All codes
F037
F037 – Epicondyle - closed reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Epicondyle - closed reduction
When to Use
- Use F037 for the closed reduction of a displaced medial or lateral epicondyle fracture of the humerus when no open surgical intervention is required.
- Select F037 when performing a manipulation under sedation or local anesthesia to restore anatomical alignment of an epicondylar fragment that does not necessitate internal fixation.
Common Pitfalls
- Billing F037 in conjunction with a fracture consultation code (A035) is often rejected; ensure the consultation is clearly distinct from the surgical procedure if both are claimed.
- Failing to document the specific epicondyle involved (medial vs. lateral) and the post-reduction stability, which are critical for audit justification of the surgical fee.
Billing Tips
- If the procedure is performed after hours for a non-elective fracture, ensure you append E409 or E410 to the F037 claim to capture the 50% or 75% premium respectively.
Provider Fee$126.25
Surgical Assistant Fee$75.06
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.