D011 – Open reduction - acute
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
D011 is a surgical procedure for the open reduction of an acute dislocation of the radial head. This service is performed by a surgeon (suffix A). Payment for surgical assistance (suffix B) and anaesthesia (suffix C) are calculated based on basic units plus time units.
When to Use
- Use D011 for the formal open surgical reduction of an acute radial head dislocation when closed reduction attempts have failed or are deemed inappropriate.
- Distinguish D011 from D012, which is specifically for the open reduction of a chronic (old/neglected) dislocation of the radial head.
Common Pitfalls
- Billing D011 for a closed reduction procedure; closed reductions of the radial head should be billed using the appropriate R-code (e.g., R540) rather than this surgical code.
- Failing to document the 'acute' nature of the injury, which is a requirement for D011; chronic cases must be billed under D012 to avoid audit discrepancies.
- Attempting to bill a consultation fee on the same day as D011; surgical procedures generally include the pre-operative assessment and immediate post-operative care.
Billing Tips
- Ensure the operative report clearly details the open nature of the reduction to support the use of D011 over closed reduction codes.
- If the procedure is performed on a trauma patient, verify the Injury Severity Score (ISS) and document it in the chart to justify the E420 trauma premium.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
Listed under the heading 'Reduction' of 'Dislocations' for the 'Radial head'.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.