Download List Of Procedures With Laterality

ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
15820
15822
15823
19160
19162
19180
19182
19200
19220
DESCRIPTION
19340
19342
19350
19357
19361
19364
19366
Blepharoplasty, lower eyelid
Blepharoplasty, upper eyelid;
Blepharoplasty, upper eyelid; with excessive skin weighting down lid
Mastectomy, partial;
Mastectomy, partial; with axillary lymphadenectomy
Mastectomy, simple, complete
Mastectomy, subcutaneous
Mastectomy, radical, icnluding pectoral muscles, axillary lymph nodes
Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation)
Mastectomy, modified radical, including axillary lymph nodes, w/ or w/o pectoralis minor muscle, but excluding pectoralis major
muscle
Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
Nipple/areola reconstruction
Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion
Breast reconstruction with latissimus dorsi flap, with or without prosthetic implant
Breast reconstruction with free flap
Breast reconstruction with other technique
19367
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site;
19369
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor site
19370
19371
23515
23520
23530
23532
23540
23550
23552
23570
23585
23600
23620
23630
23650
23660
23665
23670
23675
23680
23700
23900
23920
24500
24515
Open periprosthetic capsulotomy, breast
Periprosthetic capsulectomy, breast
Open treatment of clavicular fracture, w/ or w/o internal or external fixation
Closed treatment of sternoclavicular dislocation
Open treatment of sternoclavicular disloction, acute or chronic;
Open treatment of sternoclavicular disloction, w/ fascial graft (includes obtaining graft)
Closed tratment of acromioclavicular dislocation
Open treatment of acromioclavicular dislocation, acute or chronic;
Open treatment of acromioclavicular dislocation, acute or chronic; w/ fascial graft (includes obtaining graft)
Closed treatment of scapular fracture
Open treatment of scapular fracture (body, glenoid or acromion) w/ or w/o internal fixation
Closed treatment of proximal humeral (surgical or anatomical neck) fracture
Open treatment of proximal humeral (surgical or anatomical neck) fracture, w/ or w/o internal or external fixation, w/ or w/o repair
of tuberosity(-ies);
Open treatment of proximal humeral (surgical or anatomical neck) fracture, w/ or w/o internal or external fixation, w/ or w/o repair
of tuberosity(-ies); w/ proximal humeral prosthetic replacement
Closed treatment of greater tuberosity fracture
Open treatment of greater tuberosity fracture, w/ or w/o internal or external fixation
Closed treatment of shoulder dislocation
Open treatment of acute shoulder dislocation
Closed treatment of shoulder dislocation,/ fracture of greater tuberosity
Open treatment of shoulder dislocation, w/ fracture of greater tuberosity, w/ or w/o internal or external fixation
Closed treatment of shoulder dislocation, w/ surgical or anatomical neck fracture
Open treatment of shoulder dislocation, w/ surgical or anatomical neck fracture, w/ or w/o internal or external fixation
Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)
Interthoracoscapular amputation (forequarter)
Disarticulation of shoulder;
Closed treatment of humeral shaft fracture
Open treatment of humeral shaft fracture w/ plate/screws, w/ or w/o cerclage
24516
Open treatment of humeral shaft fracture, w/ insertion of intramedullary implant, w/ or w/o cerclage and/or locking screws
24530
Closed treatment of supracondylar or transcondylar humeral fracture, w/ or w/o intercondylar extension
Open treatment of humeral supracondylar or transcondylar fracture, w/ or w/o internal or external fixation; w/o intercondylar
extension
Open treatment of humeral supracondylar or transcondylar fracture, w/ or w/o internal or external fixation; w/ intercondylar
extension
Closed treatment of humeral epicondylar fracture, medial or lateral;
Open treatment of humeral epicondylar fracture, medial or lateral, w/ or w/o internal or external fixation
Closed treatment of humeral condylar fracture, medial or lateral
Open treatment of humeral condylar fracture, medial or lateral, w/ or w/o internal or external fixation
Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal
radius);
Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal
radius); w/ implant arthroplasty
Treatment of closed elbow dislocation
19240
23615
23616
24545
24546
24560
24575
24576
24579
24586
24587
24600
Page 1 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
DESCRIPTION
24615
Open treatment of acute or chronic elbow dislocation
24620
Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna w/ dislocation of radial head)
25530
25545
25560
25574
25575
Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna w/ dislocation of radial head), w/
or w/o internal or external fixation
Closed treatment of radial head subluxation in child, "nursemaid elbow"
Closed treatment of radial head or neck fracture
Open treatment of radial head or neck fracture, w/ or w/o internal fixation or radial head excision;
Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal
radius); w/ radial head prosthetic replacement
Closed treatment of ulnar fracture, proximal end (olecranon process)
Open treatment of ulnar fracture proximal end (olecranon process), w/ or w/o internal or external fixation
Amputation, arm through humerus; w/ primary closure
Amputation, arm through humerus; open, circular (guillotine)
Amputation, arm through humerus; secondary closure or scar revision
Amputation, arm through humerus; re-amputation
Amputation, arm through humerus; w/ implant
Closed treatment of radial shaft fracture
Open treatment of radial shaft fracture, w/ or w/o internal or external fixation
Closed treatment of radial shaft fracture, w/ dislocation of distal radio-ulnar joint (Galeazzi fracture/dislocation)
Open treatment of radial shaft fracture, w/ internal and/or external fixation and closed treatment of dislocation of distal radio-ulnar
joint (Galeazzi fracture/dislocation), w/ or w/o percutaneous skeletal fixation
Open treatment of radial shaft fracture, w/ internal and/or external fixation and open treatment, w/ or w/o internal or external
fixation of distal radio-ulnar joint (Galleazi fracture/dislocation), includes repair of triangular cartilage
Closed treatment of ulnar shaft fracture
Open treatment of ulnar shaft fracture, w/ or w/o internal or external fixation
Closed treatment of radial and ulnar shaft fractures
Open treatment of radial and ulnar shaft fractures, w/ internal or external fixation; of radius or ulna
Open treatment of radial and ulnar shaft fractures, w/ internal or external fixation; of radius and ulna
25600
Closed treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, w/ or w/o fracture of ulnar styloid
24635
24640
24650
24665
24666
24670
24685
24900
24920
24925
24930
24931
25500
25515
25520
25525
25526
25622
25628
25630
25645
25650
25660
25670
25675
25676
25680
25685
25690
25695
25900
25905
25907
25909
25920
25922
25924
25927
25929
25931
26600
26607
26615
26641
26645
Open treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, w/ or w/o fracture of ulnar styloid, w/
or w/o internal or external fixation
Closed treatment of carpal scaphoid (navicular) fracture
Open treatment of carpal scaphoid (navicular) fracture, w/ or w/o internal or external fixation
Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular))
Open treatment of carpal bone fracture (excluding carpal scaphoid (navicular)), each bone
Closed treatment of ulnar styloid fracture
Closed treatment of radiocarpal or intercarpal dislocation, one or more bones
Open treatment of radiocarpal or intercarpal dislocation, one or more bones
Closed treatment of distal radioulnar dislocation
Open treatment of distal radioulnar dislocation, acute or chronic
Closed treatment of trans-scaphoperilunar type of fracture dislocation
Open treatment of trans-scaphoperilunar type of fracture dislocation
Closed treatment of lunate dislocation
Open treatment of lunate dislocation
Amputation, forearm, through, radius and ulna;
Amputation, forearm, through, open, circular (guillotine)
Amputation, forearm, through, secondary closure or scar revision
Amputation, forearm, through, re-amputation
Disarticulation through wrist;
Disarticulation through wrist; secondary closure or scar revision
Disarticulation through wrist; re-amputation
Transmetacarpal amputation;
Transmetacarpal amputation; secondary closure or scar revision
Transmetacarpal amputation; re-amputation
Closed treatment of metacarpal fracture, single
Closed treatment of metacarpal fracture, w/ internal or external fixation
Open treatment of metacarpal fracture, single, w/ or w/o internal or external fixation, each bone
Closed treatment of carpometacarpal dislocation, thumb
Closed tratment of carpometacarpal fracture dislocation, thumb (Bennett fracture)
26665
Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), w/ or w/o internal or external fixation
26670
Closed treatment of carpometacarpal dislocation, other than thumb (Bennett fracture); single
Open treatment of carpometacarpal dislocation, other than thumb (Bennett fracture); single, w/ or w/o Open treatment of
carpometacarpal dislocation, other than thumb (Bennett fracture); single, internal or external fixation
25620
26685
Page 2 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
DESCRIPTION
26750
26765
26770
26785
26910
Open treatment of carpometacarpal dislocation, other than thumb (Bennett fracture); single, complex, multiple or delayed
reduction
Closed treatment of metacarpophalangeal dislocation, single
Open treatment of metacarpophalangeal dislocation, single, w/ or w/o internal or external fixation
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb
Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, w/ or w/o internal or external fixation,
each
Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint
Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, w/ or w/o internal or external fixation,
each
Closed treatment of distal phalangeal fracture, finger or thumb
Open treatment of distal phalangeal fracture, finger or thumb, w/ or w/o internal or external fixation, each
Closed treatment of interphalangeal joint dislocation, single
Open treatment of interphalangeal joint dislocation, w/ or w/o internal or external fixation, single
Amputation, metacarpal, w/ finger or thumb (ray amputation), single, w/ or w/o interosseous transfer
26951
Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; w/ direct closure
26686
26700
26715
26720
26735
26740
26746
27217
Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; w/ local advancement flaps
(V-Y, hood)
Treatment of slipped femoral epiphysis; by traction, w/o reduction
Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ
Open treatment of slipped femoral epiphysis; single of multiple pinning or bone graft (includes obtaining graft)
Open treatment of slipped femoral epiphysis; closed manipulation w/ single or multiple pinning
Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman type procedure)
Open treatment of slipped femoral epiphysis; osteotomy and internal fixation
Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s) (e.g., pelvic fracture(s) w/c do not disrupt the pelvic
ring), w/ internal fixation
Open treatment of anterior ring fracture and/or dislocation w/ internal fixation (includes pubic symphysis and/or rami)
27218
Open treatment of posterior ring fracture and/or dislocation w/ internal fixation (includes ilium, sacroiliac joint and/or sacrum)
27220
27226
Closed treatment of acetabulum (hip socket) fracture(s)
Open treatment of posterior or anterior acetabular wall fracture, w/ internal fixation
Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the
acetabulum, w/ internal fixation
26952
27175
27176
27177
27178
27179
27181
27215
27227
27228
Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column
fracture w/ complete articular detachment, or single column or transverse fracture w/ associated acetabular wall fracture, w/ inte
27230
Closed treatment of femoral fracture, proximal end, neck
27236
Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement (direct fracture exposure)
27238
27246
27248
27250
27253
Closed treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture
Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; w/ plate/screw type implant, w/ or w/o
cerclage
Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; w/ intramedullary implant, w/ or w/o
interlocking screws and/or cerclage
Closed treatment of greater trochanteric fracture
Open treatment of greater trochanteric fracture, w/ or w/o internal or external fixation
Closed treatment of hip dislocation, traumatic
Open treatment of hip dislocation, traumatic, w/o internal fixation
27254
Open treatment of hip dislocation, traumatic w/ acetabular wall and femoral head fracture, w/ or w/o internal or external fixation
27244
27245
27258
27259
27265
27290
27295
27501
27502
27503
27506
27507
27510
Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head
in acetabulum (including tenotomy, etc);
Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head
in acetabulum (including tenotomy, etc); w/ femoral shaft shortening
Closed treatment of post hip arthroplasty dislocation
Interpelviabdominal amputation (hindquarter amputation)
Disarticulation of hip
Closed treatment of supracondylar or transcondylar femoral fracture w/ or w/o intercondylar extension
Closed treatment of femoral shaft fracture, w/ or w/o skin or skeletal traction
Closed treatment of supracondylar or transcondylar femoral fracture w/ or w/o intercondylar extension, w/ or w/o skin or skeletal
traction
Open treatment of femoral shaft fracture, w/ or w/o external fixation, w/ insertion of intramedullary implant, w/ or w/o cerclage
and/or locking screws
Open treatment of femoral shaft fracture w/ plate/screws, w/ or w/o cerclage
Closed treatment of femoral fracture, distal end, medial or lateral condyle
Page 3 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
DESCRIPTION
27514
27516
27519
27520
27524
27530
27535
27536
27538
Open treatment of femoral supracondylar or transcondylar fracture w/o intercondylar extension, w/ or w/o internal or external
fixation
Open treatment of femoral supracondylar or transcondylar fracture w/ intercondylar extension, w/ or w/o internal or external
fixation
Open treatment of femoral fracture, distal end, medial or lateral condyle, w/ or w/o internal or external fixation
Closed treatment of distal femoral epiphyseal separation
Open treatment of distal femoral epiphyseal separation, w/ or w/o internal or external fixation
Closed treatment of patellar fracture
Open treatment of patellar fracture, w/ internal fixation and/or partial or complete patellectomy and soft tissue repair
Closed treatment of tibial fracture, proximal (plateau)
Open treatment of tibial fracture, proximal (plateau); unicondylar, w/ or w/o internal or external fixation
Open treatment of tibial fracture, proximal (plateau); bicondylar, w/ or w/o internal fixation
Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee
27540
Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, w/ or w/o internal or external fixation
27550
27560
27566
27590
27591
27592
27594
27596
27598
27750
Closed treatment of knee dislocation
Open treatment of knee dislocation, w/ or w/o internal or external fixation; w/o primary ligamentous repair or
augmentation/reconstruction
Open treatment of knee dislocation, w/ or w/o internal or external fixation; w/ primary ligamentous repair
Open treatment of knee dislocation, w/ or w/o internal or external fixation; w/ primary ligamentous repair, w/
augmentation/reconstruction
Closed treatment of patellar dislocation
Open treatment of patellar dislocation, w/ or w/o partial or total patellectomy
Amputation, thigh, through femur, any level;
Amputation, thigh, through femur, any level; immediate fitting technique including first cast
Amputation, thigh, through femur, any level; open, circular (guillotine)
Amputation, thigh, through femur, any level; secondary closure or scar revision
Amputation, thigh, through femur, any level; re-amputaion
Disarticulation at knee
Closed treatment of tibial shaft fracture (w/ or w/o fibular fracture)
27752
Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction
27758
27829
27830
Open treatment of tibial shaft fracture (w/ or w/o fibular fracture) w/ plate/screws, w/ or w/o cerclage
Open treatment of tibial shaft fracture (w/ or w/o fibular fracture) by intramedullary implant, w/ or w/o interlocking screws and/or
cerclage
Closed treatment of medial malleolus fracture
Open treatment of medial malleolus fracture, w/ or w/o internal or external fixation
Closed treatment of proximal fibula or shaft fracture
Open treatment of proximal fibula or shaft fracture, w/ or w/o internal or external fixation
Closed treatment of distal fibular fracture (lateral malleolus)
Open treatment of distal fibular fracture (lateral malleolus), w/ or w/o internal or external fixation w/o manipulation
Closed treatment of bimalleolar ankle fracture, (including Potts)
Open treatment of bimalleolar ankle fracture, w/ or w/o internal or external fixation
Closed treatment of trimalleolar ankle fracture
Open treatment of trimalleolar ankle fracture, w/ or w/o internal or external fixation, medial and/or lateral malleolus; w/o fixation
of posterior lip
Open treatment of trimalleolar ankle fracture, w/ or w/o internal or external fixation, medial and/or lateral malleolus; w/ fixation of
posterior lip
Closed treatment of fracture of weight bearing articular portion of distal tibia (e.g., pilon or tibial plafond)
Open treatment of fracture of weight bearing articular surface/portion of distal tibia (e.g., pilon or tibial plafond), w/ internal or
external fixation; of fibula only
Open treatment of fracture of weight bearing articular surface/portion of distal tibia (e.g., pilon or tibial plafond), w/ internal or
external fixation; of tibia only
Open treatment of fracture of weight bearing articular surface/portion of distal tibia (e.g., pilon or tibial plafond), w/ internal or
external fixation; of both tibia and fibula
Open treatment of distal tibiofibular joint (syndesmosis) disruption, w/ or w/o internal or external fixation
Closed treatment of proximal tibiofibular joint dislocation
27832
Open treatment of proximal tibiofibular joint dislocation, w/ or w/o internal or external fixation, or w/ excision of proximal fibula
27840
27846
27848
27880
27881
27882
27884
27886
Closed treatment of ankle dislocation
Open treatment of ankle dislocation, w/ or w/o percutaneous skeletal fixation; w/o repair or internal fixation
Open treatment of ankle dislocation, w/ or w/o percutaneous skeletal fixation; w/ repair or internal or external fixation
Amputation, leg, through tibia and fibula;
Amputation, leg, through tibia and fibula; w/ immediate fitting technique including application of first cast
Amputation, leg, through tibia and fibula; open, circular (guillotine)
Amputation, leg, through tibia and fibula; secondary closure or scar revision
Amputation, leg, through tibia and fibula; re-amputation
27511
27513
27556
27557
27558
27759
27760
27766
27780
27784
27786
27792
27808
27814
27816
27822
27823
27824
27826
27827
27828
Page 4 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
DESCRIPTION
27888
Amputation, ankle, through malleoli of tibia and fibula (Syme, Pirogoff type procedures), w/ plastic closure and resection of nerves
27889
28400
28415
Ankle disarticulation
Closed treatment of calcaneal fracture
Open treatment of calcaneal fracture, w/ or w/o internal or external fixation;
Open treatment of calcaneal fracture, w/ or w/o internal or external fixation; w/ primary iliac or other autogenous bone graft
(includes obtaining graft)
Closed treatment of talus fracture
Open treatment of talus fracture, w/ or w/o internal or external fixation
Treatment of tarsal bone fracture (except talus and calcaneus)
Open treatment of tarsal bone fracture (except talus and calcaneus), w/ or w/o internal or external fixation
Closed treatment of metatarsal fracture
Open treatment of metatarsal fracture, w/ or w/o internal or external fixation
Closed treatment of fracture great toe, phalanx or phalanges
Open treatment of fracture great toe, phalanx or phalanges, w/ or w/o internal or external fixation
Closed treatment of fracture, phalanx or phalanges, other than great toe
Open treatment of fracture, phalanx or phalanges, other than great toe, w/ or w/o internal or external fixation
Closed treatment of sesamoid fracture
Open treatment of sesamoid fracture, w/ or w/o internal fixation
Closed treatment of tarsal bone dislocation, other than talotarsal
Open treatment of tarsal bone dislocation, w/ or w/o internal or external fixation
Closed treatment of talotarsal joint dislocation
Open treatment of talotarsal joint dislocation, w/ or w/o internal or external fixation
Closed treatment of tarsometatarsal joint dislocation
Open treatment of tarsometatarsal joint dislocation, w/ or w/o internal or external fixation
Closed treatment of metatarsophalangeal joint dislocation
Open treatment of metatarsophalangeal joint dislocation, w/ or w/o internal or external fixation
Closed treatment of interphalangeal joint dislocation
Open treatment of interphalangeal joint dislocation, w/ or w/o internal or external fixation
Amputation, foot; midtarsal (Chopart type procedure)
Amputation, metatarsal, w/ toe, single
Amputation, toe; metatarsophalangeal joint
Amputation, toe; interphalangeal joint
Application of body cast, shoulder to hips; plaster Velpeau
Application of body cast, shoulder to hips; shoulder to hand (long arm)
Application of body cast, shoulder to hips; elbow to finger (short arm)
Application of body cast, shoulder to hips; hand and lower forearm (gauntlet)
Application of hip spica cast; one leg
Application of hip spica cast; one and one-half spica or both legs
Application of long leg cast (thigh to toes);
Application of long leg cast (thigh to toes); walker or ambulatory type
Application of long leg cast brace
Application of cylinder cast (thigh to ankle)
Application of short leg cast (below knee to toes);
Application of short leg cast (below knee to toes); walking or ambulatory type
Application of patellar tendon bearing (PTB) cast
Application of rigid total contact leg cast
Application of clubfoot cast w/ molding or manipulation, long or short leg
Repair initial inguinal hernia, under age 6 months, w/ or w/o hydrocelectomy; reducible
Repair initial inguinal hernia, under age 6 months, w/ or w/o hydrocelectomy; incarcerated
Repair initial inguinal hernia, under age 6 months, w/ or w/o hydrocelectomy; strangulated
Repair initial inguinal hernia, age 6 months to under 5 years, w/ or w/o hydrocelectomy; reducible
Repair initial inguinal hernia, age 6 months to under 5 years, w/ or w/o hydrocelectomy; incarcerated
Repair initial inguinal hernia, age 6 months to under 5 years, w/ or w/o hydrocelectomy; strangulated
Repair initial inguinal hernia, age 5 years or over; reducible
Repair initial inguinal hernia, age 5 years or over; incarcerated
Repair initial inguinal hernia, age 5 years or over; strangulated
Repair recurrent inguinal hernia, any age; reducible
Repair recurrent inguinal hernia, any age; incarcerated
Repair recurrent inguinal hernia, any age; strangulated
Repair inguinal hernia, sliding, any age
Repair lumbar hernia
Repair initial femoral hernia, any age; reducible
Repair initial femoral hernia, any age; incarcerated
Repair initial femoral hernia, any age; strangulated
Repair recurrent femoral hernia; reducible
Repair recurrent femoral hernia; incarcerated
28420
28430
28445
28450
28465
28470
28485
28490
28505
28510
28525
28530
28531
28540
28555
28570
28585
28600
28615
28630
28645
28660
28675
28800
28810
28820
28825
29058
29065
29075
29085
29305
29325
29345
29355
29358
29365
29405
29425
29435
29445
29450
49495
49496
49497
49500
49501
49502
49505
49507
49509
49520
49521
49522
49525
49540
49550
49553
49554
49555
49557
Page 5 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
49558
49560
49561
49562
49565
49566
49567
49590
49650
49651
54520
54530
54535
54550
54560
54600
54620
54640
54650
54670
54680
54690
54692
61330
61332
61333
61334
65091
65093
65101
65103
65105
65110
65112
65114
65130
65135
65140
65150
65155
65175
65205
65210
65222
65235
65260
65265
65270
65273
65275
65280
65285
65286
65290
65450
65710
65730
65750
65755
65760
65765
65767
65770
65771
65772
65775
65780
DESCRIPTION
Repair recurrent femoral hernia; strangulated
Repair initial incisional hernia; reducible
Repair initial incisional hernia; incarcerated
Repair initial incisional hernia; strangulated
Repair recurrent incisional hernia; reducible
Repair recurrent incisional hernia; incarcerated
Repair recurrent incisional hernia; strangulated
Repair spigelian hernia
Laparoscopy, surgical; repair of initial inguinal hernia
Laparoscopy, surgical; repair of recurrent inguinal hernia
Orchiectomy, simple (including subcapsular), w/ or w/o testicular prosthesis, scrotal or inguinal approach
Orchiectomy, radical, for tumor; inguinal approach
Orchiectomy, radical, for tumor; w/ abdominal exploration
Exploration for undescended testis (inguinal or scrotal area)
Exploration for undescended testis w/ abdominal exploration
Reduction of torsion of testis, surgical, w/ or w/o fixation of contralateral testis
Fixation of contralateral testis
Orchiopexy, inguinal approach, w/ or w/o hernia repair
Orchiopexy, abdominal approach, for intra-abdominal testis (e.g., Fowler-Stephens)
Suture or repair of testicular injury
Transplantation of testis(es) to thigh (because of scrotal destruction)
Laparoscopy, surgical; orchiectomy
Laparoscopy, surgical; orchiopexy for intra-abdominal testis
Decompression of orbit only, transcranial approach
Exploration of orbit (transcranial approach); w/ biopsy
Exploration of orbit (transcranial approach); w/ removal of lesion
Exploration of orbit (transcranial approach); w/ removal of foreign body
Evisceration of ocular contents; w/o implant
Evisceration of ocular contents; w/ implant
Enucleation of eye; w/o implant
Enucleation of eye; w/ implant, muscles not attached to implant
Enucleation of eye; w/ implant, muscles attached to implant
Exenteration of orbit without skin graft, removal of orbital contents; only
Exenteration of orbit without skin graft, removal of orbital contents; w/ therapeutic removal of bone
Exenteration of orbit without skin graft, removal of orbital contents; w/ muscle or myocutaneous flap
Insertion of ocular implant; after evisceration, in scleral shell
Insertion of ocular implant; after enucleation, muscles not attached to implant
Insertion of ocular implant; after enucleation, muscles attached to implant
Reinsertion of ocular implant; with or without conjunctival graft
Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant
Removal of ocular implant
Removal of foreign body, external eye; conjunctival, superficial
Removal of foreign body, external eye; subconjunctival or scleral, with slit lamp
Removal of foreign body, external eye; cornea, with slit lamp
Removal of foreign body, intraocular; from anterior chamber or lens
Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior route
Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction
Repair of laceration; conjunctiva, w/ or w/o nonperforating laceration sclera, direct closure
Repair of laceration; conjunctiva, by mobilization and rearrangement
Repair of laceration; cornea, nonperforating, w/ or w/o removal foreign body
Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue
Repair of laceration; cornea and/or sclera, perforating, w/ reposition or resection of uveal tissue
Repair of laceration; application of tissue glue, wounds of cornea and/or sclera
Repair of wound, extraocular muscle, tendon and/ or Tenons capsule
Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization
Keratoplasty (corneal transplant); lamellar
Keratoplasty (corneal transplant); penetrating (except in aphakia)
Keratoplasty (corneal transplant); penetrating (in aphakia)
Keratoplasty (corneal transplant); penetrating (in pseudophakia)
Keratomileusis
Keratophakia
Epikeratoplasty
Keratoprosthesis
Radial keratotomy
Corneal relaxing incision for correction of surgically induced astigmatism
Corneal wedge resection for correction of surgically induced astigmatism
Ocular surface reconstruction; amniotic membrane transplantation
Page 6 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
65781
65782
65805
DESCRIPTION
65815
65820
65850
65855
65860
Ocular surface reconstruction; limbal stem cell allograft (eg, cadaveric or living donor)
Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)
Paracentesis of anterior chamber of eye; w/ therapeutic release of aqueous
Paracentesis of anterior chamber of eye; w/ removal of vitreous and/or discission of anterior hyaloid membrane, w/ or w/o air
injection
Paracentesis of anterior chamber of eye; w/ removal of blood, w/ or w/o irrigation and/or air injection
Goniotomy
Trabeculotomy ab externo
Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)
Severing adhesions of anterior segment, laser technique
65865
Severing adhesions of anterior segment of eye, incisional technique (w/ or w/o injection of air or liquid); goniosynechiae
65870
Severing adhesions of anterior segment of eye, incisional technique (w/ or w/o injection of air or liquid); anterior synechiae, except
goniosynechiae
65875
Severing adhesions of anterior segment of eye, incisional technique (w/ or w/o injection of air or liquid); posterior synechiae
65880
Severing adhesions of anterior segment of eye, incisional technique (w/ or w/o injection of air or liquid); corneovitreal adhesions
65900
65920
66150
66155
66160
66165
66170
66180
66185
66220
66225
66500
66505
66600
66605
66625
66630
66680
66682
66700
66710
66720
66740
66761
Removal of epithelial material, anterior segment eye
Removal of implanted material, anterior segment eye
Fistulization of scalera for glaucoma; trephination w/ iridectomy
Fistulization of scalera for glaucoma; thermocauterization w/ iridectomy
Fistulization of scalera for glaucoma; sclerectomy w/ punch or scissors, w/ iridectomy
Fistulization of scalera for glaucoma; iridencleisis or iridotasis
Fistulization of scalera for glaucoma; trabeculectomy ab externo in absence of previous surgery
Fistulization of scalera for glaucoma; trabeculectomy ab externo w/ scarring from previous ocular surgery or trauma (includes
injection of antifibrotic agents)
Aquenous shunt to extraocular reservoir (e.g., Molteno, Schocket, Denver-Krupin)
Revision of aqueous shunt to extraocular reservoir
Repair of scleral staphyloma; w/o graft
Repair of scleral staphyloma; w/ graft
Iridotomy by stab incision; except transfixion
Iridotomy by stab incision; w/ transfixion as for iris bombe
Iridectomy, w/ corneoscleral or corneal section; for removal of lesion
Iridectomy, w/ corneoscleral or corneal section; w/ cyclectomy
Iridectomy, w/ corneoscleral or corneal section; peripheral for glaucoma
Iridectomy, w/ corneoscleral or corneal section; sector for glaucoma
Repair of iris, ciliary body (as for iridodialysis)
Suture of iris, ciliary body w/ retrieval of suture through small incision (e.g., McCannel suture)
Ciliary body destruction; diathermy
Ciliary body destruction; cyclophotocoagulation
Ciliary body destruction; cryotherapy
Ciliary body destruction; cyclodialysis
Iridotomy/iridectomy by laser surgery (e.g., for glaucoma) ( one or more sessions)
66762
Iridoplasty by photocoagulation (one or more sessions) (e.g., for improvement of vision, for widening of anterior chamber angle)
66770
66840
Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure)
Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique
(Ziegler or Wheeler knife)
Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior
hyaloid); laser surgery (e.g., YAG laser) (one or more stages)
Repositioning of intraocular lens prosthesis, requiring an incision
Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) w/ corneo-scleral section, w/
or w/o iridectomy (iridocapsulotomy, iridocapsulectomy)
Removal of lens material; aspiration technique, one or more stages
66850
Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (e.g., phacoemulsification), w/ aspiration
66852
66920
66930
66940
Removal of lens material; pars plana approach, with or without vitrectomy
Removal of lens material; intracapsular
Removal of lens material; intracapsular, for dislocated lens
Removal of lens material; extracapsular
66982
Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique
(eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in rout
66983*
Intracapsular cataract extraction w/ insertion of intraocular lens prosthesis (one stage procedure)
66984*
Extracapsular cataract removal w/ insertion of intraocular lens prosthesis (one stage procedure), (e.g., irrigation and aspiration)
65810
66172
66820
66821
66825
66830
Page 7 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
DESCRIPTION
66985
66986
Insertion of intraocular lens prosthesis, not associated with cataract removal
Exchange of intraocular lens
66987*
Extracapsular cataract removal w/ insertion of intraocular lens prosthesis (one stage procedure), (e.g., phacoemulsification)
66991
66992
66993
66994
66995
66996
66997
66998
66999
67005
Revision of failed filter; with or without explantation/exchange of shunt
Revision of failed filter; with excision of bleb cyst
Revision of failed filter; with choroidal tap
Revision of failed filter; with posterior sclerotomy
Revision of failed filter; with anterior chamber reformation
Revision of filtering bleb, needling technique; without injection of anti-metabolite
Revision of filtering bleb, needling technique; with injection of anti-metabolite
Release of scleral flap suture by laser suture lysis (new code)
Revision of overfiltering bleb (includes autologous blood injection, cryotherapy, mattress sutures, etc.)
Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal
67010
Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal w/ mechanical vitrectomy
67015
67036
67038
67039
67040
67041
67042
67043
Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy)
Vitrectomy, mechanical, pars plana approach;
Vitrectomy, mechanical, pars plana approach; w/ epiretinal membrane stripping
Vitrectomy, mechanical, pars plana approach; w/ focal endolaser photocoagulation
Vitrectomy, mechanical, pars plana approach; w/ endolaser panretinal photocoagulation
Vitrectomy, mechanical, pars plana approach; with internal limiting membrane (ILM) peeling
Vitrectomy, mechanical, pars plana approach; with radial optic nerve neurotomy (RON)
Vitrectomy, mechanical, pars plana approach; with sheathotomy for branch retinal vein occlusion
67044
Vitrectomy, mechanical, pars plana approach; with macular translocation (limited by retinotomy and/or scleral imbrication)
67045
67046
67047
Vitrectomy, mechanical, pars plana approach; with macular translocation (total)
Vitrectomy, mechanical, pars plana approach; with removal of subretinal membranes
Vitrectomy, mechanical, pars plana approach; with removal of choroidal neovascular membrane
67048
Vitrectomy, mechanical, pars plana approach; with endodrainage of subretinal hemorrhage (with or without tPA injection)
67049
67050
Vitrectomy, mechanical, pars plana approach; with removal of dropped IOL
Vitrectomy, mechanical, pars plana approach; with phacofragmentation for dropped lens material
67051
Vitrectomy, mechanical, pars plana approach; with internal tamponade with air, gas, silicone oil, perfluorocarbon liquid
67052
Vitrectomy, mechanical, pars plana approach; with insertion of scleral fixated intraocular lens, with or without anterior vitrectomy
67101
67105
Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, w/ or w/o drainage of subretinal fluid
Repair of retinal detachment, one or more sessions; photocoagulation, w/ or w/o drainage of subretinal fluid
Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), w/ or w/o
implant, w/ or w/o cryotherapy, photocoagulation, and drainage of subretinal fluid
Repair of retinal detachment; w/ vitrectomy, any method, w/ or w/o air or gas tamponade, focal endolaser photocoagulation,
cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique
Repair of retinal detachment; by injection of air or other gas (e.g., pneumatic retinopexy)
Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair(s)
using scleral buckling or vitrectomy techniques
Release of encircling material (posterior segment)
Removal of implanted material, posterior segment; extraocular
Removal of implanted material, posterior segment; intraocular
Destruction of localized lesion of retina (e.g., maculopathy, choroidopathy, small tumors), one or more sessions; cryotherapy,
diathermy
Destruction of localized lesion of retina (e.g., maculopathy, choroidopathy, small tumors), one or more sessions; photocoagulation
(laser or xenon arc)
Destruction of localized lesion of retina (e.g., maculopathy, choroidopathy, small tumors), one or more sessions; radiation by
implantation of source (includes removal of source)
67107
67108
67110
67112
67115
67120
67121
67208
67210
67218
67220
Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photocoagulation (e.g., laser), one or more sessions
67221
Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photodynamic therapy (includes intravenous infusions
67222
Destruction of localized lesion of choroid (e.g., choroidal neovascularization); transpupillary thermotherapy
67227
Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions; cryotherapy, diathermy
67228
67250
67311
67312
Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions; photocoagulation (laser or
xenon arc)
Scleral reinforcement
Strabismus surgery, recession or resection procedure (patient not previously operated on); one horizontal muscle
Strabismus surgery, recession or resection procedure (patient not previously operated on); two horizontal muscles
Page 8 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
DESCRIPTION
67334
67340
67343
67345
67400
67405
67412
67413
67414
67415
67420
67430
67440
67445
67550
67560
67580
67581
67582
67583
Strabismus surgery, recession or resection procedure (patient not previously operated on); one vertical muscle (excluding superior
oblique)
Strabismus surgery, recession or resection procedure (patient not previously operated on); two or more vertical muscles (excluding
superior oblique)
Strabismus surgery, any procedure (patient not previously operated on), superior oblique muscle
Transposition procedure (e.g., for paretic extraocular muscle), any extraocular muscle (specify)
Strabismus surgery on patient w/ previous eye surgery or injury that did not involve the extraocular muscles
Strabismus surgery on patient w/ scaring of extraocular muscles (e.g., prior ocular injury, strabismus or retinal detachment surgery)
or restrictive myopathy (e.g., dysthyroid ophthalmopathy)
Strabismus surgery by posterior fixation suture technique, w/ or w/o muscle recession
Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s)
Release of extensive scar tissue w/o detaching extraocular muscle
Chemodenervation of extraocular muscle
Orbitotomy w/o bone flap (frontal or transconjunctival approach); for exploration, w/ or w/o biopsy
Orbitotomy w/o bone flap (frontal or transconjunctival approach); w/ drainage only
Orbitotomy w/o bone flap (frontal or transconjunctival approach); w/ removal of lesion
Orbitotomy w/o bone flap (frontal or transconjunctival approach); w/ removal of foreign body
Orbitotomy w/o bone flap (frontal or transconjunctival approach); w/ removal of bone for decompression
Fine needle aspiration of orbital contents
Orbitotomy w/ bone flap or window, lateral approach (e.g., Kroenlein); w/ removal of lesion
Orbitotomy w/ bone flap or window, lateral approach (e.g., Kroenlein); w/ removal of foreign body
Orbitotomy w/ bone flap or window, lateral approach (e.g., Kroenlein); w/ drainage
Orbitotomy w/ bone flap or window, lateral approach (e.g., Kroenlein); w/ removal of bone for decompression
Orbital implant (implant outside muscle cone); insertion
Orbital implant (implant outside muscle cone); removal or revision
Repair of anophthalmic socket; with insertion or removal of orbital implant within muscle cone
Repair of anophthalmic socket; with exchange or orbital implant
Repair of anophthalmic socket; with exchange of orbital implant and reattachment of muscles
Repair of anophthalmic socket; with fornix reconstruction using sutures
67584
Repair of anophthalmic socket; with fornix reconstruction using buccal mucosal graft or amnion graft, including harvesting of graft
67585
Repair of anophthalmic socket; with revision of implant and fornix reconstruction using sutures
Repair of anophthalmic socket; with revision of implant and fornix reconstruction using buccal mucosal graft, or amnion graft
(including harvesting of graft)
Blepharotomy, drainage of abscess, eyelid
Severing of tarsorrhaphy
Canthotomy
Excision of chalazion
Repair of trichiasis; by electroepilation, electrosurgery, cryotherapy or laser surgery
Repair of trichiasis; incision of lid margin
Repair of trichiasis; incision of lid margin, with free mucous membrane graft
Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure
Temporary closure of eyelids suture (e.g., frost suture)
Construction of intermargin adhesions, median tarsorrhaphy, or canthorrhaphy;
Construction of intermargin adhesions, median tarsorrhaphy, or canthorrhaphy; with transportation of tarsal plate
Repair of brow ptosis (supraciliary, midforehead or coronal approach)
Repair of blepharoptosis; frontalis muscle technique with suture or other material
Repair of blepharoptosis; frontalis muscle technique with fascial sling (includes obtaining fascia)
Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach
Repair of blepharoptosis; (tarso) levator resection or advancement, external approach
Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia)
Repair of blepharoptosis; conjunctivo-tarso-Mullers muscle-levator resection (Fasanella-Servat type)
Repair of lid retraction (eyelid recession); without spacer
Correction of lagophthalmos, with implantation of upper eyelid load
Repair of ectropion; suture
Repair of ectropion; thermocauterization
Blepharoplasty, excision tarsal wedge
67314
67316
67318
67320
67331
67332
67586
67700
67710
67715
67800
67825
67830
67835
67840
67875
67880
67882
67900
67901
67902
67903
67904
67906
67908
67911
67912
67914
67915
67916
Page 9 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
DESCRIPTION
67917
67921
67922
67923
67924
Blepharoplasty, extensive (e.g., Kuhnt-Szymanowski or tarsal strip operations)
Repair of entropion; suture
Repair of entropion; thermocauterization
Blepharoplasty, excision tarsal wedge
Blepharoplasty, extensive (e.g., Wheeler operation)
67930
Suture of recent wound, eyelid, involving lid margin, tarsus, and/ or palpebral conjunctiva direct closure; partial thickness
67935
67950
Suture of recent wound, eyelid, involving lid margin, tarsus, and/ or palpebral conjunctiva direct closure; full thickness
Canthoplasty (reconstruction of canthus)
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin
graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin
graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, one
stage or first stage
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, one stage or
first stage
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, one stage or
first stage
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage
Conjunctivoplasty; with conjunctival graft or extensive rearrangement
Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft)
Conjunctivoplasty reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement
Conjunctivoplasty reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft)
Repair of symblepharon; conjunctivoplasty, without graft
Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft)
Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens
Conjunctival flap; bridge or partial
Conjunctival flap; total (such as Gunderson thin flap or purse string flap)
Harvesting conjunctival allograft, living donor
Incision, drainage of lacrimal gland
Incision, drainage of lacrimal sac (dacryocystostomy)
Snip incision of lacrimal punctum
Excision of lacrimal gland (dacryoadenectomy), except for tumor
Excision of lacrimal sac (dacryocystectomy)
Removal of foreign body or dacryolith, lacrimal passages
Excision of lacrimal gland tumor; frontal approach
Excision of lacrimal gland tumor; involving osteotomy
Plastic repair of canaliculi
Correction of everted punctum, cautery
Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)
Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube
Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent
Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery
Closure of lacrimal fistula
Probing of nasolacrimal duct; requiring general anesthesia
Probing of nasolacrimal duct; with insertion of tube or stent
Reconstruction of external auditory canal (meatoplasty) (e.g., for stenosis due to trauma, infection)
67961
67966
67971
67973
67974
67975
68320
68325
68326
68328
68330
68335
68340
68360
68362
68371
68400
68420
68440
68500
68520
68530
68540
68550
68700
68705
68720
68745
68750
68760
68770
68811
68815
69310
Page 10 of 11
ANNEX 7. LIST OF PROCEDURES WITH LATERALITY
RVS CODE
DESCRIPTION
69320
69400
69405
69420
69421
69433
69436
69440
69450
69535
69620
69650
69660
Reconstruction external auditory canal for congenital atresia, single stage
Eustachian tube inflation, transnasal; w/ catheterization
Eustachian tube catheterization, transtympanic
Myringotomy including aspiration and/or eustachian tube inflation
Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia
Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia
Tympanostomy (requiring insertion of ventilating tube), w/ general anesthesia
Middle ear exploration through postauricular or ear canal incision
Tympanolysis, transcanal
Resection temporal bone, external approach
Myringoplasty (surgery confined to drumhead and donor area)
Stapes mobilization
Stapedectomy or stapedotomy w/ reestablishment of ossicular continuity, w/ or w/o use of foreign material;
69661
Stapedectomy or stapedotomy w/ reestablishment of ossicular continuity, w/ or w/o use of foreign material; w/ footplate drill out
69662
69666
69667
69670
69676
69700
69720
69725
69740
69745
Revision of stapedectomy or stapedotomy
Repair oval window fistula
Repair round window fistula
Mastoid obliteration
Tympanic neurectomy
Closure postauricular fistula, mastoid
Decompression facial nerve, intratemporal; lateral to geniculate ganglion
Decompression facial nerve, intratemporal; including medial to geniculate ganglion
Suture facial nerve, intratemporal, w/ or w/o graft or decompression; lateral to geniculate ganglion
Suture facial nerve, intratemporal, w/ or w/o graft or decompression; including medial to geniculate ganglion
Labyrinthotomy, w/ or w/o cryosurgery including other nonexcisional destructive procedures or perfusion of vestbuloactive drugs
(single or multiple perfusions); transcanal
Labyrinthotomy, w/ or w/o cryosurgery including other nonexcisional destructive procedures or perfusion of vestbuloactive drugs
(single or multiple perfusions); w/ mastoidectomy
Endolymphatic sac operation; w/o shunt
Endolymphatic sac operation; w/ shunt
Fenestration semicircular canal
Revision fenestration operation
Labyrinthectomy; transcanal
Labyrinthectomy; w/ mastoidectomy
Vestibular nerve section, translabyrinthine approach
Cochlear device implantation, w/ or w/o mastoidectomy
Vestibular nerve section, transcranial approach
Total facial nerve decompression and/or repair (may include graft)
Decompression internal auditory canal
Removal of tumor, temporal bone
69801
69802
69805
69806
69820
69840
69905
69910
69915
69930
69950
69955
69960
69970
*subject to policies contained in PC 17 s 2013
Page 11 of 11