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T461
T461 – T461
OHIP Other Code · Schedule of Benefits
When to Use
- Use T461 for the surgical repair of a ruptured or lacerated tendon of the hand or wrist requiring primary suture or graft.
- Apply this code when performing a secondary reconstruction or tenoplasty of a hand tendon that has failed to heal or requires functional restoration.
Common Pitfalls
- Billing T461 in conjunction with a minor procedure code like G365 is often flagged for unbundling if the tendon repair is considered part of the primary surgical site access.
- Failing to include the appropriate diagnostic code for the specific tendon involved (e.g., extensor vs. flexor) can lead to manual review or rejection by the Ministry.
Billing Tips
- Ensure the operative report explicitly details the complexity of the repair, such as the use of a tendon graft or pulley reconstruction, to justify the fee against potential audit inquiries.
- If multiple tendons are repaired during the same session, bill the primary tendon at 100% and subsequent tendons using the appropriate multiple procedure rules, typically at 85% or 50% depending on the specific surgical site.
Provider Fee$679.90
Specialist Fee$679.90
Effective: April 1, 2025
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