Coding questions

In the ENT section, ‘Manipulation under anaesthesia of fractured nose (as sole procedure) – does the ‘sole procedure’ mean that if any other procedure code is present then the spell should be excluded?

yes

In the ENT section, ‘Tonsillectomy’ – given the listed exclusions, can I assume that procedure code F34.7 (Coblation tonsillectomy) should be included?

yes

In the General Surgery section, ‘Primary repair of inguinal hernia’ – given the next line in this list, I assume that where you include T20 codes this should exclude T20 codes where there is an additional code of Z94.1?

yes

And that the same is true for the Urology section, ‘Endoscopic resection of prostate (TUR)’ for procedure code M65.3 (reference the next line)?

yes

And that the same is true for the Vascular Surgery section, ‘Vascular vein surgery’ for procedure codes L858 (reference 2 lines lower) (procedure code L877 is specifically excluded, reference 5 lines lower)?

Agree L858 should be used in the EVLT section and not above(should be an exclusion code), as written for L877

In the Orthopaedic surgery section, ‘Minimally invasive knee replacement’ – the criteria are exactly the same as the next line ‘Unicompartmental knee replacement’; are there two category descriptions for the same category, or should there be a different set of criteria for one of the descriptions?

We are struggling with coding here, new procedures that are not truly represented in the current coding.

In the Orthopaedic surgery section, ‘Arthroscopy of knee including meniscectomy, meniscal or other repair’ – the first criteria code (W82) has slipped forward; therefore should the 95% and 5% be in daycase and 23 hour stay, or 23 hour stay and under 72 hour stay?

As it reads day and 23hr stay – only the codes slipped

Also in this description – W88 appears here and in ‘Diagnostic arthroscopic examination of shoulder joint’; can I assume that in this ‘knee’ category, that all W88 that aren’t in the ‘shoulder’ category should be included?

No specific codes for knee at W88 is a catchall – see numbers from HES 05/06 – would assume a number of weird joint arthroscopies!

W88.1 Diagnostic endoscopic examination of other joint, Diagnostic endoscopic examination of joint and biopsy of lesion of joint nec

179

W88.8 Diagnostic endoscopic examination of other joint, Other specified

308

W88.9 Diagnostic endoscopic examination of other joint, Unspecified

2,775