Fee Navigator®

    Governing Rule: 7.1

    DEFINITIONS

    • 7.1.1 FUNCTIONAL AREA

      Functional area includes the following anatomical areas: Head, face, neck, shoulder, axilla, elbow, wrist, hand, groin, perineum, hip, knee, ankle, foot, and includes coverage of exposed vital structures (bone, tendon, major vessel, nerve). Paired structures would be claimed as two separate areas, e.g., right and left wrist would be claimed as two separate areas.

    • 7.1.2 NON - FUNCTIONAL AREA

      Non-functional area includes the following anatomical areas: Posterior trunk, anterior trunk, arm (above elbow), forearm (below elbow), thigh, leg (below knee). Paired structures would be claimed as two separate areas, e.g., right and left arm would be claimed as two separate areas.

    • 7.1.3 TYPES OF INJURY
      1. Acute: Primary - refers to procedure within 10 days,
      2. Subacute: Secondary - refers to procedure within 11-21 days,
      3. Chronic: refers to procedures more than 21 days after injury.