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    Health Service Code 57.6 E

    Creation of ileo-anal pouch and ileo-anal anastomosis following previous total colectomy

    NOTE:

    HSCs 57.6 A through 57.6 E may not be claimed in addition to HSCs 60.52A or 60.52B.

    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$1648.06

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    BMIBMI2ANYesIncrease By25%
    ROLEANEYesReplace Base$589.48
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSSTYesReplace Base$280.58
    ROLE2ANESYesReplace Base$22.07
    2ANU2ANU1For Each Call Pay Base At100%
    2ANU2ANU2 - 302For Each Call Increase By$22.07
    SAUSAU1For Each Call Pay Base At100%
    SAUSAU2 - 33For Each Call Increase By$37.04
    SAQUSAQU1 - 36For Each Call Pay Base At100%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LVPLVP75YesReduce Base To75%

    Governing Rules: