F079 – Tibia with or without fibula - closed reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This fee code represents a surgical procedure for fractures and/or dislocations. The fee listed is for the primary surgeon (suffix A). Services for surgical assistance (suffix B) and anaesthesia (suffix C) are also eligible and are calculated based on a system of basic units and time-based units as outlined in the General Preamble (-). The procedure is subject to various premiums, including for age, after-hours, and trauma cases.
When to Use
- Use F079 for the closed reduction of a tibial shaft fracture, with or without an associated fibular fracture, performed in an emergency or operating room setting.
- Use this code when the fracture is successfully managed via closed manipulation and casting/splinting, as opposed to open reduction internal fixation (ORIF) which would require a different surgical code.
Common Pitfalls
- Billing F079 concurrently with an after-hours premium (E409/E410) and a trauma premium (E420) will result in a rejection, as E420 is explicitly excluded when other special visit or after-hours premiums are applied.
- Failure to document the specific Injury Severity Score (ISS) in the medical record will lead to an automatic audit recovery if the E420 trauma premium is claimed.
- Submitting F079 for a procedure that involves an open reduction; if the skin is breached or the fracture site is surgically exposed, F079 is inappropriate and a more specific open reduction code must be selected.
Billing Tips
- Always verify the patient's age at the time of the procedure to ensure the correct age-based premium (e.g., 10% to 30% increase) is appended to the claim.
- Ensure the start time of the procedure is accurately recorded in the operative note to support the application of after-hours premiums (E409/E410) if the procedure commences outside of standard daytime hours.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary as per .
If supervised by a Supervising Physician, the medical record must identify the Supervising Physician, the Medical Trainee, the service performed, patient consent, and be signed off by the Supervising Physician as per .
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