TOTAL Head and Neck Congenital Defects 50

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1 Operative Minimums Effective July 1, 2014 Review Committee for Plastic Surgery NOTE: The index procedure number for Laser is tracked by Total Laser and not by the subcategories of Aesthetic Laser and Reconstructive Laser Congenital Defects Primary cleft lip repair Primary cleft palate repair Secondary cleft lip or palate repair Cleft lip nasal deformity repair 5050 Craniomaxillofacial reconstruction 5055 Vascular malformation (laser) 5060 Other Congenital Defects procedures TOTAL Congenital Defects 50 Neoplasms Reconstruction after neoplasm resection with skin graft 5120 Reconstruction after neoplasm resection with local flap Reconstruction after neoplasm resection with free flap Resection of skin cancer 5150 Resection of other head and neck neoplasm 5160 Other Neoplasms procedures TOTAL - Head & Neck Neoplasms 70 Trauma Treat occlusal injury Treat upper midface fracture Treat nasal fracture Treat complex soft tissue injury Other Trauma procedures TOTAL - Trauma 50 Breast Macromastia Breast Reduction 24 TOTAL - Breast Macromastia 24 Absent Breast Breast reconstruction with implant or expander Breast reconstruction with pedicle flap 4

2 5430 Breast reconstruction with free flap Secondary procedures 5450 Fat grafting (absent breast) TOTAL - Absent Breast 100 Other Deformities of Breast (Reconstructive) Treat other deformities TOTAL - Other Deformities Of Breast (Reconstructive) TOTAL BREAST PROCEDURES (RECONSTRUCTIVE) TOTAL - BREAST PROCEDURES (RECONSTRUCTIVE) 100 Wounds or Deformities of Trunk Treat pressure ulcer - debridement or VAC Treat pressure ulcer with flap Treat wounds of trunk with flap 15 TOTAL - Wounds or Deformities of Trunk 23 Other Deformities or Disease Processes of Trunk Treat other deformities TOTAL - Other Deformities or Disease Processes of Trunk TOTAL TRUNK PROCEDURES TOTAL - TRUNK PROCEDURES 25 Hand and Upper Extremity Wound Requiring Reconstruction 5810 Reconstruction by primary closure Reconstruction with skin graft Reconstruction with flap Amputation 7 TOTAL - Hand and Upper Extremity Wound Requiring Reconstruction 23 Tendon (Extensor or Repair/reconstruct tendon with or without graft 16

3 Flexor) Operative release of tendon adhesion/tendon lengthening Tendon Transfer 2 TOTAL - Tendon (Extensor or Flexor) 22 Nerve Injury Repair/reconstruct nerve with or without graft 10 TOTAL - Nerve Injury 10 Fracture or Dislocation Operative repair of fracture or dislocation Release of joint contracture 2 TOTAL - Fracture or Dislocation 32 Dupuytren's Contracture Operative treatment of Dupuytren s contracture (INCLUDING NEEDLE AND COLLAGENASE CODES) 2 TOTAL - Dupuytren's Contracture 2 Nerve Compression Nerve decompression 16 TOTAL - Nerve Compression 16 Arterial Insufficiency or Traumatic Amputation of Digit, Hand, or Upper Extremity Arterial repair, revascularization, or replantation of digit, hand, or upper extremity 4 TOTAL - Arterial Insufficiency or Traumatic Amputation of Digit, Hand, or Upper Extremity 4 Other Deformity or Disease Process Arthroplasty/arthrodesis Treat congenital deformity Treat neoplasm (benign or malignant) Other Deformity or Disease Process procedures TOTAL - Other Deformity or Disease Process 13 TOTAL HAND AND UPPER EXTREMITY PROCS TOTAL - HAND AND UPPER EXTREMITY PROCS 122 Lower Extremity Treatment with graft 12

4 Wounds an Deformities Treatment with local flap Treatment with free flap or revascularization/replantation 3 TOTAL - Lower Extremity Wounds and Deformities 24 Other Deformities of Lower Extremity Treat other deformities TOTAL - Other Deformities of Lower Extremity TOTAL LOWER EXTREMITY PROCEDURES TOTAL - LOWER EXTREMITY PROCEDURES 25 Integument Burns 6810 Burn reconstruction Other Integument Burns procedures TOTAL - Integument Burns 24 Lesions of the Integument Treat benign lesions 6920 Treat malignant lesions TOTAL - Lesions of the Integument Wounds and Other Lesions of the Integument Treat deformities TOTAL - Wounds and Other Lesions of the Integument TOTAL RECONSTRUCTIVE PROCEDURES 1000 Aesthetic Deformity 7110 Facelift Brow lift Blepharoplasty Rhinoplasty Other Aesthetic Deformity procedures 50

5 TOTAL - Aesthetic Deformity Breast Micromastia Breast augmentation Fat grafting (breast micromastia) TOTAL - Breast Micromastia 16 Breast Ptosis Mastopexy 12 TOTAL - Breast Ptosis 12 Other Deformities of Breast (Aesthetic) Other Deformities of Breast procedures TOTAL - Other Deformities of Breast (Aesthetic) delete TOTAL BREAST PROCEDURES (AESTHETIC) TOTAL BREAST PROCEDURES (AESTHETIC) 30 Trunk/Extremity Aesthetic Deformities 7510 Brachioplasty Abdominoplasty Body lift Thighplasty Suction assisted lipoplasty Other Trunk/Extremity Aesthetic Deformities procedures TOTAL - Trunk/Extremity Aesthetic Deformities 50 TOTAL AESTHETIC PROCEDURES TOTAL AESTHETIC PROCEDURES 150 TOTAL INDEX PROCEDURES TOTAL INDEX PROCEDURES 1150 Additional Procedures (Non-Index) Botulinum toxin injection Soft tissue filters (MERGE INTO 7520) Duplicated abdominoplasty code TOTAL - Additional Procedures (Non-Index) Microvascular/Free Tissue Transplant Microvascular/free tissue transplant 20 TOTAL - Microvascular/free tissue transplant 20

6 Tissue Expansion Tissue expansion 30 TOTAL - Tissue expansion 30 Suction Assist Lipoplasty suction assist lipoplasty Trunk suction assist lipoplasty Ext suction assist lipoplasty TOTAL - Suction Assist Lipoplasty 15 Use of Injectables Botulinum toxin injection 7 Soft tissue fillers 7 Autologous fat 7 TOTAL - Use of Injectables 21 Laser TOTAL - Lasers 10

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