R628

PDF page 548 / SP6

SURGICAL PREAMBLE
PREAMBLE
 24. Morbidly obese patients
     E676 is eligible for payment once per patient per physician in addition to the amount eligible for
     payment for the major surgical procedure(s) where a morbidly obese patient undergoes major
     surgery to the neck, thorax, peritoneal cavity, retroperitoneum, pelvis, or hip and:
    a. the patient has a Body Mass Index (BMI) greater than 40
    b. the surgery is rendered under general anaesthesia using either an open technique for the
       neck, thorax, or hip, or an open or laparoscopic technique for the peritoneal cavity, pelvis,
       retroperitoneum; and
    c. the principal surgical technique is neither aspiration, core or fine needle biopsy, dilation,
       endoscopy, mediastinoscopy, thoracoscopy, cautery, ablation nor catheterization.
E676A Morbidly obese patient, surgeon, to procedural fee(s)...... add                      25%
E676B Morbidly obese patient, surgical assistant, to major procedure
        add                                                                               6 units
     Note:
     E676A/B is only payable with the following procedures: D043, D046, D047, D052, E090, E499,
     E500, E505, E546, E589, E593, E626, E627, E655, E664, E673, E686, E697, E704, E706,
     E707, E708, E709, E711, E712, E713, E714, E718, E721, E722, E725, E728, E729, E731,
     E733, E734, E735, E736, E737, E738, E739, E743, E745, E748, E752, E754, E762, E764,
     E765, E766, E767, E768, E769, E771, E794, E796, E852, E853, E854, E855, E857, E860,
     E880, E882, E883, E884, E885, F100, F101, F135, M081, M082, M084, M090, M099, M100,
     M142, M143, M144, P018, P041, P042, P050, P055, P056, P057, P058, P059, P060, R108,
     R109, R216, R241, R269, R330, R423, R439, R440, R443, R470, R481, R488, R491, R553,
     R569, R590, R627, R628, R639, R686, R786, R800, R802, R803, R805, R806, R807, R811,
     R814, R815, R817, R823, R825, R826, R834, R839, R852, R855, R856, R858, R860, R861,
     R910, R885, R905, R913, R914, R915, R932, R933, R934, R935, R936, R937, S089, S090,
     S114, S115, S116, S117, S118, S120, S121, S122, S123, S124, S125, S128, S129, S131,
     S132, S133, S134, S137, S138, S139, S140, S149, S150, S154, S157, S158, S159, S160,
     S162, S164, S165, S166, S167, S168, S169, S170, S171, S172, S173, S175, S176, S177,
     S180, S182, S183, S184, S185, S187, S188, S189, S191, S192, S193, S194, S195, S196,
     S197, S199, S204, S207, S213, S214, S215, S217, S218, S222, S227, S265, S266, S267,
     S269, S270, S271, S274, S275, S276, S278, S280, S281, S282, S285, S287, S291, S292,
     S294, S295, S297, S298, S299, S300, S301, S302, S303, S304, S305, S306, S307, S308,
     S309, S310, S311, S312, S313, S314, S315, S318, S319, S321, S323, S325, S329, S332,
     S340, S342, S343, S344, S345, S405, S411, S416, S420, S422, S424, S427, S431, S432,
     S433, S434, S435, S436, S438, S440, S441, S445, S446, S447, S448, S449, S450, S451,
     S452, S453, S454, S455, S457, S460, S461, S462, S465, S466, S467, S468, S471, S482,
     S483, S488, S490, S491, S512, S513, S546, S549, S561, S590, S650, S651, S652, S710,
     S714, S727, S728, S729, S731, S733, S735, S736, S738, S739, S740, S741, S743, S745,
     S747, S748, S750, S751, S757, S758, S759, S760, S761, S763, S764, S766, S775, S776,
     S778, S780, S781, S782, S784, S788, S789, S790, S792, S793, S795, S798, S799, S800,
     S813, Z427, Z526, Z552, Z553, Z564, Z569, Z577, Z594, Z737, Z738

PDF page 619 / N39

Fractures - dislocation(s)
      No Reduction
   UVC - Coccyx................................................................................ visit.fee
   UVC - Pelvic Ring .........................................................................  visit.fee
   UVC - Sacrum ............................................................................... visit.fee
   UVC - Femoral neck, pertrochanteric, intertrochanteric,
           trochanteric, subtrochanteric ..............................................         visit.fee
   UVC - Acetabulum ........................................................................    visit.fee
      [Commentary:
      Application of femoral fracture transport splint, skin traction or pelvic sling constitute
      emergency splinting rather than closed reductions. These are included in visit fee, if
      performed.]
      Closed Reduction
      Pelvic ring
# F134 - Closed reduction of anterior and/or posterior pelvic ring
           fracture(s) and/or dislocation(s) including rigid external
           fixation of anterior/posterior pelvic ring and/or percutaneous
           fixation of anterior pelvic ring. ............................................                6      750.00    6
# D059 - Closed reduction of sacrum and/or unilateral SI joint
           dislocation, with or without closed reduction of anterior
           pelvic ring fracture(s), including percutaneous fixation of
           sacrum and/or SI joint ........................................................                      800.00    6
  E555 - rigid external fixation to D059............................... add 50%
  E569 - percutaneous fixation of anterior pelvic ring only, to D059
            ............................................................................. add 50%
# D042 - Hip dislocation ....................................................................                   268.25    6
      Open reduction
# F135 Anterior pelvic ring fracture excluding sacrum, sacro-iliac
          joint(s) or acetabulum.........................................................                6      950.00    8
# D060 Sacrum and/or unilateral sacroiliac joint .................................                       6      950.00    6
# D052 Lips .........................................................................................    7      922.90    8
# D046 One pillar ................................................................................       6     1458.50    10
# D047 Two pillars...............................................................................        8     2187.15    12
# D043 Hip dislocation ........................................................................          7      406.45    7
# R628 Hip dislocation, late, after four weeks .....................................                     7      774.90    10
# F100 Femoral neck, pertrochanteric, intertrochanteric, trochanteric –
          cannulated screws, pin/plate and screws or intramedullary
          fixation with proximal and distal locking screws .................                             6      771.75    10
# F101 Primary prosthesis, femur only (includes Moore, Thompson,
          Unipolar, Bipolar)................................................................             6      672.65    10
     Slipped epiphysis
# R607 - closed reduction/traction ....................................................                  6      387.00    8

PDF page 620 / N40

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
PELVIS AND HIP
                                                                                              Asst         Surg         Anae
# R642 - closed reduction/internal fixation ........................................           6           502.30        8
# R627 - open reduction/fixation .......................................................       6           758.65        8
     Payment rules:
     1.F134 is not eligible for payment if percutaneous fixation of the sacrum or sacroiliac joint(s) is
       performed.
        2.F134 is not eligible for payment for application of a pelvic sling or MAST trousers to a pelvic
          fracture.
        3.E555 and E569 are not eligible for payment with F134 as this fee code includes rigid external
          fixation of anterior/posterior pelvic ring and/or percutaneous fixation of anterior pelvis.
        4.E569 is not eligible for payment with D059 for percutaneous fixation of the sacrum and/or
          unilateral SI joint as this is included in D059
        5.Open reduction of acetabular or femoral head or hip fracture or dislocations include
          arthrotomy and/or removal of loose body(ies) if performed.
        6.F101 includes reduction and fixation of trochanteric fracture if performed.
        7.R628 is not eligible for payment with D042
        [Commentary:
        Open reduction codes for pelvic fractures should only be claimed when the operative
        procedure includes exposure of the fracture with reduction and internal fixation. Minimally
        invasive, image-guided reduction without fracture exposure and with percutaneous fixation
        does not constitute open reduction.]
     Sacro-coccygeal
  UVC - closed reduction .................................................................                visit.fee
# D061 - open, removal of coccyx.....................................................            6         193.00          6
     Congenital/developmental dislocation of the hip
# R404 - closed reduction (includes tenotomy and cast) ..................                                  190.20          7
# R405 - repeat (includes cast) .........................................................                  131.80          6
# R406 - open reduction (includes tenotomy and arthrotomy) ..........                            7         472.35          7

Master, record 4853. Record Layout PDF, page 1.

R62820260401999999990000774900000000903700000000000000000159600000001596000

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.