D012 – Closed reduction, pulled elbow
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service involves the closed (non-surgical) reduction of a dislocated radial head. This condition, often termed a 'pulled elbow', is common in young children. The fee listed is for the surgeon performing the procedure (suffix A). An anaesthetist (suffix C) may claim this service with 6 base units plus time units if anaesthesia is required.
When to Use
- Use D012 for the successful closed reduction of a radial head subluxation (pulled elbow) in a pediatric patient.
- Use this code when the clinical presentation involves a classic history of longitudinal traction on the forearm followed by refusal to use the limb, distinct from a fracture managed under D011.
Common Pitfalls
- Billing D012 alongside a minor assessment code (A001/A007) is often rejected; ensure the procedure is distinct and not part of a standard physical exam to avoid bundling denials.
- Failing to apply the mandatory age-based premium for patients under 16 years old results in significant underpayment, as D012 is a surgical procedure subject to the GP64 age-based multipliers.
Billing Tips
- Always append the appropriate age-based premium (e.g., 10% for ages 5-15) to the D012 claim to ensure the full procedural value is captured.
- If the procedure is performed in an Emergency Department setting, ensure you bill the appropriate Special Visit Premium (Table I) in addition to D012, as the procedure fee itself is not inclusive of the visit premium.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
In accordance with , all insured services must be documented in appropriate records. The record must establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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