E975

PDF page 613 / N33

Lateral canthoplasty
# R399 unilateral .................................................................................    6      204.80    6
# E930          - when done in conjunction with another procedure..... add                                    102.35
    Hypertelorism correction
# R376 - intracranial approach* ........................................................              12     2334.85    25
# R377 - subcranial U osteotomies*..................................................                  12     1950.15    25
# R678 - medial orbital wall osteotomies* .........................................                   10     1228.70    20
# R679 - medial and lateral orbital wall osteotomies* .......................                         10     1612.30    20
    Orbital dystopia*
# R391 - intracranial approach..........................................................              12     1950.15    25
# R392 - extracranial approach.........................................................               10     1485.10    20
    Orbital cranial osteotomy*
# R380 - intracranial approach..........................................................              12     1495.50    25
         Note:
         Claims for R380 with N153 rendered for the same patient should be submitted using the
         manual review indicator and accompanied by supporting documentation.
# R381        - extracranial approach.........................................................        10     1121.50    20
    Late correction traumatic enophthalmos
     Tessier Technique - total periorbital stripping and bone grafts.
# R680 - intracranial..........................................................................       12     1997.05    25
# R681 - extracranial.........................................................................        10     1443.95    20
    Harvesting of bone graft when not included
# Z263 Iliac bone graft ........................................................................              102.35
      Rib graft
# Z264 - one rib ................................................................................             154.00
# E975    - each subsequent rib................................................... add                         76.50
      Costochondral or chondral graft
# Z265 - one rib ................................................................................             230.65
# E976     - each subsequent rib................................................... add                       154.00
# Z266 - split cranial graft .................................................................                204.80
      Note:
      * Includes harvesting and grafting of bone or cartilage grafts.

PDF page 614 / N34

Bicoronal flaps
  R347 Bicoronal flaps ........................................................................ 200.00
     Note:
     R347 requires elevation of bicoronal flaps with exposure of the upper half facial skeleton and
     subsequent closure and re-suspension of soft tissues.
      REDUCTION
    Fractures
      Orbit - open reduction rim/wall fracture
# E173 Zygomatic fracture dislocation ................................................            6         594.70          7
# E933     - with mini-plate(s)**, per major fracture line ................ add                              99.85
# E934     - with primary bone graft (separate site) ...................... add                             204.80
      Orbit
# E174 - blowout fracture of floor......................................................          6         767.70          7
# E934     - with primary bone graft (separate site) ...................... add                             204.80
      Nasal bones - to include manipulation of nasal septum
# F136 - closed reduction .................................................................                 102.35           6
# F137 - open reduction....................................................................                 316.35          10
# E825   - with mini-plate(s)**, per major fracture line ................ add                                63.95
      Orbit with maxilla
# F150 - closed reduction and dental wiring .....................................        256.40 7
# F142 - with wiring and local fixation............................................... 6 685.20 7
# E830     - with mini-plate(s)**, per major fracture line ................ add          107.20
# E932     - primary bone graft reconstruction (separate site) in
             addition to local repair, unilateral ............................... add    205.00
# E935     - primary bone graft reconstruction (separate site) in
             addition to local repair, bilateral ................................. add   307.70
      Note:
      E932, E934, and E935 are not to be billed with Z263, Z264, Z265, Z266, E975, or E976.
        Midface fractures

Master, record 1660. Record Layout PDF, page 1.

E97520250401999999990000076500000000000000000000000000000000000000000000000

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.