Health Service Code 91.09A
Diaphyseal bone external fixation with possible metaphyseal fixation
NOTE:
This will include complex cases such as a severe tibial plateau fracture that can not be treated with internal fixation.
| Category: | 14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days) |
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| Base rate: | $527.41 |
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AMA billing tips:
91.09A should NOT be used for wrist pinning; 91.09B should be used for closed reduction and pinning of distal radius metaphyseal fractures.
Governing Rules:
6.8.1
HSCs with a designated category code of 1 and 15 include related post-operative services and those with a designated category code of 3, 4, 6 and 14 include both related pre-operative and post-operative services.
- a consultation benefit may be claimed up to and including the day of surgery.
- pre-operative hospital care may be claimed by the physician who performs the surgery if information is submitted to show that conservative treatment was attempted before surgery was performed.
- benefits may be claimed as applicable for complications occurring during or following post-operative time periods.
- Deleted
- HSC 03.04R may be claimed in the pre-operative time frame when all conditions in the notes have been met.
The following chart gives the pre-operative and post-operative periods.
6.9.7
The section on multiple procedures does not apply where the lesser or secondary procedure is:
- a fracture that is otherwise provided for in this Schedule,
- a dislocation,
- a procedure considered to be part of an inclusive benefit, or
- a secondary procedure that is paid in full as an additional item or as an interpretation of a diagnostic test as a listed benefit in the Schedule,
- a procedure listed in the following table which may be claimed at 100% when performed as a second or subsequent procedure by any physician, regardless of whether the procedures are performed by one or more physicians and regardless of whether additional incisions are required to perform the procedure. This does not apply to anesthetic services; refer to GR 12.4.9.
- a procedure listed in the following table that may be claimed at 100% when performed as a second or subsequent procedure through a different incision by any physician, regardless of whether the procedures are performed by one or more physicians. This does not apply to anesthetic services; refer to GR 12.4.
- Procedures in different groups in the following table may be claimed at 100% each when performed at the same operative encounter. For example, procedures listed in group B may be claimed at 100% when performed at the same operative encounter as procedures listed in group A. Two procedures from the same group will continue to be paid at 100% and 75% for second and subsequent procedures. This does not apply to anesthetic services; refer to GR 12.4.
Group A
Group B
Group C
Group D
