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D041
D041 – Patella - open reduction - early
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Early open reduction is a surgical procedure to repair a fractured or dislocated patella (kneecap) shortly after the injury has occurred. This involves an incision to directly access and realign the bone fragments or relocate the patella, which are then typically stabilized with internal fixation hardware.
When to Use
- Use D041 for the acute, non-elective open reduction and internal fixation (ORIF) of a patellar fracture performed shortly after the injury.
- Select D041 when the procedure involves direct surgical exposure to realign fragments, distinguishing it from closed reduction procedures (e.g., R255) where no incision is made.
Common Pitfalls
- Billing D041 as an elective procedure when it qualifies for after-hours premiums (E409/E410) can result in significant loss of revenue for urgent trauma cases.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium alongside D041 will lead to automatic rejection.
Billing Tips
- Always verify if the procedure meets the 'non-elective' criteria to trigger E409 or E410, as these provide a substantial percentage increase over the base fee.
- Ensure that if a surgical assistant is utilized, their claim includes the appropriate special visit premium (e.g., C999B) if the case requires travel and occurs during night hours.
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