All codes
F004
F004 – Phalanx fracture - no reduction, rigid immobilization
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service covers the treatment for a fracture of a phalanx (a bone in the finger or thumb) that does not require reduction (realignment of the bone). The management consists of applying rigid immobilization, such as a splint or cast, to stabilize the fracture for healing. This fee code does not include anaesthesia.
When to Use
- Use F004 for stable, non-displaced phalanx fractures where the primary intervention is the application of a splint or cast without any manipulation or reduction.
- Use this code for isolated finger fractures that are clinically stable and do not meet the criteria for F005, which requires active reduction or manipulation.
Common Pitfalls
- Billing F004 alongside an office visit code (e.g., A007) is a common error, as the assessment is considered bundled into the surgical procedure fee per the General Preamble.
- Attempting to bill F004 when a reduction was actually performed will lead to audit discrepancies; use F005 if any manipulation was required to align the fracture.
Billing Tips
- If you apply a plaster cast in an office setting rather than a hospital, ensure you append E584 to the claim to capture the additional flat fee for materials and application.
- Always verify the patient's age at the time of service to ensure the appropriate age-based surgical premium (10% to 30%) is applied to the base F004 fee.
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