M116 – Chest wall - fixation for trauma
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
M116 is for the surgical fixation of the chest wall due to trauma. This service includes standard pre-operative and post-operative care as defined in the Surgical Preamble (:531). - The fee for M116A covers the primary surgical repair. - E604A may be claimed for each additional rib fixed beyond the fourth rib. - Assistant services (M116B) are calculated using 6 base units plus time units (:99). - Anaesthesia services (M116C) are calculated using 7 base units plus time units (:106). - Payment for a second surgical assistant requires independent consideration by a medical consultant (:104). - Various premiums may be applicable, including those for age, after-hours service, and trauma severity.
When to Use
- Use M116A for the primary surgical fixation of multiple rib fractures resulting from acute trauma where stabilization is clinically indicated.
- Use M116A in conjunction with E604A when the surgical repair involves the fixation of more than four ribs.
Common Pitfalls
- Failing to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, which leads to automatic rejection.
- Incorrectly billing E604A for the first four ribs; this code is strictly for the fifth rib and beyond.
- Attempting to claim a second surgical assistant without prior authorization from a medical consultant, which is a mandatory requirement for M116.
Billing Tips
- Ensure the E420 trauma premium is submitted on the same claim as M116A to avoid processing delays.
- When multiple procedures are performed during the same operative session, remember that the 85% rule applies to secondary procedures unless they are for distinct complications or unrelated conditions.
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