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
22/10/2017 XR360 Embolisation of vascular mass (including uterine embolisation) Embolisation of vascular mass including uterine artery embolisation, sclerotherapy and embolisation of pelvic venous congestion including pelvic varices' Narrative Change Submitted Improves coding structure and adds clarityI am commenting as a consultant interventional radiologist and an acknowledged key opinion leader in the UK Europe & the world on pelvic venous incompetence. I have attached by e-mail important references and recommend code XR362 is removed completely and the narrative to code XR360 is modified. Specifically patients with lower limb varicose veins who are said to have an association with pelvic venous varicose veins are being referred for this procedure by a handful of clinics as an adjunct to formal varicose vein surgery (particularly EVLT VNUS with radiofrequency ablation glue or open ligation & stripping) with a claim that this improves the outcome of the formal surgical procedure or reduces the rate of lower limb varicose vein recurrence. However evidence of any role for this interventional radiology procedure is purely anecdotal only and specifically NO critical level I evidence by way of a Randomised Controlled (Prospective) Clinical Trial is available. The code should be withdrawn and the indication for treating lower limb varicose veins specifically excluded. I am the leading further discussion on behalf of the British Society of Interventional Radiologists for The Royal College of Radiologists at a National webinar shortly to discuss the treatement of two related entities: 1. Pelvic Venous Congestion Syndrome 2. Treatment of pelvic varices It is suggested that these two indications (far fewer referrals) be retained and included in the code XR360 with a slight modification of the wording of 2. to 'Embolisation and/or sclerotherapy of pelvic vein varices' (vide infra) with consideration of changing the narrative of XR360 to 'Embolisation of vascular mass including uterine artery embolisation sclerotherapy and embolisation of pelvic venous congestion including pelvic varices'.
22/10/2017 XR362 N/A N/A Inactivate Submitted I am commenting as a consultant interventional radiologist and an acknowledged key opinion leader in the UK Europe & the world on pelvic venous incompetence. I have attached by e-mail important references and recommend code XR362 is removed completely and the narrative to code XR360 is modified. Specifically patients with lower limb varicose veins who are said to have an association with pelvic venous varicose veins are being referred for this procedure by a handful of clinics as an adjunct to formal varicose vein surgery (particularly EVLT VNUS with radiofrequency ablation glue or open ligation & stripping) with a claim that this improves the outcome of the formal surgical procedure or reduces the rate of lower limb varicose vein recurrence. However evidence of any role for this interventional radiology procedure is purely anecdotal only and specifically NO critical level I evidence by way of a Randomised Controlled (Prospective) Clinical Trial is available. The code should be withdrawn and the indication for treating lower limb varicose veins specifically excluded. I am the leading further discussion on behalf of the British Society of Interventional Radiologists for The Royal College of Radiologists at a National webinar shortly to discuss the treatement of two related entities: 1. Pelvic Venous Congestion Syndrome 2. Treatment of pelvic varices It is suggested that these two indications (far fewer referrals) be retained and included in the code XR360 with a slight modification of the wording of 2. to 'Embolisation and/or sclerotherapy of pelvic vein varices' (vide infra) with consideration of changing the narrative of XR360 to 'Embolisation of vascular mass including uterine artery embolisation sclerotherapy and embolisation of pelvic venous congestion including pelvic varices'.
18/10/2017 N/A N/A Proximal femoral replacement New Code Submitted Improves coding structure and adds clarityPlease see request 4016
18/10/2017 W3734 Second, third or further revision total hip replacement or proximal femoral replacement (excluding acetabular liner and head changes) Second, third or further revision total hip replacement (excluding acetabular liner and head changes) Narrative Change Submitted Improves coding structure and adds clarityWe understand that proximal femoral replacement is primarily carried out for bone tumours. Proximal femoral replacement procedure involves a different approach than a revisional hip replacement in that it involves much more replacement of the affected bone and the muscles have to be reattached following this procedure. We recommend a new code is added for proximal femoral replacement. file:///C:/Users/sharon71/Downloads/102%20Proximal%20femoral%20endoprosthetic%20replacement%20v%204%20(1).pdf
18/10/2017 N/A N/A Trans-oral robotic assisted surgery New Code Submitted Brand new procedure/testUsed in the treatment of head and neck tumours.
17/10/2017 xxxxx N/A Professional Continuous Glucose Monitoring New Code Submitted Currently there is no appropriate code for this diagnostic test
16/10/2017 N/A N/A Reconstruction of breast using transverse upper gracilis (TUG) flap (including delayed reconstruction and nipple reconstruction) (2 flaps per breast) - bilateral New Code Submitted Brand new procedure/testsee 4012
16/10/2017 N/A N/A Reconstruction of breast using transverse upper gracilis (TUG) flap (including delayed reconstruction and nipple reconstruction) (2 flaps) - unilateral New Code Submitted Brand new procedure/testWe understand reconstruction of breast using transverse upper gracilis (TUG) flap can now be carried out using 2 flaps.
16/10/2017 N/A N/A Reconstruction of breast using transverse upper gracilis (TUG) flap (including delayed reconstruction and nipple reconstruction) (single flap)- bilateral New Code Submitted Improves coding structure and adds clarityWe feel there needs to be a bilateral code for breast reconstruction using TUG flap
16/10/2017 B2987 Reconstruction of breast using transverse upper gracilis (TUG) flap (including delayed reconstruction and nipple reconstruction) Reconstruction of breast using transverse upper gracilis (TUG) flap (including delayed reconstruction and nipple reconstruction) (single flap)- unilateral Narrative Change Submitted To reflect updated clinical practiceWe have found that advances in this procedure are now taking place which involves using 2 flaps rather than one. We feel the code should be updated to clarify this is for a single flap and also to indicate this is a unilateral code.
16/10/2017 N/A N/A Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - bilateral (2 flaps per breast) New Code Submitted Improves coding structure and adds clarityPlease see 4006/7
16/10/2017 B2996 Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - bilateral Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - bilateral (single flap per breast) Narrative Change Submitted To reflect updated clinical practicePlease see 4006/7
16/10/2017 N/A N/A Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - unilateral (2 flaps) New Code Submitted Brand new procedure/test
16/10/2017 B2986 Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - unilateral Reconstruction of breast using deep inferior epigastric perforator flap (DIEP) (including delayed reconstruction) - unilateral (single flap) Narrative Change Submitted To reflect updated clinical practiceWe have found that advances in this procedure are now taking place which involves using 2 flaps rather than one. We suggest that this code is amended to reflect it is for single flap surgery
12/10/2017 N/A N/A fractional flow reserveCT FFRCT New Code Submitted Improves coding structure and adds clarityCurrently we have a code for CTCA with FFRCT but clinically the FFRCT element maybe used weeks after the CTCA.
09/10/2017 25120 Dorsal root ganglion block (local anaesthetic or neurolytic) (as sole procedure) N/A Coding Principles Submitted Anaesthetic colleagues have explained that an epidural injection, whether carried out through the lumbar or sacral route will achieve ganglion root blockade, since the dorsal roots lie in the epidural space. Hence the epidural and dorsal root codes need never be used together.
09/10/2017 X3770 Intramuscular injection with x-ray control (e.g. piriformis block) N/A Coding Principles Submitted We feel this should be an integral part of the procedure and so should not be coded separately.
09/10/2017 N/A N/A Nitrogen Washout test for lung capacity New Code Submitted Brand new procedure/test
09/10/2017 N/A N/A Anterior correction of adult idiopathic scoliosis with instrumentation, +/-fusion (including spinal cord monitoring) New Code Submitted Improves coding structure and adds clarity There are 4 different codes for juvenile scoliosis (V4000; V4100; V4110 &V4120) and only one for adult scoliosis (V4280) so our Chief Medical Officer feels there should be equivalent codes for adult scolioisis
09/10/2017 N/A N/A Posterior correction of adult idiopathic scoliosis with instrumentation, +/-fusion (including spinal cord monitoring) New Code Submitted Improves coding structure and adds clarity There are 4 different codes for juvenile scoliosis (V4000; V4100; V4110 &V4120) and only one for adult scoliosis (V4280) so our Chief Medical Officer feels there should be equivalent codes for adult scolioisis
09/10/2017 unsure N/A Combined anterior and posterior correction and instrumentation, +/-fusion of adult idiopathic scoliosis (including spinal monitoring) New Code Submitted Improves coding structure and adds clarity There are 4 different codes for juvenile scoliosis (V4000; V4100; V4110 &V4120) and only one for adult scoliosis (V4280) so our Chief Medical Officer feels there should be equivalent codes for adult scolioisis
03/10/2017 A5291 Transforaminal epidural (cervical) N/A Coding Principles Submitted See 3977...
03/10/2017 A5292 Transforaminal epidural (thoracic) N/A Coding Principles Submitted See 3977..
03/10/2017 A5294 Transforaminal epidural (caudal) N/A Coding Principles Submitted See 3977...
03/10/2017 A5293 Transforaminal epidural (lumbar) N/A Coding Principles Submitted We need to add unbundling rules to the new epidural codes. These have been reviewed by our medical affairs director and match those rules against A5290
20/09/2017 M1130 Therapeutic ureterorenoscopy (+/- cystoscopy and insertion/removal of stent) N/A Coding Principles Published Medical director feels that these procedures should unbundle
20/09/2017 M1120 Diagnostic ureterorenoscopy (+/- cystoscopy) N/A Coding Principles Published Medical director feels that these procedures should unbundle
20/09/2017 M1120 Diagnostic ureterorenoscopy (+/- cystoscopy) N/A Coding Principles Published Bupa medical director feels that these procedures should unbundle
19/09/2017 N/A N/A PSMA Pet scan New Code Published Brand new procedure/testBrand new procedure/test
19/09/2017 M1120 Diagnostic ureterorenoscopy (+/- cystoscopy) N/A Coding Principles Published Bupa medical director feels that these procedures should unbundle
18/09/2017 N/A N/A Inclusive charges for upright MRI scan of one spinal area in flexion and extension (2 part) New Code Published Improves coding structure and adds clarityUpright MRI we would like to propose the following updated policy • The customer must have a diagnostic MR of the spinal area in question on an MR scanner that is at least 1.5T • This means that the units offering upright MRI cannot preauthorise a diagnostic scan with immediate proceed to dynamic (eg flexion and extension) • The customer must have on-going objective symptoms Indications Ongoing objective symptoms despite a normal mri‎ indicating a potential dynamic issue that may not be apparent on a supine film i.e. exacerbated by standing. Potential subtle instability that requires flexion/extension imaging‎ of a specific region
18/09/2017 M1120 Diagnostic ureterorenoscopy (+/- cystoscopy) N/A Coding Principles Published Our medical director feels that these codes should unbundle
18/09/2017 K4100 Bypass for coronary artery(ies) (including harvesting of grafts and endarterectomy) N/A Coding Principles Published
14/09/2017 K4100 Bypass for coronary artery(ies) (including harvesting of grafts and endarterectomy) N/A Coding Principles Published Our CMO feels these two codes should unbundle.
13/09/2017 N/A N/A Stress ECG with pharmaceutical agent (with reporting) New Code Published Brand new procedure/testNo code for a stress ECG using drugs to induce / influence heart rate and assess conductivity e.g. ajmaline challenge for
12/09/2017 N/A N/A Lutetium 177 therapy for neuroendocrine tumours. New Code Rejected Brand new procedure/testBrand new procedure/test
11/09/2017 H5541 N/A Adjustment or removal of Seton under general anaesthetic New Code Published
11/09/2017 N/A N/A Seton placement for treatment of anal fistula New Code Published Improves coding structure and adds clarityImproves coding structure and adds clarity.... We currently do not have a code for Seton placement alone – the seton stitch is +/- in H5520 Laying open of high anal fistula (fistulotomy) +/- insertion of stitch (including sigmoidoscopy) and H5510 Laying open of low anal fistula (fistulotomy) +/- insertion of stitch (including sigmoidoscopy)
11/09/2017 N/A N/A Injection of therapeutic substance into keloid scar New Code Published Improves coding structure and adds clarityImproves coding structure and adds clarity
11/09/2017 IM064 PET/CT Scan Cardiac stress N/A Inactivate Published Current code replaced by a new codeSee Request 3953
11/09/2017 IM063 PET/CT Scan Cardiac rest PET/CT scan with Rubidium (including stress & rest) test Narrative Change Published Improves coding structure and adds clarityWe currently have two codes available for PET/CT Scan Cardiac – one for stress test (IM064) and one for rest test (IM063). We will be using one of these codes for PET/CT Scan Cardiac using Rubidium and the CMOs have advised this test should include both the rest and stress stages – therefore we do not need a separate code for each. We propose to retain the IM063 code and retire the IM064 code REF: http://jnm.snmjournals.org/content/48/5/783.full https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650901/
07/09/2017 5071B N/A Thromboelastography (TEG) New Code Published
07/09/2017 5070B N/A Autoantibodies against C1q New Code Published
07/09/2017 5069O N/A Culture VRE screen New Code Published
07/09/2017 5068O N/A Culture MDRA screen New Code Published
07/09/2017 5068S N/A Staphylococcus PVL testing New Code Published
07/09/2017 5067B N/A 16s RNA PCR testing New Code Published
07/09/2017 5066F N/A Faecal screen - Rotavirus New Code Published
07/09/2017 5065F N/A Faecal screen - Adenovirus New Code Published
07/09/2017 5064U N/A Urinary mast cell markers New Code Published
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