E378

PDF page 785 / Z1

OTHER TERMS AND DEFINITIONS
                  1. The preamble to the Musculoskeletal System Surgical Procedures section also applies to this
                     section as applicable (e.g. fractures).
                  2. Fusion of one disc level (one motion segment) includes two levels of instrumentation.
                  3. Obtaining bone for grafting is included as a component of all fusion procedures and is not
                     eligible for payment when performed with any fusion procedure.
                  4. Thoracotomy performed in conjunction with spinal procedures by a surgeon not performing the
                     spinal surgery constitutes M137 (P14).
                  5. Laparotomy performed in conjunction with spinal procedures by a surgeon not performing the
                     spinal surgery constitutes S312 (S34).
                  6. Three-dimensional (3D) computer-assisted stereotactic navigation (E378) must include the pre-
                     operative or intra-operative generation of axial, sagittal and coronal reformatted images that are
                     processed and virtually represented in 3D by a surgical navigational system. In addition, the
                     surgical navigational system must be used to reflect the position of an image-guided (tracked)
                     surgical tool(s) relative to the patient's anatomy. This may be performed by either frame or
                     frameless technique and applies to any spinal level.
                  7. Two-dimensional (2D) computer-assisted stereotactic navigation (E379) must include the intra-
                     operative generation of antero-posterior, lateral or multiple oblique 2D views that are processed
                     and virtually represented in 2D by a surgical navigational system. In addition, the surgical
                     navigational system must be used to reflect the position of an image-guided (tracked) surgical
                     tool(s) relative to the patient's anatomy. This may be performed by either frame or frameless
                     technique and applies to any spinal level.
                     Note:
                     The use of an intra-operative imaging tool such as a portable x-ray, fluoroscope (2D or 3D), CT,
                     MRI or ultrasound for "live" localization without a surgical navigational system as defined
                     above does not constitute E378 or E379 and is not eligible for payment.
                  8. Acute spinal cord injury premium (E383) is only eligible for payment when rendered to patients
                     who are described under ASIA impairment scale ratings A to C and have acute conditions
                     which have been present for 6 weeks or less.

PDF page 791 / Z7

SPINAL SURGICAL PROCEDURES
 POSTERIOR SPINAL ARTHRODESIS FOLLOWING DECOMPRESSION OR OSTEOTOMY
                                                    Asst    Surg  Anae
    All levels
# E378     - 3D stereotactic spinal procedure ............................... add             510.00
# E379     - 2D stereotactic spinal procedure ............................... add             510.00
    Cervical, Thoracic & Lumbar … without instrumentation
# E369    - one disc level, to N509, N510, N520, N511 or N512 . add                           255.00
# E364    - each additional disc level fused, to E369................... add                  102.00
    Cervical … with instrumentation - by same surgeon
# E384    - C1/C2 screw fixation (transarticular, pedicle, lateral mass),
            to N509, N510, N560, N561or N572 ......................... add                   1020.00
# E370    - one disc level - below C2, to N509, N510, N572, N574,
            N575, N576, N560 or N561 ....................................... add              880.15
# E371    - fusion to occiput, to E384........................................... add         816.00
# E366         - each additional disc level fused except fusion to occiput or
                 fusion of cervico-thoracic junction, to E384 or E370.. add                   153.00
# E377         - cervico-thoracic junction, to N509, N510, E370, N572,
                 N574, N560 or N561 .................................................. add    255.00
         Note:
         Submit claims for levels fused in addition to E384 or E370 using one of E366, E371 or E377 as
         appropriate.
         [Commentary:
         E370 will be reduced to E366 if claimed with E384.]

PDF page 794 / Z10

#
                                    SPINAL SURGICAL PROCEDURES
    FRACTURES OF THE SPINE
                                                                                                            Asst         Surg         Anae
    # F200 No reduction, brace (includes Halo orthosis), total care by
             operating surgeon...............................................................                            178.50
    # F201 Closed reduction, fracture/dislocation (Halo or caliper traction)                                  6          280.50          6
    # E383   - acute spinal cord injury premium, to F201 ................. add                                           255.00
    # N572 Open reduction, any single level, spine fracture/dislocation,
               anterior/posterior ................................................................ 8 1097.30 11
    # E395     - open reduction, additional level, spine fracture/
                 dislocation, anterior/posterior, to N572....................... add                  306.00
          [Commentary:
          For closed and open reduction of sacral or sacro-iliac fractures and/or dislocations, see listings
          in the Pelvis and Hip section of the Schedule.]
    # E383    - acute spinal cord injury premium, to N572................. add        255.00
    # E362    - combined thoracotomy/laparotomy, to N572.............. add            153.00
    # E378    - 3D stereotactic spinal procedure, to N572 ................. add       510.00
    # E379    - 2D stereotactic spinal procedure, to N572 ................. add       510.00
          [Commentary:
          See Spinal Surgical Procedures Preamble for definition of eligible 2D and 3D stereotactic
          navigation systems.]
    # N573 Anterior odontoid screw fixation..............................................                     8        1020.00          11
    # E378   - 3D stereotactic spinal procedure, to N573 ................. add                                          510.00
    # E379   - 2D stereotactic spinal procedure, to N573 ................. add                                          510.00
    # N570 Vertebroplasty (injection of bone cement) as sole procedure,
             first level .............................................................................        7        1004.50           9
    # E388   - vertebroplasty combined with any other procedure, first
                level, to other procedure ............................................ add                               204.00
    # E391   - vertebroplasty, each additional level, to N570 or E388
                 ................................................................................... add                 252.95
    # N583 Kyphoplasty (balloon tamp and injection of bone cement) as
             sole procedure, first level....................................................                   8       1201.55          11
    # E392   - kyphoplasty combined with any other procedure, first
               level, to other procedure ............................................ add                                510.00
    # E393   - kyphoplasty, each additional level, to N583 or E392.. add                                                 510.00
             Note:
             1.Decompressive services at the level of the fracture are not eligible for payment when
               rendered with N572 as they are included in the open reduction.
             2.No other services in the Spinal Surgical Procedures section are eligible for payment when
               rendered with N573 except E378 or E379.
             3.No other services in the Spinal Surgical Procedures section are eligible for payment when
               rendered with N570 except E391.
             4.No other services in the Spinal Surgical Procedures section are eligible for payment when
               rendered with N583 except E393.
             [Commentary:
             Fusion procedures are eligible for payment when performed in addition to N572.]

Master, record 1120. Record Layout PDF, page 1.

E37820250401999999990000510000000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.