Medicine Specialty Planning Responsibility OPCS Code Procedure / Medicine Commentary Clinical Evidence Base Link to Pathway/ Guidelines Dermatology *also under Plastic Surgery, General Surgery Health Board S04.1>3 S04.8 S05.1>5 S05.8>9 S06.1>5 S06.8>9 S09.1>5 S09.8>9 S10.1>5 S10.8>9 S11.1>5 S11.8>9 Benign skin conditions – other e.g. benign pigmented moles, milia, skin tags, molluscum contagiosum, keratoses (basal cell papillomata), sebaceous cysts, corns/callous, dermatofibromas, comedones Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances. Dermatology *also under Plastic Surgery, General Surgery Health Board S04.1>3 S04.8 S05.1>5 S05.8>9 S06.1>5 S06.8>9 S09.1>5 S09.8>9 S10.1>5 S10.8>9 S11.1>5 S11.8>9 Benign skin conditions – Removal of Lipomata Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances. Dermatology *also under Plastic Surgery Health Board S04.1>3 S04.8 S05.1>5 S05.8>9 S06.1>5 S06.8>9 S09.1>5 S09.8>9 S10.1>5 S10.8>9 Benign skin conditions – Removal of Viral warts Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances. Genital)
General Medicine Health Board No code Treatment for Sleep Apnoea Can be undertaken in line with NICE guidance. An IPFR is required for all other circumstances. Medicine WHSSC X52.1 Hyperbaric Oxygen Therapy (HBOT) for all indications Please see WHSSC criteria for referral. WHSSC will only commission emergency HBOT. WHSSC will be notified by the hyperbaric chamber of emergency admission retrospectively and will not require prior approval. HBOT should not be used for: Mild / Moderate Carbon Monoxide Poisoning responding to Normobaric Oxygen treatment Osteoradionecrosis Non – healing diabetic wounds/ulcers An IPFR is required for all other circumstances. Medicine Health Board No code Mirror Therapy There are no agreed criteria for use without an IPFR Medicines Management Specialty Planning Responsibility Code Procedure / Medicine Commentary Clinical Evidence Base Link to Pathway/ Guidelines
W94 W95 Orthopaedics Health Board W581 Hip Resurfacing Techniques Can be undertaken in line with NICE guidance. An IPFR is required for all other circumstances. Orthopaedics Health Board V33.7 + Y08 Laser Lumbar Micro-Discectomy Can be undertaken in line with NICE guidance. An IPFR is required for all other circumstances. Orthopaedics *also under Plastic Surgery Health Board T59.1>4 T59.8>9 T60.1>.4 T60.8>9 Surgical Removal of Ganglia The evidence suggests that there is a high rate of spontaneous resolution for ganglia and that reassurance should be the first therapeutic intervention for most patients and all children. There are no agreed criteria for the surgical removal of Ganglia without an IPFR. Orthopaedics Health Board W79.1>2 Surgical Treatment of Hallux Valgus The HB will fund specialist advice and surgical treatment if the following surgical criteria are met: Osteoarthritis affecting the 1st Metatarsophalangeal joint Impending or actual skin compromise Severe deformity causing pain in adjacent toes Inability to wear steel toe capped boots preventing ability to work An IPFR is required for all other circumstances. Any other referral should explicitly state reasons (e.g. Hallux rigidus, or specialised shoes). All Wales Directive by National Orthopaedic Delivery Board (2011) Orthopaedics Health Board U13.2/ Y53.2 + Z84.3 or + Z84.6 Therapeutic use of Ultrasound in Hip and Knee Osteoarthritis There are no agreed criteria for use without an IPFR
Urology Hyperhidrosis Treatment of overactive bladder in women Botulinum Toxin type A is recommended as an option for the prophylaxis of headaches in adults with chronic migraine (defined as headaches on at least 15 days per month of which at least 8 days are with migraine): that has not responded to at least three prior pharmacological prophylaxis therapies and whose condition is appropriately managed for medication overuse. Botulinum Toxin is not available for the treatment of facial ageing or excessive wrinkles For treatment of overactive bladder in women, bladder wall injection should only be used in the treatment of idiopathic detrusor over activity only in women who have not responded to conservative treatments (including antimuscarinic drugs e.g. oxybutynin) and who are willing and able to self catheterize. NICE notes that there is a gap in treatment between conservative treatment and surgery and Botulinum Toxin has been adopted to fill this position, however, this is in advance of high quality data on efficacy, safety and long term outcomes. An IPFR is required for all other circumstances. Neurosurgery WHSSC A10.8 Y11.4 (plus code G20.X) Subthalamotomy for Parkinson’s Disease Can only be undertaken in line with NICE guidance. An IPFR is required for all other circumstances.
Plastic Surgery *also under Dermatology, General Surgery WHSSC S04.1>3 S04.8 S05.1>5 S05.8>9 S06.1>5 S06.8>9 S09.1>5 S09.8>9 S10.1>5 S10.8>9 S11.1>5 S11.8>9 Benign skin conditions – other e.g. benign pigmented moles, milia, skin tags, molluscum contagiosum, keratoses (basal cell papillomata), sebaceous cysts, corns/callous, dermatofibromas, comedones Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances. Plastic Surgery *also under Dermatology, General Surgery WHSSC S04.1>3 S04.8 S05.1>5 S05.8>9 S06.1>5 S06.8>9 S09.1>5 S09.8>9 S10.1>5 S10.8>9 S11.1>5 S11.8>9 Benign skin conditions – Removal of Lipomata Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances. Plastic Surgery *also under Dermatology WHSSC S04.1>3 S04.8 S05.1>5 S05.8>9 S06.1>5 S06.8>9 S09.1>5 S09.8>9 S10.1>5 S10.8>9 Benign skin conditions – Removal of Viral warts (Non Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances.
S11.1>5 S11.8>9 Plastic Surgery WHSSC S03.1>3 S03.8>9 Body Contouring – Other e.g. Buttock lift, Thigh lift, Arm lift (brachioplasty) Can only be undertaken in line with the WHSSC Policy on Body Contouring. An IPFR is required for all other circumstances. Plastic Surgery WHSSC S02.1 >2 S02.8>9 Body Contouring -‘Tummy Tuck’ (Apronectomy or Abdominoplasty Can only be undertaken in line with the WHSSC Policy on Body Contouring. An IPFR is required for all other circumstances. Plastic Surgery *also under Dermatology, General Medicine, Gynaecology, Neurology, Ophthalmology, Orthopaedics, Urology WHSSC X85.1 Botulinum Toxin Botulinum Toxin should Not be used EXCEPT for the treatment of pathological conditions by appropriate specialists in cases of: Frey’s syndrome Blepharospasm Cerebral Palsy Spasticity in adults following neurological illness or injury Hyperhidrosis Treatment of overactive bladder in women Botulinum Toxin type A is recommended as an option for the prophylaxis of headaches in adults with chronic migraine (defined as headaches on at least 15 days per month of which at least 8 days are with migraine): that has not responded to at least three prior pharmacological prophylaxis therapies and whose condition is appropriately managed for medication overuse. Botulinum Toxin is not available for the treatment of facial ageing or excessive wrinkles
Plastic Surgery WHSSC S10.3 S11.3 S60.1>4 Y06.4 – Surgery or Laser Treatment Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances. Plastic Surgery *also under ENT WHSSC E02 E07.1>3 E07.8>9 Nose Can only be undertaken in line with the WHSSC Policy on Facial Surgery. An IPFR is required for all other circumstances. Plastic Surgery WHSSC S06.5 or S06.9 + Y06.4 S23.1>4 Skin conditions: Scar revision Should NOT be used EXCEPT for treatment of scars which interfere with function following burns or treatments for keloid or post surgical scarring. An IPFR is required for all other circumstances. Plastic Surgery WHSSC (ICD10= L81.9) Skin The recommended NHS suitable treatment for is cosmetic camouflage. Access to a qualified camouflage beautician should be available on the NHS for this and other skin conditions requiring camouflage. Plastic Surgery WHSSC S60.1>2 Skin “Resurfacing Techniques” – laser, dermabrasion & dermal peels Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances. Plastic Surgery *also under Orthopaedics WHSSC T59.1>4 T59.8>9 T60.1>.4 T60.8>9 Surgical Removal of Ganglia The evidence suggests that there is a high rate of spontaneous resolution for ganglia and that reassurance should be the first therapeutic intervention for most patients and all children. There are no agreed criteria for the surgical removal of Ganglia without an IPFR. Plastic Surgery WHSSC S09.2 Tattoo Removal Can only be undertaken in line with the WHSSC Policy on Plastic Surgery.
ENT WHSSC D24 Ear-Cochlear Implants Can only be undertaken in line with the WHSSC Policy on Cochlear Implants. An IPFR is required for all other circumstances. ENT *also under Plastic Surgery Health Board D03.3 Ear -Correction of prominent ears (Pinnaplasty/ Otoplasty) Can only be undertaken in line with the WHSSC Policy on Facial Surgery. An IPFR is required for all other circumstances. ENT Health Board D15.1 Grommets Drainage of middle ear in Otitis Media with Effusion (OME) Insertion of grommets is one of the five surgical procedures that the Department of Health monitors as indicators of excess surgical activity. NICE guidelines on the surgical management of otitis media with effusion in children makes recommendations specifically on the surgical management of OME in children under the age of 12. The guidelines state that a period of observation of the hearing loss over 3 months (with accurate audiometry), and its impact on the child's development, is recommended in order to determine whether resolution occurs or if further treatment is needed Persistence of hearing loss with adverse effects on the child will require further action, which may include surgery. Children with persistent bilateral OME documented over a period of 3 months with a hearing level in the better ear of 25–30 dBHL or worse averaged at 0.5, 1, 2 and 4 kHz (or equivalent dBA where dBHL not available) should be considered for surgical intervention. In children with Down's syndrome, hearing aids should normally be offered and OME with hearing loss. In children with cleft palate:
insertion of ventilation tubes at primary closure of the cleft palate should be performed only after careful otological and audiological assessment; insertion of ventilation tubes should be offered as an alternative to hearing aids in children with cleft palate who have OME and persistent hearing loss. An IPFR is required for all other circumstances. ENT *also under Plastic Surgery Health Board E02 E073 Nose -Rhinoplasty Can only be undertaken in line with the WHSSC Policy on Facial Surgery. An IPFR is required for all other circumstances. ENT Health Board F32.8 Soft-Palate Implants for Obstructive Sleep Apnoea There are no agreed criteria for use without an IPFR ENT Health Board F34.1>5 F34.7>9 Tonsillectomy in Children & Adults Tonsillectomy is one of the five surgical procedures that the Department of Health monitors as indicators of excess surgical activity. Can be undertaken if patients meet ALL of the following criteria prior to referral: Sore throat is due to tonsillitis Five or more episodes of sore throat per year Symptoms for at least one year Episodes of sore throat are disabling and prevent normal function When in doubt as to whether tonsillectomy would be beneficial, a six-month period of watchful waiting is recommended prior to tonsillectomy to establish firmly the patterns of symptoms and allow the patient to consider fully the implications of the operation.
conservative treatments (including antimuscarinic drugs e.g. oxybutynin) and who are willing and able to self catheterize. NICE notes that there is a gap in treatment between conservative treatment and surgery and Botulinum Toxin has been adopted to fill this position, however, this is in advance of high quality data on efficacy, safety and long term outcomes. An IPFR is required for all other circumstances. Ophthalmology Health Board C40.4 C44.1>2 C46.1 C46.7 C47.6 Corneal Implants for the Correction of Refractive Error in the Absence of other Ocular Pathology such as Keratoconus Can be undertaken in line with NICE guidance. An IPFR is required for all other circumstances. Ophthalmology *also under Plastic Surgery Health Board C12.1>6 C12.8>9 C13.1>4 C13.8>9 C15.1>5 C15.8>9 Eyelid Can only be undertaken in line with the WHSSC Policy on Facial Surgery. An IPFR is required for all other circumstances. Ophthalmology *also under Plastic Surgery Health Board C13.1>4 C13.8>9 Eyelid- Xanthelasma Palpebrum (Fatty deposits on the eyelids) Can only be undertaken in line with the WHSSC Policy on Plastic Surgery. An IPFR is required for all other circumstances. Ophthalmology Health Board C44 C45 C46.1 Laser Therapy for Short Sight Should NOT be used EXCEPT if the patient has a biometry error following cataract surgery. Current evidence suggests that photorefractive (laser) surgery for the correction of refractive errors is safe and efficacious for use in appropriately selected patients. However, the safety and effectiveness of this procedure should be considered against the alternative methods of