D023 – Acromio-clavicular/sterno-clavicular - open reduction
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Open reduction of a fracture or dislocation in the shoulder, arm, or chest region. This is a surgical procedure listed in the Musculoskeletal System section of the Schedule of Benefits. Payment for this service is determined by the role of the physician, indicated by a suffix: - Surgeon (Suffix A): Billed as D023A. The listed fee is for the surgical procedure. - Surgical Assistant (Suffix B): Billed as D023B. Payment is calculated based on 6 base units plus time units. See to for detailed calculation rules for surgical assistants. - Anaesthetist (Suffix C): Billed as D023C. Payment is calculated based on 7 base units plus time units. See to for detailed calculation rules for anaesthesiologists. This service includes all common elements of insured services as described in and . As a surgical procedure, it also includes the specific elements for assistance at surgery () or anaesthesia () depending on the suffix used.
When to Use
- Use D023A for the open reduction of an acromio-clavicular (AC) joint dislocation requiring surgical fixation.
- Use D023A for the open reduction of a sterno-clavicular (SC) joint dislocation where closed reduction has failed or is inappropriate.
- Use D023A for the open reduction of fractures involving the clavicle that specifically require an open approach to the AC or SC joint articulation.
Common Pitfalls
- Billing D023A for a closed reduction; closed procedures for these joints are typically managed under different codes or visit fees, not surgical open reduction codes.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which leads to automatic rejection.
- Incorrectly billing D023A for a standard clavicle shaft fracture fixation, which is covered under different musculoskeletal codes (e.g., R596 series).
Billing Tips
- Ensure the surgical report explicitly describes the open reduction of the joint to justify the use of D023A over standard fracture fixation codes.
- When claiming after-hours premiums (E409/E410), ensure the start time of the procedure is clearly documented to support the specific time-based eligibility criteria.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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