F056 – Phalanx fracture - no reduction - rigid immobilization
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Treatment of a fracture of a phalanx of the foot involving no reduction but requiring rigid immobilization. This is a surgical procedure with a fee payable to the surgeon (suffix A). Payment may be increased by age-based premiums for patients under 16 years old as per . Additional premiums for after-hours service (E409, E410) and major trauma (E420) may apply if conditions are met. Add-on codes E584 for casting outside a hospital and E560 for each additional phalanx are also listed.
When to Use
- Use F056 for non-displaced phalanx fractures of the foot that require rigid immobilization, such as a buddy tape with a splint or a cast, where no manual or surgical reduction was performed.
- Use F056 when treating a single phalanx fracture; if multiple phalanges are treated, F056 remains the base code and E560 is added for each additional phalanx.
Common Pitfalls
- Do not bill F056 if any form of reduction (manual or surgical) was performed; those cases require codes like F058 or F060.
- Avoid billing E584 for casting performed within a hospital setting, as this add-on is specifically restricted to services rendered outside of a hospital.
- Failure to document the Injury Severity Score (ISS) in the clinical notes will result in the automatic rejection of the E420 trauma premium.
Billing Tips
- Ensure that when multiple phalanx fractures are treated on the same day, you bill F056 once as the primary procedure and append E560 for every additional phalanx treated.
- If the patient is under 16 years of age, remember that the age-based premium is applied automatically to the base fee of F056, increasing the total procedural value.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
When claiming the trauma premium E420, the medical record must list the Injury Severity Score (ISS).
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