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T528
T528 – T528
OHIP Other Code · Schedule of Benefits
When to Use
- Use T528 for the definitive surgical management of a complex fracture of the acetabulum requiring open reduction and internal fixation.
- Apply this code when performing a primary reconstruction of the acetabulum involving multiple columns or associated fractures that necessitate extensive surgical exposure.
Common Pitfalls
- Billing T528 in conjunction with other fracture reduction codes for the same anatomical site is considered unbundling and will result in automatic rejection.
- Failure to document the specific complexity of the fracture pattern or the use of specialized internal fixation hardware often leads to audit scrutiny regarding the appropriateness of this high-value code.
Billing Tips
- Ensure the operative report explicitly details the column involvement and the specific fixation techniques used to justify the high-complexity fee associated with T528.
Provider Fee$1,562.20
Specialist Fee$1,562.20
Effective: February 1, 2011
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