E581

PDF page 593 / N13

Tendon
      Tenoplasty
# R557 - one .....................................................................................    6      223.65      7
# E050    - each additional........................................................... add                    77.05
      Tendon graft
# R559 - one .....................................................................................    6      382.30      7
# E052    - each additional........................................................... add                   324.35
# R586 Reconstruction of flexor tendon pulley, per finger...................                                  97.35      7
      Silicone rod insertion
# R554 - one .....................................................................................    6      294.20      7
# E051     - each additional........................................................... add                  245.90
      Transplant/transfer
# R563 - single ..................................................................................    6      376.05      7
# E054    - each additional........................................................... add                   311.60
      Tendon repair - extensor
# R578 - suture extensor tendon and/or open repair acute or chronic
          boutonniere deformity, single                                                               6      276.10      7
# E580 - each additional*............................................................ add                    119.40
      Flexor
# R585 - single ..................................................................................    6      433.10      7
# E581    - each additional* ......................................................... add                   181.55
      Mallet finger or Boutonniere deformity
   UVC - closed .................................................................................           visit.fee
         Note:
         *If additional tendon repair(s) requires a separate incision, bill according to Surgical Preamble
         SP2.
         [Commentary:
         Open repair of acute or chronic mallet or Boutonniere deformity may be claimed as R578.]

PDF page 599 / N19

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
 ELBOW AND FOREARM
                                                                                                     Asst   Surg     Anae
    RECONSTRUCTION
    Fascia
     Repair fascial defects
# R476 - small ...................................................................................    6     144.80    7
# R478 - large with or without synthetic graft or rotation flap ............                          6     290.55    7
    Ligaments
# R597 Simple/single repair ................................................................          6     325.45    7
# R548 Extensive/multiple repair.........................................................             6     511.45    7
       Tendons
      Suture flexor tendon excluding distal biceps tendon repair and/or reconstruction
# R585 - single .................................................................................. 6 433.10           7
# E581    - each additional........................................................... add           181.55
# R183 Distal biceps tendon repair .....................................................              6     700.00    7
# R184 Distal triceps tendon repair .....................................................             6     500.00    7
# E061   - Delayed repair requiring use of tendon graft, to R183 or
           R184 .................................................................. add 50%
         Payment rules:
         1.R183 and R184 includes mobilization of muscle, tenolysis, tendon repair as well as reduction
           and fixation of bony injury if required.
         2.E061 is only eligible for payment for surgical repair performed more than 6 weeks from the
           date of injury.
         3.E061 is only eligible for payment for irreparable tears requiring the use of tendon graft.
         4.E061 includes extensive muscle and tendon mobilization, tendon lengthening or other
           tenoplasty and the use and/or harvest of allograft or autograft tendon.
         5.E061 is not eligible for payment for chronic biceps or triceps tears that are directly repairable
           without the use of a tendon graft.
         [Commentary:
         Suture of extensor tendons of forearm may be claimed using fee codes from hand/wrist
         section.]
      Tenoplasty
# R557 - single ..................................................................................    6     223.65    7
# E050    - each additional.......................................................... add                    77.05
      Tenolysis
# R556 - single ..................................................................................    6     202.25    6
# E599    - each additional .......................................................... add                   87.20
      Transposition/transplantation/transfer
# R563 - single ..................................................................................    6     376.05    7
# E056    - each additional .......................................................... add                   91.90
# R583 Steindler flexoplasty................................................................          6     344.85    7

PDF page 765 / X13

Nerve graft
# N183 - minor - (sensory/cutaneous nerve).....................................                    6 471.05 6
# N288 - major - (mixed sensory and motor nerve, or pure motor
          nerve) ................................................................................. 6 927.55 6
# E899    - for each additional cable, to N288 ............................. add                     102.45
      Payment rules:
      1.N188 or N285 when performed through the same incision as flexor tendon repairs R585 or
        E581 is an insured service payable at nil.
         2.N289, N287, N293, N291, N183 and/or N288 include exploration, decompression, division,
           excision, and/or neurolysis of the nerve(s) involved, if performed.
         3.N293 or N291 are only eligible for payment for coaptation of one or more donor nerve
           fascicles to a recipient nerve.
         4.Nerve graft fees include harvesting of the nerve(s) required for grafting.
         5.Peripheral nerve fees codes include any guidance, nerve stimulation, or nerve mapping if
           performed.

Master, record 1277. Record Layout PDF, page 1.

E58120260401999999990000181550000000000000000000000000000000000000000000000

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.