All codes
T536
T536 – T536
OHIP Other Code · Schedule of Benefits
When to Use
- Use T536 for the surgical repair of a complete or incomplete rupture of the Achilles tendon.
- Apply this code when performing an open repair of a chronic Achilles tendon rupture requiring reconstruction or graft augmentation.
- Select T536 instead of minor soft tissue repair codes when the procedure involves formal tendon re-approximation and suturing.
Common Pitfalls
- Billing T536 alongside minor debridement codes like S101 is often rejected as the debridement is considered integral to the surgical approach.
- Submitting T536 for simple tendonitis or peritendinitis management is an audit risk, as this code is strictly for traumatic or chronic rupture repair.
- Failing to include the appropriate diagnostic code for the rupture (e.g., ICD-9 727.67) will result in automatic claim rejection.
Billing Tips
- If an additional procedure such as a gastrocnemius recession is performed during the same session, bill the secondary procedure at 50% using the appropriate modifier.
- Ensure the operative report explicitly details the tendon re-approximation technique to justify the high-value fee associated with T536.
Provider Fee$1,399.81
Specialist Fee$1,399.81
Effective: February 1, 2011
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