This is the diagnostic list that lists the diagnostic procedures for Priority Health Business policy and must be read in conjunction with:
The diagnostic procedures on this diagnostic list have been grouped together for customer friendly use. In addition, descriptions are provided to explain the diagnostic procedures covered under the relevant modules under Priority Health Business.
This list applies from 1 July 2013 and is reviewed on 1 July every year and may be updated. If your policy is part of a subsidised health scheme, this list will take effect from your next group anniversary date.
It is important that you obtain pre-approval before you have a diagnostic procedure by calling 0800 123 nib. This process will confirm what is covered and what is required for you to make a claim. Take a copy of this diagnostic list as well as the Priority Health Business surgical list to your doctor who will be able to tell you if the procedure being recommended is on the list.
If any pre-approved diagnostic procedure leads to a pre-approved surgical procedure during the diagnostic procedure being performed, the Benefit maximum of that pre-approved diagnostic procedure will be reviewed accordingly.
In order for any diagnostic procedure undertaken to be covered it must:
Your registered specialist recommends that you have a Bilateral Breast Ultrasound and Breast Fine Needle Aspiration (FNA). These diagnostic procedures are listed below under the Base Cover: Major Surgical Module. Within four months of having these diagnostics, a mastectomy surgical procedure is undertaken. Mastectomy is a listed surgical procedure under Base Cover: Major Surgical Module and is covered. Because the diagnostic procedures relate to this surgery, they are covered under the Procedure-Related Diagnostics Benefit in the Base Cover: Major Surgical Module, with a benefit maximum of $4,000 per insured person, per policy year.
Your registered specialist recommends that you have a Nasendoscopy. This diagnostic procedure is listed below under Module 1: Other Surgical Cover. Within four months of having this diagnostic procedure, a septoplasty surgical procedure is undertaken. Septoplasty is a listed surgical procedure under Module 1: Other Surgical Cover and is covered. Because the diagnostic procedure undertaken relates to this surgery, it is covered under the Procedure-Related Diagnostics Benefit in Module 1: Other Surgical Cover, with a benefit maximum of $4,000 per insured person, per policy year.
Diagnostic procedures in Module 2: Cancer and Non-Surgical Hospitalisation Cover must be undertaken in connection with private chemotherapy, radiotherapy or brachytherapy for cancer, and within the four months immediately before and after the date of treatment or admission to an approved private hospital.
Diagnostic procedures in Module 5: Specialist and Diagnostic Cover covers diagnostic procedures that do not relate to a covered surgical procedure or fall outside the four months time frame from your covered surgical procedure or chemotherapy, radiotherapy or brachytherapy treatment.
There are times when a claim may not be covered. Please check your acceptance certificate or renewal certificate for specific exclusions and your policy document which sets our standard exclusions. A copy of the policy wording can be downloaded from www.nib.co.nz or contact us on 0800 123 nib.
*This is an example only. Please refer to your policy wording for full terms and conditions of cover.
BC = Base Cover: Major Surgical Module Mod 1 = Module 1: Other Surgical Cover
Mod 2 = Module 2: Cancer and Non-surgical hospitalisation Cover Mod 5 = Module 5: Specialist and Diagnostic Cover
Body site | Diagnostic procedure description | BC | Mod 1 | Mod 2 | Mod 5 | Explanation |
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Breast – diagnostics |
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Breast | BREAST – Biopsy with Frozen Section | ✓ | ✓ | ✓ | Breast Biopsy is removal of a sample of breast tissue for examination Frozen section is a sample of tissue which is frozen and analysed at the time of operation | |
Breast | BREAST – Localisation +/- Hookwire/D Wire Biopsy | ✓ | ✓ | ✓ | Breast localisation is determining the site or place of an area of breast tissue with a Hook or D Wire for a biopsy to be taken | |
Breast | BREAST – Bilateral Mammography | ✓ | ✓ | ✓ | ✓ | A specific low dose x-ray used to screen or diagnose conditions of the breast |
Breast | BREAST – Ultrasound Mammography | ✓ | ✓ | ✓ | ✓ | The exposure of the breasts to high-frequency sound waves to produce a picture of the breast tissue |
Breast | DIAGNOSTIC – Fine Needle Aspiration | ✓ | ✓ | ✓ | The use of a fine needle introduced through the skin to draw off fluid accumulation or take a sample of breast tissue to review | |
Breast | BREAST – Sentinel Node Biopsy | ✓ | ✓ | ✓ | A procedure to take a tissue sample | |
Abdominal and pelvic: colon – diagnostics |
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Colon | COLON – Sigmoidoscopy | ✓ | ✓ | ✓ | ✓ | A procedure to see inside the sigmoid colon and rectum using a telescope |
Colon | COLON – Colonoscopy & Sigmoidoscopy | ✓ | ✓ | ✓ | ✓ | A procedure to see inside the sigmoid colon and colon using a telescope |
Colon | COLON – Colonoscopy +/- Biopsy | ✓ | ✓ | ✓ | A procedure to see inside the colon using a telescope +/- sampling the tissue | |
Colon | COLON – Colonoscopy – Total Procedure Cost | ✓ | ✓ | ✓ | ✓ | A procedure to see inside the colon from the anus to the caecum and beyond if possible using a telescope +/- sampling the tissue |
Colon | COLON – Colonoscopy & Gastroscopy | ✓ | ✓ | Colonoscopy is a procedure to see inside the colon using a telescope +/- sampling the tissue Gastroscopy is a procedure to see inside the oesophagus and stomach using a telescope +/- sampling the tissue | ||
Abdominal and pelvic: stomach and throat – diagnostics |
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Stomach | GASTROSCOPY – Total Cost Procedure | ✓ | ✓ | A procedure to see inside the oesophagus and stomach using a telescope +/- sampling the tissue | ||
Stomach | STOMACH – Gastroscopy +/- Biopsy | ✓ | ✓ | A procedure to see inside the oesophagus and stomach using a telescope +/- sampling the tissue | ||
Throat | DIAGNOSTIC – Oesophagoscopy | ✓ | ✓ | A procedure to see inside the oesophagus using a telescope | ||
Throat | THROAT – Pharyngo-Oesophagoscopy | ✓ | ✓ | A procedure using a telescope to examine the throat (larynx and pharynx) and the oesophagus | ||
Throat | OESOPHAGUS – Manometry 24 Ambulatory pH Testing | ✓ | ✓ | A procedure used to measure the pressure in the oesophagus and stomach and measure the degree of acid present over 24 hour period | ||
Throat | OESOPHAGUS – Oesophageal Motility + 24hr Ambulatory Study | ✓ | ✓ | A procedure used to measure the pressure in the oesophagus and stomach over 24 hour period | ||
Throat | OESOPHAGUS – Oesophageal Motility Study | ✓ | ✓ | A procedure used to measure the pressure in the oesophagus | ||
Abdominal and pelvic: small bowel – diagnostics |
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Small bowel | SMALL BOWEL – Capsule Endoscopy Cam Pill | ✓ | ✓ | ✓ | A procedure using a camera and wireless transmitter which is swallowed in a capsule. The camera takes pictures of the small bowel as it passes through | |
Abdominal and pelvic surgery: gynaecology – diagnostics |
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Abdomen/Pelvis | DIAGNOSTIC – Laparoscopy – Gynaecology | ✓ | ✓ | ✓ | A key hole procedure to see inside the pelvis and abdomen using a telescope. | |
Cervix | CERVIX – Colposcopy +/- Biopsy | ✓ | ✓ | A procedure to take a tissue sample from the cervix for review | ||
Uterus | UTERUS – Hysteroscopy | ✓ | ✓ | ✓ | A procedure to see inside the vagina, cervix and uterus using a telescope. | |
Vulva | VULVA – Biopsy | ✓ | ✓ | A procedure to take a tissue sample from the vulva for review | ||
Urology: the water works, kidney, bladder (and all connecting tubes and soft tissues) – diagnostics |
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Bladder | BLADDER – Cystoscopy | ✓ | ✓ | ✓ | Examination of the bladder using a telescope on a soft tube | |
Bladder/Ureter | BLADDER – Cystoscopy / Urethroscopy | ✓ | ✓ | ✓ | A procedure to see inside the urinary bladder and the ureter using a telescope | |
Prostate | PROSTATE – Trans Rectal Ultrasound TRUS + biopsy | ✓ | ✓ | ✓ | A procedure using ultrasound – high frequency sound waves – to examine the rectum, prostate and other structures + take tissue samples | |
Ureter | URETER – Ureterorenoscopy | ✓ | ✓ | ✓ | A procedure to see inside the ureter using a telescope | |
Urine | DIAGNOSTIC – Urodynamic Assessment | ✓ | ✓ | ✓ | ✓ | A procedure using ultrasound to study the function of the bladder and urethra and evaluate urine flow and output |
Cardiology: the heart and circulatory system, blood vessels – diagnostics (including cardiac investigations) |
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Heart | HEART – Coronary Angiogram | ✓ | ✓ | A procedure using a radio-opaque dye and x-ray to examine blood vessels | ||
Heart | Cardiac Investigation Group | ✓ | ✓ | ✓ | ✓ | This is limited to the following diagnostics only. Electrocardiography (ECG) is a test to trace the electrical activity of the heart. ETT Exercise Stress test is a test to determine function under pressure. Echocardiogram (ECHO) is a sonogram of the heart. Holter Monitor Ambulatory ECG is a 24 hour monitoring test. |
Heart | HEART – Trans Oesophageal Echocardiography TOE | ✓ | ✓ | A procedure using high frequency sound waves to provide pictures of the heart valves and chambers combined with doppler ultrasound which evaluates the blood flow across the heart valves | ||
Heart | CT Angiogram | ✓ | ✓ | Computerised tomography is an x-ray of blood vessels, arteries and veins | ||
Neck/Limbs | ARTERY – Angiogram Peripheral | ✓ | ✓ | A procedure using a radio-opaque dye and x-ray to examine blood vessels usually in the neck, abdomen, pelvis and limbs | ||
Lung – diagnostics |
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Lung | DIAGNOSTIC – Bronchoscopy | ✓ | ✓ | A procedure to see inside the lungs using a telescope | ||
Bone and limbs – diagnostics |
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Back bone | MRI Spine | ✓ | ✓ | Magnetic Resonance Imaging scan which uses magnetism and radio waves to form a picture of body tissue | ||
Back bone | CT Spine | ✓ | ✓ | Computerised tomography is an x-ray of the spine | ||
Bone | BONE – Dexa /DXA | ✓ | ✓ | ✓ | A procedure using dual energy x-ray to measure the density of bone | |
Knee | KNEE – Arthroscopy | ✓ | ✓ | A procedure to see inside the knee joint using a telescope. | ||
Limbs | CT Limbs Extremity | ✓ | ✓ | Computerised tomography is an x-ray of the legs or arms | ||
Limbs | MRI Limbs Extremity | ✓ | ✓ | Magnetic Resonance Imaging scan which uses magnetism and radio waves to form a picture of the limbs | ||
Limbs | NERVE Conduction Studies and Electromyography EMG | ✓ | ✓ | A procedure which evaluates the electrical impulses of the peripheral nerves to detect if the signals are functioning | ||
General body sites: the trunk of the human body to include the digestive system – diagnostics |
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Body | MRI Musculo Skeletal | ✓ | ✓ | ✓ | Magnetic Resonance Imaging scan which uses magnetism and radio waves to form a picture of the skeleton and muscles | |
Body | CT Musculo Skeletal | ✓ | ✓ | ✓ | Computerised tomography is an x-ray of the skeleton and muscles | |
Bones | X-RAY – Examinations and Image Transfers | ✓ | ✓ | ✓ | ✓ | A procedure using electromagnetic radiation to form medical images |
Gallbladder | ERCP (Endoscopic Retrograde Cholangio Pancreatography) | ✓ | ✓ | A procedure using a telescope and fluoroscopy to diagnose conditions of gallbladder, bile system and ducts of the pancreas | ||
Soft tissue | Ultrasound | ✓ | ✓ | ✓ | ✓ | A procedure using high frequency sound waves, sonography, to provide pictures of the inside of the body |
Specific body site | E U A – Examination under Anaesthetic | ✓ | ✓ | A procedure where a system or organ of the body is examined. Usually requested where access is invasive or in children where absolute co-operation is required | ||
Trunk | MRI Abdomen or Pelvis or Chest | ✓ | ✓ | ✓ | Magnetic Resonance Imaging scan which uses magnetism and radio waves to form a picture of body tissue of the chest abdomen and pelvis | |
Trunk | CT Abdomen or Pelvis or Chest (including CT Colon) | ✓ | ✓ | ✓ | Computerised tomography is an x-ray of the chest abdomen, pelvis and large bowel | |
Nuclear medicine – diagnostics |
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Bone | BONE – Scintigraphy | ✓ | ✓ | ✓ | A nuclear medicine procedure using a radioactive isotope and external detectors to capture the radiation emitted from the bone | |
Specific body site | PET Scan | ✓ | ✓ | A nuclear medicine procedure using a radiotracer and external detectors to measure the amount of radiotracer absorbed by the body. There is a range of radiotracer used depending on the body site examined. PET scans may be superimposed on CT or MRI scans | ||
Specific body site | Myocardial perfusion test | ✓ | ✓ | A nuclear medicine procedure using a radioactive isotope and external detectors to capture the radiation emitted from the function of the heart muscle | ||
Sensory: eyes – diagnostics |
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Eye | EYE – Ocular CT Scan (OCT) | ✓ | ✓ | A procedure used to assess the structures of the eye | ||
Eye | EYE – Visual Fields | ✓ | ✓ | An analysis recording of the peripheral visual field is relation to specific eye diseases | ||
Eye | ARTERY – Temporal Artery Biopsy | ✓ | ✓ | A surgical biopsy where a small piece of tissue is removed from the temporal artery to review for inflammation | ||
Eye | EYE – Fluorescein Angiography | ✓ | ✓ | A procedure for examining the circulation of the retina in the eye using a dye | ||
Otolaryngology (ENT) – diagnostics |
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Mouth | MOUTH – Intra Oral Biopsy | ✓ | ✓ | A procedure to take a tissue sample from the mouth for analysis | ||
Mouth | MOUTH – Ortopantomogram (Panorex) | ✓ | ✓ | A dental x-ray scanning the teeth of both the upper and lower jaws | ||
Mouth | MOUTH – Biopsy | ✓ | ✓ | A procedure to take a tissue sample from the mouth for analysis | ||
Nose | NOSE – Nasendoscopy | ✓ | ✓ | A procedure to see inside the pharynx (throat) and larynx (voice box) using a telescope | ||
Sinuses | CT Sinus | ✓ | ✓ | Computerised tomography is an x-ray of the sinuses | ||
Throat | PHAYNX – Pharyngoscopy +/- Biopsy (Nasal Endoscopy) | ✓ | ✓ | A procedure to see inside the pharynx (throat) using a telescope | ||
Throat | THROAT – Laryngoscopy +/- Biopsy | ✓ | ✓ | A procedure to see inside the larynx (voice box) using a telescope | ||
Upper airways | DIAGNOSTIC – Panendoscopy | ✓ | ✓ | A procedure to see inside the pharynx, larynx, upper trachea, and oesophagus using a telescope | ||
Skin – diagnostics |
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Skin | SKIN – Biopsy | ✓ | ✓ | A procedure to obtain a sample of skin tissue for review | ||
Oncology (cancer treatment) – diagnostics |
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Vein | VEIN – Port-o-cath – Insertion & Removal | ✓ | ✓ | Insertion or removal of a plastic tube into a blood vessel for admission of chemotherapy |