HRGs for IS ECN _ IS FCN

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					     IS ECN & IS FCN Proposed HRGs - for use from 1 April 2009
       Final
                                               HRG Code Description                             Limitations
       HRG
                                                                                            Only: A09.1, A09.2,
      AA09Z Intracranial Procedures Except Trauma with Other Diagnoses - category 4         A09.4, A10.7, A57.5,
                                                                                            A57.7 & A57.8
            Intracranial Procedures Except Trauma with Brain Tumours or Cerebral            Only: A03.3, A03.8
      AA18Z
            Cysts - category 1 or 2                                                         & A03.9
            Intracranial Procedures Except Trauma with Cerebral Degenerations or            Only: A03.3, A03.8
      AA19Z
            Miscellaneous Disorders of Nervous System - category 1 or 2                     & A03.9
                 Intracranial Procedures Except Trauma with Muscular, Balance, Cranial or   Only: A03.3, A03.8,
      AA20Z
                 Peripheral Nerve disorders; Epilepsy; Head Injury - category 1 or 2        A03.9 & A31.3

                                                                                            Only: A03.3, A03.8,
                 Intracranial Procedures Except Trauma with Other Diagnoses - category 1 or
      AA21Z                                                                                 A03.9, A73.8, A84.1,
                 2
                                                                                            A84.2 & A84.3
      AB02Z      Complex Major Pain Procedures
      AB03Z      Complex Pain Procedures
      AB04Z      Major Pain Procedures
      AB05Z      Intermediate Pain Procedures
      AB06Z      Minor Pain Procedures
      BZ01Z      Enhanced Cataract Surgery
      BZ02Z      Phacoemulsification Cataract Extraction and Lens Implant
      BZ03Z      Non-Phacoemulsification Cataract Surgery
      BZ04Z      Lens Capsulotomy
      BZ05Z      Oculoplastics category 3
      BZ06A      Oculoplastics category 2: 19 years and over
      BZ07A      Oculoplastics category 1: 19 years and over
      BZ08A      Orbits / lacrimal category 3: 19 years and over
      BZ09A      Orbits / lacrimal category 2: 19 years and over
      BZ10A      Orbits / lacrimal category 1: 19 years and over
      BZ11Z      Cornea / Sclera - category 3
      BZ12Z      Cornea / Sclera - category 2
      BZ13Z      Cornea / Sclera - category 1
      BZ14A      Ocular Motility category 3: 19 years and over
      BZ15A      Ocular Motility category 2: 19 years and over
      BZ16A      Ocular Motility category 1: 19 years and over
      BZ17Z      Glaucoma - category 3
      BZ18Z      Glaucoma - category 2
      BZ19Z      Glaucoma - category 1
      BZ20Z      Vitreous Retinal Procedures - category 4
      BZ21Z      Vitreous Retinal Procedures - category 3
      BZ22Z      Vitreous Retinal Procedures - category 2
      BZ23Z      Vitreous Retinal Procedures - category 1
      CZ01V      Minor Mouth Procedures 19 years and over with CC
      CZ01Y      Minor Mouth Procedures 19 years and over without CC
      CZ02W      Intermediate Mouth Procedures 19 years and over with Major CC
      CZ02X      Intermediate Mouth Procedures 19 years and over with Intermediate CC
      CZ02Y      Intermediate Mouth Procedures 19 years and over without CC
      CZ03V      Major Mouth Procedures 19 years and over with CC
      CZ03Y      Major Mouth Procedures 19 years and over without CC
      CZ04O      Complex Major Mouth Procedures with Major CC
      CZ04P      Complex Major Mouth Procedures with Intermediate CC
      CZ04Q      Complex Major Mouth Procedures without CC
      CZ05V      Tonsillectomy 19 years and over with CC
      CZ05Y      Tonsillectomy 19 years and over without CC
      CZ06N      Minor Throat Procedures with CC
      CZ06Q      Minor Throat Procedures without CC


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       Final
                                               HRG Code Description                          Limitations
       HRG
      CZ07O      Exteriorisation of Trachea with Major CC
      CZ07P      Exteriorisation of Trachea with Intermediate CC
      CZ07Q      Exteriorisation of Trachea without CC
      CZ08V      Minor Ear Procedures 19 years and over with CC
      CZ08Y      Minor Ear Procedures19 years and over without CC
      CZ09V      Intermediate Ear Procedures 19 years and over with CC
      CZ09Y      Intermediate Ear Procedures 19 years and over without CC
      CZ10V      Major Ear Procedures 19 years and over with CC
      CZ10Y      Major Ear Procedures 19 years and over without CC
      CZ12V      Minor Nose Procedures 19 years and over with CC
      CZ12Y      Minor Nose Procedures 19 years and over without CC
      CZ13V      Intermediate Nose Procedures 19 years and over with CC
      CZ13Y      Intermediate Nose Procedures 19 years and over without CC
      CZ14V      Major Nose Procedures 19 years and over with CC
      CZ14Y      Major Nose Procedures 19 years and over without CC
      CZ15N      Complex Major Nose Procedures with CC
      CZ15Q      Complex Major Nose Procedures without CC
      CZ16N      Minor Maxillo-facial Procedures with CC
      CZ16Q      Minor Maxillo-facial Procedures without CC
      CZ17V      Intermediate Maxillo-facial Procedures 19 years and over with CC
      CZ17Y      Intermediate Maxillo-facial Procedures 19 years and over without CC
      CZ18R      Major Maxillo-facial Procedures 19 years and over
       DA02      Direct Access Transthoracic Echocardiogram
      DZ02A      Complex Thoracic Procedures with Major CC
      DZ02B      Complex Thoracic Procedures with CC
      DZ02C      Complex Thoracic Procedures without CC
      DZ03A      Major Thoracic Procedures with CC
      DZ03B      Major Thoracic Procedures without CC
      DZ04A      Intermediate Thoracic Procedures with CC
      DZ04B      Intermediate Thoracic Procedures without CC
      DZ05Z      Other Thoracic Procedures
      DZ06Z      Minor Thoracic Procedures
      DZ07Z      Fibre optic Bronchoscopy
      DZ08Z      Rigid Bronchoscopy
      EA03Z      Pace 1 - Single chamber or Implantable Diagnostic Device
                 Pace 1 - Single chamber or Implantable Diagnostic Device and other
      EA04Z
                 (Catheterisation; EP; Ablation; Percutaneous Coronary Intervention)
      EA05Z      Pace 2 - Dual Chamber
      EA06Z      Pace 2 - Dual Chamber and other (Catheterisation; EP; Ablation; PCI)
                 Pace 3 - Biventricular and all congenital pacemaker Procedures -
      EA07Z
                 Resynchronisation Therapy
                 Congenital Interventions: Percutaneous transluminal ASD/VSD/PFO closure
      EA09Z
                 and valve insertion
                 Congenital Interventions: Balloon valve intermediate interventions and
      EA10Z
                 arterial duct closure
                 Congenital Interventions: Other including Septostomy, Embolisations, Non-
      EA11Z
                 coronary Stents and Energy Moderated Perforation
      EA12Z      Implantation of Cardioverter - Defibrillator only
      EA13Z      Implantation of Cardioverter - Defibrillator with other Procedures
      EA14Z      Coronary Artery Bypass Graft (First Time)
      EA15Z      Coronary Artery Bypass Graft (First Time) with Cardiac Catheterisation
                 Coronary Artery Bypass Graft (First Time) with Percutaneous Coronary
      EA16Z
                 Intervention, Pacing, EP or RFA +/- Catheterisation
      EA17Z      Single Cardiac Valve Procedures
      EA18Z      Single Cardiac Valve Procedures with Catheterisation
                 Single Cardiac Valve Procedures with Percutaneous Coronary Intervention,
      EA19Z
                 Pacing, EP or RFA +/- Catheterisation
      EA20Z      Other Complex Cardiac Surgery and Re-do's


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       Final
                                         HRG Code Description                                      Limitations
       HRG
      EA21Z Other Complex Cardiac Surgery with Catheterisation
             Other Complex Cardiac Surgery with Percutaneous Coronary Intervention,
      EA22Z
             Pacing, EP or RFA +/- Catheterisation
      EA27Z Standard EP or Ablation
             Standard EP or Ablation with Catheterisation or Percutaneous Coronary
      EA28Z
             Intervention
      EA29Z Complex Ablation (includes Atrial Fibrillation or Ventricular Tachycardia)
             Complex Ablation (includes Atrial Fibrillation or Ventricular Tachycardia) with
      EA30Z
             Catheterisation or Percutaneous Coronary Intervention
      EA31Z Percutaneous Coronary Intervention (0-2 Stents)
      EA32Z Percutaneous Coronary Intervention (0-2 stents) and Catheterisation
      EA33Z Percutaneous Coronary Interventions with 3 or more Stents
             Percutaneous Coronary Interventions with 3 or more Stents and
      EA34Z
             Catheterisation
      EA35Z Other Transluminal Percutaneous Interventions
      EA36Z Catheter 19 years and over
             Pacemaker Procedure without Generator Implant (includes resiting and
      EA39Z
             removal of cardiac pacemaker system)
      EA40Z Other Non-Complex Cardiac Surgery
      EA41Z Other Non-Complex Cardiac Surgery + Catheterisation
             Other Non-Complex Cardiac Surgery + other (includes PCI; Pacing; EP; RFA
      EA42Z
             +/- Catheterisation - not ICD)
      EA44Z Minor Cardiac Procedures
             Complex Echocardiogram (include Congenital, Transoesophageal and Fetal
      EA45Z
             Echocardiography)
      EA46Z Simple Echocardiogram
      EA47Z Electrocardiogram Monitoring and stress testing
             Diagnostic and intermediate procedures on the upper GI tract 19 years and         Excluding: G10.5 &
      FZ03A
             over                                                                              G10.8
      FZ04A Very Major Stomach or Duodenum Procedures with Major CC
      FZ04B Very Major Stomach or Duodenum Procedures without Major CC
      FZ06A Very Major Small Intestine Procedures with CC                                      Excluding: G68
      FZ06B Very Major Small Intestine Procedures without CC                                   Excluding: G68
      FZ07A Major Small Intestine Procedures with CC
      FZ07B Major Small Intestine Procedures without CC
      FZ08A Complex Large Intestine Procedures with Major CC
      FZ08B Complex Large Intestine Procedures without Major CC
      FZ09A Proximal colon procedures with Major CC
      FZ09B Proximal colon procedures without Major CC
      FZ10A Distal colon procedures with Major CC
      FZ10B Distal colon procedures without Major CC
      FZ11A Large Intestine - Major Procedures with Major CC
      FZ11B Large Intestine - Major Procedures without Major CC
      FZ12A General Abdominal - Very Major or Major Procedures with Major CC                   Excluding: 85.5
      FZ12B General Abdominal - Very Major or Major Procedures with Intermediate CC            Excluding: 85.5
      FZ12C General Abdominal - Very Major or Major Procedures without CC                      Excluding: 85.5
      FZ13A General Abdominal - Diagnostic Procedures with CC
      FZ13B General Abdominal - Diagnostic Procedures without CC
      FZ14Z Complex Procedures for Inflammatory Bowel Disease
      FZ15Z Major Procedures for Inflammatory Bowel Disease
      FZ17A Abdominal Hernia Procedures 19 years and over with Major CC
      FZ17B Abdominal Hernia Procedures 19 years and over with Intermediate CC
      FZ17C Abdominal Hernia Procedures 19 years and over without CC
            Inguinal Umbilical or Femoral Hernia Repairs 19 years and over with Major
      FZ18A
            CC
            Inguinal Umbilical or Femoral Hernia Repairs 19 years and over with
      FZ18B
            Intermediate CC


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       Final
                                               HRG Code Description                             Limitations
       HRG
      FZ18C Inguinal Umbilical or Femoral Hernia Repairs 19 years and over without CC
      FZ19Z Herniotomy Procedures
                                                                                            Only: H02.1, H02.2,
      FZ20A Appendicectomy Procedures 19 years and over with Major CC
                                                                                            H02.3 & H02.8

                                                                                            Only: H02.1, H02.2,
      FZ20B Appendicectomy Procedures 19 years and over without Major CC
                                                                                            H02.3 & H02.8
      FZ21Z Major Anal Procedures
      FZ22A Intermediate Anal Procedures 19 years and over
      FZ23Z Minor Anal Procedures
            Major Therapeutic Open or Endoscopic Procedures 19 years and over with
      FZ24A
            Major CC
            Major Therapeutic Open or Endoscopic Procedures 19 years and over with
      FZ24B
            Intermediate CC
            Major Therapeutic Open or Endoscopic Procedures 19 years and over
      FZ24C
            without CC
            Therapeutic Endoscopic or Intermediate Stomach or Duodenum Procedures
      FZ25A
            19 years and over
      FZ26A Endoscopic or Intermediate Large Intestine Procedures 19 years and over
                 Endoscopic or Intermediate General Abdominal Procedures 19 years and
      FZ27A
                 over with Major CC
                 Endoscopic or Intermediate General Abdominal Procedures 19 years and
      FZ27B
                 over with Intermediate CC
                 Endoscopic or Intermediate General Abdominal Procedures 19 years and
      FZ27C
                 over without CC
                 Endoscopic or Intermediate Procedures for Inflammatory Bowel Disease 19
      FZ28A
                 years and over with CC
                 Endoscopic or Intermediate Procedures for Inflammatory Bowel Disease 19
      FZ28B
                 years and over without CC
      FZ30Z Diagnostic Endoscopic or Intermediate Procedures for Gastrointestinal Bleed
      GA02Z      Hepatobiliary Procedures category 8
      GA03Z      Hepatobiliary Procedures category 7
      GA04Z      Hepatobiliary Procedures category 6
      GA05A      Hepatobiliary Procedures category 5 with CC
      GA05B      Hepatobiliary Procedures category 5 without CC
      GA06Z      Hepatobiliary Procedures category 4
      GA07A      Hepatobiliary Procedures category 3 with CC
      GA07B      Hepatobiliary Procedures category 3 without CC
      GA08A      Hepatobiliary Procedures category 2 with CC
      GA08B      Hepatobiliary Procedures category 2 without CC
      GA09A      Hepatobiliary Procedures category 1 with CC
      GA09B      Hepatobiliary Procedures category 1 without CC
      GA10A      Cholecystectomy with CC
      GA10B      Cholecystectomy without CC
      GB03A      Endoscopic/Radiology category 2 with CC
      GB03B      Endoscopic/Radiology category 2 without CC
      GB04A      Endoscopic/Radiology category 1 with Major CC
      GB04B      Endoscopic/Radiology category 1 with Intermediate CC
      GB04C      Endoscopic/Radiology category 1 without CC
      GB05A      Endoscopic Retrograde Cholangiopancreatography category 3 with CC
      GB05B Endoscopic Retrograde Cholangiopancreatography category 3 without CC
                 Endoscopic Retrograde Cholangiopancreatography category 2 with length of
      GB06A
                 stay 3 days or more with Major CC


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       Final
                                               HRG Code Description                         Limitations
       HRG
                 Endoscopic Retrograde Cholangiopancreatography category 2 with length of
      GB06B
                 stay 3 days or more with Intermediate CC
                 Endoscopic Retrograde Cholangiopancreatography category 2 with length of
      GB06C
                 stay 3 days or more without CC
                 Endoscopic Retrograde Cholangiopancreatography category 2 with length of
      GB06D
                 stay 2 days or less
                 Endoscopic Retrograde Cholangiopancreatography category 1 with length of
      GB07A
                 stay 3 days or more with CC
                 Endoscopic Retrograde Cholangiopancreatography category 1 with length of
      GB07B
                 stay 3 days or more without CC
                 Endoscopic Retrograde Cholangiopancreatography category 1 with length of
      GB07C
                 stay 2 days or less
      HA01B      Reconstruction Procedures Category 6 with CC
      HA01C      Reconstruction Procedures Category 6 without CC
      HA02Z      Reconstruction Procedures Category 5
      HA03Z      Reconstruction Procedures Category 4
      HA04B      Reconstruction Procedures Category 3 with CC
      HA04C      Reconstruction Procedures Category 3 without CC
      HA05Z      Reconstruction Procedures Category 2
      HA06Z      Reconstruction Procedures Category 1
      HB11A      Major Hip Procedures for non Trauma Category 2 with Major CC
      HB11B      Major Hip Procedures for non Trauma Category 2 with CC
      HB11C      Major Hip Procedures for non Trauma Category 2 without CC
      HB12A      Major Hip Procedures for non Trauma Category 1 with Major CC
      HB12B      Major Hip Procedures for non Trauma Category 1 with CC
      HB12C      Major Hip Procedures for non Trauma Category 1 without CC
      HB13Z      Intermediate Hip Procedures for non Trauma Category 2
      HB14B      Intermediate Hip Procedures for non Trauma Category 1 with CC
      HB14C      Intermediate Hip Procedures for non Trauma Category 1 without CC
      HB15B      Minor Hip Procedures for non Trauma Category 2 with CC
      HB15C      Minor Hip Procedures for non Trauma Category 2 without CC
      HB16B      Minor Hip Procedures for non Trauma Category 1 with CC
      HB16C      Minor Hip Procedures for non Trauma Category 1 without CC
      HB21A      Major Knee Procedures for non Trauma Category 2 with Major CC
      HB21B      Major Knee Procedures for non Trauma Category 2 with CC
      HB21C      Major Knee Procedures for non Trauma Category 2 without CC
      HB22B      Major Knee Procedures for non Trauma Category 1 with CC
      HB22C      Major Knee Procedures for non Trauma Category 1 without CC
      HB23B      Intermediate Knee Procedures for non Trauma with CC
      HB23C      Intermediate Knee Procedures for non Trauma without CC
      HB24B      Minor Knee Procedures for non Trauma Category 2 with CC
      HB24C      Minor Knee Procedures for non Trauma Category 2 without CC
      HB25A      Minor Knee Procedures for non Trauma Category 1 with Major CC
      HB25B      Minor Knee Procedures for non Trauma Category 1 with CC
      HB25C      Minor Knee Procedures for non Trauma Category 1 without CC
      HB31Z      Major Foot Procedures for non -Trauma
      HB32Z      Intermediate Foot Procedures for non -Trauma Category 2
      HB33B      Intermediate Foot Procedures for Non -Trauma Category 1 with CC
      HB33C      Intermediate Foot Procedures for Non -Trauma Category 1 without CC
      HB34B      Minor Foot Procedures for Non -Trauma Category 2 with CC
      HB34C      Minor Foot Procedures for Non -Trauma Category 2 without CC
      HB35B      Minor Foot Procedures for Non -Trauma Category 1 with CC
      HB35C      Minor Foot Procedures for Non -Trauma Category 1 without CC
      HB41B      Major Arm Procedures for non Trauma with CC
      HB41C      Major Arm Procedures for non Trauma without CC
      HB42B      Intermediate Arm Procedures for non Trauma Category 2 with CC
      HB42C      Intermediate Arm Procedures for non Trauma Category 2 without CC
      HB43B      Intermediate Arm Procedures for non Trauma Category 1 with CC


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       Final
                                               HRG Code Description                             Limitations
       HRG
      HB43C      Intermediate Arm Procedures for non Trauma Category 1 without CC
      HB44B      Minor Arm Procedures for non Trauma Category 2 with CC
      HB44C      Minor Arm Procedures for non Trauma Category 2 without CC
      HB45B      Minor Arm Procedures for non Trauma Category 1 with CC
      HB45C      Minor Arm Procedures for non Trauma Category 1 without CC
      HB51Z      Major Hand Procedures for non Trauma Category 2
      HB52B      Major Hand Procedures for non Trauma Category 1 with CC
      HB52C      Major Hand Procedures for non Trauma Category 1 without CC
                                                                                            Excluding: X08.1 &
      HB53Z Intermediate Hand Procedures for non Trauma Category 2
                                                                                            X08.9
      HB54B      Intermediate Hand Procedures for non Trauma Category 1 with CC
      HB54C      Intermediate Hand Procedures for non Trauma Category 1 without CC
      HB55B      Minor Hand Procedures for non Trauma Category 2 with CC
      HB55C      Minor Hand Procedures for non Trauma Category 2 without CC
      HB56B      Minor Hand Procedures for non Trauma Category 1 with CC
      HB56C      Minor Hand Procedures for non Trauma Category 1 without CC
      HB99Z      Other Procedures for non Trauma
      HC01Z      Extradural Spine Major 2
      HC02B      Extradural Spine Major 1 with CC
                                                                                            Excluding: V37.1 &
      HC02C Extradural Spine Major 1 without CC
                                                                                            V37.4
      HC03A      Extradural Spine Intermediate 2 with Major CC
      HC03B      Extradural Spine Intermediate 2 with CC
      HC03C      Extradural Spine Intermediate 2 without CC
      HC04A      Extradural Spine Intermediate 1 with Major CC
      HC04B      Extradural Spine Intermediate 1 with CC
      HC04C      Extradural Spine Intermediate 1 without CC
                                                                                            Only: V54.2, W06.2,
      HC05B Extradural Spine Minor 2 with CC
                                                                                            W33.6 & W06.6
      HC05C      Extradural Spine Minor 2 without CC
      HC06A      Extradural Spine Minor 1 with Major CC                                     Only: V52.3
      HC06B      Extradural Spine Minor 1 with CC                                           Only: V52.3
      HC06C      Extradural Spine Minor 1 without CC                                        Only: V52.3
      HC07Z      Intradural Spine Major 2
      HC08Z      Intradural Spine Major 1
      HC09Z      Intradural Spine Intermediate 2
      HC10Z      Intradural Spine Intermediate 1
      HC11Z      Intradural Spine Minor 2
      HC12Z      Intradural Spine Minor 1
      JA01Z      Free Perforator Breast Reconstruction
      JA02Z      Free Myocutaneous Breast Reconstruction
      JA03Z      Pedicled TRAM Reconstruction of Breast
       JA04Z     Pedicled Myocutaneous Breast Reconstruction with Insertion of Prosthesis
                 Pedicled Myocutaneous Breast Reconstruction without Insertion of
       JA05Z
                 Prosthesis
      JA06Z      Major Breast Procedures category 3
      JA07A      Major Breast Procedures category 2 with Major CC
      JA07B      Major Breast Procedures category 2 with Intermediate CC
      JA07C      Major Breast Procedures category 2 without CC
      JA08Z      Major Breast Procedures category 1
      JA09A      Intermediate Breast Procedures with CC
      JA09B      Intermediate Breast Procedures without CC
      JA10Z      Minor Breast Procedures category 2
      JA11A      Minor Breast Procedures category 1 with Major CC
      JA11B      Minor Breast Procedures category 1 with Intermediate CC
      JA11C      Minor Breast Procedures category 1 without CC


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       Final
                                               HRG Code Description          Limitations
       HRG
      JC01A      Major Multiple Skin Procedures with Major CC
      JC01B      Major Multiple Skin Procedures with Intermediate CC
      JC01C      Major Multiple Skin Procedures without CC
      JC02A      Major Skin Procedures category 2 with Major CC
      JC02B      Major Skin Procedures category 2 with Intermediate CC
      JC02C      Major Skin Procedures category 2 without CC
                                                                         Excluding Cosmetic
      JC03A Major Skin Procedures category 1 with Major CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC03B Major Skin Procedures category 1 with Intermediate CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC03C Major Skin Procedures category 1 without CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC04A Intermediate Skin Procedures with Major CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC04B Intermediate Skin Procedures with Intermediate CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC04C Intermediate Skin Procedures without CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC05A Minor Skin Procedures category 3 with Major CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC05B Minor Skin Procedures category 3 with Intermediate CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC05C Minor Skin Procedures category 3 without CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC06A Minor Skin Procedures category 2 with Major CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC06B Minor Skin Procedures category 2 with Intermediate CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC06C Minor Skin Procedures category 2 without CC
                                                                         Procedures

                                                                         Excluding Cosmetic
      JC07Z Minor Skin Procedures category 1
                                                                         Procedures
      JC09Z      Patch Tests
      JC10Z      Investigative procedures 2
      JC12Z      Urticaria tests
      JC14Z      Skin Therapies level 2
      JC15Z      Skin Therapies level 3
      JC16Z      Skin Therapies level 4
      JC17Z      Skin Therapies level 5
      JC18Z      Electrical and other invasive therapy 2
      JC20Z      Electrical and other invasive therapy 3
      KA01A      Major Thyroid Procedures with CC
      KA01B      Major Thyroid Procedures without CC
      KA02Z      Minor Thyroid Procedures
      KA03A      Parathyroid Procedures with CC


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       Final
                                               HRG Code Description                               Limitations
       HRG
      KA03B      Parathyroid Procedures without CC
      KA04Z      Adrenal Procedures
      LB01A      Percutaneous Nephrostomy with CC
      LB01B      Percutaneous Nephrostomy without CC
                                                                                              Excluding: M01.1,
      LB02A Kidney Major Open Procedure 19 years and over with Major CC                       M02.3, X45.1 &
                                                                                              X45.8
                                                                                              Excluding: M01.1,
      LB02B Kidney Major Open Procedure 19 years and over with Intermediate CC                M02.3, X45.1 &
                                                                                              X45.8
                                                                                              Excluding: M01.1,
      LB02C Kidney Major Open Procedure 19 years and over without CC                          M02.3, X45.1 &
                                                                                              X45.8
                                                                                              Excluding: M01.1,
      LB03Z Laparoscopic Operations on Kidney and Ureter                                      M02.3, X45.1 &
                                                                                              X45.8
      LB04A Kidney Major Endoscopic Procedure with CC
      LB04B Kidney Major Endoscopic Procedure without CC
            Kidney Intermediate Technical, Endoscopic and Percutaneous Interventions
      LB05A
            19 years and over with Major CC
            Kidney Intermediate Technical, Endoscopic and Percutaneous Interventions
      LB05B
            19 years and over with Intermediate CC
            Kidney Intermediate Technical, Endoscopic and Percutaneous Interventions
      LB05C
            19 years and over without CC
      LB07Z Ureter Open Procedure
      LB08Z Ureter Major Endoscopic Procedure
      LB09A Ureter Intermediate Endoscopic Procedure 19 years and over with CC
      LB09B Ureter Intermediate Endoscopic Procedure 19 years and over without CC
      LB10Z Bladder Major Open Procedures / Reconstruction
      LB11Z Urinary Diversion without Cystectomy
      LB12Z Bladder Intermediate Open Procedure
      LB13A Bladder Major Endoscopic Procedure with CC
      LB13B Bladder Major Endoscopic Procedure without CC
            Bladder Intermediate Endoscopic Procedure 19 years and over with Major
      LB14A
            CC
            Bladder Intermediate Endoscopic Procedure 19 years and over with
      LB14B
            Intermediate CC
      LB14C Bladder Intermediate Endoscopic Procedure 19 years and over without CC
      LB15A      Bladder Minor Procedure 19 years and over with Major CC
      LB15B      Bladder Minor Procedure 19 years and over with Intermediate CC
      LB15C      Bladder Minor Procedure 19 years and over without CC
      LB21Z      Bladder Neck Open Procedures - Male
      LB22Z      Laparoscopic Bladder Neck Procedures - Male
      LB23Z      Bladder Neck Open Procedures - Female
      LB24Z      Laparoscopic Bladder Neck Procedures - Female
      LB25A      Prostate Transuretheral Resection Procedure with Major CC
      LB25B      Prostate Transuretheral Resection Procedure with Intermediate CC
      LB25C      Prostate Transuretheral Resection Procedure without CC
                 Prostate / Bladder Neck Intermediate Endoscopic Procedure - Male and
      LB26Z
                 Female
                 Prostate or Bladder Neck Minor Endoscopic Procedure - Male, with length of
      LB27Z
                 stay 1 day or less
      LB29A      Urethra Major Open Procedures 19 years and over
      LB31Z      Penis Major / Intermediate Open Procedures
                                                                                              Only: N27.1 to
      LB32A Penile Conditions and Minor Procedures 19 years and over with CC
                                                                                              N30.8



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       Final
                                               HRG Code Description                            Limitations
       HRG
                                                                                           Only: N27.1 to
      LB32B Penile Conditions and Minor Procedures 19 years and over without CC
                                                                                           N30.8
      LB33Z Vasectomy Procedures
            Scrotum, Testis or Vas Deferens Open Procedures 19 years and over with         Excluding: N34.1 &
      LB34A
            CC                                                                             N34.2
            Scrotum, Testis or Vas Deferens Open Procedures 19 years and over              Excluding: N34.1 &
      LB34B
            without CC                                                                     N34.2
      LB36Z Extracorporeal Lithotripsy
      LB39A Cystectomy with Urinary Diversion and Reconstruction with CC
      LB39B Cystectomy with Urinary Diversion and Reconstruction without CC
      LB43Z Treatment of Erectile Dysfunction
      MA01Z Lower and Upper Genital Tract Very Complex Major Procedures
      MA02Z Lower and Upper Genital Tract Complex Major Procedures
      MA03A Lower Genital Tract Major Procedures with CC
      MA03B Lower Genital Tract Major Procedures without CC
      MA04A Lower Genital Tract Intermediate Procedures with CC
      MA04B Lower Genital Tract Intermediate Procedures without CC
      MA05A Lower Genital Tract Minor Procedures with CC
      MA05B Lower Genital Tract Minor Procedures without CC
      MA07A Upper Genital Tract Major Procedures without malignancy with CC
      MA07B Upper Genital Tract Major Procedures without malignancy without CC
      MA08Z Upper Genital Tract Laparoscopic / Endoscopic Major Procedures
      MA09Z Upper Genital Tract Laparoscopic / Endoscopic Intermediate Procedures
      MA10Z Upper Genital Tract Laparoscopic / Endoscopic Minor Procedures
      MA11A Upper Genital Tract Intermediate Procedures with CC
      MA11B Upper Genital Tract Intermediate Procedures without CC
      MA12Z Resection and ablation procedures for intra-uterine lesions
                                                                                           Excluding: Q10.1,
                                                                                           Q10.2, Q41.1,
      MA13A Upper Genital Tract Minor Procedures 19 years and over with CC
                                                                                           Q41.2, Q41.4, Q41.5
                                                                                           & Q56.1
                                                                                           Excluding: Q10.1,
                                                                                           Q10.2, Q41.1,
      MA13B Upper Genital Tract Minor Procedures 19 years and over without CC
                                                                                           Q41.2, Q41.4, Q41.5
                                                                                           & Q56.1
                                                                                           Excluding
      QZ03Z Bypasses to Tibial Arteries                                                    emergency
                                                                                           procedures
      QZ04Z      Extracranial or Upper Limb Arterial Surgery
      QZ05A      Miscellaneous Vascular Procedures with CC
      QZ05B      Miscellaneous Vascular Procedures without CC
      QZ06Z      Varicose Veins with Ulcer or with CC
      QZ07B      Redo Bilateral Varicose Vein Procedures without CC
      QZ08B      Redo Unilateral Varicose Vein Procedures without CC
      QZ09B      Primary Bilateral Varicose Vein Procedures without CC
      QZ10B      Primary Unilateral Varicose Vein Procedures without CC
                 Foot Procedures for Diabetes or Arterial Disease, and Procedures to
      QZ12Z                                                                                 Only: X11.2 & X11.9
                 Amputation Stumps
      QZ13A      Vascular Access for Renal Replacement Therapy with CC
      QZ13B      Vascular Access for Renal Replacement Therapy without CC
      QZ14A      Vascular Access except for Renal Replacement Therapy with CC
      QZ14B      Vascular Access except for Renal Replacement Therapy without CC
      QZ15A      Therapeutic Endovascular Procedures with Major CC
      QZ15B      Therapeutic Endovascular Procedures with Intermediate CC
      QZ15C      Therapeutic Endovascular Procedures without CC
                 Diagnostic Vascular Radiology and other transluminal Procedures with Major
      QZ16A
                 CC



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       Final
                                               HRG Code Description                   Limitations
       HRG
            Diagnostic Vascular Radiology and other transluminal Procedures with
      QZ16B
            Intermediate CC
            Diagnostic Vascular Radiology and other transluminal Procedures without
      QZ16C
            CC




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IS ECN &
                                                                                 Specialty pathway
 IS FCN                     HRG CODE DESCRIPTION
                                                                               (to surgical procedure)
  HRGs
   A01     Intracranial Procedures Except Trauma - Category 1            Neurosurgery
   A02     Intracranial Procedures Except Trauma - Category 2            Neurosurgery
   A03     Intracranial Procedures Except Trauma - Category 3            Neurosurgery
   A04     Intracranial Procedures Except Trauma - Category 4            Neurosurgery
   A07     Intermediate Pain Procedures                                  Pain Management
   A08     Percutaneous Image Controlled Pain Procedures                 Neurosurgery
   B13     Phakoemulsification Cataract Extraction and Insertion of Lens Ophthalmology
   B14     Non Phakoemulsification Cataract Surgery                      Ophthalmology
   B15     Other Lens Surgery Low Complexity                             Ophthalmology
   B16     Oculoplastic Low Complexity                                   Ophthalmology
   B17     Oculoplastic Intermediate Complexity                          Ophthalmology
   B18     Oculoplastic High Complexity                                  Ophthalmology
   B19     Orbit / Lacrimal Low Complexity                               Ophthalmology
   B20     Orbit / Lacrimal Intermediate Complexity                      Ophthalmology
   B21     Orbit / Lacrimal High Complexity                              Ophthalmology
   B22     Cornea / Sclera Low Complexity                                Ophthalmology
   B23     Cornea / Sclera Intermediate / High Complexity                Ophthalmology
   B24     Ocular Motility Intermediate Complexity                       Ophthalmology
   B25     Ocular Motility Redo / Adjustable / High Complexity           Ophthalmology
   B26     Glaucoma / Uvea Low Complexity                                Ophthalmology
   B27     Glaucoma / Uvea Intermediate Complexity                       Ophthalmology
   B28     Glaucoma / Uvea High Complexity                               Ophthalmology
   B29     Surgical Retina Low Complexity                                Ophthalmology
   B30     Surgical Retina Intermediate Complexity                       Ophthalmology
   B31     Surgical Retina High Complexity                               Ophthalmology
   C04     Minor Mouth or Throat Procedures                              ENT
   C15     Minor Maxillo-facial/ENT procedures                           ENT
   C21     Intermediate Ear Procedures                                   ENT
   C22     Intermediate Nose Procedures                                  ENT
   C31     Major Ear Procedures                                          ENT
   C32     Major Nose Procedures                                         ENT
   C41     Complex Major Ear Procedures                                  ENT
   C42     Complex Major Nose Procedures                                 ENT
   C55     Minor Ear Procedures                                          ENT
   C56     Minor Nose Procedures                                         ENT
   C57     Major Mouth or Throat Procedures                              ENT
   C58     Intermediate Mouth or Throat Procedures                       ENT
   C60     Cochlea Implants                                              ENT
   D04     Intermediate Thoracic Procedures w cc                         Surgery - Cardiothoracic
   D05     Intermediate Thoracic Procedures w/o cc                       Surgery - Cardiothoracic
   D06     Minor Thoracic Procedures                                     Surgery - Cardiothoracic
   D07     Fibreoptic Bronchoscopy                                       Surgery - Cardiothoracic
   D08     Rigid Bronchoscopy                                            Surgery - Cardiothoracic
   E03     Cardiac Valve Procedures                                      Surgery - Cardiothoracic
   E04     Coronary Bypass                                               Surgery - Cardiothoracic
   E08     Pacemaker Implant except for AMI, Heart Failure or Shock      Surgery - Cardiothoracic
   E09     Cardiac Pacemaker Replacement/Revision                        Surgery - Cardiothoracic
   E13     Cardiac Catheterisation and Angiography with complications    Surgery - Cardiothoracic
   E14     Cardiac Catheterisation and Angiography without complications Surgery - Cardiothoracic
   E15     Percutaneous Coronary Intervention                            Surgery - Cardiothoracic
   E38                                                                    >18
           Electrophysiological and other Percutaneous Cardiac ProceduresSurgery - Cardiothoracic
   E40     Other Cardiothoracic or Circulatory Procedures >18            Surgery - Cardiothoracic
   F02     Oesophagus - Very Major Procedures                            Surgery - Cardiothoracic
   F03     Oesophagus - Major Procedures or Prostheses                   Surgery not otherwise Specified
   F04     Therapeutic endoscopic procedures                             Diagnostic Endoscopy
   F06     Diagnostic Procedures, Oesophagus and Stomach                 Diagnostic Endoscopy
   F12     Stomach or Duodenum Very Major Procedures                     GI and Liver - Medical / Surgical
   F13     Stomach or Duodenum - Major Procedures >69 or w cc            GI and Liver - Medical / Surgical
   F14     Stomach or Duodenum - Major Procedures <70 or w/o cc          GI and Liver - Medical / Surgical
   F15                                                                    Procedures
           Stomach or Duodenum - Therapeutic Endoscopic or IntermediateSurgery not otherwise Specified
   F21     Small Intestine - Very Major Procedures                       Diagnostic Endoscopy
   F22     Small Intestine - Major Procedures >69 or w cc                GI and Liver - Medical / Surgical
   F23     Small Intestine - Major Procedures <70 w/o cc                 GI and Liver - Medical / Surgical
   F31     Large Intestine - Complex Procedures                          GI and Liver - Medical / Surgical
   F32     Large Intestine - Very Major Procedures                       GI and Liver - Medical / Surgical
   F33     Large Intestine - Major Procedures w cc                       GI and Liver - Medical / Surgical
   F34     Large Intestine - Major Procedures w/o cc                     GI and Liver - Medical / Surgical
   F35     Large Intestine - Endoscopic or Intermediate Procedures       GI and Liver - Medical / Surgical


                                                                                                             11 / 13
F41                                                                   GI
      General Abdominal - Very Major or Major Procedures >69 or w cc and Liver - Medical / Surgical
F42   General Abdominal - Very Major or Major Procedures <70 w/o ccGI and Liver - Medical / Surgical
F43                                                                   GI w cc
      General Abdominal - Endoscopic or Intermediate Procedures >69 orand Liver - Medical / Surgical
F44                                                                   GI and
      General Abdominal - Endoscopic or Intermediate Procedures <70 w/o ccLiver - Medical / Surgical
F45   General Abdominal - Diagnostic Procedures                       GI and Liver - Medical / Surgical
F51   Inflammatory Bowel Disease - Complex Procedures                 GI and Liver - Medical / Surgical
F52   Inflammatory Bowel Disease - Major Procedures                   GI and Liver - Medical / Surgical
F53                                                                   GI and Liver w cc
      Inflammatory Bowel Disease - Endoscopic or Intermediate Procedures >69 or - Medical / Surgical
F54                                                                   GI and Liver - cc
      Inflammatory Bowel Disease - Endoscopic or Intermediate Procedures <70 w/o Medical / Surgical
F62                                                                   GI and
      Gastrointestinal Bleed - Major or Therapeutic Endoscopic Procedures Liver - Medical / Surgical
F63                                                                   Diagnostic
      Gastrointestinal Bleed - Diagnostic Endoscopic or Intermediate Procedures Endoscopy
F71   Abdominal Hernia Procedures >69 or w cc                         Surgery not otherwise Specified
F72   Abdominal Hernia Procedures <70 w/o cc                          Surgery not otherwise Specified
F73   Inguinal Umbilical or Femoral Hernia Repairs >69 or w cc        Surgery not otherwise Specified
F74   Inguinal Umbilical or Femoral Hernia Repairs <70 w/o cc         Surgery not otherwise Specified
F75   Herniotomy Procedures                                           Surgery not otherwise Specified
F91   Anus - Major Procedures                                         GI and Liver - Medical / Surgical
F92   Anus - Intermediate Procedures >69 or w cc                      GI and Liver - Medical / Surgical
F93   Anus - Intermediate Procedures <70 w/o cc                       GI and Liver - Medical / Surgical
F94   Anus - Minor Procedures >69 or w cc                             GI and Liver - Medical / Surgical
F95   Anus - Minor Procedures <70 w/o cc                              GI and Liver - Medical / Surgical
G04   Liver - Major Procedures >69 or w cc                            GI and Liver - Medical / Surgical
G05   Liver - Major Procedures <70 w/o cc                             GI and Liver - Medical / Surgical
G12   Biliary Tract - Very Major Procedures                           GI and Liver - Medical / Surgical
G13   Cholecystectomy >69 or w cc                                     GI and Liver - Medical / Surgical
G14   Cholecystectomy <70 w/o cc                                      GI and Liver - Medical / Surgical
G15   Therapeutic Pancreatic or Biliary Procedures                    GI and Liver - Medical / Surgical
G16   Diagnostic Pancreatic or Biliary Procedures w cc                GI and Liver - Medical / Surgical
G17   Diagnostic Pancreatic or Biliary Procedures w/o cc              GI and Liver - Medical / Surgical
G27   Procedures on the Spleen                                        GI and Liver - Medical / Surgical
H01   Bilateral Primary Hip Replacement                               Orthopaedics
H03   Bilateral Primary Knee Replacement                              Orthopaedics
H04   Primary Knee Replacement                                        Orthopaedics
H07   Primary or Revisional Shoulder, Elbow, or Ankle Replacements Orthopaedics
H08   Joint Replacements or Revisions, Site Unspecified               Orthopaedics
H09   Anterior Cruciate Ligament Reconstruction                       Orthopaedics
H10   Arthroscopies                                                   Orthopaedics
H11   Foot Procedures - Category 1                                    Orthopaedics
H12   Foot Procedures - Category 2                                    Orthopaedics
H13   Hand Procedures - Category 1                                    Orthopaedics
H14   Hand Procedures - Category 2                                    Orthopaedics
H15   Hand Procedures - Category 3                                    Orthopaedics
H16   Soft Tissue or Other Bone Procedures - Category 1 >69 or w cc Orthopaedics
H17   Soft Tissue or Other Bone Procedures - Category 1 <70 w/o cc Orthopaedics
H18   Soft Tissue or Other Bone Procedures - Category 2 >69 or w cc Orthopaedics
H19   Soft Tissue or Other Bone Procedures - Category 2 <70 w/o cc Orthopaedics
H20   Muscle, Tendon or Ligament Procedures - Category 1              Orthopaedics
H21   Muscle, Tendon or Ligament Procedures - Category 2              Orthopaedics
H22   Minor Procedures to the Musculoskeletal System                  Orthopaedics
H29   Congenital Hip Dislocation with Open Procedures                 Orthopaedics
H51   Removal of Fixation Device >69 or w cc                          Orthopaedics
H52   Removal of Fixation Device <70 w/o cc                           Orthopaedics
H70   Resurfacing of Hip                                              Orthopaedics
H71   Revisional Procedures to Hips                                   Orthopaedics
H72   Revisional Procedures to Knees                                  Orthopaedics
H80   Primary Hip Replacement Cemented                                Orthopaedics
H81   Primary Hip Replacement Uncemented                              Orthopaedics
J01   Complex Breast Reconstruction using Flaps                       Surgery - Breast
J04   Intermediate Breast Surgery w cc                                Surgery - Breast
J05   Intermediate Breast Surgery w/o cc                              Surgery - Breast
J06   Minor Breast Surgery w cc                                       Surgery - Breast
J07   Minor Breast Surgery w/o cc                                     Surgery - Breast
J11   Lymph Dissection Procedures                                     Surgery not otherwise Specified
J12   Drainage of Ascites                                             Surgery not otherwise Specified
J29   Major Reconstructive Surgery                                    Surgery - Plastic
J30   Major Skin Procedures >49 or w cc                               Surgery - Plastic
J31   Major Skin Procedures <50 w/o cc                                Surgery - Plastic
J32   Intermediate Skin Procedures                                    Surgery - Plastic
J33   Minor Skin Procedures - Category 3                              Dermatology
J34   Minor Skin Procedures - Category 2 w cc                         Dermatology
J35   Minor Skin Procedures - Category 2 w/o cc                       Dermatology


                                                                                                          12 / 13
J36   Minor Skin Procedures - Category 1 w cc                        Dermatology
J37   Minor Skin Procedures - Category 1 w/o cc                      Dermatology
J46   Total Mastectomy w cc                                          Surgery - Breast
J47   Total Mastectomy w/o cc                                        Surgery - Breast
J48   Partial/Subtotal Mastectomy w cc                               Surgery - Breast
J49   Partial/Subtotal Mastectomy w/o cc                             Surgery - Breast
J50   Other Major Breast Surgery                                     Surgery - Breast
K01   Thyroid Procedures                                             Surgery not otherwise Specified
K02   Parathyroid Procedures                                         Surgery not otherwise Specified
K03   Adrenal Procedures                                             Surgery not otherwise Specified
L02   Kidney Major Open Procedure >49 or w cc                        Urology
L03   Kidney Major Open Procedure <50 w/o cc                         Urology
L04   Kidney Major Endoscopic Procedure                              Urology
L05   Kidney Intermediate Endoscopic Procedure >69 or w cc           Urology
L06   Kidney Intermediate Endoscopic Procedure <70 w/o cc            Urology
L11   Ureter Open Procedure                                          Urology
L12   Ureter Major Endoscopic Procedure                              Urology
L13   Ureter Intermediate Endoscopic Procedure                       Urology
L14   Bladder Major Open Procedures or Reconstruction                Urology
L15   Urinary Diversion without Cystectomy                           Urology
L16   Bladder Intermediate Open Procedure                            Urology
L17   Bladder Major Endoscopic Procedure                             Urology
L18   Bladder Intermediate Endoscopic Procedure w cc                 Urology
L19   Bladder Intermediate Endoscopic Procedure w/o cc               Urology
L20   Bladder Minor Endoscopic Procedure w cc                        Urology
L21   Bladder Minor Endoscopic Procedure w/o cc                      Urology
L25   Bladder Neck Open Procedures Male                              Urology
L26   Bladder Neck Open Procedures Female                            Urology
L27   Prostate Transurethral Resection Procedure >69 or w cc         Urology
L28   Prostate Transurethral Resection Procedure <70 w/o cc          Urology
L29                                                                  Urology
      Prostate or Bladder Neck Intermediate Endoscopic Procedure (Male and Female)
L30                                                                  Urology
      Prostate or Bladder Neck Minor Endoscopic Procedure (Male and Female)
L33   Urethra Major Open Procedures                                  Urology
L34   Urethra Intermediate or Minor Procedures >69 or w cc           Urology
L35   Urethra Intermediate or Minor Procedures <70 w/o cc            Urology
L37   Penis Major or Intermediate Open Procedures                    Urology
L38   Penis Minor Open Procedure > 69 or w cc                        Urology
L39   Penis Minor Open Procedure <70 w/o cc                          Urology
L41   Vasectomy Procedures                                           Urology
L42   Scrotum Testis or Vas Deferens Open Procedures >69 or w cc Urology
L43   Scrotum Testis or Vas Deferens Open Procedures <70 w/o cc Urology
L45   Extracorporeal Lithotripsy                                     Urology
L46   Renal Replacement Associated Procedures                        Urology
L47   Renal Replacement Therapy w cc                                 Urology
L48   Renal Replacement Therapy w/o cc                               Urology
L68   Cystectomy with Urinary Diversion and Reconstruction           Urology / Gynaecology
M01   Lower Genital Tract Minor Procedures                           Gynaecology
M02   Lower Genital Tract Intermediate Procedures                    Gynaecology
M03   Lower Genital Tract Major Procedures                           Gynaecology
M04   Lower Genital Tract Complex Major Procedures                   Gynaecology
M05   Upper Genital Tract Minor Procedures                           Gynaecology
M06   Upper Genital Tract Intermediate Procedures                    Gynaecology
M07   Upper Genital Tract Major Procedures                           Gynaecology
M08   Upper Genital Tract Complex Major Procedures                   Gynaecology
Q03   Lower Limb Arterial Surgery                                    Surgery - Vascular
Q04   Bypasses to Tibial Arteries                                    Surgery - Vascular
Q05   Extracranial or Upper Limb Arterial Surgery                    Surgery - Vascular
Q06   Miscellaneous Vascular Procedures                              Surgery - Vascular
Q09   Procedures on the Lymphatic System w cc                        Surgery - Vascular
Q10   Procedures on the Lymphatic System w/o cc                      Surgery - Vascular
Q11   Varicose Vein Procedures                                       Surgery - Vascular
Q12   Therapeutic Endovascular Procedures                            Surgery - Vascular
Q15   Amputations                                                    Orthopaedics
Q16                                                                  Orthopaedics
      Foot Procedures for Diabetes or Arterial Disease, and Procedures to Amputation Stumps
Q19   Vascular Access for Renal Replacement Therapy                  Surgery - Vascular
R01   Minor Spinal Procedures                                        Orthopaedics
R02   Surgery for Prolapsed Intervertebral Disc                      Orthopaedics
R03   Decompression and Effusion for Degenerative Spinal Disorders Orthopaedics
R09   Revisional Spinal Procedures                                   Orthopaedics
R19   Intermediate Spinal Procedures                                 Orthopaedics



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