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E X T E R N A L

F I X A T O R S
84.71 Application of external fixator device, monoplanar system EXCLUDES other hybrid device or system (84.73) ring device or system (84.72) 84.72 Application of external fixation device, ring system Ilizarov type Sheffield type EXCLUDES monoplanar device or system (84.71) other hybrid device or system (84.73) 84.73 Application of hybrid external fixator device Hybrid system using both ring and monoplanar devices EXCLUDES monoplanar device or system, when used alone (84.71) ring device or system, when used alone (84.72) 4th digit 78.6 Removal of implanted devices from bone {0-9} ICD-9 Diagnosis Codes According to the ICD-9-CM Official Guidelines for Coding and Reporting Effective November 15, 2006: Coding of Pathologic Fractures 1) Acute Fractures vs. Aftercare Pathologic fractures are reported using subcategory 733.1, when the fracture is newly diagnosed. Subcategory 733.1 may be used while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, evaluation and treatment by a new physician. Fractures are coded using the aftercare codes (subcategories V54.0, V54.2, V54.8 or V54.9) for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are: cast change or removal, removal of external or internal fixation device, medication adjustment, and follow up visits following fracture treatment. Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes. Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate codes. Pathologic fractures are not coded in the 800-829 range, but instead are assigned to subcategory 733.1. Coding of Traumatic Fractures The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site in accordance with both the provisions within categories 800-829 and the level of detail furnished by medical record content. Combination categories for multiple fractures are provided for use when there is insufficient detail

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The following codes are representative of services or diagnoses that may be associated with use of these products. Not all are to be used together. Final determinations of the correct coding are made by the claims submitter/provider ONLY. Hospital Coding The reimbursement for orthopedic medical devices is often already included in the APC or DRG payment mechanisms for Medicare. Few medical devices have specific HCPCS codes which represent the device; particularly, for external fracture fixation devices. This is true across the manufacturer or vendor industry and is not isolated to Orthofix products. For non-Medicare patients, depending on contractual and other general stipulations of the payer, direct invoicing may be allowed. Effective for dates of service on or after October 1, 2005, ICD-9 hospital procedure codes representing utilization of external fixation products are as follows: (Please refer to the November 2005 AHA Coding Clinic for examples and further information.) ICD-9 Procedure 4th digit 84.7 Adjunct codes for external fixator devices Code also any primary procedure performed: application of external fixator device (78.10, 78.12-78.13, 78.15, 78.17-78.19) reduction of fracture and dislocation (79.00 79.89)

in the medical record (such as trauma cases transferred to another hospital), when the reporting form limits the number of codes that can be used in reporting pertinent clinical data, or when there is insufficient specificity at the fourth-digit or fifth-digit level. More specific guidelines are as follows: 1) Acute Fractures vs. Aftercare Traumatic fractures are coded using the acute fracture codes (800-829) while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. Fractures are coded using the aftercare codes (subcategories V54.0, V54.1, V54.8, or V54.9) for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are: cast change or removal, removal of external or internal fixation device, medication adjustment, and follow up visits following fracture treatment. Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes. 2) Multiple fractures of same limb Multiple fractures of same limb classifiable to the same three-digit or four-digit category are coded to that category. 3) Multiple unilateral or bilateral fractures of same bone Multiple unilateral or bilateral fractures of same bone(s) but classified to different fourth-digit subdivisions (bone part) within the same three-digit category are coded individually by site. 4) Multiple fracture categories 819 and 828 Multiple fracture categories 819 and 828 classify bilateral fractures of both upper limbs (819) and both lower limbs (828), but without any detail at the fourth-digit level other than open and closed type of fractures.

The reimbursement for fracture fixation, whether internal or external, is frequently included in the CPT code. Codes for external fixation are to be used only when external fixation is not already listed as part of the basic procedure. Example: 25545 Open treatment of ulnar shaft fracture, with or without internal or external fixation 26615 Open treatment of metacarpal fracture, single, with or without internal or external fixation, each bone 27784 Open treatment of proximal fibula or shaft fracture, with or without internal or external fixation In cases where the CPT does not contain inclusion of external fixation, it is appropriate to list the procedure for application of the device(s) separately. 20690 Application of a uniplane (pins or wires in one plane) unilateral, external fixation system (According to the AMAs CPT Assistant, Code 20690 my only be listed in addition to the code for the treatment of a fracture or joint injury when external fixation is not already listed as a part of the basic procedure performed.) 20692 Application of a multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Montecelli type) 20693 Adjustment or revision of external fixation system requiring anesthesia (e.g., new pin(s) or wire(s) and/or new ring(s) or bar(s)) (According to the AMAs CPT Assistant, bedside or office adjustments of an external fixation device are considered part of the protocol for use of the external fixation device. However, if general anesthesia is required to perform an adjustment or revision of an external fixation system (e.g., new pins, wires, rings or bars), then CPT code 20693 may be reported.) 20694 Removal, under anesthesia, of external fixation system This code may be reported only if performed under general anesthesia. New Code for 2007: 25606 Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation.
It is the customers responsibility to determine which combination of codes from any listing provided actually applies to that specific patient encounter. Providers of services or items are ultimately responsible for the content of the bills they present to Medicare or any other payer. The customer shall be solely responsible for: (i) determining if, and under what circumstances, it can seek third party reimbursement for Devices; (ii) obtaining, as necessary, third party payor pre-authorizations for the Devices; and (iii) any and all coding, billing, coverage, and collection of payment from third party payors or patients. CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. CPT is a registered trademark of the American Medical Association (AMA). The scope of utilization of CPT is determined by the AMA, the copyright holder. Any questions pertaining to the use of the CPT should be addressed to the AMA. End Users do not act for or on the behalf o Orthofix. Orthofix. DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER. ORTHOFIX WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE OR ON THEIR WEBSITE. In no event shall Orthofix be liable for direct, indirect, special, incidental or consequential damages arising out of the use of such information or material.

APC:
20690 20692 20693 20694 SI T T T T Description Level 11 Musculoskeletal procedure Level 11 Musculoskeletal procedure Level 1 Musculoskeletal procedure Level 1 Musculoskeletal procedure 0050 0050 0049 0049

HCPCS For the anchor/screw component only: C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) CPT According to CPT: Percutaneous skeletal fixation describes fracture treatment which is neither open nor closed. In this procedure, the fracture fragments are not visualized, but fixation (e.g. pins) is placed across the fracture site, usually under X-ray imaging. External fixation is the usage of skeletal pins plus an attaching mechanism/device used for temporary or definitive treatment of acute or chronic bony deformity.

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OF- 0705(A)-PL-US Orthofix Inc. 5/2007