E491

PDF page 626 / N46

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
KNEE
                                                                              Asst      Surg     Anae
         4.Prior approval may be granted for E494 or E495 in patients with Kellgren-Lawrence grade 3
           or 4 osteoarthritis (see Kohn MD, Sassoon AA, Fernando ND. Classifications in brief:
           Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res. 2016 Aug;
           474(8):1886-93) if the clinical record supports:
            a.Significant functional impairment caused by an unstable articular chondral flap or
               degenerative meniscal tear which has not responded to a minimum of six months active
               non-surgical treatment; and
            b.the patient is not a current candidate for knee realignment or arthroplasty.]
# E476 Removal of symptomatic loose body(ies) and/or screw ... add                                                 192.00
      Note:
      Removal of iatrogenic loose body(ies) is not eligible for payment.
# E491 Lateral release .................................................................. add                      161.45
# E492 Synovectomy - for diseased synovium, anterior, posterior or
         complete....................................................................... add                       231.30
# E493 Drilling of defect (includes removal of loose body(ies) ..... add                                           251.55
# E478 Pinning of osteochondral fragment ................................... add                                   251.55

Master, record 1188. Record Layout PDF, page 1.

E49120250401999999990000161450000000000000000000000000000000000000000000000

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.