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D040
D040 – Patella - closed reduction - without anaesthetic
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the closed reduction of a dislocated patella (kneecap), performed without anaesthetic. As a surgical procedure, this service includes all inherent components as defined in the Schedule of Benefits, such as pre-procedural assessment and post-procedural care. This service is not eligible for delegation per . For the same procedure performed with anaesthetic, see D031.
When to Use
- Use D040 when performing a manual reduction of an acute patellar dislocation in the office or emergency setting without the use of procedural sedation or local anaesthetic.
- Select D040 for the initial reduction attempt; if the procedure fails and requires sedation or general anaesthetic, you must switch to D031.
Common Pitfalls
- Billing D040 in addition to an assessment code (e.g., A007) is a common error; the surgical fee for D040 is comprehensive and includes the pre-procedural assessment.
- Attempting to bill D040 alongside R255 or R403 is disallowed, as the procedural fee for D040 is intended to cover the entire encounter for the reduction.
Billing Tips
- If the procedure is performed non-electively during after-hours periods, ensure you append the appropriate premium code (E409 or E410) to the D040 claim to increase the procedural fee by 50% or 75% respectively.
- Always document the absence of anaesthetic clearly in the chart, as this is the primary differentiator between D040 and the higher-valued D031.
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