M117 – Sternal fixation for trauma
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving the fixation of the sternum to treat trauma. This procedure is eligible for surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) services. According to the Schedule, the fee for this service includes standard pre-operative care (visits 1-2 days before surgery) and post-operative care (for up to two weeks post-op), with some exceptions for separately billable visits (see ). Notably, when M117 is performed, the service of a second surgical assistant is eligible for payment without requiring special authorization (see ).
When to Use
- Use M117 for open reduction and internal fixation of sternal fractures resulting from blunt chest trauma.
- Use M117 when performing sternal stabilization in patients with flail chest or sternal dehiscence following trauma.
Common Pitfalls
- Billing M117 with a separate visit code for pre-operative assessment within 48 hours of the procedure, as this is included in the surgical fee.
- Failing to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, which leads to automatic rejection.
- Attempting to bill for a second surgical assistant using a special authorization code, when M117 explicitly permits a second assistant without such requirements.
Billing Tips
- When performing multiple procedures during the same operative session, ensure M117 is billed at 100% if it is the major procedure, with subsequent procedures billed at 85% per the multiple procedure rule.
- Always verify if the procedure qualifies for E420; if the patient meets the ISS threshold, the 50% premium is a significant addition to the base fee of $251.45.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
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