Unbundling rules

We will not pay additionally for:

Procedures that are considered integral to a specific procedure for example:

• Osteotomy of long bone during total hip replacement
• Cardiac catheterisation prior to coronary angioplasty
• Diagnostic arthroscopy with therapeutic arthroscopic procedures
• Bilateral oophorectomy and salpingectomy as part of total abdominal hysterectomy
• Endoscopic examination of ureter with endoscopic retrograde pyelography
• Radiographic imaging for procedures that are usually performed under X-ray control

Procedures integral to a wide range of procedures for example:

• Insertion of intravenous access for medication administration
• Phlebotomy
• Primary suturing of a wound and removal of sutures
• Application and management of postoperative dressings and analgesic devices (e.g. patient controlled analgesia)

Procedures for gaining access to the target organ system or operation site for example:

• Clearance of impacted wax prior to myringotomy
• Adhesiolysis or exploratory laparotomy prior to intra-abdominal procedures
• Urethroscopy or cystoscopy with other endoscopic intravesical or nephro-ureteric procedures
• Bronchoscopy prior to thoracic surgery where the diagnosis has already been established

Endoscopic procedures done as part of an open procedure or converted to an open procedure for example:

• Laparoscopic cholecystectomy converted to an open procedure

Procedures for postoperative analgesia performed by the operator under general anaesthesia

Unacceptable codes include W9030, W9040, W9012, W9013, W9014, W9015, S5210, A7350 and AC100.

Procedures additional to a procedure specified as 'as sole procedure'

Where the CCSD narrative specifies 'as sole procedure', such codes may not be used in combination with any other code except for procedures performed at completely different anatomical sites.