F046 – Radius - distal - closed reduction, under general anaesthetic
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This billing code represents a surgical procedure within the Musculoskeletal System section of the OHIP Schedule of Benefits, specifically 'Radius - distal - closed reduction, under general anaesthetic'. Based on the fee structure, it is a procedure for which fees for a primary surgeon (A-suffix), a surgical assistant (B-suffix), and an anaesthesiologist (C-suffix) are payable.
When to Use
- Use F046 for a distal radius fracture requiring closed reduction performed under general anaesthesia in a hospital setting.
- Use this code when the reduction is performed by the primary surgeon, distinct from F047 which covers closed reduction under local or regional anaesthesia.
Common Pitfalls
- Billing F046 when the procedure was performed under local anaesthesia or sedation only; this code strictly requires general anaesthesia.
- Failing to append the correct suffix (A for surgeon, B for assistant, C for anaesthesiologist) which will result in automatic claim rejection.
- Attempting to bill a separate office visit or consultation fee on the same day as the procedure without meeting the criteria for a separate, unrelated service.
Billing Tips
- Ensure the anaesthesiologist and surgical assistant are aware of the specific procedure code to ensure their claims for C and B suffixes respectively are linked correctly to the primary surgical event.
- If the procedure is performed after hours or on a weekend, ensure the appropriate premium (E409 or E410) is applied to the procedural fee to maximize reimbursement.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
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.
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