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F065
F065 – Open reduction - two or more metatarsus fractures
OHIP Anaesthesia Code — REDUCTION · Schedule of Benefits
Open reduction of fractures of two or more metatarsal bones. As a surgical procedure, this fee is for the surgeon's work (billed with suffix A) and includes the pre-operative evaluation where the decision to operate is made, the surgical procedure itself, and normal in-hospital post-operative care. This procedure is eligible for separate claims for surgical assistance (suffix B) and anaesthesia (suffix C), each with its own set of rules and payable units.
When to Use
- Use F065 for the open reduction of two or more metatarsal fractures when internal fixation is required.
- Use this code when the surgical intervention involves multiple metatarsals, as it is specifically designated for 'two or more' fractures, distinguishing it from single fracture codes like F061 or F062.
Common Pitfalls
- Billing F065 alongside individual fracture codes (e.g., F061) for the same foot is considered unbundling and will result in claim rejection.
- Failing to document the specific number of metatarsals reduced can lead to audit scrutiny if the claim is flagged for review of the 'two or more' requirement.
Billing Tips
- Ensure the surgical report clearly identifies the specific metatarsals involved to justify the use of the 'two or more' code over single-fracture alternatives.
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