ANNEX

COD E RV U

DESCRIPTIVE TERMS Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia) Incision and drainage of pilonidal cyst Incision and removal of foreign body, subcutaneous tissues Incision and drainage of hematoma, seroma, or fluid collection !uncture aspiration of abscess, hematoma, bulla, or cyst !aring or curettement of benign hyper#eratotic s#in lesion $% or $%o chemical cauteri&ation (such as verrucae or clavi) not e'tending through the stratum corneum (e.g., callus or $art) $% or $%o local anesthesia( single lesion t$o to four lesions )iopsy of s#in, subcutaneous tissue and%or mucous membrane (including simple closure), unless other$ise listed ( single or multiple lesion +having of epidermal or dermal lesion, single lesion, trun#, arms or legs( lesion diameter 0." cm or less lesion diameter 0.6 to 1.0 cm lesion diameter 1.1 to 2.0 cm lesion diameter over 2.0 cm +having of epidermal or dermal lesion, single lesion, scalp, nec#, hands, feet, genitalia( lesion diameter 0." cm or less lesion diameter 0.6 to 1.0 cm lesion diameter 1.1 to 2.0 cm lesion diameter over 2.0 cm , v , , y , , , u u ( . ,
less

10060 1008 0 1012 0 101 0 1016 0 110"0 110"1 11100 11*00 11*01 11*02 11*0* 11*0" 11*06 11*0, 11*08 11*10 11*11 11*12 11*1* 11 00 11 20 11 0 11600 11601 11602 1160* 1160 11606 11620 11621 11622 1162* 1162 11626 116 0 116 1 116 2 116 * 116 116 6 11, 0 11,"2 11,62

10 10 10 10 10 10 1" 10 1" 2 *0 *" 1" 2 *0 *" 2 *0 *" 0 10 10 12 1" 1" 1" 1" 1" 1" 20 20 20 20 20 20 20 20 20 20 20 20 10 2" 2"

lesion diameter 0.6 to 1.0 cm lesion diameter 1.1 to 2.0 cm lesion diameter over 2.0 cm -'cision, benign lesion, e'cept s#in tag (unless listed else$here), trun#, arms or legs( lesion diameter 0." cm or less -'cision, benign lesion, e'cept s#in tag (unless listed else$here), scalp, nec#, hands, feet, genitalia( lesion diameter 0." cm or less -'cision, other benign lesion (unless listed else$here), face, ears, eyelids, nose, lips, mucous membrane( lesion diameter 0." cm or less -'cision, malignant lesion, trun#, arms, or legs( lesion diameter 0." cm or less lesion diameter 0.6 to 1.0 cm lesion diameter 1.1 to 2.0 cm lesion diameter 2.1 to *.0 cm lesion diameter *.1 to .0 cm lesion diameter over .0 cm -'cision, malignant lesion, scalp, nec#, hands, feet, genitalia( lesion diameter 0." cm or less lesion diameter 0.6 to 1.0 cm lesion diameter 1.1 to 2.0 cm lesion diameter 2.1 to *.0 cm lesion diameter *.1 to .0 cm lesion diameter over .0 cm -'cision, malignant lesion, face, ears, eyelids, nose, lips( lesion diameter 0." cm or less lesion diameter 0.6 to 1.0 cm lesion diameter 1.1 to 2.0 cm lesion diameter 2.1 to *.0 cm lesion diameter *.1 to .0 cm lesion diameter over .0 cm -vacuation of subungual hematoma $% amputation of tuft of distal phalan' .econstruction of nail bed $% graft

1 00 0 1 00 1 1 0 0 1 0 1 1 06 0 1 06 1

/d0acent tissue transfer or rearrangement, trun#( defect 10 s1 cm or less defect 10.1 s1 cm to *0.0 s1 cm /d0acent tissue transfer or rearrangement, forehead, chee#s, chin, mouth, nec#, a'illae, genitalia, hands and%or feet( defect 10 s1 cm or less defect 10.1 s1 cm to *0.0 s1 cm /d0acent tissue transfer or rearrangement, eyelids, nose, ears and%or lips( defect 10 s1 cm or less defect 10.1 s1 cm to *0.0 s1 cm

80 80 80 100 100 100

1 of 22

ANNEX
COD E 1 *" 0 1"0" 0 1"10 0 1"12 0 1"20 0 1"22 0 1"2 0 1"", 2 1"", 1""8 0 1"6" 0 1",* 2 1",* trun# 1",* 6 1",* 8 1", 0 1"," 0 1"," 6 1"," , 1"," 8 1",6 0 1",, 0 1"82 0 1"82 2 1"82 * 1"8 2 1":2 0 1":* 1 1":* * 1":* 1":* upper e'tremity lo$er e'tremity 2lap( island pedicle neurovascular pedicle 2ree muscle flap $% or $%o s#in graft $% microvascular anastomosis 2ree s#in flap $% microvascular anastomosis 2ree fascial flap $% microvascular anastomosis 8raft( composite (e.g., full thic#ness of e'ternal ear or nasal ala), including primary closure, donor area derma9fat9fascia )lepharoplasty, lo$er eyelid )lepharoplasty, upper eyelid( $ith e'cessive s#in $eighting do$n lid free muscle graft by microsurgical techni1ue -'cision, coccygeal pressure ulcer, $% coccygectomy( $% primary suture -'cision, sacral pressure ulcer, $% primary suture( $% ostectomy -'cision, sacral pressure ulcer, $% s#in flap closure( -'cision, sacral pressure ulcer, $% muscle or myocutaneous flap closure( *10 *10 *10 260 260 260 260 260 110 110 "" "" ,0 260 160 110 160 80 2*" RV U 180 0 0 110 110 110 160 160 160 110 110 *10

DESCRIPTIVE TERMS 2illeted finger or toe flap, including preparation of recipient site !inch graft, single or multiple, to cover small ulcer, tip or digit, or other minimal open area (e'cept on face), up to defect si&e 2 cm diameter +plit graft, trun#, scalp, arms, legs, hands, and%or feet (e'cept multiple digits)( 100 s1 cm or less, or each one percent of body area of infants and children (e'cept 1"0"0) +plit graft, face, eyelids, mouth, nec#, ears, orbits, genitalia, and%or multiple digits( 100 s1 cm or less, or each one percent of body area of infants and children (e'cept 1"0"0) 2ull thic#ness graft, free, including direct closure of donor site, trun#( 20 s1 cm or less 2ull thic#ness graft, free, including direct closure of donor site, scalp, arms, and%or legs( 20 s1 cm or less 2ull thic#ness graft, free, including direct closure of donor site, forehead, chee#s, chin, mouth, nec#, a'illae, genitalia, hands, and%or feet( 20 s1 cm or less scalp, arms, or legs forehead, chee#s, chin, mouth, nec#, a'illae, genitalia, hands or feet 3ross finger flap, including free graft to donor site 4ransfer, intermediate, of any pedicle flap (e.g., abdomen to $rist, 56al#ing5 tube), any location 7uscle, myocutaneous, or fasciocutaneous flap( head and nec# (e.g., temporalis, masseter, sternocleidomastoid, levator scapulae)

6 1": 1 1": 1": 6 1":" 0 1":" 1 1":" 2 1":" * 1":" 6 1":" 8 1601 0 160* " 160 0 1,00 0 1,10 0 1,26 0 1,26 1 1,26 2 1,26 *

$% ostectomy (ischiectomy) -'cision, ischial pressure ulcer, $% s#in flap closure( -'cision, ischial pressure ulcer, $% ostectomy, $% muscle or myocutaneous flap closure -'cision, trochanteric pressure ulcer, $% primary suture( $% ostectomy -'cision, trochanteric pressure ulcer, $% s#in flap closure( $% ostectomy -'cision, trochanteric pressure ulcer, $% muscle or myocutaneous flap closure( $% ostectomy ;ressings and%or debridement, initial or subse1uent -scharotomy -'cision burn $ound, $%o s#in grafting, employing alloplastic dressing (e.g., synthetic mesh), any anatomic site ;estruction by any method, including laser, $% or $%o surgical curettement, all benign facial lesions or premalignant lesions in any location, or benign lesions other than cutaneous vascular proliferative lesions, including local anesthesia( any number of lesions ;estruction by any method, including laser, of benign s#in lesions other than cutaneous vascular proliferative lesions on any area other than the face, including local anesthesia( any number of lesions ;estruction, malignant lesion, any method, trun#, arms or legs( lesion diameter 0." cm or less lesion diameter 0.6 to 1.0 cm ;estruction, malignant lesion, any method, trun#, arms or legs( lesion diameter 1.1 to 2.0 cm lesion diameter 2.1 to *.0 cm

110 160 2*" ,0 110 110 160 210 2*" 0 160 "0

*0 *0 20 20 20 20

2 of 22

ANNEX
COD E 1,26 lesion diameter *.1 to .0 cm 1,26 6 1,2, 0 1,2, 1 1,2, 2 1,2, * 1,2, 1,2, 6 1,28 1 1,28 2 1,28 * 1,28 1,28 6 1,*0 mapping, color coding of specimens, microscopic e'amination of specimens by the surgeon, and complete histopathologic preparation( first stage, fresh tissue techni1ue, up to " specimens 1:00 0 1:02 0 1:10 0 1:112 1:12 0 1:16 0 1:18 0 1:18 2 1:20 0 1:2 0 1:26 0 1:2, 1 1:2, 2 2101 0 2102 " 2102 6 2102 !uncture aspiration of cyst of breast( 7astotomy $% e'ploration or drainage of abscess, deep )iopsy of breast( needle core -'cision of lactiferous duct fistula -'cision of cyst, fibroadenoma, or other benign or malignant tumor aberrant breast tissue, duct lesion or nipple lesion (e'cept 1:1 0), male or female, one or more lesions 7astectomy, partial( 7astectomy, simple, complete 7astectomy, subcutaneous 7astectomy, radical, icnluding pectoral muscles, a'illary lymph nodes 7astectomy, modified radical, including a'illary lymph nodes, $% or $%o pectoralis minor muscle, but e'cluding pectoralis ma0or muscle -'cision of chest $all tumor including ribs -'cision of chest $all tumor involving ribs, $% plastic reconstruction( $%o mediastinal lymphadenectomy $% mediastinal lymphadenectomy /rthrotomy, temporomandibular 0oint -'cision of bone (e.g., for osteomyelitis or bone abscess)( mandible facial bone(s) .emoval by contouring of benign tumor of facial bone (e.g., fibrous dysplasia) *0 lesion diameter over .0 cm ;estruction, malignant lesion, any method, scalp, nec#, hands, feet, genitalia( lesion diameter 0." cm or less lesion diameter 0.6 to 1.0 cm ;estruction, malignant lesion, any method, scalp, nec#, hands, feet, genitalia( lesion diameter 1.1 to 2.0 cm lesion diameter 2.1 to *.0 cm lesion diameter *.1 to .0 cm lesion diameter over .0 cm ;estruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane( lesion diameter 0.6 to 1.0 cm lesion diameter 1.1 to 2.0 cm lesion diameter 2.1 to *.0 cm lesion diameter *.1 to .0 cm lesion diameter over .0 cm 3hemosurgery (7oh<s micrographic techni1ue), including removal of all gross tumor, surgical e'cision of tissue specimens, 20 20 20 20 20 20 20 20 2" 2" 2" 2" 2"

DESCRIPTIVE TERMS

RVU

10 "0 10 0 *0 80 100 60 200 200 *00 00 "0 "0 100 100 100

: 210* 0 210* 1 210* 2 210* 210 0 210 1 211:8 21*0 0 21*1 " 21*2 " 21** 0 21** " 21** 6 21** , 21** : 21* 0 21* * 21* " 21*" "

-'cision of benign tumor or cyst of facial bone other than mandible -'cision of torus mandibularis -'cision of ma'illary torus palatinus -'cision of malignant tumor of facial bone other than mandible -'cision of benign cyst or tumor of mandible( simple comple' =steotomy, mandible, segmental 3losed treatment of s#ull fracture $%o operation 3losed treatment of nasal bone fracture =pen treatment of nasal fracture( uncomplicated complicated, $% internal and%or e'ternal s#eletal fi'ation $% concomitant open treatment of fractured septum =pen treatment of nasal septal fracture, $% or $%o stabili&ation 3losed treatment of nasal septal fracture $% e'ternal fi'ation !ercutaneous treatment of nasoethmoid comple' fracture, $% splint, $ire or headcap fi'ation, including repair of canthal ligaments and%or the nasolacrimal apparatus =pen treatment of depressed frontal sinus fracture 3losed treatment of nasoma'illary comple' fracture (>e2ort II type), $% interdental $ire fi'ation or fi'ation of denture or splint !ercutaneous treatment of fracture of malar area, including &ygomatic arch and malar tripod, $% manipulation

100 100 100 1"0 100 110 200 60 60 80 80 80 80 60 100 110 110 1 0 110

3 of 22

ANNEX
COD E 21 * 1 21 8 0 21 8 " 21"0 1 21"" 0 21"" " 21"" 6 21"" , 22"" 22"" 6 22"" 8 2"", 26*" 0 2,": 0 2,," : 2,88 0 *010 0 *011, *01* 0 *01 0 *0*1 0 *0"2 0 *0" 0 *0" " *0"6 0 *0"8 0 *060 0 *06* 0 *080 1 *080 2 *0:0 " *0:1 "

DESCRIPTIVE TERMS 3losed treatment of craniofacial separation (>e2ort III type) using interdental $ire fi'ation of denture or splint 3losed treatment of temporomandibular dislocation( initial or subse1uent complicated (e.g., recurrent re1uiring interma'illary fi'ation or splinting), initial or subse1uent Incision and drainage, deep abscess or hematoma, soft tissues of nec# or thora'( )iopsy, soft tissue of nec# or thora' -'cision tumor, soft tissue of nec# or thora'( subcutaneous deep, subfascial, intramuscular .adical resection of tumor (e.g., malignant neoplasm), soft tissue of nec# or thora' /rthrodesis, anterior interbody techni1ue, including minimal dis#ectomy to prepare interspace (other than for decompression)( cervical belo$ 32 thoracic lumbar =pen treatment of radial /?; ulnar shaft fractures, $% internal or e'ternal fi'ation( of radius or ulna 2le'or tendon repair or advancement, single, not in 5no man<s land5, primary or secondary $%o free graft, each tendon /mputation, thigh, through femur, any level( =pen treatment of tibial shaft fracture ($% or $%o fibular fracture) by intramedullary implant, $% or $%o interloc#ing scre$s and%or cerclage /mputation, leg, through tibia and fibula( )iopsy, intranasal -'cision or destruction, any method (including laser), intranasal lesion( internal approach -'cision turbinate, partial or complete +ubmucous resection turbinate, partial or complete .emoval foreign body, intranasal( re1uiring general anesthesia +eptoplasty or submucous resection, $% or $%o cartilage scoring, contouring or replacement $% graft .epair choanal atresia( intranasal transpalatine >ysis intranasal synechia .epair fistula( oroma'illary (combine $% *10*0 if antrotomy is included) oronasal .epair nasal septal perforations 3auteri&ation and%or ablation, mucosa of turbinates, unilateral or bilateral, any method, ( superficial intramural 3ontrol nasal hemorrhage, posterior, $% posterior nasal pac#s and%or cauteri&ation, any method( initial >igation arteries( ethmoidal

RVU 80 "0 120 20 20 *0 "0 200 *"0 *00 *00 1:0 80 200 180 200 20 "0 ," ," *0 ," ," 100 0 80 80 80 "0 "0 *0 80

*0:2 0 *0:* 0 *100 0 *100 2 *102 0 *10* 0 *10* 2 *10 0 *10" 0 *10" 1 *10, 0 *10, " *108 0 *108 1 *108 " *108 6 *108 , *10: 0 *120 0 *120 1 *120 "

internal ma'illary artery, transantral 2racture nasal turbinate(s), therapeutic >avage by cannulation( ma'illary sinus (antrum puncture or natural ostium) sphenoid sinus +inusotomy, ma'illary (antrotomy)( intranasal radical (3ald$ell9>uc) $%o removal of antrochoanal polyps radical (3ald$ell9>uc) $% removal of antrochoanal polyps !terygoma'illary fossa surgery, any approach +inusotomy, sphenoid, $% or $%o biopsy( $% mucosal stripping or removal of polyp(s) +inusotomy frontal( e'ternal, simple (trephine operation) transorbital, unilateral (for mucocele or osteoma, >ynch type) obliterative $%o osteoplastic flap, bro$ incision (includes ablation) obliterative, $%o osteoplastic flap, coronal inicision (includes ablation) obliterative, $% osteoplastic flap, coronal incision nonobliterative, $% osteoplastic flap, bro$ incision nonobliterative, $% osteoplastic flap, coronal incision +inusotomy combined, three or more sinuses -thmoidectomy( intranasal, anterior intranasal, total e'tranasal, total

80 "0 2" *0 "0 80 80 1"0 1"0 1"0 80 80 80 80 1"0 1"0 1"0 1"0 80 80 80

4 of 22

ANNEX
COD E *122 " *12* 0 *12* 1 *12* * *12* , *12* 8 *12* : *12 0 *12" *12" " *12, 6 *128 , *128 8 *1*0 0 *1*6 0 *1*6 " *1*6 , *1*6 8 *1*, 0 *1*, " *1*8 0 *1*8 2 *1*: " *1 0 0 *1 2 0 *1"* 0 *1"* 1 *1"* " *1"* 6 *1" 0 *1" 1 *1"6 0 *1"6 7a'illectomy( $%o orbital e'enteration $% orbital e'enteration (en bloc) ?asal endoscopy, diagnostic, unilateral or bilateral ?asal%sinus endoscopy, diagnostic $% ma'illary sinusoscopy (via inferior meatus or canine fossa puncture) ?asal%sinus endoscopy, surgical( $% biopsy, polypectomy or debridement $% control of epista'is $% dacrylocystorhinostomy $% concha bullosa resection ?asal%sinus endoscopy, surgical( $% ethmoidectomy, partial (anterior) $% ethmoidectomy, total (anterior and posterior) ?asal%sinus endoscopy, surgical $% frontal sinus e'ploration, $% or $%o removal of tissue from frontal sinus ?asal%sinus endoscopy, surgical, $% sphenoidotomy $% removal of tissure from the sphenoid sinus >aryngotomy (thyrotomy, laryngofissure)( $% removal of tumor or laryngocele, cordectomy >aryngectomy( total, $%o radical nec# dissection total, $% radical nec# dissection subtotal supraglottic, $%o radical nec# dissection subtotal supraglottic, $% radical nec# dissection !artial laryngectomy (hemilaryngectomy)( hori&ontal laterovertical anterovertical antero9latero9vertical !haryngolaryngectomy, $% radical nec# dissection( $% reconstruction /rytenoidectomy or arytenoidope'y, e'ternal approach -piglottidectomy >aryngoscopy, direct, operative, $% foreign body removal( $% operating microscope >aryngoscopy, direct, operative, $% biopsy( $% operating microscope >aryngoscopy, direct, operative, $% e'cision of tumor and%or stripping of vocal cords or epiglottis( $% operating microscope >aryngoscopy, direct, operative, $% arytenoidectomy( $% operating microscope

DESCRIPTIVE TERMS

RVU *00 *"0 60 60 80 80 80 100 100 100 100 100 100 100 210 2"0 220 2 0 210 210 210 210 *00 200 1"0 80 80 80 80 80 80 200 200

1 *1", 0 *1", 1 *1", " *1", 6 *1", , *1", 8 *1", : *1"8 0 *1"8 2 *1"8 *1"8 6 *1"8 , *1": " *160 0 *160 1 *160 * *160 " *161 0 *1611 *161 2 *161 * *161

>aryngoscopy, direct, $% in0ection into vocal cord(s), therapeutic( $% operating microscope >aryngoscopy, fle'ible fiberoptic( diagnostic $% biopsy $% removal of foreign body $% removal of lesion >aryngoscopy, fle'ible or rigid fiberoptic, $% stroboscopy >aryngoplasty( for laryngeal $eb, t$o stage, $% #eel insertion and removal for laryngeal stenosis, $% graft or core mold, including tracheotomy $% open reduction of fracture $% closed manipulative reduction >aryngoplasty, cricoid split +ection recurrent laryngeal nerve, therapeutic , unilateral 4racheostomy, planned ( under t$o years 4racheostomy, emergency procedure( transtracheal cricothyroid membrane 4racheostomy, fenestration procedure $ith s#in flaps 3onstruction of tracheoesophageal fistula and subse1uent insertion of an alaryngeal speech prosthesis (e.g., voice button, )lom9 +inger prosthesis) 4racheal puncture, percutaneous $% transtracheal aspiration and%or in0ection 4racheostoma revision( simple, $%o flap rotation comple', $% flap rotation

80 80 80 80 80 80 80 200 200 200 200 200 1"0 80 8" 8" 8" 8" :0 ," 80 :0

5 of 22

ANNEX
COD E *161 " *162 2 *162 " *162 8 *162 : *16* 0 *16* 1 *16* " *16 0 *16 1 *16 " *1,1 , *1," 0 *1," " *1,, 0 *1,, " *1,8 0 *1,8 1 *1,8 " *1,8 6 *180 0 *180 " *200 2 *200 " *202 0 *20* " *20* 6 **2* 8 **:, *6 8 8 *681 0 *681 " RV U 80 6" 6" 6" 6" 100 100 100 200 200 1"0 1"0 2"0 2"0 00 00 *00 *"0 2"0 00 1"0 2"0 60 60 :" 80 10" 200 200 "0 "0 "0

DESCRIPTIVE TERMS 4racheobronchoscopy through established tracheostomy incision )ronchoscopy( diagnostic, (fle'ible or rigid), $% or $%o cell $ashing or brushing $% biopsy $% transbronchial lung biopsy, $% or $%o fluoroscopic guidance $% transbronchial needle aspiration biopsy $% tracheal or bronchial dilation or closed reduction of fracture $% tracheal dilation and placement of tracheal stent $% removal of foreign body $% e'cision of tumor $% destruction of tumor or relief of stenosis by any method other than e'cision (e.g., laser) $% therapeutic aspiration of tracheobronchial tree, (e.g., drainage of lung abscess) 3atheteri&ation $% bronchial brush biopsy 4racheoplasty( cervical tracheopharyngeal fistuli&ation, each stage )ronchoplasty( graft repair e'cision stenosis and anastomosis -'cision tracheal stenosis and anastomosis( cervical cervicothoracic -'cision of tracheal tumor or carcinoma( cervical thoracic +uture of tracheal $ound or in0ury( cervical intrathoracic 4horacentesis $% insertion of tube $% or $%o $ater seal (e.g., for pneumothora') 3hemical pleurodesis (e.g., for recurrent or persistent pneumothora') 4ube thoracostomy $% or $%o $ater seal (e.g., for abscess, hemothora', empyema) 4horacostomy( $% rib resection for empyema $% open flap drainage for empyema .emoval of permanent transvenous electrode(s) by thoracotomy .emoval of intra9aortic balloon assist device from the ascending aorta, including repair of the ascending aorta, $% or $%o graft !lacement of central venous catheter (subclavian, 0ugular, or other vein) (e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy)( percutaneous or cutdo$n arteriovenous, e'ternal (+cribner type) arteriovenous, e'ternal revision, or closure

*,18 *,18 , *,20 *,20 " *82* 0 *82 0 *8*0 0 *8*8 0 *8*8 1 *8*8 2 *8"0 0 *8"0 " *8"1 0 *8"" 0 *8"" " *8", 0 *8", 1 *8", 2 *8,0 0 *8,2 0

!rimary percutaneous transluminal mechanical thrombectomy, non9coronary, arterial or arterial bypass graft including fluoroscopic guidance and intraprocedural pharmacological thrombolytic in0ections( one or more vessels !ercutaneous transluminal mechanical thrombectomy, veins, including intraprocedural pharmacological thrombolytic in0ections and fluoroscopic guidance( one or more vessels 4ranscatheter occlusion or emboli&ation (e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, non9central nervous system, non9head or nec# 4ranscatheter placement of an intravascular stent(s), (non9coronary vessel), percutaneous( initial vessel )one marro$ harvesting for transplantation )one marro$ or peripheral blood derived peripheral stem cell transplantation ;rainage of lymph node abscess or lymphadenitis +uture and%or ligation of thoracic duct( cervical approach thoracic approach abdominal approach )iopsy or e'cision or lymph node(s)( superficial by needle, superficial (e.g., cervical, inguinal, a'illary) deep cervical node(s) -'cision of cystic hygroma, a'illary or cervical( $%o deep neurovascular dissection $% deep neurovascular dissection >aparoscopy, surgical( $ith retroperitoneal lymph node sampling (biopsy), single or multiple $ith bilateral total pelvic lymphadenectomy $ith bilateral total pelvic lymphadenectomy and peri9aortic lymph node sampling (biopsy), single or multiple +uprahyoid lymphadenectomy 3ervical lymphadenectomy (complete)

*00 *00 *00 *00 100 2"0 0 200 200 200 20 20 0 2"0 *00 180 200 "0 180 200

6 of 22

ANNEX
COD E *8,2 3ervical lymphadenectomy (modified radical nec# dissection) *8, 0 *8, " *8, 6 *:00 0 0 : 0 0,0 0 0,0 1 0,0 2 0,2 0 0,6 1 080 0 080 8 081 0 08* 0 08* 1 08 0 08 2 08 100 0 100 " 100 6 100 , 100 8 101 " 101 6 101 , 1100 110" 1108 1110 111" 11 0 12" 0 12" 1 12" /'illary lymphadenectomy( superficial complete 4horacic lymphadenectomy, regional, including mediastinal and peritracheal nodes 7ediastinotomy $ith e'ploration, drainage, removal of foreign body, or biopsy( cervical approach )iopsy of lip !lastic repair of cleft lip%nasal deformity( primary, partial or complete, unilateral primary bilateral, one stage procedure primary bilateral, one of t$o stages secondary, by recreation of defect and reclosure $% cross lip pedicle flap (/bbe9-stlander type), including sectioning and inserting of pedicle ;rainage of abscess, cyst, hematoma, vestibule of mouth )iopsy, vestibule of mouth -'cision of lesion of mucosa and submucosa, vestibule of mouth 3losure of laceration, vestibule of mouth( 2." cm or less over 2." cm or comple' @estibuloplasty( anterior posterior, unilateral entire arch Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth( lingual sublingual, superficial sublingual, deep, supramylohyoid submental space submandibular space -'traoral incision and drainage of abscess,cyst,or hematoma of floor of mouth(sublingual submental submandibular )iopsy of tongue( anterior t$o9thirds posterior one9third )iopsy of floor of mouth -'cision of lesion of tongue $%o closure -'cision of lingual frenum (frenectomy) 8lossectomy( complete or total, $% or $%o tracheostomy, $%o radical nec# dissection .epair of laceration 2." cm or less( floor of mouth and%or anterior t$o9thirds of tongue posterior one9third of tongue .epair of laceration of tongue, floor of mouth, over 2.6 cm or comple' 200 1"0 200 2"0 100 1" 2"0 2"0 200 200 2"0 20 20 20 20 20 80 80 100 20 20 20 20 20 20 20 20 1" 1" 1" 2" 2" 2"0 "0 "0 "0

DESCRIPTIVE TERMS

RVU

2 1"0 0 1"1 0 1"2 0 180 0 180 " 182 0 182 1 182 2 182 * 182 8 18* 0 18" 0 18, 2 18, 200 0 2*0 0 2*1 0 2*2 0 2 0 0 2 0 :

2renoplasty (surgical revision of frenum, eg, $% A9plasty) +uture of tongue to lip for micrognathia (;ouglas type procedure) 2renoplasty (surgical revision of frenum, eg, $% A9plasty) ;rainage of abscess, cyst, hematoma from dentoalveolar structures .emoval of embedded foreign body from dentoalveolar structures( soft tissues 8ingivectomy, e'cision gingiva =perculectomy, e'cision pericoronal tissues -'cision of fibrous tuberosities, dentoalveolar structures -'cision of osseous tuberosities, dentoalveolar structures -'cision of hyperplastic alveolar mucosa /lveolectomy, including curettage of osteitis or se1uestrectomy ;estruction of lesion (e'cept e'cision), dentoalveolar structures 8ingivoplasty /lveoloplasty ;rainage of abscess of palate, uvula ;rainage of abscess( parotid ;rainage of abscess( subma'illary or sublingual, intraoral subma'illary, e'ternal )iopsy of salivary gland( needle 7arsupiali&ation of sublingual salivary cyst (ranula)

"0 "0 "0 20 10 *0 *0 *0 *0 *0 0 0 100 100 *0 20 20 20 1" 2"

7 of 22

ANNEX
COD E 2 1 0 2 1 " 2 2 " 2 0 2 " 0 2"0 0 2"0 " 2"0 , 2"0 8 2"0 : 2"1 0 260 0 266 " 2,0 0 2,2 0 2,2 " 280 0 280 2 280 280 6 280 8 280 : 281 0 282 0 282 " 28* 0 28* " *20 0 *20 2 *20 *20 " *21 " *21 RV U 1"0 200 200 100 100 100 100 100 100 100 100 0 0 0 0 0 *0 *0 *0 *0 *0 *0 100 100 100 100 100 60 60 :0 :0 :0 ,0

DESCRIPTIVE TERMS -'cision of parotid tumor or parotid gland( lateral lobe, $%o nerve dissection lateral lobe, $% dissection and preservation of facial nerve total, en bloc removal $% sacrifice of facial nerve -'cision of submandibular (subma'illary) gland -'cision of sublingual gland !lastic repair of salivary duct, sialodochoplasty( primary or simple secondary or complicated !arotid duct diversion, bilateral (6il#e type procedure)( $% e'cision of one submandibular gland $% e'cision of both submandibular glands $% ligation of both submandibular (6harton<s) ducts 3losure salivary fistula >igation salivary duct, intraoral Incision and drainage abscess( peritonsillar retropharyngeal or parapharyngeal, intraoral approach retropharyngeal or parapharyngeal, e'ternal approach )iopsy( oropharyn' hypopharyn' nasopharyn', visible lesion, simple nasopharyn', survey for un#no$n primary lesion -'cision or destruction of lesion of pharyn', any method .emoval of foreign body from pharyn' -'cision branchial cleft cyst or vestige, confined to s#in and subcutaneous tissues 4onsillectomy and adenoidectomy 4onsillectomy, primary or secondary /denoidectomy, primary /denoidectomy, secondary -sophagoscopy, rigid or fle'ible( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple $% in0ection sclerosis of esophageal varices $% band ligation of esophageal varices $% removal of foreign body $% removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

6 *21 , *21 : *22 0 *22 6 *22 , *22 8 *2*

$% removal of tumor(s), polyp(s), or other lesion(s) by snare techni1ue $% insertion of plastic tube or stent $% balloon dilation (less than *0 mm diameter) $% insertion of guide $ire follo$ed by dilation over guide $ire $% control of bleeding, any method $% ablation of tumor(s) polyp(s), or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare techni1ue Bpper gastrointestinal endoscopy, simple primary e'amination ( e.g. $% small diameter fle'ible endoscope)

80 100 100 100 :0 100 60 60 60 80 :0 :0 100 100 :0 100 100 ,0 80 :0

*2* " *2* : *2 1 *2 * *2 *2 " *2 6 *2 , *2 8 *2 : *2" 0 *2" 1 *2" "

Bpper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and%or 0e0unum as appropriate( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple $% transendoscopic tube or catheter placement $% in0ection sclerosis of esophageal and%or gastric varices $% band ligation of esophageal and%or gastric varices $% dilation of gastric outlet for obstruction, any method $% directed placement of percutaneous gastrostomy tube $% removal or foreign body $% insertion of guide $ire follo$ed by dilation of esophagus over guide $ire $% ballon dilation of esophagus (less than *0 mm diameter) $% removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery $% removal of tumor(s), polyp(s), or other lesion(s) by snare techni1ue $% control of bleeding, any method

8 of 22

ANNEX
COD E *2" 8 *2" : *26 0 *26 1 *26 2 *26 * *26 *26 " *26 , *26 8 *26 : *2, 1 *2, 2 **0 0 *"0 0 *"0 1 *"0 2 *"1 0 *"2 0 *60 0 *60 " *61 0 *611 *62 0 *62 1 *62 2 *6* 1 *6* 2 *6* * *6* *6* 8 *6* RV U

DESCRIPTIVE TERMS $% ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare techni1ue $% endoscopic ultrasound e'amination -ndoscopic retrograde cholangiopancreatography (-.3!)( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple $% sphincterotomy%papillotomy $% pressure measurement of sphincter of =ddi (pancreatic duct or common bile duct) $% endoscopic retrograde removal of stone(s) from biliary and%or pancreatic ducts $% endoscopic retrograde destruction, lithotripsy of stone(s), any method $% endoscopic retrograde insertion of nasobiliary or nasopancreatic drainage tube $% endoscopic retrograde insertion of tube or stent into bile or pancreatic duct $% endoscopic retrograde removal of foreign body and%or change of tube or stent $% endoscopic retrograde balloon dilation of ampulla, biliary and%or pancreatic duct(s) $% ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare techni1ue -sophagoplasty, (plastic repair or reconstruction), cervical approach( $%o repair of tracheoesophageal fistula 8astrotomy( $% e'ploration or foreign body removal $% suture repair of bleeding ulcer $% suture repair of pre9e'isting esophagogastric laceration (e.g., 7allory96eiss) $% esophageal dilation and insertion of permanent intraluminal tube (e.g., 3elestin or 7ousseau'9)arbin) !yloromyotomy, cutting of pyloric muscle (2redet9.amstedt type operation) )iopsy of stomach( by capsule, tube, peroral (one or more specimens) by laparotomy -'cision, local( ulcer or benign tumor of stomach malignant tumor of stomach 8astrectomy, total( $% esophagoenterostomy $% .ou'9en9C reconstruction $% formation of intestinal pouch, any type 8astrectomy, partial, distal( $% gastroduodenostomy $% gastro0e0unostomy $% .ou'9en9C reconstruction $% formation of intestinal pouch 8astrectomy, partial, pro'imal, thoracic or abdominal approach including esophagogastrostomy, $% vagotomy( $% pyloroplasty or pyloromyotomy

100 :0 120 120 1*0 1*0 1"0 160 1 0 1 0 1 0 1"0 1"0 200 200 2*0 2*0 2*0 2*0 0 200 2*0 2*0 "00 ""0 ""0 00 00 "00 "00 "00 ""0

: *6 0 *6 1 *80 0 *81 0 *82 0 *82 " *8* 0 *8* 1 *8* 2 *8 0 *8 2 *8 * *8 6 *8 , *8 8 *8" 0 *8" " *86 0 *86 "

@agotomy including pyloroplasty, $% or $%o gastrostomy( truncal or selective parietal cell (highly selective) !yloroplasty 8astroduodenostomy 8astro0e0unostomy( $%o vagotomy $% vagotomy, any type 8astrostomy, temporary (tube, rubber or plastic) ( neonatal, for feeding 8astrostomy, permanent, $% construction of gastric tube 8astrorrhaphy, suture of perforated duodenal or gastric ulcer, $ound, or in0ury 8astric restrictive procedure, $%o gastric bypass, for morbid obesity( vertical9banded gastroplasty other than vertical9banded gastroplasty 8astric restrictive procedure, $% gastric bypass for morbid obesity( $% short limb (less than 100 cm) .ou'9en9C gastroenterostomy $% small bo$el reconstruction to limit absorption .evision of gastric restrictive procedure for morbid obesity .evision of gastroduodenal anastomosis (gastroduodenostomy) $% reconstruction( $%o vagotomy $% vagotomy .evision of gastro0e0unal anastomosis (gastro0e0unostomy) $% reconstruction, $% or $%o partial gastrectomy or bo$el resection( $%o vagotomy $% vagotomy

2"0 *00 2"0 "00 *00 *"0 2"0 2"0 2"0 *00 00 "0 "0 "0 "0 "0 "00 "0 "00

9 of 22

ANNEX
COD E *8, 0 *88 0 00 " 01 0 02 0 02 1 02 " 0" 0 0"" 10 0 110 111 12 0 12 " 1* 0 1 0 1 1 1 * 1 1 " 1 6 1 , 1" 0 1" 1 1" 2 1" * 1" " 1" 6 16 0 22 , *0 0 *1 0 *1 2 *1 3losure of gastrostomy, surgical 3losure of gastrocolic fistula -nterolysis (freeing of intestinal adhesion) ;uodenotomy, for e'ploration, biopsy(s), or foreign body removal -nterotomy, small bo$el, other than duodenum( for e'ploration, biopsy(s), or foreign body removal for decompression (e.g., )a#er tube) 3olotomy, for e'ploration, biopsy(s), or foreign body removal .eduction of volvulus, intussusception, internal hernia, by laparotomy 3orrection of malrotation by lysis of duodenal bands and%or reduction of midgut volvulus (e.g., >add procedure) )iopsy of intestine by capsule, tube, peroral (one or more specimens) -'cision of one or more lessions of small or large bo$el not re1uiring anastomosis, e'teriori&ation, or fistuli&ation( single enterotomy multiple enterotomies -nterectomy, resection of small intestine( single resection and anastomosis $% enterostomy -nteroenterostomy, anastomosis of intestine, $% or $%o cutaneous enterostomy 3olectomy, partial( $% anastomosis $% s#in level cecostomy or colostomy $% end colostomy and closure of distal segment (Dartmann type procedure) $% resection, $% colostomy or ileostomy and creation of mucofistula $% coloproctostomy (lo$ pelvic anastomosis) $% coloproctostomy (lo$ pelvic anastomosis), $% colostomy abdominal and transanal approach 3olectomy, total, abdominal, $%o proctectomy( $% ileostomy or ileoproctostomy $% continent ileostomy $% rectal mucosectomy, ileoanal anastomosis, $% or $%o loop ileostomy $% rectal mucosectomy, ileoanal anastomosis, creation of ileal reservior (+ or E), $% or $%o loop ileostomy 3olectomy, total, abdominal, $% proctectomy( $% ileostomy $% continent ileostomy 3olectomy $% removal of terminal ileum and ileocolostomy >aparoscopy, surgical( closure of enterostomy, large or small intestine, $ith resection and anastomosis -nterostomy or cecostomy, tube (e.g., for decompression or feeding) Ileostomy or 0e0unostomy, non9 tube .evision of ileostomy( simple (release of superficial scar) complicated (reconstruction in9depth) RV U *00 "0 "0 *"0 2"0 2"0 2"0 *"0 00 100 2"0 *00 *00 *00 *"0 "0 "0 "0 "0 20 "0 "00 "00 "00 ""0 ""0 ""0 ""0 ""0 1"0 100 1*0 1"0 1*0

DESCRIPTIVE TERMS

*1 6 *2 0 *2 2 * 0 * " * 6 *6 0 *6 1 *6 * *6 *6 " *6 6 *6 : *, 2 *, * *, 6 *, , *, 8

3ontinent ileostomy (Foch procedure) 3olostomy or s#in level cecostomy( $% multiple biopsies (e.g., for Dirschsprung disease) .evision of colostomy( simple (release of superficial scar) complicated (reconstruction in 9 depth ) $% repair of paracolostomy hernia +mall intestinal endoscopy, enteroscopy, beyond second portion of duodenum, not including ileum( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple $% removal of foreign body $% removal of tumor(s), polyp(s), or other lesions(s) by snare techni1ue $% removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery $% control of bleeding, any method $% ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare tenchni1ue $% placement of percutaneous 0e0unostomy tube $% conversion of percutaneous gastrostomy tube to percutaneous 0e0unostomy tube +mall intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple $% control of bleeding, any method

200 1"0 200 1"0 200 200 :0 :0 100 100 100 100 110 110 110 100 100 110

10 of 22

ANNEX
COD E *8 0 *8 2 *8 " *8 6 *8 8 *8 : *: 0 *: 1 *: 2 *: * *: $% removal of tumor(s), polyp(s), or other lesion(s) by snare techni1ue 60 2 60 * 60 60 " 61 " 62 0 62 " :, 0 "00 0 "00 " "02 0 "10 0 "10 8 "1" 0 "1: 0 "*0 0 "*0 * "*0 " "*0 , "*0 : +uture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, $ound, in0ury or rupture( single perforation multiple perforation +uture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, $ound, in0ury or rupture (single or multiple perforations)( $%o colostomy $% colostomy Intestinal stricturoplasty (enterotomy and enterorrhaphy) $% or $%o dilation, for intestinal obstruction 3losure of enterostomy, large or small intestine( $% resection and anastomosis >aparoscopy, surgical( appendectomy 4ransrectal drainage of pelvic abscess Incision and drainage of submucosal abscess, rectum Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess )iopsy of anorectal $all, anal approach (e.g., congenital megacolon) /norectal myomectomy ;ivision of stricture of rectum ;estruction of rectal tumor, any method (e.g., electrodesiccation) transanal approach !roctosigmoidoscopy, rigid( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% dilation, any method $% biopsy, single or multiple $% removal of foreign body $% removal of single tumor, polyp, or other lesion by snare techni1ue 110 2"0 2"0 2"0 2"0 2"0 200 200 120 200 100 200 1"0 200 80 100 *0 "0 *0 0 "0 RV U :0 :0 :0 :0 :0 :0 100 100 100 110

DESCRIPTIVE TERMS Ileoscopy, through stoma( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple -ndoscopic evaluation of small intestinal (abdominal or pelvic) pouch( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple 3olonoscopy through stoma( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple $% removal of foreign body $% control of bleeding, any method $% removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery $% ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar caurtery or snare techni1ue

"*1 " "*1 , "*2 0 "*2 1 "** 0 "** 1 "** 2 "** * "** "** , "** 8 "** : "*" " "*, 8 "*, : "*8 0 "*8 2 "*8 *

$% removal of multiple tumors, polyps or other lesions by hot biopsy forceps, bipolar cautery or snare techni1ue $% control of bleeding, any method $% ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare techni1ue (e.g., laser) $% decompression of volvulus +igmoidoscopy, fle'ible( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% biopsy, single or multiple $% removal of foreign body $% removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery $% control of bleeding, any method $% decompression of volvulus, any method $% removal of tumor(s), polyp(s), or other lesion(s) by snare techni1ue $% ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare techni1ue 3olonoscopy, rigid or fle'ible, transabdominal via colotomy, single or multiple 3olonoscopy, fle'ible, pro'imal to splenic fle'ure( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing, $% or $%o colon decompression $% removal of foreign body $% biopsy, single or multiple $% control of bleeding, any method $% ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare techni1ue

60 60 60 60 0 0 "0 "0 60 80 60 ,0 60 80 80 80 100 :0

11 of 22

ANNEX
COD E "*8 $% removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery "*8 " ":0 " ":1 0 ":1 " 60 0 622 1 62* 0 62" 0 62" " 62" , 62" 8 626 0 626 1 626 2 62, 0 62, " 628 0 628 8 6*2 0 660 0 661 0 6611 661 2 661 661 " 6,0 " 6,1 " 6,1 6 6,* 0 6,* " 6, 0 6, $% removal of tumor(s), polyp(s), or other lesion(s) by snare techni1ue ;ilation of anal sphincter under anesthesia other than local ;ilation of rectal stricture under anesthesia other than local .emoval of fecal impaction or foreign body under anesthesia Incision and drainage of ischiorectal and%or perirectal abscess Demorrhoidectomy, by simple ligature (e.g., rubber band) -'cision of e'ternal hemorrhoid tags and%or multiple papillae Demorrhoidectomy, e'ternal, complete Demorrhoidectomy, internal and e'ternal, simple( $% fissurectomy $% fistulectomy, $% or $%o fissurectomy Demorrhoidectomy, internal and e'ternal, comple' or e'tensive( $% fissurectomy $% fistulectomy, $% or $%o fissurectomy +urgical treatment of anal fistula (fistulectomy%fistulotomy)( subcutaneous submuscular comple' or multiple, $% or $%o placement of seton 3losure of anal fistula $% rectal advancement flap -nucleation or e'cision of e'ternal thrombotic hemorrhoid /noscopy( diagnostic, $% or $%o collection of specimen(s) by brushing or $ashing $% removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery $% removal of single tumor, polyp or other lesion by snare techni1ue $% removal of multiple tumor, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare techni1ue $% control of bleeding, any method $% ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare techni1ue /noplasty, plastic operation for stricture( infant .epair of lo$ imperforate anus( $% anoperineal fistula (5cut9bac#5 procedure) $% transportation of anoperineal or anovestibular fistula .epair of high imperforate anus $%o fistula( perineal or sacroperineal approach combined transabdominal and sacroperineal approaches .epair of high imperforate anus $% rectourethral or rectovaginal fistula( perineal or sacroperineal approach combined transabdominal and sacroperineal approaches :0 100 0 0 0 0 80 80 80 80 80 80 80 80 80 80 80 80 100 80 20 *0 0 0 *0 "0 1"0 1"0 2"0 2"0 *00 200 *"0 RV U

DESCRIPTIVE TERMS

2 6, .epair of cloacal anomaly by anorectovaginoplasty and urethroplasty, sacroperineal approach 6, 6 6, 8 6," 1 ,10 0 ,1* " ,1* 6 ,*, 0 ,*, 1 , : 0 ,"1 0 ,"11 ,"" 2 ,"" * ,"" ,"" " ,"" 6 ,"6 2 ,60 0 ,6* 0 .epair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach( $% vaginal lengthening by intestinal graft or pedicle flaps +phincteroplasty, anal, for incontinence or prolapse( child )iopsy of liver, $edge >iver allotransplantation( orthotopic, partial or $hole, from cadaver or living donor, any age heterotopic, partial or $hole, from cadaver or living donor, any age >aparoscopy, surgical, ablation of one or more liver tumor(s)( radiofre1uency cryosurgical !ercutaneous cholecystostomy Introduction of percutaneous transhepatic catheter for biliary drainage Introduction of percutaneous transhepatic stent for internal and e'ternal biliary drainage )iliary endoscopy, percutaneous via 49 tube or other tract( diagnostic, $% or $%o collection of specimen(s) by brushing and%or $ashing $% biopsy, single or multiple $% removal of stone(s) $% dilation of biliary duct stricture(s) $%o stent $% dilation of biliary duct stricture(s) $% stent >aparoscopy, surgical( cholecystectomy (any method) 3holecystectomy( )iliary duct stone e'traction, percutaneous via 49tube tract, bas#et, or snare (e.g., )urhenne techni1ue) "0 "00 "00 1"0 100 00 00 100 100 200 200 200 1"0 1"0 1"0 1"0 1"0 200 200 1"0

12 of 22

ANNEX
COD E 800 " 810 0 81 0 81 " 81 6 81" * 81" $%o pancreato0e0unostomy 81" " 816 0 818 0 8"2 0 8" " 8"" 8"" 6 :*2 1 :*2 2 : : " :"0 0 :"0 " "006 0 "006 " "00, " "008 0 "01* 0 "01* " "022 0 "022 " "02* 0 "02 0 "028 0 "02: 0 "0*2 !ancreatectomy, total !ancreatectomy, total or subtotal, $% autologous transplantation of pancreas or pancreatic islets !ancreatico0e0unostomy, side9to9side anastomosis (!uesto$9type operation) Internal anastomosis of pacreatic cyst to gastrointestinal tract( direct !ancreatorrhaphy for trauma 4ransplantation of pancreatic allograft .emoval of transplanted pancreatic allograft >aparoscopy, surgical( $ith biopsy (single or multiple) $ith aspiration of cavity or cyst (single or multiple) .epair initial inguinal hernia, under age 6 months, $% or $%o hydrocelectomy( reducible .epair initial inguinal hernia, age 6 months to under " years, $% or $%o hydrocelectomy( reducible .epair initial inguinal hernia, age " years or over( reducible ?ephrolithotomy( removal of calculus secondary surgical operation for calculus removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy) !ercutaneous nephrostolithotomy or pyelostolithotomy, $% or $%o dilation, endoscopy, lithotripsy, stenting, or bas#et e'traction( up to 2 cm $% removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy) complicated (e.g., secondary operation, congenital #idney abnormality) ?ephrectomy, including partial ureterectomy, any approach including rib resection( complicated because of previous surgery on same #idney radical, $% regional lymphadenectomy and%or vena caval thrombectomy ?ephrectomy, partial -'cision or unroofing of cyst(s) of #idney -'cision of perinephric cyst ;onor nephrectomy, $% preparation and maintenance of allograft( from living donor "0 "00 "00 00 *00 *"0 200 1"0 "0 80 80 80 80 180 200 2"0 200 1"0 1,0 180 200 200 180 120 120 180

DESCRIPTIVE TERMS .esection or debridement of pancreas and peripancreatic tissue for acute necroti&ing pancreatitis )iopsy of pancreas, open, any method (e.g., fine needle aspiration, needle core biopsy, $edge biopsy) !ancreatectomy, distal subtotal, $% or $%o splenectomy( $%o pancreatico0e0unostomy $% pancreatico0e0unostomy !ancreatectomy, distal, near9total $% preservation of duodenum (3hild9type procedure) !ancreatectomy, pro'imal subtotal $% near total duodenectomy, choledochoenterostomy and duodeno0e0unostomy (pylorus9 sparing, 6hipple9type procedure)( $% pancreato0e0unostomy

RVU *00 80 *00 *"0 *"0 "00

0 "0*6 0 "0*6 " "0*, 0 "0*8 0 "0*: 1 "0*: 2 "0*: * "0 0 0 "0 0 " "0" 1 "0" 2 "0" * "061 0 "062 0 "06* 0 "06" 0 "0,0 0 "0,1 " "0,6 0

.enal allotransplantation, implantation of graft( e'cluding donor and recipient nephrectomy $% recipient nephrectomy .emoval of transplanted renal allograft .enal autotransplantation, reimplantation of #idney Instillation of therapeutic agent into renal pelvis and%or ureter through established nephrostomy, pyelostomy or ureterostomy tube Introduction of intracatheter or catheter into renal pelvis for drainage and%or in0ection, percutaneous Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and%or in0ection, percutaneous !yeloplasty (2oley C9pyeloplasty), plastic operation on renal pelvis, $% or $%o plastic operation on ureter, nephrope'y, nephrostomy, pyelostomy, or ureteral splinting( simple complicated (congenital #idney abnormality, secondary pyeloplasty, solitary #idney, calycoplasty) >aparoscopy, surgical( ablation of renal cysts ablation of renal mass lesion(s) partial nephrectomy Breterolithotomy( upper one9third of ureter middle one9third of ureter lo$er one9third of ureter Breterectomy, $% bladder cuff Breteroplasty, plastic operation on ureter (e.g., stricture) Breterolysis, $% or $%o repositioning of ureter for retroperitoneal fibrosis Breteroureterostomy

*00 80 200 *"0 "0 "0 "0 200 220 60 "0 200 1*0 120 1*0 1*0 1*0 1*0 1*0

13 of 22

ANNEX
COD E "0,8 0 "0: 0 "10 0 "10" 0 "106 0 "106 " "1"0 0 "160 0 "1,2 0 "1: 0 "200 0 "200 " "220 "221 "222 "22* "22* " "22 0 "22, 0 "22, " "22, 6 "2*1 0 "2*1 , "2*1 8 "2*2 0 "2*2 " "2** 2 "2** " "2* 0 "2 " 3ystourethroscopy, $% biopsy 3ystourethroscopy, $% fulguration (including cryosurgery or laser surgery) of trigone, bladder nec#, prostatic fossa, urethra, or periurethral glands 3ystourethroscopy, $% fulguration (including cryosurgery or laser surgery) or treatment of 7I?=. (less than 0." cm) lesion(s) $% or $%o biopsy 3ystourethroscopy, $% fulguration (including cryosurgery or laser surgery) and%or resection of( +7/>> bladder tumor(s) (0." cm to 2.0 cm) 7-;IB7 bladder tumor(s) (2.0 to ".0 cm) >/.8- bladder tumor(s) 3ystourethroscopy, $% internal urethrotomy( female male 3ystourethroscopy $% direct vision internal urethrotomy 3ystourethroscopy, $% removal of foreign body, calculus, or ureteral stent from urethra or bladder >itholapa'yG crushing or fragmentation of calculus by any means in bladder and removal of fragments( simple or small (less than 2." cm) complicated or large (over 2." cm) 3ystourethroscopy (including ureteral catheteri&ation)( $% removal of ureteral calculus $% fragmentation of ureteral calculus (e.g., ultrasonic or electro9hydraulic techni1ue) 3ystourethroscopy, $% insertion of ind$elling ureteral stent (e.g., 8ibbons or double9E type) 3ystourethroscopy, $% ureteroscopy and%or pyeloscopy (includes dilation of the ureter and%or pyeloureteral 0unction by any method)( 3ystourethroscopy $% incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds 4ransurethral incision of prostate 60 ,0 ,0 120 1*" 1"0 ," ," 8" 60 100 110 ,0 100 60 80 110 1"0

DESCRIPTIVE TERMS Breteroneocystostomy( anastomosis of single ureter to bladder ;eligation of ureter 3ystostomy, cystotomy $% drainage 3ystolithotomy, cystotomy $% removal of calculus, $%o vesical nec# resection 4ransvesical ureterolithotomy 3ystotomy, $% stone bas#et e'traction and%or ultrasonic or electrohydraulic fragmentation of ureteral calculus -'cision of urachal cyst or sinus, $% or $%o umbilical hernia repair In0ection procedure for cystography or voiding urethrocystography )ladder instillation of anticarcinogenic agent 3losure of bladder e'strophy 3ystourethroscopy 3ystourethroscopy, $% ureteral catheteri&ation, $% or $%o irrigation, instillation, or ureteropyelography, e'clusive of radiologic service(

RVU 180 1*0 "0 8" 1*0 1*0 200 *0 *0 200 0 "0

0 "2"0 0 "260 1 "262 0 "26* 0 "26 0 "2,0 0 "*60 0 "*60 " "*66 " " *0 0 " *0 " "0 " " "2 0 " "* 0 " "* " " "" 0 " "6 0 " 60 0

4ransurethral resection of bladder nec# 4ransurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatomy, cystourethroscopy, urethral calibration and%or dilation, and internal urethrotomy are included) 4ransurethral resection( of residual obstructive tissue after :0 days postoperative of regro$th of obstructive tissue longer than one year postoperative of postoperative bladder nec# contracture 4ransurethral drainage of prostatic abscess ;ilation of urethral stricture by passage of sound or urethral dilator, male ;ilation of urethral stricture or vesical nec#, male, general or conduction (spinal) anesthesia ;ilation of female urethra, general or conduction (spinal) anesthesia !lastic operation of penis for straightening of chordee (e.g., hypospadias), $% or $%o mobili&ation of urethra !lastic operation on penis for correction of chordee or for first stage hypospadias repair $% or $%o transplantation of prepuce and%or s#in flaps )iopsy of testis, incisional =rchiectomy, simple (including subcapsular), $% or $%o testicular prosthesis, scrotal or inguinal approach =rchiectomy, radical, for tumor( inguinal approach $% abdominal e'ploration -'ploration for undescended testis (inguinal or scrotal area) -'ploration for undescended testis $% abdominal e'ploration .eduction of torsion of testis, surgical, $% or $%o fi'ation of contralateral testis

1"0 2"0 120 2"0 120 100 20 20 20 "0 :0 20 60 6" 8" 60 8" 6"

14 of 22

ANNEX
COD E " 6 0 " 6" 0 " 6, 0 " 82 0 " 8 0 ""0 0 ""0 1 ""06 0 """0 0 """* 0 """* " """ 0 """" 0 "",0 0 ""80 1 ""81 0 ""81 2 ""81 " ""82 1 ""8 0 ""8 2 ""8 " ""8" : ""86 6 "6 0 " "6 2 0 "6 0 "6 1 "6"0 1 "660 " "662 0

DESCRIPTIVE TERMS =rchiope'y, inguinal approach, $% or $%o hernia repair =rchiope'y, abdominal approach, for intra9abdominal testis (e.g., 2o$ler9+tephens) +uture or repair of testicular in0ury -'ploration of epididymis, $% or $%o biopsy -'cision of spermatocele, $% or $%o epididymectomy -'cision of hydrocele( unilateral bilateral .epair of tunica vaginalis hydrocele ()ottle type) -'cision of hydrocele of spermatic cord, unilateral -'cision of varicocele or ligation of spermatic veins for varicocele( abdominal approach $% hernia repair >aparoscopy, surgical( $ith ligation of spermatic veins for varicocele )iopsy, prostate( needle or punch, single or multiple, any approach !rostatectomy, perineal, subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and%or dilation, and internal urethrotomy) !rostatectomy, perineal radical( $% lymph node biopsy(s) (limited pelvic lymphadenectomy) $% bilateral pelvic lymphadenectomy, including e'ternal iliac, hypogastric and obturator nodes !rostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and%or dilation, and internal urethrotomy)( suprapubic, subtotal, one or t$o stages !rostatectomy, retropubic radical, $% or $%o nerve sparing( $% lymph node biopsy(s) (limited pelvic lymphadenectomy) $% bilateral pelvic lymphadenectomy, including e'ternal iliac, hypogastric, and obturator nodes 4ransperineal placement of needles, catheters or pellets into prostate for interstitial radioelement application, $ith or $ithout cystoscopy, ultrasound or 34 scan guidance >aparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing Incision and drainage of vulva or perineal abscess Incision and drainage of )artholin<s gland abscess 7arsupiali&ation of )artholin<s gland cyst >ysis of labial adhesions ;estruction of lesion(s), vulva( any method )iopsy of vulva or perineum ( one lesion @ulvectomy simple( partial

RVU 60 8" "0 2" *0 "0 100 "0 "0 ," :0 :0 :0 2" 2 0 *00 *20 *20 2 0 *00 *20 *20 100 *00 1" 2" "0 2" 2" 2" 80

"662 " "66* 0 "6,0 0 "6,2 0 "6, 0 ",00 0 ",06 1 ",10 0 ",12 0 ",1* 0 ",1* " ",22 0 ",2* 0 ",2" 0 ",26 0 ",26 " ",*0 0 ", 1 " ", " 2 ", " ","2 2 ",,2 0

complete @ulvectomy, radical, partial( !artial hymenectomy or revision of hymenal ring Dymenotomy, simple incision -'cision of )artholin<s gland or cyst 3olpotomy( $% e'ploration ;estruction of vaginal lesion(s) )iopsy of vaginal mucosa 3olpocleisis (>e 2ort type) -'cision of vaginal septum -'cision of vaginal cyst or tumor !lastic operation on urethral sphincter, vaginal approach (e.g., Felly urethral plication) !lastic repair of urethrocele !osterior colporrhaphy, repair of rectocele $% or $%o perineorrhaphy 3ombined anteroposterior colporrhaphy( $% enterocele repair 3losure of rectovaginal fistula( vaginal or transanal approach .emoval of impacted vaginal foreign body under anesthesia 3olposcopy (@aginoscopy) 3olposcopy( $% biopsy(s) of the cervi' and%or endocervical curettage loop electrode e'cision 4rachelorrhaphy, plastic repair of uterine cervi', vaginal approach

1"0 180 "0 2" "0 80 20 20 180 2" "0 80 80 120 1"0 200 120 0 *0 0 ," 100

15 of 22

ANNEX
COD E "810 0 "812 0 "81 " "8*0 0 "8* " "8"" " "8"" 8 "8"" : "8"6 0 "8"6 2 "8"6 * "866 0 "866 1 "866 2 "86, 0 "86, 2 "86, * "8,0 0 "8,2 0 "8, 0 "8,6 0 "8,, 0 "880 0 "880 " "882 0 "882 2 "882 " "8:0 0 "8:2 0 "8:2 " "8:6 0 ":12 RV U "0 "0 100 10 100 "0 ," 100 100 ," 80 12" *"0 :0 :0 12" 1"0 120 1"0 1"0 1"0 1"0 120 120 120 120 120 100 100 1"0

DESCRIPTIVE TERMS -ndometrial sampling (biopsy) $% or $%o endocervical sampling (biopsy), $%o cervical dilation, any method ;ilation and curettage vaginal approach Insertion of intrauterine device (IB;) 4ranscervical introduction of fallopian tube catheter for diagnosis and%or re9establishing patency (any method), $% or $%o hysterosalpingography Dysteroscopy, diagnostic Dysteroscopy, surgical( $ith sampling (biopsy) of endometrium and%or polypectomy, $ith or $ithout ; H 3 $ith lysis of intrauterine adhesions (any method) $ith division or resection of intrauterine septum (any method) $ith removal of impacted foreign body $ith endometrial ablation (e.g., endometrial resection, electrosurgical ablation thermoablation) >aparoscopy, surgical( $ith lysis of adhesions (salphingolysis, ovariolysis) $ith removal of adne'al structures (partial or total oophorectomy and%or salpingectomy) $ith fulguration or e'cision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method $ith fulguration of oviducts ($ith or $ithout transection) $ith fimbrioplasty $ith salphingostomy (salpingoneostomy) +alpingectomy, complete or partial, unilateral or bilateral +alpingo9oophorectomy, complete or partial, unilateral or bilateral >ysis of adhesions (salpingolysis, ovariolysis) 2imbrioplasty +alpingostomy (salpingoneostomy) ;rainage of ovarian cyst(s), unilateral or bilateral ( vaginal approach abdominal approach ;rainage of ovarian abscess( vaginal approach abdominal approach 4ransposition, ovary(s) )iopsy of ovary, unilateral or bilateral 6edge resection or bisection of ovary, unilateral or bilateral =varian cystectomy, unilateral or bilateral >aparotomy, for staging or restaging of ovarian malignancy (5second loo#5), $% or $%o omentectomy, peritoneal $ashing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment $% pelvic and limited para9aortic lymphadenectomy +urgical treatment of ectopic pregnancy( tubal or ovarian, re1uiring salpingectomy and%or oophorectomy, abdominal or

180 180

0 ":12 1 ":1" 0 ":1" 1 ":81 2 ":8, 0 6000 1 6010 0 6020 0 6021 0 6021 2 6022 0 6022 " 602 0 602" 2 602" 602, 0 602, 1 6110" 6110, 61108

vaginal approach tubal or ovarian, $%o salpingectomy and%or oophorectomy >aparoscopic treatment of ectopic pregnancy( $%o salpingectomy and%or oophorectomy $% salpingectomy and%or oophorectomy 4reatment of incomplete abortion, any trimester, completed surgically Bterine evacuation and curettage for hydatidiform mole /spiration and%or in0ection, thyroid cyst )iopsy thyroid, percutaneous core needle -'cision of cyst or adenoma of thyroid , or transection of isthmus !artial thyroid lobectomy, unilateral( $% or $%o isthmusectomy $% contralateral subtotal lobectomy, including isthmusectomy 4otal thyroid lobectomy, unilateral( $% or $%o isthmusectomy $% contralateral subtotal lobectomy, including isthmusectomy 4hyroidectomy, total or complete 4hyroidectomy, total or subtotal for malignancy( $% limited nec# dissection $% radical nec# dissection 4hyroidectomy, including substernal thyroid gland( sternal split or transhoracic approach cervical approach 4$ist drill hole for subdural or ventricular puncture( not follo$ed by other surgery for implanting venticular catheter or pressure recording device for evacuation and%or drainage of subdural hematoma 180 180 180 "0 80 0 0 120 1"0 200 180 200 2"0 2"0 *00 *00 *00 100 200 2"0

16 of 22

ANNEX
COD E 61120 611 0 611"0 611" 611"6 612" 0 612" * 61*0 61*0 " 61*1 2 61*2 0 61* * 61 " 0 61"1 8 61"2 1 61"* 6 61"" 6 61", 0 61", 1 61": 0

DESCRIPTIVE TERMS )urr hole(s) for ventricular puncture (including in0ection of gas, contrast media, dye, or radioactive material)( not follo$ed by other surgery )urr hole(s) or trephine( $% biopsy of brain or intracranial lesion $% drainage of brain abscess or cyst )urr hole(s) $% evacuation and%or drainage of hematoma, e'tradural or subdural )urr hole(s)( $% aspiration of hematoma or cyst, intracerebral )urr hole(s) or trephine, supratentorial )urr hole(s) or trephine, infratentorial, unilateral or bilateral 3raniectomy or craniotomy, e'ploratory( supratentorial infratentorial (posterior fossa) 3raniectomy or craniotomy for evacuation of hematoma, supratentorial( e'tradural or subdural 3raniectomy or craniotomy, drainage of intracranial abscess( supratentorial 3raniectomy, suboccipital $% cervical laminectomy for decompression of medulla and spinal cord, $% or $%o dural graft (e.g., /rnold93hiari malformation) 3raniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian ganglion 3raniectomy for e'cision of brain tumor, infratentorial or posterior fossa( e'cept meningioma, cerebellopontine angle tumor, or midline tumor at base of s#ull midline tumor at base of s#ull for e'cision of cerebral epileptogenic focus, $% electrocorticography during surgery (includes removal of electrode array) 3raniotomy for craniosynostosis( frontal or parietal bone flap 3raniectomy or craniotomy( $% e'cision of foreign body from brain $% treatment of penetrating $ound of brain Infratemporal pre9auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline s#ull base, nasopharyn'), $% or $%o disarticulation of the mandible, including parotidectomy, craniotomy, decompression and%or mobili&ation of the facial nerve and%or petrous carotid artery Infratemporal post9auricular approach to middle cranial fossa (internal auditory meatus, petrous ape', tentorium, cavernous sinus, parasellar area, infratemporal fossa) inlcuding mastoidectomy, resection of sigmoid sinus, $% or $%o decompression and%or mobili&ation of contents of auditory canal or petrous carotid artery 4ranscatheter oclussion or emboli&ation (e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method( central nervous system (intracranial, spinal cord) non9central nervous system, head or nec# (e'tracranial, brachiocephalic branch) +urgery of intracranial arteriovenous malformation( dural, simple dural, comple' +urgery of intracranial aneurysm, cervical approach by application of occluding clamp to cervical carotid artery (+elverstone9 3rutchfield type) by intra9arterial emboli&ation, in0ection procedure or balloon catheter /nastomosis, arterial, e'tracranial9intracranial (e.g., middle cerebral%cortical) arteries 3reation of lesion by stereotactic method, including burr hole(s) and locali&ing and recording techni1ues, single or multiple stages( globus pallidus or thalamus subcortical structure(s) other than globus pallidus or thalamus

RVU 1"0 2"0 2"0 2"0 2"0 1"0 200 2"0 *00 *00 *00 *"0 *"0 "2" 600 00 *00 *"0 *," 600

61": 1 6162 6162 6 616: 0 616: 2 61,0 * 61,1 0 61,11 61,2 0 61,*

600

600 00 00 "00 1"0 "00 ""0 ""0 "00

" 61," 0 61," 1 61,6 0 61,: 0 61,: 1 61,: * 61,: " 618" " 6186 0 618, 0 618, " 6200 0 6200 " 6220 1 6222 0

+tereotactic biopsy, aspiration, or e'cision,including burr hole(s), for intracranial lesion( $% computeri&ed a'ial tomography +tereotactic implantation of depth electrodes into the cerebrum for long term sei&ure monitoring 3reation of lesion by stereotactic method, percutaneous, by neurolytic agent (e.g., alcohol, thermal, electrical, radiofre1uency)( gasserian ganglion trigeminal medullary tract +tereotactic radiosurgery (particle beam,gamma ray or linear accelerator) +tereotactic computer assisted volumetric intracranial procedure 4$ist drill or burr hole(s) for implantation of neurostimulator electrodes( subcortical 3raniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral( cortical 3raniectomy for implantation of neurostimulator electrodes, cerebellar( cortical subcortical -levation of depressed s#ull fracture( simple, e'tradural compound or comminuted, e'tradural @entriculocisternostomy, third ventricle( stereotactic method 3reation of shunt( ventriculo9atrial, 90ugular,9auricular

"00 "00 "00 2"0 2"0 "00 "00 ""0 "0 "0 ""0 200 2"0 *00 200

17 of 22

ANNEX
COD E 6222 * 622* 0 6226 8 6226 : 622, 0 6228 , 62*" 0 62*" 1 62*6 0 62*6 1 62*6 2 6"0: 1 6"0: * 6"10 1 6"10 * 6"10 " 6"2, 0 6"2, * 6"2, " 6"28 0 6"28 " 6"28 6 6"2: 0 6" 0 0 6" 1 0 6" 2 0 6" 2 6 6" " 0 6",1 0 6",* 0 6"," 0 6"," " ventriculo9peritonial,9pleural, other terminus .eplacement or revision of 3+2 (@!) shunt, obstructed valve, or distal catheter in shunt system !ercutaneous aspiration, spinal cord cyst or syrin' )iopsy of spinal cord, percutaneous needle +pinal puncture, lumbar, diagnostic /spiration procedure, percutaneous, of nucleus pulposus of intervertebral dis#, any method, single or multiple levels, lumbar Implantation, revision or repositioning of intrathecal or epidural catheter, for implantable reservoir or implantable infusion pump( $%o laminectomy $% laminectomy Implantation or replacement of device for intrathecal or epidural drug infusion( subcutaneous reservoir non9programmable pump programmable pump, including preparation of pump, $% or $%o programming -visceration of ocular contents( $%o implant $% implant -nucleation of eye( $%o implant $% implant, muscles not attached to implant $% implant, muscles attached to implant .epair of laceration( con0unctiva, $% or $%o nonperforating laceration sclera, direct closure con0unctiva, by mobili&ation and rearrangement cornea, nonperforating, $% or $%o removal foreign body cornea and%or sclera, perforating, not involving uveal tissue cornea and%or sclera, perforating, $% reposition or resection of uveal tissue application of tissue glue, $ounds of cornea and%or sclera .epair of $ound, e'traocular muscle, tendon and% or 4enon<s capsule -'cision of lesion, cornea (#eratectomy, lamellar, partial), e'cept pterygium )iopsy of cornea -'cision or transposition of pterygium( $ithout graft $ith graft ;estruction of lesion of cornea by cryotherapy, photocoagulation or thermocauteri&ation Feratoplasty (corneal transplant)( lamellar penetrating (e'cept in apha#ia) penetrating (in apha#ia) penetrating (in pseudopha#ia)

DESCRIPTIVE TERMS

RVU 200 1"0 ," ," 20 1"0 100 2"0 "0 100 1"0 80 80 80 80 80 *0 *0 "0 120 1"0 "0 "0 0 *0 0 "0 *0 200 200 200 200

6",6 , 6",, 0 6",, 1 6",, 2 6",, " 6"80 " 6"81 0 6"81 " 6"82 0 6"8" 0 6"8" " 6"86 " 6"8, 0 6"8, " 6"88 0 6":0 0 6":2 0 6":* 0 661* 0 661" 0 661" "

-pi#eratoplasty Feratoprosthesis .adial #eratotomy 3orneal rela'ing incision for correction of surgically induced astigmatism 3orneal $edge resection for correction of surgically induced astigmatism !aracentesis of anterior chamber of eye( $% therapeutic release of a1ueous $% removal of vitreous and%or discission of anterior hyaloid membrane, $% or $%o air in0ection $% removal of blood, $% or $%o irrigation and%or air in0ection 8oniotomy 4rabeculotomy ab e'terno 4rabeculoplasty by laser surgery, one or more sessions (defined treatment series) +evering adhesions of anterior segment of eye, incisional techni1ue ($% or $%o in0ection of air or li1uid) ( goniosynechiae anterior synechiae, e'cept goniosynechiae posterior synechiae corneovitreal adhesions .emoval of epithelial material, anterior segment eye .emoval of implanted material, anterior segment eye .emoval of blood clot, anterior segment eye -'cision of lesion, sclera 2istuli&ation of scalera for glaucoma( trephination $% iridectomy thermocauteri&ation $% iridectomy

100 200 :0 :0 :0 *0 "0 "0 1"0 1"0 80 60 60 60 60 60 80 *0 0 100 100

18 of 22

ANNEX
COD E 6616 0 6616 " 661, 0 661, 2 6618 0 6618 " 6622 0 6622 " 662" 0 66"0 0 66"0 " 6660 0 6660 " 6662 " 666* 0 6668 0 6668 2 66,0 0 66,1 0 66,2 0 66, 0 66,6 2 66,, 0 6682 0 6682 1 6682 " 668* 0 668" 2 6,00 " 6,01 " 6,02 "

DESCRIPTIVE TERMS sclerectomy $% punch or scissors, $% iridectomy iridencleisis or iridotasis trabeculectomy ab e'terno in absence of previous surgery trabeculectomy ab e'terno $% scarring from previous ocular surgery or trauma (includes in0ection of antifibrotic agents) /1uenous shunt to e'traocular reservoir (e.g., 7olteno, +choc#et, ;enver9Frupin) .evision of a1ueous shunt to e'traocular reservoir .epair of scleral staphyloma( $%o graft $% graft .evision or repair of operative $ound of anterior segment, any type, early or late, ma0or or minor procedure Iridotomy by stab incision ( e'cept transfi'ion $% transfi'ion as for iris bombe Iridectomy, $% corneoscleral or corneal section( for removal of lesion $% cyclectomy peripheral for glaucoma sector for glaucoma .epair of iris, ciliary body (as for iridodialysis) +uture of iris, ciliary body $% retrieval of suture through small incision (e.g., 7c3annel suture) 3iliary body destruction( diathermy cyclophotocoagulation cryotherapy cyclodialysis Iridoplasty by photocoagulation (one or more sessions) (e.g., for improvement of vision, for $idening of anterior chamber angle) ;estruction of cyst or lesion iris or ciliary body (none'cisional procedure) ;iscission of secondary membranous cataract (opacified posterior lens capsule and%or anterior hyaloid)( stab incision techni1ue (Aiegler or 6heeler #nife) laser surgery (e.g., C/8 laser) (one or more stages) .epositioning of intraocular lens prosthesis, re1uiring an incision .emoval of secondary membranous cataract (opacified posterior lens capsule and%or anterior hyaloid) $% corneo9scleral section, $% or $%o iridectomy (iridocapsulotomy, iridocapsulectomy) pars plana approach, $ith or $ithout vitrectomy .emoval of vitreous, anterior approach (open s#y techni1ue or limbal incision)( partial removal /spiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy) In0ection of vitreous substitute, pars plana or limbal approach, (fluid9gas e'change), $% or $%o aspiration

RVU 100 100 100 180 200 200 80 1"0 :0 60 60 80 100 80 80 100 :0 ,0 ,0 ,0 ,0 80 60 80 0 100 80 180 2"0 "0 80

6,0* 6 6,0* 8 6,0* : 6,0 0 6,0 1 6,0 2 6,0 * 6,0 6,0 " 6,0 6 6,0 , 6,0 8 6,0 : 6,0" 0 6,0" 1 6,0" 2 6,10 1 6,10 " 6,10 ,

@itrectomy, mechanical, pars plana approach( $% epiretinal membrane stripping $% focal endolaser photocoagulation $% endolaser panretinal photocoagulation @itrectomy, mechanical, pars plana approach( $ith internal limiting membrane (I>7) peeling $ith radial optic nerve neurotomy (.=?) $ith sheathotomy for branch retinal vein occlusion $ith macular translocation (limited by retinotomy and%or scleral imbrication) $ith macular translocation (total) $ith removal of subretinal membranes $ith removal of choroidal neovascular membrane $ith endodrainage of subretinal hemorrhage ($ith or $ithout t!/ in0ection) $ith removal of dropped I=> $ith phacofragmentation for dropped lens material $ith internal tamponade $ith air, gas, silicone oil, perfluorocarbon li1uid $ith insertion of scleral fi'ated intraocular lens, $ith or $ithout anterior vitrectomy .epair of retinal detachment, one or more sessions( cryotherapy or diathermy, $% or $%o drainage of subretinal fluid photocoagulation, $% or $%o drainage of subretinal fluid .epair of retinal detachment( scleral buc#ling (such as lamellar scleral dissection, imbrication or encircling procedure), $% or $%o implant, $% or $%o cryotherapy, photocoagulation, and drainage of subretinal fluid

*00 *00 *00 *00 *00 *00 *00 *00 *00 *00 *00 *00 *00 *00 *00 2"0 *00 220 *00

19 of 22

ANNEX
COD E 6,10 8 6,110 6,112 6,11" 6,12 0 6,12 1 6,20 8 6,21 0 6,21 8 6,22 0 6,22 1 6,22 2 6,22 , 6,22 8 6,2" 0 6, 0 0 6, 0 " 6, 1 2 6, 1 * 6, 1 6, 2 0 6, * 0 6, 0 6, " 6,", 0 6,"8 0 6,"8 2 6,"8 * 6,"8 6,"8 " 6,"8 6 6,,0 RV U *00 200 *00 80 80 120 80 80 80 80 80 80 80 80 80 *00 *00 *00 *00 *00 *00 *00 *00 *00 *"0 80 120 120 120 120 120 20

DESCRIPTIVE TERMS $% vitrectomy, any method, $% or $%o air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buc#ling, and%or removal of lens by same techni1ue by in0ection of air or other gas (e.g., pneumatic retinope'y) by scleral buc#ling or vitrectomy, on patient having previous ipsilateral retinal detachment repair(s) using scleral buc#ling or vitrectomy techni1ues .elease of encircling material (posterior segment) .emoval of implanted material, posterior segment( e'traocular intraocular ;estruction of locali&ed lesion of retina (e.g., maculopathy, choroidopathy, small tumors), one or more sessions( cryotherapy, diathermy photocoagulation (laser or 'enon arc) radiation by implantation of source (includes removal of source) ;estruction of locali&ed lesion of choroid (e.g., choroidal neovasculari&ation)( photocoagulation (e.g., laser), one or more sessions photodynamic therapy (includes intravenous infusions transpupillary thermotherapy ;estruction of e'tensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions( cryotherapy, diathermy photocoagulation (laser or 'enon arc) +cleral reinforcement =rbitotomy $%o bone flap (frontal or transcon0unctival approach)( for e'ploration, $% or $%o biopsy $% drainage only $% removal of lesion $% removal of foreign body $% removal of bone for decompression =rbitotomy $% bone flap or $indo$, lateral approach (e.g., Froenlein)( $% removal of lesion $% removal of foreign body $% drainage $% removal of bone for decompression =ptic nerve decompression (e.g., incision or fenestration of optic nerve sheath) .epair of anophthalmic soc#et( $ith insertion or removal of orbital implant $ithin muscle cone $ith e'change of orbital implant and reattachment of muscles $ith forni' reconstruction using sutures $ith forni' reconstruction using buccal mucosal graft or amnion graft, including harvesting of graft $ith revision of implant and forni' reconstruction using sutures $ith revision of implant and forni' reconstruction using buccal mucosal graft, or amnion graft (including harvesting of graft) )lepharotomy, drainage of abscess, eyelid

0 6,,1 0 6,,1 " 6,80 0 6,81 0 6,8, " 6,88 0 6,88 2 6,:0 0 6,:0 8 6,:1 6,:1 " 6,:* " 6,:" 0 6,:, 1 6,:, * 6,:, 6810 0 68110

+evering of tarsorrhaphy 3anthotomy -'cision of chala&ion )iopsy of eyelid 4emporary closure of eyelids suture (e.g., frost suture) 3onstruction of intermargin adhesions, median tarsorrhaphy, or canthorrhaphy( $ith transportation of tarsal plate .epair of bro$ ptosis (supraciliary, midforehead or coronal approach) con0unctivo9tarso97uller<s muscle9levator resection (2asanella9+ervat type) .epair of ectropionG suture thermocauteri&ation full thic#ness 3anthoplasty (reconstruction of canthus) .econstruction of eyelid, full thic#ness by transfer of tarsocon0unctival flap from opposing eyelid( up to t$o9thirds of eyelid, one stage or first stage total eyelid, lo$er, one stage or first stage total eyelid, upper, one stage or first stage )iopsy of con0unctiva -'cision of lesion, con0unctiva( up to 1 cm

20 20 20 20 20 20 *0 100 100 *0 *0 80 80 200 2"0 2"0 20 *0

20 of 22

ANNEX
COD E 6811" 681* 0 68* 0 68*6 0 68*6 2 68 0 0 68 2 0 68 0 68"0 0 68"1 0 68"2 0 68"2 " 68"* 0 68" 0 68,0 0 68,2 0 68, " 68," 0 68,6 0 68,, 0 68811 6:10 0 6:10 " 6:110 6:12 0 6:1 0 6:1 " 6:1" 0 6:1" " 6:22 0 6:22 2 6: 2 0 6: 2 1 6: * * over 1 cm $ith ad0acent sclera division of symblepharon, $ith or $ithout insertion of conformer or contact lens 3on0unctival flap( bridge or partial total (such as 8underson thin flap or purse string flap) Incision, drainage of lacrimal gland Incision, drainage of lacrimal sac (dacryocystostomy) +nip incision of lacrimal punctum -'cision of lacrimal gland (dacryoadenectomy), e'cept for tumor )iopsy of lacrimal gland -'cision of lacrimal sac (dacryocystectomy) )iopsy of lacrimal sac .emoval of foreign body or dacryolith, lacrimal passages -'cision of lacrimal gland tumor( frontal approach !lastic repair of canaliculi ;acryocystorhinostomy (fistuli&ation of lacrimal sac to nasal cavity) con0unctivorhinostomy (fistuli&ation of con0unctiva to nasal cavity)( $ithout tube $ith insertion of tube or stent 3losure of the lacrimal punctum( by thermocauteri&ation, ligation, or laser surgery 3losure of lacrimal fistula !robing of nasolacrimal duct( re1uiring general anesthesia )iopsy e'ternal ear )iopsy e'ternal auditory canal -'cision e'ternal ear( partial, simple repair complete amputation -'cision e'ostosis(es), e'ternal auditory canal -'cision soft tissue lesion, e'ternal auditory canal .adical e'cision e'ternal auditory canal lesion( $%o nec# dissection $% nec# dissection ;ebridement, mastoidectomy cavity, simple (e.g., routine cleaning) ;ebridement, mastoidectomy cavity, comple' (e.g., $% anesthesia or more than routine cleaning) 7yringotomy including aspiration and%or eustachian tube inflation 7yringotomy including aspiration and%or eustachian tube inflation re1uiring general anesthesia 4ympanostomy (re1uiring insertion of ventilating tube), local or topical anesthesia

DESCRIPTIVE TERMS

RVU *0 *0 100 ,0 ,0 20 20 20 80 20 80 20 20 100 "0 100 100 120 *0 " *0 20 20 0 80 "0 "0 1"0 200 *0 "0 20 *0 0

6: * 6 6: 0 6: " 0 6:"0 1 6:"0 2 6:"11 6:"" 0 6:"" 2 6:"" 6:60 1 6:6* 1 :2:, " :2:8 2 :2:: " :*"0 1 :*"1 0 :*"11 :*"1 :*"2

4ympanostomy (re1uiring insertion of ventilating tube), $% general anesthesia 7iddle ear e'ploration through postauricular or ear canal incision 4ympanolysis, transcanal 4ransmastoid antrotomy (5simple5 mastoidectomy) 7astoidectomy( complete radical -'cision aural glomus tumor( transcanal transmastoid e'tended (e'tratemporal) .evision mastoidectomy( resulting in complete mastoidectomy 4ympanoplasty $%o mastoidectomy (including canalplasty, atticotomy and% or middle ear surgery), initial or revision( $%o ossicular chain reconstruction 4hrombolysis, coronary( by intracoronary infusion, including coronary angiography !ercutaneous transluminal coronary balloon angioplasty, one or more vessel !ercutaneous transluminal coronary atherectomy, by mechanical or other method, $ith or $ithout balloon angioplasty, one or more vessel .ight heart catheteri&ation >eft heart catheteri&ation, retrograde, from the brachial artery, a'illary artery or femoral artery( percutaneous by cutdo$n >eft heart catheteri&ation by left ventricular puncture 3ombined transseptal and retrograde left heart catheteri&ation

0 100 "0 120 1"0 1"0 200 200 200 1"0 160 1"0 200 200 100 100 100 100 1"0 1"0

:*"2 6

3ombined right heart catheteri&ation and retrograde left heart catheteri&ation

21 of 22

ANNEX
COD E :*"2 , :*"2 8 :*"2 : :*"* 0 :*"* 1 :*"

DESCRIPTIVE TERMS 3ombined right heart catheteri&ation and transseptal left heart catheteri&ation through intact septum ($ith or $ithout retrograde left heart catheteri&ation) 3ombined right heart catheteri&ation $ith left ventricular puncture ($ith or $ithout retrograde left heart catheteri&ation) 3ombined right heart catheteri&ation and left heart catheteri&ation through e'isting septal opening ($ith or $ithout retrograde left heart catheteri&ation) .ight heart catheteri&ation, for congenital cardiac anomalies 3ombined right heart catheteri&ation and retrograde left heart catheteri&ation, for congenital cardiac anomalies for aortography

RVU 1"0 1"0 1"0 100 1"0 1"0

22 of 22