Chapter 16 / Bones, joints and connective tissue/tendon muscle

When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances).

We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant.

Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures.

EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice.

Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure.

Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service.

There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression.

Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3).

Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas.

The following definitions are used throughout this section:

Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna

Small bones – all bones of hand, wrist, foot, ankle and also the patella

Large joints – ankle, elbow, hip, knee, shoulder and wrist

Small joints – all other joints of the hand and foot

Child Aged 0-15

Adult Aged 16 and over


16.1 - Connective tissue/tendon muscle

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



A8460 Static single measurement of muscle compartment pressures (Including reporting) Minor £200.00 £100.00 Show arrow
A8470 Dynamic laboratory investigation involving measurement of muscle compartment pressures with manometer Intermediate £200.00 £0.00 Show arrow
T5230 Excision of plantar fibroma Intermediate £200.00 £165.00 Show arrow
T5250 Endoscopic plantar fascia release Intermediate £200.00 £165.00
T5900 Excision of ganglion Intermediate £300.00 £165.00 Show arrow
T6000 Repeat excision of ganglion Intermediate £250.00 £165.00 Show arrow
T6220 Excision of bursa Intermediate £200.00 £165.00 Show arrow
T6580 Tendon graft, as sole procedure (not otherwise specified) Intermediate £400.00 £165.00 Show arrow
T6800 Delayed or secondary repair of tendon (including graft, transfer and/or prosthesis) (not otherwise specified) Major £550.00 £165.00 Show arrow
T7231 Open release of constriction of sheath of tendon (e.g. trigger finger) Intermediate £300.00 £165.00 Show arrow
T7232 Percutaneous release of constriction of sheath of tendon (e.g. trigger finger) Intermediate £300.00 £165.00 Show arrow
T6910 Tenolysis, of extensor, not otherwise specified Intermediate £350.00 £165.00 Show arrow
T6980 Tenolysis, of flexor tendon (not otherwise specified) Major £450.00 £165.00 Show arrow
T7010 Percutaneous tenotomy Minor £150.00 £110.00 Show arrow
T7050 Lengthening of tendon(s), or open tenotomy Intermediate £350.00 £165.00 Show arrow
T7110 Tenosynovectomy Intermediate £300.00 £165.00 Show arrow
T8002 Minor release of muscle for pain or contracture (involving small joint) Intermediate £350.00 £220.00 Show arrow
T8003 Major release of muscle for pain or contracture (eg Quadriceps) (involving large joint) Intermediate £350.00 £220.00 Show arrow
T8100 Open biopsy of muscle or soft tissue lesion Minor £200.00 £110.00 Show arrow
W6960 Needle biopsy of synovium Minor £100.00 £100.00
W8100 Open excision of calcific deposit (eg shoulder, hip) Minor £200.00 £165.00 Show arrow

16.2 - Bone (non-specific)

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



W0640 Total excision of sesamoid bone Intermediate £200.00 £165.00 Show arrow
W0700 Excision of ectopic bone Minor £200.00 £165.00 Show arrow
W0850 Partial excision of bone (including exostoses) Intermediate £300.00 £165.00 Show arrow
W0950 Radical clearance of sarcoma of trunk or limbs, +/- amputation or insertion of prosthesis Complex £750.00 £275.00 Show arrow
W0960 Excision of benign tumour of bone with bone grafting Xmajor £750.00 £275.00 Show arrow
W0951 Radical clearance of sarcoma of head and neck necessitating flap reconstruction Complex £1,000.00 £500.00 Show arrow
W1080 Osteotomy of long bone, with/without fixation, including graft Major £550.00 £220.00 Show arrow
W1800 Drainage/debridement of bone(s), including sequestectomy for osteomyelitis Intermediate £400.00 £165.00 Show arrow
W2700 Fixation of epiphysis, including epiphysiodesis, correction of angular deformity Intermediate £350.00 £220.00 Show arrow
W2702 Epiphysiolysis (eg Langenskiold procedure) Intermediate £350.00 £220.00 Show arrow
W3620 Open bone biopsy as sole procedure Intermediate £200.00 £165.00 Show arrow
W3622 Needle biopsy of bone as sole procedure Minor £200.00 £165.00 Show arrow
W3650 Diagnostic aspiration and trephine biopsy of bone marrow, including analysis Minor £200.00 £165.00 Show arrow
W3651 Diagnostic aspiration of bone marrow Minor £100.00 £100.00 Show arrow
W3652 Trephine biopsy of bone marrow Minor £200.00 £100.00 Show arrow
W0961 Radical clearance of benign bone tumour with reconstruction +/- insertion of prosthesis Complex £900.00 £330.00

16.3 - Fractures

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



Long bones

W1920 Primary open reduction of long bone with fixation Major £600.00 £275.00 Show arrow
W2100 Primary open reduction of intra-articular fracture of long bone with internal fixation, eg proximal humerus or proximal tibia (with or without arthroscopic assistance) Major £550.00 £275.00 Show arrow
W2310 Secondary open reduction of fractured long bone and intra-medullary fixation or internal fixation for non-union/mal union – including intra-articular (including bone graft) Xmajor £550.00 £220.00 Show arrow
W2380 Locked intramedullary nailing of fractured long bone Xmajor £750.00 £275.00 Show arrow
W2500 Closed reduction of fracture of long bone with external fixation (excluding fixation by cast or percutaneous K-wires) Major £500.00 £220.00 Show arrow
W2502 Closed reduction of fracture of long bone, including cast or percutaneous K-wires Intermediate £500.00 £220.00 Show arrow


Small bones

W1940 Primary open reduction of short bone with fixation (including intra-articular) Intermediate £450.00 £220.00 Show arrow
W2300 Secondary open reduction of fracture of short bone (including intra-articular fracture for delayed/non-union and including bone graft) Major £500.00 £165.00 Show arrow
W2580 Closed reduction of fracture of short bone with external fixator Intermediate £250.00 £165.00 Show arrow
W2582 Closed reduction of fracture of short bone (including cast or percutaneous K-wires) Intermediate £250.00 £165.00 Show arrow


Pelvis/acetabulum and femur

W1910 Primary reduction of fracture of neck of femur and internal fixation Xmajor £650.00 £275.00 Show arrow
W1320 Osteotomy of proximal femur Xmajor £650.00 £275.00 Show arrow
W1380 Arthroscopic femoro-acetabular surgery for hip impingement syndrome Xmajor £800.00 £440.00 Show arrow
W1390 Open femoro-acetabular surgery for hip impingement Xmajor £800.00 £440.00 Show arrow
W1642 Open reduction/internal fixation of posterior rim of acetabulum Complex £1,000.00 £275.00 Show arrow
W1643 Open reduction/internal fixation of either posterior wall/column or acetabulum or anterior column of acetabulum Complex £1,000.00 £440.00 Show arrow
W1644 Open reduction/internal fixation of both columns of acetabulum Complex £1,000.00 £550.00 Show arrow
W1645 Open reduction/internal fixation plus bone graft symphysis pubis Complex £1,000.00 £330.00 Show arrow
W1646 Open reduction/internal fixation of sacro-iliac joint Complex £1,000.00 £440.00 Show arrow
W1647 Open reduction/internal fixation of fractures of the greater trochanter, including fixation of non-union of greater trochanter after trochanteric osteotomy Xmajor £650.00 £275.00 Show arrow


Joints

W6630 Primary closed reduction of fracture or dislocation of joint, with or without fixation including cast application Intermediate £300.00 £165.00 Show arrow
W6522 Primary open reduction of dislocation of small joint Intermediate £550.00 £220.00 Show arrow
W6523 Primary open reduction of dislocation of large joint Intermediate £550.00 £220.00 Show arrow
W6702 Secondary open reduction of dislocation of small joint Intermediate £250.00 £165.00 Show arrow
W6703 Secondary open reduction of dislocation of large joint Intermediate £250.00 £165.00 Show arrow


Fixation devices

W2830 Removal of internal fixation from bone/joint, excluding K-wires Intermediate £400.00 £165.00 Show arrow
W3020 Adjustments to Ilizarov frame/rings Major £550.00 £165.00 Show arrow
W3040 Application of Ilizarov frame for secondary non-union/mal-union including osteotomy Complex £1,600.00 £495.00 Show arrow
W3050 Adjustments to pin sites secondary for non-union/mal-union Minor Minor £350.00 £110.00
W3032 Removal of fixator/frame/pins/wires and change of plaster Intermediate £200.00 £110.00 Show arrow
W3530 Removal of percutaneous wire Minor Minor £150.00 £110.00 Show arrow


Other (eg POP)

X4822 Change of cast under general anaesthetic Minor Minor £150.00 £110.00 Show arrow
X4810 Change of cast without general anaesthetic £75.00 £0.00 Show arrow
T5540 Fasciotomy of limb Major £500.00 £220.00
S5730 Surgical toilet and debridement of deep wound, including traumatic or post-operative aetiology Minor £150.00 £110.00 Show arrow
W3100 Bone graft (as sole procedure) Major £450.00 £220.00 Show arrow

16.4 - Nerves

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



A6030 Transection of peripheral nerve for neuroma Intermediate £250.00 £165.00 Show arrow
A6080 Neurectomy (major nerve) Intermediate £400.00 £165.00
A6110 Excision of lesion of peripheral nerve (eg neurilemoma) Intermediate £300.00 £165.00
A6180 Excision of lesion of major nerve Intermediate £400.00 £165.00 Show arrow
A6300 Graft to peripheral nerve Xmajor £650.00 £275.00 Show arrow
A6302 Graft to major nerve Xmajor £650.00 £275.00 Show arrow
A6400 Repair of peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6402 Repair of major nerve Major £300.00 £165.00 Show arrow
A6510 Carpal tunnel release (open) Intermediate £250.00 £165.00 Show arrow
A6580 Carpal tunnel release (open) - bilateral Intermediate £450.00 £275.00 Show arrow
A6600 Release of entrapment of deeply placed peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6700 Release of entrapment of peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6710 Cubital tunnel release (open) (without transposition) Intermediate £250.00 £165.00 Show arrow
A6711 Cubital tunnel release (open) bilateral (without transposition) Intermediate £450.00 £275.00 Show arrow
A6810 Neurolysis and transposition of peripheral nerve (excludes carpal tunnel release) Intermediate £300.00 £165.00 Show arrow
A6900 Revision of release of peripheral nerve Major £450.00 £165.00 Show arrow
A7010 Implantation of neurostimulator to peripheral nerve Major £550.00 £110.00 Show arrow
A7011 Trial of neurostimulator to peripheral nerve (as sole procedure) not at time of permanent implant Intermediate £450.00 £110.00 Show arrow
A6530 Carpal tunnel release (endoscopic) Intermediate £250.00 £165.00 Show arrow
A6570 Carpal tunnel release (endoscopic) - Bilateral Intermediate £450.00 £275.00 Show arrow
A6740 Cubital tunnel release (endoscopic) (without transposition) Intermediate £250.00 £165.00 Show arrow
A6750 Cubital tunnel release (endoscopic) Bilateral (without transposition) Intermediate £450.00 £275.00 Show arrow
A7310 Biopsy of peripheral nerve Intermediate £250.00 £165.00 Show arrow
A7340 Exploration and grafting of brachial plexus Complex £1,000.00 £660.00 Show arrow

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



W5540 Debridement of infected total joint replacement Major £550.00 £275.00 Show arrow
W5722 Excision reconstruction of small joint Major £500.00 £220.00 Show arrow
W5723 Excision reconstruction of large joint Major £500.00 £220.00 Show arrow
W6912 Total synovectomy of small joint Major £500.00 £220.00 Show arrow
W9050 Shoulder hydrodistension +/- image guidance Minor £150.00 £0.00 Show arrow
W9031 Three or more Injections, +/- aspiration, into joint(s), cyst, bursa or soft tissue, with image guidance Minor £175.00 £0.00 Show arrow
W6913 Total synovectomy of large joint Major £500.00 £220.00 Show arrow
W7400 Reconstruction of one or two ligaments not elsewhere specified Major £450.00 £165.00 Show arrow
W7500 Prosthetic open repair of ligament Major £450.00 £165.00 Show arrow
W7881 Release of contracture of interphalangeal joint of finger (excluding trigger finger or Dupuytren's disease) Intermediate £250.00 £220.00 Show arrow
W8150 Arthrotomy of large joint, including removal of loose body from joint Intermediate £350.00 £165.00 Show arrow
W8180 Arthrotomy of small joint, including removal of loose body from joint Minor £100.00 £100.00 Show arrow
W8300 Therapeutic arthroscopy operation on articular cartilage (other than W8200 and W8230) (as sole procedure) Intermediate £350.00 £275.00 Show arrow
W8380 Therapeutic arthroscopy operation on articular cartilage (other than W8200) - bilateral (as sole procedure) Major £550.00 £385.00 Show arrow
W8600 Therapeutic arthroscopy operation on cavity of joint (not otherwise specified) (as sole procedure) Major £550.00 £275.00 Show arrow
W8680 Therapeutic arthroscopy operation on cavity of joint - bilateral (not otherwise specified) (as sole procedure) Complex £800.00 £385.00 Show arrow
W8700 Diagnostic arthroscopic examination of joint, with or without biopsy (not otherwise specified) (as sole procedure) Intermediate £250.00 £220.00 Show arrow
W8780 Diagnostic arthroscopic examination of joint, with or without biopsy - bilateral (not otherwise specified) (as sole procedure) Intermediate £400.00 £275.00 Show arrow
W8782 Flexible arthroscopy, +/- biopsy (as sole procedure) Intermediate £200.00 £165.00 Show arrow
W9017 Yttrium joint injection (with radioactive precautions) Minor £100.00 £0.00 Show arrow
W9020 Dynamic arthrogram of joint Intermediate £100.00 £100.00 Show arrow
W9030 Injection(s) +/- aspiration, into joint, cyst, bursa or soft tissue with image guidance Minor £150.00 £0.00 Show arrow
W9240 Examination/ manipulation of joint under general anaesthetic +/- injection +/- arthrogram (as sole procedure) Minor £150.00 £110.00 Show arrow
W9032 Injection of viscosupplement into joint with image guidance Minor £150.00 £0.00
W9033 Injection of viscosupplement into joint with image guidance - bilateral Minor £150.00 £0.00
W9035 Injection(s) +/- aspiration, into two or more joints, cysts, bursae or soft tissue, with image guidance Minor £150.00 £0.00
W9042 Injection of viscosupplement into joint Minor £75.00 £0.00
W9043 Injections of viscosupplement into joints - bilateral Minor £75.00 £0.00
W9045 Injection(s) +/- aspiration, into two or more joints, cysts, bursae or soft tissue Minor £75.00 £0.00
W9170 Manipulation of foot/ankle joint under local anaesthetic +/- injection (as a sole procedure) Minor £110.00 £0.00

16.6 - Hand

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



Incision/excision

T7440 Injection into cord for Dupuytren’s Contracture (including post injection finger extension) Minor £250.00 £0.00 Show arrow
T5202 Dupuytren’s fasciectomy palm only Intermediate £350.00 £165.00 Show arrow
T5203 Dupuytren’s fasciectomy single digit with proximal interphalangeal joint Intermediate £350.00 £165.00 Show arrow