F081 – Medial or lateral tibial plateau fracture reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
F081 is a surgical procedure. In accordance with the OHIP Schedule of Benefits, the claim for this service must include a suffix to identify the role of the physician: - Suffix A for the physician performing the procedure. - Suffix B for a physician assisting at the surgery. - Suffix C for a physician administering the anaesthetic. The fee for the surgical procedure (suffix A) includes the major pre-operative visit, the surgery itself, and normal post-operative care. Payment for surgical assistants (suffix B) and anaesthetists (suffix C) is calculated based on a system of basic units and time units, as detailed in the 'Surgical Assistants' Services' (-) and 'Anaesthesiologists' Services' (-) sections of the General Preamble. Additional premiums may be applicable, including: - Age-Based Premiums: For patients in specific age groups (e.g., under 16 years of age) as per . - After Hours Procedure Premiums: For non-elective procedures commencing after hours (E409, E410) as per . - Trauma Premium: (E420) For qualifying trauma patients as per .
When to Use
- Use F081 for the closed or open reduction of a single medial or lateral tibial plateau fracture where internal fixation is required.
- Use F081 when performing the definitive surgical management of a plateau fracture, distinguishing it from simple casting or splinting which would be billed as a fracture care visit (e.g., K040).
- Use F081 as the primary procedure code when the surgical approach involves the reduction of the plateau; do not bill secondary codes for routine debridement or standard closure.
Common Pitfalls
- Billing a hospital admission assessment (A005) on the same day as F081 is a common rejection; only the major pre-operative visit is eligible if the decision to operate was made during that encounter.
- Attempting to bill F081 alongside other fracture reductions (e.g., fibular shaft fracture) often triggers a 'multiple procedure' audit; ensure you are applying the appropriate 100%/50%/25% rule for multiple surgical procedures.
- Failure to append the correct suffix (A, B, or C) will result in an automatic rejection, as the system cannot process the claim without identifying the physician's specific role.
Billing Tips
- If the procedure qualifies as an emergency trauma case, ensure you append the E420 trauma premium to maximize the claim value beyond the base fee.
- Always verify if the procedure occurred during after-hours windows to apply E409 or E410, as these premiums are not automatically calculated by the system.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record 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.
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