All codes
T413
T413 – T413
OHIP Other Code · Schedule of Benefits
When to Use
- Use T413 for the initial assessment of a patient with a suspected or confirmed fracture requiring reduction, provided the service is performed in an emergency department or urgent care setting.
- Apply this code when the clinical encounter involves the definitive management of a fracture, such as closed reduction, which distinguishes it from a standard minor assessment code like A007.
Common Pitfalls
- Billing T413 in conjunction with a standard office visit code (A007) for the same encounter will trigger a rejection for duplicate assessment services.
- Failing to include the appropriate fracture management fee code alongside T413 often leads to under-billing, as T413 is intended to capture the assessment component rather than the procedural work.
Billing Tips
- Ensure the diagnostic code on the claim matches the fracture site to avoid automated audits that flag discrepancies between the assessment code and the ICD-9 diagnosis.
Provider Fee$48.90
Specialist Fee$48.90
Effective: April 1, 2025
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