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F054
F054 – Fracture of neck of humerus - closed reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This surgical procedure involves the closed reduction (realignment without surgical incision) of a fracture of the neck of the humerus, specifically when there is no accompanying dislocation of the humeral head. This procedure is typically performed under anaesthesia.
When to Use
- Use F054 for the closed reduction of a humeral neck fracture when the humeral head remains in the glenoid fossa.
- Choose F054 when the procedure is performed under sedation or general anaesthesia without the need for an open surgical incision.
Common Pitfalls
- Billing F054 when the injury involves a dislocation of the humeral head, which would require a different code such as F053 or F055 depending on the specific reduction requirements.
- Attempting to bill an assistant fee for this procedure, which is explicitly disallowed under the payment adjustment rules for F054.
- Failing to document the specific nature of the reduction; if the procedure evolves into an open reduction, F054 is no longer the appropriate code.
Billing Tips
- Ensure that any applicable after-hours premiums (E409, E410) are applied correctly based on the procedure start time, as these are not automatically calculated by the system.
- If the patient meets the trauma criteria (ISS > 15 for adults or > 12 for children), ensure the ISS score is clearly documented in the chart to support the E420 premium, noting that this cannot be combined with after-hours premiums.
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