Ilizarov Bone Lengthening

Section: Surgery
Effective Date: January 01, 2020
Revised Date: January 22, 2020
Last Reviewed: January 22, 2020

Description

The Ilizarov technique involves the use of a circular external fixator device which is attached to the bone by transfixion wires. A corticotomy (percutaneous osteotomy) is performed to permit attachment of the wires. Periodic adjustment of the external fixator then produces a distractive lengthening force, which gradually stimulates new bone growth.

Criteria

Bone lengthening procedures may be considered medically necessary for correction of congenital or post-traumatic limb length discrepancies; and/or angular deformities of the limb (arm, forearm, thigh or leg) when ANY ONE of the following are met:

  • demonstrable non-union or mal-union of long bone with or without bone loss or infection;
  • where lengthening of an amputation stump is needed for proper fitting of a prosthesis;
  • where leg lengthening is needed to equalize leg length discrepancy greater than 6 cm and for correction of congenital or post-traumatic angular-rotational deformations of the long bones;
  • when used for bone defects with or without deformities.

Bone lengthening for conditions other than the above is not medically necessary and, therefore, is not eligible for payment.

Use of a bone-lengthening device for the sole purpose of altering short stature is considered cosmetic; and is therefore, not covered.

Insertion of wires and subsequent osteotomy of the affected limb are performed in the hospital. Removal of the device can be performed in an outpatient setting; thus, hospitalization to remove the bone lengthening device is not medically necessary.

NOTE: Non-union/mal-union is defined as not having united within a minimum of three (3) months of the original trauma.

Procedure Codes

 

20690206922069320694206962069724420
25391253932746627715

Diagnosis Codes

Covered for procedure codes: 20690, 20692, 20693, 20694, 20696, 20697, 24420, 25391, 25393, 27466, and 27715

M21.021 M21.022 M21.029 M21.051 M21.052 M21.059 M21.061
M21.062 M21.069 M21.121 M21.122 M21.129 M21.151 M21.152
M21.159 M21.161 M21.162 M21.169 M21.721 M21.722 M21.729
M21.731 M21.732 M21.733 M21.734 M21.739 M21.751 M21.752
M21.759 M21.761 M21.762 M21.763 M21.764 M21.769 M21.821
M21.822 M21.829 M21.831 M21.832 M21.839 M21.851 M21.852
M21.859 M21.921 M21.922 M21.929 M21.931 M21.932 M21.939
M21.951 M21.952 M21.959 M21.961 M21.962 M21.969 M80.00XK
M80.00XP M80.011K M80.011P M80.012K M80.012P M80.019K M80.019P
M80.021K M80.021P M80.022K M80.022P M80.029K M80.029P M80.031K
M80.031P M80.032K M80.032P M80.039K M80.039P M80.041K M80.041P
M80.042K M80.042P M80.049K M80.049P M80.051K M80.051P M80.052K
M80.052P M80.059K M80.059P M80.061K M80.061P M80.062K M80.062P
M80.069K M80.069P M80.071K M80.071P M80.072K M80.072P M80.079K
M80.079P M80.811K M80.811P M80.812K M80.812P M80.819K M80.819P
M80.821K M80.821P M80.822K M80.822P M80.829K M80.829P M80.831K
M80.831P M80.832K M80.832P M80.839K M80.839P M80.851K M80.851P
M80.852K M80.852P M80.859K M80.859P M80.861K M80.861P M80.862K
M80.862P M80.869K M80.869P M80.871K M80.871P M80.872K M80.872P
M80.879K M80.879P Q68.8 Q71.10 Q71.11 Q71.12 Q71.13
Q71.20 Q71.21 Q71.22 Q71.23 Q71.40 Q71.41 Q71.42
Q71.43 Q71.50 Q71.51 Q71.52 Q71.53 Q71.811 Q71.812
Q71.813 Q71.819 Q71.891 Q71.892 Q71.893 Q71.899 Q71.90
Q71.91 Q71.92 Q71.93 Q72.10 Q72.11 Q72.12 Q72.13
Q72.20 Q72.21 Q72.22 Q72.23 Q72.40 Q72.41 Q72.42
Q72.43 Q72.50 Q72.51 Q72.52 Q72.53 Q72.60 Q72.61
Q72.62 Q72.63 Q72.70 Q72.811 Q72.812 Q72.813 Q72.819
Q72.891 Q72.892 Q72.893 Q72.899 Q72.90 Q72.91 Q72.92
Q72.93 Q73.8 Q74.0 Q74.2 Q74.8 Q74.9 T87.89

 

Non-Covered Diagnosis Codes for procedure codes: 20690, 20692, 20693, 20696, 20697, 27466, and 27715

R62.50R62.52R62.59

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