10.40.08.03

.03 Examples of Fragmentation of Billing.

A. By way of illustration, but not limitation, fragmentation of billing in Regulation .02B(3)(i), of this chapter, includes breaking the following general procedures into the following listed specific procedures:

(1) Keller bunionectomy — a multi-step procedure, which may include any or all of the following:

(a) Resection of medial eminence 1st metatarsal head;

(b) Resection base of proximal phalanx;

(c) Capsulotomy/capsulorrhaphy;

(d) Z-plasty of extensor tendon; and

(e) Sesamoidectomy.

(2) Lesser metatarsal osteotomy — a multi-step procedure, which may include any or all of the following:

(a) Tenoplasty;

(b) Capsulotomy/capsulorrhaphy;

(c) Osteotomy; and

(d) Fixation.

B. Fragmentation of billing is especially egregious when the licensee bills for both the general and specific procedures.