F006 – Intra-articular closed reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is for the closed reduction of an intra-articular fracture, which is a fracture that extends into a joint surface. This procedure is typically performed on the bones of the hand or wrist. As a surgical procedure, it is eligible for age-based premiums for patients under 16 years of age as per , and after-hours premiums (E409, E410) or the trauma premium (E420) may apply if conditions are met. Add-on code E584 is payable for the application of a plaster cast when rendered outside of a hospital setting. Add-on code E503 is payable for each additional intra-articular closed reduction performed during the same session.
When to Use
- Use F006 specifically for closed reduction of fractures involving the articular surface, such as intra-articular phalangeal or metacarpal fractures, rather than simple shaft fractures which may fall under F005.
- Apply F006 when the procedure involves manual manipulation to restore joint congruity, distinguishing it from simple splinting or casting services.
Common Pitfalls
- Billing F006 for extra-articular fractures is a common audit trigger; ensure the operative report explicitly confirms the fracture line extends into the joint space.
- Failing to document the Injury Severity Score (ISS) in the medical record will lead to the rejection of the E420 trauma premium when billed alongside F006.
- Attempting to bill E584 for cast application within a hospital setting is an invalid claim, as this add-on is restricted to office, home, or Independent Health Facility settings.
Billing Tips
- If multiple intra-articular fractures are reduced during the same encounter, bill F006 for the first procedure and E503 for each subsequent reduction to ensure proper compensation for additional work.
- Always verify the patient's exact age at the time of the procedure to ensure the correct age-based premium (GP64) is applied, as these are calculated as a percentage increase on the base fee.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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