Z213 – Below knee, knee splints
OHIP Psychiatric Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Application of a cast, such as for a club-foot. This service is classified as a surgical procedure. A key feature of this service is that it can be delegated to a physician's employee in the physician's office, provided all requirements in the 'Delegated Procedure' section of the General Preamble () are met. These requirements include the procedure being historically delegatable, and, in most cases, the physician being physically present in the office. However, for certain simple office procedures like casts, the physician's presence is not required if the procedure is performed by a properly trained person on the physician's own patient and is documented appropriately. Application of plaster casts or corrective splints are not to be claimed if applied at the time of surgery (except for the application of a cast brace) or applied during the first 2 weeks for a fracture or dislocation when a procedural fee is applicable. The subsequent application of plaster casts may be claimed according to the Schedule.
When to Use
- Use Z213 for the application of a below-knee plaster cast or corrective splint for non-fracture conditions like club-foot or chronic tendonitis.
- Use Z213 for subsequent cast changes required after the initial two-week post-fracture period has elapsed.
Common Pitfalls
- Billing Z213 within the first 14 days of a fracture or dislocation treatment is a common audit trigger, as this is considered inclusive of the initial procedural fee.
- Submitting Z213 for a cast applied in a hospital or Family Health Team setting is ineligible, as the delegation rule specifically requires the staff to be employed directly by the physician's private office.
- Attempting to bill an assessment code (e.g., A007) alongside Z213 during the same encounter often leads to rejection unless the assessment is for an unrelated condition.
Billing Tips
- Ensure your documentation explicitly notes the 'delegated' nature of the procedure and the name of the staff member if the physician was not physically present during the application.
- Apply the 25% age premium if the patient is between 30 days and one year of age, as Z213 is classified as a surgical procedure under the General Preamble.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures, Delegated Procedure
Claims for services delegated to an individual employed by the physician submitting the claim are payable by OHIP. Claims are not payable for delegated services provided by an individual who is employed by a facility or organization such as a public hospital, public health unit, industrial clinics, long-term care facilities or Family Health Teams.
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