................

6 6

336.60 451.50

7 7

TRANSPLANT

S

# S201 # S202

mall bowel transplant

- donor.................................................................................................................. - recipient ............................................................................................................

6 20

964.50 2748.75

8 30

# S196 # S197 # E807

Multivisceral transplant

- donor.................................................................................................................. - recipient, without evisceration............................................................................

- recipient, with evisceration, to S197 ........................................................add

6 25

2748.75 7934.35 2644.75

8 35

Payment rules: 1. S197 must include transplant of the small bowel and liver, with or without transplant of the duodenum, stomach, pancreas

and large bowel.

2. S196 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/S196/S197 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, 2016) S19

Amd 12 Draft 1

DIGESTIVE SYSTEM SURGICAL PROCEDURES ABDOMEN, PERITONEUM AND OMENTUM

Asst Surg Anae

INCISION

Peritoneal abscess

# #

S313 S314

- subphrenic ......................................................................................................... - abdominal ..........................................................................................................

7 6

370.95 264.45

7 7

# #

#

Z569 Z594

E686

Pelvic abscess, incision and drainage - rectal or vaginal approach ........................ Percutaneous abdominal abscess drainage including daily supervision, for one or

more abscesses within the same abdominal quadrant or the pelvis.................. - within each other abdominal quadrant, or the pelvis (if the initial abscess was

not in the pelvis)........................................................................................add

122.05

288.30

144.10

7

Z595 Replacement of drainage catheter in abdominal abscess ....................................... 54.05

# Z574 Removal of infected sutures from abdominal wall or re-exploration of wound for bleeding - general anaesthetic........................................................................... 6 94.85 7

# S311 Umbilical vein intra-abdominal dissection and catheterization ................................ 6 232.50 6

Note: For vascular newborn - see Diagnostic & Therapeutic Procedures - Vascular Cannulation.

# S320 Insertion of antabuse into abdominal wall................................................................ 58.15

# #

Insertion of peritoneo-jugular shunt for ascites

S203 - primary ............................................................................................................... S209 - revision...............................................................................................................

7 7

281.85 208.15

7 7

# #

S310 S315

Insertion of intraperitoneal chemotherapy port by laparotomy or laparoscopy ........ Removal of intraperitoneal chemotherapy port by laparotomy or laparoscopy........

6 6

215.10 215.10

6 6

Payment rules: S310 or S315 are not eligible for payment in addition to any open or laparoscopic abdominal procedure.

EXCISION

#

#

S316

S317

Excision of full thickness abdominal wall tumour and primary closure (see General Preamble GP8) ..................................................................................................

Umbilectomy - plastic............................................................................................... 6 I.C 111.45

7 7

# # #

Panniculectomy

S318 Panniculectomy, including any necessary diastasis repair ...................................... E748 - with repair of umbilical hernia, to S318.....................................................add E809 - excision of pannus that extends beyond the mid thigh, to S318...............add

6 500.00 122.05 250.00

6

Note: 1. Panniculectomy is only insured in those circumstances described in Appendix D of this Schedule. Prior authorization of

payment from the MOHLTC is required.

2. S318 is not eligible for payment when performed in conjunction with abdominal or pelvic procedures unless the payment requirements for panniculectomy are separately fulfilled.

[Commentary: 1. In circumstances where the proposed panniculectomy surgery may include excision of a pannus that extends below the mid

thigh, the requesting physician must provide sufficient information with the request for prior authorization of payment.

2. Abdominoplasty is not an insured service.]

# S319 Mesenteric cyst........................................................................................................ 6 335.15 6

December 22, 2015 (effective March 1, 2016) S29