Gastric fundoplication for chronic reflux oesophagitis (PS51) PS51 G241, G243, G461 Funding may be considered under the following conditions: The procedure is recommended as a treatment option in adults who have at least one of the following characteristics: Regular, significant symptoms of gastro-oesophageal reflux despite receiving at least one year of continuous pharmacological treatment up to the maximum dose licensed for reflux oesophagitis. Significant volume reflux placing them at risk of aspiration. Anaemia because of oesophagitis. PA Primary Care/ Secondary Care Hallux Valgus Treatment of bunions W151-4 W791/2 Funding may be considered under the following conditions: Have been managed via MSK or podiatry services first before consideration of orthopaedic surgery and Has documented functional impairment and Inability to wear suitable footwear and Patient is fully aware of pros and cons of surgery having used patient decision aids. PA Primary Care Treatment of Hydrocele PS026 N11* and T193 with code of N43* or P835 Testicular torsion is a emergency and is not restricted within this policy. Funding for surgical treatment of hydrocele may be considered when the following has been confirmed: There is significant discomfort which prevents voiding, sexual function, mobility or dressing Additionally; Interventions should be delayed until at least 2 years of age. An ultrasound investigation may be of in the initial assessment where there is a diagnostic uncertainty but should not be repeated. Secondary Care Hysterectomy in heavy menstrual bleeding (menorrhagia) Hysterectomy for cases of heavy menstrual bleeding/ menorrhagia should not be offered unless ALL the following criteria are met: PA Secondary Care
Procedure Policy Exclusions/Exceptions Auth Req Requestor & Forms Adenoidectomy for Children with Recurrent Upper Respiratory Tract Infections Not routinely funded. When offered in combination with myringotomy (grommet insertion) and/or tonsillectomy which are subject to separate prior authorisation arrangements. IFR Secondary Care Appliances and devices for cosmetic purposes (high-grade silicon cosmesis and/or None. IFR Primary Care Secondary Care Arthroscopic Surgery for Hip Impingement (Arthroscopic & Open Approaches) PS006 None. IFR Secondary Care Asymptomatic Inguinal Hernia PS148 Asymptomatic Inguinal Hernias are not routinely funded. Surgery for Symptomatic hernias do not require approval. IFR Primary Care Autologous Injections for Musculoskeletal Conditions PS024 None. IFR Primary Care Secondary Care Balloon Catheter sinus dilation for Chronic Rhinosinusitis PS018 Not routinely funded, however patients that represent an anaesthetic risk may be considered under IFR arrangements if exceptional. IFR Secondary Care Bariatric surgery procedures in severely obese adults who have failed to respond to lifestyle and Tier 3 interventions PS013 Patients who have not completed a recognised specialist weight management programme may be referred for bariatric surgery if exceptional circumstances can be demonstrated and patients meet the pre-surgery criteria. Individual funding requests (IFR) should be made to the CCG and should also consider the pre-surgery criteria for patients set out in PS013. Note: Bariatric surgery is limited to adjustable gastric banding, sleeve gastrectomy and Roux-en-Y bypass performed at a recognised specialist centre. Complications IFR Primary Care/Secondary Care