Connection supplemental articles and policies - January 2008

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Connection - January 2008 (pdf, 334 KB)

supplemental articles

Practice guideline: treatment of patients with major depressive disorder
National asthma guidelines updated
FCHP reimburses for hospice and palliative medicine consults
Commercial and Medicare formulary updates
Tips for Medicare coding
Tips for bilateral services and modifier -50 (+ code tables)
- 150% payment adjustment for bilateral procedures applies.
- 150% payment adjustment does not apply. RVU’s are already based on the procedure being performed as a bilateral procedure.
- The usual payment adjustment for bilateral procedures does not apply. Pay 100% of the fee schedule amount for each side or unit.

policies and forms

The following policy is new:

Hospice and palliative medicine consult payment policy

The following policies have been reviewed and have substantial changes. For more details, please see “policy changes” below.

The following policies have been reviewed and do not have substantial changes.

practice guideline: treatment of patients with major depressive disorder

by Toni P.Coughlin, R.N., B.S.N.,C.C.M.

Beacon Health Strategies, FCHP’s behavioral health partner, has adopted several clinical practice guidelines to assist providers in the assessment of treatment of behavioral health disorders among FCHP members. Prior to the adoption and dissemination of each guideline, the relevant scientific literature is reviewed by a multidisciplinary team that includes board-certified psychiatrists. Beacon reviews and approves clinical practice guidelines at least every two years and updates them as needed.

Beacon has adopted the American Psychiatric Association practice guideline for the treatment of patients with major depressive disorder. The purpose of the guideline is to assist the physician faced with the task of implementing specific antidepressant treatment(s).

This guideline summarizes the specific forms of somatic, psychotherapeutic, psychosocial and educational treatments that have been developed to deal with major depressive disorder. It begins at the point where the psychiatrist has diagnosed an adult patient who is older than 18 years as suffering from major depressive disorder, according to the criteria defined in DSM-IV, and has medically evaluated the patient to ascertain the presence of alcohol or substance use disorder or other somatic factors that may contribute to the disease process.

The five components for treating major depressive disorder included in the depression guideline are the following:

Psychiatric management
Acute-phase treatment
Continuation-phase treatment
Maintenance-phase treatment
Discontinuation of active treatment

The APA clinical practice guideline for the treatment of patients with major depressive disorder can be found at www.guideline.gov.

If you have any questions or comments about the use of practice guidelines, or would like to recommend a particular guideline, please contact Dr. B.J. Berk, Beacon’s newly named Medical Director at bjberk@beaconhs.com or 1-781-994.7589. More information can be found on Beacon’s Web site at www.beaconhealthstrategies.com.

national asthma guidelines updated

The National Asthma Education and Prevention Program recently issued comprehensive updates to its clinical guidelines for the diagnosis and management of asthma.

The Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma—Full Report, 2007, highlights the importance of asthma control and introduces novel strategies to monitor asthma symptoms. They also feature an expanded section on childhood asthma.

pharmacotherapy
The guidelines advocate for a stepwise approach to control asthma, which involves increasing medication dosages and types as needed, and decreasing them whenever possible, based on the level of asthma control. The stepwise asthma management charts are revised and expanded to specify treatment for three age groups: 0 to 4 years, 5 to 11 years and 12 years or older. The 5-to-11 age group was added because new evidence suggests that children in this age group may respond differently than adults to asthma medications.

Recommendations on medications are updated to reflect the latest evidence on effectiveness and safety. EPR-3 reaffirms that patients with persistent asthma need both long-term medications to control asthma and prevent exacerbations, as well as quick-relief medications for symptoms as needed. For all age groups, inhaled corticosteroids are recommended as the most effective medication for long-term control.

The guidelines are available at www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.

fchp reimburses for hospice and palliative consultations

FCHP is delighted to provide reimbursement for “hospice and palliative medicine” consultations offered in our pilot program area of Worcester County. Provider reimbursement information is referenced below.

Who can provide a hospice and palliative medicine consultation?
“Hospice and palliative medicine” consultants are either physicians who are certified by the American Board of Hospice and Palliative Medicine or who are tenured as a hospice medical director, or are credentialed nurse practitioners or physician assistants working under the supervision of a physician specializing in “hospice and palliative medicine.” The American Board of Medical Specialties will grant board certification in “hospice and palliative medicine” in 2008.

What does FCHP cover for hospice and palliative medicine consultations?
As with any specialty consultation, FCHP will cover “hospice and palliative medicine” consultations provided by a credentialed “hospice and palliative medicine” physician and referred by the member’s PCP. The PCP will contact the specialist and provide his or her vendor number (National Provider Number) and name. The member may have a copayment consistent with his/her health plan option. Hospice and palliative medicine consultative services can be provided in a number of locations, including hospitals, skilled nursing facilities, a patient’s home or a physician’s office.

What are the coverage and reimbursement criteria?
Reimbursement for hospice and palliative medicine consultations will be made to the contracted hospice and palliative medicine physician on a fee-for-service basis. Reimbursement for consultations provided by the licensed and credentialed nurse practitioner or physician assistant will be conducted in accordance with the FCHP medical payment policy ADM0040, Nurse Practitioner/Physician Assistant Payment Policy.

The member is responsible for a copayment for this service.

During a hospice and palliative medicine consultation, no direct medical care is provided (such as ordering pain medication or laboratory or radiology services, etc.). FCHP will not cover related services when ordered by the hospice and palliative medicine physician. Rather, the hospice and palliative medicine physician will communicate back to the referring PCP the results of the consultation, with recommendations for pain management, symptom control and plan of care.

FCHP will credential the hospice and palliative medicine physician, as well as the nurse practitioner and physician assistant working under the supervision of a physician specializing in hospice and palliative medicine.

Are there billing/coding guidelines?
Hospice and palliative medicine consults should be billed with the appropriate CPT code, depending on the place of service (for example, office consults (99241-99245), inpatient consults (99251-99255) or home visit (99341-99345 and 99347-99350)). The ICD-9-CM code V66.7 should be billed as a secondary diagnosis in conjunction with the member’s primary diagnosis.

Services should be submitted using industry standard forms or HIPAA standard electronic formats.

policy changes

The following policies available with this issue of Connection have substantial changes.

Emergency department payment policy

The Industry Standard for hydration, therapeutic, prophylactic and diagnostic injections and infusion services is that the physician will not be reimbursed for infusion/injection services (codes 90760-90779) when provided in an emergency room setting. Modifiers -26 and -TC cannot be used with these codes.

Global surgical payment policy

Added to coverage and reimbursement criteria: This allows for one copayment per physician or physician practice and one copayment per outpatient facility to be taken within the global period.
Removed from To bill for postoperative care for reporting section:
- Providers are permitted to collect applicable copayments for services within the global period.

Nurse practitioner/physician assistant payment policy

The modifier SA should be appended to the procedure code for all NP/PA services that are billed under the supervising physician.
Coding guidelines have been clarified.

Procedure code review policy

Name changed from annual code review policy.
Added under preauthorization requirements:

We recognize that new codes can be published on a quarterly basis. We will review these codes within 30 days of the effective date and notify providers of all determinations via the next published Connection newsletter

formulary updates

Fallon Community Health Plan often makes changes to its formularies, including changing prior authorization requirements and adding new medications. Please note the following changes to our commercial plan formulary.

COMMERCIAL PLAN FORMULARY

additions

Azor® (amlodipine/olmesartan)	Tier 3
Calomist® (cyanocobalamin) Nasal Spray	Tier 3, PA required
Extina® (ketoconazole) 2% Foam	Tier 3, PA required
Janumet® (sitagliptin/metformin)	Tier 3

changes

Januvia® (sitagliptin)

PA removed

new to market policy*

Somatuline® (lanreotide)

* FCHP’s New to Market Policy was enacted to ensure patient safety and to allow for adequate time for the development, review and approval of clinical criteria. When a new medication first becomes available, it will fall under this policy and be excluded from coverage. A process is in place that allows for the quick review of provider requests for noncovered pharmaceuticals.

MEDICARE PART D FORMULARY

additions

Adagen	Added as Tier 3, PA required
Anadrol	Added as Tier 3, PA required
Angeliq	Added as Tier 3
Aranesp albumin free	Added as Tier 3, PA required
Atripla	Added as Tier 3
Attenuvax	Added as Tier 3
Avastin	Added as Tier 2, PA required
Cardura XL	Added as Tier 3, QLL
Coreg CR	Added as Tier 2, QLL
Emsam	Added as Tier 3, PA required
Engerix-B	Added as Tier 3, PA required
Enjuvia	Added as Tier 3
Femcon FE	Added as Tier 3
Gammagard	Added as Tier 2, PA required
Gammar-P	Added as Tier 3, PA required
Gamunex	Added as Tier 3, PA required
Gardasil	Added as Tier 3
Herceptin	Added as Tier 3, PA required
Hibtiter	Added as Tier 3
Intron-a	Added as Tier 2, PA required
Iveegam	Added as Tier 3, PA required
Invega	Added as Tier 3, PA required
Janumet	Added as Tier 3
Januvia	Added as Tier 3
Kadian	Added as Tier 3
Lotrel	Added as Tier 3
Meruvax II	Added as Tier 3
Methitest	Added as Tier 3
M-r-vax II	Added as Tier 3
Mumpsvax	Added as Tier 3
Orapred ODT	Added as Tier 3
Oxandrin	Added as Tier 3, PA required
Polygam S/D	Added as Tier 3, PA required
Prezista	Added as Tier 3
Proleukin	Added as Tier 3, PA required
Rabavert	Added as Tier 3
Rotateq	Added as Tier 3
Seasonique	Added as Tier 3
Seroquel XR	Added as Tier 3
Sprycel	Added as Tier 3, PA required
Tekturna	Added as Tier 3, PA required
Tetanus toxoid	Added as Tier 3
Trisenox	Added as Tier 3, PA required
Tykerb	Added as Tier 3, PA required
Tyzeka	Added as Tier 3, PA required
Velcade	Added as Tier 3, PA required
Venoglobul	Added as Tier 3, PA required
Yaz	Added as Tier 3
Zolinza	Added as Tier 3, PA required

changes

Eth-oxydose conc	PA removed
Accuneb	Tier change
Accupril	QLL increased
Aclovate	Tier change
Acthib	PA removed
Actonel with calcium	QLL added
Actoplus met	QLL increased
Agrylin	Tier change
Ambien	QLL increased
Anexsia	PA removed
Aralast	PA added
Arava	Tier change
Axert	QLL increased
Cardura	QLL increased
Ciloxan	Tier change
Colestid	Tier change
Comvax	PA removed
Dantrium	Tier change
Daptacel	PA removed
Ddavp	Tier change
Depo-testosterone	Tier change
Didronel	Tier change
Diflucan 50, 100, 200 mg tabs	PA removed & QLL added
Dostinex	QLL increased
Faslodex soln	Tier change
Flonase	Tier change
Grifulvin V susp	Tier change
Humalog (vial)	Tier change
Ipol	PA removed
Kytril	QLL removed
Lamictal chew	Tier change
Levemir	PA removed
Lidoderm	QLL increased
Lithobid	Tier change
Lofibra	Tier change
Lorcet plus	PA removed
Lotronex	Tier change
Malarone 62.5 mg;25 mg tabs	Tier change
Marinol	QLL removed
Methergine	Tier change
Metrogel vaginal	Tier change
Metrolotion	Tier change
Miacalcin	Tier change
M-m-r II	PA removed
Naprelan	PA removed
Neupogen	PA added
Nilandron	PA removed
Nitrostat	Tier change
Norpace	Tier change
Norpace CR	Tier change
Oxyfast conc	PA removed
Pamine	PA removed
Parnate	Tier change
Prandin	QLL increased
Premarin cream	Tier change
Proscar	Tier change
Prozac 40 mg caps	PA added
Recombivax HB	PA removed
Retrovir	Tier change
Roferon-A	PA removed
Rythmol SR	Tier change
Salagen	Tier change
Sandostatin	Tier change
Sonata	QLL increased
Surmontil	Tier change
Transderm-Scop	QLL increased
Tripedia	PA removed
Twinrix	PA removed
Urocit-K	Tier change
Vaqta	PA removed
Varivax	PA removed
Verelan PM	PA removed
Wellbutrin XL	Tier change
Zavesca	PA removed
Zithromax	Tier change
Zofran	QLL removed

tips for medicare coding

Did you know that diagnosis codes not only impact our corporate and industry reporting, but also our reimbursement from the Centers for Medicare & Medicaid?

As a an organization that offers Medicare Advantage plans, Fallon Community Health Plan is required to submit diagnostic information to CMS on a regular basis. These submissions are based on claims data and identify ICD-9 codes present for a specific provider on any date of service. About 20% of all available ICD-9 codes are translated into a severity-adjusted level of reimbursement based on values associated with Hierarchical Condition Categories, or HCCs.

CMS has mapped in excess of 3,200 diagnosis codes to 70 categories of clinically similar diagnoses for the basis of payment within the Risk Adjustment Rating Methodology. HCC captures the severity of illness, are additive and need to be documented and coded at least once each calendar year per CMS guidelines.

improvements for better reimbursement
The Risk Adjustment Rating Methodology employed by CMS has presented several opportunities for FCHP and our partners to identify areas for quality coding improvements with the potential for increased reimbursement. This process is very detailed, and not only requires implementation of accurate coding and charting practices but also complete and detailed claims submission practices.

The risk adjustment process can be broken down into three components:

The first step in the physician-data process is appropriate medical record documentation. This includes the recording of conditions and diseases; updating a problem list, if used; and recording of the patient’s name on each page of the medical record. Physicians should sign and date each entry in the medical record. Remember to include all active diagnosis codes.

Documentation of the medical record is both the responsibility of the clinical and non-clinical staff. Physician participation in the coding and billing process is essential. Practices may even employ physician reviewers or, at the very least, establish regular meetings with the coding and billing staff to share issues in documentation. Even if a third-party billing service is used, the responsibility for accuracy and quality of the medical record lies with the physician.
The second step is ICD-9-CM coding based on medical record documentation.
The third step is the physician reporting the ICD-9-CM diagnostic data to FCHP, using the CMS 1500 or UB92 claim form.

If you have any questions regarding the Risk Adjustment Payment Methodology, please contact your Provider Relations Representative at 1-866-ASK-FCHP, option #4. FCHP representatives from our Medicare Reimbursement & Analytics Department are available to conduct practice and group presentations as appropriate.

tips for bilateral services and modifier -50

One of the most frequently asked billing questions we receive is how to bill for bilateral services. In this article, we’ll address the correct use of modifier -50.

Bilateral services are services performed on both sides of the body during (a) the same operative session or (b) on the same day. The modifier -50 is not applicable to services that are bilateral by definition or the CPT code description states “bilateral’ or “unilateral.”

CPT defines modifier -50: “Bilateral Procedure—Unless otherwise identified in the listing, bilateral procedures that are performed at the same operative session should be identified by adding the -50 modifier to the appropriate five-digit code.”

When reporting bilateral diagnostic and surgical services, use modifier -50. Bilateral diagnostic and surgical services are billed on one claim line with modifier -50 and the units billed should be one. Don’t use the -50 modifier to report services already identified as bilateral by definition.

When reporting bilateral radiological services, use the -RT and -LT modifiers. Radiological services are billed on two claim lines with the -RT and -LT modifier and one unit on each line. Don’t use the -RT and -LT modifier to report services already identified as bilateral by definition.

Reimbursement for bilateral services is determined by the Medicare Physician Fee Schedule Database.

bilateral indicator	definition	fchp instructions
0	150% payment adjustment for bilateral procedures does not apply. If the procedure is reported with modifier -50 or with -RT and -LT, the payment is based for the two sides, or the lower of the actual charges for both sides, or 100% of the fee schedule amount for a single code.	Do not submit these codes with modifier -50.
1	150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier -50, the payment is based on the lower of the total charges for both sides or 150% of the fee schedule for a single code.	Submit the procedure code on a single claim line with modifier -50 with “1” unit. See Table A below for a list of codes.
2	150% payment adjustment does not apply. Relative Value Units (RVUs) are already based on the procedure being preformed as a bilateral procedure. If the procedure is reported with a modifier -50, or twice on the same day by any other means, the payment is based on both sides of the total actual charge by the physician for both sides or 100% of the fee schedule for a single code.	Do not submit these codes with modifier -50. Submit the procedure code on a single claim line with “1” unit. See Table B below for a list of codes.
3	The usual payment adjustment for bilateral procedures does not apply. If the procedure is reported with modifier -50 or is reported for both sides on the same day, payment is based on each side or organ or site of a paired organ on the lower of the actual charge for each side, or 100% of the fee schedule amount for each side. Services in this category are generally radiology or other diagnostic tests that are not subject to the special payment rules for other bilateral surgeries.	Submit radiology procedure code on two claim lines with the -RT and -LT modifiers with “1” unit on each claim line. See Table C below for a list of codes.
9	Bilateral concept does not apply.	Do not submit these codes with modifier -50.

Table A – 150% payment adjustment for bilateral procedures applies.

Table B – 150% payment adjustment does not apply. RVU’s are already based on the procedure being performed as a bilateral procedure.

Table C - The usual payment adjustment for bilateral procedures does not apply. Pay 100% of the fee schedule amount for each side or unit.

Table A – 150% payment adjustment for bilateral procedures applies

Code	Modifier	Description
0016T		Thermotx choroid vasc lesion
0017T		Photocoagulat macular drusen
15820		Revision of lower eyelid
15821		Revision of lower eyelid
15822		Revision of upper eyelid
15823		Revision of upper eyelid
15824		Removal of forehead wrinkles
15825		Removal of neck wrinkles
15826		Removal of brow wrinkles
15828		Removal of face wrinkles
15829		Removal of skin wrinkles
19020		Incision of breast lesion
19030		Injection for breast x-ray
19100		Bx breast percut w/o image
19101		Biopsy of breast, open
19102		Bx breast percut w/image
19103		Bx breast percut w/device
19105		Cryosurg ablate fa, each
19110		Nipple exploration
19112		Excise breast duct fistula
19120		Removal of breast lesion
19125		Excision, breast lesion
19290		Place needle wire, breast
19296		Place po breast cath for rad
19298		Place breast rad tube/caths
19300		Removal of breast tissue
19301		Partical mastectomy
19302		P-mastectomy w/ln removal
19303		Mast, simple, complete
19304		Mast, subq
19305		Mast, radical
19306		Mast, rad, urban type
19307		Mast, mod rad
19316		Suspension of breast
19318		Reduction of large breast
19324		Enlarge breast
19325		Enlarge breast with implant
19328		Removal of breast implant
19330		Removal of implant material
19340		Immediate breast prosthesis
19342		Delayed breast prosthesis
19350		Breast reconstruction
19355		Correct inverted nipple(s)
19357		Breast reconstruction
19361		Breast reconstr w/lat flap
19364		Breast reconstruction
19366		Breast reconstruction
19367		Breast reconstruction
19368		Breast reconstruction
19369		Breast reconstruction
19370		Surgery of breast capsule
19371		Removal of breast capsule
19380		Revise breast reconstruction
19396		Design custom breast implant
19499		Breast surgery procedure
20100		Explore wound, neck
20150		Excise epiphyseal bar
20526		Ther injection, carp tunnel
20600		Drain/inject, joint/bursa
20605		Drain/inject, joint/bursa
20610		Drain/inject, joint/bursa
20802		Replantation, arm, complete
20805		Replant forearm, complete
20808		Replantation hand, complete
20824		Replantation thumb, complete
20827		Replantation thumb, complete
20838		Replantation foot, complete
20982		Ablate, bone tumor(s) perq
21010		Incision of jaw joint
21050		Removal of jaw joint
21060		Remove jaw joint cartilage
21070		Remove coronoid process
21077		Prepare face/oral prosthesis
21086		Prepare face/oral prosthesis
21240		Reconstruction of jaw joint
21242		Reconstruction of jaw joint
21243		Reconstruction of jaw joint
21280		Revision of eyelid
21282		Revision of eyelid
21480		Reset dislocated jaw
21485		Reset dislocated jaw
21490		Repair dislocated jaw
21615		Removal of rib
21616		Removal of rib and nerves
23020		Release shoulder joint
23031		Drain shoulder bursa
23035		Drain shoulder bone lesion
23040		Exploratory shoulder surgery
23044		Exploratory shoulder surgery
23065		Biopsy shoulder tissues
23066		Biopsy shoulder tissues
23075		Removal of shoulder lesion
23076		Removal of shoulder lesion
23077		Remove tumor of shoulder
23100		Biopsy of shoulder joint
23101		Shoulder joint surgery
23105		Remove shoulder joint lining
23106		Incision of collarbone joint
23107		Explore treat shoulder joint
23125		Removal of collar bone
23130		Remove shoulder bone, part
23140		Removal of bone lesion
23145		Removal of bone lesion
23146		Removal of bone lesion
23150		Removal of humerus lesion
23155		Removal of humerus lesion
23156		Removal of humerus lesion
23170		Remove collar bone lesion
23172		Remove shoulder blade lesion
23174		Remove humerus lesion
23180		Remove collar bone lesion
23182		Remove shoulder blade lesion
23184		Remove humerus lesion
23190		Partial removal of scapula
23195		Removal of head of humerus
23200		Removal of collar bone
23210		Removal of shoulder blade
23220		Partial removal of humerus
23221		Partial removal of humerus
23222		Partial removal of humerus
23330		Remove shoulder foreign body
23331		Remove shoulder foreign body
23332		Remove shoulder foreign body
23350		Injection for shoulder x-ray
23400		Fixation of shoulder blade
23410		Repair rotator cuff, acute
23412		Repair rotator cuff, chronic
23415		Release of shoulder ligament
23420		Repair of shoulder
23430		Repair biceps tendon
23440		Remove/transplant tendon
23450		Repair shoulder capsule
23455		Repair shoulder capsule
23460		Repair shoulder capsule
23462		Repair shoulder capsule
23465		Repair shoulder capsule
23466		Repair shoulder capsule
23470		Reconstruct shoulder joint
23472		Reconstruct shoulder joint
23480		Revision of collar bone
23485		Revision of collar bone
23490		Reinforce clavicle
23491		Reinforce shoulder bones
23500		Treat clavicle fracture
23505		Treat clavicle fracture
23515		Treat clavicle fracture
23520		Treat clavicle dislocation

23525		Treat clavicle dislocation
23530		Treat clavicle dislocation
23532		Treat clavicle dislocation
23540		Treat clavicle dislocation
23545		Treat clavicle dislocation
23550		Treat clavicle dislocation
23552		Treat clavicle dislocation
23570		Treat shoulder blade fx
23575		Treat shoulder blade fx
23585		Treat scapula fracture
23600		Treat humerus fracture
23605		Treat humerus fracture
23615		Treat humerus fracture
23616		Treat humerus fracture
23620		Treat humerus fracture
23625		Treat humerus fracture
23630		Treat humerus fracture
23650		Treat shoulder dislocation
23655		Treat shoulder dislocation
23660		Treat shoulder dislocation
23665		Treat dislocation/fracture
23670		Treat dislocation/fracture
23675		Treat dislocation/fracture
23680		Treat dislocation/fracture
23800		Fusion of shoulder joint
23930		Drainage of arm lesion
23931		Drainage of arm bursa
23935		Drain arm/elbow bone lesion
24000		Exploratory elbow surgery
24006		Release elbow joint
24065		Biopsy arm/elbow soft tissue
24066		Biopsy arm/elbow soft tissue
24075		Remove arm/elbow lesion
24076		Remove arm/elbow lesion
24077		Remove tumor of arm/elbow
24100		Biopsy elbow joint lining
24101		Explore/treat elbow joint
24102		Remove elbow joint lining
24105		Removal of elbow bursa
24110		Remove humerus lesion
24115		Remove/graft bone lesion
24116		Remove/graft bone lesion
24120		Remove elbow lesion
24125		Remove/graft bone lesion
24126		Remove/graft bone lesion
24130		Removal of head of radius
24134		Removal of arm bone lesion
24136		Remove radius bone lesion
24138		Remove elbow bone lesion
24140		Partial removal of arm bone
24145		Partial removal of radius
24147		Partial removal of elbow
24149		Radical resection of elbow
24150		Extensive humerus surgery
24151		Extensive humerus surgery
24152		Extensive radius surgery
24153		Extensive radius surgery
24155		Removal of elbow joint
24160		Remove elbow joint implant
24164		Remove radius head implant
24200		Removal of arm foreign body
24201		Removal of arm foreign body
24220		Injection for elbow x-ray
24300		Manipulate elbow w/anesth
24330		Revision of arm muscles
24331		Revision of arm muscles
24332		Tenolysis, triceps
24340		Repair of biceps tendon
24341		Repair arm tendon/muscle
24342		Repair of ruptured tendon
24343		Repr elbow lat ligmnt w/tiss
24344		Reconstruct elbow lat ligmnt
24345		Repr elbw med ligmnt w/tissu
24346		Reconstruct elbow med ligmnt
24350		Repair of tennis elbow
24351		Repair of tennis elbow
24352		Repair of tennis elbow
24354		Repair of tennis elbow
24356		Revision of tennis elbow
24360		Reconstruct elbow joint
24361		Reconstruct elbow joint
24362		Reconstruct elbow joint
24363		Replace elbow joint
24365		Reconstruct head of radius
24366		Reconstruct head of radius
24400		Revision of humerus
24410		Revision of humerus
24420		Revision of humerus
24430		Repair of humerus
24435		Repair humerus with graft
24470		Revision of elbow joint
24495		Decompression of forearm
24498		Reinforce humerus
24500		Treat humerus fracture
24505		Treat humerus fracture
24515		Treat humerus fracture
24516		Treat humerus fracture
24530		Treat humerus fracture
24535		Treat humerus fracture
24538		Treat humerus fracture
24545		Treat humerus fracture
24546		Treat humerus fracture
24560		Treat humerus fracture
24565		Treat humerus fracture
24566		Treat humerus fracture
24575		Treat humerus fracture
24576		Treat humerus fracture
24577		Treat humerus fracture
24579		Treat humerus fracture
24582		Treat humerus fracture
24586		Treat elbow fracture
24587		Treat elbow fracture
24600		Treat elbow dislocation
24605		Treat elbow dislocation
24615		Treat elbow dislocation
24620		Treat elbow fracture
24635		Treat elbow fracture
24640		Treat elbow dislocation
24650		Treat radius fracture
24655		Treat radius fracture
24665		Treat radius fracture
24666		Treat radius fracture
24670		Treat ulnar fracture
24675		Treat ulnar fracture
24685		Treat ulnar fracture
24800		Fusion of elbow joint
24802		Fusion/graft of elbow joint
24900		Amputation of upper arm
24920		Amputation of upper arm
24925		Amputation follow-up surgery
24930		Amputation follow-up surgery
24931		Amputate upper arm & implant
24935		Revision of amputation
24940		Revision of upper arm
24999		Upper arm/elbow surgery
25000		Incision of tendon sheath
25001		Incise flexor carpi radialis
25020		Decompress forearm 1 space
25023		Decompress forearm 1 space
25024		Decompress forearm 2 spaces
25025		Decompress forearm 2 spaces
25028		Drainage of forearm lesion
25031		Drainage of forearm bursa
25035		Treat forearm bone lesion
25040		Explore/treat wrist joint
25065		Biopsy forearm soft tissues
25066		Biopsy forearm soft tissues
25075		Removal forearm lesion subcu
25076		Removal forearm lesion deep
25077		Remove tumor, forearm/wrist

25085		Incision of wrist capsule
25100		Biopsy of wrist joint
25101		Explore/treat wrist joint
25105		Remove wrist joint lining
25107		Remove wrist joint cartilage
25109		Excise tendon forearm/wrist
25110		Remove wrist tendon lesion
25111		Remove wrist tendon lesion
25112		Reremove wrist tendon lesion
25115		Remove wrist/forearm lesion
25116		Remove wrist/forearm lesion
25118		Excise wrist tendon sheath
25119		Partial removal of ulna
25120		Removal of forearm lesion
25125		Remove/graft forearm lesion
25126		Remove/graft forearm lesion
25130		Removal of wrist lesion
25135		Remove & graft wrist lesion
25136		Remove & graft wrist lesion
25145		Remove forearm bone lesion
25150		Partial removal of ulna
25151		Partial removal of radius
25170		Extensive forearm surgery
25230		Partial removal of radius
25240		Partial removal of ulna
25246		Injection for wrist x-ray
25248		Remove forearm foreign body
25250		Removal of wrist prosthesis
25259		Manipulate wrist w/anesthes
25275		Repair forearm tendon sheath
25300		Fusion of tendons at wrist
25301		Fusion of tendons at wrist
25315		Revise palsy hand tendon(s)
25316		Revise palsy hand tendon(s)
25320		Repair/revise wrist joint
25332		Revise wrist joint
25335		Realignment of hand
25337		Reconstruct ulna/radioulnar
25350		Revision of radius
25355		Revision of radius
25360		Revision of ulna
25365		Revise radius & ulna
25370		Revise radius or ulna
25375		Revise radius & ulna
25390		Shorten radius or ulna
25391		Lengthen radius or ulna
25392		Shorten radius & ulna
25393		Lengthen radius & ulna
25394		Repair carpal bone, shorten
25400		Repair radius or ulna
25405		Repair/graft radius or ulna
25415		Repair radius & ulna
25420		Repair/graft radius & ulna
25425		Repair/graft radius or ulna
25426		Repair/graft radius & ulna
25430		Vasc graft into carpal bone
25431		Repair nonunion carpal bone
25440		Repair/graft wrist bone
25441		Reconstruct wrist joint
25442		Reconstruct wrist joint
25443		Reconstruct wrist joint
25444		Reconstruct wrist joint
25445		Reconstruct wrist joint
25446		Wrist replacement
25447		Repair wrist joint(s)
25449		Remove wrist joint implant
25450		Revision of wrist joint
25455		Revision of wrist joint
25490		Reinforce radius
25491		Reinforce ulna
25492		Reinforce radius and ulna
25500		Treat fracture of radius
25505		Treat fracture of radius
25515		Treat fracture of radius
25520		Treat fracture of radius
25525		Treat fracture of radius
25526		Treat fracture of radius
25530		Treat fracture of ulna
25535		Treat fracture of ulna
25545		Treat fracture of ulna
25560		Treat fracture radius & ulna
25565		Treat fracture radius & ulna
25574		Treat fracture radius & ulna
25575		Treat fracture radius/ulna
25600		Treat fracture radius/ulna
25605		Treat fracture radius/ulna
25606		Treat fx distal radial
25607		Treat fx rad extra-articul
25608		Treat fx rad intra-articul
25609		Treat fx radial 3+ frag
25622		Treat wrist bone fracture
25624		Treat wrist bone fracture
25628		Treat wrist bone fracture
25630

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