ADVANCE DYNAMIC ROM ELBOW RANGE OF MOTION AND COMMON DIAGNOSES Elbow Extension Advance Dynamic ROM® System Part # (Right Elbow): 199084-001 Part # (Left Elbow): 199083-001 HCPC Code: E1800* Elbow Flexion Advance Dynamic ROM® System Part # (Right Elbow): 199086-001 Part # (Left Elbow): 199085-001 HCPC Code: E1800* Range of Motion: -10º to +130º extension Range of Motion: -10º to +146º flexion WRIST FOREARM SUPINATION Common Diagnoses: Radial head fractures, Humeral fractures, Elbow dislocations, Elbow fractures, Radial or ulnar fractures, Burns, Joint arthroplasties, Other orthopedic conditions Forearm Supination Advance Dynamic ROM® System Part # (Right Forearm): 199163-001 Part # (Left Forearm): 199162-001 HCPC Code: E1802* Range of Motion: 80º to 190º supination (90º neutral) Common Diagnoses: Radial head fractures, Elbow dislocations, Elbow fractures, Fractures (distal, radial, ulnar), Colles’ fractures, Wrist fractures, Tendon and ligament repairs, Other orthopedic conditions Wrist Extension Advance Dynamic ROM® System Part # (Right Wrist): 199262-001 Part # (Left Wrist): 199261-001 HCPC Code: E1805* Wrist Flexion Advance Dynamic ROM® System Part # (Right Wrist): 199264-001 Part # (Left Wrist): 199263-001 HCPC Code: E1805* Range of Motion: -95º to +35º extension Range of Motion: -35º to +95º flexion Common Diagnoses: Fractures (Colles’, distal radius and others), Tendon and ligament repairs, Dislocations, Burns, Wrist arthroplasties, Rheumatoid arthritis, Other orthopedic conditions ® KNEE ADVANCE DYNAMIC ROM Knee Extension Advance Dynamic ROM® System Part # (Right Knee): 199090-001 Part # (Left Knee): 199089-001 HCPC Code: E1810* Knee Flexion Advance Dynamic ROM® System Part # (Right Knee): 199092-001 Part # (Left Knee): 199091-001 HCPC Code: E1810* Range of Motion: -10º to +130º extension Range of Motion: -10º to +146º flexion ® Common Diagnoses: Total knee replacements, Tibial plateau fractures, Tendon and ligament repairs (ACL, PCL), Burns, Tendon releases, Other orthopedic conditions Below the Knee Amputee Extension - Advance Dynamic ROM® System Part # (Right Knee): 199164-001 Part # (Left Knee): 199165-001 HCPC Code: E1810* Range of Motion: -10º to +130º extension Common Diagnoses: Distal limb removal ANKLE Ankle Dorsiflexion Advance Dynamic ROM® System Part # (Ankle Dorsiflexion): 199095-001 HCPC Code: E1815* Extension Range of Motion: -70º to +60º extension Common Diagnoses: Fractures (malleolar, distal tibial, talar and others), Plantar fasciitis, Ruptured Achilles tendon, Tendon and ligament repairs, Foot drop, Burns, Head trauma and spinal cord injuries, Cerebral palsy (CP), Cerebral vascular accident (CVA), Other orthopedic and neurological conditions Ordering information: Call (800) 328-2536 or visit http://www.djoglobal.com/products/empi/advance-dynamic-rom *DJO provides possible coding suggestions based on publicly available information as a convenience to our customers. DJO products that have been assigned HCPCS codes by Medicare through the coding verification process are noted with an asterisk above. The assigned codes are the required billing codes for these particular products. For all other products, it is within the sole discretion of the customer to determine the appropriate billing code, as well as, whether the use of a product complies with medical necessity and other documentation requirements of the payor. DJO accepts no responsibility whatsoever in this regard. Nor does DJO make claims, promises or guarantees as to the availability of reimbursement for any DJO product. Empi, Inc. I A DJO Global Company T 800.328.2536 D 651.415.9000 205 Highway 22 East I Clear Lake, SD 57226 I U.S.A. Empi.com ©2013 Encore Medical, L.P. 00-1395 Rev A