E482

PDF page 589 / N9

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
 HAND AND WRIST
                                                                                         Asst   Surg     Anae
    ARTHROSCOPY
# R682 Wrist arthroscopy setup, includes when rendered
         debridement, synovectomy, synovial biopsy, removal of
         loose body(ies) and/or screw, drilling of defect or
         microfracture, and/or wrist ganglion debridement. .............                  6     400.00    7
         Note:
         1.A wrist procedure listed in the Hand and Wrist section of the Schedule performed
           arthroscopically is eligible for payment in addition to R682 if that procedure is not described
           as a component of R682 or described by an E-add-on code to R682.
         2.Arthroscopic E-add-on codes listed below are not eligible for payment in addition to R682
           when the service described by the E-code is a generally accepted component of a procedure
           described in Note #1.
# E479 Arthroscopy of midcarpal and/or distal radio-ulnar joint,
          through separate portals, to R682................................ add                 192.00
# E478 Pinning of osteochondral fragment, to R682 .................... add          251.55
      Note:
      F-prefix fracture procedures are not eligible for payment with E478 for the same fracture.
# E480 Triangular fibrocartilage complex repair, to R682 ............. add                      350.65
# E482 Soft tissue capsular release, for contractures, without bone
         procedure, to R682....................................................... add          251.55
# E483 Synovectomy for inflammatory arthritis requiring a minimum of
          90 minutes to resect, to R682 ...................................... add              326.55
      Payment rules:
      1.Synovectomy less then 90 minutes in duration is included in R682.
         2.Only one of E482 or E483 is eligible for payment same patient same day.

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 616 / N36

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
PELVIS AND HIP
                                                                                                         Asst         Surg         Anae
    AMPUTATION
# R631 Hemipelvectomy - hindquarter................................................                        10         796.20         15
# R630 Hip disarticulation ...................................................................             10         753.50         10
    ARTHRODESIS
# R469 Sacro-iliac joint .......................................................................            6         395.25          7
# R514 Symphysis pubis.....................................................................                 6         387.00          7
# R470 Hip ..........................................................................................       6         703.45          8
    ARTHROPLASTY
# R439 Unipolar ..................................................................................          6         641.15         10
# R440 Total hip replacement - acetabulum and femur.......................                                  8         708.70         10
# R553 Total hip replacement with take down of fusion ......................                                8         972.90         15
    Revision total arthroplasty hip - one or both components
# R241 - acetabular or femoral .........................................................                    9        1304.80         15
# E589    - bone graft to acetabulum ........................................... add                                  101.25
# E593    - acetabular reconstruction (extensive, including bone
            grafts)......................................................................... add                      194.00
# R481 Reattachment of greater trochanter (late)...............................                             6         290.55          8
    Removal only
# R443 - non-cemented ....................................................................                  6         447.30          8
# R488 - cemented............................................................................               6         557.75          8
# R491 Replacement acetabular liner and/or femoral head................                                     8         532.30         10
    ARTHROSCOPY
# R686 Hip arthroscopy set up, includes when rendered debridement,
         synovectomy, removal of loose body(ies) and/or screw,
         drilling of defect, microfracture, abrasion arthroplasty, and/
         or synovial biopsy...............................................................                  6         669.80         10
# E487 Resection of labrum, to R686 ........................................... add                                   240.00
# E488 Repair of labrum, to R686................................................. add                                 350.00
# E482 Soft tissue capsular release without bone procedure, to R686
          ..................................................................................... add                   251.55
# E490 Osteochondroplasty (extensive bone and arthrofibrotic tissue
         removal requiring a minimum of 2 hours to resect), to R686
          ..................................................................................... add                   500.00
         Payment rules:
         1.E487 is not eligible for payment in addition to E488.
         2.Only one of E482 or E490 is eligible for payment same patient same day.
         3.Osteochondroplasty requiring less than 2 hours is included in R686.

Master, record 1179. Record Layout PDF, page 1.

E48220250401999999990000251550000000000000000000000000000000000000000000000

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.