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Orthopaedics Schedule of Benefits for Professional Fees 2019 Orthopaedics AMPUTATION PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE Amputation, finger or thumb, primary or secondary, any 3140 joint or phalanx, single, including neurectomies; with direct No € 414.10 € 183.00 € 210.13 € 69.00 closure (use also for traumatic amputations) 3145 Amputation of two or more fingers No € 785.15 € 364.00 € 397.70 € 88.00 3280 Amputation through forearm No € 785.15 € 479.00 € 382.33 € 88.00 3415 Amputation through arm No € 785.15 € 364.00 € 397.70 € 88.00 3464 Fore quarter amputation No € 1,249.48 € 579.00 € 652.93 € 117.00 3645 Above knee amputation No € 824.10 € 546.00 € 442.80 € 88.00 3690 Hind quarter amputation No € 1,615.40 € 636.00 € 818.98 € 196.00 3790 Below knee amputation No € 1,183.88 € 409.00 € 602.70 € 88.00 4255 Trans metatarsal amputation of foot No € 591.43 € 273.00 € 299.30 € 69.00 4260 Trans metatarsal amputation of one toe No € 353.63 € 136.00 € 177.33 € 48.00 4261 Trans metatarsal amputation of two or more toes No € 591.43 € 273.00 € 299.30 € 69.00 4330 Trimming of stump following amputation of limb No € 343.38 € 136.00 € 171.18 € 69.00 ANKLE PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE 3955 Arthrodesis of ankle joint No € 884.58 € 409.00 € 447.93 € 117.00 Arthroscopy, ankle, with or without removal of loose 3956 body or foreign body, with or without synovectomy, No Independent Procedure, € 465.35 € 204.00 € 254.20 € 69.00 debridement (I.P.) Day Care Arthroscopy, ankle, surgical, excision of osteochondral 3961 defect of talus and/ or tibia, including drilling of the No Independent Procedure 1 Night Only € 447.00 € 281.00 € 258.00 € 169.00 defect (I.P.) Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond 3962 fracture, with or without internal fixation (includes No Independent Procedure € 702.13 € 299.00 € 420.25 € 179.00 arthroscopy) (I.P.) Arthroscopy, subtalar joint, surgical, with subtalar 3963 arthrodesis (I.P.) No Independent Procedure € 835.38 € 355.00 € 502.25 € 213.00 Fracture of medial or lateral malleolus (1st degree Pott's 3965 fracture), internal fixation of No € 624.23 € 273.00 € 320.83 € 88.00 ANKLE PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE Fracture of posterior malleolus without fracture of other 3970 malleolus, internal fixation of No € 685.73 € 319.00 € 348.50 € 88.00 Open treatment of bimalleolar ankle fracture, with or 3971 without internal fixation No € 730.83 € 336.00 € 387.45 € 88.00 Fracture of trimalleolar ankle fracture with or without 3972 internal or external fixation, medial and/ or lateral No € 806.68 € 436.00 € 420.25 € 244.00 malleolus; with fixation of posterior lip 3975 Fracture, Pott's, closed reduction of No € 392.58 € 183.00 € 210.13 € 88.00 Closed reduction manipulation of dislocated ankle joint, 3976 with or without percutaneous skeletal fixation such as pins No € 426.40 € 230.00 € 309.55 € 182.00 3980 Synovectomy and debridement No Day Care € 669.00 € 319.00 € 340.00 € 88.00 3985 Synovial biopsy, ankle No Diagnostic, Day Care € 137.70 € 69.00 € 168.30 € 48.00 3986 Talar fracture, open reduction and internal fixation of No € 685.73 € 319.00 € 348.50 € 88.00 3990 Tendon, achilles, elongation of No € 586.30 € 273.00 € 314.68 € 88.00 3995 Tendon, achilles, repair of No € 785.15 € 364.00 € 397.70 € 88.00 4000 Tendon transplants about the ankle joint and foot (multiple) No € 785.15 € 364.00 € 397.70 € 88.00 4005 Tendon transplants about the ankle joint and foot (single) No € 586.30 € 273.00 € 299.30 € 69.00 4010 Traumatic fracture and dislocation, open reduction of No € 785.15 € 364.00 € 397.70 € 88.00 4015 Unstable ankle, Watson Jones operation for No € 785.15 € 364.00 € 397.70 € 88.00 ARTHROCENTESIS / INJECTIONS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE Arthrocentesis, one or more injections at the same session, 4321 children aged 12 to 16; small, intermediate or large No Independent Procedure, € 99.43 € 54.00 joint (I.P.) Day Care Arthrocentesis, children aged under 12; less than 4322 4 injections at the same session to knee, wrist, elbow, No Independent Procedure, € 99.43 € 54.00 € 169.13 € 90.00 ankle and/ or shoulder joint (I.P.) Day Care Arthrocentesis, children aged under 12; 4 or more injections 4323 at the same session to knee, wrist, elbow, ankle and/ or No Independent Procedure, € 171.18 € 96.00 € 169.13 € 90.00 shoulder joint (I.P.) Day Care Arthrocentesis, children aged under 12; less than 4324 4 injections at the same session, using image guidance, No Independent Procedure, € 148.63 € 82.00 € 169.13 € 90.00 to hip, finger and/ or toe joint (I.P.) Day Care ARTHROCENTESIS / INJECTIONS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE Arthrocentesis, children aged under 12; 4 or more injections 4326 at the same session, using image guidance, to hip, finger No Independent Procedure, € 221.40 € 124.00 € 169.13 € 90.00 and/ or toe joints (I.P.) Day Care Independent Procedure, 4331 Injection, tendon sheath, ligament, or ganglion cyst (I.P.) No Side Room € 94.30 € 50.00 CONGENITAL TALIPES EQUINOVARUS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE 4019 Astragalectomy No € 685.73 € 319.00 € 343.38 € 88.00 4020 Dwyer's valgus osteotomy No € 624.23 € 273.00 € 320.83 € 88.00 4025 Manipulation and plaster fixation No Day Care € 143.50 € 69.00 € 171.18 € 48.00 4030 Manipulation and strapping No Day Care € 143.50 € 69.00 4035 Rotation osteotomy of tibia No € 812.83 € 364.00 € 414.10 € 88.00 4040 Soft tissue release No € 829.23 € 273.00 € 420.25 € 69.00 4045 Tarsal osteotomy No € 685.73 € 319.00 € 348.50 € 88.00 4050 Tendon transplant, single No € 586.30 € 273.00 € 299.30 € 69.00 4051 Tendon transplant, multiple No € 829.23 € 386.00 € 426.40 € 88.00 EXTERNAL FIXATION PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE Partial excision of osteomyelitic bone (e.g. sequestrectomy, 4305 diaphysectomy), long bones, with or without bone grafting No Independent Procedure € 884.58 € 409.00 € 447.93 € 88.00 (not for bone biopsy) (I.P.) Application of uniplane external fixation system, for the treatment of complex peri-articular and intra-articular 4306 fractures, or non unions and correcting deformity following No € 243.95 € 129.00 € 169.13 € 90.00 malunited fractures, unilateral (e.g. Extremity, pelvis) Application of multiplane external fixation system, for the treatment of complex peri-articular and intra-articular 4307 fractures, or non unions and correcting deformity following No € 436.65 € 236.00 € 265.48 € 156.00 malunited fractures, unilateral (e.g. extremity, pelvis) EXTERNAL FIXATION PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE Adjustment or revision of (uniplane or multiplane) external 4308 fixation system requiring general anaesthetic No € 403.85 € 216.00 € 243.95 € 144.00 External fixation system (uniplane or multiplane as in 4309 procedure codes 4306 and 4307) removal under general No Day Care € 288.03 € 153.00 € 171.18 € 101.00 anaesthetic FOOT PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT INDICATORS PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED RATE RATE RATE RATE Arthrodesis of all inter phalangeal joints (Lambrinudi), 4060 unilateral No € 586.30 € 273.00 € 299.30 € 88.00 Arthrodesis of all inter phalangeal joints (Lambrinudi), 4065 bilateral No € 884.58 € 409.00 € 447.93 € 117.00 4070 Arthrodesis of first metatarso phalangeal joint (I.P.) No Independent Procedure 1 Night Only € 392.58 € 183.00 € 199.88 € 69.00 4075 Arthrodesis triple, in all its forms No € 984.00 € 455.00 € 497.13 € 88.00 4080 Arthrodesis, pantalar No € 1,177.73 € 546.00 € 597.58 € 117.00 4085 Claw foot (Steindlar), muscle stripping, operations for No € 392.58 € 183.00 € 210.13 € 69.00 4090 Exostosis of first metatarsal, unilateral, removal of No Day Care This code cannot be charged in conjunction with codes 4095, 4182, 4184 € 343.38 € 136.00 € 171.18 € 69.00 4095 Exostosis of first metatarsal, bilateral, removal of No This code cannot be charged in conjunction with codes 4090, 4182, 4184 € 458.18 € 183.00 € 231.65 € 69.00 4100 Flat foot involving joint fusion, operation for No € 679.58 € 273.00 € 348.50 € 88.00 4101 Flexor tenotomy, single (foot) No Day Care € 205.00 € 97.00 € 169.13 € 48.00 4102 Flexor tenotomy, multiple (foot) No Day Care € 309.55 € 143.00 € 192.70 € 69.00 4103 Fracture of hind foot, internal fixation, unilateral No € 624.23 € 290.00 € 320.83 € 88.00 4104 Fracture of hind foot,
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