R418

PDF page 588 / N8

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
HAND AND WRIST
                                                                                                        Asst         Surg         Anae
    AMPUTATION
# R608 Phalanx, metacarpal or metacarpophalangeal joint................                                              269.30          7
# E583   - each additional, to R608 ............................................ add                                  94.60
# R612 Wrist........................................................................................       6         289.50          6
# R629 Revision of amputated finger tip .............................................                      6         241.55          6
    ARTHRODESIS
# R465 Finger-thumb ..........................................................................             6         394.70          7
# R777 Wrist - total or partial arthrodesis............................................                    6         833.45          6
     Payment rules:
     1.R465 and R777 include wrist denervation if performed.
         2.R285, R286, R316, R317, R418 are not eligible for payment with R465 or R777
         3.R777 is only eligible for payment for total wrist arthrodesis or for partial wrist arthrodesis
           involving 2 or more carpal bones
    ARTHROPLASTY
# E564  - revision of arthroplasty....................................... add 35%
    Wrist
# R437 - interposition ........................................................................            6         374.00          7
# R485 - total radio-carpal.................................................................               6        1130.15          6
# R479 - removal only .......................................................................              6         193.00          6
# R489 Single joint - total (arthrodesis and/or arthroplasties) maximum
          of 4 ..................................................................................... 6 358.60 7
# R209 First carpometacarpal joint ligament reconstruction and tendon
          interposition arthroplasty (LRTI) .........................................                6 775.00 7
# R500 Removal - prosthesis without replacement.............................                         6 144.80 6
# R236 Carpal replacement ................................................................           6 322.05 7
     Payment rules:
     1.R485 includes any and all of: carpal bone excision(s), proximal row carpectomy, radio-ulnar
       meniscectomy, intercarpal fusion(s), all tenotomies, division and repair of muscle, and wrist
       denervation, if performed.
         2.R485 is not eligible for payment for carpometacarpal arthroplasty.
         3.R285 and R316 are not eligible for payment with arthrodesis or arthroplasty fee codes for the
           same anatomic location.
         4.R209 includes excision of the trapezium, suspensionplasty of the first metacarpal, ligament
           reconstruction with local tendon graft or allograft or nonbiologic material and interposition of
           soft tissue in the trapezial void and excision of the scaphotrapezoid joint, if performed.
         5.R209 is not eligible for payment for suspensionplasty and/or hematoma-distraction
           arthroplasty alone.
         6.E551, E552, E553, R597, R548 and R601 are not eligible for payment with R209.
         [Commentary:
         Suspensionplasty performed at the time of trapeziectomy without tendon interposition
         arthroplasty is payable as R285 and R597.]

PDF page 591 / N11

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
 HAND AND WRIST
                                                                                                   Asst   Surg     Anae
    EXCISION
    Bone
# R316 Proximal row carpectomy .......................................................              6     451.90    7
# R285 Carpal - bone (one).................................................................         6     214.45    7
# R317 Dorsal exostosis (triquetrum)..................................................              6     189.75    6
# R286 Radial styloid ..........................................................................    6     234.75    7
# R283 Phalanx/metacarpal ................................................................          6     193.00    7
# R272 Bone tumour (see General Preamble GP12)..........................                           I.C     I.C     I.C
    Joint
     Synovectomy/capsulectomy/debridement
# R425 - finger joint...........................................................................    6     261.55    6
# R414 - two or more joints ...............................................................         6     339.65    7
# R407 Synovectomy of extensor or flexor tendons............................                              224.45    6
# R418 Synovectomy/debridement - wrist...........................................                   6     342.55    7
# R492 Radio-ulnar meniscectomy .....................................................               6     231.10    7
    Soft tissue
# R549 Ganglion - Simple or complex.................................................                6     221.80    6
# R551 Excision of fascia for Dupuytrens (palmar fibromatosis), single
           ray, with or without flaps. ....................................................         6     322.15    7
# E832     - excision of fascia for Dupuytrens, additional rays, to R551
             add                                                                                          273.85
# E831     - use of skin grafts, or revision surgery (with or without skin
             grafts), to R549 or R551 ................................... add 30%
         Payment rules:
         1.Excision of fascia for Dupuytren’s (R551, E832) is only insured for patients who demonstrate
           at least one of the following physical signs:
            a.Metacarpophalangeal (MCP) joint flexion contractures of 30 degrees or more.
            b.Interphalangeal (IP) joint flexion contracture of any degree.
            c.Adduction contractures of the interdigital web spaces with significant functional
              impairment.
            d.Recurrence of Dupuytren’s disease, defined as any recurrent flexion contracture of the
              MCP or IP joints following prior interventional treatment (e.g., fasciotomy/fasciectomy).
            e.Significant functional impairment with any degree of contracture at the MCP or IP joints.
         2.R551 is not payable for treatment of Dupuytren’s by aponeurotomy.
         3.A maximum of one R551 is eligible for payment per limb, per day.
         4.A maximum of two E832 are eligible for payment per limb, per day.
         5.Services listed under “Skin Flaps and Grafts” are not eligible for payment with R549 or R551.
         6.R551, E832 and E831 include the palmar and digital components of the Dupuytrens
           procedure, when rendered.
         [Commentary:
         When excision of fascia for Dupuytren’s is performed for one ray, claim R551; when two rays
         on the same hand are treated, claim R551 and E832; when three or more rays on the same
         hand are treated, claim R551 and E832 (2).]

Master, record 4646. Record Layout PDF, page 1.

R41820260401999999990000342550000000774600000000000000000111720000001117200

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.