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 Injectable Putty DBM Putty 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 in this document are representative of possible services or diagnoses that may be associated 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 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 (RVUs) 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 RVUs and payment: AA AA AA Facility RVUs represent surgical services provided in hospitals, ambulatory surgical centers, or skilled nursing facilities. Non-Facility RVUs represent surgical services provided in physician s offices. RVUs and payments are usually lower in the Facility setting because the facility is incurring some of the costs. RVUs 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 RVUs 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 RVUs cannot be calculated. PT ODE Description RVUs Facility RVUs Non-Facility proximal humerus $677 NA NA proximal humerus; 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; 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 RVUs Facility RVUs 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, insertion of intramedullary implant, or out cerclage and/or locking screws Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when ; intercondylar extension Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna 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; allograft $503 NA NA Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist $528 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, or out radial styloidectomy (includes obtaining graft and necessary fixation) $799 NA NA $783 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, internal fixation Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when $749 NA NA $734 NA NA Open treatment of ulnar styloid fracture $636 NA NA Unlisted procedure, forearm or wrist UNL UNL UNL UNL metacarpal $456 NA NA Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal Open treatment of metacarpal fracture, single, includes internal fixation, when, each bone $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), or out autograft or allograft onversion of previous hip surgery to total hip arthroplasty, or out autograft or allograft losed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; out Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; plate/screw type implant, or out cerclage Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; intramedullary implant, or out interlocking screws and/or cerclage Open treatment of greater trochanteric fracture, includes internal fixation, when $1,390 NA NA $1,717 NA NA $469 NA NA $1,262 NA NA $1,262 NA NA $761 NA NA

3 PT ODE Description RVUs Facility RVUs Non-Facility Unlisted procedure, pelvis or hip joint UNL UNL UNL UNL femur $616 NA NA femur; allograft $755 NA NA femur; 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; fixation $1,033 NA NA Open treatment of femoral shaft fracture, or out external fixation, insertion of intramedullary implant, or out cerclage and/or locking screws Open treatment of femoral supracondylar or transcondylar fracture out 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, 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 losed treatment of tibial fracture, proximal (plateau); out 7.97 $ $ 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; 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 $598 NA NA Arthroplasty, ankle; implant (total ankle) $994 NA NA Arthroplasty, ankle; revision, total ankle $994 NA NA Removal of ankle implant $589 NA NA Repair of fibula nonunion and/or malunion internal fixation $990 NA NA Treatment of tibial shaft fracture ( or out fibular fracture) by intramedullary implant, or out interlocking screws and/or cerclage $1,023 NA NA losed treatment of medial malleolus fracture; out 8.64 $ $ losed treatment of medial malleolus fracture;, or out skin or skeletal traction Open treatment of medial malleolus fracture, includes internal fixation, when $ $ $990 NA NA losed treatment of posterior malleolus fracture; out 8.06 $ $ losed treatment of posterior malleolus fracture; $450 NA NA Open treatment of posterior malleolus fracture, includes internal fixation, when Open treatment of proximal fibula or shaft fracture, includes internal fixation, when $742 NA NA $733 NA NA losed treatment of distal fibular fracture (lateral malleolus); out 8.14 $ $ losed treatment of distal fibular fracture (lateral malleolus); $ $ Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when losed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); out losed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); 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 $669 NA NA 8.55 $ $ $ $ $791 NA NA losed treatment of trimalleolar ankle fracture; out 8.19 $ $327

4 PT ODE Description RVUs Facility RVUs Non-Facility losed treatment of trimalleolar ankle fracture; $ $ Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; out fixation of posterior lip Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; fixation of posterior lip losed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), or out anesthesia; out losed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), or out anesthesia; skeletal traction and/or requiring Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of fibula only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of tibia only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of both tibia and fibula Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when $860 NA NA $980 NA NA 8.63 $ $ $ $ $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 $ $ losed treatment of talus fracture; 8.26 $ $ Open treatment of talus fracture, includes internal fixation, when $1,094 NA NA Treatment of tarsal bone fracture (except talus and calcaneus);, each 7.42 $ $ 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 Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse $749 NA NA Arthrodesis, great toe; metatarsophalangeal joint $ $ Unlisted procedure, foot or toes UNL UNL UNL UNL Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; ankle arthrodesis $1,071 NA NA Arthroscopy, subtalar joint, surgical; 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 (RVUs) 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, 2015.

5 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 N creates payment is packaged into payment for other services, including outliers. Therefore, there is no separate AP payment.status indicator Q2 are packaged only if they are billed on the same date of service any other codes a T status indicator. If not, they are separately payable under a separate AP. 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 another higher-weighted procedure. For, 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; 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; allograft head or neck of radius or olecranon process 0049 Level I Musculoskeletal T $1, 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, insertion of intramedullary implant, or out cerclage and/ or locking screws Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when ; intercondylar extension

6 PT ode Description AP AP Title SI Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna 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 carpal bones carpal bones; allograft Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist 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, or out radial styloidectomy (includes obtaining graft and necessary fixation) 0051 Level III Musculoskeletal T $3, 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, internal fixation Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when Open treatment of ulnar styloid fracture Unlisted procedure, forearm or wrist metacarpal 0053 Level I Hand Musculoskeletal Procedures T $1, Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal 0053 Level I Hand Musculoskeletal Procedures T $1, Open treatment of metacarpal fracture, single, includes internal fixation, when, each bone 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), or out autograft or allograft onversion of previous hip surgery to total hip arthroplasty, or out autograft or allograft losed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; out 0129

7 PT ode Description AP AP Title SI Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; plate/screw type implant, or out cerclage Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; intramedullary implant, or out interlocking screws and/or cerclage Open treatment of greater trochanteric fracture, includes internal fixation, when Unlisted procedure, pelvis or hip joint femur femur; allograft femur; 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; fixation Open treatment of femoral shaft fracture, or out external fixation, insertion of intramedullary implant, or out cerclage and/ or locking screws Open treatment of femoral supracondylar or transcondylar fracture out 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, internal fixation and/or partial or complete patellectomy and soft tissue repair losed treatment of tibial fracture, proximal (plateau); out 0138 Level II losed Treatment T $ Excision or curettage of bone cyst or benign tumor, tibia or fibula Excision or curettage of bone cyst or benign tumor, tibia or fibula; allograft Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula Arthroplasty, ankle 0047 Arthroplasty T $3, Arthroplasty, ankle; 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 internal fixation Treatment of tibial shaft fracture ( or out fibular fracture) by intramedullary implant, or out interlocking screws and/or cerclage

8 PT ode Description AP AP Title SI losed treatment of medial malleolus fracture; out 0138 Level II losed Treatment T $ losed treatment of medial malleolus fracture;, or out skin or skeletal traction 0431 Level IV losed Treatment T $1, Open treatment of medial malleolus fracture, includes internal fixation, when losed treatment of posterior malleolus fracture; out losed treatment of posterior malleolus fracture; Open treatment of posterior malleolus fracture, includes internal fixation, when Open treatment of proximal fibula or shaft fracture, includes internal fixation, when losed treatment of distal fibular fracture (lateral malleolus); out 0138 Level II losed Treatment T $ losed treatment of distal fibular fracture (lateral malleolus); 0138 Level II losed Treatment T $ Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when losed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); out 0138 Level II losed Treatment T $ losed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); 0139 Level III losed Treatment T $ 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 losed treatment of trimalleolar ankle fracture; out 0138 Level II losed Treatment T $ losed treatment of trimalleolar ankle fracture; 0139 Level III losed Treatment T $ Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; out fixation of posterior lip Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; fixation of posterior lip losed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), or out anesthesia; out 0138 Level II losed Treatment T $ losed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), or out anesthesia; skeletal traction and/or requiring 0431 Level IV losed Treatment T $1, Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of fibula only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of tibia only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of both tibia and fibula

9 PT ode Description AP AP Title SI 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 T $6,320 T $6, 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, losed treatment of talus fracture; 0431 Level IV losed Treatment T $1, Open treatment of talus fracture, includes internal fixation, when Treatment of tarsal bone fracture (except talus and calcaneus);, each Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when, each Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when, each Arthrodesis; pantalar Arthrodesis; triple Arthrodesis; subtalar 0056 Level II Foot Musculoskeletal Procedures Level V Musculoskeletal Level II Foot Musculoskeletal Procedures T $5,217 J $10,220 T $5, Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse Arthrodesis, great toe; metatarsophalangeal joint Unlisted procedure, foot or toes 0129 Level II Foot Musculoskeletal Procedures T $5, Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; ankle arthrodesis Arthroscopy, subtalar joint, surgical; 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

10 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. indicator J8 specifies a device-intensive procedure; paid at adjusted rate. indicator N1 indicates a packaged procedure/item; no separate payment made. indicator P2 indicates payment is based on OPPS relative payment weight. 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 another higher-weighted procedure. NA indicates a surgical procedure excluded from ASs payment for Y For, 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; 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; 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, insertion of intramedullary implant, or out cerclage and/or locking screws Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when ; intercondylar extension Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna 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 carpal bones carpal bones; allograft Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist 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, or out radial styloidectomy (includes obtaining graft and necessary fixation) Open treatment of radial shaft fracture, includes internal fixation, when G2 Y $2,063 A2 Y $2,063

11 PT ode Description PI Open treatment of ulnar shaft fracture, includes internal fixation, when Open treatment of distal radial extra-articular fracture or epiphyseal separation, internal fixation Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when Multi- Procedure Discounting? Open treatment of ulnar styloid fracture G2 Y $2, Unlisted procedure, forearm or wrist metacarpal A2 Y $ 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), or out autograft or allograft onversion of previous hip surgery to total hip arthroplasty, or out autograft or allograft losed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; out Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; plate/screw type implant, or out cerclage Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; intramedullary implant, or out interlocking screws and/or cerclage Open treatment of greater trochanteric fracture, includes internal fixation, when A2 Y $ Unlisted procedure, pelvis or hip joint femur femur; allograft femur; 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; fixation Open treatment of femoral shaft fracture, or out external fixation, insertion of intramedullary implant, or out cerclage and/or locking screws Open treatment of femoral supracondylar or transcondylar fracture out 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, internal fixation and/or partial or complete patellectomy and soft tissue repair losed treatment of tibial fracture, proximal (plateau); out G2 Y $2,318 A2 Y $ Excision or curettage of bone cyst or benign tumor, tibia or fibula

12 PT ode Description PI Excision or curettage of bone cyst or benign tumor, tibia or fibula; allograft Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula Multi- Procedure Discounting? Arthroplasty, ankle A2 Y $1, Arthroplasty, ankle; implant (total ankle) Arthroplasty, ankle; revision, total ankle Arthroplasty, ankle; revision, total ankle Removal of ankle implant A2 N $ Repair of fibula nonunion and/or malunion internal fixation G2 Y $2, Treatment of tibial shaft fracture ( or out fibular fracture) by intramedullary implant, or out interlocking screws and/or cerclage losed treatment of medial malleolus fracture; out A2 Y $ losed treatment of medial malleolus fracture;, or out skin or skeletal traction Open treatment of medial malleolus fracture, includes internal fixation, when A2 Y $ losed treatment of posterior malleolus fracture; out P2 Y $ losed treatment of posterior malleolus fracture; G2 Y $ Open treatment of posterior malleolus fracture, includes internal fixation, when Open treatment of proximal fibula or shaft fracture, includes internal fixation, when losed treatment of distal fibular fracture (lateral malleolus); out losed treatment of distal fibular fracture (lateral malleolus); Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when losed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); out losed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); 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 G2 Y $2,318 A2 Y $117 A2 Y $117 A2 Y $117 A2 Y $ losed treatment of trimalleolar ankle fracture; out A2 Y $ losed treatment of trimalleolar ankle fracture; A2 Y $ Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; out fixation of posterior lip Open treatment of trimalleolar ankle fracture, includes internal fixation, when, medial and/or lateral malleolus; fixation of posterior lip losed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), or out anesthesia; out losed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), or out anesthesia; skeletal traction and/or requiring A2 Y $117 A2 Y $719

13 PT ode Description PI Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of fibula only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of tibia only Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), internal fixation, when ; of both tibia and fibula Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when Multi- Procedure Discounting? 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 A2 Y $ losed treatment of talus fracture; A2 Y $ Open treatment of talus fracture, includes internal fixation, when Treatment of tarsal bone fracture (except talus and calcaneus);, each Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when, each P2 Y $ Arthrodesis; pantalar A2 Y $2, Arthrodesis; triple J8 N $7, Arthrodesis; subtalar A2 Y $2, Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse A2 Y $2, Arthrodesis, great toe; metatarsophalangeal joint A2 Y $2, Unlisted procedure, foot or toes Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; ankle arthrodesis A2 Y $2, Arthroscopy, subtalar joint, surgical; 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 procedures using the ALLOMATRIX Injectable 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 hronic postrheumatic arthropathy 715.X7 Osteoarthrosis, ankle and foot Traumatic arthropathy, ankle and foot Other joint derangement, not elsewhere classified, ankle and foot Periostitis, out mention of osteomyelitis, upper arm hronic osteomyelitis Pathologic fracture of humerus Pathologic fracture of distal radius and ulna Pathologic fracture of vertebrae

14 ID-9-M Diagnosis Description Pathologic fracture of neck of femur Pathologic fracture of other specified part of femur Pathologic fracture of tibia or fibula yst of bone (localized), unspecified yst of bone [metatarsal head] Solitary bone cyst Aneurysmal bone cyst Other bone cyst Aseptic necrosis of bone, site unspecified Aseptic necrosis of head of humerus Aseptic necrosis of head and neck of femur Aseptic necrosis of medial femoral condyle Aseptic necrosis of talus Aseptic necrosis of bone, other Malunion of fracture Nonunion of fracture Stress fracture of tibia or fibula Stress fracture of the metatarsals Stress fracture of other bone Stress fracture of femoral neck Stress fracture of shaft of femur Stress fracture of pelvis ID-9-M Diagnosis Description Unspecified deformity of ankle and foot, acquired 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 824.XX 825.XX losed and open fractures of neck of femur, unspecified losed and open fractures of femur losed and open fractures of tibia and fibula losed and open fracture of malleolus losed and open fractures of one or more tarsal and metarsal bones Late effect of fracture of lower extremities 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 Hospital Inpatient Diagnosis Related Group (MS-DRGs) and ID-9-M Procedure odes Diagnosis Related Groups (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. W and W M refers 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, a few exceptions, the DRG payment for the procedure code is considered complete and payment for implants is included in the 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, Revision Of Hip Or Knee Replacement W/O /M $16, Major Joint Replacement or Reattachment of Lower Extremity W M Major Joint Replacement or Reattachment of Lower Extremity WO M $19, $12,

15 DRG DRG Title National Unadjusted ID-9-M Procedure odes and Descriptions 480 Hip & Femur Procedures Except Major Joint W M $17, Hip & Femur Procedures Except Major Joint W $11, Hip & Femur Procedures Except Major Joint WO / M $9, Lower Extrem & Humer Proc Except Hip,Foot,Femur W M Lower Extrem & Humer Proc Except Hip,Foot,Femur W Lower Extrem & Humer Proc Except Hip,Foot,Femur WO /M $18, $11, $9, or Local excision and removal internal fixation devices except hip and femur W M Local excision and removal internal fixation devices except hip and femur W Local excision and removal internal fixation devices except hip and femur WO /M $17,876 $10,141 $7, or Local excision and removal internal fixation devices hip and femur W /M Local excision and removal internal fixation devices hip and femur WO /M $12, $6, Foot Procedures W $13, Foot Procedures W $9, Foot Procedures WO /M $7, or Shoulder, Elbow Or Forearm Procedure, Except Major Joint Procedure W M Shoulder, Elbow Or Forearm Procedure, Except Major Joint Procedure W Shoulder, Elbow Or Forearm Procedure, Except Major Joint Procedure WO /M $13, $9, $7, Hand or Wrist Procedure, except Major Thumb or Joint ProcedureW /M Hand or Wrist Procedure, except Major Thumb or Joint Procedure WO /M $8, $5, or Other Musculoskeletal System and onnective Tissue OR Procedures W M Other Musculoskeletal System and onnective Tissue OR Procedures W $18, $11, or 81.59

16 DRG DRG Title National Unadjusted ID-9-M Procedure odes and Descriptions 517 Other Musculoskeletal System and onnective Tissue OR Procedures WO /M $10, Tendonitis, Myositis & Bursitis W M $8, Tendonitis, Myositis & Bursitis WO M $4, or 9.07 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

17 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