E555

PDF page 583 / N3

FIXATION
# E547    - methyl methacrylate (not arthroplasty)....................... add                   59.40
# E555    - rigid external fixation (excluding casts) for closed
            reduction, to closed reduction fee ...................... add 50%
# E544    - cast bracing with closed reduction, to closed reduction fee
            ........................................................................... add 40%
# E569    - percutaneous pinning, to closed reduction fee .. add 50%
# E826    - percutaneous pinning, to F005, F006, F009, or F016
            ........................................................................... add 75%
      Payment rules:
      1.E544 is not eligible for payment when a prefabricated cast, brace or splint is used.
      2.E555 is not eligible for payment with F095, F104, F134 or any fee code that includes traction.
      3.E569 is not eligible for payment for percutaneous fixation of sacral fractures or dislocations.
      4.E569 is not eligible for payment with E826.
# E590    - rigid external fixation - pseudoarthrosis ..................... add        76.10
    Removal of internal fixation device more than 30 days after insertion
# R267 - general anaesthetic ............................................................   6           201.00    6
# R268 - local anaesthetic................................................................. 6            54.85    6
# R598 Removal of extensive external fixation device under general
         anaesthetic .........................................................................           48.25    6
    Adjustment of circumferential external fixation
# Z280 - without general anaesthetic................................................                     72.35
# Z281 - with general anaesthetic.....................................................                  145.70    6
# Z210       - Insertion traction pin - excludes fractures and dislocations                              33.35
     WOUND CARE
   E550  - insertion of closed irrigation system during a surgical
           procedure for post-operative management................ add                                   63.15

PDF page 619 / N39

Fractures - dislocation(s)
      No Reduction
   UVC - Coccyx................................................................................ visit.fee
   UVC - Pelvic Ring .........................................................................  visit.fee
   UVC - Sacrum ............................................................................... visit.fee
   UVC - Femoral neck, pertrochanteric, intertrochanteric,
           trochanteric, subtrochanteric ..............................................         visit.fee
   UVC - Acetabulum ........................................................................    visit.fee
      [Commentary:
      Application of femoral fracture transport splint, skin traction or pelvic sling constitute
      emergency splinting rather than closed reductions. These are included in visit fee, if
      performed.]
      Closed Reduction
      Pelvic ring
# F134 - Closed reduction of anterior and/or posterior pelvic ring
           fracture(s) and/or dislocation(s) including rigid external
           fixation of anterior/posterior pelvic ring and/or percutaneous
           fixation of anterior pelvic ring. ............................................                6      750.00    6
# D059 - Closed reduction of sacrum and/or unilateral SI joint
           dislocation, with or without closed reduction of anterior
           pelvic ring fracture(s), including percutaneous fixation of
           sacrum and/or SI joint ........................................................                      800.00    6
  E555 - rigid external fixation to D059............................... add 50%
  E569 - percutaneous fixation of anterior pelvic ring only, to D059
            ............................................................................. add 50%
# D042 - Hip dislocation ....................................................................                   268.25    6
      Open reduction
# F135 Anterior pelvic ring fracture excluding sacrum, sacro-iliac
          joint(s) or acetabulum.........................................................                6      950.00    8
# D060 Sacrum and/or unilateral sacroiliac joint .................................                       6      950.00    6
# D052 Lips .........................................................................................    7      922.90    8
# D046 One pillar ................................................................................       6     1458.50    10
# D047 Two pillars...............................................................................        8     2187.15    12
# D043 Hip dislocation ........................................................................          7      406.45    7
# R628 Hip dislocation, late, after four weeks .....................................                     7      774.90    10
# F100 Femoral neck, pertrochanteric, intertrochanteric, trochanteric –
          cannulated screws, pin/plate and screws or intramedullary
          fixation with proximal and distal locking screws .................                             6      771.75    10
# F101 Primary prosthesis, femur only (includes Moore, Thompson,
          Unipolar, Bipolar)................................................................             6      672.65    10
     Slipped epiphysis
# R607 - closed reduction/traction ....................................................                  6      387.00    8

PDF page 620 / N40

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
PELVIS AND HIP
                                                                                              Asst         Surg         Anae
# R642 - closed reduction/internal fixation ........................................           6           502.30        8
# R627 - open reduction/fixation .......................................................       6           758.65        8
     Payment rules:
     1.F134 is not eligible for payment if percutaneous fixation of the sacrum or sacroiliac joint(s) is
       performed.
        2.F134 is not eligible for payment for application of a pelvic sling or MAST trousers to a pelvic
          fracture.
        3.E555 and E569 are not eligible for payment with F134 as this fee code includes rigid external
          fixation of anterior/posterior pelvic ring and/or percutaneous fixation of anterior pelvis.
        4.E569 is not eligible for payment with D059 for percutaneous fixation of the sacrum and/or
          unilateral SI joint as this is included in D059
        5.Open reduction of acetabular or femoral head or hip fracture or dislocations include
          arthrotomy and/or removal of loose body(ies) if performed.
        6.F101 includes reduction and fixation of trochanteric fracture if performed.
        7.R628 is not eligible for payment with D042
        [Commentary:
        Open reduction codes for pelvic fractures should only be claimed when the operative
        procedure includes exposure of the fracture with reduction and internal fixation. Minimally
        invasive, image-guided reduction without fracture exposure and with percutaneous fixation
        does not constitute open reduction.]
     Sacro-coccygeal
  UVC - closed reduction .................................................................                visit.fee
# D061 - open, removal of coccyx.....................................................            6         193.00          6
     Congenital/developmental dislocation of the hip
# R404 - closed reduction (includes tenotomy and cast) ..................                                  190.20          7
# R405 - repeat (includes cast) .........................................................                  131.80          6
# R406 - open reduction (includes tenotomy and arthrotomy) ..........                            7         472.35          7

PDF page 623 / N43

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
 FEMUR
                                                                                                     Asst    Surg     Anae
# F095 Closed reduction of femoral fracture including one of:
        - application of external fixation, or
        - skeletal traction, or
        - closed reduction with application of unilateral or bilateral hip
          spica cast in infant or child                                                               6      407.35    6
      Open reduction
# F096 Femur .....................................................................................    6      774.05    8
# F093 Diaphyseal or metaphyseal distal femur fracture with intra-
         articular extension – with or without intramedullary fixation                                6     1285.00    8
         Payment rules:
         1.F096 includes intramedullary nail with proximal and distal locking screws if performed.
         2.F093 is not eligible for payment for repair of an isolated distal femoral osteochondral fracture.
         3.F021 and F096 are not eligible for payment with F093 for treatment of fractures below the
           intertrochanteric region on the same femur.
         4.E555 is not eligible for payment with F094 or F095.
         5.Z207 and Z209 are not eligible for payment with F095.

PDF page 637 / N57

Fractures
      Ankle
# F074 - no reduction - rigid immobilization ......................................                           67.75
# F075 - closed reduction .................................................................            6     144.80    6
      - open reduction
# F076 - one malleolus .....................................................................           6     466.70    7
# F077 - multiple malleoli or ligaments .............................................                  6     746.10    7
      Ankle fracture with tibial Plafond burst
# F104 - closed reduction and external fixation ................................            6 363.40 6
# F108 - open reduction.................................................................... 6 954.35 6
      Payment rules:
      1.F108 is only eligible for payment for AO/OTA ankle plafond fractures classified as partial
        articular (43-B) or complete articular (43-C).
         2.F108 includes repair of medial or lateral or syndesmotic ligaments of the same ankle if
           performed.
         3.F108 is not eligible for payment with, F076, F077, R185 and/or R744 for repair/
           reconstruction of the same ankle.
         4.F104 is not eligible for payment for closed reduction of an ankle tibial plafond burst fracture
           without external fixation.
         5.E555 is not eligible for payment with F104.
      Metatarsus
  F061 - one or more ........................................................................                 49.20
  F062 - with rigid immobilization .....................................................                      67.75
      - closed reduction
  F063 - one or more ........................................................................          6      98.35    6
      - open reduction
# F064 - one .....................................................................................     6     358.05    7

Master, record 1251. Record Layout PDF, page 1.

E55520130701999999990000000010000000000000000000000000000000000000000000000

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.