What is OHIP billing code D043?

D043 is "Hip dislocation - open reduction", an OHIP Orthopaedic Surgery code from the Ontario Schedule of Benefits (Physician Services).

How much does D043 pay?

The current OHIP fee for D043 is $406.45, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill D043 to OHIP?

D043 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates D043 claims against the Schedule of Benefits rules before submission.

What codes are related to D043?

Codes related to D043 in the Schedule of Benefits include D042, R628.

All codes

D043

D043 – Hip dislocation - open reduction

OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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Open reduction for a dislocated hip. This surgical procedure is listed under the Pelvis and Hip section of the Musculoskeletal System. This service is performed with suffix A for the surgeon. The fee for an assistant (suffix B) is calculated using 7 basic units plus time units (:). The fee for an anaesthesiologist (suffix C) is calculated using 7 basic units plus time units (:). As a surgical procedure, it is eligible for various premiums including age-based premiums for patients under 16 (:), after-hours procedure premiums (E409, E410) for non-elective cases (:), and the trauma premium (E420) if trauma criteria are met (:).

When to Use

Use D043 when a closed reduction attempt has failed and an open surgical approach is required to achieve hip joint reduction.
Use D043 for open reduction of a dislocated hip resulting from high-energy trauma where intra-articular debris or soft tissue interposition prevents closed reduction.

Common Pitfalls

Do not bill D043 with D042 (closed reduction) on the same date of service, as these are mutually exclusive procedures for the same joint.
Failure to document the Injury Severity Score (ISS) in the medical record will result in the rejection of the E420 trauma premium.
Attempting to claim both an after-hours premium (E409/E410) and the trauma premium (E420) simultaneously is not permitted under OHIP rules.

Billing Tips

Ensure the operative report clearly describes the open approach, as this distinguishes D043 from the closed reduction code D042.
When billing for an assistant or anaesthesiologist, ensure the claim includes the correct unit calculation (7 basic units plus time) to avoid payment discrepancies.

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Provider Fee$406.45

Surgical Assistant Fee$87.57

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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