E555 – Rigid external fixation for closed reduction
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
The E555 premium is applied to the fee for a closed reduction procedure. It is payable when rigid external fixation, excluding casts, is used. This premium increases the amount payable for the closed reduction fee by 50%. It is listed under the Fixation category of Musculoskeletal System Surgical Procedures on page of the Schedule.
When to Use
- Use E555 when applying a rigid external fixator device, such as an Ilizarov or pin-based frame, following a closed reduction of a fracture.
- Apply this premium when the fixation method provides mechanical stability that exceeds the capabilities of standard splinting or casting, which are explicitly excluded.
Common Pitfalls
- Billing E555 alongside traction-based procedures will result in automatic rejection as it is strictly prohibited by the Schedule.
- Attempting to claim E555 for simple immobilization using plaster or fiberglass casts will lead to audit recovery, as casts are specifically excluded from the definition of rigid external fixation.
Billing Tips
- Ensure the primary closed reduction fee code is billed on the same claim, as E555 acts as a 50% percentage increase modifier to that base procedure.
Percentage Premium: 0.5%
This code applies a percentage increase to the base procedure fee
Effective: July 1, 2013
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
PercentageIncrease
Musculoskeletal System Surgical Procedures, Other Premiums (including After Hours Procedure Premiums)
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