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PMB Conditions

Below is a list of all PMB Conditions

PMB CodePMB Description
485BInflammation of lacrimal passagesIncision; medical management
909BOpen wound of eyeball and other eye structuresMedical and surgical management
407BPrimary and open angle glaucoma with failed medical managementTrabeculectomy; other surgery
419BPurulent endophthalmitisVitrectomy
922BRetained intraocular foreign bodySurgical management
904BRetinal detachment; tear and other retinal disordersVitrectomy; laser treatment; other surgery
906BRetinal vascular occlusion; central retinal vein occlusionLaser surgery
409BSympathetic uveitis and degenerative disorders and conditions of globe; sight threatening thyroid optopathyEnucleation; medical management; surgery
EAR; NOSE; MOUTH AND THROAT
33CAcute and chronic mastoiditisMastoidectomy; medical management
482CAcute otitis mediaMedical and surgical management; including myringotomy
900CAcute upper airway obstruction; including croup; epiglottitis and acute laryngotracheitisMedical management; intubation; tracheostomy
950CCancer of oral cavity; pharynx; nose; ear; and larynx - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
241CCancrum orisMedical and surgical management
38CChoanal atresiaRepair of choanal atresia
133CCholesteatomaMedical and surgical management
910CChronic upper airway obstruction; resulting in cor pulmonaleMedical and surgical management
901CCleft palate and/or cleft lip without airway obstructionRepair
12CDeep open wound of neck; including larynx; fracture of larynx or trachea; openMedical and surgical management; ventilation
521CForeign body in ear and noseRemoval of foreign body; and medical and surgical management
29CForeign body in pharynx; larynx; trachea; bronchus & esophagusRemoval of foreign body
339CFracture of face bones; orbit; jaw; injury to optic and other cranial nervesMedical and surgical management
219CLeukoplakia of oral mucosa; including tongueIncision/excision; medical management
132CLife-threatening diseases of pharynx NOS; including retropharyngeal abscessMedical and surgical management
457COpen wound of ear-drumTympanoplasty; medical management
240CPeritonsillar abscessIncision and drainage of abscess; tonsillectomy; medical management
347CSialoadenitis; abscess / fistula of salivary glandsSurgery
RESPIRATORY SYSTEM
903DBacterial; viral; fungal pneumoniaMedical management; ventilation
158D# Respiratory failure; regardless of cause# Medical management; oxygen; ventilation
157DAcute asthmatic attack; pneumonia due to respiratory syncytial virus in persons under age 3Medical management
125DAdult respiratory distress syndrome; inhalation and aspiration pneumoniasMedical management; ventilation
315DAtelectasis (collapse of lung)Medical and surgical management; ventilation
340DBenign neoplasm of respiratory and intrathoracic organs Biopsy; lobectomy; Medical management; radiation therapy
950DCancer of lung; bronchus; pleura; trachea; mediastinum & other respiratory organs - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
170DEmpyema and abscess of lungMedical and surgical management
934DFrank haemoptysisMedical and surgical management
203DHypoplasia and dysplasia of lungMedical and surgical management
900DOpen fracture of ribs and sternum; multiple rib fractures; flail chestMedical and surgical management; ventilation
5DPneumothorax and haemothoraxTube thoracostomy / thoracotomy
HEART AND VASCULATURE
155EMyocarditis; cardiomyopathy; transposition of great vessels; hypoplastic left heart syndromeMedical and surgical management; cardiac transplant
108EPericarditisMedical and surgical management
907EAcute and subacute ischemic heart disease; including myocardial infarction and unstable angina Medical management; surgery; percutaneous procedures
284EAcute pulmonary heart disease and pulmonary emboliMedical and surgical management
35EAcute rheumatic feverMedical management
908EAneurysm of major artery of chest; abdomen; neck; - Unruptured or ruptured NOSSurgical management
26EArterial embolism/thrombosis: abdominal aorta; thoracic aortaMedical and surgical management
204ECardiac failure: acute or recent deterioration of chronic cardiac failure Medical treatment
98EComplete; corrected and other transposition of great vesselsRepair
97ECoronary artery anomaly Anomalous coronary artery ligation
309EDiseases and disorders of aortic valve NOSAortic valve replacement
210EDiseases of endocardium; endocarditisMedical management
314EDiseases of mitral valveValvuloplasty; valve replacement; medical management
902EDisorders of arteries: visceralBypass graft; surgical management
18EDissecting or ruptured aortic aneurysm Surgical management
915EGangrene; severe atherosclerosis of arteries of extremities; diabetes mellitus with peripheral circulatory disease Medical and surgical management including amputation
294EGiant cell arteritis; Kawasaki disease; hypersensitivity angiitisMedical management
450EHereditary hemorrhagic telangiectasiaExcision
111EInjury to major blood vessels - trunk; head and neck; and upper limbsRepair
19EInjury to major blood vessels of extremitiesLigation
903ELife-threatening cardiac arrhythmiasMedical and surgical management; pacemakers; cardioversion
900ELife-threatening complications of elective cardiac and major vascular proceduresMedical and surgical management
497EMultiple valvular diseaseSurgical management
905EOther correctable congenital cardiac conditions Surgical repair; medical management
100EPatent ductus arteriosus; aortic pulmonary fistula - persistentLigation
209EPhlebitis & thrombophlebitis; deepLigation and division; medical management
914ERheumatic pericarditis; rheumatic myocarditisMedical management
16ERupture of papillary muscleMedical and surgical management
99ETetralogy of Fallot (TOF)Total repair tetralogy
93EVentricular septal defect - persistentClosure
GASTRO-INTESTINAL SYSTEM
920FAnal Fissure; Anal fistulaFissurectomy ; Fistulectomy; medical management
41FAbscess of intestineDrain abscess; medical management
489FAcquired hypertrophic pyloric stenosis and other disorders of the stomach and duodenum Surgical management
254FAcute diverticulitis of colonMedical and surgical management; including colon resection
124FAcute vascular insufficiency of intestine Colectomy
337FAmoebiasis; typhoidMedical management
264FAnal and rectal polypExcision of polyp
9FAppendicitisAppendectomy
952FCancer of retroperitoneum; peritoneum; omentum & mesentery - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
950CCancer of the gastro-intestinal tract; including oesophagus; stomach; bowel; rectum; anus - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
214FOesophageal strictureDilatation; surgery
516FOesophageal varicesMedical management; surgical shunt; sclerotherapy
902FGastric or intestinal ulcers with hemorrhage or perforationSurgery; endoscopic diagnosis; medical management
901FGastroenteritis and colitis with life-threatening haemorrhage or dehydration; regardless of causeMedical management
6FHernia with obstruction and/or gangrene; uncomplicated hernias under age 18Repair; bowel resection
20FIntestinal obstruction without mention of hernia; symptomatic foreign body in stomach; intestines; colon & rectum Excision; surgery; medical management
232FParalytic ileusMedical management
498FPeritoneal adhesionSurgical management
3FPeritonitis; regardless of causeMedical and surgical management
555FRectal prolapsePartial colectomy
900FRupture of intra-abdominal organRepair; splenectomy; resection
507FThrombosed and complicated haemorrhoids Haemorrhoidectomy; incision
325GAcute necrosis of liverMedical management
327GAcute pancreatitisMedical management; and where appropriate; surgical management
36GBudd-Chiari syndrome; and other venous embolism and thrombosisThrombectomy / ligation
910GCalculus of bile duct with cholecystitis Medical management; cholecystectomy; other open or closed surgery
950GCancer of liver; biliary system and pancreas - treatableMedical and surgical management
255GCyst and pseudocyst of pancreasDrainage of pancreatic cyst
156GDisorders of bile ductExcision; repair
910GGallstone with cholecystitis and/or jaundice Medical management; cholecystectomy; other open or closed surgery
743GHepatorenal syndromeMedical management
27GLiver abscess; pancreatic abscessMedical and surgical management
911GLiver failure; hepatic vascular obstruction; inborn errors of liver metabolism; biliary atresiaLiver transplant; other surgery; medical management
231GPortal vein thrombosisShunt
MUSCULOSKELETAL SYSTEM; TRAUMA NOS
353HAbscess of bursa or tendonIncision and drainage
32HAcute osteomyelitisMedical and surgical management
950HCancer of bones - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
206HChronic osteomyelitisIncision and drainage
85HCongenital dislocation of hip; coxa vara and valga; congenital clubfootRepair / reconstruction
147HCrush injuries of trunk; upper limbs; lower limbs; including blood vesselsSurgical management; ventilation; acute renal dialysis
491HDislocations / fractures of vertebral column without spinal cord injury Medical management; surgical stabilisation
500HDisruptions of the achilles / quadriceps tendonsRepair
178HFracture of hipReduction; hip replacement
445HInjury to internal organsMedical and surgical management
900HOpen fracture / dislocation of bones and jointsReduction / relocation; medical and surgical management
34HPyogenic arthritisMedical and surgical management
901HTraumatic amputation of limbs; hands; feet; and digitsReplantation / amputation
SKIN AND BREAST
465JAcute lymphadenitisIncision and drainage; medical management
900JBurns; greater than 10% of body surface; or more than 5% involving head; neck; hands; perineumDebridement; free skin graft; medical management
950JCancer of breast - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
954JCancer of skin; excluding malignant melanoma - treatableIf histologically confirmed; Medical and surgical management; which includes radiation therapy
952JCancer of soft tissue; including sarcomas and malignancies of the adnexa - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
349JCellulitis and abscesses with risk of organ or limb damage or septiceamia if untreated; necrotizing fasciitisMedical and surgical management
901JDisseminated bullous skin disease; including pemphigus; pemphigoid; epidermolysis bullosa; epidermolytic hyperkeratosisMedical management
951JLethal midline granulomaMedical management; which includes radiation therapy
953JMalignant melanoma of skin - treatableMedical and surgical management; which includes radiation therapy
356JPyoderma; body; deep-seated fungal infectionsMedical management
112JToxic epidermal necrolysis and staphylococcal scalded skin syndrome; Stevens-Johnson syndromeMedical management
331KAcute thyroiditisMedical management
951KBenign and malignant tumours of pituitary gland with/without hypersecretion syndromesMedical and surgical management; radiation therapy
30KBenign neoplasm of islets of Langerhans Excision of tumour; medical management
950KCancer of endocrine system; excluding thyroid - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
952KCancer of thyroid - treatable; carcinoid syndromeMedical and surgical management; which includes chemotherapy and radiation therapy
61KCongenital hypothyroidismMedical management
902KDisorder of adrenal secretion NOSMedical management; adrenalectomy
447KDisorders of parathyroid gland; benign neoplasm of parathyroid gland Medical and surgical management
31KHypoglycemic coma; hyperglycemia; diabetic ketoacidosisMedical management
901KLife-threatening congenital abnormalities of carbohydrate; lipid; protein and amino acid metabolismMedical management
903KLife-threatening disorders of fluid and electrolyte balance; NOSMedical management
URINARY AND MALE GENITAL SYSTEM
354LAbscess of prostateTurp; drain abscess
904LAcute and chronic pyelonephritis; renal and perinephric abscess Medical and surgical management
903LAcute glomerulonephritis and nephritic syndromeMedical management
954LCancer of penis and other male genital organ - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
953LCancer of prostate gland - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
950LCancer of testis - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
952LCancer of urinary system including kidney and bladder - treatableMedical and surgical management; which includes chemotherapy and radiation therapy
906LCongenital anomalies of urinary system - symptomatic and life-threateningNephrectomy / repair
901LEnd stage renal disease regardless of causeDialysis and renal transplant where Department of Health criteria are met only (see criteria published in GPS 004-9001)
900LHyperplasia of the prostate; with acute urinary retention or obstructive renal failureTransurethral resection; medical management
905LObstruction of the urogenital tract; regardless of causeCatheterisation; surgery; endoscopic removal of obstructing agent: lithotripsy
436LTorsion of testisOrchidectomy; repair
43LTrauma to the urinary system including ruptured bladderCystorrhaphy; suture; repair
289LUreteral fistula (intestinal)Nephrostomy
359LVesicoureteral refluxMedical management; replantation
FEMALE REPRODUCTIVE SYSTEM
539MAbscesses of Bartholin's gland and vulvaIncision and drainage; medical management
288MAcute pelvic inflammatory diseaseMedical and surgical management
954MCancer of Cervix - treatableMedical and surgical management; which includes radiation therapy and chemotherapy
952MCancer of ovary - treatableMedical and surgical management; which includes radiation therapy and chemotherapy
950MCancer of uterus - treatableMedical and surgical management; which includes radiation therapy and chemotherapy
953MCancer of vagina; vulva and other female genital organs NOS - treatableMedical and surgical management; which includes radiation therapy and chemotherapy
960M Cervical and breast cancer screeningCervical smears; periodic breast examination
645MCongenital abnormalities of the female genitaliaMedical and surgical management
266MDysplasia of cervix and cervical carcinoma-in-situ; cervical condylomataMedical and surgical management
53MEctopic pregnancySurgery
460MFistula involving female genital tractClosure of fistula
951MHydatidiform mole; choriocarcinomaD & C; hysterectomy; chemotherapy
902MInfertility (Explanatory Note 9 of Annexure A of Regulations)Medical and surgical management
528MMenopausal management; anomalies of ovaries; primary and secondary amenorrhoea; female sex hormones abnormalities NOS; including hirsutismMedical and surgical management; including hormone replacement therapy
434MNon-inflammatory disorders and benign neoplasms of ovary; fallopian tubes and uterusSalpingectomy; oophorectomy; hysterectomy; medical and surgical management
237MSexual abuse; including rapeMedical management; psychotherapy
903MSpontaneous abortionMedical and surgical manegment
435MTorsion of ovaryOophorectomy; ovarian cystectomy
530MUterine prolapse; cystoceleSurgical repair
296MVoluntary termination of pregnancyInduced abortion; medical and surgical management
PREGNANCY AND CHILDBIRTH
67N# Low birth weight (under 1000g) with respiratory difficulties# Medical management not including ventilation
967N# Low birth weight (under 2500 grams & > 1000g) with respiratory difficulties# Medical management; including ventilation; intensive care therapy
71NBirth trauma for babyMedical management; surgery
901NCongenital systemic infections affecting the newbornMedical management; ventilation
904NHaematological disorders of the newbornMedical management
54NNecrotizing enterocolitis in newbornMedical and surgical management
74NNeonatal and infant GIT abnormalities and disorders; including malrotation and atresiaMedical and surgical management
902NNeonatal endocrine; metabolic and toxin-induced conditions Medical management
903NNeurological abnormalities in the newbornMedical management
52NPregnancyAntenatal and obstetric care necessitating hospitalisation; including delivery
56NRespiratory conditions of newbornMedical management; ventilation
50SSyphilis - congenital; secondary and tertiaryMedical management
260S# Imminent death regardless of diagnosis# Comfort care; pain relief; hydration
113SAcquired haemolytic anaemiasMedical management
901SAcute leukemias; lymphomasMedical management; which includes chemotherapy; radiation therapy; bone marrow transplantation
48SAnaphylactic shockMedical management; ventilation
900SAplastic anemia; agranulocytosis; other life-threatening hereditary immune deficiencies Bone marrow transplantation; medical management
197SBotulismMedical management
338SCholera; rat-bite feverMedical management
196SChronic Granulomatous disease Medical management; which includes radiation therapy
916SCoagulation defectsMedical management
246SCysticercosis; other systemic cestode infectionMedical management
903SDeep-seated (excluding nail infections); disseminated and systemic fungal infectionsMedical management; surgery
44SErysipelasMedical management
179SHereditary angioedema; angioneurotic oedemaMedical and surgical management
174SHereditary haemolytic anaemias (e.g. sickle cell); dyserythropoietic anemia (congenital)Medical management
906AAcute generalised paralysis; including polio and Guillain-BarreMedical management; ventilation and plasmapheresis
913SImmune compromise NOS and associated life-threatening infections NOSMedical management
341ABasal ganglia; extra-pyramidal disorders; other dystonias NOSInitial diagnosis; initiation of medical management
912SLeprosy and other systemic mycobacterial infections; Excluding tuberculosisMedical management
950ABenign and malignant brain tumours; treatableMedical and surgical management which includes radiation therapy and chemotherapy
336SLeptospirosis; spirochaetal infections NOSMedical management
49ACompound/ depressed fractures of skullCraniotomy/ craniectomy
252SLife-threatening anaemia NOSMedical management; transfusion
213ADifficulty in breathing; eating; swallowing; bowel; or bladder control due to non-progressive neurological (including spinal) condition or injuryMedical and surgical management; ventilation
908SLife-threatening conditions due to exposure to the elements; including hypo and hyperthermia; lighting strikesMedical management
83AEncephalocele; congenital hydrocephalusShunt; surgery
907SLife-threatening rickettsial and other arthropod-borne diseasesMedical management
902AEpilepsy (status epilepticus; initial diagnosis; candidate for neurosurgery)Medical management; ventilation; neurosurgery
172SMalaria; trypanosomiasis; other life-threatening parasitic diseaseMedical management
211AIntraspinal and Intracranial abscessMedical and surgical management
904SMetastatic infections; septiceamiaMedical management
910SMultiple myeloma and chronic leukaemiasMedical management which includes chemotherapy and radiation therapy
513AMyasthenia gravis; muscular dystrophy; neuro-myopathies NOSInitial diagnosis; initiation of medical management; therapy for acute complications and exacerbations
247SPoisoning by ingestion; injection; and non-medicinal agentsMedical management
510APeripheral nerve injury with open woundNeuroplasty
911SSexually transmitted diseases with systemic involvement not elsewhere specifiedMedical management
940AReversible CNS abnormalities due to other systemic diseaseMedical and surgical management
128STetanus; anthrax; Whipple's diseaseMedical management
1ASevere / moderate head injury: hematoma / oedema with loss of consciousnessMedical and surgical management; ventilation
84ASpina BifidaSurgical management
316SToxic effect of gasses; fumes; and vaporsMedical therapy
941ASpinal cord compression; ischaemia or degenerative disease NOSMedical and surgical management
11STuberculosisDiagnosis and acute medical management; successful transfer to maintenance therapy in accordance to DOH guidelines
937STumour of internal organ (excludes skin): unknown whether benign or malignant Biopsy
28ASubarachnoid and intracranial hemorrhage / hematoma; compression of brainMedical and surgical management
15SWhooping cough; diptheriaMedical management
305ATetanusMedical management; ventilation
MENTAL ILLNESS
265ATransient cerebral ischaemia; life-threatening cerebrovascular conditions NOSEvaluation; medical management; surgery
182TAbuse or dependence on Psychoactive substance; including alcoholHospital-based management up to 3 weeks/year
109AVertebral dislocations/ fractures; open or closed with injury to spinal cordRepair /reconstruction; medical management; inpatient rehabilitation up to 2 months
910TAcute delusional mood; anxiety; personality; perception disorders and organic mental disorder caused by drugs Hospital-based management up to 3 days
684AViral meningitis; encephalitis; myelitis and encephalomyelitisMedical management
901TAcute stress disorder accompanied by recent significant trauma; including physical or sexual abuseHospital admission for psychotherapy / counselling up to 3 days; or up to 12 outpatient psychotherapy / counselling contacts
EYE
910TAlcohol withdrawal delirium; alcohol intoxication deliriumHospital-based management up to 3 days leading to rehabilitation
47BAcute orbital cellulitis Medical and surgical management
908TAnorexia Nervosa and Bulimia NervosaHospital-based management up to 3 weeks/year or minimum of 15 outpatient contacts per year
394BAngle-closure glaucomaIridectomy; laser surgery; medical and surgical management
903TAttempted suicide; irrespective of cause Hospital-based management up to 3 days or up to 6 outpatient contacts
184TBrief reactive psychosisHospital-based management up to 3 weeks/year
950BCancer of the eye and orbit - treatableMedical and surgical management; which includes radiation therapy and chemotherapy
910TDelirium: Amphetamine; Cocaine; or other psychoactive substanceHospital-based management up to 3 days
901BCataract; aphakiaExtraction of cataract; lens implant
902TMajor affective disorders; including unipolar and bipolar depressionHospital-based management up to 3 weeks/year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts
911BCorneal ulcer; Superficial injury of eye and adnexa Conjunctival flap; medical management
907TSchizophrenic and paranoid delusional disorders Hospital-based management up to 3 weeks/year
405BGlaucoma associated with disorders of the lensSurgical management
909TTreatable dementiaAdmission for initial diagnosis; management of acute psychotic symptoms - up to 1 week
386BHerpes zoster & herpes simplex with ophthalmic complicationsMedical management
389BHyphaemaRemoval of blood clot; observation
177DCovid 19Screening, Testing, Medical management including Ventilation, Rehabilitation.

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