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
26/09/2016 X6575 Peptide receptor radionuclide therapy N/A Coding Principles Submitted We understand that Peptide receptor radionuclide therapy is used in advanced cases, those cases that are unresponsive to treatment or unsuitable for other therapies. It is used as an isolated treatment and would not be performed in conjunction with radiotherapy (as this is a type of radiation treatment) or chemo (as it would not be possible to identify which treatment is effective).
26/09/2016 N/A N/A Laser hair removal, from free flap reconstruction as result of tumour or pilonidal sinus New Code Submitted Brand new procedure/testOur Medical affairs director has advised that laser hair removal is being used on free flaps following breast reconstruction and to treat a non healing pilonidal sinus.
23/09/2016 U0090 Harvesting for allogeneic peripheral blood stem cell transplant Harvesting for matched related peripheral blood stem cell transplant Narrative Change Submitted Improves coding structure and adds clarityAllogenic bone marrow transplants are from one person to another. The donor is a close family member or unrelated donor with a similar tissue type. We currently have 2 codes for harvesting stem cells; U0090 Harvesting for allogeneic peripheral blood stem cell transplant U0095 Harvesting for match unrelated peripheral blood stem cell transplant. Our medical affairs director has advised it would clarify the appropriate use of U0090 if the narrative is changed to indicate this should be used in the case of a related donor.
23/09/2016 U0020 Harvesting for allogeneic bone marrow transplant Harvesting for matched related bone marrow transplant Narrative Change Submitted Improves coding structure and adds clarityAllogenic bone marrow transplants are from one person to another. The donor is a close family member or unrelated donor with a similar tissue type. We currently have 2 codes for harvesting stem cells; U0020 Harvesting for allogeneic bone marrow transplant and U0030 Harvesting for matched unrelated bone marrow transplant. Our medical affairs director has advised it would clarify the appropriate use of U0020 if the narrative is changed to indicate this should be used in the case of a related donor.
22/09/2016 CD030 Zio patch monitor Wireless ECG patch Narrative Change Submitted We’ve had the following external query – ‘If I use an ECG patch other than Zio (CD030) what code do I use or does that code cover all ECG patches?’. Do we need to consider changing the narrative of CD030 to remove the manufacturer name?
21/09/2016 D0702 Aural toilet (including microsuction and/or suction of exteriorised mastoid cavity) Aural toilet (including microsuction and/or suction of exteriorised mastoid cavity) including bilateral Narrative Change Submitted This is a minor procedure that would be done on both ears if necessary at the same time therefore changing the narrative to 'including bilateral' reflects clinical practice.
12/09/2016 N/A N/A Insertion of breast lesion marker under image control New Code Submitted Brand new procedure/test
08/09/2016 W9170 Manipulation of foot/ankle joint under local anaesthetic +/- injection Manipulation of foot/ankle joint under local anaesthetic +/- injection (as a sole procedure) Narrative Change Submitted Improves coding structure and adds clarityOur board rep has advised that this is carried out as an integral part of all foot ankle/ surgery.
07/09/2016 H2502 Diagnostic flexible sigmoidoscopy (including forceps biopsy and proctoscopy) N/A Coding Principles Submitted Sigmoidoscopy is included in the narrative of both procedures
07/09/2016 XR450 Dilatation of stricture under imaging control N/A Coding Principles Submitted Our board representative has advised that H2502 is an integral part of the dilatation.
07/09/2016 N/A N/A BRCA full sequencing, somatic testing New Code Submitted Improves coding structure and adds clarity
07/09/2016 N/A N/A BRCA 1&2 full sequencing, germline testing New Code Submitted Improves coding structure and adds clarityImproves coding structure and adds clarity
06/09/2016 N/A N/A Uni compartmental knee arthroplasty with robotic assistance New Code Submitted Improves coding structure and adds clarityTechnical adjunct to W5200
06/09/2016 N/A N/A Total Hip Replacement with robotic assistance New Code Submitted Improves coding structure and adds clarityTechnical adjunct to W3712
06/09/2016 V4280 Correction of degenerative scoliosis including decompression +/- fusion (including spinal cord monitoring) N/A Coding Principles Submitted Please can the spinal cord monitoring codes be added as spinal cord monitoring is included in the narrative of V4280.
01/09/2016 N/A N/A Customised total prosthetic replacement of knee joint New Code Submitted Improves coding structure and adds clarityPlease see request 3459
01/09/2016 N/A N/A Customised bicompartmental knee replacement New Code Submitted Improves coding structure and adds clarityPlease see request 3459
01/09/2016 W4211 Customised knee arthroplasty Customised unicompartmental knee replacement Narrative Change Submitted Improves coding structure and adds clarityWe have been advised that customised knee replacements can be carried out using unicompartmental bicompartmental and total knee replacement prosthesis. This change would add clarity to the type of replacement being used and bring the customised codes into alignment with other knee replacement codes.
31/08/2016 M6533 Holmium Laser Enucleation of Prostatic Adenoma (HoLEP) N/A Coding Principles Submitted M4430 is an integral part of M6533. http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/HoLEP.pdf
31/08/2016 E3680 N/A N/A Reinstatement Rejected Code still requiredThe flexible nasendoscopy as an outpatient prcedure is a standard routine ENT outpatient procdeure performed on about 75% of patients. By removing the code and allowing the E2500 code has allowed insurence companies to automaticaly drop potential revenue from outpatient clinics . I feel as do many other ENT surgeons that this should be reinstated. thanking you in anticipation
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 Published 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 Published 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 Published 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 Published 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 Published 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 Published 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 Published 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 Published 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 Published Standard procedure with currently no CCSD code.
15/08/2016 N1710 N/A Vasectomy (bilateral ligation of Vas Deferens) New Code Published Standard procedure that currently has no CCSD code.
10/08/2016 E3680 N/A N/A Reinstatement Published 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 Published 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 Published 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 Published 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 Published 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.
05/08/2016 M3411 Robotic assisted laparoscopic cystectomy with prostatectomy Robotic assisted laparoscopic cystoprostatectomy Narrative Change Published
05/08/2016 XR121 Image-guided vacuum assisted excision biopsy of breast lesions Unilateral image guided vacuum assisted excision of breast lesion (with biopsy) Narrative Change Published
05/08/2016 E2500 Diagnostic endoscopic examination of pharynx/larynx +/- stroboscopy (including biopsy) (as sole procedure) Diagnostic nasolaryngopharyngoscopy (including biopsy) as sole procedure Narrative Change Published
05/08/2016 XR122 N/A Bilateral image guided vacuum assisted excision of breast lesion (with biopsy) New Code Published
04/08/2016 E0220 N/A Septorhinoplasty (including attention to turbinates) New Code Published 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 Published 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 Published 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 N/A Reinstatement Rejected 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 Published 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 Published 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 Rejected 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.
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