D061 – Open removal of coccyx
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Open removal of the coccyx is a surgical procedure listed under the Musculoskeletal System section. The amount payable for the surgical assistant service is based on 6 basic units plus time units. The amount payable for anaesthesia service is based on 6 basic units plus time units.
When to Use
- Use D061 for the definitive open surgical excision of the coccyx, typically indicated for chronic, refractory coccydynia that has failed all conservative management.
- Use this code for the surgical management of a pilonidal cyst or sinus when the procedure specifically involves the open removal of the coccygeal bone itself, rather than just soft tissue debridement.
Common Pitfalls
- Billing D061 for simple incision and drainage or excision of a pilonidal cyst without the actual removal of the coccyx will lead to claim rejection or audit recovery.
- Failing to document the Injury Severity Score (ISS) when attempting to append the E420 trauma premium will result in the automatic rejection of the premium portion of the claim.
Billing Tips
- Ensure the surgical assistant and anaesthesiologist claims correctly utilize the 6 basic units provided in the fee schedule, as these are fixed and not subject to surgeon discretion.
- If the procedure is performed on an emergency basis after hours, ensure the appropriate E-series after-hours premium is appended to the base D061 fee to maximize the procedural reimbursement.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
For payment of the E420 trauma premium, the medical record must list the Injury Severity Score (ISS).
Basic Surgical Assistant Units (Asst): 6
Basic Anaesthesia Units (Anae): 6
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