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F049
F049 – Tuberosity - open reduction (without cuff tear)
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Open reduction of a tuberosity fracture involves surgically exposing the fracture site to realign the bone fragments. This service is specified for cases where the rotator cuff is intact. This procedure is listed under the Musculoskeletal System Surgical Procedures for the shoulder.
When to Use
- Use F049 for open reduction and internal fixation of an isolated greater or lesser tuberosity fracture where the rotator cuff remains attached to the fragment.
- Select F049 when the surgical approach confirms the rotator cuff is intact, distinguishing it from F047 or F048 which involve rotator cuff repair or reconstruction.
Common Pitfalls
- Billing F049 in conjunction with rotator cuff repair codes will trigger a rejection; if a cuff tear is identified and repaired intraoperatively, you must bill the appropriate cuff repair code instead.
- Failure to document the integrity of the rotator cuff in the operative report creates an audit risk, as the distinction between F049 and cuff-involved codes is strictly based on this finding.
Billing Tips
- Ensure the operative report explicitly states 'rotator cuff intact' to justify the use of F049 over more complex shoulder reconstruction codes.
Provider Fee$290.55
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
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