R391

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.

Master, record 4619. Record Layout PDF, page 1.

R39120260401999999990001950150000001549200000000000000000399000000003990000

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.