R086

PDF page 563 / M13

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
 SKIN AND SUBCUTANEOUS TISSUE
                                                                                               Asst   Surg    Anae
    Debridement, excision, fasciotomy, escharotomy, and/or grafting - in Operating Room
# R691 Minor burn................................................................... per unit  75.00
# R692 Moderate burn ............................................................ per unit     87.50
# R693 Major burn................................................................... per unit 100.00
     Payment rules:
     1.R691, R692 and R693 are eligible for payment only when rendered in an Operating Room.
         2.Unit means ¼ hour or major part thereof.
         3.Time units are calculated based on the time spent by the physician in direct contact with the
           patient and commence when the physician is first in attendance with the patient in the
           operating room and end when the physician is no longer in attendance with that patient in the
           operating room.
         4.Only one of R691, R692 or R693 is eligible for payment for the same patient during the same
           encounter.
         5.R083, R084, R085, R086, R087, R088, R091, R092, R093, R495 are not eligible for payment
           in addition to R691, R692 or R693.
         [Commentary:
         See General Preamble GP7 for definitions and time-keeping requirements. As noted on GP7,
         start and stop times must be recorded in the patient's permanent medical record or the service
         is not eligible for payment.]

PDF page 569 / M19

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
 SKIN AND SUBCUTANEOUS TISSUE
                                                                                                    Asst   Surg     Anae
       D. Myocutaneous, myogenous or fascia-cutaneous flaps
     Note:
     To include closure of donor site defect by any means.
# R005 Sterno-mastoid, tensor fascia lata, gluteus maximus, gracilis,
          sartorius, rectus femoris, gastrocnemius (medial and
          lateral), trapezius................................................................        6     545.00    6
# R006 Pectoralis major ...................................................................... 6 734.95              6
# R155 Latissimus dorsi or unilateral rectus abdominus.....................                    6 734.95              6
     Note:
     R006 is not eligible for payment for post-mastectomy breast reconstruction.
# R008 Lower transverse rectus abdominus flap ................................                       6     984.55    8
      Repair of abdominal defect
# Z196 - different surgeon ................................................................                377.65
# E523   - same surgeon, to other procedure............................. add                               321.00
# R009 Myocutaneous - osseous flaps e.g. pectoralis major
         myocutaneous flap with rib graft, trapezius flap with scapula
         spine...................................................................................    6     783.40    8
# R007 Other - (see General Preamble GP12) ...................................                      I.C    I.C      I.C
       SKIN GRAFTS
    A. Split thickness grafts (for burn grafts see pages M10 & M11)
# R084 Very minor, very small areas, e.g. trauma ..............................        92.30 7
# R085 Minor, medium sized areas, e.g. small or skin ulcer, breast, etc             6 140.25 6
# R086 Intermediate, large areas, e.g. trunk, arms, legs ....................       6 259.10 7
# R087 Major, complex areas, e.g. face, neck, hands ........................        6 388.00 7
# R088 Extensive major, very large area(s) ........................................ 6 567.95 6
     Note:
     The medical record must demonstrate the appropriateness of code claimed relative to size.

Master, record 4342. Record Layout PDF, page 1.

R08620260401999999990000259100000000774600000000000000000111720000001117200

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.