D036 – Ankle dislocation - open reduction
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Open reduction of an ankle dislocation. This service is a surgical procedure listed under the Musculoskeletal System section for the foot and ankle. The fee for the surgeon (suffix A) is a flat rate, while fees for an assistant (suffix B) and anaesthetist (suffix C) are calculated based on 6 and 7 base units respectively, plus time units.
When to Use
- Use D036 for the surgical open reduction of an ankle dislocation when the procedure requires formal operative exposure, distinguishing it from closed reduction procedures.
- Use this code for acute traumatic ankle dislocations requiring surgical intervention, ensuring it is not used for recurrent instability cases which fall under ligament repair codes.
Common Pitfalls
- Billing D036 for recurrent ankle instability or chronic subluxation, which must be claimed using specific ligament repair fee codes instead.
- Failing to document the specific operative approach, as billing D036 for a closed reduction or simple manipulation will result in audit recovery.
Billing Tips
- Ensure the operative report clearly details the open nature of the reduction to justify the use of D036 over lower-valued closed reduction codes.
- When performing multiple procedures during the same session, remember that assistant and anaesthetist units are restricted to the major procedure's base units as per GP85 and GP93.
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. The Act requires that the record 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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