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E579

E579Metatarsophalangeal dislocation - each additional

OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

This service is for the application of each additional plaster cast for a metatarsophalangeal dislocation, following the application of the first cast (E584). It is intended to be used as an add-on to the closed reduction procedure (D030). This service is only payable for procedures performed outside of a hospital setting.

When to Use

  • Use E579 only when a second or subsequent plaster cast is applied to the same metatarsophalangeal joint following the initial application of E584.
  • Apply this code exclusively for procedures performed in an office or clinic setting, as it is strictly prohibited for hospital-based care.

Common Pitfalls

  • Billing E579 without a corresponding E584 on the same claim will result in an automatic rejection.
  • Attempting to bill E579 for a hospital-based procedure is a common audit trigger, as the code is explicitly restricted to non-hospital settings.
  • Submitting E579 without the primary closed reduction code D030 will lead to claim denial, as the entire sequence must be linked to the reduction procedure.

Billing Tips

  • Ensure the clinical record clearly justifies the medical necessity for multiple cast applications to support the use of E579 as an add-on.
  • Apply after-hours premiums like E409 or E410 to the base procedure and the E579 add-on if the criteria for non-elective, after-hours care are met.
Provider Fee$10.25

Effective: April 1, 2025

Category

N. Musculoskeletal System Surgical Procedures

Subcategory

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES

Service Type

Procedure

Code Classes

Musculoskeletal System Surgical Procedures

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