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D042
D042 – Hip dislocation
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Closed reduction of a hip dislocation. This procedure is listed under the Pelvis and Hip, Reduction, Dislocations section of the Musculoskeletal System surgical procedures.
When to Use
- Use D042 for the acute, closed reduction of a hip dislocation performed in an emergency or surgical setting.
- Use this code when the reduction is performed manually or with traction, provided it does not involve an open surgical approach.
Common Pitfalls
- Do not attempt to bill D042 alongside R628, as these are mutually exclusive for the same episode of care.
- Avoid billing for surgical assistance (suffix B) with D042, as the OHIP Schedule of Benefits explicitly lists no basic units for assistance for this procedure.
- Failure to document the specific trauma details or the Injury Severity Score (ISS) will result in the rejection of the E420 trauma premium if claimed.
Billing Tips
- If the procedure is performed after hours, ensure you apply the correct E409 or E410 premium rather than a general special visit fee, as these are specifically eligible for surgical procedures.
- Always verify the patient's age at the time of the procedure to automatically apply the appropriate age-based surgical premium (e.g., AGE_PREMIUM_LT30D or AGE_PREMIUM_5Y_TO_16Y) to maximize the claim value.
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