E559 – Metacarpal fracture - open reduction - each additional
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This code represents the surgical fee for the open reduction of each additional metacarpal fracture, following the primary reduction billed under F011. It is an add-on service and cannot be billed independently.
As a surgical procedure, this service is eligible for various premiums:
- Age-Based Premiums: As outlined on , percentage increases apply for patients in specific age groups (e.g., under 16 years).
- After Hours Premiums: If the procedure is non-elective and starts after hours, E409 or E410 may be applicable as per .
- Trauma Premium: E420 may be added if the service is for a trauma patient meeting the Injury Severity Score (ISS) criteria on .
Note on Assistant and Anaesthesia Fees:
Assistant (B) and anaesthetist (C) services are not claimed using this code. Their fees are calculated based on the basic units of the major procedure (F011) plus the total time for all procedures performed, as per the rules on and .
When to Use
- Use E559 when performing an open reduction on a second, distinct metacarpal fracture during the same operative session as the primary F011 procedure.
- Apply E559 for each additional metacarpal bone requiring open reduction beyond the first bone addressed by F011.
Common Pitfalls
- Billing E559 as a standalone code will result in an automatic rejection; it must be linked to a primary F011 claim on the same service date.
- Attempting to use E559 for closed reductions or percutaneous pinning is incorrect, as this code is strictly defined for open reduction procedures.
Billing Tips
- Ensure the primary procedure F011 is billed first, followed by E559 for each subsequent metacarpal, to ensure the claim logic correctly identifies the add-on relationship.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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