D063 – Open reduction - Temporomandibular joint
OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Open reduction for a dislocation of the temporomandibular joint. This code is prefixed with a '#' symbol, which has specific implications for facility fees. As per , when this service is performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital's global budget. If provided in an Integrated Community Health Services Centre (ICHSC), these are funded by the ICHSC. Patients cannot be charged for these components when the service is rendered outside of a hospital or ICHSC.
When to Use
- Use D063 for the surgical open reduction of a TMJ dislocation when closed reduction techniques have failed or are contraindicated.
- Use D063 when the procedure involves an open surgical approach to address the dislocation, distinguishing it from D062 which typically covers closed reduction/manipulation.
Common Pitfalls
- Billing D063 when only a closed reduction was performed; ensure the operative report clearly documents the open surgical approach to support the higher-valued code.
- Attempting to bill facility fees or tray fees for this procedure; the '#' prefix confirms that all facility, equipment, and personnel costs are covered by the hospital or ICHSC global budget.
Billing Tips
- Ensure the operative report explicitly details the surgical exposure of the joint to justify the 'open' nature of the procedure compared to D062.
- Verify the patient's age and the timing of the procedure to correctly apply the appropriate age-based surgical premiums or after-hours premiums (E409/E410) if the criteria are met.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
The '#' prefix indicates that for services performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital global budget. If provided in an ICHSC, these are funded by the ICHSC. Patients cannot be charged for these components when the service is rendered outside of a hospital or ICHSC. (Source: )
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