| (C) Partial or total blindness.
(2) Surgery for cataract with or without implantation
of intraocular lens.
(A) Complications requiring additional treatment and/or
surgery.
(B) Need for glasses or contact lenses.
(C) Complications requiring the removal of implanted
lens.
(D) Partial or total blindness.
(3) Retinal or vitreous surgery.
(A) Complications requiring additional treatment and/or
surgery.
(B) Recurrence or spread of disease.
(C) Partial or total blindness.
(4) Reconstructive and/or plastic surgical procedures
of the eye and eye region, such as blepharoplasty, tumor, fracture,
lacrimal surgery, foreign body, abscess, or trauma.
(A) Blindness.
(B) Nerve damage with loss of use and/or feeling to
eye or other areas of face.
(C) Painful or unattractive scarring.
(D) Worsening or unsatisfactory appearance.
(E) Dry eye.
(5) Photocoagulation and/or cryotherapy.
(A) Complications requiring additional treatment and/or
surgery.
(B) Pain.
(C) Partial or total blindness.
(6) Corneal surgery, such as corneal transplant, refractive
surgery and pterygium.
(A) Complications requiring additional treatment and/or
surgery.
(B) Pain.
(C) Need for glasses or contact lenses.
(D) Partial or total blindness.
(7) Glaucoma surgery by any method.
(A) Complications requiring additional treatment and/or
surgery.
(B) Worsening of the glaucoma.
(C) Pain.
(D) Partial or total blindness.
(8) Removal of the eye or its contents (enucleation
or evisceration).
(A) Complications requiring additional treatment and/or
surgery.
(B) Worsening or unsatisfactory appearance.
(C) Recurrence or spread of disease.
(9) Surgery for penetrating ocular injury, including
intraocular foreign body.
(A) Complications requiring additional treatment and/or
surgery.
(B) Possible removal of eye.
(C) Pain.
(D) Partial or total blindness.
(g) Female genital system treatments and procedures.
(1) Hysterectomy (abdominal and vaginal).
(A) Uncontrollable leakage of urine.
(B) Injury to bladder.
(C) Sterility.
(D) Injury to the tube (ureter) between the kidney
and the bladder.
(E) Injury to the bowel and/or intestinal obstruction.
(F) Need to covert to abdominal incision.
(G) If a power morcellator in laparoscopic surgery
is utilized, include the following risks:
(i) If cancer is present, may increase the risk of
the spread of cancer.
(ii) Increased risk of damage to adjacent structures.
(2) All fallopian tube and ovarian surgery with or
without hysterectomy, including removal and lysis of adhesions.
(A) Injury to the bowel and/or bladder.
(B) Sterility.
(C) Failure to obtain fertility (if applicable).
(D) Failure to obtain sterility (if applicable).
(E) Loss of ovarian functions or hormone production
from ovary(ies).
(F) If performed with hysterectomy, all associated
risks under paragraph (1) of this subsection.
(G) For fallopian tube occlusion (for sterilization
with or without hysterectomy), see subparagraph (14) of this paragraph.
(3) Removing fibroids (uterine myomectomy).
(A) Injury to bladder.
(B) Sterility.
(C) Injury to the tube (ureter) between the kidney
and the bladder.
(D) Injury to the bowel and/or intestinal obstruction.
(E) May need to convert to hysterectomy.
(F) If a power morcellator in laparoscopic surgery
is utilized, include the following risks:
(i) If cancer is present, may increase the risk of
the spread of cancer.
(ii) Increased risk of damage to adjacent structures.
(4) Uterine suspension.
(A) Uncontrollable leakage of urine.
(B) Injury to bladder.
(C) Injury to the tube (ureter) between the kidney
and the bladder.
(D) Injury to the bowel and/or intestinal obstruction.
(5) Removal of the nerves to the uterus (presacral
neurectomy).
(A) Uncontrollable leakage of urine.
(B) Injury to bladder.
(C) Injury to the tube (ureter) between the kidney
and the bladder.
(D) Injury to the bowel and/or intestinal obstruction.
(E) Hemorrhage (severe bleeding).
(6) Removal of the cervix.
(A) Uncontrollable leakage of urine.
(B) Injury to bladder.
(C) Sterility.
(D) Injury to the tube (ureter) between the kidney
and the bladder.
(E) Injury to the bowel and/or intestinal obstruction.
(F) Need to convert to abdominal incision.
(7) Repair of vaginal hernia (anterior and/or posterior
colporrhaphy and/or enterocele repair).
(A) Uncontrollable leakage of urine.
(B) Injury to bladder.
(C) Sterility.
(D) Injury to the tube (ureter) between the kidney
and the bladder.
(E) Injury to the bowel and/or intestinal obstruction.
(F) Mesh erosion (with damage to vagina and adjacent
tissue).
(8) Abdominal suspension of the bladder (retropubic
urethropexy).
(A) Uncontrollable leakage of urine.
(B) Injury to bladder.
(C) Injury to the tube (ureter) between the kidney
and the bladder.
(D) Injury to the bowel and/or intestinal obstruction.
(9) Conization of cervix.
(A) Hemorrhage (severe bleeding) which may result in
hysterectomy.
(B) Sterility.
(C) Injury to bladder.
(D) Injury to rectum.
(10) Dilation and curettage of uterus (diagnostic/therapeutic).
(A) Possible hysterectomy.
(B) Perforation (hole) created in the uterus.
(C) Sterility.
(D) Injury to bowel and/or bladder.
(E) Abdominal incision and operation to correct injury.
(11) Surgical abortion/dilation and curettage/dilation
and evacuation.
(A) Possible hysterectomy.
(B) Perforation (hole) created in the uterus.
(C) Sterility.
(D) Injury to the bowel and/or bladder.
(E) Abdominal incision and operation to correct injury.
(F) Failure to remove all products of conception.
(12) Medical abortion/non-surgical.
(A) Hemorrhage with possible need for surgical intervention.
(B) Failure to remove all products of conception.
(C) Sterility.
(13) Selective salpingography and tubal reconstruction.
(A) Perforation (hole) created in the uterus or Fallopian
tube.
(B) Future ectopic pregnancy (pregnancy outside of
the uterus).
(C) Pelvic infection.
(14) Fallopian tube occlusion (for sterilization with
or without hysterectomy).
(A) Perforation (hole) created in the uterus or Fallopian
tube.
(B) Future ectopic pregnancy (pregnancy outside of
the uterus).
(C) Pelvic infection.
(D) Failure to obtain sterility.
(15) Hysteroscopy.
(A) Perforation (hole) created in the uterus.
(B) Fluid overload/electrolyte imbalance.
(C) Possible hysterectomy.
Cont'd... |
