CHAPTER A - nomesco

STRUCTURE AN D CLASSIFICATION GUIDELINES
Composite procedures and multiple procedures
Some well established standard procedures consist of a set combination of more than one procedure that may otherwise
occur independently. When such a standard procedure is frequent and invariably embraces the same component procedures,
the combined standard procedure may be allocated a basic code, as a composite procedure code.
A composite code is equivalent to any other basic procedure code and represents its content of component procedures,
which are not coded separately. E.g.:
JAH 20 Staging laparotomy
With systematic lymph node biopsies and biopsy of liver in lymphoma
Concurrent splenectomy, see: JMA 10
In this operation, the mandatory regional lymph node biopsies and liver biopsy are not coded separately. A splenectomy is
usually, but not invariably, performed and must be coded separately.
In the case of lymph node excision as part of an operation where the basic procedure code does not embrace lymph node
excision, multiple codes are employed.
E.g.:
HAB 40 Wedge excision of mammary gland
PJD 42 Excision of axillary lymph nodes
and optionally:
ZXA 00 Right side
Code sequence in multiple procedures
If more than one procedure is executed at the same time and there is no composite procedure code covering the
combination, multiple codes must be registered with the main procedure code appearing first and the others in chronological
sequence. The main procedure is the procedure that in the judgement of the surgeon is the most extensive and requires most
of the resources employed.
E.g.:
GAE 30 Repair of combined injury to chest wall and diaphragm
AAD 00 Evacuation of epidural haematoma
EDC 35 Closed reduction and immobilisation of fracture of mandible
and optionally:
ZXD 00 Emergency procedure
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