I
CERTAIN DIAGNOSTIC AND THERAPEUTIC PROCEDURES
II
OPERATIONS ON THE NERVOUS SYSTEM
III
OPERATIONS ON THE ENDOCRINE SYSTEM
IV
OPERATIONS ON THE EYES
V
OPERATIONS ON THE EARS
VI
OPERATIONS ON THE NOSE, MOUTH,AND PHARYNX
VII
OPERATIONS ON THE RESPIRATORY SYSTEM
- 42
  EXCISION OF LARYNX
- 43
  OTHER OPERATIONS ON LARYNX AND TRACHEA
- 44
  EXCISION OF BRONCHUS AND LUNG
- 45
  OTHER OPERATIONS ON BRONCHUS AND LUNG
  - 45.0
    Incision of bronchus
  - 45.1
    Incision of lung
  - 45.4
    Repair and plastic operations on bronchus and lung
  - 45.5
    Lung transplant
    - 45.5 A
      Lung transplant
      With recipient pneumonectomy
      NOTE: 1. May be claimed with HSC 49.5 A. 2. When performed as a bilateral procedure and/or when claimed in addition to HSC 49.5A, the procedural benefit may be claimed at 100% for both lungs. This does not apply to the anesthetic rate.
    - 45.5 B
      Donor pneumonectomy
  - 45.6
    Combined heart-lung transplantation
  - 45.8
    Invasive diagnostic procedures on bronchus and lung
- 46
  OPERATIONS ON CHEST WALL, PLEURA, MEDIASTINUM, AND DIAPHRAGM
VIII
OPERATIONS ON THE CARDIOVASCULAR SYSTEM
IX
OPERATIONS ON THE HEMIC AND LYMPHATIC SYSTEMS
X
OPERATIONS ON THE DIGESTIVE SYSTEM AND ABDOMINAL REGION
XI
OPERATIONS ON THE URINARY TRACT
XII
OPERATIONS ON THE MALE GENITAL ORGANS
XIII
OPERATIONS ON THE FEMALE GENITAL ORGANS
XIV
OBSTETRIC PROCEDURES
XV
OPERATIONS ON THE MUSCULOSKELETAL SYSTEM
XVI
OPERATIONS ON THE BREAST
XVII
OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE
XVIII
PROCEDURES NOT ELSEWHERE CLASSIFIED
LABORATORY AND PATHOLOGY
DIAGNOSTIC RADIOLOGY
NOTE: As stated in G.R. 11.1.1, claims for services in the Diagnostic Radiology section will not be payable unless the physician has been approved by the CPSA to provide those services.
THERAPEUTIC RADIOLOGY

Health Service Code 45.5 A

Lung transplant

With recipient pneumonectomy

NOTE:

May be claimed with HSC 49.5 A.
When performed as a bilateral procedure and/or when claimed in addition to HSC 49.5A, the procedural benefit may be claimed at 100% for both lungs. This does not apply to the anesthetic rate.

Category:	14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
Base rate:	$4973.68

AMA billing tips:

For donor harvesting claims following the date of death:
1. Submit the claim using the date of death as the PHN becomes invalid following the date of death.
2. Add text to the claim that states the date that the harvesting occurred.

Fee modifiers:

Type	Code	# of calls	Explicit	Action	Amount
BMI	BMIANE		Yes	Increase By	25%
BMI	BMIPRO		Yes	Increase By	25%
BMI	BMI2AN		Yes	Increase By	25%
AGE	L30			Increase Base To	150%
ROLE	ANE		Yes	Replace Base	$1412.89
ROLE	SA		Yes	Replace Base	$148.42
ROLE	SAQS		Yes	Replace Base	$51.10
ROLE	SSCVT		Yes	Replace Base	$312.56
ROLE	SSST		Yes	Replace Base	$325.09
ROLE	2ANES		Yes	Replace Base	$22.44
VANE	L30AN			Increase By	$110.16
VANE	L30AT2			Increase By	$110.16
ANEU	ANEU	1		For Each Call Pay Base At	100%
ANEU	ANEU	2 - 2		For Each Call Pay Base At	75%
2ANU	2ANU	1		For Each Call Pay Base At	100%
2ANU	2ANU	2 - 150		For Each Call Increase By	$22.44
SAU	SAU	1		For Each Call Pay Base At	100%
SAU	SAU	2 - 37		For Each Call Increase By	$37.13
SAQU	SAQU	1 - 36		For Each Call Pay Base At	100%
CALL	NBRSER	1		For Each Call Pay Base At	100%
CALL	NBRSER	2 - 2		For Each Call Pay Base At	100%
REDO	COMPLT		Yes	Increase Base To	150%
REDO	PART		Yes	Increase Base To	125%
REDO	REDO1		Yes	Increase Base To	175%
REDO	REDO2		Yes	Increase Base To	225%
REDO	REDO3		Yes	Increase Base To	275%
REDO	REDO4		Yes	Increase Base To	325%
REDO	REDO5		Yes	Increase Base To	375%
SURC	EV		Yes	Increase By	$48.82
SURC	NTAM		Yes	Increase By	$117.12
SURC	NTPM		Yes	Increase By	$117.12
SURC	WK		Yes	Increase By	$48.82
LMTS	L44		Yes	Increase Base To	150%
LMTS	L44ANE		Yes	Increase Base By	$110.16
LVP	LVP75		Yes	Reduce Base To	75%

Governing Rules:

6.8.1
HSCs with a designated category code of 1 and 15 include related post-operative services and those with a designated category code of 3, 4, 6 and 14 include both related pre-operative and post-operative services.
1. a consultation benefit may be claimed up to and including the day of surgery.
2. pre-operative hospital care may be claimed by the physician who performs the surgery if information is submitted to show that conservative treatment was attempted before surgery was performed.
3. benefits may be claimed as applicable for complications occurring during or following post-operative time periods.
4. Deleted
5. HSC 03.04R may be claimed in the pre-operative time frame when all conditions in the notes have been met.
The following chart gives the pre-operative and post-operative periods.
Category Pre-operative Post-operative
1 0 - Days 14 - Days
3 7 - Days 7 - Days
4 7 - Days 14 - Days
6 14 - Days 14 - Days
14 30 - Days 14 - Days
15 0 - Days 7 - Days

6.15.4

Benefits that may be claimed for redos for one of the following HSCs vary depending on how many redos have been performed in the past, (whether partly or wholly), through that incision. The first redo may be claimed at 175% of the listed benefit, the second at 225%, the third at 275%, the fourth at 325%, and the fifth at 375%.

44.21	44.3 A	44.3 B	44.4 A	44.4 B	44.4 C
44.5 A	44.5 B	45.1 A	45.1 B	45.5 A	46.3 C
47.02A	47.02C	47.04	47.12A	47.12B	47.13A
47.13B	47.13C	47.14A	47.14B	47.15A	47.15B
47.15C	47.23A	47.23B	47.25A	47.25B	47.25C
47.25D	47.27A	47.29A	47.39A	47.54A	47.54B
47.55A	47.55B	47.55C	47.81	47.82	47.83A
47.83B	47.84A	47.91A	47.92A	47.92B	47.93A
47.93B	47.95A	48.12	48.12A	48.13	48.13A
48.14	48.14A	48.15A	48.15B	48.15C	48.15D
48.15E	48.15F	48.15G	48.15H	49.12	49.12B
49.2 A	49.2 B	49.31	49.39	49.39B	49.39C
49.4 B	49.5 A	49.61A	49.62A	49.62B	49.64A
49.7 C	49.7 J	49.7JA	49.7 K	49.7KA	49.7 L
49.7LA	49.7 M	49.7MA	49.9 A	49.91	49.98X

50.04A	50.05A	50.14	50.15A	50.24A	50.24B
50.34A	50.34B	50.34D	50.34K	50.34L	50.75B
50.75C	51.21A	51.21B	51.21C	51.3 C

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Health Service Codes

Health Service Code 45.5 A

Lung transplant

With recipient pneumonectomy

NOTE:

AMA billing tips:

Fee modifiers:

Governing Rules:

Category	Pre-operative	Post-operative
1	0 - Days	14 - Days
3	7 - Days	7 - Days
4	7 - Days	14 - Days
6	14 - Days	14 - Days
14	30 - Days	14 - Days
15	0 - Days	7 - Days

Fee Navigator®

Health Service Codes

Health Service Code 45.5 A

Lung transplant

With recipient pneumonectomy

NOTE:

AMA billing tips:

Fee modifiers:

Governing Rules:

Fee Navigator^®