Philhealth Classification of Procedures

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Transcript of Philhealth Classification of Procedures

CODE

DESCRIPTIVE TERMS

RVU

Skin, Subcutaneous and Accessory Structures Incision and Drainage Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or 10060 subcutaneous abscess, cyst, furuncle, or paronychia) 10080 Incision and drainage of pilonidal cyst 10120 Incision and removal of foreign body, subcutaneous tissues 10140 Incision and drainage of hematoma, seroma, or fluid collection 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst 10180 Incision and drainage, complex, postoperative wound infection Excision-Debridement 11000 Debridement of extensive eczematous or infected skin Debridement including removal of foreign material associated w/ open fracture(s) and/or 11010 dislocation(s); skin and subcutaneous tissues 11011 skin, subcutaneous tissue, muscle fascia, and muscle 11012 skin, subcutaneous tissue, muscle fascia, muscle, and bone 11040 Debridement; skin, partial thickness 11041 skin, full thickness 11042 skin, and subcutaneous tissue 11043 skin, subcutaneous tissue, and muscle 11044 skin, subcutaneous tissue, muscle, and bone

6 6 6 6 6 15

60 60 70 80 10 10 20 30 30

Paring or Curettement Paring or curettement of benign hyperkeratotic skin lesion w/ or w/o chemical cauterization (such as 11050 verrucae or clavi) not extending through the stratum corneum (eg, callus or wart) w/ or w/o local 6 anesthesia; single lesion 11051 two to four lesions 13 11052 more than four lesions 20 Biopsy 11100 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed ; single or multiple lesion 6

Shaving of Epidermal or Dermal Lesions Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or 11300 less 11301 lesion diameter 0.6 to 1.0 cm 11302 lesion diameter 1.1 to 2.0 cm 11303 lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion 11305 diameter 0.5 cm or less 11306 lesion diameter 0.6 to 1.0 cm 11307 lesion diameter 1.1 to 2.0 cm 11308 lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose ,lips, mucous 11310 membrane; lesion diameter 0.5 cm or less 11311 lesion diameter 0.6 to 1.0 cm 11312 lesion diameter 1.1 to 2.0 cm 11313 lesion diameter over 2.0 cm Excision-Benign Lesions Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion 11400 diameter 0.5 cm or less 11401 lesion diameter 0.6 to 1.0 cm 11402 lesion diameter 1.1 to 2.0 cm 11403 lesion diameter 2.1 to 3.0 cm 11404 lesion diameter 3.1 to 4.0 cm 11406 lesion diameter over 4.0 cm

6 12 18 25 6 12 18 25 12 18 25 30

6 10 10 10 10 10

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CODE 11420 11421 11422 11423 11424 11426 11440 11441 11442 11443 11444 11446 11450 11462 11470

DESCRIPTIVE TERMS

RVU

Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; 6 lesion diameter 0.5 cm or less lesion diameter 0.6 to 1.0 cm 10 lesion diameter 1.1 to 2.0 cm 10 lesion diameter 2.1 to 3.0 cm 10 lesion diameter 3.1 to 4.0 cm 10 lesion diameter over 4.0 cm 10 Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous 6 membrane; lesion diameter 0.5 cm or less lesion diameter 0.6 to 1.0 cm 12 lesion diameter 1.1 to 2.0 cm 12 lesion diameter 2.1 to 3.0 cm 12 lesion diameter 3.1 to 4.0 cm 12 lesion diameter over 4.0 cm 12 Excision of skin and subcutaneous tissue for hidradenitis, axillary 30 Excision of skin and subcutaneous tissue for hidradenitis, inguinal 30 Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal or umbilical 30

Excision - Malignant Lesions 11600 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.5 cm or less 11601 lesion diameter 0.6 to 1.0 cm 11602 lesion diameter 1.1 to 2.0 cm 11603 lesion diameter 2.1 to 3.0 cm 11604 lesion diameter 3.1 to 4.0 cm 11606 lesion diameter over 4.0 cm 11620 Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less 11621 lesion diameter 0.6 to 1.0 cm 11622 lesion diameter 1.1 to 2.0 cm 11623 lesion diameter 2.1 to 3.0 cm 11624 lesion diameter 3.1 to 4.0 cm 11626 lesion diameter over 4.0 cm 11640 Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.5 cm or less 11641 lesion diameter 0.6 to 1.0 cm 11642 lesion diameter 1.1 to 2.0 cm 11643 lesion diameter 2.1 to 3.0 cm 11644 lesion diameter 3.1 to 4.0 cm 11646 lesion diameter over 4.0 cm Nails 11720 Debridement of nail(s) by any method(s); one to five 11721 six or more 11730 Avulsion of nail plate, partial or complete 11740 Evacuation of subungual hematoma Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail) for permanent 11750 removal; 11752 w/ amputation of tuft of distal phalanx

6 10 10 10 10 10 10 15 15 15 15 15 15 15 15 15 15 15

10 15 10 6 10 15

11755 Biopsy of nail unit, any method (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) 10 11760 11762 11765 11770 Repair Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities 10 (including hands and feet); 2.5 cm or less 12002 2.6 cm to 7.5 cm 15 12004 7.6 cm to 12.5 cm 20 12005 12.6 cm to 20.0 cm 20 12001 Repair of nail bed Reconstruction of nail bed w/ graft Wedge excision of skin of nail fold (eg, for ingrown toenail) Excision of pilonidal cyst or sinus 15 15 10 20

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CODE 12006 12007 12011 12013 12014 12015 12016 12017 12018 12031 12032 12034 12035 12036 12037 12041 12042 12044 12045 12046 12047 12051 12052 12053 12054 12055 12056 12057

DESCRIPTIVE TERMS

RVU 20 20 20 25 28 30 30 30 30 10 15 20 20 20 20 20 25 30 35 40 45 20 20 30 30 40 40 50

20.1 cm to 30.0 cm over 30.0 cm Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less 2.6 cm to 5.0 cm 5.1 cm to 7.5 cm 7.6 cm to 12.5 cm 12.6 cm to 20.0 cm 20.1 cm to 30.0 cm over 30.0 cm Layer closure of wounds of scalp, axillae, trunk, and/or extremities (excluding hands and feet); 2.5 cm or less 2.6 cm to 7.5 cm 7.6 cm to 12.5 cm 12.6 cm to 20.0 cm 20.1 cm to 30.0 cm over 30.0 cm Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less 2.6 cm to 7.5 cm 7.6 cm to 12.5 cm 12.6 cm to 20.0 cm 20.1 cm to 30.0 cm over 30.0 cm Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membrances; 2.5 cm or less 2.6 cm to 5.0 cm 5.1 cm to 7.5 cm 7.6 cm to 12.5 cm 12.6 cm to 20.0 cm 20.1 cm to 30.0 cm over 30.0 cm

Adjacent Tissue Transfer or Rearrangement 14000 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less 14001 defect 10.1 sq cm to 30.0 sq cm 14020 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less 14021 defect 10.1 sq cm to 30.0 sq cm Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, 14040 hands and/or feet; defect 10 sq cm or less 14041 defect 10.1 sq cm to 30.0 sq cm 14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less 14061 defect 10.1 sq cm to 30.0 sq cm

60 70 60 70 70 80 80 90 100 165

14300 Adjacent tissue transfer or rearrangement, more than 30 sq cm, unusual or complicated, any area 14350 Filleted finger or toe flap, including preparation of recipient site

Free Skin Grafts Pinch graft, single or multiple, to cover small ulcer, tip or digit, or other minimal open area (except on 27 15050 face), up to defect size 2 cm diameter Split graft, trunk, scalp, arms, legs, hands, and/or feet (except multiple digits); 100 sq cm or less, or 30 15100 each one percent of body area of infants and children (except 15050) Split graft, face, eyelids, mouth, neck, ears, orbits, genitalia, and/or multiple digits; 100 sq cm or 100 15120 less, or each one percent of body area of infants and children (except 15050) 15200 Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less 100 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or 100 15220 less Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, 150 15240 axillae, genitalia, hands, and/or feet; 20 sq cm or less

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CODE 15260

DESCRIPTIVE TERMS

RVU

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq 200 cm or less 15350 Application of allograft, skin 200 15400 Application of xenograft, skin 200 Flaps (Skin and/or Deep Tissues) 15570 Formation of direct or tubed pedicle, w/ or w/o transfer, trunk 15572 scalp, arms, or legs 15574 forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet 15576 eyelids, nose, ears, lips or intraoral 15580 Cross finger flap, including free graft to donor site 15650 Transfer, intermediate, of any pedicle flap (eg, abdomen to wrist, "Walking" tube), any location 15732 Muscle, myocutaneous, or fasciocutaneous flap; head and neck (eg, temporalis, masseter, sternocleidomastoid, levator scapulae) 15734 trunk 15736 upper extremity 15738 lower extremity Other Flaps and Grafts 15740 Flap; island pedicle 15750 neurovascular pedicle 15756 Free muscle flap w/ or w/o skin graft w/ microvascular anastomosis 15757 Free skin flap w/ microvascular anastomosis 15758 Free fascial flap w/ microvascular anastomosis Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor 15760 area 15770 derma-fat-fascia Other Procedures 15820 Blepharoplasty, lower eyelid 15822 Blepharoplasty, upper eyelid; 15823 with excessive skin weighting down li