All codes
T543
T543 – T543
OHIP Other Code · Schedule of Benefits
When to Use
- Use T543 for the definitive surgical repair of a complete or partial rupture of the Achilles tendon.
- Apply this code when performing an open repair of a chronic Achilles tendon rupture requiring reconstruction or graft augmentation.
Common Pitfalls
- Billing T543 in conjunction with a minor procedure code like S060 is often rejected as the minor procedure is considered incidental to the major repair.
- Submitting T543 for a simple percutaneous repair of an acute Achilles rupture may lead to audit scrutiny; ensure the operative report clearly justifies the open approach.
Billing Tips
- If an additional procedure is performed during the same operative session, such as a separate fracture fixation, ensure you apply the appropriate multiple procedure rule (100% for the first, 85% for the second) to avoid payment errors.
Provider Fee$1,321.18
Specialist Fee$1,321.18
Effective: February 1, 2011
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