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D031
D031 – Patella - closed reduction - with anaesthetic
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service provides for the closed reduction of a dislocated patella. This procedure involves manually manipulating the kneecap back into its proper position without making a surgical incision. The service includes the administration of anaesthesia to facilitate the reduction and ensure patient comfort. This procedure is categorized under Musculoskeletal System Surgical Procedures for the knee.
When to Use
- Use D031 when performing a closed reduction of a dislocated patella that requires procedural sedation or regional anaesthesia to facilitate the reduction.
- Use this code for the initial reduction attempt in the emergency department or operating room where the patient requires pharmacological assistance to achieve muscle relaxation for the procedure.
Common Pitfalls
- Do not bill D031 if the reduction was performed without any form of anaesthetic or sedation, as the code specifically includes the administration of anaesthesia.
- Avoid billing D031 in conjunction with a standard emergency department visit code (e.g., A405) unless the visit involves a separate, unrelated clinical assessment that meets the requirements for a concurrent visit.
- Failure to document the specific type of anaesthesia or sedation used is a common audit risk, as the code definition explicitly includes this component.
Billing Tips
- If the procedure is performed after hours, ensure you apply the appropriate E-code premium (E409 or E410) if you are not an Emergency Department Physician, as these are not automatically triggered by the base code.
- If the patient meets the specific Injury Severity Score (ISS) criteria, apply the E420 trauma premium, but note that this cannot be claimed alongside after-hours or special visit premiums.
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