| (D) Radiation complications: pneumonitis (inflammation
of lung) which is potentially fatal; inflammation of stomach, intestines,
gallbladder, pancreas; stomach or intestinal ulcer; scarring of liver.
(4) Thermal and other ablative techniques for treatment
of tumors (for curative intent or palliation) including radiofrequency
ablation, microwave ablation, cryoablation, and high intensity focused
ultrasound (HIFU).
(A) Injury to tumor-containing organ or adjacent organs/structures.
(B) Injury to nearby nerves potentially resulting in
temporary or chronic (continuing) pain and/or loss of use and/or feeling.
(C) Failure to completely treat tumor.
(5) TIPS (Transjugular Intrahepatic Portosystemic Shunt)
and its variants such as DIPS (Direct Intrahepatic Portocaval Shunt).
(A) All associated risks as listed under subsection
(b)(2)(B) - (D) of this section.
(B) Hepatic encephalopathy (confusion/decreased ability
to think).
(C) Liver failure or injury.
(D) Gallbladder injury.
(E) Hemorrhage (severe bleeding).
(F) Recurrent ascites (fluid building up in abdomen)
and/or bleeding.
(G) Kidney failure.
(H) Heart failure.
(I) Death.
(6) Myelography.
(A) Chronic (continuing) pain.
(B) Nerve injury with loss of use and/or feeling.
(C) Transient (temporary) headache, nausea, and/or
vomiting.
(D) Numbness.
(E) Seizure.
(7) Percutaneous abscess/fluid collection drainage
(percutaneous abscess/seroma/lymphocele drainage and/or sclerosis
(inclusive of percutaneous, transgluteal, transrectal and transvaginal
routes)).
(A) Sepsis (infection in the blood stream), possibly
resulting in shock (severe decrease in blood pressure).
(B) Injury to nearby organs.
(C) Hemorrhage (severe bleeding).
(D) Infection of collection which was not previously
infected, or additional infection of abscess.
(8) Procedures utilizing prolonged fluoroscopy.
(A) Skin injury (such as epilation (hair loss), burns,
or ulcers).
(B) Cataracts (for procedures in the region of the
head).
(o) Respiratory system treatments and procedures.
(1) Biopsy and/or excision (removal) of lesion of larynx,
vocal cords, trachea.
(A) Loss or change of voice.
(B) Swallowing or breathing difficulties.
(C) Perforation (hole) or fistula (connection) in esophagus
(tube from throat to stomach).
(2) Rhinoplasty (surgery to change the shape of the
nose) or nasal reconstruction with or without nasal septoplasty (surgical
procedure to remove blockage in or straighten the bone and cartilage
dividing the space between the two nostrils).
(A) Deformity of skin, bone or cartilage.
(B) Creation of new problems, such as perforation of
the nasal septum (hole in wall between the right and left halves of
the nose) or breathing difficulty.
(3) Submucous resection of nasal septum or nasal septoplasty
(surgery to remove blockage in or straighten the bone and cartilage
dividing the space between the two nostrils).
(A) Persistence, recurrence or worsening of the obstruction.
(B) Perforation of nasal septum (hole in the bone and/or
cartilage dividing the space between the right and left halves of
the nose) with dryness and crusting.
(C) External deformity of the nose.
(4) Sinus surgery/endoscopic sinus surgery.
(A) Spinal fluid leak.
(B) Visual loss or other eye injury.
(C) Numbness in front teeth and palate (top of mouth).
(D) Loss or reduction in sense of taste or smell.
(E) Recurrence of disease.
(F) Empty Nose Syndrome (sensation of nasal congestion,
sensation of not being able to take in adequate air through nose).
(G) Injury to tear duct causing drainage of tears down
the cheek.
(H) Brain injury and/or infection.
(I) Injury to nasal septum (the bone and cartilage
dividing the space between the two nostrils).
(J) Nasal obstruction.
(5) Lung biopsy (removal of small piece of tissue from
inside of lung).
(A) Air leak with pneumothorax (leak of air from lung
to inside of chest causing the lung to collapse) with need for insertion
of chest tube or repeat surgery.
(B) Hemothorax (blood in the chest around the lung)
possibly requiring additional procedures.
(C) Hemoptysis (coughing up blood which can result
in trouble breathing and the need to be placed on a ventilator or
breathing machine and oxygen).
(6) Segmental resection of lung (removal of a portion
of a lung).
(A) Hemothorax (blood in the chest around the lung).
(B) Abscess (infected fluid collection) in chest.
(C) Air leak with pneumothorax (leak of air from lung
inside of chest causing the lung to collapse) with need for insertion
of chest drainage tube into space between lung and chest wall or repeat
surgery.
(D) Need for additional surgery.
(7) Thoracotomy (surgery to reach the inside of the
chest).
(A) Hemothorax (blood in the chest around the lung).
(B) Abscess (infected fluid collection) in chest.
(C) Air leak with pneumothorax (leak of air from lung
inside of chest causing the lung to collapse) with need for insertion
of chest drainage tube into space between lung and chest wall or repeat
surgery.
(D) Need for additional surgery.
(8) VATS - video-assisted thoracoscopic surgery (camera-assisted
surgery to reach the inside of the chest through small incisions)
(A) Hemothorax (blood in the chest around the lung).
(B) Abscess (infected fluid collection) in chest.
(C) Air leak with pneumothorax (leak of air from lung
inside of chest causing the lung to collapse) with need for insertion
of chest drainage tube into space between lung and chest wall or repeat
surgery.
(D) Need for additional surgery.
(E) Need to convert to open surgery.
(9) Percutaneous (puncture through the skin instead
of incision) or Open (surgical incision) tracheostomy.
(A) Loss of voice.
(B) Breathing difficulties.
(C) Pneumothorax (collapsed lung) with e need for insertion
of chest tube.
(D) Hemothorax (blood in the chest around the lung).
(E) Scarring in trachea (windpipe).
(F) Fistula (connection) between trachea into esophagus
(tube from throat to stomach) or great vessels.
(G) Bronchospasm (constriction of the airways leading
to trouble breathing).
(H) Hemoptysis (coughing up blood which can result
in trouble breathing and the need to be placed on a ventilator or
breathing machine and oxygen).
(10) Bronchoscopy (insertion of a camera into the airways
of the neck and chest).
(A) Mucosal injury (damage to lining of airways) including
perforation (hole in the airway).
(B) Pneumothorax (collapsed lung) with need for insertion
of chest tube.
(C) Pneumomediastinum (air enters the space around
the airways including the space around the heart).
(D) Injury to vocal cords, laryngospasm (irritation/spasm
of the vocal cords) or laryngeal edema (swelling of the vocal cords).
(E) Bronchospasm (constriction of the airways leading
to trouble breathing).
(F) Hemoptysis (coughing up blood which can result
in trouble breathing and the need to be placed on a ventilator or
breathing machine and oxygen).
(11) Endobronchial valve placement (device inserted
into airways in the lung that controls air movement into and out of
abnormal portions of a lung).
(A) Mucosal injury (damage to lining of airways) including
perforation (hole in the airway).
(B) Pneumothorax (collapsed lung) with need for insertion
of chest tube.
(C) Pneumomediastinum (air enters the space around
the airways including the space around the heart).
(D) Injury to vocal cords, laryngospasm (irritation/spasm
of the vocal cords) or laryngeal edema (swelling of the vocal cords).
Cont'd... |
