F038 – Epicondyle - open reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service code represents a surgical procedure related to the integumentary system. Payment rules for the surgeon (A), assistant (B), and anaesthetist (C) apply as detailed in the General Preamble. This includes the calculation of fees based on basic and time units for assistants (-) and anaesthetists (-). The service includes all common elements of insured services (-) and specific elements for surgical procedures.
When to Use
- Use F038 for open reduction of an epicondylar fracture of the humerus when internal fixation is required to restore anatomical alignment.
- Select F038 when the procedure involves an open approach to the epicondyle, distinguishing it from closed reduction procedures like F037 which do not involve surgical incision.
Common Pitfalls
- Billing F038 with a consultation or assessment code on the same day is generally disallowed unless the assessment is for a separate, unrelated condition.
- Failure to include the required surgical assistant or anaesthetist premiums (E400 series) when the procedure is performed after hours will result in underpayment.
Billing Tips
- Ensure the operative report clearly details the open reduction to support the use of F038 over less invasive codes, as auditors specifically look for evidence of surgical exposure.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.