All codes
E561
E561 – Phalanx fracture - each additional
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
When to Use
- Use E561 for the second and third phalanx fractures when you have performed a closed reduction on three separate phalanges of the foot during the same encounter.
- Use E561 in conjunction with F058 when multiple toes require closed reduction for fractures, with F058 covering the first toe and E561 covering each subsequent toe.
Common Pitfalls
- Do not bill E561 as a standalone code; it must be submitted on the same claim as F058 to avoid automatic rejection.
- Avoid billing E561 for multiple fractures on the same phalanx; it is intended for additional distinct phalanges, not multiple fracture sites on a single bone.
- Do not confuse E561 with E560, which is the add-on code for additional metatarsal fractures; using the wrong add-on code will trigger a claim adjustment.
Billing Tips
- Ensure the number of units for E561 matches the total number of additional phalanges reduced beyond the first one covered by F058.
- If performing the reduction in an office setting, remember that E584 is only eligible if the cast is applied after the initial two-week post-fracture period, as casting during the initial reduction is considered inclusive to the procedure.
Provider Fee$14.90
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Procedure
Code Classes
Musculoskeletal System Surgical Procedures
This is an add-on code to be billed for each additional phalanx fracture undergoing closed reduction after the first, which is billed using F058.
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