Recent Requests

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Recent Requests shows all amendment requests that have a submitted, under review, approved, published or rejected status.
Approved, published and rejected requests will remain on this page for 75 days. 

The codes and narrative listed are those proposed, view the Schedule to see actual approved codes and narratives.

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Request
Number
Date Code Current
Narrative
Proposed
Narrative
Type Current
Status
Reasons for
change
24/08/2016 N/A N/A Retinopexy using cryotherapy New Code Submitted Improves coding structure and adds clarity: The existing codes for vitrectomy are limited as many treatment options exist and not all procedures justify the full codes currently available. Our proposed additional 3 code(s) - see separate requests - we hope give more accurate options. (Request numbers 3441; 3447 and 3448)
24/08/2016 N/A N/A Peel of epiretinal fibroglial membrane (ERM peel) New Code Submitted Improves coding structure and adds clarity: The existing codes for vitrectomy are limited as many treatment options exist and not all procedures justify the full codes currently available. Our proposed additional 3 code(s) - see separate requests - we hope give more accurate options. (Request numbers 3441; 3447 and 3448)
22/08/2016 M0910 Endoscopic fragmentation of calculi of kidney (including cystoscopy and insertion/removal of stent) N/A Coding Principles Submitted M2920 Endoscopic insertion/removal of prosthesis into ureter (including bilateral and cystoscopy, +/- pyelography) and M2930 Removal of prosthesis from ureter (including cystoscopy) are listed as unacceptable with M2730 Ureteroscopic extraction of calculus of ureter (including cystoscopy and insertion/removal of stent) but NOT with M0910 Endoscopic fragmentation of calculi of kidney (including cystoscopy and insertion/removal of stent). Aviva suggests that they should be.
22/08/2016 N/A N/A Removal of internal tamponade agent from vitreous body (ROSO) New Code Submitted Improves coding structure and adds clarity: The existing codes for vitrectomy are limited as many treatment options exist and not all procedures justify the full codes currently available. Our proposed additional 3 code(s) - see separate requests - we hope give more accurate options. (Request numbers 3441; 3447 and 3448)
18/08/2016 U0095 N/A Harvesting for matched unrelated peripheral blood stem cell transplant New Code Submitted Improves coding structure and adds clarityThis code appears to be missing from the chapter as there are 3 stem cell transplant codes but only 2 harvesting codes. It is shown correctly with the bone marrow codes as there are 3 for transplant & 3 for harvesting.
17/08/2016 C2650 Probing of nasolacrimal system +/- syringing and/or irrigation N/A Coding Principles Submitted Our clinical team has highlighted that there are codes which would not be expected to be done twice in the same setting, we have already discussed if there is a procedure being done on the same day twice but on different body parts / or other clinical justification, then the provider contacts that insurers helpline to follow their process. This follows the coding principle of “If the procedures cannot be performed in conjunction i.e one or the other”. The reason why this code should not unbundle is because clinically these codes would not be expected to be performed twice on the same day as there is no clinical rationale to perform twice in one day. There maybe on the rare occasion reason such as practitioner error to perform biopsy etc but this should not mean the procedure is performed twice on the same day.
17/08/2016 X3770 Intramuscular injection with x-ray control (e.g. piriformis block) N/A Coding Principles Submitted Our clinical team has highlighted that there are codes which would not be expected to be done twice in the same setting, we have already discussed if there is a procedure being done on the same day twice but on different body parts / or other clinical justification, then the provider contacts that insurers helpline to follow their process. This follows the coding principle of “If the procedures cannot be performed in conjunction i.e one or the other”. The reason why this code should not unbundle is because clinically these codes would not be expected to be performed twice on the same day as there is no clinical rationale to perform twice in one day. There maybe on the rare occasion reason such as practitioner error to perform biopsy etc but this should not mean the procedure is performed twice on the same day.
17/08/2016 XR917 Peripherally inserted central venous catheters (PICCs) under X-ray guidance N/A Coding Principles Submitted Our clinical team has highlighted that there are codes which would not be expected to be done twice in the same setting, we have already discussed if there is a procedure being done on the same day twice but on different body parts / or other clinical justification, then the provider contacts that insurers helpline to follow their process. This follows the coding principle of “If the procedures cannot be performed in conjunction i.e one or the other”. The reason why this code should not unbundle is because clinically these codes would not be expected to be performed twice on the same day as there is no clinical rationale to perform twice in one day. There maybe on the rare occasion reason such as practitioner error to perform biopsy etc but this should not mean the procedure is performed twice on the same day.
17/08/2016 G6500 Diagnostic oesophago-gastro-duodenoscopy (OGD) includes forceps biopsy, biopsy urease test and dye spray N/A Coding Principles Submitted Our clinical team has highlighted that there are codes which would not be expected to be done twice in the same setting, we have already discussed if there is a procedure being done on the same day twice but on different body parts / or other clinical justification, then the provider contacts that insurers helpline to follow their process. This follows the coding principle of “If the procedures cannot be performed in conjunction i.e one or the other”. The reason why this code should not unbundle is because clinically these codes would not be expected to be performed twice on the same day as there is no clinical rationale to perform twice in one day. There maybe on the rare occasion reason such as practitioner error to perform biopsy etc but this should not mean the procedure is performed twice on the same day.
17/08/2016 XR110 Ultrasound guided biopsy(ies) N/A Coding Principles Submitted Our clinical team has highlighted that there are codes which would not be expected to be done twice in the same setting, we have already discussed if there is a procedure being done on the same day twice but on different body parts / or other clinical justification, then the provider contacts that insurers helpline to follow their process. This follows the coding principle of “If the procedures cannot be performed in conjunction i.e one or the other”. The reason why this code should not unbundle is because clinically these codes would not be expected to be performed twice on the same day as there is no clinical rationale to perform twice in one day. There maybe on the rare occasion reason such as practitioner error to perform biopsy etc but this should not mean the procedure is performed twice on the same day.
17/08/2016 H2003 Therapeutic colonoscopy with snare loop biopsy or excision of lesion N/A Coding Principles Submitted Our clinical team has highlighted that there are codes which would not be expected to be done twice in the same setting, we have already discussed if there is a procedure being done on the same day twice but on different body parts / or other clinical justification, then the provider contacts that insurers helpline to follow their process. This follows the coding principle of “If the procedures cannot be performed in conjunction i.e one or the other”. The reason why this code should not unbundle is because clinically these codes would not be expected to be performed twice on the same day as there is no clinical rationale to perform twice in one day. There maybe on the rare occasion reason such as practitioner error to perform biopsy etc but this should not mean the procedure is performed twice on the same day.
17/08/2016 H2002 Diagnostic colonoscopy, includes forceps biopsy of colon and ileum N/A Coding Principles Submitted Our clinical team has highlighted that there are codes which would not be expected to be done twice in the same setting, we have already discussed if there is a procedure being done on the same day twice but on different body parts / or other clinical justification, then the provider contacts that insurers helpline to follow their process. This follows the coding principle of “If the procedures cannot be performed in conjunction i.e one or the other”. The reason why this code should not unbundle is because clinically these codes would not be expected to be performed twice on the same day as there is no clinical rationale to perform twice in one day. There maybe on the rare occasion reason such as practitioner error to perform biopsy etc but this should not mean the procedure is performed twice on the same day.
15/08/2016 N1810 N/A Vasectomy reversal (vasovasostomy) bilateral New Code Submitted Standard procedure with currently no CCSD code.
15/08/2016 N1710 N/A Vasectomy (bilateral ligation of Vas Deferens) New Code Submitted Standard procedure that currently has no CCSD code.
10/08/2016 E3680 N/A N/A Reinstatement Submitted Code still requiredCode E2500 which has been suggested as an alternative to E3680 is totally unsuitable. E3680 is always performed as a flexible endoscopic procedure with an awake patient and therefore requires additional clinical skills and also by definition and need assesses the nasal cavities which is NOT described by E2500. Conditions of the nose/sinuses are important to detect in assessing the aetiology of hypopharyngeal and laryngeal symptoms even if patients have few or no nasal or sinus complaints. E3680 is correctly and fully described as endoscopic nasopharyngolaryngoscopy and is therefore a combination of nasendoscopy and laryngopharyngoscopy. The original request for removal of this code was made by someone clearly with no real understanding of the clinical aspects described here. As a Specialist I have to take responsibility for interpretation of scope findings and would be negligent if I missed sinonasal pathology which could be contributing to throat or laryngeal symptoms. I have contacted a number of my ENT colleagues who agree. If this code is not reinstated then nasedoscopy will need to be added to E2500 to fully describe the clinical activity and this is cumbersome and unnecessarily complex when we had a perfectly good code in place already. The CCSD coding should accurately reflect the clinical work done and the removal of E3680 is regressive. A few years ago I was advised by insurer that E2500 was unsuitable for the above as it didn't describe the flexible scope procedure accurately and was asked to use the E3680 code so they clearly agree with me.
10/08/2016 V4280 Correction of degenerative scoliosis including decompression +/- fusion Correction of degenerative scoliosis including decompression +/- fusion (including spinal cord monitoring) Narrative Change Submitted To reflect updated clinical practiceIt is our understanding that spinal monitoring is routinely carried out with this procedure and the narrative change will reflect this. In addition V4000V4100 V4110 and V4120 are all scoliosis codes that include spinal cord monitoring in the narrative.
08/08/2016 J0782 N/A Microwave ablation for primary or metastatic cancer of the liver New Code Submitted Brand new procedure/testNICE interventional procedure guidance [IPG553] published April 2016 says: “Current evidence on microwave ablation for treating liver metastases raises no major safety concerns and the evidence on efficacy is adequate in terms of tumour ablation. Therefore this procedure may be used provided that standard arrangements are in place for clinical governance consent and audit.”
08/08/2016 N/A N/A Laser resection of lung metastases New Code Submitted Brand new procedure/testCurrently being carried out (since 2010) at the Royal Brompton Hospital the lung laser uses a special wavelength laser beam to remove tumours from patients’ lungs with minimal damage to neighbouring healthy lung tissue. Although the laser can be helpful on selected primary tumours it is most commonly used on secondary lung tumours as surgery on the former usually requires removing a larger part of the lung.
08/08/2016 N/A N/A Peptide receptor radionuclide therapy New Code Submitted Brand new procedure/testThis treatment is currently being provided by several hospitals namely the Royal Free and the Surrey County Hospitals. Peptide receptor radionuclide therapy (PRRT) is a molecular therapy used to treat a specific type of cancer called neuroendocrine carcinoma or neuroendocrine tumours). PRRT is also currently being investigated as a treatment for prostate and pancreatic tumours.
04/08/2016 E0220 N/A Septorhinoplasty (including attention to turbinates) New Code Submitted Improves coding structure and adds claritySee rationale under narrative change request 3415.............
04/08/2016 E0230 Septorhinoplasty +/- graft/implant following trauma or excision of tumour (including attention to turbinates) Septorhinoplasty including graft/implant following trauma or excision of tumour (including attention to turbinates) Narrative Change Submitted Improves coding structure and adds clarityAs with the recent request to change the narrative of M3410 to reflect differences in complexity we feel there should be 2 separate codes for septorhinoplasty one to cover the more complex procedure which includes a graft/implant following trauma or excision of tumour and one for a straightforward septorhinoplasty (see new code request)...................
04/08/2016 N/A N/A Vertebral corpectomy including two level discectomy and spinal decompression. New Code Submitted Improves coding structure and adds clarityWe have been contacted by a surgeon who was unable to find a suitable code for this procedure. He explained this is surgery of greater magnitude than an anterior cervical discectomy whereby the whole of a vertebral body is removed performing a 2 level discectomy and drilling out the whole of the vertebral body to decompress the spinal cord over a 3cm distance. Our CMO agreed and therefore we are requesting this additional code.
01/08/2016 E3680 N/A Endoscopic Nasolaryngopharyngoscopy as a sole outpatient procedure Reinstatement Submitted Code still requiredThis code also includes nasal examination and postnasal space examination. Its correct title should be nasopharyngolaryngoscopy and the code E2500 does not adequately describe this event. The code E3680 should be reinstated as it describes a discrete clinical activity that is different to E2500. I am also concerned that this code change has been implemented without specialty medical advice that would have avoided considerable confusion to patients and clinicians
27/07/2016 N/A N/A Non-directed bronchoalveolar lavage (NBL) New Code Submitted Brand new procedure/testNeither myself or an insurer have been able to find an appropriate code to think this test to so would be grateful if a new code could be created (or the correct existing code advised)
27/07/2016 Q0790 Laparoscopic total hysterectomy (+/- oophorectomy) +/- ureterolysis N/A Coding Principles Submitted As the Q0790 narrative includes oophorectomy our CMO feels Q2230 - Oophorectomy and salpingectomy, +/- biopsy eg. omentum, peritoneum, lymph node (as sole procedure) (including bilateral) should be listed as an unacceptable combination with Q0790.
26/07/2016 G8084 N/A combined gastroscopy and flexible sigmoidoscopy New Code Submitted Currently there is no code for this combined procedure but there is a G8082 for gastroscopy/colonoscopy. When I recently did a G6500/H2502 with sedation I wasn't allowed to be paid for the H2502 component which makes no sense to me - it is a limited colonoscopy and is an extra procedure so should be recognized a such.
20/07/2016 N/A N/A Liposuction for Lymphoedema Extremity New Code Under Review Brand new procedure/testBrand new procedure/test
20/07/2016 N/A N/A Lymphatico-Venous Anastomosis (LVA) New Code Under Review Brand new procedure/testBrand new procedure/test
20/07/2016 N/A N/A Free microvascular lymph-node transfer New Code Under Review Brand new procedure/testBrand new procedure/test
18/07/2016 N/A N/A Repositioning of lens implant New Code Published We are receiving requests from surgeons/hospitals where the implanted intraocular lens slips out of position following cataract surgery. We have a code for lens exchange / implant (C7520) but we don’t have a code for repositioning of the existing artificial intraocular lens. Currently we have had to code this under C7520 which clinically isn't correct so we need a new code to close the gap in coding.
14/07/2016 M4290 Endoscopic investigation of bladder using hexaminolevulinate blue light florescence +/- resection of lesions N/A Inactivate Published See code request for 3393 for reasons.
14/07/2016 M4512 Diagnostic examination of bladder using hexaminolevulinate blue-light fluorescence cystoscopy EXAMINATION OF BLADDER USING HEXAMINOLEVULINATE BLUE-LIGHT FLUORESCENCE CYSTOSCOPY +/- RESECTION OF LESIONS Narrative Change Published To replace codes already in the scheduleCodes M4290 and M4512 are essentially describing the same procedure. As it currently stands you could bill either code for an endoscopic examination of bladder using blue light without a resection of lesion. Therefore it makes sense to have one code with +/- resection of lesions. Code M4290 would need to be deactivated.
14/07/2016 X3750 Botulinus toxin injections to muscle Botulinum toxin injections to muscle Narrative Change Published The correct term for the injectable should be botulinum toxin. Botulinus relates to the illness – botulinus intoxication or botulism. This also aligns the coding structure as it matches the other Botox code C3780 Injection of botulinum toxin into extraocular or periocular muscles.
12/07/2016 M3411 N/A Robotic assisted laparoscopic cystectomy without prostatectomy. New Code Published Improves coding structure and adds clarityTo provide for situations where the procedure is performed without the additional procedure of prostatectomy. See previous narrative change for M3410.
12/07/2016 M3410 Robotic assisted laparoscopic cystectomy +/- the removal of prostate Robotic assisted laparoscopic cystectomy with prostatectomy. Narrative Change Published Improves coding structure and adds clarityThis procedure requires two codes to account for situations where prostatectomy is performed and those situations where prostatectomy is not performed. Our CMO feels that the use of +/- does not take into account the complexity of the additional prostatectomy procedure. *** See new code request for Robotic assisted laparoscopic cystectomy without prostatectomy.
08/07/2016 CD015 Stress echo +/- contrast - exercise N/A Coding Principles Published On the procedure schedule 20110 unbundle with 20132, we feel CD015 is similar to 20132 and should unbundle to align with the procedure schedule.
08/07/2016 20110 ECG (including reporting) N/A Coding Principles Published These two codes are integral to one another, 20130 includes ECG and reporting and so there would not be a need for 20110 to be performed alongside. This should also be mirrored on the procedure schedule as they are on both schedules
08/07/2016 N/A N/A Multiparametric MRI of Brain New Code Under Review Brand new procedure/testComplex MRI that doesn't fit inside the normal scope of standard MRI. Requires multiple additional acquisition sequences and complex additional processing and analysis for interpretation/reporting. Length of protocol and analysis is not reflected in existing codes. BUPA have requested creation of new code after detailed discussions were had between Nuada Medical Julia Ross (Head of Cardiac Cancer & Radiology Healthcare Management) and Adam Waldman (PhD FRCP FRCR Professor of Neuroradiology).
07/07/2016 Q5450 N/A Laparoscopic hysteropexy (including sacrohysteropexy) +/- ureterolysis Narrative Change Published To align current codes and consistencyTo bring this relatively new code in line with similar ones eg. Q1701 Q3800 & Q3900.
07/07/2016 M7940 Internal urethrotomy (including cystoscopy) Internal urethrotomy (including cystoscopy +/- dilatation) Narrative Change Published Improves coding structure and adds clarityThis procedure often includes dilatation which does not add a significant amount of time to the operation or increase complexity.
01/07/2016 C6012 Canaloplasty N/A Coding Principles Published
01/07/2016 20130 Exercise ECG (including base line 12 lead ECG and reporting) N/A Coding Principles Published
01/07/2016 W2582 Closed reduction of fracture of small bone (including cast or percutaneous K-wires) Closed reduction of fracture of short bone with external fixator Narrative Change Published
01/07/2016 W2580 Closed reduction of fracture of small bone with external fixator Closed reduction of fracture of short bone with external fixator Narrative Change Published
01/07/2016 W2300 Secondary open reduction of fracture of small bone (including intra-articular fracture for delayed/non-union and including bone graft) Secondary open reduction of fracture of short bone (including intra-articular fracture for delayed/non-union and including bone graft) Narrative Change Published
01/07/2016 W1940 Primary open reduction of small bone with fixation (including intra-articular) Primary open reduction of short bone with fixation (including intra-articular) Narrative Change Published
01/07/2016 W1641 Osteotomy of small bone of hand (including fixation and bone grafting) Osteotomy of short bone of hand (including fixation and bone grafting) Narrative Change Published
01/07/2016 W1040 Osteotomy of small bone of foot (excluding hallux valgus and including internal fixation) Osteotomy of short bone of foot (excluding hallux valgus and including internal fixation) Narrative Change Published
01/07/2016 20110 ECG (including reporting) N/A Coding Principles Published
28/06/2016 C6111 Laser trabeculoplasty (including topical or local anaesthetic) - unilateral N/A Coding Principles Published This code should mirror the unbundling of C6110 as it is the bilateral version of it. When this code was agreed a few months ago it was agreed to mirror the unbundling but it does not seem to have gone through
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