Surgery Charges & Hospital Charges
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1NORTH DEKALB ORTHOPEDICS, P.C.
Surgery Charges & Hospital Charges
PAUL F. RICHIN, M.D.
ROBERT S. BACHNER, M.D.
LAWRENCE A. BIRCOLL, M.D.
505 IRVIN CT SUITE 200 , DECATUR, GEORGIA 30030
(404) 294-4111
PATIENT NAME:_____________________________________
BILLING DATE:______/________/____
XRAY # _____________________
DATE OF INJURY:_________/________/_________
STATE INJURY OCCURRED_____________
AUTO
OTHER
W/C
REFERRING MD ________________________________
REFERRAL # _________________________________________________________
INSURANCE COMPANY NAME / CODE _________________________________________________ / __________________________________
LOCATION:
ER (23)_____
Outpatient (22) ______ Inpatient (21) ______ Dates Hospitalized ________/_______/_______ - ________/________/________
HOSPITAL E/M Codes:
Date for E/M Service :___________/___________/___________
ICD-9:
New And Old Patient:
9922_____
1
2
3
57 decision
____________
Subsequent Hospital Care:
9923_____
1
2
3
____________
Emergency:
9928_____
1
2
3
4
5
57 decision
____________
Consultations:
9925_____
1
2
3
4
5
57 decision
____________
Common ICD9's:
816.00
Fx Phalanx, hand, closed NOS
825.25
Fx Metatarsal
813.41
Fx Distal Radius
826.0
Fx Phalanx
805.4
Lumbar Spine Fx
(coll e s, closed)
355.6
Morton’s Neuroma
Date for PROCEDURE- :_______ /_________/__________
805.2
Thoracic Spine Fx
813.42
Fx Distal Radius
-------------------------------------------------
(intra-arctic)
----------------------------------------------------
831.1
Ant Shoulder Di s loc
814.01
Fx Scaphoid
715.16
Knee OA (DJD)
CPT:
Modifier:
ICD9:
Charges:
726.19
Shoulder Bursitis
814.00
Fx carpal bone
732.4
Osgood Schlatte rs
727.61
Rotator Cuff Tear
842.10
Sprain Hand
732.7
Osteochondritis Dissecans
840.9
Shoulder Sprain
842.00
Sprain Wrist
717.89
Internal Derangement
___________
_________
__________
___________
812.00
Fx Prox Humerus
718.83
Joint Derange ment Wrist
717.83
Torn ACL
812.21
Fx Humerus Shaft (closed)
354.0
Carpal Tunnel Syndrome
836.0
Torn Medial Meniscus
727.03
Trigger Finger
836.1
Torn Lateral Meni s cus
810.00
Fx Clavicle
719.41
Shoulder Pain
727.04
DeQuervain’s
844.9
Sprain Knee
___________
_________
__________
___________
718.01
Labral Tear (Shoulder)
727.41
Ganglion
844.1
Sprain MCL
-----------------------------------------
736.1
Mallet finger
844.0
Sprain LCL
733.00
Osteoporosis
834.00
Disloc finger
726.61
Pes Bursitis
714.0
Rheumatoid Arthritis
----------------------------------------------
726.65
Pre-patellar Bursitis
___________
_________
__________
___________
733.82
Nonunion of Fx
715.15
Hip OA (DJD)
726.65
Patellar Tendonitis
733.42
AVN Hip
717.7
Chon dromalacia Pa tella
733.81
Malunion of Fx
996.77
Complication of Prosthesis
726.5
Hip Trochanteric Bursitis
___________
_________
__________
___________
-------------------------------------------
808.2
Fx Pubis
727.65
Rupture Quads Tendon
808.0
Fx Acetabulum
727.66
Rupture Patellar Tendon
813.01
Fx Olecranon
813.05
Fx Radial Head
808.8
Fx Pelvis, NOS
717.2
Deranged PostMed Men
726.33
Olecranon Bursitis
820.02
Fx Femoral Neck
717.43
Deranged PostLat Meniscus
___________
_________
__________
___________
726.32
Tennis Elbow
820.21
Fx Intertroch hip
717.5
Deranged Meniscus other
813.23
Fx Radius & Ulna Shafts
821.01
Fx Femur Shaft
822.0
Fx Patella (closed)
813.22
Fx Ulna Shaft
------------------------------------------------
823.00
Fx Tibial Plateau (closed)
812.40
Fx Distal Humerus (NOS)
824.0
Fx Medial Malleol u s
823.80
Fx Tibia Shaft
$
TOTAL:
824.2
Fx. Lateral Malleolus
823.81
Fx Fibula Shaft
_________________________
719.42
Elbow Pain
824.4
Fx Bimalleolar
823.22
Fx Tib-Fib Shaft
--------------------------------------------
824.6
Fx Trimalleolar
823.01
Fx Prox Fibula
845.00
Sprain Ankle
836.3
Dislocation Patella
714.0
Rheumatoid Arthritis
996.77
Complication Internal Prosthesis
845.02
Lateral Ankle Sprain
727.89
Synovial Plica
733.82
Nonunion Fracture
717.6
Loose Body in Knee
733.81
Malunion Fracture
734.0
Halux Valgus
815.00
Fx Metacarpal Cl o sed
735.2
Hallux Rigidus
825.0
Fx. Calcaneus
CPT
Description
25605
Closed tx distal radius fx w/ reduction
27524
ORIF patellar fx or patellectomy
28296
Correct HalVal (Mitchell, Chevron osteot
25622
Closed tx scaphoid fx (no manip.)
27530
Closed tx tib plateau fx (no manip.)
28308
Ostoeotomy MT base/shaft (not first)
26055
Release Trigger Finger
27535
ORIF tibial plateau fx (un icondylar)
28322
Repair non/malunion MT +/- bone graft
20650
Insert Steinman Traction pin
26160
Excision tendon sheath cyst or ganglion
27536
ORIF tibial plateau fx (bicon dylar)
28415
ORIF calcaneus fx
20680
Removal of hardware (major)
26605
Closed tx MC fx w/manipulation ea.
27560
Closed tx patellar dislocation
28430
Closed tx talus fx
22310
Treat vertebral body fracture
26650
Perc. Pin CMC fx/disloc Bennett's fx
27570
Manipulatio n knee under anesthesia
28465
ORIF tarsal bone fx (not tal/calc)
22315
Treat vertebral body fx with cast/brace
26735
Open tx phalanx shaft fx
28470
Closed tx metatarsal fx
26770
Closed treat IP dislocation w/manip
27600
Fasciotomy leg (anterior and/or lat comp
28485
ORIF Metatarsal fx
23130
Acromioplasty (partial)
27650
Repair achilles tendo n rupture (primary)
28575
Closed tx talotarsal disloc w/manip.
23150
Excision/Curretage bone cyst prox hum
27030
Arthrotomy hip for infection
27675
Repair dislocating peroneal tendons
28605
Closed tx Lisfra nc disloc w/ane sthesia
23415
Release C-A Ligament + Acromioplasty
27071
Core Decompression for AVN
27720
ORIF Non-Mal-Union tibia (no graft)
28615
ORIF TMT disloc (Lisfranc)
23420
Repair complete Rot. Cuff Avulsion
27090
Removal of hip prosthesis
27724
27720 with iliac or autograft
28635
Closed tx MTP disloc w/anesthesia
23430
Biceps Tenodesis for rupture
27125
Hip hemi-arthroplasty
27752
Closed tx tibial shaft fx w/ manip.
28820
Amputation toe @ MTP joint
23450
Shoulder Capsulorrhaphy
27130
Total hip arthroplasty
27756
External fixation tibial shaft fx
23455
Anterior shoulder stab. (Bankart)
27132
Conversi o n prev. hip surg. to THA
27758
ORIF tibial shaft fx
29805
Shoulder Scope - diag nostic
27134
Revision THA (both components)
27759
IM Nailing tibial shaft fx
29806
Shoulder Scope - capsulorrhaphy
23600
Treat Prox humerus fx (closed)
29807
Shoulder Scope - repair SLAP lesion
23615
ORIF Prox humerus fx
27193
Closed tx pelvic ri n g fx/di s loc
27762
Closed tx med. mall. fx w/ manip.
29822
Shoulder Scope - limited debridement
23665
Closed Tx. Gr. Tub fx with dislocation
27235
Perc. pinning femoral neck fx
27786
Closed tx lat. malleolus fx (no manip.)
29823
Shoulder Scope - extensive debride.
23680
Open tx Surg/Anat neck fx with disloc
27236
ORIF or Hemi for Fem Neck fx
27792
ORIF lateral malleolus fx
29824
Shoulder Scope - Mumford
23700
Manipulatio n shoulder under anesthesia
27244
ORIF inter-sub troch. hip fx
27814
ORIF bimalleolar ankl e fx
29825
Shoulder Scope - lysis ad hesion & manip
27246
Closed tx. gt. troch. fx
27822
ORIF trimalleolar ankle fx
29826
Shoulder Scope - w/ subacrom decomp.
24356
Repair of tennis elbow with ostectomy
27248
Open tx Gt. troch fx (ORIF)
27827
ORIF pilon fx (tibial ORIF only)
24500
Closed Treatm ent hume rus fracture
27829
Open tx syndesmosis disruption ankle
29855
Knee Scope tx of tibial plateau fx
24505
Closed Rx. hu merus fracture with manip
27310
Arthrotomy knee for infection/for body
27840
Closed tx ankle dislocation
29874
Knee Scope - removal loose body
24515
ORIF Humerus shaft
27334
Arthrotomy knee for synovectomy
27848
27848 with repair or ORIF or OREF
29875
Knee Scope - limited synovectomy, plica
24516
IM Nailing hum eral shaft fracture
27350
Patellectomy or Hemipatellectomy
29876
Knee Scope -2 compt synovectomy
24600
Closed Tx. elbow dislocation
27360
Partial excision knee area for osteo
28002
I & D foot (deep) for infection
29877
Knee Scope - debride, chondroplasty
24650
Closed Tx. radi a l head fx. (-manip)
27380
Repair patellar ten don rupture
28080
Excision Morton's Neu roma, single
29879
Knee Scope - abrasio n arthroplasty/drill
24670
Closed tx olecranon fx (-manip)
27385
Repair quad s rupture or ham s rupture
28100
Excision/curettage cyst talus/calcaneus
29880
Knee Scope - med & lat menisectomy
24685
ORIF Olecranon fx
27422
27420 with extensor realign (Goldwaite)
28110
Partial excision 5th MT head (bunionette
29881
Knee Scope - med or lat menisectomy
27425
Lateral retinacular relea se
28112
Complete excision 2,3,4th MT heads
29882
Knee Scope - med or lat menis repa ir
25000
DeQuervain's Release of tendon sheath
27430
Quadricepsplasty
28113
Complete excision 5th MT head
29886
Knee Scope - dri l l osteo. dissecans
25111
Excision primary wrist ganglion (vo/do)
28126
Condylectom y, base of ea. toe (DuVries)
29888
Knee Scope - ACL Reconstruction
25295
Tenolysis flexor/extensor tendon ea.
27446
Uni Knee Replacement
28160
Hemiphalangectomy or IP jt. excision
25515
ORIF radial shaft fx
27447
Total knee arthroplasty
28175
Radical resection phalanx for tumor
29895
Ankle Scope - partial synovectomy
25530
Closed tx ulnar shaft fx (nightstick)
27487
Revision TKA (all compon ents)
28200
Repair of foot flexor tendon
29897
Ankle Scope - limited debridement
25545
ORIF Ulnar shaft fx
27488
Removal TKA and insert spacer
28272
Capsulotom y IP jt. for contracture
29898
Ankle Scope - extensive debridement
25565
Closed tx rad & uln shaft fx's w/ reduct
28285
Hammertoe: IP fusion, phalangectomy
25575
ORIF radius and ulna fx
27501
Closed tx supracondylar fx w/o manip.
28288
Partial removal of MT head (1-5)
64718
Ulnar nerve transposition at elbow
27506
IM Nailing femoral shaft fx
28289
Dorsal Cheilectomy for Hallux Rigidus
64721
Carpal Tunnel Release
25600
Closed tx distal radius fx (no reduct)
27507
ORIF femoral shaft fx (Plate-screws)
28292
Correct Hal.Val. (Keller, McBride)
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