E481

PDF page 596 / N16

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
ELBOW AND FOREARM
                                                                                                       Asst         Surg          Anae
    AMPUTATION
# R613 Through radius and ulna.........................................................                   6         351.05          7
# R614 Elbow disarticulation ...............................................................              6         289.50          6
    ARTHRODESIS
# R466 Elbow ......................................................................................       6         833.45          6
    ARTHROPLASTY
# E564 revision of elbow arthroplasty ................................... add 35%
# R281 Ulna replacement (lower end).................................................                      6         296.90           6
# R288 Implant radial head .................................................................              6         452.00           6
# R499 Removal of total replacement .................................................                     6         402.75           7
# R438 Humeral Prosthesis ................................................................                6         676.90          10
# R486 Complete arthroplasty replacement........................................                          6        1205.95           8
# R510 Interposition arthroplasty ........................................................                6         435.20           7
    ARTHROSCOPY
# R683 Elbow arthroscopy setup, includes when rendered
          debridement, synovectomy, synovial biopsy, removal of
          loose body(ies) and/or screw, drilling of defect or
          microfracture, and/or arthroscopic epicondylar release .....                                    6         400.00          7
         Note:
         1.An elbow procedure listed in the Elbow section of the Schedule performed arthroscopically is
           eligible for payment in addition to R683 if that procedure is not described as a component of
           R683 or described by an E-add-on code to R683.
         2.Arthroscopic E-add-on codes listed below are not eligible for payment in addition to R683
           when the service described by the E-code is a generally accepted component of a procedure
           described in Note #1.
# E478 Pinning of osteochondral fragment, to R683 .................... add                                          251.55
         Note:
         F-prefix fracture procedures are not eligible for payment with E478 for the same fracture.
# E481 Osteochondroplasty (extensive bone and arthrofibrotic tissue
         removal requiring a minimum of 2 hours to resect), to R683
          ..................................................................................... add                 500.00
# E482 Soft tissue capsular release for contractures without bone
         procedure, to R683....................................................... add                              251.55
# E483 Synovectomy for inflammatory arthritis requiring a minimum of
          90 minutes to resect, to R683 ...................................... add 326.55
      Payment rules:
      1.Only one of E481, E482 or E483 is eligible for payment same patient same day.
         2.Synovectomy less then 90 minutes in duration is included in R683.
         3.Osteochondroplasty less than 2 hours in duration is included in R683.

PDF page 633 / N53

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
 FOOT AND ANKLE
                                                                                                     Asst   Surg     Anae
      Metatarsophalyngeal interposition
# R456 - single ..................................................................................    6     144.80    6
# E538    - each additional........................................................... add                   38.00
# R453 Metatarsophalyngeal (Swansons, etc.)...................................                        6     376.60    7
# R454 - multiple ...............................................................................     6     387.00    7
# R500 Removal - prosthesis without replacement.............................                          6     144.80    6
    ARTHROSCOPY
# R688 Ankle arthroscopy setup, includes when rendered
         debridement, synovectomy, removal of loose body(ies) and/
         or screw, drilling of defect or microfracture and/or synovial
         biopsy .................................................................................     6     400.00    7
         Note:
         1.An ankle procedure listed in the Foot and Ankle section of the Schedule performed
           arthroscopically is eligible for payment in addition to R688 if that procedure is not described
           as a component of R688 or described by an E-add-on code to R688.
         2.Arthroscopic E-add-on codes listed below are not eligible for payment in addition to R688
           when the service described by the E-code is a generally accepted component of a procedure
           described in Note #1.
# E477 Arthroscopy of subtalar and/or intratarsal joint(s), through
          separate portals, to R688 ............................................. add                       192.00
# E478 Pinning of osteochondral fragment, to R688 .................... add          251.55
      Note:
      F-prefix fracture procedures are not eligible for payment with E478 for the same fracture.
# E481 Osteochondroplasty (extensive bone and arthrofibrotic tissue
         removal requiring a minimum of 2 hours to resect),
          to R688........................................................................ add               500.00
# E483 Synovectomy for inflammatory arthritis requiring a minimum of
         90 minutes to resect, to R688 ...................................... add                           326.55
# R689 Excision of Os Trigonum (sole procedure).............................. 6 230.00                                7
     Payment rules:
     1.Only one of E481 or E483 is eligible for payment same patient same day.
         2.R688 is not eligible for payment in addition to R689.

Master, record 1178. Record Layout PDF, page 1.

E48120250401999999990000500000000000000000000000000000000000000000000000000

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.