| (D) Loss of senses (blindness, double vision, deafness,
smell, numbness, taste).
(E) Weakness, paralysis, loss of coordination.
(F) Cerebrospinal fluid leak with potential for severe
headaches.
(G) Meningitis (infection of coverings of brain and
spinal cord).
(H) Brain abscess.
(I) Persistent vegetative state (not able to communicate
or interact with others).
(J) Hydrocephalus (abnormal fluid buildup causing pressure
in the brain).
(K) Seizures (uncontrolled nerve activity).
(L) Need for permanent breathing tube and/or permanent
feeding tube.
(2) Cranial nerve operations.
(A) Weakness, numbness, impaired muscle function or
paralysis.
(B) Recurrence, continuation or worsening of the condition
that required this operation (no improvement or symptoms made worse).
(C) Seizures (uncontrolled nerve activity).
(D) New or different pain.
(E) Stroke (damage to brain resulting in loss of one
or more functions).
(F) Persistent vegetative state (not able to communicate
or interact with others).
(G) Loss of senses (blindness, double vision, deafness,
smell, numbness, taste).
(H) Cerebrospinal fluid leak with potential for severe
headaches.
(I) Meningitis (infection of coverings of brain and
spinal cord).
(J) Need for prolonged nursing care.
(K) Need for permanent breathing tube and/or permanent
feeding tube.
(3) Spine operation, including laminectomy, decompression,
fusion, internal fixation or procedures for nerve root or spinal cord
compression; diagnosis; pain; deformity; mechanical instability; injury;
removal of tumor, abscess or hematoma (excluding coccygeal operations).
(A) Weakness, pain, numbness or clumsiness.
(B) Impaired muscle function or paralysis.
(C) Incontinence, impotence or impaired bowel function
(loss of bowel/bladder control and/or sexual function).
(D) Migration of implants (movement of implanted devices).
(E) Failure of implants (breaking of implanted devices).
(F) Adjacent level degeneration (breakdown of spine
above and/or below the level treated).
(G) Cerebrospinal fluid leak with potential for severe
headaches.
(H) Meningitis (infection of coverings of brain and
spinal cord).
(I) Recurrence, continuation or worsening of the condition
that required this operation (no improvement or symptoms made worse).
(J) Unstable spine (abnormal movement between bones
and/or soft tissues of the spine).
(4) Peripheral nerve operation; nerve grafts, decompression,
transposition or tumor removal; neurorrhaphy, neurectomy or neurolysis.
(A) Numbness.
(B) Impaired muscle function.
(C) Recurrence, continuation or worsening of the condition
that required this operation (no improvement or symptoms made worse).
(D) Continued, increased or different pain.
(E) Weakness.
(5) Transphenoidal hypophysectomy or other pituitary
gland operation.
(A) Cerebrospinal fluid leak with potential for severe
headaches.
(B) Necessity for hormone replacement.
(C) Recurrence or continuation of the condition that
required this operation.
(D) Deformity or perforation of nasal septum (hole
in wall between the right and left halves of the nose).
(E) Facial nerve injury resulting in disfigurement
(loss of nerve function controlling muscles in face).
(F) Loss of senses (blindness, double vision, deafness,
smell, numbness, taste).
(G) Stroke (damage to brain resulting in loss of one
or more functions).
(H) Persistent vegetative state (not able to communicate
or interact with others).
(I) Headaches.
(6) Cerebrospinal fluid shunting procedure or revision.
(A) Shunt obstruction (blockage of shunt/tubing causing
it to stop draining adequately).
(B) Malposition or migration of shunt/tubing (improper
positioning or later movement of shunt/tubing causing it to stop draining
adequately).
(C) Seizures (uncontrolled nerve activity).
(D) Recurrence or continuation of brain dysfunction.
(E) Injury to internal organs of the chest or abdomen.
(F) Brain injury.
(G) Stroke (damage to brain resulting in loss of one
or more functions).
(H) Persistent vegetative state (not able to communicate
or interact with others).
(I) Loss of senses (blindness, double vision, deafness,
smell, numbness, taste).
(J) Cerebrospinal fluid leak with potential for severe
headaches.
(K) Meningitis (infection of coverings of brain and
spinal cord).
(L) Need for prolonged nursing care.
(M) Need for permanent breathing tube and/or permanent
feeding tube.
(7) Elevation of depressed skull fracture.
(A) Loss of brain function such as memory and/or ability
to speak.
(B) Recurrence, continuation or worsening of the condition
that required this operation (no improvement or symptoms made worse).
(C) Loss of senses (blindness, double vision, deafness,
smell, numbness, taste).
(D) Weakness, paralysis, loss of coordination.
(E) Cerebrospinal fluid leak with potential for severe
headaches.
(F) Meningitis (infection of coverings of brain and
spinal cord).
(G) Brain abscess.
(H) Persistent vegetative state (not able to communicate
or interact with others).
(I) Seizures (uncontrolled nerve activity).
(J) Need for permanent breathing tube and/or permanent
feeding tube.
(n) Radiology.
(1) Splenoportography (needle injection of contrast
media into the spleen).
(A) All associated risks as listed under subsection
(b)(2)(B) of this section.
(B) Injury to the spleen requiring blood transfusion
and/or removal of the spleen.
(2) Chemoembolization.
(A) All associated risks as listed under subsection
(b)(2)(B) of this section.
(B) Tumor lysis syndrome (rapid death of tumor cells,
releasing their contents which can be harmful).
(C) Injury to or failure of liver (or other organ in
which tumor is located).
(D) Risks of the chemotherapeutic agent(s) utilized.
(E) Cholecystitis (inflammation of the gallbladder)
(for liver or other upper GI embolizations).
(F) Abscess (infected fluid collection) in the liver
or other embolized organ requiring further intervention.
(G) Biloma (collection of bile in or near the liver
requiring drainage) (for liver embolizations).
(3) Radioembolization.
(A) All associated risks as listed under subsection
(b)(2)(B) of this section.
(B) Tumor lysis syndrome (rapid death of tumor cells,
releasing their contents which can be harmful).
(C) Injury to or failure of liver (or other organ in
which tumor is located).
(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).
Cont'd... |
