“BCBST
UM Guidelines
Master Index

Listed Alphabetically

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

- A -

Achilles Tendon Repair

Acromioplasty and Rotator Cuff Repair

Adrenalectomy by Laparoscopy

Ambulatory Surgery Complications: Observation Care

Angioplasty, Percutaneous Coronary Intervention

Ankle Dislocation, Closed or Open Reduction

Ankle Fracture, Closed, Open Reduction, Internal Fixation (ORIF)

Aortic Coarctation, Angioplasty

Apparent Life-Threatening Event

Appendectomy, Uncomplicated, Open or Laparoscopic, Pediatric

Appendectomy, without Peritonitis

Appendectomy, without Peritonitis, by Laparoscopy

Appendectomy for Ruptured Appendix with Abscess or Generalized Peritonitis, Open or Laparoscopic, Pediatric

Arthrography, MR

Assertive Community Treatment (ACT)/Program of Assertive Community Treatment (PACT)

Assistant Surgeon Guidelines

- B -

Bladder Excision: Cystectomy with Urinary Diversion, Conduit or Continent

Bladder Incision: Cystotomy

Bladder Instillation for Treatment of Interstitial Cystitis

Bone Excision

Bowel Surgery: Small Intestine Resection

- C -

Cardiac Pacemaker Implantation

Cardiac Septal Defect: Atrial, Transcatheter Closure

Cardiac Valvotomy, Percutaneous

Carotid Artery Angioplasty with Stent Placement (CAS)

Cervical Fusion, Anterior

Cesarean Delivery

Cholecystectomy with Common Duct Exploration by Laparoscopy

Cognitive Communication Disorders Rehabilitation

Comprehensive Child and Family Treatment (CCFT): Intensive Outpatient Program

Continuous Treatment Team (CTT): Intensive Outpatient Program

- D -

Deep Brain Stimulation (DBS)

- E -

EEG, Video Monitoring

EEG, Video Monitoring, Pediatric

Elbow Fracture, Open Treatment

Elbow Arthroplasty

Electrophysiologic Study and Implantable Cardioverter-Defibrillator (ICD) Insertion, Transvenous

Endovascular Repair (EVR), Thoracic Aorta

Enucleation or Evisceration of Eyeball

Esophageal Diverticulectomy, Endoscopic

- F -

Failure to Thrive

Femur Fracture, Removal of Internal Fixation Device

Foot Fracture, Calcaneus or Talus, Open Reduction, Internal Fixation (ORIF)

Fundoplasty, Esophagogastric, by Laparoscopy

Fundoplasty, Esophagogastric, by Laparoscopy, Pediatric

- G -

Gastrectomy, Partial - Billroth I or II

Gastric Restrictive Procedure with Gastric Bypass by Laparoscopy

Gastric Restrictive Procedure without Gastric Bypass by Laparoscopy

- H -

Hemophilia

Hernia Repair (Non-Hiatal)

Hip Arthroplasty

Hip Resurfacing

Hospice Care

Humerus Fracture, Closed or Open Reduction

Hyperbaric Oxygen

Hyperemesis Gravidarum - Case Management

Hypophysectomy, Nasal Approach

Hysterectomy, Laparoscopic

Hysterectomy, Vaginal

Hysterectomy, Vaginal, Surgical with Radical Laparoscopy

- I -

Idiopathic Thrombocytopenic Purpura (ITP), Pediatric

Ileus

Intestinal Obstruction

- J -

- K -

Knee Arthroplasty, Total

Knee Arthrotomy

Knee Dislocation, Closed or Open Reduction

Knee: Fracture of Tibial Plateau, Closed or Open Reduction

Knee: Patella Reconstruction or Realignment for Recurrent Dislocation

- L -

Laparotomy for Gynecologic Surgery, Including Myomectomy, Oophorectomy, and Salpingectomy

Level 2 Adult Mental Health Case Management (BHL2ACM): Intensive Outpatient Program

Liver Transplant

Liver Transplant, Pediatric

Lumbar Diskectomy, Foraminotomy, or Laminotomy

Lumbar Laminectomy

Lysis of Adhesions by Laparoscopy

- M -

Mandibular Osteotomy

Mastectomy, Complete

Mastectomy, Complete, with Insertion of Breast Prosthesis or Tissue Expander

Mastectomy, Partial (Lumpectomy)

Medical Nutrition Therapy for Dietary Counseling

Medical Oncology GRG

- N -

Neck Dissection

Nephrectomy by Laparoscopy

Neutropenia after Chemotherapy, Pediatric

- O -

Orbital Exploration

Orchidectomy

Other Psychiatric Disorders: Intensive Outpatient Program

Other Psychiatric Disorders: Residential Care

- P -

Pancreatectomy

Pancreatitis, with Common Duct Stone

Parathyroidectomy

Patent Ductus Arteriosus, Open, Thoracoscopic, or Transcatheter Closure

Patent Ductus Arteriosus, Open, Thoracoscopic, or Transcatheter Closure, Pediatric

Pediatric Adenotonsillectomy for Obstructive Sleep Apnea Syndrome (OSAS): Observation Care

Percutaneous Revascularization, Lower Extremity

Prostatectomy, Radical

Prostatectomy, Transurethral Resection (TURP)

Pyloroplasty and Vagotomy

- Q -

- R -

Renal Transplant

Repair of Pelvic Organ Prolapse

Respite Care, Adult: Residential Care

Respite Care, Child/Adolescent: Residential Care

Retinal Detachment Repair

- S -

Shunt, Ventriculoperitoneal for Hydrocephalus

Skilled Nursing Facility/Inpatient Rehabilitation Fax Form

Skilled Nursing Facility (SNF) Levels of Care

Slipped Upper Femoral Epiphysis, Closed Reduction

Sub-Acute Behavioral Health Level of Care, Adult: Partial Hospital Program

Substance-Related Disorders: Inpatient Care

Supported Housing: Residential Care

Sympathectomy by Thoracoscopy or Laparoscopy

- T -

Thoracic Surgery & Pulmonary Disease Intensive Care Admission

Thoracotomy with Biopsy or Miscellaneous Procedures by Video-Assisted Thoracic Surgery (VATS)

Thyroidectomy

Tibia/Fibula Shaft Fracture, Closed or Open Reduction

Tibial Osteotomy, Adult

Tibial Osteotomy, Child or Adolescent

Transcatheter Permanent Occlusion or Embolization

- U -

Urethral Diverticulum, Excision

Urethral Suspension Procedures

Urethroplasty

Uterine Artery Embolization

- V -

Vaginal Delivery

Vaginal Delivery - Operative

Vertebroplasty and Kyphoplasty

Vitrectomy

- W -

Wrist Arthroplasty

- X - Y - Z -

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