All codes
T384
T384 – T384
OHIP Other Code · Schedule of Benefits
When to Use
- Use T384 for the surgical repair of a complete rupture of the Achilles tendon, specifically involving open operative intervention.
- Select this code when the procedure involves the primary repair of a tendon rupture where the surgical approach requires formal incision and suturing, distinguishing it from percutaneous techniques.
- Apply T384 when performing a formal tendon reconstruction or repair that exceeds the complexity of minor tendon procedures billed under lower-tier codes.
Common Pitfalls
- Billing T384 in conjunction with other surgical codes for the same anatomical site may trigger a 'duplicate service' or 'incidental procedure' rejection if the work is considered part of the global surgical package.
- Failing to document the specific complexity of the repair can lead to audit scrutiny, as T384 is a high-value code that requires clear evidence of the extensive surgical work performed.
- Incorrectly billing T384 for percutaneous or minimally invasive repairs that do not meet the criteria for an open surgical procedure as defined by the Schedule of Benefits.
Billing Tips
- Ensure that the operative report explicitly details the extent of the tendon damage and the specific surgical technique used to justify the high-value fee of T384 over less intensive tendon repair codes.
- If additional procedures are performed during the same operative session, verify if they are eligible for 50% reduction or if they are considered bundled into the T384 global fee.
Provider Fee$1,605.99
Specialist Fee$1,605.99
Effective: April 1, 2025
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