<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.40.08.03" title_num="10" subtitle_num="40" chapter_num="08" heading="Examples of Fragmentation of Billing.">
  <paragraph num="A.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Keller bunionectomy — a multi-step procedure, which may include any or all of the following:</text>
      <paragraph num="(a)">
        <text>Resection of medial eminence 1st metatarsal head;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Resection base of proximal phalanx;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Capsulotomy/capsulorrhaphy;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Z-plasty of extensor tendon; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Sesamoidectomy.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Lesser metatarsal osteotomy — a multi-step procedure, which may include any or all of the following:</text>
      <paragraph num="(a)">
        <text>Tenoplasty;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Capsulotomy/capsulorrhaphy;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Osteotomy; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Fixation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Fragmentation of billing is especially egregious when the licensee bills for both the general and specific procedures.</text>
  </paragraph>
</regulation>