F043 – Fracture of shaft - closed reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Closed reduction of a fracture of the shaft of the humerus. This service is a surgical procedure listed under the Musculoskeletal System section. Payment for the surgeon (suffix A) is a flat fee. Fees for an assistant (suffix B) and anaesthesiologist (suffix C) are calculated based on base units plus time units. The base units are 6 for the assistant and 6 for the anaesthesiologist. This service is eligible for various premiums, including those for after-hours service, age of the patient, and severe trauma.
When to Use
- Use F043 specifically for the closed reduction of a humeral shaft fracture when no open surgical approach is required.
- Select F043 when the procedure is performed in a hospital setting and involves manual manipulation to achieve anatomical alignment of the shaft.
Common Pitfalls
- Billing F043 in conjunction with open reduction codes (e.g., F044) for the same fracture site, which will trigger a rejection for duplicate or conflicting procedures.
- Failing to document the specific anatomical location as the 'shaft' of the humerus, as billing F043 for fractures involving the proximal or distal ends (e.g., F042) is an audit risk.
- Incorrectly applying trauma premiums (E420) without explicit documentation of the Injury Severity Score (ISS) in the patient record.
Billing Tips
- Ensure that after-hours premiums (E409/E410) are only applied if the procedure is non-elective or delayed by an intervening surgical emergency.
- Always verify that the surgical assistant and anaesthesiologist base units (6 units each) are correctly calculated alongside time-based units to avoid underpayment.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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