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
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
- 98
  OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE
  - 98.0
    Incision of skin and subcutaneous tissue
  - 98.1
    Excision of skin and subcutaneous tissue
  - 98.2
    Suture of skin and subcutaneous tissue
  - 98.4
    Free skin graft
  - 98.5
    Flap or pedicle graft
    NOTE: 1. Functional areas includes the following anatomical areas: Head, neck, axillae, elbow, wrist, hand, groin, perineum, hip, knee, ankle, foot and includes coverage of exposed vital structures (bone, tendon, major vessel, nerve) 2. Flaps (HSCs 98.53,98.5A,98.51A,98.51B) for functional areas are designated by FNCAR modifier, add 50% to total benefit. 3. Flap size 5-10 cms or double Z-plasty designated by 2ZPL modifier, add 25% to benefit. 4. Flap size greater than 10 cms or triple Z-plasty designated by 3ZPL modifier, add 50% to benefit. 5. Composite tissue resection (includes bone) designated by CMPRSC modifier, add 25% to benefit. 6. Only one modifier (CMPRSC, FNCAR, 2ZPL, 3ZPL) may be claimed per flap.
  - 98.6
    Plastic operations on lip and external mouth
  - 98.7
    Other repair and reconstruction of skin and subcutaneous tissue
    - 98.71
      Correction of syndactyly
      NOTE: Grafts are paid per anatomic functional area
    - 98.72
      Facial rhytidectomy
      That for facial palsy
      NOTE: One side only.
    - 98.73
      Repair for facial weakness
    - 98.74
      Size reduction plastic operation
    - 98.79
      Other repair and reconstruction of skin and subcutaneous tissue NEC
      NOTE: 1. Fee includes harvesting and insertion. 2. Grafting to the nasal tip and tip rhinoplasty may not be claimed together. 3. Grafting to the nasal dorsum and dorsal rhinoplasty may not be claimed together.
  - 98.8
    Invasive diagnostic procedures on skin and subcutaneous tissue
  - 98.9
    Other 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 98.71D

Vandenbos procedure

NOTE:

A single call applies per digit treated.

Additional notes:

Listed under 98.71 - Correction of syndactyly:
Grafts are paid per anatomic functional area

Category:	1 Major Procedure (pre-operative period: 0 days, post-operative period: 14 days)
Base rate:	$108.61

Fee modifiers:

Type	Code	Explicit	Action	Amount
TRAY	MAJT		Increase By	$38.88
NBTR	NBTR	Yes
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
14.1
A major tray service benefit may be claimed for the following procedures only when they are performed in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services.
01.03 01.04A 01.05A 01.24A 01.24B 01.24BA
01.24BB 01.34 02.84A 02.84B 03.22B 03.25
07.53B 07.53D 07.53E 07.57A
12.31 13.59C 17.08A 17.81A 18.29F 18.29FA
21.42 21.69A 22.13A 22.13B 22.13C 22.5 A
22.51A 22.62A 22.71 22.81 25.1 A 25.29A
25.39D
32.01A 32.81 33.02A 33.22B 34.0 A 34.1 A
34.89A 37.82A 38.89A 39.21A 39.62A 39.83A
39.83A
40.92A 46.91
50.4 A 50.97A 52.1 A 52.11A 52.13 56.93B
60.24C 61.01B 61.03 61.29B 61.37A 61.39B
66.91A
70.1 70.5 A 72.91 75.64 79.23A 79.29E
82.81A 82.91A 83.7 A 87.3 87.55A 89.37A
89.37B 89.41A 89.41B 89.42A
93.39B 93.39C 95.02A 95.09A 95.81A 97.11B
97.83A 97.89B 98.04A 98.6 A 98.6 B 98.12A
98.12B 98.12C 98.12H 98.12J 98.12M 98.12N
98.12Q 98.12R 98.12T 98.14A 98.22A 98.22B
98.71D 98.81A 98.96A 98.96B 98.96C 98.96D

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Health Service Codes

Health Service Code 98.71D

Vandenbos procedure

NOTE:

Additional notes:

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

01.03	01.04A	01.05A	01.24A	01.24B	01.24BA
01.24BB	01.34	02.84A	02.84B	03.22B	03.25
07.53B	07.53D	07.53E	07.57A

21.42	21.69A	22.13A	22.13B	22.13C	22.5 A
22.51A	22.62A	22.71	22.81	25.1 A	25.29A
25.39D

32.01A	32.81	33.02A	33.22B	34.0 A	34.1 A
34.89A	37.82A	38.89A	39.21A	39.62A	39.83A
39.83A

93.39B	93.39C	95.02A	95.09A	95.81A	97.11B
97.83A	97.89B	98.04A	98.6 A	98.6 B	98.12A
98.12B	98.12C	98.12H	98.12J	98.12M	98.12N
98.12Q	98.12R	98.12T	98.14A	98.22A	98.22B
98.71D	98.81A	98.96A	98.96B	98.96C	98.96D

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Health Service Codes

Health Service Code 98.71D

Vandenbos procedure

NOTE:

Additional notes:

Fee modifiers:

Governing Rules:

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