D025 – Acromio-clavicular/sterno-clavicular - closed with anaesthetic
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service involves the closed, non-operative manipulative reduction of a dislocation of either the acromio-clavicular or sterno-clavicular joint, a procedure that requires anaesthesia. The fee for the primary surgical procedure is claimed with suffix A. This service is also eligible for payment for a surgical assistant (suffix B) and an anaesthetist (suffix C), with fees calculated based on basic and time units specified in the Schedule.
When to Use
- Use D025 for the closed reduction of an acute acromio-clavicular (AC) joint dislocation requiring sedation or general anaesthesia.
- Use D025 for the closed reduction of a sterno-clavicular (SC) joint dislocation when the procedure is performed under anaesthetic.
- Do not use D025 for simple splinting or immobilization; the code specifically requires a manipulative reduction performed under anaesthesia.
Common Pitfalls
- Billing D025 without documenting the specific type of anaesthesia used, which is a mandatory requirement for this code.
- Confusing D025 with D014; D025 is strictly for AC/SC joint dislocations, whereas D014 covers other specific musculoskeletal reductions.
- Failing to include the required suffix (A for surgeon, B for assistant, C for anaesthetist) which will result in an automatic rejection.
Billing Tips
- Ensure the operative report explicitly states the reduction was closed and performed under anaesthesia to support the claim during a potential audit.
- When billing for the anaesthetist (suffix C) or assistant (suffix B), ensure the base units are correctly calculated as 6 units plus time units as per the Schedule of Benefits.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records to establish that:
- an insured service was provided;
- the service for which the account is submitted is the service that was rendered; and
- the service was medically necessary.
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