E492

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

PDF page 626 / N46

Note:
         F-prefix fracture procedures are not eligible for payment with E478 for the same fracture.
# E494 Debridement (degenerative cartilage) – substantial
         debridement of 1 or more focal flaps of unstable
         degenerative articular cartilage causing mechanical
         symptoms, includes, when rendered, synovectomy,
         meniscal trimming and/or chondroplasty...................... add                                          299.00
# E498 Debridement (trauma) - substantial debridement of 1 or more
         focal flaps of unstable post-traumatic articular cartilage
         causing mechanical symptoms, includes, when rendered,
         synovectomy, meniscal trimming and/or chondroplasty add                                                   299.00
         Payment rules:
         1.E492 is not eligible for payment in addition to E494 or E498.
         2.E498 is not eligible for payment with R687 or E494.
         3.E494 or E498 are not eligible for payment for the debridement of cartilage flaps for the
           purpose of surgical visualization alone.
         [Commentary:
         When E494 or E495 are claimed with R687, or E498 is claimed with R699 it is recommended
         that the intra-articular pathology be documented with pre- and post-procedural photographic
         images taken during arthroscopy which are archived in the permanent medical record where
         possible.]
# E489 Microfracture and/or abrasion arthroplasty, for cartilage
         deficiency (includes removal of loose body(ies)........... add                                            250.00
# E495 Meniscectomy, partial or total, for symptomatic meniscal tear
         ..................................................................................... add                 240.45

Master, record 1189. Record Layout PDF, page 1.

E49220250401999999990000231300000000000000000000000000000000000000000000000

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.