ECLIPSE

Online Eligibility Presenting Illness List (Version 1.4) – current as at 1/4/2019

The following table contains the current list of presenting illness that can be submitted in the ECLIPSE Online Eligibility Check (OEC).

Code OEC Description
301 Minor Gynaecological Surgery
302 Assisted Reproductive services or infertility treatments
303 Pregnancy related services including Obstetrics
304 Eye – Laser Surgery / refractive
305 Eye – Cataracts
306 Eye – Glaucoma
309 Cardiac (heart and artery)
310 Psychiatric
311 Rehabilitation
313 Surgical Podiatry
314 Dialysis for chronic renal failure
315 Chemotherapy
318 Teeth/Dental
319 Palliative care
320 Medical admission
321 Gastric Banding and all obesity related treatment
322 Bone Marrow transfusion or transplant (autologous and allogeneic incl harvesting, cryopreservation)
323 Spinal Fusion
324 Back and spinal surgery excluding spinal fusion surgery
330 Endoscopy including Colonoscopy and gastroscopy
331 Cystoscopy
333 Oesophagoscopy
334 Shoulder arthroscopy and selected minor shoulder procedures
335 Ankle arthroscopy and ankle ligament repair
336 Knee arthroscopy and meniscectomy
341 Joint replacement – Hip
342 Joint replacement – Knee
343 Joint replacement – Shoulder
344 Joint replacement – Other
347 Appendicitis
350 Lithotripsy
351 Insulin Pumps
360 Sleep Studies
361 Removal of Tonsils and Adenoids
370 Plastic and reconstructive surgery
375 Cosmetic
376 Abdominoplasty
377 Blepharoplasty
378 Breast Augumentation/Reduction
379 Labioplasty/vulvoplasty
380 Lipectomy
381 Liposuction
382 Penile Enlargements
383 Ptosis of skin
384 Rhinoplasty
385 Surgical face lifts
390 Sterilisation
393 Brain Surgery
394 Vascular Surgery
395 Organ Transplant
399 Unknown or Other Surgery
400 Miscarriage and termination of pregnancy
401 Gynaecology
402 Assisted reproductive services
403 Pregnancy and birth
404 Male reproductive system
405 Cataracts
406 Eye (not cataracts)
407 Eye – Laser
408 Lung and chest
409 Heart and vascular system
410 Hospital psychiatric services
411 Rehabilitation
412 Palliative care
413 Kidney and bladder
414 Dialysis for chronic kidney failure
415 Chemotherapy, radiotherapy and immunotherapy for cancer
416 Blood
417 Bone marrow transfusion or transplant
418 Dental surgery
419 Podiatric surgery (provided by a registered podiatric surgeon)
420 Medical admission (unknown)
423 Back, neck and spine
424 Bone, joint and muscle
425 Joint reconstructions
426 Joint replacements – other
427 Joint replacements (hip and knee)
430 Gastrointestinal endoscopy
431 Hernia and appendix
432 Digestive system
433 Weight loss surgery
441 Pain management
442 Pain management with device
451 Insulin pumps
452 Diabetes management (excluding insulin pumps)
460 Sleep studies
461 Tonsils, adenoids and grommets
462 Ear, nose and throat
463 Implantation of hearing devices
470 Plastic and reconstructive surgery (medically necessary)
471 Skin
475 Cosmetic surgery
478 Breast surgery (medically necessary)
493 Brain and nervous system
495 Organ transplant
499 Unknown or other surgery

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