Codes for internal or external fixation are to be used only when internal or external fixation is not already listed as part of the basic procedure.

Transcription

1 code it ALLOMATRIX DR Putty DBM Putty with cancellous chips HPS Device odes HPS codes are developed and maintained by MS and are used to report items such as medical devices, implants, drugs and supplies. -codes are a special type of HPS code designed specifically for hospital use in billing for certain outpatient items and procedures. Other payers may also accept -codes. S codes are used by private insurers to report drugs, services, and supplies for which there are no national codes but for which codes are needed by the private sector to implement policies, programs, or claims processing. They are for the purpose of meeting the particular needs of the private sector. Not all implanted items have a specific HPS code. If desired, a miscellaneous HPS code can be used. HPS ode Description 2015 Reimbursement odes The following codes contained within this document are representative of possible services or diagnoses that may be associated with use of Wright products. This is not a complete listing of possible codes. Not all of the codes are necessarily to be used together. Some codes may be considered a component of another ( bundled ). Final determination of the correct or appropriate coding for services are made by the claims submitter/provider and should be consistent with the billing policies of the patient s health insurance program. PT codes and descriptors are copyrighted by the American Medical Association (AMA). PT is a registered trademark of the American Medical Association. For further information, visit Anchor/screw for opposing bone-to-bone or soft tissue bone (implantable) Reference: List of Device ategory odes for Present or Previous Pass-Through and Related Definitions, January 2015 PT odes odes for internal or external fixation are to be used only when internal or external fixation is not already listed as part of the basic procedure. Physician oding Resource based relative value scale (RBRVS) is the prospective payment system uses to reimburse physicians. Each service has relative value units () that indicate its rank compared to all other services in terms of the relative costs of the resources required, including physician work, practice expenses, and malpractice insurance. The RVU is converted to a flat payment amount using a standardized conversion factor. Different sites of services have different and payment: AA AA AA Facility represent surgical services provided in hospitals, ambulatory surgical centers, or skilled nursing facilities. Non-Facility represent surgical services provided in physician s offices. and payments are usually lower in the Facility setting because the facility is incurring some of the costs. and payments are usually higher in the Non-Facility setting because the physician incurs all costs there and the physician must be reimbursed for those costs. NA indicates that the Non-Facility do not exist because the service is expected to be in a facility. UNL indicates the PT code as unlisted, and therefore Non-Facility or Facility cannot be calculated. PT ODE Description Facility Non-Facility proximal humerus 18.9 $677 NA NA proximal humerus; with allograft $693 NA NA Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck $776 NA NA Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when, includes repair of tuberosity(s), when Open treatment of greater humeral tuberosity fracture, includes internal fixation, when $905 NA NA $799 NA NA Excision or curettage of bone cyst or benign tumor, humerus $600 NA NA Excision or curettage of bone cyst or benign tumor, humerus; with allograft $883 NA NA head or neck of radius or olecranon process $538 NA NA Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus $765 NA NA

2 PT ODE Description Facility Non-Facility Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck $590 NA NA Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process $690 NA NA Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when ; with intercondylar extension Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when $605 NA NA $896 NA NA $880 NA NA $1,063 NA NA $687 NA NA $665 NA NA $667 NA NA Unlisted procedure, humerus or elbow UNL UNL UNL UNL carpal bones $454 NA NA carpal bones; with allograft $503 NA NA Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular) (includes obtaining graft and necessary fixation), each bone Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation) $799 NA NA $783 NA NA Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist $528 NA NA Open treatment of radial shaft fracture, includes internal fixation, when $683 NA NA Open treatment of ulnar shaft fracture, includes internal fixation, when $636 NA NA Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation $749 NA NA Open treatment of ulnar styloid fracture $636 NA NA Unlisted procedure, forearm or wrist UNL UNL UNL UNL Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal Open treatment of metacarpal fracture, single, includes internal fixation, when, each bone $734 NA NA $507 NA NA $587 NA NA Unlisted procedure, hands or fingers UNL UNL UNL UNL Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular) $935 NA NA Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure) $1,124 NA NA Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft onversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage Open treatment of greater trochanteric fracture, includes internal fixation, when $1,390 NA NA $1,717 NA NA $1,262 NA NA $1,262 NA NA $761 NA NA Unlisted procedure, pelvis or hip joint UNL UNL UNL UNL femur $616 NA NA femur; with allograft $755 NA NA

3 PT ODE Description Facility Non-Facility femur; with internal fixation (List in addition to code for primary procedure) Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal 8.01 $287 NA NA $870 NA NA Osteotomy, femur, shaft or supracondylar; with fixation $1,033 NA NA Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, includes internal fixation, when Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation, when Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair $1,371 NA NA $1,021 NA NA $991 NA NA $770 NA NA Excision or curettage of bone cyst or benign tumor, tibia or fibula $601 NA NA Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft $794 NA NA Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula $856 NA NA $685 NA NA Arthroplasty, ankle; with implant (total ankle) $994 NA NA Arthroplasty, ankle; revision, total ankle $1,140 NA NA Removal of ankle implant $589 NA NA Repair of fibula nonunion and/or malunion with internal fixation $990 NA NA Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage Open treatment of medial malleolus fracture, includes internal fixation, when Open treatment of posterior malleolus fracture, includes internal fixation, when Open treatment of proximal fibula or shaft fracture, includes internal fixation, when Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; without fixation of posterior lip Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; with fixation of posterior lip Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of fibula only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of tibia only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of both tibia and fibula Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when $1,023 NA NA $626 NA NA $742 NA NA $733 NA NA $669 NA NA $791 NA NA $860 NA NA $980 NA NA $852 NA NA $1,107 NA NA $1,327 NA NA $700 NA NA Arthrodesis, ankle, open $1,057 NA NA Arthrodesis, tibiofibular joint, proximal or distal $701 NA NA Unlisted procedure, leg or ankle UNL UNL UNL UNL Excision or curettage of bone cyst or benign tumor, talus or calcaneus $ $ Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus $ $697

4 PT ODE Description Facility Non-Facility Open treatment of talus fracture, includes internal fixation, when $1,094 NA NA Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when, each $632 NA NA Arthrodesis; pantalar $1,290 NA NA Arthrodesis; triple $963 NA NA Arthrodesis; subtalar $797 NA NA Unlisted procedure, foot or toes UNL UNL UNL UNL Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis $1,071 NA NA Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis $899 NA NA Reference: Program; Policies Under the Physician Fee Schedule and Other Revisions to Part B for Y 2015 Final Rule, Addendum B: Y 2015 Value Units () and related information used in determining final payments. See also: Physician Fee Schedule (MPFS) onversion Factor: The Y 2015 MPFS conversion factor is $ for January 1, 2015 through March 31, as a result of ongress passing a fix to the sustainable growth rate (SGR) in April The fix provided for a zero percent update for services furnished between January 1 and March 31, Hospital Outpatient oding (APs) Ambulatory payment classifications (APs) is the prospective payment system uses to reimburse hospitals for outpatient services. Each PT code for a significant procedure is assigned to a specific AP class based on clinical and resource similarities. Each AP has a relative weight that indicates its rank compared to all other procedures in terms of the relative costs. The relative weight is then converted to a flat payment amount using a standardized conversion factor. Multiple APs can be assigned for the same case if multiple procedures are. The status indicator (SI) signifies how a code is handled for payment. Specifically, status Indicator indicates an inpatient procedure, Not paid under OPPS. Patient should be admitted and billed as an inpatient. Status indicator J1 will trigger a comprehensive AP payment for the claim, meaning a single AP will be paid while all other items and services on the same date of service will no longer generate separate payment. Status indicator T means that the code pays at 100% of the rate when it is the only procedure or is the highest-weighted procedure, but pays at 50% of the rate when it is submitted with another higher-weighted procedure. Status indicator N are paid under the OPPS, but their payment is packaged into payment for a separately paid service. Status indicator Q2 are packaged only if they are billed on the same date of service with any other codes with a T status indicator. If not, they are separately payable under a separate AP. For, with a few exceptions, the AP payment for the procedure code is considered complete. In general, separate payment is not made for Implanted devices. Instead, payment for implants used in the procedure is included in the payment for the procedure. However, private payers may have carve-outs for implants. UA indicates unassigned as has not valued this procedure. Reimbursement policy and pricing will vary among non- payers. PT ode Description AP AP Title SI proximal humerus proximal humerus; with allograft Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when, includes repair of tuberosity(s), when Open treatment of greater humeral tuberosity fracture, includes internal fixation, when Excision or curettage of bone cyst or benign tumor, humerus 0049 Level I Musculoskeletal T $1, Excision or curettage of bone cyst or benign tumor, humerus; with allograft head or neck of radius or olecranon process 0049 Level I Musculoskeletal T $1,660

5 PT ode Description AP AP Title SI Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/ or locking screws Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when ; with intercondylar extension Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when Unlisted procedure, humerus or elbow 0129 Level I losed Treatment Fracture T $ carpal bones carpal bones; with allograft Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular) (includes obtaining graft and necessary fixation), each bone 0051 Level III Musculoskeletal T $3, Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation) 0051 Level III Musculoskeletal T $3, Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist Open treatment of radial shaft fracture, includes internal fixation, when Open treatment of ulnar shaft fracture, includes internal fixation, when Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation Open treatment of ulnar styloid fracture Unlisted procedure, forearm or wrist 0129 Level I losed Treatment Fracture T $ Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal 0053 Level I Hand Musculoskeletal Procedures T $1,228

6 PT ode Description AP AP Title SI Open treatment of metacarpal fracture, single, includes internal fixation, when, each bone Unlisted procedure, hands or fingers 0129 Level I losed Treatment Fracture T $ Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular) Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure) Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft onversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage Open treatment of greater trochanteric fracture, includes internal fixation, when Unlisted procedure, pelvis or hip joint 0129 Level I losed Treatment Fracture T $ femur femur; with allograft femur; with internal fixation (List in addition to code for primary procedure) N Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal Osteotomy, femur, shaft or supracondylar; with fixation Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/ or locking screws Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, includes internal fixation, when Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation, when Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair Excision or curettage of bone cyst or benign tumor, tibia or fibula Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia

7 PT ode Description AP AP Title SI Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula Arthroplasty, ankle; with implant (total ankle) Arthroplasty, ankle; revision, total ankle Removal of ankle implant 0049 Level I Musculoskeletal Q $1, Repair of fibula nonunion and/or malunion with internal fixation Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage Open treatment of medial malleolus fracture, includes internal fixation, when Open treatment of posterior malleolus fracture, includes internal fixation, when Open treatment of proximal fibula or shaft fracture, includes internal fixation, when Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; without fixation of posterior lip Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; with fixation of posterior lip Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of fibula only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of tibia only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of both tibia and fibula Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when Arthrodesis, ankle, open Arthrodesis, tibiofibular joint, proximal or distal Unlisted procedure, leg or ankle 0129 Level IV Musculoskeletal Level IV Musculoskeletal Level I losed Treatment Fracture T $6,320 T $6,320 T $ Excision or curettage of bone cyst or benign tumor, talus or calcaneus 0055 Level I Foot Musculoskeletal Procedures T $1, Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus 0055 Level I Foot Musculoskeletal Procedures T $1, Open treatment of talus fracture, includes internal fixation, when

8 PT ode Description AP AP Title SI Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when, each Arthrodesis; pantalar Arthrodesis; triple Arthrodesis; subtalar Unlisted procedure, foot or toes 0129 Level II Foot Musculoskeletal Procedures Level V Musculoskeletal Level II Foot Musculoskeletal Procedures Level I losed Treatment Fracture T $5,217 J $10,220 T $5,217 T $ Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis 0042 Level II Arthroscopy T $4, Level II Arthroscopy T $4,344 Reference: Program: Hospital Outpatient Prospective System Final Rule Addendum - Final HPS odes Payable Under the 2015 OPPS by AP Ambulatory Surgery enter (AS) oding s prospective payment system for ASs is based on the systems used for hospital outpatient services and physician office-based procedures. Each PT code for an AS-covered procedure is assigned a relative weight and flat payment amount which is then adjusted for the AS setting. Multiple procedures can be paid for the same case if multiple codes are submitted. The payment indicator (PI) signifies how a code is handled for payment. Specifically, payment indicator A2 means a surgical procedure whose payment is based on the hospital outpatient rate. indicator G2 is a technical variation but also means a surgical procedures whose payment is based on the hospital outpatient rate. When the Multiple Procedure Discount is Yes, it indicates that the code pays at 100% of the rate when it is the only procedure or is the highest-weighted procedure, but pays at 50% of the rate when it is submitted with another higher-weighted procedure. For, with a few exceptions, the AS payment for the procedure code is considered complete. In general, separate payment is not made for Implanted devices. Instead, payment for implants used in the procedure is included in the payment for the procedure. However, private payers may have carve-outs for implants. PT ode Description PI Multi- Procedure Discounting? proximal humerus proximal humerus; with allograft Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when, includes repair of tuberosity(s), when Open treatment of greater humeral tuberosity fracture, includes internal fixation, when Excision or curettage of bone cyst or benign tumor, humerus A2 Y $ Excision or curettage of bone cyst or benign tumor, humerus; with allograft head or neck of radius or olecranon process Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck A2 Y $ Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws

9 PT ode Description PI Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when ; with intercondylar extension Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when Multi- Procedure Discounting? Unlisted procedure, humerus or elbow carpal bones carpal bones; with allograft Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular) (includes obtaining graft and necessary fixation), each bone Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation) Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist Open treatment of radial shaft fracture, includes internal fixation, when Open treatment of ulnar shaft fracture, includes internal fixation, when Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation G2 Y $2,063 A2 Y $2, Open treatment of ulnar styloid fracture G2 Y $2, Unlisted procedure, forearm or wrist Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal Open treatment of metacarpal fracture, single, includes internal fixation, when, each bone A2 Y $ Unlisted procedure, hands or fingers Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular) Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure) Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft onversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage Open treatment of greater trochanteric fracture, includes internal fixation, when Unlisted procedure, pelvis or hip joint femur femur; with allograft femur; with internal fixation (List in addition to code for primary procedure) Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal G2 Y $93 N1 N Osteotomy, femur, shaft or supracondylar; with fixation

10 PT ode Description PI Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, includes internal fixation, when Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation, when Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair Multi- Procedure Discounting? G2 Y $2, Excision or curettage of bone cyst or benign tumor, tibia or fibula Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula Arthroplasty, ankle; with implant (total ankle) Arthroplasty, ankle; revision, total ankle Removal of ankle implant A2 N $ Repair of fibula nonunion and/or malunion with internal fixation G2 Y $2, Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage Open treatment of medial malleolus fracture, includes internal fixation, when Open treatment of posterior malleolus fracture, includes internal fixation, when Open treatment of proximal fibula or shaft fracture, includes internal fixation, when Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; without fixation of posterior lip Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; with fixation of posterior lip Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of fibula only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of tibia only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when ; of both tibia and fibula Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when G2 Y $2, Arthrodesis, ankle, open A2 Y $3, Arthrodesis, tibiofibular joint, proximal or distal A2 Y $3, Unlisted procedure, leg or ankle Excision or curettage of bone cyst or benign tumor, talus or calcaneus A2 Y $ Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus Open treatment of talus fracture, includes internal fixation, when A2 Y $956

11 PT ode Description PI Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when, each Multi- Procedure Discounting? Arthrodesis; pantalar A2 Y $2, Arthrodesis; triple J8 N $7, Arthrodesis; subtalar A2 Y $2, Unlisted procedure, foot or toes Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis A2 Y $2, Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis G2 Y $2,382 Reference: Program: Hospital Outpatient Prospective and Ambulatory Surgical enter Final Rule, Addendum AA -- Final AS overed Surgical Procedures for Y 2015 (Including Surgical Procedures for Which is Packaged), Addendum EE -- Surgical Procedures Proposed to be Excluded from in ASs for Y 2015 ID-9-M Diagnosis odes ID-9-M diagnosis codes are used by all providers, including physicians, hospitals and ASs, and in all settings, including inpatient and outpatient. Diagnosis codes indicate the reason for the procedure and are mandatory for reimbursement. The codes shown below are those that are common with procedures using the ALLOMATRIX DR Putty, though other codes may also be appropriate. This list includes common codes assigned for ankle and foot disorders. The ID-9-M book should always be referenced for diagnostic coding. ID-9-M Diagnosis Description Rheumatoid arthritis auda equina syndrome without mention of neurogenic bladder auda equina syndrome with neurogenic bladder 715.X7 Osteoarthrosis, ankle and foot Pathologic fracture of humerus Pathologic fracture of distal radius and ulna Pathologic fracture of vertebrae Pathologic fracture of neck of femur Pathologic fracture of other specified part of femur Pathologic fracture of tibia or fibula yst of bone [metatarsal head] Malunion of fracture Nonunion of fracture Stress fracture of tibia or fibula Stress fracture of the metatarsals Stress fracture of femoral neck Stress fracture of shaft of femur Stress fracture of pelvis Unspecified deformity of ankle and foot, acquired losed fracture of acetabulum Fracture of medial malleolus, closed Fracture of medial malleolus, open Fracture of lateral malleolus, closed Fracture of lateral malleolus, open ID-9-M Diagnosis Description Bimalleolar fracture, closed Bimalleolar fracture, open Trimalleolar fracture, closed Trimalleolar fracture, open Unspecified fracture of ankle, closed 808.X 812.XX 813.XX losed or open fracture of acetabulum, pubis, ilium, ishium, or multiple sites of pelvis losed and open fractures of humerus losed and open fractures of radius and ulna 814.0X losed and open fractures of carpal bones 820.XX 821.XX 823.XX 825.XX losed and open fracturesof neck of femur, unspecified losed and open fractures of femur losed and open fractures of tibia and fibula losed and open fractures of one or more tarsal and metarsal bones Late effect of fracture of lower extremities Mechanical loosening of prosthetic joint Dislocation of prosthetic joint Broken prosthetic joint implant Peri-prosthetic fracture around prosthetic joint Peri-prosthetic osteolysis Articular bearing surface wear of prosthetic joint Other mechanical complication of prosthetic joint implant Other mechanical complication of other internal orthopedic device, implant, and graft

12 Hospital Inpatient Diagnosis Related Group (MS-DRGs) and ID-9-M Procedure odes Diagnosis Related Groups (MS-DRGs) is the prospective payment system uses to reimburse hospitals for inpatient services. Each inpatient stay is assigned to a specific group based on clinical and resource similarities for its ID-9-M diagnosis and procedure codes. Only one DRG is assigned to each inpatient case, regardless of the number of diagnosis and procedure codes.both and M refer to secondary diagnoses that are designated as complications/comorbidities () or major complications/comorbidities (M). Each DRG has a relative weight which is then converted to a flat payment amount using standard operating and capital amounts. For, with a few exceptions, the MS-DRG payment for the procedure is considered complete and payment for implants is included in the MS-DRG payment. However, private payers may have carve-outs for implants. DRG DRG Title National Unadjusted ID-9-M Procedure odes and Descriptions 466 Revision of Hip or Knee Replacement W M $30, Revision of Hip or Knee Replacement W $20, with Revision of Hip or Knee Replacement WO /M $16, Major Joint Replacement or Reattachment of Lower Extremity W M Major Joint Replacement or Reattachment of Lower Extremity WO M $19, $12, with Hip & Femur Procedures Except Major Joint W M $17, Hip & Femur Procedures Except Major Joint W $11, with Hip & Femur Procedures Except Major Joint WO / M $9, Lower Extrem & Humer Proc Except Hip,Foot,Femur W M $18, Lower Extrem & Humer Proc Except Hip,Foot,Femur W $11, & with Lower Extrem & Humer Proc Except Hip,Foot,Femur W/O /M $9, Local Excision & Removal Int Fix Devices Exc Hip & Femur W M $17, Local Excision & Removal Int Fix Devices Exc Hip & Femur W $10, & with Local Excision & Removal Int Fix Devices Exc Hip & Femur WO /M $7, Arthroscopy with Shoulder,Elbow or Forearm Proc,Exc Major Joint Proc W M $13, Shoulder,Elbow or Forearm Proc,Exc Major Joint Proc W $9, with Shoulder,Elbow or Forearm Proc,Exc Major Joint Proc WO /M $7,603

13 DRG DRG Title National Unadjusted ID-9-M Procedure odes and Descriptions Hand or Wrist Proc, Except Major Thumb or Joint Proc W /M Hand or Wrist Proc, Except Major Thumb or Joint Proc WO /M $8, $5, with Other Musculoskelet Sys & onn Tiss O.R. Proc W M $18, Other Musculoskelet Sys & onn Tiss O.R. Proc W $11, with Other Musculoskelet Sys & onn Tiss O.R. Proc WO / M $10,119 Reference: Program: Hospital Inpatient Prospective Systems for Acute are Hospitals Table 5 List of Severity Diagnosis Related Groups (MS-DRGs) ing Factors FY 2015 Final Rule

14 Disclaimer The coding and reimbursement information and data provided by Wright Medical Technology is presented for informational purposes only and is accurate as of its date of publication. It is the provider's responsibility to report the codes that accurately describe the products and services furnished to individual patients. Reimbursement is dynamic. Laws and regulations regarding reimbursement change frequently and providers are solely responsible for all decisions related to coding and billing including determining, if and under what circumstances, it is appropriate to seek reimbursement for products and services and for obtaining pre-authorization, if necessary. For these reasons, providers are advised to contact and/or specific payers if they have any questions regarding billing, coverage and payment. Likewise, providers should contact a medical specialty society or the AMA for coding clarification. Providers should check the complete and current HPS and/or PT manual to see and consider all possible HPS and/ or PT codes. Wright Medical Technology makes no representation or warranty regarding this information or its completeness or accuracy and will bear no responsibility for the results or consequences of the use of this information. Wright Medical Technology, Inc herry Road Memphis, TN Trademarks and Registered marks of Wright Medical Technology, Inc Wright Medical Technology, Inc. All Rights Reserved A_16-Apr-2015