D039 – Knee - open reduction
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Dislocations - Knee - open reduction is a surgical procedure to realign the bones of the knee joint after a dislocation. The fee for anaesthesia is based on 7 basic units plus time units. The fee for a surgical assistant is based on 6 basic units plus time units. See anaesthesiologist () and surgical assistant () sections for full details on unit calculations.
When to Use
- Use D039 specifically for open reduction procedures where surgical exposure of the knee joint is required to address a dislocation.
- Do not use D039 for closed reductions; use the appropriate non-surgical reduction codes instead.
- Use D039 when the procedure involves internal fixation or formal joint reconstruction following the dislocation, distinguishing it from simple manipulation under anesthesia.
Common Pitfalls
- Billing D039 alongside D038 for the same knee is a common audit trigger; ensure the documentation clearly justifies the necessity of both if performed.
- Failing to document the exact start and stop times for the surgical assistant and anaesthesiologist will lead to automatic rejection of the time-based unit claims.
- Omitting the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium for D039 is a frequent cause of recovery audits.
Billing Tips
- Always verify that the operative report explicitly describes the open approach, as this is the primary clinical justification for the D039 fee over closed reduction alternatives.
- Ensure that any applicable age-based premiums or after-hours modifiers (E409, E410) are submitted on the same claim as the primary D039 code to ensure correct processing.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
An operative report is required.
For time-based services (anaesthesia, surgical assistant), the start and stop times must be documented in the patient's permanent medical record as per and .
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